JOURNAL OF ATHLETIC TRAINING Official Publication of the National Athletic Trainers’ Association, Inc Volume 47, Number 3, Supplement, 2012 Free Communications Review NATA Foundation Research NATA Foundation Board of Subcommittee Committee Directors Jennifer E. Earl-Boehm, PhD, ATC Darin A. Padua, PhD, ATC Michelle D. Boyd, MS, ATC Vice Chair Chair Truman State University University of Wisconsin, Milwaukee University of North Carolina, Chapel Hill Ray Castle, PhD, ATC Thomas P. Dompier, PhD, ATC Louisiana State University Past Chair Jennifer E. Earl-Boehm, PhD, ATC Datalys Center for Sports Injury Vice Chair for Free Communications Robert T. Floyd, EdD, ATC Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Research & Prevention University of Wisconsin, Milwaukee University of West Alabama Indianapolis, IN Sandra J. Shultz, PhD, ATC M. Susan Guyer, DPE, ATC, LAT Joseph M. Hart, III, PhD, ATC Vice Chair for Student Grants Springfield College University of Virginia University of North Carolina, Greensboro Mark Hoffman, PhD, ATC Lisa Jutte, PhD, ATC, LAT Oregon State University Xavior University Riann M. Smith, PhD, ATC Vice Chair for General Grants MaryBeth Horodyski, EdD, ATC Thomas Kaminski, PhD, ATC, FACSM University of Michigan University of Florida University of Delaware Brian G. Ragan, PhD, ATC Scott J. Johnson, MSED, ATC, LAT Melanie L. McGrath, PhD, ATC Vice Chair for Awards Old Dominion University University of Nebraska-Omaha Ohio University Robert D. Kersey, PhD, ATC Darin A. Padua, PhD, ATC Steven P. Broglio, PhD, ATC California State University–Fullerton University of North Carolina, Chapel University of Michigan Hill David H. Perrin, PhD, ATC Michael S. Ferrara, PhD, ATC University of North Carolina, Greensboro William Pitney, EdD, ATC University of Georgia Northern Illinois University Richard Ray, EdD, ATC Tricia Hubbard, PhD, ATC Hope College Brian Ragan, PhD, ATC University of North Carolina, Student Awards Chair Charlotte Charles J. Redmond, MS, MEd, ATC, PT Ohio University Springfield College Lennart D. Johns, PhD, ATC Sandra J. Shultz, PhD, ATC Quinnipiac University Robb Rehberg, PhD, ATC, NREMT University of North Carolina, William Paterson University Greensboro Kristen L. Kucera, PhD, ATC Duke University Valerie Rich Moody, PhD, ATC, LAT Stephen Straub, PhD, ATC University of Montana Quinnipiac University Timothy A. McGuine, PhD, ATC University of Wisconsin Health Clark Simpson, MBA, ATC, LAT Charles A. Thigpen, PhD, ATC, PT Sports Medicine Work Center Middletown, IN Proaxis Therapy Eric L. Sauers, PhD, ATC Walter “Kip” Smith, MEd, ATC, LAT Kavin Tsang, PhD, ATC A. T. Still University Indiana University California State University, Fullerton Timothy Speicher, PhD, ATC Susan Yeargin, PhD, ATC Ogden, UT University of South Carolina Clinton B. Thompson, MA, ATC Mukilteo, Washington 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 2012 by The National Athletic Trainers’ Association, Inc. All rights reserved. Printed in the U.S.A. Journal of Athletic Training S-1 Take this Supplement to St Louis and use it as a guide to the Free Communications Sessions

Dear NATA Members and Friends:

We are pleased to present the annual Supplement to the Journal of Athletic Training. This Supplement contains abstracts presented at the 2012 NATA Annual Meeting &

Clinical Symposia as part of the NATA Foundation Free Communications Program. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021

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

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

Support from NATA members, corporations, and other affiliated groups make this supplement and all of the Foundation’s programs possible. Please note projects funded by the NATA Foundation and by the generous contributions of our donors are specified in this Supplement. To make an investment in the future of the profession, please contact the Foundation today at 800-TRY-NATA, extension 147. NATA and its Foundation are pleased to offer this supplement as a service to NATA members. We hope that it provides theoretical and practical information you can use to improve your effectiveness as a certified athletic trainer. Thank you for your support!

Sincerely,

Mark A. Hoffman, PhD, ATC Marjorie J. Albohm, MS, ATC President, NATA Research & Education Foundation President, NATA

S-2 Volume 47 • Number 3 (Supplement) May 2012 Dear Colleagues:

On behalf of the National Athletic Trainers’ Association Research and Education Foundation and the Free Communications Committee, we would like to thank all the authors who submitted abstracts to the Free Communications Program. We are happy to report a record number of submissions again this year with the total exceeding 450 submissions in the Peer Reviewed and Student Exchange Tracks, combined. We are excited about this year’s Free Communications Program as we believe it contains an exciting mix of both high caliber research reports and clinical case study reports. Please keep in mind that we consider oral Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 and poster presentations to be equal in terms of caliber and encourage clinicians and researchers to attend both oral and posters sessions.

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

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

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

Sincerely,

Jennifer E. Earl-Boehm, PhD, ATC Tom Dompier PhD ATC Vice Chair for Free Communications, Past Chair NATA Research & Education Foundation Research Committee Journal of Athletic Training S-3 JOURNAL OF ATHLETIC TRAINING Official Publication of the National Athletic Trainers’ Association, Inc Volume 47, Number 3, Supplement, 2012 Table of Contents Moderator Page Free Communications: Room 275 Wednesday, June 27, 2012 8:00AM-9:30AM ...... Thematic Poster: ...... Concussion Assessment: ...... Jason Mihalik, PhD, CAT(C), ATC ...... S-11 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 9:45AM-10:30AM ...... Hydration Issues ...... Susan Yeargin, PhD, ATC...... S-16 10:45AM-12:00PM ...... Proximal Factors Related to ...... Knee Injuries ...... Phillip Gribble, PhD, ATC ...... S-18 12:15PM-1:15PM ...... Knee EBF ...... David Bazett-Jones, PhD, ATC ...... S-21

Thursday, June 28, 2012 8:00AM-9:00AM ...... Nutrition and Supplementation..Kevin Miller, PhD, ATC ...... S-22 9:30AM-10:15AM ...... Prevention & Treatment of ...... Exertional Heat Stroke ...... Michael Ferrara, PhD, ATC ...... S-25 10:30AM-11:30AM ...... Exertional Heat Stroke EBF ..... David Csillan, MS, ATC ...... S-26 5:00PM-6:00PM ...... Head and Spine EBF ...... Ron Courson, ATC, PT ...... S-26

Friday, June 29, 2012 8:00AM-10:10AM ...... Thematic Poster: Quality of Life ...... Assessments After Injury ...... Joseph Hart, III, PhD, ATC ...... S-27 10:15AM-11:30AM ...... Neurophysiology ...... Buz Swanik, PhD, ATC...... S-36 11:45PM-1:15PM ...... Thematic Poster: Functional Testing ...... and Movement Screening ...... David Bell, PhD, ATC, CSCS ...... S-40 1:30 PM-2:15 PM ...... Soft Tissue Mobilization ...... Jeremy Searson, MS, ATC ...... S-46 2:45PM-4:30PM ...... Thematic Poster: Ankle ...... Biomechanics ...... Erik Wikstrom, PhD, ATC, FNATA ...... S-48

Free Communications: Room 274 Wednesday, June 27, 2012 8:00AM-9:15AM ...... Master Student Award Finalists ...... Brian Ragan, PhD, ATC ...... S-53 9:30AM-10:45AM ...... Doctoral Student Award ...... Finalists ...... Brian Ragan, PhD, ATC ...... S-56 11:00AM-12:00PM ...... Clinical Educators’ Influence on ...... Student Development...... Paul Geisler, EdD, ATC...... S-59 12:15PM-1:15PM ...... Educators EBF ...... Leamor Kahanov, EdD, ATC ...... S-61

Thursday, June 28, 2012 8:00AM-9:00AM ...... Case Studies: Musculoskeletal ...... Conditions ...... Kelli Pugh, MS, ATC ...... S-62 9:30AM-10:15AM ...... Using Evidence in ...... Clinical Practice ...... Sarah Manspeaker, PhD, ATC ...... S-65 10:30AM-11:30AM ..... Patellofemoral Pain: Etiology ...... and Intervention ...... Jenny Thorpe, MS, ATC ...... S-67 5:00PM-6:00PM ...... Ankle EBF ...... Brian Pietrosimone, PhD, ATC ...... S-69

S-4 Volume 47 • Number 3 (Supplement) May 2012 Moderator Page

Friday, June 29, 2012 8:00AM-9:30AM ...... Taping and Bracing ...... Tim McGuine, PhD, ATC ...... S-70 9:45AM-11:15AM ...... Case Studies: General ...... Medical Conditions Katie Walsh, EdD, ATC ...... S-74 11:30AM-1:00PM ...... Neuromuscular Aspects of ...... Shoulder Injury ...... Kevin Laudner, PhD, ATC ...... S-78 1:15PM-2:30PM ...... Modifiable Factors of Lower

...... Extremity Injury ...... Steve Zinder, PhD, ATC...... S-82 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 2:45PM-4:00PM ...... Adolescent Musculoskeletal ...... Studies ...... Jon Almquist, ATC...... S-85

Free Communications: Room 260-267 Wednesday, June 27, 2012 8:00AM-9:15AM ...... Improving Cryotherapy ...... Efficacy ...... TBA ...... S-89 9:30AM-10:30AM ...... Current Modality Trends... Mark Merrick, PhD, ATC ...... S-92 10:45AM-12:00PM ...... Characteristics of ...... Overhead Athletes ...... Jason Scibek, PhD, ATC ...... S-95 12:15PM-1:15PM ...... Shoulder EBF ...... Paul Borsa, PhD, ATC ...... S-98

Thursday, June 28, 2012 8:00AM-9:00AM ...... Epidemiology of Injury in ...... Youth Sports ...... Kristin Kucera, PhD, ATC...... S-99 9:15AM-10:30AM ...... Clinical Assessments ...... David Bell, PhD, ATC ...... S-102 10:45AM-11:30AM ...... Protective Equipment ...... Mike Kordecki, DPT, SCS, ATC ...... S-106 5:00PM-6:00PM ...... Wound Management EBF . Bernadette Buckley, PhD, ATC ...... S-107

Friday, June 29, 2012 8:00AM-9:15AM ...... Core Stability ...... Matt Gage, PhD, ATC ...... S-108 9:30AM-10:45AM ...... Effects of Concussion ...... on Gait and Balance...... Johna Mihalik, PhD, ATC ...... S-111 11:00AM-12:30PM ...... Lower Extremity ...... Rehabilitation ...... Kate Jackson Pfile, PhD, ATC ...... S-115 12:45PM-1:30PM ...... Instructional Strategies in Athletic ...... Training Education ...... Andy Winterstein, PhD, ATC ...... S-119 1:45PM-2:45PM ...... Employment Issues ...... in Athletic Training ...... Tory Lindley, MA, ATC ...... S-121

Journal of Athletic Training S-5 Free Communications, Poster Presentations: Exhibit Hall Page

Wednesday, June 27, 2012, 10:00AM-11:30AM

Thursday, June 28, 2012, 10:00AM-5:00PM; authors present 10:00AM-11:30AM

Friday, June 29, 2012, 10:00AM-1:00PM Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Undergraduate Poster Award Finalists ...... S-124 Master Poster Award Finalists ...... S-128 Doctoral Poster Award Finalists ...... S-132 Case Studies ...... S-188

Awards

The New Investigator Award...... S-7 Freddie H. Fu, MD ...... S-8 The Doctoral Dissertation Award ...... S-9 David H. Perrin, PhD, ATC, FNATA, FACSM ...... S-10

Indexes

Author Index ...... S-210 Subject Index...... S-214

Editorial Staff

Editor-in-Chief Business Office Manager Managing Editor Christopher D. Ingersoll, John Honaman, CFRE Leslie E. Neistadt, ELS PhD, ATC, FNATA, FACSM National Athletic Hughston Sports Central Michigan University Trainers’Association, Inc Medicine Foundation, Inc Mt Pleasant, MI Dallas, TX Columbus, GA

Editorial Assistants Michelle Evans Erick Richman Columbus, GA

S-6 Volume 47 • Number 3 (Supplement) May 2012 The New Investigator Award Presented in Honor of Freddie H. Fu, MD Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021

Patrick O. McKeon, PhD, ATC University of Kentucky

To Patrick McKeon, PhD, ATC, the importance of clinical research is matched only by the importance of the people whom you work with. Dr McKeon was first introduced to athletic training by his high school athletic trainer, Scott Ellis, MS, ATC, at New Jersey’s Waldwick High School. Through Dr McKeon’s work with Scott, he developed an interest in athletic training as a career and earned a bachelor’s degree in athletic training from Springfield College in Massachusetts.

After 2 years as a high school athletic trainer, he decided to pursue higher education “to become a better clinician and educator.” He earned his master’s degree in sports health care from the Arizona School of Health Sciences, where he began to see “the value of research in substantiating decisions that we make from a clinical perspective.” In other words, he became interested in “why we do what we do and how we can continue to build on the body of knowledge that is our profession.” Dr McKeon went on to hold positions as an athletic trainer and clinical instructor at Canisius and Marist Colleges.

While teaching at Marist, McKeon met Jay Hertel, PhD, ATC, FNATA, FACSM, at the 2004 Eastern Athletic Trainers’ Association meeting and discussed the value of pursuing a doctoral degree and conducting clinical research. At the University of Virginia, where Dr McKeon earned his doctorate, he learned important lessons from Dr Hertel about integrating elements of sensorimotor control theory and clinical practice to ask and answer clinically relevant research questions.

Today, Dr McKeon has published more than 20 research articles and is an assistant professor at the University of Kentucky, where he concentrates on graduate athletic training education and research, teaching students how to integrate evidence from research into clinical practice to enhance health care for the physically active.

Dr McKeon’s research targets lower extremity injury, particularly ankle instability and related sensorimotor dysfunction, and he collaborates with Erik Wikstrom, PhD, ATC, FACSM, to explore ankle rehabilitation strategies. In addition, he works with his wife, Jennifer Medina McKeon, PhD, ATC; Tim McGuine, PhD, ATC; Phillip Gribble, PhD, ATC; and Dr Hertel, investigating clinically relevant assessments to identify ankle sprain risk factors in adolescents.

Overall, Dr McKeon wants to be remembered for his dedication to “the systemic process by which we can address clinical questions through research.” He, his wife, and their mentor Dr Hertel developed what they call the “clinical scientific method” to refine the generation of evidence in athletic training research. The steps of the clinical scientific method are (1) observing and describing a clinical phenomenon, (2) developing a hypothetical model to explain the phenomenon, (3) using the model to predict outcomes, and (4) developing intervention strategies based on the hypothetical model to alter the course of the clinical phenomenon. Dr McKeon believes that this model is relevant not only for clinical research but also for clinical practice.

In addition to his wife, whom he described as his best friend, soul mate, and the greatest research partner he could ask for, Dr McKeon credits his research success to Dr Hertel. Also, he thanks his cousin, James J. Collins, PhD, for his constant inspiration and the many mentors, colleagues, classmates, friends, and students who have helped him become the scholar he is today. He especially thanks his mother, Marie, for pushing him to always go beyond the first draft, and his father, Owen, for helping him to think outside the box and blaze his own trail. Dr McKeon looks forward to guiding his son, Robert Owen, just as his mom and dad did him. Journal of Athletic Training S-7 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021

Freddie H. Fu, MD

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

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

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

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

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

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

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

S-8 Volume 47 • Number 3 (Supplement) May 2012 The Doctoral Dissertation Award Presented in Honor of David H. Perrin, PhD, ATC Sponsored by Friends of Dr. Perrin

Lindsay J. DiStefano, PhD, ATC Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 University of Connecticut

Similar to many athletic trainers, Lindsay J. DiStefano entered the field of athletic training to merge her interests in a career in health care and sports. Now that she has earned her PhD and ATC credentials, Dr DiStefano credits her mentors for guiding her and helping her to recognize a passion for research, teaching, and clinical practice. Although it wasn’t always her dream to pursue a doctoral degree in human movement science, Dr DiStefano said, “Sometimes life just opens doors and you have to trust that everything will work out.”

Dr DiStefano’s willingness to walk through those open doors, as well as her hard work and dedication to research, have made her the recipient of the 2012 David H. Perrin Doctoral Dissertation Award. The majority of Dr DiStefano’s research centers on sport-related musculoskeletal injury prevention with a focus on the anterior cruciate ligament, specifically in the youth population. Such injuries can be particularly traumatic in young children and teenagers because they often require surgical reconstruction and a long rehabilitation period; despite optimal care, osteoarthritis can occur and reduce the chances of remaining physically active over the lifespan. Dr DiStefano recognizes the importance of preventing such youth sport injuries from occurring in the first place. She is currently studying injury prevention programs in youth and military populations, evaluating the development of risk factors for injury in children, and investigating new methods to translate injury prevention to the community at large.

In addition to finding ways to prevent youth sport musculoskeletal injuries, Dr DiStefano also enjoys the excitement of finishing a study and figuring out the answers to some of her questions. She views research as an ongoing process because every study leads to more questions. Not only does Dr DiStefano’s research answer some of her own questions, it also gives her the ability to share that information with parents and youth athletes firsthand.

Dr DiStefano has been an assistant professor at the University of Connecticut, where she teaches in the Department of Kinesiology, since 2009. As a young faculty member, her most rewarding teaching experiences so far have been watching and helping undergraduate students grow and begin their own careers.

As for her legacy, Dr DiStefano hopes to be remembered as someone known for having a passion for trying to figure out ways to keep young people safer in sports. She believes that teaching young people how to land, run, and cut with good technique should help to reduce the number of athletic injuries they sustain.

For contributing to her success, Dr DiStefano thanks mentors Sara Brown, MS, ATC; Kevin M. Guskiewicz, PhD, ATC, FNATA, FACSM; Mark Laursen, MS, ATC; Stephen W. Marshall, PhD; and Darin Padua, PhD, ATC; her parents, Nancy and James Strickland; her husband Michael DiStefano, MA, ATC and their son, Jack.

Journal of Athletic Training S-9 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021

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

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

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

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

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

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

S-10 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Thematic Poster: Concussion Assessment Wednesday, June 27, 2012, 8:00AM-9:30AM, Room 275; Moderator: Jason Mihalik, PhD, CAT(C), ATC 12298FOSP Equivalence of Alternate Forms of a alternate form equivalence. Repeated list, postural stability testing, Computerized Neuropsychological Measures ANOVA was utilized to neurocognitive testing, and Gradual Test determine changes in effort across time Return to Play Protocol (GRPP) has Resch JE, Macciocchi SN, Ferrara, for Green’s WMT. All analyses were been recommended by several MS: University of Georgia, Athens, performed with α = .05. Results: ICIs concussion consensus statements and GA; The University of Texas at revealed non-equivalence of composite position papers. Health care pro- Arlington, Arlington, TX; Shepherd verbal memory between form 1 and fessionals caring for concussed Center, Atlanta, GA forms 2, 3, and 4. Non-equivalence was student-athletes across the United also observed between form 1 and form States may be not be following these Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Computerized neuro- 3 for composite visual memory and guidelines and may be allowing psychological (CNP) testing is widely visual motor speed. Forms 2 and 4 were student-athletes to return to par- utilized for sport-related concussion non-equivalent for composite verbal ticipation (RTP) prematurely. management. The most widely used memory. Forms 3 and 4 were non- Objective: To investigate how the CNP is the ImPACT. There have been equivalent for composite reaction time. duration of RTP and GRPP for several studies that have evaluated the Pearson r’s ranged from -.263 and .712 concussed high school student-athletes reliability and sensitivity of the for non-equivalent forms. All was influenced by the type of ImPACT but virtually no studies that participants scored greater than 85% Concussion Management Program have evaluated equivalence of percent on immediate and delayed recall, (CMP) which incorporated two ImPACT’s alternate forms. Form consistency, and paired associates of different neuropsychological testing equivalence is important to determine the Green’s WMT suggesting good batteries for RTP decision-making. clinical utility of CNP testing for effort was provided at all time points. Design: Retrospective cross-sectional management of concussion. Objective: Conclusions: Alternate forms of investigation. Setting: Two different To determine alternate form neuropsychological tests are utilized to neurocognitive tests were utilized equivalence of the ImPACT. Design: minimize practice effects over repeated within a CMP in 42 public high schools Repeated Measures. Setting: Research assessments. Alternate forms of in the State of Hawaii. Patients or laboratory. Patients or Other ImPACT were not equivalent for one or Other Participants: Concussed Participants: Participants consisted of more composite scores. Clinicians student-athletes (n=426, between age 108 (N=108), healthy, college should consider psychometric 13 to 18) received baseline and post- participants aged 20.6 + 1.52 years, properties when interpreting results of concussion neurocognitive testing 171.6 + 9.71 cm tall, and mean mass of neuropsychological testing. during school year (SY) 2010-11. 66.9 + 11.92 kg. Interventions: Interventions: Two different neuro- Participants were divided into 6 equal 12302OOSP cognitive tests used in a CMP were Comparison of Concussion groups and were administered alternate compared: 18 schools utilized the Management Programs on forms of ImPACT using clinically Immediate Post-Concussion Assess- Return to Participation relevant time points (day 1, day 45, and ment and Cognitive Testing (ImPACT) Outcomes of Concussed High day 50) mimicking a typical concussion and 24 schools utilized Standard School Student-Athletes During recovery pattern. All participants Assessment of Concussion (SAC). 2010-11 completed a baseline evaluation using Main Outcome Measures: Complete Kanaoka T, Oshiro RS, Furutani TM, form 1 followed by a serial combination data sets for days of restricted parti- Goeckeritz LM, Wahl TP, Kocher of the remaining alternate forms at day cipation post-concussion (ImPACT MH, Cleary MA, Murata NM, 45 and day 50. Participants were also n=239, SAC n=129), duration of the Uyeno RK: State of Hawaii administered Green’s Word Memory GRPP until return to unrestricted Department of Education, Honolulu, Test (WMT) as a measure of effort. participation (ImPACT n=231, SAC HI; Department of Kinesiology and Main Outcome Measures: ImPACT n=125), and 95% confidence interval Rehabilitation Science, University calculates five composite scores: (CI). The duration of the GRPP was of Hawaii at Manoa, Honolulu, HI; composite verbal and visual memory, defined as the number of days of the University of Hawaii Honolulu visual motor speed, and reaction time. rehabilitation period starting from light Community College, Honolulu, HI Inferential Confidence Intervals (ICI)s aerobic exercise to full-contact were calculated to compare ImPACT’s practice. The GRPP consisted of five alternate forms and their respective Context: A multifaceted approach for steps, each separated by a minimum of composite scores. Pearson moment the management of sport related 24 hr. Results: No significant concussion that includes a clinical correlations and independent t-tests (F1=.277, p=.599) difference was found were also utilized to further analyze examination, graded symptom check between restricted participation post- Journal of Athletic Training S-11 concussion for ImPACT=17.71±11.91 effects between an ADHD and control 0.024), and psychomotor speed (CI=16.19-19.23) days compared to sample. Design: Prospective re- (109.75±10.34 vs. 101.19±8.04;

SAC=18.33±7.91 (CI=16.95-19.70) peated measures design. Setting: F1,31=8.957, p=0.005). Our healthy days. No significant (F1=.104, p=.748) Controlled clinical research setting. control participants performed difference was found for average Patients or Other Participants: significantly better on these measures duration of GRPP that incorporated Thirty-four physically active compared to ADHD participants not ImPACT=8.95±5.61 (CI=8.22-9.68) participants; 17 ADHD, 17 controls (9 taking stimulant medication (P<0.05 days compared to SAC=9.14±4.53 males, 8 females in each group); for all). The ADHD participants (CI=8.33-9.94) days. Conclusions: age=21.29±2.03 years. Control performed significantly better during We found that the days of restricted participants were matched to ADHD the first session (104.56±10.15) than participation post-concussion and the participants based on age, gender and second session (94.38±13.95) on

duration of GRPP for concussed number of previous concussions. composite memory (F1,31=11.40, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 student-athletes was not significantly Interventions: Participants were p=0.002) and controls performed different when using the two different evaluated three times (7-9 days sepa- better during the first session neurocognitive testing batteries in the rated each session; mean=7.26±0.53 (28.88±0.60) than second session CMPs. The two neurocognitive testing days). Participants completed a (27.88±1.16) on SAC total score batteries used in this study are just one computerized neurocognitive test (F1,32=7.79, p=0.009). Conclusions: part of the multifaceted nature of the battery (CNS Vital Signs; CNSVS), a ADHD athletes presented with RTP decision-making as part of a brief mental status examination (the improved performance on select comprehensive CMP. Furthermore, a Standardized Assessment of Con- neurocognitive domains while on their CMP incorporating a neurocognitive cussion; SAC), and a postural control prescribed stimulant medications. test in addition to clinical examination, assessment (the Balance Error Scoring Baseline and post-injury testing of graded symptom check list, postural System; BESS). The ADHD partici- ADHD athletes should occur while on stability testing, and GRPP is vital to pants completed sessions 1 and 2 medication. Clinicians should make determining appropriate duration of without their stimulant medication, and every effort to obtain baseline RTP and prevent the premature release session 3 on stimulant medication. neurocognitive measures for ADHD of concussed student-athletes. Injury Comparisons between groups and athletes because it may be especially surveillance is an important aspect of medication status (ADHD group only) difficult to compare post-injury future recommendations and modi- were examined using separate 2 scores to normative values due to fication of CMPs. (group) x 2 (sessions 2 & 3) mixed differences in practice effects. model ANOVAs for each outcome 12130DOSP measure. Differences in practice 12169SOSP The Effects of Attention Deficit effects between groups were Sport Concussion Assessment Hyperactivity Disorder (ADHD) examined using separate 2 (group) x 2 Tool-2 (SCAT2) Scores Following and Stimulant Medications on (session 1 & 2) mixed model ANOVAs Concussion in Adolescent Athletes Performance on Concussion for each outcome measure. We With and Without a Prior Assessment Tests employed an a priori alpha level of Concussion History Littleton AC, Guskiewicz KM, 0.05. Tukey post hoc analyses were Yakuboff MK, Mayfield RM, Schmidt JD, Register-Mihalik JK, employed when the omnibus tests for Chhabra A, Bay RC, Valovich Gioia GA, Mihalik JP, Waicus KM: interaction effects were significant. McLeod TC: A.T. Still University, University of North Carolina, Chapel Main Outcome Measures: CNSVS Mesa, AZ; The Orthopedic Clinic Hill, NC; Children’s National standard scores (neurocognitive index, Association, Phoenix, AZ Medical Center, Rockville, MD composite memory, verbal memory, visual memory, processing speed, Context: The SCAT2 was developed Context: The effects of attention executive function, psychomotor following the 3rd International deficit hyperactivity disorder (ADHD) speed, reaction time, complex Consensus Conference on Concussion and stimulant medications on attention and cognitive flexibility), as a means to improve and standardize performance during concussion SAC total score, and BESS total error the sideline evaluation of sport-related assessment testing are unclear. This score. Results: The ADHD parti- concussion. This tool assesses becomes of importance when cipants performed significantly better concussion-related signs and interpreting post-concussive scores while on medication compared to the symptoms, cognition, balance, and relative to pre-season baseline scores off medication condition in overall coordination. To date, there is little in individuals with ADHD. Objective: neurocognition (measured by known regarding the scores on this tool 1) Examine the effects of ADHD and neurocognitive index;(103.37±9.44 following a concussive injury. Objective: This study aimed to stimulant medications on neuro- vs. 97.88±8.61; F1,31=6.03, p=0.020), cognitive and balance performance; 2) processing speed (110.65± 10.27 determine whether a prior history of concussion affects post-injury scores on Examine differences in practice vs.103.13±9.39; F1,31=5.61, p= S-12 Volume 47 • Number 3 (Supplement) May 2012 the SCAT-2. Design: Cross-sectional. between positive and negative groups SAC (mSAC). The Immediate Memory Setting: Secondary school athletic at any time point. Conclusions: section of the mSAC was modified by training facilities. Patients or Other Regardless of concussion history, administering a list of 15 different Participants: Adolescent athletes SCAT2 scores decreased significantly words during one trial with the athlete with (n=115, 107 males, 8 females, at DOI, demonstrating impairments in a recalling as many of the 15 words as age=15.7±1.1 years, grade=10.0±1.0) composite score that includes possible. The 15 words used in the and without (n=41, 33 males, 8 females, symptoms, cognition, and balance. mSAC were from the three alternative age=15.4±1.0 years, grade=9.9±1.0) a Both groups showed improvements by word lists available for the SAC. Main prior history of concussion, who were D3, where scores were not different Outcome Measures: To determine if the participating in contact interscholastic from BL. Having a prior history of SAC Immediate Memory section has a sports and sustained a concussion concussion does not seem to result in ceiling effect, the mSAC was

diagnosed by an athletic trainer. greater deficits following a subsequent administered with the total number of Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Interventions: A concussion history concussion on the SCAT2. Future words recalled being the primary survey and SCAT2 were administered studies should evaluate other modifying outcome of interest. Any athlete capable to participants at a preseason baseline. factors that could impact post-injury of recalling 5 or more words from the The SCAT2 was also administered on interpretation of the SCAT2. Funding mSAC 15-item word list would also be the day of injury (DOI), and days 3 (D3) provided by a grant from the National able to recall all 5 words from the first, and 10 (D10) post-concussion. The Operating Committee on Standards for second and third trial of the SAC; SCAT2 is comprised of a 22-item Athletic Equipment (NOCSAE). resulting in these athletes achieving the graded symptom scale, 2-item sign highest possible score of 15 for the score, Glasgow Coma Scale (GCS), 12230MOSP SAC. The number and percentage of Maddocks questions, Standardized Does the Standardized Assessment athletes scoring greater than 5 on the Assessment of Concussion (SAC), of Concussion (SAC) Have a mSAC reflected the extent of the ceiling modified Balance Error Scoring System Ceiling Effect among Female effect and underestimation of ability (BESS), and coordination examination. Collegiate Athletes associated with the SAC. The Shapiro- The SCAT2 total score is calculated by Hammond N, Caswell A, Scott CB, Wilk test of normality was used to summing each component score, and Leyer B, Draper R, Snook EM: determine if the mSAC data were has a maximum of 100 points. Subjects Department of Kinesiology, normally distributed. Results: The were grouped as “positive” or University of Massachusetts, mSAC Immediate Memory data were “negative” according to their Amherst, Amherst, MA normally distributed (Shapiro-Wilk test concussion history on the preseason P=.18). Twenty-four athletes scored questionnaire. Main Outcome Context: It is important to accurately greater than 5 on the mSAC suggesting Measures: The dependent variable was assess cognitive ability during baseline that 80% of the athletes’ Immediate SCAT2 total score. Generalized concussion screening testing. Tests with Memory ability is underestimated by the estimating equations analysis with an a ceiling effect (i.e. the test is too easy SAC. Conclusion: There is a con- inverse Gaussian distribution was used and everyone scores highly at baseline) siderable ceiling effect on the SAC’s following reflection transformation of are likely to underestimate the cognitive Immediate Memory section that the dependent variable. Sequential ability of some athletes during baseline resulted in the underestimation of Bonferroni pairwise comparisons were testing. Underestimation of baseline baseline cognitive ability in these used to determine differences (p<.05, ability makes the interpretation of post- female athletes. The ceiling effect seen two-tailed) across the 4 days for the concussion score changes difficult. with Immediate Memory suggests that total SCAT2 score. Lower scores on the Limited psychometric evaluation has the total SAC score is not an accurate SCAT2 indicate greater deficits. examined whether commonly used assessment of baseline cognitive ability. Results: A significant group by time concussion screening measures, such as Because the SAC is a commonly used interaction was found (p<.001). In the the Standardized Assessment of screening tool, replication of this study positive concussion group, SCAT2 Concussion’s (SAC), have ceiling is needed in other samples of athletes total score at DOI (74.6±13.3) was effects. Objective: To determine what to determine if a ceiling effect similar significantly lower than BL (84.9±8.31), percentage of people are under- to those of this female collegiate athlete D3 (81.6±11.6), and D10 (90.1±8.6). estimated with the SAC’s Immediate is observed in other samples. Scores at D10 were significantly higher Memory section. Design: Cross- than BL and D3. SCAT2 total score in sectional. Setting: Athletic training the negative group at DOI (72.5±14.9) room offices. Patients or Other was significantly lower than BL Participants: Thirty female athletes (86.1±8.4) and D10 (86.9±11.8), but not (19.6±1.1 years) concussion free different than D3 (78.0±19.8). Scores at during the previous 6 months volunt- D3 were significantly lower than D10. eered for this study. Interventions: The There were no significant differences athletes were administered a modified Journal of Athletic Training S-13 12226SOSP Ceiling Effect of a Concussion of 15 for the AC. The number of Assessment of Concussion (SAC) for Screening Measure in Male athletes scoring greater than 5 on the age-stratified high school athletes have Collegiate Athletes mSAC reflected the extent of the not been previously reported. Smith JB, Brodeur J, Lebeda M, ceiling effect and the number of Objective: To determine differences Chang P, Sooy J, Snook EM: athletes whose baseline Immediate in age and gender, and to provide Division of Athletics and Memory scores were underestimated. normative values for SAC baseline Department of Kinesiology, Results: The mSAC Immediate scores of healthy high school athletes. University of Massachusetts Memory data were normally Design: Retrospective cross- Amherst, Amherst, MA distributed (skewness =0.07; kurtosis sectional study. Setting: Controlled =-0.23) providing evidence that the environment free of external stimuli distribution of mSAC scores matched Context: Accurately assessing in 11 participating high schools. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 cognitive ability during baseline the distribution of ability levels among Starting in 2010, baseline concussion concussion testing is critical. If there the athletes. A total of 38 athletes testing was implemented by a statewide is a ceiling effect (i.e. test is too easy scored higher than 5 on the mSAC CMP led by a contingent of athletic and everyone scores highly at baseline) indicating that 80% of the athletes’ trainers funded by the State of Hawaii it is likely that the baseline cognitive Immediate Memory ability would be Department of Health. Participants: ability of the individual’s will be underestimated by the SAC. Con- De-identified data from baseline SAC underestimated, making the inter- clusion: The Immediate Memory tests for 854 [age=15.2±1.2 years old pretation of post-concussion changes section of the SAC has a ceiling effect (y/o), females (F) n=308, males (M) questionable. Limited research has resulting in the underestimation of n=546] high school athletes free of examined whether specific com- cognitive ability. The Immediate injury. Interventions: Baseline SAC ponents of commonly used con- Memory score is part of the total score testing during 2010-2011 for all cussion screening measures, such as suggesting that the SAC provides an contact sport athletes was ad- the Standardized Assessment of Con- inaccurate assessment of baseline ministered on an individual basis prior cussion’s (SAC), suffer from ceiling cognitive ability. Additional work on to their respective competitive effects. Objective: To determine the developing new psychometrically seasons by athletic trainers who had proportion of athlete’s baseline sound items for the immediate prior knowledge utilizing the SAC. cognitive ability that is underestimated memory section is warranted. Main Outcome Measures: Total by the immediate memory section of SAC score was compared using the SAC due to ceiling effect. Design: 12304OOSP univariate analysis of variance on Normative Baseline Values for Cross-sectional. Setting: Quiet gender (M, F) and three age groups Standard Assessment of Concussion athletic training exam room. Patients (13-14y/o n=314, 15-16y/o n=422, in Healthy Male and Female High or Other Participants: Sixty and 17-18y/o n=118). Mean, standard School Athletes during 2010-2011 Division I male athletes (20.6±1.3 deviation (SD), and 95% confidence Goeckeritz LM, Wahl TP, Cleary MC, years) with no history of concussion intervals were reported. Results: No Oshiro RS, Kocher MH, Furutani TM, in the previous six months volunteered significant (F = .640, p=.528, Kanaoka T, Stickley CD, Kimura IF, 2 for this study. Interventions: The power=.158) differences in baseline Murata NM: State of Hawaii athletes were administered a modified SAC scores were found between 13- Department of Education, Honolulu, SAC (mSAC).The Immediate Memory 14y/o (25.89±2.53, CI= 25.61 HI; Department of Kinesiology and section of the SAC was modified from -26.20), 15-16y/o (25.96± 2.52, Rehabilitation Sciences, University three trials of the same five words to CI=25.81-26.31), and 17-18y/o of Hawaii at Manoa, Honolulu, HI one trial of 15 words. The 15 words (25.48± 2.92, CI=25.22-26.30). used in the mSAC were from the three Signif-icantly (F =9.729, p=.002) Context: On-site mental status is a 1 alternative word lists of the SAC. higher baseline SAC scores were key component of concussion Main Outcome Measures: The total found for females (26.31±2.40, evaluation and a comprehensive number of words recalled on the CI=25.88-26.64) compared to males concussion manage-ment program mSAC immediate memory section was (25.62±2.65, CI= 25.31-25.79). (CMP). Baseline values for mental the dependent variable of this study. Conclusions: In a large sample of status are an important piece of data Based on the assumption that any high school athletes, we found no age when screening for concussion or athlete capable of recalling 5 or more differences and that female high making return to participation (RTP) words from the mSAC 15-item word athletes score better on the SAC than decisions, and may not always be list would also be able to recall all 5 males. These findings suggest that a available. Using age and gender- words from the first, second and third single SAC baseline may remain valid specific norms may be useful in cases trial of the SAC. Athletes recalling 5 for high school athletes during their where no baseline data exist. or more words on the mSAC should entire high school matriculation. Normative values of the Standard also obtain the highest possible score Using the SAC on the sideline and S-14 Volume 47 • Number 3 (Supplement) May 2012 comparing to a normal baseline range and the delayed memory to 10 words. of SAC scores may be helpful for The participant’s responses were athletic trainers when determining if analyzed using the Rasch model for scores appear reasonably valid. In model-data fit. Common items were cases where no baseline exists, anchored based on a previous SAC normative data may help health care calibration. Main Outcome Meas- providers make return to participation ures: Model-data fit was evaluated decision. using infit and outfit statistics (<0.5 and >1.5). A Wright item-person map was 12177DOSP visually inspected for the alignment of Improving the Memory Items of the item and person estimates. Rasch Standardized Assessment of modeling places items and people on Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Concussion through Rasch the same common metric. Descriptive Calibration statistics of the participants’ abilities Mc Elhiney D, Ragan BG: Ohio were examined. Item difficulties were University, Division of Athletic assessed. Results: The data fit the Training, Athens, OH model with all of the new items having acceptable infit/outfit statistics (misfit). Context: The Standardized The Wright item-person map showed a Assessment of Concussion (SAC) is good overlap between persons and a common concussion screening tool items. The mean participant ability that is included in the Military Acute estimate was (mean ± SD) 2.55 ± 0.87 Concussion Evaluation (MACE) and logits, where a higher score represents the Sports Concussion Assessment Tool higher ability. The mean difficulty 2 (SCAT2). The baseline-post injury estimates were 2.42 ± 1.6 logits for comparison recommended by the immediate memory and 3.02 ± 0.94 National Athletic Trainers’ Association logits for delayed memory. A range of (NATA) is an individual-centered ±2 SD based on participant estimates approach that emphasizes the validity was calculated at 0.81 to 4.29 logits. and accuracy of baseline test scores. All, but one item (90%) from the The validity of the SAC baseline immediate memory section and all memory scores has been questioned items (100%) in the delayed memory with many of the memory items not section fell within the range of the meeting acceptable psychometric participant ability estimate. Item thresholds. Objective: To evaluate the difficulties for the immediate memory items for a new memory section on the section ranged from -1.39 to 3.82 logits modified SAC (mSAC) using Rasch while the delayed memory section modeling. Design: Cross-sectional ranged from 1.17 to 4.33 logits. The design. Setting: Laboratory. Parti- higher the logit score represents more cipants: Two-hundred participants difficult items. Conclusions: Rasch with no history of concussion in the modeling is a powerful tool used to previous 6 months (aged 19.6 ± 2.2 develop and improve measures. Despite years; n=93 men, n=107 women) validity issues is appears that the SAC volunteered for this study. Inter- memory section can be improved to vention: Participants completed a provide valid baseline scores. health history questionnaire. The mSAC test was a verbal interview taking approximately 5 minutes to complete. Ten new words were selected to make it more difficult to remember by increasing word length, examining relationships among words, and determining rhyming patterns. The administration of the memory sections changed increasing the immediate memory to 10 words repeated 1 time

Journal of Athletic Training S-15 Free Communications, Oral Presentations: Hydration Issues Wednesday, June 27, 2012, 9:45AM-10:30AM, Room 275; Moderator: Susan Yeargin, PhD, ATC 12272MOEX 12343FOEX Perceptual Responses during and flat bench press) were conducted Impact of Refrigeration and Freezing Strength/Power Testing in before and after 45 min of recovery on Measurements of Hydration Dehydrated and Rehydrated while consuming the randomly assigned Status Conditions in Healthy, rehydration beverage. Main Outcome Eberman LE, Yeargin SW, Adams Resistance-Trained Men Measures: Dependent variables were HM, Niemann AJ, Mata HL: Indiana Hamer JL Cleary MA, McGuire perceptual responses: thirst and State University, Terre Haute, IN GM: Department of Kinesiology thermal sensations, fatigue and and Rehabilitation Science, motivation ratings, and rating of Context: Hydration status is among University of Hawaii at Manoa, perceived exertion (RPE) recorded several variables measured to Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Honolulu, HI before and after 4%BML/dehydrated determine risk of exertional heat illness then 0%BML/euhydrated conditions. during pre-participation exams for Context: Perceptual responses to Urine specific gravity was measured preseason practices in summer months. exer-cise in a hot and humid to ensure accurate hydration status. To aid in the evaluation process, environment may be an effective way Analysis of variance with repeated researchers have been seeking to to identify an athlete that is nearing measures was used to identify identify the easiest and most valid dehydration and becoming susceptible differences between the CHO and the hydration assessment methods. This to heat illness. Objective: To placebo beverages. Results: Signi- research has primarily included examine the difference in perceptual ficant differences were found between investigations of instrumentation, but responses to dehydration followed by tests but not conditions. Thirst has not yet included the impact of rehydration using a carbohydrate sensations at pre-4% (8.2±0.3) were temperature and storage of samples electrolyte (CHO) sports beverage significantly (F3 = 88.997, P<.001) prior to assessment. Objective: To compared to a non-caloric flavored higher than pre-0% (1.3±0.2) and post- determine the impact of storage in placebo. Design: Double-blind 0% (2.3±0.4). Thermal sensations at various temperatures on the measure of randomized cross-over repeated- pre-4% (5.1±0.4) were significantly urine osmolality. Design: Descriptive measures design. Setting: Parti- (F3=19.429, P<.001) higher than pre- diagnostic validity study. Setting: cipants were dehydrated by an 0% (2.5±0.4) and post-0% (4.2±0.5). Biochemical research laboratory. overnight fast followed by active Fatigue at pre-4% (6.3±.7) was Patients or Other Participants: dehydration by performing a heat significantly (F3=14.093, P<.001) Seventy-five healthy participants stress trial outdoors in a hot and humid higher than pre-0% (3.8±0.8) and post- (52 males, 23 females; mean age= 0% (5.0±0.6). Motivation was not environment (WBGTo=25.5 ±1.7°C). 22±4years; mean self-reported All other testing was conducted in an significantly different for test height=176±23cm and mass=80±18 air conditioned laboratory. Par- (F3=1.666, P=.227, power=.329). kg) recruited from campus provided ticipants: Five healthy college males RPE at post-4% (14.8±0.7) was one or more samples (total samples

(age= 22.3±1.2yr, mass= 79.8±8.7kg, significantly (F3=7.790, P=.004) =83). Interventions: Participants height=173.7±5.6 cm) who were higher than pre-0% (7.4±1.2) and post- completed the informed consent and a resistance trained (anaerobic/aerobic 0% (13.8±0.7). Conclusions: We brief health history questionnaire to workout 2-3 times/week) with no found no difference in perceptional determine any exclusionary criteria history of heat-induced illness. responses when consuming CHO and (diabetes, kidney disease, menstruation, Interventions: Independent variables non-caloric flavored placebo when etc.). We provided participants with a were experimental condition (CHO performing maximal exercises in a clean specimen cup and asked them to beverage and non-caloric flavored dehydrated state. Thirst, thermal and provide a sample of 20mL of urine or placebo) in two levels of hydration fatigue responses were affected by more. This allowed us to separate the [dehydrated 4% body mass loss (BML) dehydration which may have caused a samples evenly into cups for the room and 0% BML/euhydrated]. Invest- decrease in performance compared to temperature, refrigeration and frozen igators and participants were blind to the euhy-drated condition. Our specimens. We analyzed the day 1, room the contents of the sports bottle perceptual response questions were an temperature sample within 2 hours of containing the randomly assigned accurate and reliable indication of void for osmolality using a freezing rehydration beverage. Following when an athlete is nearing dehydration point depression osmometer. Also, baseline testing, participants and may provide athletic trainers with within the 2 hour window, we placed the completed a heat stress trial until a a less invasive protocol to recognize additional specimens in the refrigerator 4.2±0.6% BML was achieved. signs and symptoms of heat illness (2.4°C) and freezer (-18.0°C). On day Strength/power tests (1-repetition during exercise. 3, 48 hours after the void, we removed maximum vertical jump, back squat, the samples from the refrigerator and S-16 Volume 47 • Number 3 (Supplement) May 2012 freezer. The frozen samples thawed Objective: To examine the relation-ship significant differences between while we analyzed the refrigerated between self reported alcohol baseline hydration status (1.017 samples. Main Outcome Measures: consumption and hydration. Design: ±0.001) and follow-up day 1 We used a one-way ANOVA to Observational correlational design. (1.021±0.001) as well as follow-up day compare the room temperature Setting: Biochemical research 3 (1.020±0.001). We also identified sample on day 1 and day 3, the laboratory. Patients or Other a significant difference between sports refrigerated and frozen samples. Participants: Five Division I athletic on AUDIT score (F4,86=4.279, p=0.003 Results: We did not identify any teams at a mid-size mid-west η²=0.166) with significant differences significant differences (F3,331= 0.106, institution (ages of 18-26; football between athletes with the highest p =0.96, 1-β=0.99) among the room =15, baseball=25, softball=11, soccer reported alcohol consumption from temperature (day 1 [740±284] and day =25, volleyball=15; men=40, women softball (9.73±1.22) and the lower

3 [742±281]), refrigerated (747 =51) participated in three data reported alcohol consumption athletes Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 ±283), and frozen samples (724 collection sessions. Interventions: in soccer (4.36±0.81) and baseball ±278). Conclusion: Our findings During the fall athletic season, we (4.36±0.81). Conclusions: Although suggest that samples do not need to observed the relationship between self we were unable to identify strong be refrigerated or frozen if assessed reported alcohol consumption and correlations between dependent within 48 hours of void. For hydration on three occasions: during measures, our results may indicate clinicians, this indicates that analysis the pre-participation physical exam alcohol consumption has an impact on does not need to be completed (PPE), on a Sunday or Monday hydration status. Although other immediately and samples do not need following an “off day” and again 3 days factors may have influenced hydration, to be stored in any specific manner following. Main Outcome we did identify significant hypo- other than room temperature. Measures: We measured hydration hydration following alcohol Clinicians should continue to evaluate status using a clinical refractometer consumption over the follow-up urine for hydration status during pre- and self reported alcohol consumption periods. participation exams and preseason using the alcohol use disorders practices to monitor athletes for identification test (AUDIT: range=0- increased risk for exertional heat 40). Informed consent was acquired illness. Previous research, in during an initial team meeting. Athletic combination with our findings suggest Training Services performed baseline clinicians can use digital or clinical hydration status testing during PPEs, refractometers, without refrigeration as part of regular practice for each or agitation within 48 hours of void team. Data collection on the “off day” to assess hydration status. and subsequent testing day varied by team schedule during team check-in or 12341MOIN regularly scheduled treatment time in Relationship Between Self the athletic training facility. Athletes Reported Alcohol Consumption voided at least 20mL of urine into a and Hydration specimen cup for analysis. We Dziedzicki DJ, Eberman LE, calculated z-scores to normalize the Kahanov L, Mata H: Indiana State data and then used a Spearman’s rho University, Terre Haute, IN correlation to evaluate the relationship between dependent measures. We Context: Research suggests that used a repeated-measures ANOVA to collegiate student-athletes are at an analyze hydration status over the three increased risk for binge drinking time sessions. We compared teams on behaviors. Alcohol has numerous AUDIT scores using a one-way negative physiological effects, ANOVA, and used Bonferonni particularly in relation to hydration corrections and post-hoc comparisons status. Alcohol has long been when appropriate. We established the established as a diuretic with long alpha level at p<0.05 a-priori. Results: lasting effects, which has implications We identified no significant or strong for hypohydration following relationships between AUDIT scores consumption. Hypohydration has and hydration status (Spearman’s rho been directly linked to decreases in correlation=0.003, p range=0.973). performance and therefore this We identified significant differences relationship between alcohol and in hydration status over time hydration should be evaluated. η (F2,269=5.226, p=0.006, ²=0.037) with Journal of Athletic Training S-17 Free Communications, Oral Presentations: Proximal Factors Related to Knee Injuries Wednesday, June 27, 2012, 10:45AM-12:00PM, Room 275; Moderator: Phillip Gribble, PhD, ATC 12215FOBI 12F23FOBI Prospective Differences in Lower repeated measures ANOVA were Frontal and Transverse Plane Hip Extremity Biomechanics between performed to compare the dependent and Knee Kinetics and Kinematics ACL Injured and Healthy variables between groups (ACL- During Running in Individuals Individuals injured, Healthy) and sexes (males, with PFP Padua DA, Boling MC, Goerger BM, females) across each time point of the Earl-Boehm JE, Bazett-Jones D, Beutler AI, Marshall SW: Sports jump-landing task (0%, 15%, 50%, Joshi M, Oblak P, Ferber R, Emory

Medicine Research Laboratory, 85%, 100%). Inspection of 95% C, Hamstra-Wright K, Bolgla L: Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 University of North Carolina, Chapel confidence-intervals was performed to University of Wisconsin-Milwaukee, Hill, NC; University of North Florida, investigate significant interactions. Milwaukee, WI Jacksonville, FL; Uniformed Services Results: Significant group (ACL- University of the Health Sciences, injured, Healthy) by time (0%, 15%, Context: Altered frontal and transverse Bethesda, MD 50%, 85%, 100%) interactions were plane kinematics of the hip and knee observed for the following variables: have been found in individuals with Context: Few studies have knee valgus angle (p<0.001) [85%: Patellofemoral Pain (PFP), though prospectively compared lower Healthy=-8.7 (-9.1,-8.6), ACL- findings have been inconsistent. extremity biomechanics of those who injured=-6.3 (-8.2,-4.5)], knee rotation Though knee abduction moment has go on to suffer ACL injury to those who angle (p=0.005) [100%: Healthy=7.7 been related to developing PFP and to do not. However, these studies are (7.0,7.5), ACL-injured=4.9 (2.7,6.2)], developing patellofemoral joint limited by small numbers of subjects hip adduction angle (p=0.001) [0%: osteoarthritis, few studies have who go on to suffer ACL injury (less Healthy=-10.2 (-9.9,-9.6), ACL- examined the hip and knee kinetics in than 10 subjects). Objective: To injured=-6.7 (-7.8,-5.1)], and hip rota- PFP patients. Objective: The purpose compare knee and hip joint kinematics tion angle (p<0.001) [100%: Healthy was to determine if there are differences and kinetics between individuals who =-10.4 (-10.2,-10.1), ACL-injured= in frontal and transverse plane hip and go on to suffer ACL injury and those -8.2 (-9.7,-6.1)]. No signi-ficant main knee joint moments and angles during who do not. Design: Cross-sectional. effects or interactions involving group running between individuals with and Setting: Research laboratory. Patients were revealed for knee and hip flexion without PFP. Design: Cross-sectional. or Other Participants: 5,908 healthy, angle or three-dimensional internal Setting: Research laboratory. Partici- physically active participants knee moments (p>0.05). Con- pants: 30 patients with PFP (17 (males=3,630;females=2,278; clusions: These findings indicate that females, 13 males; Age 27.5±5.6yrs; age=18.6±0.6 yrs, ht=173.5±9.2 cm, individuals who go onto suffer ACL Mass 72.5±12.0kg; Height 1.75± wt=71.9±12.9 kg) were baseline tested. injury demonstrate less knee valgus, 0.60m) and 24 control participants (13 92 of the original participants later knee internal rotation, hip abduction, females, 11 males; Age 28.0±7.4yrs; suffered a non-contact/indirect contact and hip external rotation angle Mass 68.9±8.95kg; Height 1.7±0.32m) ACL injury after baseline testing (ACL- compared to those that do not suffer completed the study. PFP participants injured males=57, ACL-injured fe- ACL injury. No interactions involve had pain: 3/10 for a minimum of 4 males=35, Healthy males=3,573, sex and group were demonstrated, thus weeks, during physical activity, Healthy females=2243). Interven- differences in ACL-injured and prolonged sitting, jumping, and/or tions: Three-dimensional knee and hip Healthy groups are similar between squatting. The control group were free joint kinematics and kinetics were males and females. Therefore, altered from lower extremity injury and had no quantified using an electromagnetic frontal and transverse plane motion history of PFP. All participants were motion analysis system and force plate control at the hip and knee appears to active a minimum of 30 minutes at least while participants performed a jump- be important prospective risk factors 3 days/week. For the PFP participants landing task (3-trials). Main Outcome for ACL injury. Future research the most painful knee was tested, and Measures: Three-dimensional knee investigating the effects of modifying this was matched for the controls. and hip joint angles and knee joint frontal and transverse plane hip and Interventions: The independent internal moments (normalized to body knee motion and the influence on ACL variables were sex (Male, Female) weight x height) were calculated at the injury rates is warranted.(Funded by the and group (PFP, Control). Three- following time points during the stance- NIAMS Division of the National dimensional data were collected at 200 phase of the jump-landing task: 0% Institutes of Health, #R01- Hz and ground reaction force data were (initial contact),15%, 50%, 85%, 100% AR050461001) collected at 1000 Hz while participants (take-off). Separate mixed-model ran (3.5-4.5 m/s) wearing standard

S-18 Volume 47 • Number 3 (Supplement) May 2012 12F05MOBI footwear. After several practice trials, Comparison of Trunk and Lower Measures: Joint displacement, defined 5 trials were recorded. Main Outcome Extremity Kinematics in as the difference between the maximum Measures: The dependent variables Individuals With and Without or minimum joint angle and the angle at were stance phase peak joint angles (hip Patellofemoral Pain initial contact, was calculated during adduction and internal rotation, knee Schwane BG, Goerger BM, Goto the stance phase for each dependent adduction and internal rotation) and S, Aguilar AJ, Blackburn JT, Padua variable. Independent t-tests were moments (hip abduction and external DA: University of North Carolina performed to compare the dependent rotation, knee abduction and external at Chapel Hill, Chapel Hill, NC variables between groups. Results: rotation). Internal joint moments were There was a significant difference calculated using an inverse dynamics Context: Trunk kinematics are (t38=2.082, p=0.044) between groups for approach, and normalized to body mass. knee internal rotation dis-placement, theorized to contribute to Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Multivariate ANOVA, using Sidak’s test patellofemoral pain (PFP). However, with the PFP group (12.8+7.2°) for multiple comparisons, was the majority of this research has been displaying approx-imately 4° more knee performed to identify differences conducted in healthy individuals, and internal rota tion displacement than the between the independent variables there is limited research on trunk control group (8.9+4.4°). However, there (p<0.05). Results: There was a kinematics in subjects with PFP. were no significant between g roup significant group x sex interaction for Understanding trunk and lower differences for the other dependent knee abduction moment (p=0.029). extremity kinematics in this population variables (p>0.05) (PFP Group: trunk Post-hoc comparisons indicated that may improve our understanding of PFP flexion=1.7+1.1°, trunk lateral males with PFP demonstrated pathomechanics and highlight new flexion=1.7+1.7°, trunk rotation= significantly (p=0.05) greater knee avenues for possible interventions. -5.5+ 4.6°, hip flexion=-4.6+ 3.4°, hip abduction moment than control Objective: To compare trunk and adduction=10.5+4.1°, hip internal (PFPS=1.0±0.51, Control=0.70±0.22 lower extremity kinematics between rotation=4.4+ 3.3°, knee flexion Nm/kg). In females, there was no subjects with PFP and healthy controls =79.7+ 5.9°, knee valgus=-2.6+5.1°; significant difference (p=0.29) in knee during a stair descent task. Design: Control Group: trunk flexion=1.7+ abduction moment between PFP Cross-sectional. Setting: Research 0.9°, trunk lateral flexion=1.6+ 0.8°, (0.84±0.29Nm/kg) and Control laboratory. Patients or Other trunk rotation= -4.7+4.3°, hip flexion (1.0±.50Nm/kg). Regardless of gender Participants: Participants included =-4.6+ 3.9°, hip adduction=10.9+ (group main effect, p=0.038), those 20 females with PFP (Age: 22.2+3.1 4.2°, hip internal rotation=4.0+3.3°, with PFP had greater hip abduction years, Height: 164.5+9.2 cm, Mass: knee flexion= 79.3+ 5.8°, knee valgus moment than controls (PFP= -1.93± 63.5+13.6 kg) and 20 healthy females = -2.7+ 3.0°). Conclusions: Knee 0.29, Control=-.1.73±0.38 Nm/kg). (Age: 21.0+2.6 years, Height: internal rotation is not typically There were no significant differences 164.5+7.1 cm, Mass: 63.8+12.7 kg). associated with PFP. The presence of in any of the other variables measured Participants with PFP met the greater knee internal rotation may be (p>0.05). Conclusions: Individuals following criteria: retropatellar knee a compensatory mechanism of those with PFP exhibit increased loading at pain with physical activity; pain on with PFP to decrease pain during the hip and knee in the frontal plane. palpation of either the patellar facets activity by unloading the lateral facet The altered loading could result from or femoral condyles; and negative of the patellofemoral joint. Although compensatory trunk lean or pelvic drop findings on examination of the knee this study did not find differences in due to weakness or pain. This study ligaments, menisci, bursa, and synovial trunk kinematics between groups, supports a growing body of literature plica. Interventions: Each participant future studies incorporating more that suggests frontal plane loading of performed a stair descent task at a challenging tasks to examine the hip and knee is an important factor controlled pace (3 trials). A seven- kinematic differences are warranted. for PFP and potentially knee OA, and camera infrared optical motion capture Funded by the NATA Research and may be different between genders. system was used to collect three- Education Foundation dimensional trunk and lower extremity kinematic data. Dependent variables included tri-planar displacement of the trunk, hip, and knee during the stance phase (initial contact to toe-off for the involved limb) during stair descent. Analysis of dependent variables was limited to the involved limb of the PFP group and matched dominant limb of the control group. Main Outcome

Journal of Athletic Training S-19 12139MOBI 12340MOBI Maximal Gluteal Strength Does Not preferred to kick a ball. Main Outcome The Effects of Hip Strength on Correlate with Jump-Landing Measures: Bilateral gluteus maximus Gluteal Muscle Activity and Biomechanics and gluteus medius strength was Lower Extremity Kinematics Strouse AM, Lepley AS, Ericksen digitized and maximal values were Homan KJ, Norcross MF, Goerger HM, Doebel SC, Pfile KR, Gribble exported. Two individual assessors BM, Prentice WE, Blackburn JT: PA, Pietrosimone BG: University scored the LESS, and met to resolve University of North Carolina, of Toledo, Toledo, OH any discrepancies. Lower LESS scores Chapel Hill, NC denote better landing mechanics with Context: The Landing Error Scoring fewer errors. The trial with the greatest Context: The effects of hip muscle System (LESS) has been developed as amount of errors was included for strength and activation on kinematic analysis. Four separate Pearson a clinical tool to evaluate gross ACL loading mechanisms have been Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 neuromuscular dysfunction during Product Moment Corre-lations were reported in isolation with equivocal landing. Improper lower extremity performed to assess the relationship results. However, the combination of biomechanics, specifically dynamic between the strength of the selected these factors likely influences joint knee valgus during jump-landing may gluteal muscle of the dominant and non- kinematics, and our understanding of increase the risk of non-contact lower dominant sides and LESS score. Alpha ACL injury biomechanics may be extremity injury. The proximal level was set a priori at P<0.05. improved by investigating these factors component of dynamic knee valgus Results: No significant correlations concomitantly. Objective: To evaluate results from internal rotation and were found between LESS score and the influence of hip strength on gluteal adduction of the femur, which are strength for the dominant gluteus activation and kinematic ACL loading controlled by gluteus maximus and maximus (r=0.003, P=0.99), non- mechanisms. Stronger individuals were gluteus medius function. Currently the dominant gluteus maximus (r=0.16, hypothesized to display similar lower relationship between gluteal strength P=0.4), dominant gluteus medius extremity kinematics, but lesser gluteal and LESS score remains unknown. (r=0.12, P=0.53), or non-dominant activation than weaker individuals. Objective: Investigate the relationship gluteus medius (r=-0.037, P=0.848). Design: Cross-sectional. Setting: between bilateral gluteus maximus and Con-clusions: No relationships were Research laboratory. Participants: gluteus medius strength and overall found between gluteal muscle strength Eighty-two healthy, physically active landing biomechanics in healthy and biomechanical errors accumulated volunteers (41 males, 41 females; females. Design: Descriptive labor- during a dynamic jump-landing task. 20.9±2.4 years, 1.74±0.10 cm, 70.3±16.1 atory study. Setting: Research This data provides evidence that kg). Interventions: Hip strength and laboratory. Patients or Other Partic- maximal gluteal strength is not a major gluteus maximus (GMax) and medius ipants: Thirty females (21.5±2.2yrs; contributing factor to dynamic landing (GMed) electromyo-graphic (EMG) 164.6±5.82cm, 64.84±12.0kg) with biomechanics. Therefore, strength amplitudes were measured during no history of lower extremity injury may not be the most influential maximal voluntary isometric contrac- volunteered. Interventions: Bilateral clinical factor in which practitioners tions (MVIC). Gluteal EMG and three- gluteus maximus and gluteus medius should focus to improve poor jump- dimensional knee and hip kinematics strength were assessed using maximal landing bio-mechanics. Future were assessed during a double-leg jump voluntary isometric contractions in the research should examine other landing task via an electromagnetic midrange of motion using an isokinetic factors besides strength, such as motion capture system. Main Outcome dynamometer. Strength was tested in neuromuscular control or muscle Measures: Peak hip extension (EXT), the open-chain in prone and side lying activation and timing, which may external rotation (ER), and abduction positions for gluteus maximus and better contribute to overall landing (ABD) forces during MVICs were gluteus medius muscles, respectively. biomechanics. multiplied by segment length to produce The order of muscle and limb tested peak torques, and normalized to the was randomized. Following strength product of subject height and weight. testing, participants performed three Knee valgus, hip internal rotation, and jump-landing trials from a 30cm box. hip adduction angular displacements, Participants were instructed to jump and average GMax and GMed EMG off the box to a standardized distance amplitudes were identified during the of 50% their height, and immediately loading phase of landing. Seven rebound to a maximal vertical jump. participants (2M, 5F) were identified as Each jump-landing trial was video outliers and excluded from analysis. For recorded and later scored for errors. each strength measure, the remaining Leg dominance was determined as the participants’ data were arranged into leg with which each participant tertiles, and one-tailed independent t-

S-20 Volume 47 • Number 3 (Supplement) May 2012 tests were used to compare landing ±22.94 %MVIC, p=0.057), and GMed kinematics and gluteal EMG between EMG was lesser in individuals with the highest and lowest tertiles (i.e. stronger hip abductors (55.87 ±29.75 High vs. Low strength groups). vs. 84.56± 35.14 %MVIC, p=0.071). Results: The High strength groups Conclusion: Individuals with greater had greater hip EXT(0.013±0.017 vs. hip strength utilize lesser gluteal 0.080± 0.009 [x(BW*Ht)-1], activation than weaker individuals p<0.001),ER (0.057± 0.001 vs. while displaying similar angular 0.037±0.003 [x(BW*Ht)-1], p< displacements. Increasing gluteal 0.001), and ABD (0.128±0.018 vs. strength may be important for ACL 0.076±0.007 [x(BW*Ht)-1], p<0.001) injury prevention, as weaker in-

strength than the Low groups. The High dividuals may be susceptible to Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 strength groups exhibited similar knee increased displace-ments during more valgus (EXT:-10.19±6.07º vs. challenging dynamic tasks due to -11.26±7.69º, p=0.589; ER:-9.56 lesser reserve neural drive (i.e. ±7.04º vs. -11.74±7.60º, p=0.298; remaining %MVIC) and a potentially ABD :-11.22±6.96º vs. -10.13 ±7.65º, greater risk of fatigue. These find-ings p=0.600), hip internal rotation also suggest that simultaneous (EXT:8.33±5.95º vs. 8.19±5.07º, assessment of muscle strength and p=0.929; ER:7.01±6.27º vs. 9.78± activation are necessary when 5.53º, p=0.104), and hip adduction evaluating their effects on landing (ABD:4.47±3.81º vs. 3.30±2.24º, p= kinematics. 0.191) displacements as the Low groups. However, GMax EMG was lesser in individuals with stronger hip extensors (55.87± 29.75 vs. 84.56± 35.14 %MVIC, p=0.003) and external rotators (33.78±22.04 vs. 45.52

Knee EBF Wednesday, June 27, 2012, 12:15PM-1:15PM, Room 275; Moderator: David Bazett-Jones, PhD, ATC

Journal of Athletic Training S-21 Free Communications, Oral Presentations: Nutrition and Supplementation Thursday, June 28, 2012, 8:00AM-9:00AM, Room 275; Moderator: Kevin Miller, PhD, ATC 12270OONU 12233DOIN Regimented Sodium Replacement (specific gravity=1.018±.009) en- Understanding Prevalence and using Sodium Capsules Compared sured euhydration. %Δ mass the Attitudes: Dietary and Exercise to Ad Lib Consumption of High mornings of Days 3, 5 and 10 was Behaviors among African Sodium Fluids on Electrolyte calculated from baseline. Both years American Collegiate Athletes Balance in NFL Players during the players had 15 practices the first 9 Lewis DW, Leaver-Dunn D, Nickelson Pre-season days of camp. At meals players J, Torres-McGehee T, Usdan S: The Bartolozzi AR, Fowkes Godek S, consumed sodium containing fluids University of Alabama, Tuscaloosa, Morrison KE, Peduzzi C, Condon S, and salt capsules (Year1) in amounts AL; University of South Carolina, Burkholder R, Dorshimer GR: equal to 50% of daily sweat sodium Columbia, SC Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Pennsylvania Hospital, Philadelphia, losses, and in Year2 they were PA; The HEAT Institute at West encouraged to consume as much Context: Historically, eating disorder Chester University, West Chester PA; sodium containing fluid (458 mg to research has been primarily centered on Philadelphia Eagles, Philadelphia, PA g· l-1) as tolerated. Main Outcome Caucasian females between the ages of Measures: %ΔPV, %Δmass, blood 15-24 years.1-3 The lack of inclusion of Context: Previous field research sodium, potassium and chloride. Two- diverse minority populations from indicates that sodium replacement helps way ANOVA with repeated measures robustly designed eating disorder maintain sodium balance, plasma and correlated t-tests were used. research has profoundly limited the volume and body weight in football Results: Mean WBGT during generalizability for theory, treatment, players during pre-season. It is unknown practices for days 1–9 were not and diagnosis. Objective: The purpose whether ad libitum consumption of high different (Capsules=25±3.5ºC and of this study was to examine eating and sodium fluids maintains sodium and Fluids= 25.5 ±3.1ºC). Sodium and exercise behaviors among African- fluid balance as well as planned sodium %ΔPV were lower on Day3 in Fluids American athletes enrolled at replacement using fluids and sodium versus Capsules (137.8±1.4 versus historically black colleges and capsules. Objective: To individually 140.6± 1.5mmol·l-1,P=.004) and (-.6± universities (HBCUs). Design: This replace 50% of daily sodium losses 11% versus +11±10%,P=.006). In study consisted of a cross-sectional using fluids and salt capsules Fluids, chloride was lower Day3 analysis using non-probability (Capsules) versus ad lib high sodium (104± 1.9mmol·l-1) compared to convenience sampling procedures. fluids only (Fluids) in NFL players baseline (106.4±1.6 mmol·l-1) and Setting: The study took place during during preseason and measure blood Day10 (106.6±2mmol·l-1),P=.05. pre-participation physical examinations electrolytes, changes in plasma volume Potassium was higher on Day5 in at two southeast regional HBCUs. (%ΔPV) and body mass (%Δmass). We Capsules (4.9± .37mmol·l-1) versus Patients or Other Participants: The hypothesized that Fluids would not baseline (4.4± .3mmol·l-1), Day3 target population for this study was maintain blood sodium or increase PV (4.4±.3mmol·l-1), and Day10 (4.6±.35 athletes enrolled at HBCUs (n = 128). compared to Capsules. Design: Obser- mmol·l1)P<.001. PV increased over Athletes were defined as students with vational cohort. Setting: Consecutive time in Capsules and on Day3 was 11% full-time academic enrollment status, preseason training camps (Year1 and above baseline and remained there on who have participated in NCAA or Year2) of one NFL team. Patients or Day5 (12.4±15%) and Day10 NAIA sanctioned athletic events within Other Participants: Eleven NFL (9.3±10%), P =.04. No differences the study’s academic calendar year. The players (ht=187±5cm, mass =113.4±17kg were found for %Δmass. Con- mean age among participants was 19.7 and BSA= 2.38±0.17m2) volunteered, 6 clusions: Sodium remained constant years. The study’s response rate was 35 players participated in both years and during the first 10 days of preseason percent. Interventions: Subjects the other 5 were physically matched. in NFL players who replaced 50% of completed the EAT-26, EDS-21, Interventions: We took blood samples their daily sweat sodium losses using ORTO-15, and Pulvers’ Figural Stimuli for baseline measures when players sodium capsules. This was not the case (2002) instruments; as well as reported to camp and prior to the with Fluids. Importantly, %ΔPV was additional demographic question items morning practice on Days 3, 5 and 10. higher on Day3 in Capsules (+11.4%) addressing key covariates for the Blood electrolytes (sodium, potassium compared to Fluids (-.6%) which is purposes of control and investigation. and chloride) were determined by ion- likely clinically relevant. Results Main Outcome Measures: The selective electrode and %ΔPV was support individualized dry sodium primary outcome measures of interest calculated using hematocrit and replacement for NFL players during were eating disorder risk, orthorexia hemoglobin. Baseline mass was training camp. nervosa risk, exercise dependency risk, recorded after urine samples and body image perception. Regression (osmolality=681±302 mOsm·kg-1) and analysis (Logistical and Multiple S-22 Volume 47 • Number 3 (Supplement) May 2012 Regression Analysis), factor analysis, not been compared with respect to min (IV =1153 ± 266ml and Oral = ANOVA, chi-square analysis, and efficiency in sodium (Na+) re- 886 ± 399ml), and therefore Na+ simple descriptive statistics served as placement. Objective: To investigate intake (IV = 525 ±121mg and Oral = the primary quantitative means of oral (Oral) versus IV Na+ replacement 404 ±182mg) were not different (P = investigating the study’s research as measured by Na+ retention after .09). Total Na+ replacement at 180 min questions. Results: Overall, analysis exercise-induced weight loss in was greater in IV (2190 ±477mg) than of descriptive statistics show that the football players, and to evaluate thirst Oral (1042 ±517mg), P <.001. percentage of participants at risk for and ad lib fluid consumption following Conclusions: Results indicate that eating disorder, orthorexia nervosa, these methods. Design: Randomized Na+ replacement via IV fluids resulted and exercise dependency were 6 cross-over study. Setting: Controlled in twice the sodium retention percent, 9 percent, and 30 percent University laboratory. Patients or compared to oral ingestion of the same

respectively. MANOVA post-hoc Other Participants: Nine collegiate volume of electrolyte enhanced Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 analysis revealed that there was not a football players (age: 20.9±1.1y, carbohydrate/electrolyte drink con- significant difference between the height: 181.5± 3.4cm, mass: taining a similar amount of Na+. A high perceived mean Body Mass Indexes 100.3±21kg) volunteered to par- oral sodium load may stimulate a (BMIs) among subjects who classify ticipate. Interventions: On two naturetic response from the gut, themselves as overweight and normal occasions, while HR and rectal therefore IV replacement may be weight (p = .142), with most subjects temperature was continuously advantageous for certain athletes when (68%) perceiving themselves as of monitored, subjects exercised in an sodium retention is important. normal weight. When accounting for environmental chamber (35pC, actual BMI and perceived BMI, 70%RH) until 2.5% body weight loss 12F10 African-American participants were was reached. Subjects were given 1.5L Ferritin, Hematocrit, and more likely to report that they are of of readily available, commonly used Hemoglobin as Biochemical normal weight when they are actually electrolyte enhanced fluids via IV (5% Markers of Iron Deficiency in classified as overweight when dextrose and 78mEq·l Na+) or Oral Collegiate Runners compared to other races (OR = 1.873, (6% CHO and ~ 68mEq·l Na+) Rancourt CS, Eberman LE, 95%CI:1.824 – 1.944). Conclusions: methods during a 15 min time period Kahanov L, Adams H, Ingebretsen Based upon the study’s results, it is immediately following exercise. At J, Landis M: Indiana State advisable for health officials to focus 150 min post treatment all subjects University, Terre Haute, IN; their attention on matching perception drank CHO/Electrolyte fluids ad lib. Union Hospital, Terre Haute, IN with reality as it relates to weight Urine Na+ concentration (via ion- among African-American collegiate selective electrode) and urine volume Context: Research suggests that athletes. This information will aid in (mL) were measured at 60, 120 and endurance athletes experience lower promoting a healthy lifestyle among 180 min following treatment. Ratings than normal hematology levels during participants during their post-sport of thirst (0=not thirsty to 7=very season, which may be a result of lives. Continued analysis is needed to thirsty) were recorded prior to ad lib overtraining. Serum ferritin has been confirm the results. drinking at 150 min and total fluid identified as a biochemical indicator of consumed between 150 and 180 min iron deficiency and may also be 12273FOEX was measured. Two-way ANOVA and insufficient in over-trained athletes. Intravenous Versus Oral Sodium correlated t-tests (with a Bonferroni Objective: To observe serum ferritin, Replacement in Collegiate Football correction when appropriate) were hemoglobin, and hematocrit levels of Players After an Exercise-induced used with P<.05. Main Outcomes collegiate runners. Design: Retro- Reduction in Body Weight by 2.5% Measures: Na+ retention(mg) at 120 spective research design. Setting: Fowkes Godek S, Godek JJ, min [IV or Oral Na+ intake (mg) – NCAA Division I Institution in the mid- Bartolozzi AR: HEAT Institute at urinary excretion (mg)], thirst ratings, western US. Participants: As part of West Chester University, West ad lib fluid consumption (ml) and the pre-participation physical exam, Chester, PA; DevTay Enterprises, additional Na+ intake (mg) between male(n=23;age=20±1; height = 69.7± Kennett Square, PA; Pennsylvania 150 and 180 min, and total Na+ 2.5in; weight= 147.4± 16.3lb; in- Hospital, Philadelphia, PA replacement (mg) at 180 min. season mileage= 60.2± 19.6/wk; off- Results: At 120 min post treatment, season mileage= 75.4± 13.0/wk) and Context: High sweat sodium losses IV retained greater Na+ (1665.4 female (n=19; age=20 ±1; height= have been documented in athletes such ±422mg) compared to Oral (638± 64.2±2.7in; weight= 126.0±14.5lb; in- as football and ice hockey players, 451mg), P <.001. Thirst ratings were season mileage= 40.1±7.9/wk; off- therefore, sodium replacement may be higher in IV between 30 and 60 min season mileage= 39.3±5.9/wk) cross- helpful for these athletes. Oral and and between 60 and 120 min, both country and track athletes underwent intravenous (IV) fluid replacement have P<.016. However, ad lib fluid blood-draw and physical history been studied but these methods have consumption between 150 and 180 examinations. Interventions: Follow- Journal of Athletic Training S-23 ing the examinations, we acquired These findings suggest that increased access to the anonymous data for mileage among males may lead to further analysis. Main Outcome increased hematocrit levels and Measures: We collected age, height, potentially fatigue and decreased weight, gender, ferritin, hematocrit, performance. and hemoglobin levels from all participating athletes. We used linear regression to determine the role of in- and off-season mileage on the dependent measures. Results: Overall, the collegiate runners

demonstrated within normal limits Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 ferritin (males=63.4±29.38ng/mL, normal range=30-400ng/mL; females =44.1±50.8ng/mL, normal range=13- 150ng/mL), hematocrit (males= 41.7± 2.2%, low range<45%; females= 38.9±2.2%, low range<40%), and hemoglobin levels (males= 14.6±0.8 g/dL, normal range=13.8-18.0g/dL; females=13.7±0.7g/dL, normal range= 12.1-15.1g/dL). However when flagging athletes for low levels, we found differences in at-risk athletes based on the criteria. Ferritin flags suggested that 2 males and 1 female were lower than normal; hematocrit flags suggested that 22 males and 12 females were lower than normal; hemoglobin flags suggested that 6 males were lower than normal. We determined that among males, in- season (p=0.045) and off-season (p=0.008) mileage are significant predictors of hematocrit (r=0.662, R2=0.438, p=0.024), but not ferritin (r=0.459, R2=0.210, p=0.493). Female runners mileage was not a predictor for hematocrit (r=0.423, R2=0.179, p =0.454) and ferritin (r=0.662, R2 =0.438, p=0.024). Conclusions: The collected hema- tology levels may be an indication of over-training; however, such levels are expected of the body’s response to stress and return to normal levels during periods of rest/off-season. The research suggests that observing ferritin levels alone may not be sufficient to determine iron deficiency. Hematocrit level is a more sensitive indicator of iron deficiency when triangulated with ferritin and training regime. Furthermore, in-season and off-season mileage significantly predict hematocrit among males.

S-24 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Prevention & Treatment of Exertional Heat Stroke Thursday, June 28, 2012, 9:30AM-10:15AM, Room 275; Moderator: Michael Ferrara, PhD, ATC 12033MOEM 12F18FOEX The Secondary School Football with an athletic trainer regularly and Validity of the Heat Observation Coach’s Perspective of Sudden these interactions were evaluated by Technology System During Death in Sport the coach as positive and influential. Summer Football Conditioning Adams WM, McGrath BT, Thirty of the 38 coaches had full-time McDermott BP, Guadagno J: Mazerolle SM, Pagnotta KD, Casa athletic trainers on staff, 4 part-time, University of Tennessee at DJ: University of Connecticut, and the remainder were lacking Chattanooga, Chattanooga, TN

Storrs, CT medical coverage by an athletic Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 trainer. The second theme, limited Context: Body temperature Context: Prior research has examined knowledge, reflected the secondary assessment for the recognition of the first aid knowledge and decision coach’s misgiving regarding causes of exertional hyperthermia is imperative. making among secondary school sudden death as well as signs and Despite current recommendations to coaches, but little is known about their symptoms associated with certain assess body temperature via rectal knowledge of sudden death in sport or conditions. Many coaches were only means, there are many alternatives their relationship with an athletic aware of the most predominant causes available. It is crucial for athletic trainer. Objective: Evaluate the of sudden death including cardiac and trainers to utilize valid and reliable knowledge of the secondary school head injuries. They also felt dizziness methods to assess body temperature. football coach regarding sudden death and fatigue were the most important The heat observation technology in sport and their relationship with their factors to diagnosis a case of heat (HOT) system is promoted as athletic trainer. Design: An exploratory stroke. The final theme highlights the providing an early warning of qualitative study utilizing asynchronous confidence, due to basic emergency impending heat illness. This system online interviewing. Setting: Web- care training, of the coach regarding measures forehead skin temperature based management system. Patients or management of an emergency via a thermistor and, normally applies Other Participants: 38 secondary situation, despite a lack of knowledge. an algorithm to that reading to school head football coaches (37 males, Conclusions: The secondary school estimate body temperature. 1 female) participated in this study with football coach values and understands Objective: The purpose of this study an average age of 47+10 years old. On the role of the athletic trainer was to assess the potential validity of average each coach had 12+9 years regarding patient and emergency care. the HOT system during outdoor experience as a head football coach. The secondary coach, however, is summer football conditioning Data Collection and Analysis: unaware of the potential causes of sessions. Design: Observational field Participants responded to a series of sudden death in sport, symptoms study. Setting: Voluntary summer online questions by journaling their associated with some conditions of con-ditioning (90.0 ± 5.3°F dry bulb, thoughts and experiences. Questions sudden death, and holds a higher self- 48.4 ± 5.0%RH). Patients or Other were focused on knowledge of sudden confidence in management abilities Participants: 20 NCAA-FCS death, prevention strategies, and than indicated by their knowledge competitive football players (20 ± 2y, professional relationships with athletic level. Athletic trainers, when working 183.8 ± 7.3cm, 95.9 ± 18.3kg) trainers. Multiple analyst triangulation with the secondary coach, can have a voluntarily participated. Inter- and peer review were included as steps positive influence on their ventions: Participants completed to establish data credibility. The data implementation of strategies to normally scheduled voluntary summer was analyzed borrowing from the prevent sudden death. Moreover, the conditioning workouts according to principles of a general inductive data illustrates the importance of their strength and conditioning approach. Results: Three dominant having an athletic trainer present to schedule. Forehead skin temperature themes emerged from the data: positive help prevent sudden death in sport, as data were collected via HOT professional relationships, limited the coach is ill-prepared. headbands and gastrointestinal knowledge regarding sudden death, temperature (TGI) via ingestible and self-efficacy and emergency care. thermistors taken at least 5 hours prior The first theme illustrated the secondary to activity. Specific data points within coach’s positive professional relation- subject were later matched for time ships with athletic trainers regarding point comparisons within 30s. Main patient care and emergency Outcome Measures: TGI and HOT procedures. Thirty-four of the 38 skin temperature. Results: Temper- coaches, who participated, interacted ature results were significantly

Journal of Athletic Training S-25 different between HOT (96.8 ± 2.1°F) Observational field study. Setting: (1.024±0.008, p<0.001), and 48h and TGI (100.7 ± 1.2°F; p<.001). There 2011 Ironman World Championships (1.016±0.006, p=0.006). While 24h was no significant correlation between in Kona, Hawaii (28.9°C, 71% relative Usg was similar to POST (p=0.15), it temperature readings (r = -.119; humidity). Patients or Other was significantly different from 48h p=.070), and this relationship Participants: 33 subjects (n=22 Usg (p=<0.001). Ucol was significantly demonstrated that HOT readings males, 11 females) entered in the lower PRE (3±2), vs. POST, 24h and decreased as TGI increased. Con- Ironman World Championships 48h (6±2, 6±1, 5±2 respectively, clusions: Our findings did not participated (Mean± SD: age= 40± p<0.001). Thirst was significantly demonstrate potential validity of the 11y; height= 174.5± 9.1cm; weight lower PRE (4±2) vs. POST (5±2, HOT system to provide an accurate =70±11.8kg; percent body fat= 11.4 p=0.002), but not 24h and 48h. warning. A negative relationship between ±4.1%). Interventions: No inter- Conclusions: Participants reached

TGI and skin temperatures provided by vention occurred. Main Outcome thresholds for dehydration post race Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 HOT suggest that no corrective Measures: Data collection occurred as demonstrated by BML and urine algorithm could be applied either. Until prior to (PRE), immediately post indices; however BML returned to independent research demonstrates the (POST), 24 hours (24h) and 48 hours baseline by 24h and Usg reached current engineering and algorithm as (48h) following the race. A one-way euhydrated standards (Usg<1.020) by effective, athletic trainers should repeated measures ANOVA with 48h. BML was not correlated with a continue to utilize valid and reliable Bonferroni corrections were reduction in finish time. Overall these methods of temperature assessment on performed to examine differences results indicate that elite triathletes exercising patients. across time for perceived thirst, were able to greatly minimize the perceived pain, urine specific gravity degree of dehydration during the race 12223DOEX (Usg), urine color (Ucol), body mass (2.3% BML post race), especially Examination of Performance loss (BML) and percent BML considering the duration of the event and Hydration Responses in Elite (%BML). Pearson’s bivariate and high sweat rates (estimations of Triathletes During the Ironman correlations were used for total fluid losses based on sweat rates World Championship Triathlon comparisons with finishing time. Alpha range from 15.5L for women and 18L Stearns RL, Casa DJ, DeMartini JK, level was set a priori at 0.05. Results: for men). Athletes also demonstrated Huggins RA, Munõz CX, Pagnotta Average finish time (h:min) was an ability to return quickly to pre-race KD, Volk B, Maresh CM: Korey 11:03±1:25h (males:10:34±1:08h, body mass. Stringer Institute, University of females: 12:00± 1:30h). Average sweat Connecticut, Storrs, CT rate was 1.6±0.6L/h(males:1.7±0.6L/ h, females :1.±0.5L/h). Significant Context: Physiological demands for differences occurred for POST BML extreme endurance events, such as an (-1.7±0.9kg) vs. 24h, and 48h BML Ironman triathlon, are very unique. (0.9±1.4, -0.1±1.2kg, respectively; Within the limited number of athletes p<0.001). No significant correlation participating in such events, even less occurred between BML and finishing is known regarding the elite level time (r=0.216, p=0.242). %BML at athletes that compete. Objective: POST was 2.3±1.6% and was not Examine the hydration responses and correlated with finishing time performance characteristics of elite (r=0.124, p=0.505). Usg was level triathletes during the Ironman significantly lower PRE (1.011±0.007) World Championship race. Design: vs. POST (1.021± 0.007, p<0.001), 24h

Exertional Heat Stroke EBF Thursday, June 28, 2012, 10:30AM-11:30AM, Room 275; Moderator: David Csillan, MS, ATC

Head and Spine EBF Thursday, June 28, 2012, 5:00PM-6:00PM, Room 275; Moderator: Ron Courson, ATC, PT

S-26 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Thematic Poster: Quality of Life Assessments After Injury Friday, June 29, 2012, 8:00AM-10:00AM, Room 275; Moderator: Joseph Hart, III, PhD, ATC 12078MONE 12080MONE Individuals with Glenohumeral each test using a 10-cm visual analog Objective and Patient-Based Measures Joint Instability Maintain scale ranging from 0 (no stability) to 10 of Glenohumeral Joint Stability Stiffness and Physical Activity (completely stable). Patient-based Between Individuals with Gleno- Levels While Displaying measures, including the Disabilities of humeral Instability and Healthy Diminished Health-Related Arm, Shoulder and Hand (DASH, 30- Controls Quality of Life Compared to items, score range: 0 to 100) and Western Lechtenberg J, Huxel Bliven K, Balam Healthy Controls Ontario Shoulder Instability Index T: Arizona School of Health Sciences, Balam T, Huxel Bliven K, Lechtenberg (WOSI, 21-item, score range: 0 to 2100), A.T. Still University, Mesa, AZ J: Arizona School of Health Sciences, and the International Physical Activity Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 A.T. Still University, Mesa, AZ Questionnaire (IPAQ, 4 domains, scored Context: Glenohumeral joint (GHJ) using weighted linear equation) were instability limits the tissue’s ability to Context: Glenohumeral joint (GHJ) completed. GHJ stiffness and perception maintain stability, which is often stability relies on the integrity of its of GHJ stability were analyzed using assessed through objective clinical static (passive stiffness) and dynamic 4(condition) x 2(group) ANOVA’s with measures. GHJ instability also impacts structures (active stiffness). repeated measures. DASH, WOSI, and function and may ultimately diminish Theoretically, damage to these tissues IPAQ scores were analyzed using Mann- a patient’s health-related quality of life compromises passive and active Whitney U tests. Results: Active stiffness (HRQOL). Therefore, it is important stiffness, function, and health-related (7.4±5.3 Nm/deg) was greater than to incorporate both objective and quality of life (HRQOL). However, passive stiffness (1.0±0.3 Nm/deg, patient-based measures into clinical understanding GHJ stiffness measures p<0.001). There were no differences assessments. Objective: Examine in conjunction with patient-based between 0° and 80% ER positions for objective GHJ stability measures (laxity measures in a GHJ instability population passive (p>1.00) or active (p=0.158) and stiffness) and patient- based is limited. Objective: Measure stiffness, or between groups (p=0.97). measures (perceptions of GHJ stability differences in GHJ stiffness, patient- Perception of GHJ stability was lower in and HRQOL in GHJ instability patients based measures, and physical activity GHJ instability than healthy control for compared to healthy controls. Design: level between GHJ instability and all conditions (7.4±0.4 vs. 9.8±0.4, Cohort. Patient or Other Partici- healthy controls. Design: Cross- respectively, p<0.05). The GHJ instability pants: Thirty-one subjects (GH sectional. Patients or Other Partici- group had higher DASH (16.2±12.7 vs. instability: n =17; age: 26.5 ± 6.6 yrs; pants: Thirty-five subjects of 0.6±1.3, respectively, p<0.001) and height: 172.7±11 cm; mass: 80.5±15.1 convenience were tested (GH WOSI (665.4±383.1 vs. 41.8±62.3, kg, Healthy control: n =14; age: instability: n=18; age: 26.2±6.6 yrs; respectively, p<0.001) scores, indicating 26.8±8.1 yrs; height: 174.6±11.7 cm; height: 173.5±11.2 cm; mass: diminished HRQOL. No differences in mass: 81.4±14.8 kg) of convenience 80.5±14.7 kg, Healthy control: n=17; IPAQ scores were found (GHJ were tested. Interventions: Partici- age: 26.8±7.3 yrs; height: 174.0±12.2 instability=492.7±479.6, healthy con- pants were screened and placed into cm; mass: 80.9 ±14.9 kg). Inter- trol=417.7±473.4, p>0.05). Conclu- groups: GHJ instability or healthy ventions: Independent variables were sions: Findings of greater active than control. GHJ stability was measured condition [0°external rotation (ER)/ passive stiffness result from muscle in anterior and posterior directions with passive, 0°ER/active, 80% ER/passive, contraction. The GH instability group the GHJ positioned in neutral and 90° 80% ER/active] and group (GHJ displayed equal stiffness and physical external rotation (ER). Main Outcome instability, healthy control). Partici- activity levels to healthy controls, yet Measures: GHJ laxity (mm displace- pants completed questionnaires, reported diminished perception of GHJ ment) and endpoint stiffness (N/mm) underwent an orthopedic screen, and stability, particularly in 80% ER, and were measured using a LigMaster stiffness tests. A customized Stiffness HRQOL. These contradictory results (SportsTech, Charlottesville, VA). A Testing Instrument (STI) applied a 20° may suggest compensations in muscle single item measure of perception of ER perturbation movement (ICC = .89 activity to maintain desired physical GHJ stability was administered to .98) while simultaneously measuring activity levels and/or necessary GHJ following each test using a 10-cm visual resistance torque. Main Outcome stability at the expense of HRQOL. analog scale ranging from 0 (no Measures: Using STI data, stiffness Clinicians should treat the whole-person stability) to 10 (completely stable). (Nm/deg) was calculated as change in by monitoring HRQOL in GHJ Patient-based measures, including the displacement / change in torque. A instability patients who may present with Disabilities of Arm, Shoulder and Hand single-item measure of perception of negative objective findings. (DASH, 30-items, score range: 0 to GHJ stability was administered after 100) and Western Ontario Shoulder

Journal of Athletic Training S-27 12164FOMU Instability Index (WOSI, 21-item, The Impact of Knee Injury History subscale scores (Physical Functioning score range: 0 to 2100) were on Health-Related Quality of Life [PF], Role Physical [RP], Bodily Pain completed by subjects. GHJ laxity and in College Athletes [BP], General Health [GH], Vitality endpoint stiffness in the neutral Lam KC, Valovich McLeod TC, [VT], Social Functioning [SOF], Role position were analyzed with separate Snyder Valier AR, Bay RC: A.T. Still Emotional [RE], Mental Health [MH]), 2(direction) x 2(group) ANOVA’s with University, Mesa, AZ with higher scores indicating better repeated measures. GHJ laxity and HRQOL. To account for negatively endpoint stiffness in the anterior Context: Health-related quality of life skewed score distributions, general- direction were analyzed using separate (HRQOL) is a multi-dimensional ized linear models with inverse 2(position) x 2(group) ANOVA’s with concept that represents an individual’s Gaussian distributions were used repeated measures. Patient-based following reflection transformation of overall satisfaction with his/her own Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 measures were analyzed using separate sense of well-being. Patient-rated dependent variables for group Mann-Whitney U tests. Results: GHJ outcome measures (PROMs), such as comparisons. Pairwise comparisons laxity was greater (p=0.02) in HRQOL, capture changes that are (Bonferroni) were used to determine posterior (11.0±2.0 mm) than anterior important and meaningful to patients. differences across groups (p≤.05). (9.9±1.6 mm) directions with While group differences in HRQOL Results: Significant differences were corresponding greater (p=0.02) have been reported (eg, athlete vs. non- reported between all groups for IKDC- endpoint stiffness in anterior (8.6±1.3 athlete), little is known about the impact TS (≤.037, SKI=76.7±2.7, MKI= N/mm) than posterior (7.8±1.4 N/mm) of injury history on HRQOL in college 85.0±2.0, NKI=94.4±0.9). No group directions. There were no significant athletes. Objective: To determine differences (p>.05) were reported for differences between groups, or whether HRQOL, as measured by a the SF-12 subscales: PF (SKI= between anterior positions (p>0.05). knee-specific (International Knee 95.5±10.9, MKI=95.7±13.6, NKI= The GHJ instability group reported Documentation Committee form 98.1±8.2), RP (SKI=89.5±15.4, less stability (6.7±2.4, p<0.001) in [IKDC]) and a generic (Short Form 12 MKI=88.4±18.4, NKI=92.6±15.5), their shoulder during tests compared [SF-12]) PROM, differs in college BP (SKI=81.0±25.5, MKI=82.9±24.6, to healthy control (9.5±0.8). The GHJ athletes based on the severity of a NKI=87.7±25.3),GH (SKI= 82.6± instability group had significantly previous knee injury. Design: Cross- 15.3, MKI=84.4±12.9, NKI= 85.2 higher DASH (p<0.001, 15.8±13.0 vs. sectional. Setting: Athletic training ±17.1),VT (SKI= 66.5±21.2, MKI= 2.3±5.8, respectively) and WOSI facilities. Patients or Other Parti- 70.1±16.7, NKI=69.2±20.8), SOF (p<0.001,654.2±391.9 vs. 101.5± cipants: Intercollegiate athletes, who (SKI=86.5 ±21.6, MKI=83.5 ±25.4, 225.6, respectively) scores, indicating were cleared for full participation, NKI=89.5 ±18.7), RE (SKI= 87.0± more disability and diminished were classified into three groups based 19.4, MKI= 86.6 ±18.8, NKI=92.1 HRQOL compared to healthy controls. on a self-report of a previous knee ±14.9), MH (SKI=72.3 ±20.56, Conclusions: Findings of greater injury: severe knee injury (SKI), MKI=77.1±18.1, NKI=78.1 ±17.7). posterior GHJ laxity and anterior GHJ defined as causing loss of participation Conclusions: Our results suggest endpoint stiffness are consistent with for ≥ 10 days (male=17, female=31, that, despite returning to full previous research, and may be age=19.3±1.7years, height= 174.1± participation, college athletes who explained anatomically. There were no 11.4 cm, mass= 71.3±13.6 kg),mild previously suffered a knee injury tend group differences in objective GHJ knee injury (MKI), defined as causing to report lower knee-specific HRQOL stability measures; however, patient- loss of participation for >1 but <10 than those with no injury history and based measures found the GHJ days (male=20, female=19, age= that the severity of injury may impact instability group perceived greater 19.3±1.5 years, height= 174.0± knee-specific HRQOL. However, it disability, and diminished GHJ 11.3cm, mass= 70.5±14.2 kg), and no does not appear that knee injury history stability and HRQOL than healthy knee injury (NKI) (male=109, impacts generic/global HRQOL. controls. These findings demonstrate female=71, age=19.1±2.5 years, These findings suggest that specific how GHJ instability impacts the height= 175.9±11.3cm, mass= 71.1± PROMs (eg, IKDC) may better whole-person, emphasizing the 11.9 kg). Interventions: Injury group capture HRQOL deficits in athletes importance of using patient-based was the independent variable. who return to play following injury than measures in clinical practice. Participants completed the IKDC and generic PROMs (eg, SF-12). Future SF-12 during one testing session. studies should investigate the role of Both PROMs have published PROMs, particularly specific PROMs, measurement properties. Main as potential screening tools for patient Outcome Measures: Dependent care. variables included the IKDC total score (IKDC-TS) and the 8 SF-12

S-28 Volume 47 • Number 3 (Supplement) May 2012 12162DOMU Variability in Context of Time in used “Within the last 7 days…” context 392 female (age=15.6±1.2 years, Athletic Training-related Patient of time. Data Synthesis: The DASH, height=164.4±8.2cm, mass=60.3±11.1 Reported Outcomes (PROs) WOMAC, SF-36 were the most kg) and 907 male (age=15.6±1.2 years, David SD, Ragan BG: Division of frequently used PROs. The most height =175.8±8.9 cm, mass =75.0±18.4 Athletic Training, Ohio University, commonly used context of time, the kg) healthy adolescent athletes partici- Athens, OH shortest and longest context were pating in interscholastic sports. identified. The most commonly used Individuals who had a history of a prior Context: Patient-reported outcomes Upper Extremity time frame referred concussion were excluded from the (PRO) are essential in establishing back to the time of injury. The shortest study because a positive concussion evidence-based practice. While many timeline for the Upper Extremity history has been previously associated category was the last 24 hours and a with lower global HRQOL. Inter- PROs are available, proper selection Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 and use is important because many are longest time frame was within the last 6 ventions: Gender was the independent designed for specific purposes over months. Lower Extremity PRO most variable. Subjects completed the different lengths of time. For example, common and shortest time frame was PedsQL MFS during one testing when using PRO to measure the the in last 7 days with the last 4 weeks session. The PedsQL MFS (reliability immediate impact of an injury it is the longest. The Quality of Life =.88) is an 18-item symptom-specific important to use a measure that uses the category had no common time frame and instrument that consists of three correct context of time (e.g., last 24 the shortest being daily evaluations subscales: general fatigue (6 items: eg, hours and not over the last 4 weeks). while the longest was within the last “I feel too tired to do things that I like Objective: The purpose of this study month. Conclusions: With large to do.”), sleep fatigue (6 items: eg, “I was to examine the variability of the variability in context of time across rest a lot.”), and cognitive fatigue (6 context of time on common Health- PROs, it requires that the Athletic items: eg, “It is hard for me to keep my related Quality of Life PROs in athletic Trainer choose the appropriate one to attention on things.”). Main Outcome training. Data Sources: PRO studies produce valid outcomes. The lack of a Measures: The general, sleep, and were identified from PubMed searches, time reference on some instruments cognitive fatigue subscale scores were and reviews of Athletic Training poses significant validity issues. the dependent variables. Lower Journals. Search terms included “upper Athletic Trainers should be aware and subscale scores indicated lower extremity self-report” “lower extremity use the best instrument with the most fatigue-specific HRQOL. For sex self-report” and “quality of life.” A total appropriate time frame for their needs. comparisons, generalized linear models of 68 instruments were indentified from with inverse Gaussian distributions the literature. Common instruments 12152MOSP were used following reflection were separated into three categories: Fatigue-Specific Health-Related transformation of dependent variables. Upper Extremity (n=26), Lower Quality of Life: Sex Differences in This form of statistical analysis was Extremity (n=27), and Quality of Life Healthy Adolescent Athletes utilized to account for the negatively (n=15). Study Selection: Content Yanda A, Lam KC, Valovich McLeod skewed distribution of scores. Alpha experts reviewed then identified the TC: A.T. Still University, Mesa, AZ was <.05. Results: Female adolescent commonly used athletic training PROs. athletes demonstrated significantly Upper Extremity PROs included: Context: Fatigue is a common symptom lower scores on the general (p=0.001; Disability of the Arm, Shoulder, and following a sport-related concussion. females =85.71±17.45, males= 89.14± Hand (DASH), Flex-i-level Scale of The Pediatric Quality of Life Inventory 18.51), sleep (p=0.003; females Shoulder Function, Shoulder Pain and Multidimensional Fatigue Scale =74.0±21.19, males= 77.92± 22.89), and Disability Index, Dutch Shoulder (PedsQL MFS) is a patient-rated cognitive fatigue (p=0.001; females= Disability Questionnaire, and the outcome measure that assesses fatigue- 83.71±28.41, males=88.73±31.00) sub- PROMIS Pediatric Upper Extremity specific health-related quality of life scales. Conclusions: To our know- Scale. The Lower Extremity PROs (HRQOL). While the PedsQL MFS has ledge, this is one of the first studies to included: Knee Injury and Osteo- been utilized during the care of chronic describe the use of the PedQL MFS in arthritis Score, Hip Disability and disease patients (eg, cancer, an athletic population. The results of Osteoarthritis Outcome Score, Foot and rheumatoid arthritis), little is known of this study suggest that healthy female Ankle Outcome Score, Foot and Ankle its use in an athletic population. adolescent athletes experience lower Ability Measure, International Knee Objective: To investigate sex fatigue-specific HRQOL than their male Rating Scale, and the WOMAC Knee differences in fatigue-specific HRQOL, counterparts. These findings are in Scale. The Quality of Life PROs were as assessed by the PedsQL MFS, in agreement with previous investigations the PedsQL, SF-12 and SF-36, and healthy adolescent athletes. Design: in which female athletes reported lower Adult Quality of Life. Data Extraction: Cross-sectional. Setting: Athletic global HRQOL than male athletes. While The PRO context of time were identified training facilities. Patients or Other the differ-ences reported in this study and recorded. For example, DASH items Participants: Convenience sample of were statistically significant, it is Journal of Athletic Training S-29 unknown whether these differences are items in each cluster, and higher scores Committee on Standards for Athletic clinically meaningful. Future studies indicate greater symptom severity. Equipment (NOCSAE) should investigate the clinical Lower PedsQL scores suggest lower significance of these sex differences HRQOL.Means and standard devia- 12170FOSP and determine the clinical usefulness tions were calculated. Relationships School Absence, Academic Accommodation and Health- of the PedsQL MFS in adolescent were evaluated with Spearman’s rho (rs) athletes following an injury, particularly correlation coefficient, with correlations Related Quality of Life in sport-related concussions. Funding >.4 considered moderate. Results: The Adolescents with Sport-related provided by a grant from the National physical symptom cluster (.35±.51) was Concussion Operating Committee on Standards for moderately correlated with the PedsQL Parsons JT, Bay RC, Valovich Athletic Equipment (NOCSAE). PF (92.6±9.4; r =-.46), PSF (89.2 ±.10.6; McLeod TC: A.T. Still University, s Mesa, AZ

rs=-.47), and EF (89.3±.14.1; rs=-.45) Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 12150MOSP subscale scores and the TS (90.4±.9.2; The Relationship Between Baseline rs=-.51). The cognitive symptom cluster Context: Recognition of the impact of Concussion Symptom Clusters and (.47±.79) was moderately correlated adolescent sport-related concussion Health-Related Quality of Life in with the PedsQL SCF (84.7±.14.7; rs= (SRC) on academic performance is Adolescent Athletes -.52) and PSF (r =-.54) subscales and increasing. However, little is known Mayfield RM, Snyder AR, Bay s the TS (rs= -.54). The sleep symptom about the academic needs of RC, Valovich McLeod TC: Post- cluster (.49±.72) was moderately adolescent patients, or the impact of Professional Athletic Training correlated with the PedsQL EF (rs= SRC on education or patient health- Program, A.T. Still University, -.54), PSF (r = -.51), PF (r =-.52), and related quality of life (HRQOL). Mesa, AZ s s SCF (rs=-.40) subscales and the TS Objective: To determine the

(rs=-.56). The emotional symptom frequency of school absence and Context: Assessment of symptoms cluster (.38±.70) was moderately academic accommodation, accommo- following sport–related concussion is correlated with the PedsQL EF (rs= dation type, and relationship to both central to managing athlete recovery -.55), PSF (rs=-.51), PF (rs=-.42) clinical and patient-centered outcomes and determining when an athlete is subscales and the TS (rs=-.53). The measures, including HRQOL, ready for a return-to-play progression. total symptom score (.39±.53) was following SRC. Design: Cross- Symptoms are commonly grouped into most highly correlated with the sectional. Setting: Secondary school a total severity score or evaluated as PedsQL TS (rs=-.65), followed by PSF athletic training facilities. Patients or individual symptoms, with few studies (-.60), EF (-.57), PF (-.54), and SCF Other Participants: Interscholastic considering the separate clusters of (-.50). SOF (93.6±10.6) was not athletes participating in contact sports related symptoms and how the presence moderately correlated (rs<.4) with any who suffered a concussion diagnosed of different symptoms clusters may symptom cluster. Conclusions: These by an athletic trainer (n=149; impact athlete health status. Objective: data suggest that, generally, baseline males=130, females=19, age=15.7 To determine the relationship between self-report symptom reports are ±1.1,grade=10.0±1.0). Interven- baseline self-report symptom clusters related to HRQOL, with more self- tions: The Sport-Concussion Assess- and health-related quality of life reported symptoms associated with ment Tool-2 (SCAT2) was admin- (HRQOL) in adolescent athletes. lower HRQOL. Of particular interest istered on the date of injury (DOI), Design: Cross-sectional. Setting: High are the moderate correlations between days 3(D3), and 10(D10). Only the school classrooms and athletic training related symptom clusters and HRQOL SCAT2 symptom scales were facilities. Patients or Other Partici- subscales, such as emotional administered 30 days (D30) post- pants: A convenience sample of 3739 symptoms and emotional HRQOL, and injury. The following measures were adolescent athletes (males=74.8%, physical symptoms and physical also administered D3, D10, and D30: age=15.1±1.2; grade=10.1±1.1) parti- HRQOL, which suggests that the general survey; Pediatric Quality of cipating in interscholastic contact HRQOL instrument captures valid and Life Inventory (PedsQL) including 5 sports. Interventions: All subjects meaningful patient-oriented infor- subscales [physical (PF), psychosocial completed the Sport-Concussion mation. Moreover, these data suggest (PSF), emotional (EF), social (SOF), Assessment Tool-2 (SCAT2) and the that even at baseline, adolescent and school functioning (SFS)]; Pediatric Quality of Life Inventory athletes have meaningful symptom- Multidimensional Fatigue Scale (PedsQL) during a single-session pre- atology that impacts their HRQOL in (MFS) including 3 subscales [general season baseline. Main Outcome Mea- a number of health domains. Impact of (GF), sleep (SLF), and cognitive (CF) sures: Dependent variables include the symptomatology on HRQOL follow- fatigue]; and Headache Impact Test SCAT2 physical, cognitive, sleep, ing concussion warrants evaluation (HIT-6). The general survey captured emotional, and total symptom cluster when considering athlete clearance for school absences, occurrence of (TS). Each symptom cluster represents return-to-play. Funded by a grant academic accommodations and type the average symptom score for the from the National Operating (9-item list of accommodation types S-30 Volume 47 • Number 3 (Supplement) May 2012 12138MOBI based on expert opinion). All other Correlation Between Self-Report scores indicate better dynamic measures have established reliability Ankle Function and Dynamic stability. Results: Mean and standard and validity. Main Outcome Postural Stability in deviation for the CAIT was 25.1 ± 6.5 Measures: Dependent variables Recreationally Active Individuals while each DPSI components’ mean included occurrence of: 1) school Ko JP, Rosen AB, Brown CN: and standard deviations were APSI 0.09 absence and 2) academic accommo- University of Georgia, Athens, GA ± 0.02; MLSI 0.29 ± 0.20; VSI 0.33 ± dation; and 3) type of accommodation 0.06; DPSI 0.48 ± 0.13. There was a received. Data were analyzed with Context: The Cumberland Ankle significant correlation between MLSI descriptive and frequency analyses and Instability Tool (CAIT) has been used and CAIT (r=-0.44, p=0.003) and Mann-Whitney U tests. Results: to assess self-reported ankle function DPSI and CAIT (r = -0.42, p=0.004). School absence and accommodations Neither APSI (r=0.32, p= 0.032) nor in those with chronic ankle instability Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 data were collected for 144 patients: (CAI). The Dynamic Postural Stability VSI (r=0.11, p=0.487) were 27.8% (n=40) missed school, and Indices (DPSI) have been used the significantly correlated with CAIT. 16% (n=23) received academic assess ability to transition to a static Conclusions: These results suggest accommodations because of con- balance state during landing. It is that participants with lower perceived cussion. Accommodation types currently unclear if there is a functional stability in their ankle received: shorter day [n=9(39%)]; relationship between CAIT and DPSI (lower CAIT scores) also tended to other [n=7(30.4%)]; rest breaks score. Objective: To determine the exhibit greater dynamic postural [n=5(21.8%)]; note taker [n=5 relationship between CAIT score and instability, as evidenced by higher ML (21.8%)]; special permissions DPSI components. Design: Correla- and DPSI scores. The strength of the [n=5(21.8%)]; less homework tional. Setting: Biomechanics relationship was only moderate, but [n=3(13%)]; individualized learning Laboratory. Patients or Other was statistically significant. plan [n=2(8.7%)]; shorter classes Participants: Twenty-three partici- Interestingly, the relationship between [n=1(4.3%)]. For those requiring pants (9 Male, 14 female; age=22.4 ± self-report function and AP and V accommodations, Mann-Whitney U 3.7yrs; height=172.1 ± 8.8cm; stability indices were not significant. tests revealed significant differences mass=77.4 ± 14.4kg) participated in As excessive inversion is a primary (P<.05) in: number of school days this study. Participants reported mechanism causing a lateral ankle missed; D3 PF, PSF, and SFS, and variable ankle injury history, ranging sprain, the MLSI component of the PedsQL total score; D30 HIT6 total from no history of sprain to a history DPSI may play a more important role score. For those with school absences, of moderate-severe sprain with or in ability to stabilize from a jump Mann-Whitney U tests revealed without residual complaints of landing. significant difference in: DOI balance, instability. Interventions: In a single feelings of slowness, feeling fatigue, testing session participants completed 12123 Ankle Questionnaires Poorly confusion, drowsiness, sleep the CAIT, then performed the dynamic Correlate with Dynamic Postural problems, irritability, total symptom balance assessment (the DPSI task). Stability in Subjects with severity and endorsements (all p<.05), Participants performed 50% Functional Ankle Instability and DOI SCAT2 total score (p<.01); maximum vertical jumps, landing on a Pederson JJ, Abt JP, Keenan KA, D3 PF (p<.05), PFS (p<.01), SFS force-plate (1200Hz) 70cm in front of Sell TC, Stone DA, Lovalekar MT, (p=.001), PedsQL total score (p<.05), them on a single leg, stabilizing as Lephart SM: Neuromuscular and SLF (p<.05); D10 HIT6 total quickly as possible. Five successful Research Laboratory; Department (p<.05) Conclusions: Within 30 days trials were performed on each leg and of Sports Medicine and Nutrition; of SRC, 28% of patients missed averaged. Order of limb testing was School of Health and Rehabilitation school, and 16% required academic randomized. Pearson bivariate Sciences, University of Pittsburgh, accommodations. A shorter school correlations were calculated between Pittsburgh, PA day is the most frequently employed the CAIT and each DPSI components accommodation. Missing school or (anterior-posterior AP, medial–lateral receiving accommodation is ML, vertical V, and composite DPSI). Context: Subjects with functional associated with significant differences A Bonferroni correction was applied, ankle instability (FAI) exhibit impaired in a variety of clinically oriented and with significance set a priori at dynamic postural stability (DPS). HRQOL measures across the 30-day p<0.0125. Main Outcome Questionnaires have been developed to period. Results suggest that certain Measures: CAIT scores for each limb determine the presence of FAI; measures may be predictive of later and AP, ML, V and DPSI scores for however, the relationship between academic disruptions. Future each limb were correlated. Higher questionnaires and specific functional prospective studies in this area are CAIT scores indicate better self- deficits FAI subjects possess, DPS, is required. reported function, and lower DPSI largely unknown. Objective: To

Journal of Athletic Training S-31 determine if DPS deficits exist in FAI 0.0, p<0.001), AJFAT(FAI =17.7±4.2, minutes of exercise, 3 times per week. subjects and to identify the Control=26.2±0.4, p<0.001), and They reported variable ankle injury relationship between questionnaires CAIT (FAI=23.0 ±3.8,Control histories including no history of ankle and DPS in recreationally active male =29.6±0.8, p<0.001). Significant sprain, or history of moderate-severe subjects with FAI. Design: Cross- differences were noted for the ankle sprain with or without residual sectional study. Setting: Research VSI(FAI=0.37±0.03, Control= 0.33± instability. Interventions: Parti- laboratory. Participants: Data were 0.04, p=0.003) and DPSI (FAI= 0.40± cipants answered demographic collected on 12 subjects with FAI 0.03, Control=0.35±0.04, p=0.004) questions regarding activity level and (age=21.2±1.4 years, height= 182.2± during the anterior jump. Similar ankle injury history. They completed 5.7 cm, mass=84.9±7.8 kg) and 12 results were seen for the VSI the Cumberland Ankle Instability Tool control subjects (age=22.2± 1.1 years, (FAI=0.35±0.03, Control=0.31±0.06, (CAIT) for the right and left limbs, and height=178.6±6.5cm, mass =77.9±8.7

p=0.029) and DPSI (FAI=0.37±0.03, the Foot and Ankle Disability Index and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 kg). Inclusion criteria for the FAI Control= 0.33±0.05, p=0.025) during Sport Subscale (FADI, FADI-S) for the group were a history of at least 2 the lateral jump. Significant involved limb or matched limb. lateral ankle sprains and episodes of correlations were observed between Participants stood 70cm from an in- the ankle feeling unstable in the the MLSI and the AJFAT (r=0.61, ground force plate and performed an previous year. Inclusion criteria for p=0.035) and CAIT (r=0.73, p=0.006) anterior vertical jump to 50% of their controls were no previous ankle during the lateral jump. Conclusions: measured maximum. Participants sprains or feelings of instability. Subjects with FAI demonstrate landed on a single leg and balanced for Interventions: The questionnaires impaired DPS compared to controls. 3 seconds. Five successful trials were consisted of the Foot and Ankle Moderate to good correlations were collected on each limb in a Disability Index-Sport (FADI-S), observed between the AJFAT and CAIT randomized order. The force plate Ankle Instability Instrument (AII), and the MLSI during the lateral jump. (1200Hz) collected ground reaction Ankle Joint Functional Assessment The questionnaires were able to detect forces. Lateral ankle ligament laxity to Tool (AJFAT), and the Cumberland differences between groups but overall inversion was measured using an Ankle Instability Tool (CAIT). Singe- poorly correlated with DPS instrumented arthrometer on both leg jump landings in the anterior and suggesting the questionnaires may be ankles. Bivariate Pearson correlations lateral directions were utilized to inadequate at detecting specific were conducted with a Bonferonni assess DPS. Subjects were positioned functional deficits in FAI subjects. correction of α= 0.0125. Main 40% and 33% of their height from the Outcome Measures: Scores were edge of a force plate and a 30cm and 12067FOBI calculated for CAIT, FADI, and FADI- 15cm hurdle placed at the midpoint, Ankle Laxity is Correlated to Self- S question-naires. DPSI composite respectively. Subjects were instructed Report Function and Dynamic score was calculated and averaged for to land in the middle of the force plate, Postural Stability Index each leg. Ankle inversion displacement stabilize as quickly as possible, and Brown CN, Rosen AB, Ko JP: was recorded from the instrumented remain motionless for 5 seconds. University of Georgia, Athens, GA arthrometer and averaged over 2 trials Three trials were collected in each for each leg. The relationships between direction. Independent t-tests were Context: Chronic ankle instability displacement value and DPSI used to assess group differences in (CAI) is a common outcome following composite score, and displacement DPS and questionnaire scores. lateral ankle sprain. The role of value and questionnaire score were Pearson’s correlation coefficients pathologic ligamentous laxity in CAI assessed via bivariate Pearson were calculated to determine the is unclear, and may mitigate self-report correlation coeffi-cients. Results: relationship between questionnaires function and ability to stabilize during Means and standard deviations for the and DPS. Statistical significance was jump landing. Objective: To determine questionnaire scores were CAIT set at p<0.05 a priori. Main Outcome if there is a relationship between 25.0±6.4; FADI 96.3±9.1; FADI-S Measures: Each questionnaire was ligamentous laxity and self-report 91.9±11.3 while displacement was scored according to its instructions. ankle function questionnaires and 34.0±7.0mm and DPSI 0.48±0.13. Stability indices in the three principal dynamic postural stability index DPSI is a unitless value. Displacement directions (anterior-posterior [APSI], (DPSI) composite score in was significantly negatively correlated medial-lateral [MLSI], and vertical recreational athletes. Design: with the CAIT, FADI, and FADI-S (r= [VSI]) and the Dynamic Postural Correlational. Setting: Biomechanics -0.40 p=0.008; r=-0.43, p=0.003; r= Stability Index (DPSI) were calculated Laboratory. Patients or Other -0.41, p=0.006, respectively). Dis- to quantify DPS. Results: Significant Partici-pants: Twenty-three volun- placement was significantly positively differences existed between groups teer recreational athletes (14 males, correlated with DPSI (r=0.38, for the FADI-S (FAI=87.0±14.1, 9 females, age 22.3±3.7 years, height p=0.010). Conclusions: As ankle Control=94.2±3.2,p=0.015),AII 172.1±8.8cm, mass 77.4± 14.4kg). laxity increased, self-reported ankle (FAI=4.3±1.6,Control=0.0± Participants reported at least 30 function decreased. Additionally, as S-32 Volume 47 • Number 3 (Supplement) May 2012 12103DOMU laxity increased, so did DPSI score, function analysis was conducted to The Relationships Between Three indicating worse performance on identify a discrimination score. A subset Commonly Used Ankle Instability stabilizing as evidenced by larger of the participants (n=110) completed Questionnaires values. While the correlations were the IdFAI on two occasions (two weeks Rosen AB, Ko JP, Brown CN: only moderate, it appears increased apart) and the Lower Extremity University of Georgia, Athens, GA laxity may contribute to difficulty Functional Screen(LEFS) on one stabilizing during single leg landing occasion. The LEFS is a widely-used Context: Chronic ankle instability and reported difficulties in sporting questionnaire that measures overall (CAI) is a common condition and daily living activities. lower extremity function. IdFAI test- following lateral ankle sprain. There retest reliability was evaluated by is currently disagreement on how to 12113DOIN intraclass correlation coefficient best classify and rate degree of ankle Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Development of the Identification of (ICC ).Concurrent validity was instability. The Cumberland Ankle Functional Ankle Instability (IdFAI) 2,1 evaluated by comparing the IdFAI with Instability Tool (CAIT), Foot and Ankle Simon J, Donahue M, Docherty CL: the LEFS using a Spearman ρ. Main Disability Index (FADI) and the FADI Indiana University, Bloomington, IN Outcome Measures: The dependent Sport (FADI-S) are commonly used variables were the total scores on the tools to differentiate between those Context:Self-reported questionnaires IdFAI and the LEFS. Results: The with and without CAI. Objective: To are a common method used in factor analysis revealed 3 factors. determine the relationships between identifying individuals with ankle Factor 1(4 questions) explained 53.7% three frequently used ankle instability instability. Recently, a study illustrated of the variance, factor 2(4 questions) measures. Design: Correlational. the singular use of any of the most explained an additional 17.4%, factor Setting: Biomechanics Research frequently utilized questionnaires 3(2 questions) explained an additional Laboratory. Patients or Other Parti- failed to significantly predict ankle 6.3%, and the total instrument cipants: Twenty-four recreationally stability status. Objective: Present accounted for 78.1% of the variance. active participants (15 females, 9 males, information related to the develop- There was a distinct discrimination mean age ± standard deviation 22.3±3.8 ment, reliability and validity of a new score of 10.3 to identify people who years, height 173.33±8.67 cm, mass questionnaire, the Identification of have the minimally accepted criteria for 77.15±14.17 kg). Participants reported Functional Ankle Instability(IdFAI). FAI. Test-retest reliability ICC ranged either no history of ankle sprains, a Design: Cross Sectional Study 2,1 from 0.69 (SEM=1.09) to 0.95 previous moderate-severe sprain from Setting: Classroom setting Patients (SEM=0.42) for the items. Reliability which they had no residual symptoms or Other Participants: A total of 278 was 0.81(SEM=2.21) for factor 1, of instability, or a history of moderate- participants were recruited from the 0.94 (SEM=1.06) for factor 2, 0.83 (SEM severe sprain which resulted in residual university population. Individuals with =1.01) for factor 3, and 0.92 (SEM=2.76) symptoms of instability. Interventions: a history of a lower limb fracture were for the overall quest-ionnaire. Results Participants completed the CAIT, FADI excluded from the study. All 278 of validity testing identified and FADI-S in a single test session. individuals (125 males, 153 females, statistically significant correlation Data were assessed to make sure it met 19.75±1.43 years) participated in the between the IdFAI and LEFS (p=-0.38, all statistical assumptions. Upon development portion of this study and p<.01). Conclusions: The IdFAI is a review it was deemed necessary to use a subset of 110 individuals (54 males, simple, moderately valid, and reliable non-parametric, correlational tests to 56 females, 19.80±1.40 years) questionnaire that can be used to determine significant correlations participated in the reliability and categorize an individual’s FAI status. between the three tests (α<.01) based validity portion. Interventions: All The IdFAI was specifically designed to on violating the assumption of 278 participants completed the initial detect individuals with FAI in both a normality. Main Outcome Measures: IdFAI on one occasion. The initial clinical and a research setting and can CAIT scores were calculated out of a IdFAI was created from the Ankle be used to help ensure that subjects possible 30 points for the right and the Instability Instrument and Cumberland meet a minimum set of criteria for FAI. left legs. The FADI was calculated as a Ankle Instability Tool and consisted of percentage of a possible 104 points, 28 questions. These questions focused while the FADI-S as a percentage out on the history of ankle sprains, of a possible 32 points. Higher scores presence and severity of ankle indicated improved ankle joint instability, and functional per- function. The involved limb or test limb formance. Item reduction was from the FADI and FADI-S was completed using an exploratory factor matched to its respective side for the analysis with principal axis factoring as CAIT, therefore only 1 limb was the extraction method with varimax assessed for each participant. Non- rotation. Additionally, a discriminant parametric Kendall’s tau correlational Journal of Athletic Training S-33 tests were used to assess data based ROM is related to disability in patients predicted self-reported ankle disability on a small sample size with a number with acute lateral ankle sprains. within the first 36 hours post-injury of tied ranks. Results: Two subjects’ Objective: Determine the relationship (r=0.68, R2=0.47, P=0.02). Con- data were excluded due to being between ankle dorsiflexion and self- clusion: Following acute ankle injury, statistical outliers. The average CAIT reported disability in patients with an dorsiflexion ROM appears to be a score was 25.27±4.88. For the FADI acute lateral ankle sprain within the good indicator of self-reported and FADI-S the average percentages first 36 hours following injury. disability related to activities of daily were 98.59±2.46 and 93.27±8.66, Design: Descriptive. Setting: living. Our data suggests that respect-ively. There were statistically Clinical Laboratory. Patients or decreased dorsiflexion is related with sign-ificant relationships among the Other Participants: Eleven patients poor self-reported disability in the three scores, CAIT and FADI with acute lateral ankle sprain initial 36 hours post lateral ankle (tau=.533, p=.001), CAIT and FADI-S

volunteered for this study (8 Females, sprain. Dorsiflexion ROM predicted Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (tau=.563, p<.001) and FADI and 3 Males, 21.2±1.3yrs, 173± 11.7cm, 47% of the variance on the FADI FADI-S (tau=.721, p<.001). 75±18kg, grade I sprains=4, grade 2 questionnaire. Clinicians may consider Conclusions: The CAIT correlated sprains=7). All patients were focusing on early efforts to increase moderately with the FADI, and slightly individuals from the University dorsiflexion ROM in effort to higher with the FADI-S, while the FADI community. Interventions: Patients improve perceived disability following and FADI-S were strongly correlated. reported to a Certified Athletic Trainer acute ankle sprains. While the CAIT addresses similar and consented to participate within the aspects of self-report ankle function first 36 hours of injury. The same 240 in daily and some sporting activities Certified Athletic Trainer evaluated Physical Activity and Functional to the other questionnaires, the each patient with a standardized form Knee Outcomes in Active Young moderate corre-lation indicates the and graded each ankle sprain. The Foot Females with Anterior Knee Pain two tests may be capturing different and Ankle Disability Index (FADI) Winterstein AP, McGuine TA, components or constructs of questionnaire was administered to Carr KE, Hetzel SJ: University of perceived ankle function. The FADI quantify self-reported disability. Wisconsin-Madison, Madison, WI and FADI-S also seem to address Scores were reported as a percentage slightly varying constructs as their of full function (100%), with lower Context: The ability to maintain correlation coefficient, while strong, scores indicating decreased perceived desired physical activity (PA) levels was not exceptionally high. Therefore, function or increased ankle disability. and knee function are essential for it may be important to utilize multiple Active ankle dorsiflexion was long-term health and fitness. While questionnaires to capture a more measured in long-sitting position with there has been significant attention on complete picture of self-reported the injured ankle extending off of the surgical outcomes and return to sport ankle function. edge of a padded plinth. Patients were in anterior cruciate ligament injury instructed to dorsiflex the injured among young females, there is little 12116MOIN ankle as far as they could comfortably information on the outcomes Ankle Dorsiflexion Predicts Self- reach. The end range was quantified in associated with chronic knee injury. Reported Disability in Patients degrees using a goniometer, with The use of self-report instruments to with Acute Ankle Sprains greater values indicating increased measure the impact of structural and Hafner R, McLeod MM, Gribble dorsiflexion ROM. The mean of 3 functional impairments associated PA, Pietrosimone BG: University trials was recorded. The same with sports injuries on knee function of Toledo, Toledo, OH investigator performed all measures. and physical activity of high school and Main Outcomes: Our outcome collegiate athletes is limited. The Context: Lateral ankle sprain is the measures included percentage scores 2000 International Knee Docu- most common lower extremity injury from the FADI (69.72±17.70%), and mentation Committee (IKDC) in sport. Acute lateral ankle sprains are ankle dorsiflexion ROM measured in Functional Knee Scale is widely used associated with increased pain, degrees (9.35º±2.02º) at 36 hours to assess knee function and the disability, and increased risk of post-injury. A Pearson Product International Physical Activity developing chronic ankle instability. Moment correlation was performed Questionnaire (IPAQ - short form) is The presence of decreased ankle and squared to determine the a valid measure of self-reported dorsiflexion range of motion (ROM) relationship between FADI and ankle physical activity. Gathering objective has been demonstrated in patients with dorsiflexion and to evaluate the measures on knee function and chronic ankle injury and has been variance in dorsiflexion that accounts physical activity in active young hypothesized to contribute to long- for variance in the FADI in patients females can aid in assessing the impact term functional impairments and with acute ankle sprains. Alpha levels of chronic injury on these two disability. Unfortunately, little is were set a priori at P≤0.05 Results: components of long-term health. known about how ankle dorsiflexion Ankle dorsiflexion significantly Objective: Describe one year S-34 Volume 47 • Number 3 (Supplement) May 2012 changes in physical activity levels and knee function in a cohort of young females with anterior knee pain. Design: Prospective cohort. Settings: Data were collected at a sports medicine clinic and university health service. Participants: A convenience sample of 65 high school and college females (age = 17.8 ±1.6 years) who were diagnosed by a physician with anterior knee pain

(AKP) that was a result of participation Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 in sport or regular fitness activities. Interventions: Knee function was assessed with the 2000 IKDC knee survey (IKDC). Self-reported PA levels were measured using the International Physical Activity Questionnaire (IPAQ – short form). Knee function and self- reported PA levels were assessed pre- injury, at diagnosis, and 12 months postinjury. Main Outcome Measures: Outcome variables in- cluded the paired differences in the IKDC and PA scores (MET-min/week) from pre-injury to 12 months post- injury. Paired differences were assessed with paired T-Tests (p< 0.05) reported as the mean + SD. Results: IKDC scores at 12 months (-8.8 + 17.0) were significantly lower than preinjury scores (p < 0.001). IPAQ PA scores (MET-min/week) at 12 months were significantly lower than pre- injury levels for vigorous (-1682, + 3194; p<0.001) and total (-1862, + 4731; p<0.006) activity. Con- clusions: Active females with anterior knee pain demonstrated lower knee function scores and had lower levels of vigorous and total physical activity one year after onset of injury. Sports medicine providers need to be aware that anterior knee pain can impact knee function and desired activity levels for up to one year following onset. Measuring knee function and physical activity may provide clinicians and researchers with a more authentic outcomes assessment.

Journal of Athletic Training S-35 Free Communications, Oral Presentations: Neurophysiology Friday, June 29, 2012, 10:15AM - 11:30AM, Room 275; Moderator: Buz Swanik, PhD, ATC 12133DOBI 12120DONE Changes in Quadriceps in the vastus medialis, elicited using Relationship Between Corticospinal Corticospinal Excitability Transcranial Magnetic Stimulation Excitability and Muscle Activation of Correlate with Changes in Knee (TMS) and collected with surface the Quadriceps following an Flexion Angle during Stair Descent electromyography. Prior to collecting Experimental Knee Joint Effusion Following an Experimental Knee peak-to-peak MEPs, participants Lepley AS, Murray AM, Bahhur Joint Effusion performed knee extension at 5% of their NO, Gribble PA, Pietrosimone BG: Murray AM, Lepley AS, Bahhur maximal capabilities while an active University of Toledo, Toledo, OH NO, Armstrong CW, Gribble PA, corticospinal motor threshold was Pietrosimone BG: University of determined as the lowest TMS intensity Context: Altered quadriceps cortico- Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Toledo, Toledo, OH that elicited a measurable vastus medialis spinal excitability and voluntary (>100μV) MEP in five out of ten quadriceps activation is associated with Context: Knee joint injury often consecutive trials. Five MEPs were various knee pathologies. It is results in neuromuscular quadriceps evoked at 130% of threshold, and peak- hypothesized that upstream neural dys-function, resulting in altered lower to-peak values were averaged and changes in corticospinal excitability extremity gait patterns and kinematics. normalized to maximal Muscle may influence gross downstream Growing evidence suggests that Responses, which were elicited by neuromuscular changes in voluntary quadriceps corticospinal excitability is electrically stimulating the femoral activation. Unfortunately, due to the influenced following knee injury, nerve. Knee flexion angle was retrospective nature of the current possibly leading to quadriceps measured through 3-dimensional available research, the relationship dysfunction and gross motor deficits. motion analysis and was extracted at IC between upstream and downstream However, the relationship between using the Visual-3D processing system. changes in neuromuscular function corticospinal changes in neuromuscular IC was defined as the first 25% of stance immediately following acute injury is function and changes in joint phase, which was initiated once ground unknown. Artificially effusing the knee kinematics following acute injury reaction forces exceeded 10Nm. Percent joint with sterile saline can provide a remains unknown. Objective: Invest- change values following effusion were model to simulate acute knee injury, igate the relationship between changes calculated for MEP and knee flexion allowing for investigation of these in quadriceps corticospinal excitably angles [(post-pre)/pre)*100]. A non- relationships. Objective: Investigate and changes in knee joint flexion angle parametric Spearman rank correlation the relationship between changes in at initial contact (IC) during a stair was performed to assess the quadriceps corticospinal excitably and descent following an experimental knee relationship between change scores of changes in voluntary quadriceps joint effusion used to simulate acute corticospinal quadriceps excitability activation following an experimental joint injury. Design: Descriptive and knee flexion angle. Alpha level was knee joint effusion. Design: Descrip- labo-ratory study. Setting: Research set a priori at P<0.05.Results: A tive laboratory study. Setting: Research labo-ratory. Patients or Other Parti- significant, negative and strong laboratory. Patients or Other Partic- cipants: Eight healthy parti-ipants (5M/ correlation was found between change ipants: Eight healthy participants (5M/ 3F; 20.9±1.7yrs; 172.4 ±7.1cm; 68.8 scores of MEPs and knee flexion angle 3F; 21.3±2.05yrs; 172.4±7.1cm; ρ ±8.2kg) volunteered. Interventions: ( =-0.714,P=0.047). Conclusions: There 69.9±9.38kg) volunteered. Inter- Corticospinal excita-bility of the vastus was a strong and negative correlation ventions: Vastus medialis corticospinal medialis was tested in the left limb. between change in corticospinal excitability and voluntary activation Participants were outfitted with 26 excitability and knee flexion angle. This were tested in the left limb in a random retroreflective markers and performed suggests that individuals may up- order. Following baseline testing, three trials of stair descent on a custom regulate cortico-spinal excitability in order participants were positioned supine built staircase at a self-selected pace. to maintain similar knee flexion angles with their left knee slightly flexed in Following baseline testing, 60mL of during daily activities, such as stair preparation for knee effusion. An area sterile saline was injected into the knee descent, following acute knee injury. supralateral to the patella was cleaned joint capsule of each participant through Interventions targeting corticospinal and 3mL of 1% Xylocaine was an area supralateral to the patella. Ten excitability following knee injury may be subcutaneously injected for local minutes following effusion participants beneficial in maintaining pre-injury knee anesthetic purposes. Via a supralateral performed posttest measurements. joint kinematics. Supported by funding approach, 60mL of sterile saline was Main Outcome Measures: Quadri- through the Great Lakes Athletic injected into the knee joint capsule. ceps corticospinal excitability was Trainers’ Association. Following effusion, participants rested evaluated using the amplitude of peak- quietly for 10 minutes prior to post- to-peak motor evoked potentials (MEP) testing. Percent change scores were S-36 Volume 47 • Number 3 (Supplement) May 2012 12F26DONE calculated from pre and post Ankle Cryotherapy Does Not Affect ratios between each pair of positions: measurements for both corticospinal Hoffmann Reflex Modulation of the prone-to-bipedal (P-Bi), bipedal-to- excitability and muscle activation. A Soleus and Peroneus Longus in unipedal (Bi-Uni), and prone-to- nonparametric Spearman rank corre- Patients with Chronic Ankle unipedal (P-Uni). Separate three-way lation was performed to assess the Instability (Group x Intervention x Time) relationship between change scores of Kim KM, Hart JM, Saliba SA, ANOVAs with repeated measures and corticospinal quadriceps excitability Ingersoll CD, Hertel J: University Fisher’s LSD were performed for and voluntary quadriceps activation. of Virginia, Charlottesville, VA; statistical analysis. Results: The CAI Alpha level was set a priori at P<0.05. Central Michigan University, group was responsive to both Main Outcome Measures: Quadr- Mount Pleasant, MI interventions in Bi-Uni and P-Uni iceps corticospinal excitability was modulation, but there were no Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 evaluated with motor evoked potentials Context: Altered Hoffmann (H) reflex differences between cryotherapy and (MEP) derived using Transcranial modulation during changes in body sham treatments. The ankle cryotherapy Magnetic Stimulation (TMS) while positions was recently found in patients did not affect the soleus modulation in participants performed knee extension with chronic ankle instability (CAI).. any of the 3 positional changes. at 5% of their maximal capabilities. Ankle cryotherapy has been found to Specifically, for the soleus P-Bi Initially, a threshold was determined by influence H-reflex amplitudes in the modulation, there was a significant finding the lowest TMS intensity that ankle muscles, yet its effects on H- group main effect (P=.001). The CAI elicited a measurable (>100μV) MEP reflex modulation are unknown. group (12.6±6.4%) modulated less than response in five out of ten consecutive Objective: To assess the effects of a the healthy group (37.3±5.9%). For the trials. For analysis, five MEPs were 20-min ankle cryotherapy on H-reflex soleus Bi-Uni modulation, there was a evoked at 110% of threshold. MEP modulation of the peroneus longus and significant group by time interaction peak-to-peak values were averaged and soleus in three body positions (prone, (P=.049). The CAI pre-intervention normalized to maximal Muscle bipedal, and unipedal stances) in modulation (-12.9±5.5%) was signi- Responses, which were elicited by individuals with and without CAI. ficantly less than the CAI post- electrically stimulating the femoral Design: Descriptive laboratory study. intervention (1.8±9.2%), healthy pre- nerve. Quadriceps activation was Setting: Laboratory. Patients or intervention (2.3±5.1%), and healthy determined by using the central Other Participants: Fifteen subjects post-intervention (-2.1±8.5%) modu- activation ratio (CAR) obtained with CAI (9 males, 6 females; age= lation. Similarly, a significant inter- through the burst superimposition 23±5.8 years; height=174.7±8.1cm; action was found in the soleus P-Uni technique. Percent change scores were mass= 74.9±12.8kg) and 15 controls modulation (P=.005). The CAI pre- calculated for MEP and CAR values without any history of ankle sprains (9 intervention modulation (12.4±5.7%) [(post-pre)/pre)*100]. Results: A males, 6 females; age=24±5.8 years; was significantly less than the CAI post- significant, negative strong relationship height =171.9±9.9 cm; mass=68.9±15.5 intervention (29.2±6.8%), healthy pre- was found between change scores of kg) participated. Interventions: Inde- intervention (41.6±5.0%), and healthy MEPs and CAR (p=-0.762,P=0.028). pendent variables were group (CAI, post-intervention (39.5±6.1%) modu- Conclusions: There was a strong control), intervention (ankle cryo- lation. For peroneus longus, there were negative correlation between changes therapy, sham), and time (before and no significant interactions or main in quadriceps corticospinal excitability after the treatment). Subjects in both effects (P>.05) for any of the three and muscle activation. These results groups underwent two intervention positional modulations. Conclusions: suggest that in order to maintain sessions on different days in which they A 20-min ankle cryotherapy was not voluntary quadriceps activation had a 1.5L plastic bag filled with either found to influence H-reflex modulation following acute knee injury, individuals crushed ice (active treatment) or candy of the peroneus longus and soleus in any may need to make large compensations corn (sham intervention) applied to the of the three postural transitions in in corticospinal excitability. Therefore, individuals with and without CAI. ankle. Maximum H-reflexes (Hmax) and interventions targeting corticospinal motor waves (Mmax) from the soleus and excitability may be beneficial in peroneus longus were recorded while restoring voluntary quadriceps subjects lied prone and then stood in activation. Supported by funding quiet bipedal and unipedal stances through a grant from the Great Lakes before and after each treatment. Main Athletic Trainers’ Association. Outcome Measures: Hmax was

normalized to Mmax to obtain Hmax:Mmax ratios for the three positions. Dependent variables, for each muscle, were the

percent change scores in Hmax:Mmax

Journal of Athletic Training S-37 12132DONE 12175FONE Evidence of an Integrated Lower each muscle at the lowest TMS intensity Optimal Stimulation Parameters Extremity Motor Excitability that elicited a measurable MEP to Detect Deficits in Quadriceps Relationship to Ankle Laxity in (>100mV) in 5 out 10 consecutive Activation Patients with Chronic Ankle trials. Reflexive excitability was Grindstaff TL, Threlkeld AJ: Creighton Instability evaluated bilaterally using a brief University, Omaha, NE McLeod MM, Gribble PA, exogenous electrical stimulus over the Pietrosimone BG: University of tibial or femoral nerve to evoke a Context: The burst superimposition Toledo, Toledo, OH Hoffmann reflex in the FL or VM, technique is used to estimate respectively. An electrical stimulus was quadriceps activation, but is often Context: Gross neuromuscular used to evoke a maximal muscle associated with discomfort due to response (M-Response) in both the FL alterations have been demonstrated in electrical stimulus intensity. It is Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 ankle stabilizing muscles and and VM for normalization. Main unknown if stimulation parameters can proximal muscle groups of patients Outcome Measures: Corticospinal be manipulated to minimize discomfort with chronic ankle instability (CAI). excitability was evaluated as the average while obtaining valid estimates of It is hypothesized that these of five peak-to-peak MEPs at 120% of quadriceps activation. Objective: To neuromuscular alterations may be AMT normalized to a M-response determine optimal stimulation attributed to a need to compensate for (MEP:M) in all muscles. Maximal parameters to detect deficits in increased laxity at the ankle. Recent Hoffmann reflexes were normalized to quadriceps activation and quantify evidence suggests that these gross M-Responses (H:M) for all muscles. discomfort associated with simulation neuromuscular deficits may be Separate Pearson Product Moment parameters. Design: Descriptive modulated by both reflexive and correlations were used to determine laboratory study. Setting: University corticospinal pathways. It is critical the relationship between involved ankle research laboratory. Patients or Other to understand the relationship IE laxity and bilateral reflexive and Participants: Twelve healthy adults between ankle laxity and motor corticospinal excitability in the FL and (mean±SD, age=36.8±15.6 years, excitability in patients with CAI for VM. Alpha level was set a priori at mass=76.1±12.9 kg, height=170.2±8.6 the purpose of directing specific P≤0.05. Results: A significant and cm). Interventions: Participants were interventions. Objective: Determine strong, positive correlation was found seated on an isokinetic dynamometer. the relationship between ankle for involved IE laxity and involved A constant current stimulator and two inversion/eversion (IE) laxity and reflexive FL excitability (r=0.75, self-adhesive electrodes (8x14 cm) corticospinal and reflexive excita- P=0.003). Additionally, a significant delivered percutaneous electrical bility of the fibularis longus (FL) and moderate positive correlation was stimuli to the quadriceps. Resting twitch vastus medialis (VM) in patients with found between involved IE laxity and torque (RT) was determined by severe CAI. Design: Descriptive. uninvolved VM cortical excitability increasing stimulus intensity in 100 mA Setting: Research laboratory. (r=0.66, P=0.014). No further increments until RT plateaued. Repeated Patients or Other Participants: A significant correlations were detected. maximal volitional isometric contrac- cohort of 14 patients with severe Conclusions: As IE laxity of the tions (MVIC) were performed while unilateral CAI [Functional Ankle involved ankle increases, reflexive imposing four stimulation combi- Disability Index-Sport (FADISporτ) excitability of the involved FL and nations: train of higher voltage stimuli ≤66 out of 100%] volunteered in this corticospinal excitability of the (10 pulses; 400V) with variable current study (7F/7M, 20.6±1.7yrs, 171.8± contralateral MV also increase. This (based on RT); train of lower voltage 12.1cm, 66.9± 11.0kg, FADISport: may be indicative of a global stimuli (10 pulses; 200V) with variable 52±10.51%). Interventions: In- neuromuscular protective mechanism current (based on RT); train of lower volved-side IE ankle laxity was to cope with increased laxity and voltage stimuli (10 pulses 200V) at set quantified in degrees with an prevent future inversion ankle sprains. current (650 mA); a doublet of lower instrumented arthrometer, with larger Supported by funding through the voltage stimuli (2 pulses, 200V) with set measures indicating increased laxity. University of Toledo Interdisciplinary current (650 mA). Eight stimuli (2 of each Corticospinal excitability of the FL Grant. combination) were randomly applied and VM was measured in a seated with 2 minutes rest between each MVIC. position using transcranial magnetic Main Outcome Measures: Quadriceps stimulation (TMS) to elicit motor activation was quantified using two evoked potentials (MEP) stimulated equations, central activation ratio at the motor cortex and visualized via (CAR=MVIC/MVIC+electrical) and electromyography at the target percent activation (%Act=[MVIC- muscle. Active motor threshold MVIC+electrical]/RT). Discomfort was (AMT) was determined bilaterally for quantified using the visual analog scale

S-38 Volume 47 • Number 3 (Supplement) May 2012 (VAS). Pearson product moment correlations were used to determine the relationship between stimulation parameters and quadriceps activation equations. Differences in discomfort during RT and MVIC parameters were determined using separate one-way ANOVAs. Results: Means and standard deviations for quadriceps activation and VAS relative to each stimulation parameter were; higher voltage 10-

pulse variable current (CAR=.80±.15; Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 %Act=.69±.23; VAS RT=6.3±2.0; VAS MVIC=4.6±2.2), lower voltage 10- pulse variable current (CAR=.79±.18; %Act=.69±.24; VAS RT=6.1±1.6; VAS MVIC=4.7±2.5), lower voltage 10- pulse set current (CAR=.81±.16; %Act=.71±.24; VAS RT=6.7±2.2; VAS MVIC=5.3±2.4), and lower voltage doublet set current (CAR=.91±.12; %Act=.80±.24; VAS RT=2.9±1.7; VAS MVIC=2.2±1.6). Correlations for all measures were strong (r=.85 to .99, P< .001). There was a significant diffe- rence in VAS RT (F3,33=25.1, P< .001) and VAS MVIC (F3,33=20.0, P< .001). The lower voltage set current (650 mA) using a doublet produced less discomfort during the RT (P< .001) and MVIC (P< .001) when compared to all other combinations using a train of stimuli (10 pulses). There were no significant differences (P> .05) in discomfort among the other parameters. Conclusions: There was a strong correlation between all combinations and equations utilized to estimate quadriceps activation. Adjusting the number of pulses (2 versus 10) reduced discomfort by more than 50%, while eliciting %Act values that correlated well (r>.90) with activation levels obtained with more pulses.

Journal of Athletic Training S-39 Free Communications, Thematic Poster: Functional Testing and Movement Screening Friday, June 29, 2012, 11:45AM-1:15PM, Room 275; Moderator: David Bell, PhD, ATC, CSCS 12157FOIN 12347MOMU Influence of Static Lower Extremity Main Outcome Measures: Hip and Relationship Between Functional Alignment on Joint Kinematics knee peak joint angles were extracted Assessments in Patients with Knee During the Overhead Squat Test in during the descent phase (start to Pathologies Adolescent Athletes maximum knee flexion) of each Radtke AR, Howard JS, Morris LM, Nguyen A, Boling MC, Varone AN, overhead squat trial. LEA values were Mattacola CG: University of Buckley BD, Keene KL, DiStefano averaged over three measurements and Kentucky, Lexington, KY

LJ: College of Charleston, peak joint angles were averaged over Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Charleston, SC; University of North the five overhead squat trials. Separate Context: Patient performance on Florida, Jacksonville, FL; University step-wise linear regressions deter- functional tests is often used to monitor of Connecticut, Storrs, CT mined the extent to which static LEA progress throughout the recovery predicted hip and knee joint angles for process and release patients from Context: Efficient functional males and females. Results: In males, rehabilitation. In order for a test to screening tools are commonly used greater TFA (12.5±4.8°) predicted less effectively monitor patient progress during prospective risk factor studies hip flexion (-92.5 ±21.7°, R2=0.097, over time, it must be able to detect to help identify and understand those P= 0.037) but greater knee flexion differences in performance between factors that increase the risk of knee (96.6±11.9°, R2=0.100, P= 0.034) varying levels of pathology. Objective: injuries. Understanding factors that during the overhead squat. Greater QA To determine whether patients with may contribute to dynamic mal- in males predicted less hip internal varying levels of function will perform alignments during functional tasks will rotation (-1.8±9.8°, R2=0.135, P= differently on the unilateral stance, step help us better identify those at greatest 0.013) but greater knee valgus (-10.3 up/over, forward lunge, four square step risk of injury, particularly in the ±3.7°, R2=0.099, P= 0.035). In test (FSST), star excursion balance test adolescent athlete, where intervention females, no static LEA variables (SEBT) and the step-down test. We may be most effective. Objective: To contributed significantly to hip and hypothesized that pre-operative patients determine the influence of static lower knee kinematics during an overhead would perform worse than healthy extremity alignment (LEA) on hip and squat test (P>0.05). Conclusions: individuals for all tests except unilateral knee kinematics during the overhead While static LEA has been suggested stance. Design: Observational cross- squat test in adolescent athletes. to contribute to an increased risk of sectional study. Setting: Controlled, Design: Cross-Sectional. Setting: knee injuries, our findings suggest that laboratory setting. Patients or Other High school athlete screening. static LEA contributes minimally to Participants: 15 (5F,10M) pre- Patients or Other Partici- dynamic malalignments during an operative knee patients between the pants:Forty-five male (15.6 ± 1.3yrs, overhead squat test, particularly in the ages of 18-60 (30.4±10.2 yrs, 177.9±8.4cm, 72.0±11.7kg) and adolescent female athlete. These 181.3±10.1 cm, 196.8±40.9 lb) and 13 twenty-five female(15.8 ±1.1yrs, findings suggest that differences in (6F, 7M) healthy individuals (31±11.6 165.3 ±8.4 cm, 59.2±9.3kg) adoles- joint angles at the hip and knee when yrs, 173.1±10.5 cm, 171±34.4 lb) with cent athletes volunteered as part of a performing the overhead squat test may no current history of lower extremity larger, multi-center risk factor be more dependent on neuromuscular injury or previous history of lower screening project. Interventions: or other anatomical factors. Ongoing extremity surgery. Interventions: Clinical measures of pelvic angle (PA), research will examine whether Patients performed the unilateral genu recurvatum (GR), and navicular differences in hip and knee kinematics stance, step up/over, forward lunge, drop (ND) were measured during three during the overhead squat and static FSST, SEBT and step-down test. trials on the dominant limb by a LEA independently increase the risk of Unilateral stance, step up/over and clinician with known reliability knee injuries in adolescent athletes. forward lunge were performed on the Supported by University of North (ICC2,k>0.87). Tibiofemoral angle NeuroCom Long Force plate (TFA) and Q-angle (QA) were Florida Faculty Development (NeuroCom, Clackamas, OR). The assessed using an electromagnetic Research Grant FSST, SEBT and step-down test were tracking system. All LEA measures performed without the force plate. All were recorded to the nearest degree single-leg assessments were performed or centimeter. Three-dimensional kin- on the dominant or uninjured limb first. ematics of the hip and knee were Testing order between force plate assessed on the dominant limb during assessments and clinical assessments five consecutive overhead squats. was counterbalanced between subjects.

S-40 Volume 47 • Number 3 (Supplement) May 2012 12295MONE Unpaired T-tests (p<.05) were used to Relationship between Functional anaerobic exercise. The exercise compare performance between healthy Exercise Assessments and Balance intervention consisted of repeated individuals and pre-operative patients. Changes Following Exercise cycles of 5-minutes of incline treadmill Main Outcome Measures: For the Clifton DR, Harrison BC, Hertel walking and 1-minute of explosive unilateral stance, mean center of gravity J, Hart JM: University of Virginia, jumping exercises. Outcome measures sway velocity (deg/s) was measured. Charlottesville, VA were repeated immediately after For the step up/over, movement time exercise. Main Outcome Measures: (s) was measured. Forward lunge was Context: The Functional Movement Center of pressure (COP) standard measured in distance (% Height) and Screen (FMS™) consists of seven deviations (SD) in the medio-lateral (M- time (s). The average time of separate tests during which an examiner L) and antero-posterior(A-P) planes, completion for the FSST was used in COP velocity, COP area, and FMS™ assigns a grade (0-3) to assess mobility, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 statistical analysis. The SEBT was stability, balance and coordination composite score ™ were compared from measured in the average reach distance during functional movements. The before to after exercise using t-tests and (% leg length). The step-down test was composite score from the FMS™ has Wilcoxon rank tests as indicated. measured in number of complete been used as a screening tool for Spearman rho correlation coefficients repetitions within 30 seconds. Results: injuries among firefighters and were used to determine relationships Healthy patients (1.2s) completed the football athletes. Since the test is between FMS™ and changes in static step up/over task faster than pre- administered at rest, it is unknown balance after exercise. Results: Static operative patients (1.7s, p=.005) for the whether its scores change in response balance measures were significantly injured limb. When performing the to exercise. Balance often deteriorates altered after exercise. Specifically, A-P forward lunge on the injured limb, with exercise or fatigue and is standard deviation (Pre=1.5±0.4cm, healthy patients (53.2 % Height) associated with injury risk. Therefore Post=1.8±0.5cm, t=-3.0, p=0.01)and reached further than pre-operative by understanding the relationship COP-Area(Pre=33.1±12.3cm2 , patients (44.9 % Height, p=.001) and between FMS™ scores and exercise- Post=43.5±18.2cm2, t=-2.9, p=0.01) healthy patients completed the forward relate balance deficits clinicians may significantly increased after exercise. lunge faster (1.01s) than pre-operative better understand the potential The composite FMS™ score did not patients(1.38s p=.005). On the FSST, prognostic qualities of the FMS™. significantly change after exercise healthy patients (6.3s) performed faster Objective: To correlate FMS™ scores (pre=16[15-17]; post=16[15-16], p=0.24). than pre-operative patients (7.8s, measured in a rested state to changes There were no significant correlations p=.043). Healthy patients performed in static balance following exercise, and observed between FMS™ score and more repetitions (18.9) during the step- secondly, to compare FMS™ scores change in static balance after exercise. down test for the injured limb than pre- before and after exercise. Design: Conclusions: The FMS™ score operative patients (10.9, p=.018). Descriptive laboratory study. Setting: measured in a rested state is not related There were no differences in unilateral Laboratory. Patients or Other Partici- to changes in static balance occurring stance or SEBT between groups. pants: Twenty-seven healthy and after exercise therefore may not be Conclusions: Our findings indicate recreationally active individuals helpful in identifying injury risk related that the step up/over, forward lunge, voluntarily participated (22.0±3.1yrs, to static balance deficits. The FMS™ FSST and step-down tests can 170.2±10.2cm, 67.9±18.1kg). Parti- score is not sensitive to changes that effectively detect differences in cipants had no history of muscu- occur following 36-minutes of function, and therefore, may be useful loskeletal surgery, no injuries in the continuous aerobic and anaerobic in monitoring patient progress, previous 6 months, and exercised at exercise. especially early on in the rehabilitation least three times per week for at least 30 process. minutes per session. Interventions: Two testing sessions occurred over two days. The first session, consisted of a familiarization session for the FMS™ test. The second session took place 24-48 hours of the first session. During this session, baseline measures of the FMS™ and balance were recorded. For balance, subjects stood on a forceplate for three, 10-second trials while maintaining hands on hips and eyes closed. Participants then performed 36 minutes of continuous aerobic and

Journal of Athletic Training S-41 12153DOBI 12244MOMU Functional Performance Measures of (%LL). Linemen and non-linemen Functional Movement Screen NCAA Division I Football Players by comparison was achieved via Comparisons Between Pubertal Position independent samples t-tests with an a Levels in Male Youth Lacrosse Grooms D, Schroeder M, Miller M, priori alpha level of .05. Results: Trunk Players Chaudhari A, Schmitt L, Borchers J, extension time was significantly (p= Brawford AM, Van Lunen BL: Old Onate J: The Ohio State University, .001) lower for linemen (85.13±28.6 s) Dominion University, Norfolk, VA Columbus, OH vs. non-linemen (108.5±29.92s). Both side bridge times were significantly Context: The Functional Movement Context: Deficits in functional (p=.04) lower for linemen (left: Screen (FMS) has been developed to performance have been cited as 66.65±33.79s; right: 65.47 ±33.41) vs. screen for dysfunctional movement non-linemen (left: 83.03±33.49s; right: possible risk factors for injury including patterns. Currently, information is Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 decreased trunk muscle endurance and 81.63±32.53s). Linemen also had lacking as related to pubertal stages movement asymmetry. However, the significantly (p<.001) lower SLHOPd leg within the adolescent population. lack of sport specific normative data length (left: 190±22%LL; right: 204± Objective: To determine whether limits the clinical value of functional 22%LL) vs. non-linemen (left: whole body dysfunction patterns performance measures. With improved 239±24%LL; right: 245±24%LL). identified by the FMS will differ normative data, at risk individuals can But linemen had significantly (p<.001) between pubertal groups in youth male be better identified and allow for more higher SLHOPd work (left: 2452.52 lacrosse players. Design: Quasi- targeted performance and injury ± 309.17 N*m; right: 2563.07 experimental. Setting: Controlled prevention interventions. Objective: ±274.43 N*m) vs. non-linemen (left: Laboratory. Participants: 30 youth To determine if differences exist in the 2206.99±248.68 N*m; right 2236.69 male lacrosse players who were free of functional performance of NCAA ±279.52 m/kg). SLAR, squat per- lower extremity injury at time of football players by position. Design: formance, trunk endurance ratios and participation were grouped according Comparative analysis. Settings: SLAR and SLHOPd symmetry ratios to their pubertal level: pre-pubertal Biomechanics research laboratory. were not significantly different between (Pre)( N=8;age =9.9±1.1yrs; height= Participants: 103 uninjured NCAA the two groups. Conclusions: Study 137.3±8.8cm;mass=32.7±7.1kg), Division I collegiate male football results indicate trunk endurance and pubertal (Pub)(N=12;age=11.4±0.9 players (age = 19.3± 1.03 years, mass= SLHOPd performance is lower among yrs; height =152.3± 10.7cm;mass 105.19±19.26 kg, height= 186.4±7.35 football linemen. Accounting for body =44.3±11.0kg), and post-pubertal cm). Interventions: A compre-hensive mass the linemen produce more work (Post)(N =10;age =12.9±0.7yrs; functional performance assessment was during the SLHOPd even though they height=164.6± 5.3cm;mass =51.9± completed prior to one regular season didn’t jump as far. This corroborates 7.4kg). Interventions: Parents and consisting of trunk endurance other findings that mass should be partici-pants filled out the modified measures, single leg hop distance, taken into consideration when Pubertal Maturation Observational single leg anterior reach distance, and conducting functional performance Scale to determine pubertal group. The deep squat performance. Main Outcome testing. The decrease in trunk participants performed the 7 tests of Measures: The independent variable endurance may also be partly attributed the FMS: Deep Squat(DS), Hurdle of player position was dichotomized to the increased mass. Given the small Step(HS), In-Line Lunge(ILL), into linemen (n=26) vs. non-linemen sample size further study is needed to Shoulder Mobility(SM), Active (n=62). Dependent variables were deep determine the clinical value of these Straight Leg Raise(ASLR), Trunk squat performance (categorized 0-3), tests on risk of injury. Stability Push-Up(TS), and Rotary single leg hop for distance (SLHOPd), Stability(RS) tests. A Kruskal-Wallis single leg anterior reach (SLAR) and test was utilized to assess differences trunk endurance times for extension and between groups, as well as frequency left and right side bridge. Trunk distributions to assess the asym- extension to side bridge symmetry metries (asymm)(p<.05). Main ratios were expressed as the percentage Outcome Measure(s): The dependant of the left or right bridge over extension. variables included the Total FMS Side bridge, SLHOPd and SLAR Score(TotSc) and individual test symmetry ratios were expressed as a scores [DS;HS;ILL;ASLR;SM;TS;RS]. percentage of the longer time or longer The inde-pendent variable was pubertal distance. SLHOPd was normalized to level (pre, pub, post). Results: No percentage of leg length (%LL) and to statistically significant differences hop work (Newtons*meters (N*m). were found in FMS scores between SLAR was normalized to leg length pubertal levels for any of the measures

S-42 Volume 47 • Number 3 (Supplement) May 2012 12111MOIN (p=.21-.94). However, 50% of the The Functional Movement ScreenTM maximized specificity and sensitivity. subjects displayed ≥ 1 asymm between- as a Predictor of Ankle and Knee Additionally, positive and negative side scores, and there were 21 total Injuries in Female Collegiate likelihood ratios (+LR and -LR) and asymm noted. The Pub group displayed Athletes odds ratios were calculated. Results: the highest frequency of asymm(66.6%) Brown M, Pfile KR, Pietrosimone BG, Thirteen participants (23.6%) followed by the Post(50%) and the Ericksen HH, Lepley AS, McLeod experienced acute lower extremity Pre(25%) groups. The SM produced MM, Terada M, Gribble PA: Capital injuries. For the FMSTM composite the highest number of asymm(38.1%) University, Columbus, OH; University score, there was no statistically followed by the HS(23.8%), ILL(19.0%), of Toledo, Toledo, OH significant Group difference (t1,55=1.68; ASLR (14.3%), and TS(4.8%). The raw P=.100; d=0.52; 95%CI: -0.11, 1.15; data demonstrated that the HS did not Injured:16.08±1.12; Non-Injured:

Context: Previous investigations Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 TM have any scores of (1) reported for any suggest the Functional Movement 16.86±1.56). A FMS composite subject; but, it was also the most Screen (FMSTM) may provide strong score of 16.5 was associated with a difficult task to receive a score of (3) predictive capabilities for lower sensitivity of 0.62 and a specificity of for all groups followed by the DS. The extremity injury in some male athletes, 0.74(+LR=2.35, -LR=0.52). This Post had the least amount of (3)’s for but little information exists to establish resulted in an odds ratio of 4.50. the ASLR. Additionally when the effectiveness of injury prediction Conclusion: While no significant TM compared to the TotSc using a cut-off among female collegiate athletes. differences in FMS composite ≤ score of 14, it was found that for both Objective: To determine the capability scores were found between partici- the DS and ILL, no subject that had a of the FMSTM to predict lower extremity pants that incurred an acute lower ≤ TotSc of 14 achieved a score of (3) on injury in collegiate female basketball, extremity injury and those that did not, TM either test; in addition, none of those soccer and volleyball players. Design: the FMS composite did demonstrate ≥ that had a TotSc of 15 received a score Prospective cohort. Setting: Athletic good sensitivity and specificity. Our of (1) or below on either of these tests. training clinic. Patients or Other data showed that female collegiate TM Lastly, 86% of those falling below the Participants: Fifty-five Division I athletes that scored <16.5 on the FMS ≤ ≥ “cut-off” score of 14 demonstrated women’s basketball, soccer and composite were 4.5 times more likely 1 asymm; whereas, only 39% of those volleyball players (19.45±1.15yrs; to suffer a traumatic lower extremity above the cut-off displayed any asymm. 173.0±8.47cm; 68.0±9.66kg) volun- injury. Clinicians can consider using the TM Conclusions: No significant findings of teered. Interventions: Prior to their FMS composite as a predictor of FMS scores were found between male 2010 respective seasons, all participants traumatic ankle and knee injuries for pubertal groups; although, it was performed all seven stations of the collegiate female basketball, soccer and observed that the pubertal group FMSTM (deep squat, hurdle step, in-line volleyball players. This may be experienced more side-to-side asymm lunge, shoulder mobility, active straight important for identifying athletes that when compared to the other two leg raise, trunk stability push-up, and may benefit from intervention before groups. Further observation may rotary stability). Certified Athletic the season begins. suggest that the DS, ILL scores, and Trainers (ATC) recorded acute ankle ≥ having 1 asymm may aid in and knee injury occurrences during the determining whether the TotSc is competitive seasons. After the season, above or below the previously players were stratified into an injured determined cut-off score for risky or non-injured group depending on the patterns. recordings by the ATC’s. Main Outcome Measures: Each station of the FMSTM is scored on a 0-3 scale, with a total possible composite score of 21 points indicating a perfect performance. Independent samples t-tests were used to detect differences between the groups (injured, non-injured) for the composite score. Effect sizes (Cohen’s d) with 95% confidence intervals (CI) were calculated using pooled standard deviations. Significance was set at P<0.05. Receiver-operator charac- teristic curves were used to determine the FMSTM composite score that

Journal of Athletic Training S-43 12115MOIN 12125DOBI Star Excursion Balance Test As a characteristic curve analysis, Hip Strength Ratios and Lower Predictor of Ankle and Knee Injuries sensitivity and specificity of the Extremity Injury in NCAA in Collegiate Football Athletes performance scores were calculated to Division I Soccer Players Ford A, Gribble PA, Pfile KR, rule out and rule in the injured and Miller MM, Hertel J, Van Lunen B, Pietrosimone BG, Ericksen HM, Lepley uninjured participants. Positive and Cortes N, Schroeder M, Grooms D, AS, McLeod MM, Terada M: St. Rita’s negative likelihood ratios were then Onate J: The Ohio State University, Medical Center, Lima, OH; University calculated to create odds ratios Columbus, OH; University of Virginia, of Toledo, Toledo, OH separately for each reach direction. Charlottesville, VA; Old Dominion Results: For group differences in all University, Norfolk, VA; George Context: Poor performance on the Star directions, the injured group had lower Mason University, Washington, DC scores compared to the non-injured

Excursion Balance Test (SEBT) has Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 previously been found to predict ankle group, but all comparisons were not Context: Weak hip musculature has and knee injuries in adolescent athletes, statistically significant. However, the been identified as a factor in lower but little information exists to establish anterior reach comparison was nearly extremity injury; however, not all significant (t =-1.92, P=.058; the effectiveness of injury prediction 90 individuals exhibiting muscle weakness among collegiate football athletes. Uninjured: 72.84+6.74%, Injured: experience injury. Objective: The Objective: To determine the capability 69.21+8.90%). The anterior reach purpose of this study was to examine of the SEBT to predict lower extremity score seemed to have the best strength ratios of the hip musculature injury in collegiate football players. prediction capability. An anterior reach between college soccer players who did Design: Prospective cohort. Setting: score< 68.0% was associated with and did not suffer lower extremity Athletic training facility. Patients or moderate sensitivity (0.56) and strong injuries. Design: Cohort study. Other Participants: Ninety-two, NCAA specificity (0.81), with an odds ratio Settings: Movement analysis Division I football players (age:19.60 of 5.37. Conclusions: The results of laboratory. Participants: 382 NCAA ±1.29yrs; height: 186.84±6.51cm, the study demonstrate that the SEBT Division I collegiate soccer players; 200 mass:101.96 ±18.84 kg), medically may provide a tool for screening male (179.6 ± 6.7 cm, 76.6 ± 7.8 kg, 19.5 ± cleared for sport participation, collegiate football players at risk for 1.3 years) and 182 female (167.4 ± 6.0 volunteered. Interventions: Prior to traumatic ankle or knee injuries during cm, 62.7 ± 7.1 kg, 19.3 ± 1.1 years). the 2010-2011 football season, dynamic the competitive season. Focusing on Interventions: Peak isometric hip and postural control was measured the anterior reach score, players with knee strength was measured bilaterally in collegiate football players a normalized score less than 68% were prospectively using a portable load cell using the anterior, posteriormedial, and greater than 5 times more likely to (BTE Technologies, Hanover, MD). posteriorlateral directions of the SEBT. have suffered a traumatic ankle or knee Frontal and sagittal plane motions were Reach distances were recorded in injury. With continued investigation measured in the standing position; centimeters and expressed as a and application, clinicians and transverse plane rotations were percentage of the stance limb length researchers may be able to utilize measured in the seated position. Peak (%MAXD). During the season, a dynamic postural control measured isometric knee strength was measured Certified Athletic Trainer recorded time with the SEBT as a predictive tool to in the seated position. Peak strength lost from traumatic ankle and knee identify collegiate football athletes at values were arranged into four strength injuries. Main Outcome Measures: At risk for suffering an ankle or knee ratios: hip flexion:extension (FLX:EXT), the end of the competitive season, injury. abduction:adduction (ABD:ADD), athletes were stratified into an injured external:internal rotation (ER:IR), knee (traumatic ankle or knee; n=18) or extension:flexion (EXT:FLX). Ratio uninjured (n=74) group, accordingly. values were obtained by dividing peak The normalized means and standard strength of the agonist muscle by peak deviations of the anterior, poster- strength of the antagonist. Main iormedial, posteriorlateral and Outcome Measures: Athletes were composite (an average of the three followed prospectively for two directions) reaches were compared consecutive seasons. Each team’s ATC between the groups. Independent t- recorded all injuries. Athletes were then tests were utilized to compare the four classified as either “injured” (n=136) or reach scores between the affected side “non-injured” (n=178) for the purpose of the injured group and randomly of this analysis. Lower extremity injury selected side of the uninjured group. was defined as any event affecting the Statistical significance was set a priori lower limb, originating at the hip and at ≤.05. Using a receiver operating extending distally, that caused

S-44 Volume 47 • Number 3 (Supplement) May 2012 participation time loss for one or more days. Independent samples t-tests were conducted, with an a priori alpha level of 0.05, in order to determine if differences in strength ratio asymmetries were present between athletes who did and did not sustain a lower extremity injury. Results: A significant difference in strength ratios, with respect to lower extremity injury, was reported for one of the four

calculated strength ratios: (Hip Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 FLX:EXT p=.026, Hip ABD:ADD p=.270, Hip ER:IR p=.893, Knee EXT:FLX p=.154). Average (mean ± sd) strength ratios were: Hip FLX:EXT injured (117.9 ± 43.9%) and non-injured (108.8 ± 28.2%); Hip ABD:ADD injured (84.3 ± 36.0%) and non-injured (80.5 ± 23.4%); Hip ER:IR injured (109.7 ± 28.6%) and non-injured (110.1 ± 30.9%); Knee EXT:FLX injured (93.8 ± 30.7%) and non-injured (98.6 ± 28.5%). Conclusions: The results of this study show a significant difference between hip flexion:extension strength ratios for injured versus non-injured athletes. A greater amount of hip flexion strength comparative to hip extension may cause an imbalance in the lower extremity resulting in increased injury occurrence. Future lower extremity injury studies may benefit from focusing on hip musculature imbalances during the pre-season, rather than singularly focusing on knee strength.

Journal of Athletic Training S-45 Free Communications, Oral Presentations: Soft Tissue Mobilization Friday, June 29, 2012, 1:30 PM-2:15 PM, Room 275; Moderator: Jeremy Searson, MS, ATC 12262DOCE 12382MOTE Massage Potentiates Cell Survival left Tibialis Anterior (TA). Control Foam Rolling Prior to Stretching Mechanisms in Healthy Skeletal rats were anesthetized and positioned, Increases Hamstring Flexibility Muscle Through the Activation of but not massaged. On day 5, left TA Mohr AM, Long BC, Ryan ED, Smith Autophagy muscles were extracted and frozen for DB: Iowa Western Community Waters CM, Abshire SM, Dupont- analysis. Tissue samples were College, Council Bluffs, IA; Versteegden EE, Butterfield TA: homogenized and western blot analysis Oklahoma State University, University of Kentucky, Lexington, was performed. Membranes were Stillwater, OK; University of North KY probed for autophagy marker BCLN1 Carolina, Chapel Hill, NC and actin was used as a protein loading Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Although muscle trauma control. Membranes were scanned and Context: Foam rollers are commonly initiates an inflammatory response that analyzed using an Odessey Licor used prior to stretching. Many athletes often results in secondary hypoxic system. BCLN1 band intensity was report that foam rollers help release injury, autophagy is a cell signaling measured in relation to actin and tension in their muscles thus resulting pathway that promotes cell survival. statistical analysis was performed in greater range of motion (ROM) Through the selected removal of using SPSS version 19. Main when used prior to stretching. To date, damaged organelles, such as Outcomes: Muscle expression (in no investigators have examined the mitochondria, autophagy can act as an arbitrary units of density, AU) of influence of foam rollers and static alternative pathway to apoptosis and BCLN1 protein in massaged and stretching. Objective: To determine necrosis, thereby reducing cell death control tissues were compared with if a standard foam rolling protocol and maintaining cellular function Student’s t-test. Results: 4.5N CCL prior to static stretching increases following injury. Targeting this resulted in a significant increase in the flexibility of the hamstring muscle pathway utilizing manual therapies has expression of BCLN1 protein group. Design: Descriptive laboratory not been addressed to date, and may compared to control rat TA muscle study. Setting: Applied Musculo- prove beneficial following muscle (0.112±0.004AU vs. 0.097±0.017AU, skeletal and Human Physiology injury. Because massage is a respectively, p=0.56). Conclusions: Research Laboratory. Patients or commonly utilized manual modality Although we have previously shown Other Participants: Forty subjects for the treatment of inflammation and that massage in the form of CCL (male: n=14, age=21.29±2.58yrs, muscle pain, we have developed a attenuates the inflammatory response ht=176.62±5.28cm, mass= 73.96± cyclic compressive loading (CCL) and facilitates recovery of muscle 16.9kg; female: n=26, age=21.08 paradigm to use a massage mimetic for function following damaging eccentric ±2.91yrs, ht= 167.05±6.19cm, controlled laboratory testing. We have exercise, the mechanisms remain mass=73.62±11.52kg) with less than previously been shown CCL to enhance unknown. Here we have shown that 90° of hip flexion ROM and no lower the recovery of force and modulate the only 4 days of applied massage in the extremity injury in the 6 months prior infiltration of inflammatory cells in form of CCL results in an increased to the study participated. Inter- eccentrically exercised muscle. activation of cell survival pathways, ventions: A 2x4x6 factorial design Objective: Investigate the influence likely reducing cell stress and limiting guided data collection. Independent of moderate magnitude of CCL on cell damage and subsequent necrosis. variables were time (pre and post), autophagy markers in healthy skeletal Further work is ongoing in our condition ((static stretching (SS), rat muscle. Design: Experimental laboratory to continue to uncover foam rolling and static stretching (FR/ design utilizing basic science mechanisms belying the efficacy of SS), foam rolling (FR), and control methodologies in physiological massage. (nothing)) and day (1, 2, 3, 4, 5, 6). To systems. Therefore, alpha was set ‘a minimize accessory movement, hip priori’ at 0.10. Setting: This flexion ROM was performed by having experiment was performed within a subjects lay supine with a strap placed controlled laboratory setting. across their hip and the uninvolved leg. Participants: Consisted of 6 Male A bubble inclinometer was then aligned Wistar Rats (200g). Interventions: on the thigh of the involved leg where Subjects were placed in one of two subjects then performed active hip groups massage (4.5N load, n=3) or flexion 3 times. Subjects randomly control (0.0N load, n=3). Those assigned to the SS group received 3 receiving treatment underwent CCL one-minute static stretches with a 30- (frequency of loading 1Hz) for 30 second rest between each stretch. minutes for 4 consecutive days to the Those in the FR and FR/SS sat on the S-46 Volume 47 • Number 3 (Supplement) May 2012 foam roller supporting their body measures. Setting: High school ±2.6, post=50.8±2.6; DS: pre= 54.9 weight with their arms. Subjects then athletic training room. Participants: ±2.5, post=54.2±2.5, P=.92), and actively rolled the foam roller from 39 healthy high school male and soreness (CON: pre=.71±.39, post their ischial tuberosity to the popliteal female athletes (16.8±1.3 yrs, height =.86±.47; SS: pre=1.3±.42, post= fossa. Subject then returned to the 179.1±9.8cm, weight 77.6±17.4 kg) 1.7±.50; DS: pre=1.5±.41, post= table where hip flexion ROM from a conven-ience sample. 1.4±.48, P=.48). There was a signi- measures were again taken 3 times. Interventions: Subjects were divided ficant main effect for time in regards Main Outcome Measures: The into 3 groups: SS, DS and control to flexibility (pre=29.2±1.5, post dependent variable was hip flexion (CON). All subjects completed a brief =31.3±1.4, P<.001). No significant ROM before and after each treatment medical history form, a 2 minute main effects for time were noted for on each day. Results: There was a warm-up, and underwent pre and post- jump performance (P=.81), left

significant interaction between group testing for flexibility using a sit-and- (P=.57) or right (P=.30) leg strength, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 and time (F3,16 =7.20; P< .003). Hip reach box, vertical jump performance or soreness (P=.33). Conclusion: flexion ROM increased over the 6 using a vertec, strength using a These results suggest that an acute bout days in the SS, FR, and FR/SS groups handheld dynamometer, and soreness of static or dynamic lower extremity (Tukey-Kramer, P<.05). Subjects in using a numeric pain rating scale. The stretching may not produce a the FR/SS condition increased hip SS and DS groups completed meaningful improvement in lower flexion ROM more than those in the approximately 10 minutes of lower extremity flexibility, jump per- SS, FR, and control groups (FR/SS pre: extremity static (5 stretches) or formance, or strength in high school 77.88±15.85; post: 86.85±16.58; SS dynamic (5 stretches) stretching, with athletes. Our results are in contrast to pre: 70.68±11.27; post: 78.09±11.86; each stretch performed 3 times for 30 research reported in adults. Adolescent FR pre: 77.80±12.11; post: 82.19± seconds with a 15 second rest between athletes may respond differently to 12.37; Tukey-Kramer, P<.05). Con- sets. The CON group rested for 10 stretching than older populations, clusions: Our results support the use minutes. Main Outcome Measures: although more research in this area is of a foam roller in combination with a The dependent variables included warranted. Future studies should exam static stretching protocol. If time flexibility (cm), vertical jump whether longer-term stretching allows and maximal gains in hip flexion performance (cm), hamstring strength programs positively impact adolescent ROM are desired, foam rolling the (ppsi), and soreness (0=no soreness, flexibility and per-formance. hamstrings prior to static stretching 10=significant soreness). All would be appropriate in non-injured measurement techniques have patients who have less than 90° of reported acceptable reliability and hamstring ROM. validity, and intra-rater reliability was established for the handheld 12030MOTE dynamometer (intraclass correlation The Impact of an Acute Bout of Static coefficient=.88). A 2(time) X or Dynamic Stretching on Flexibility, 3(group) repeated measures analysis Performance, Strength and Soreness of variance was run for each dependent in High School Athletes. variable. Means and standard deviations Enz J, Snyder Valier AR: St. John’s were calculated for all variables, and Sports Medicine-HealthTracks, significance was noted at P<.05. Springfield, MO; Athletic Training Results: We found no significant Program, A.T. Still University, Mesa, interactions between group and time AZ on any of the outcomes: flexibility (CON: pre=29.1±2.4, post=30.4±2.4; Context: Sports healthcare pro- SS: pre=28.9±2.6, post=31.4±2.6; fessionals have long advocated pre- DS: pre=29.8±2.5, post=32.0±2.5, exercise stretching to increase flexibility, P=.14), jump performance (CON: enhance performance, and prevent pre=282.6±5.4, post=282.0±5.3; SS: injury. While many have investigated pre=286.4±5.9, post=286.6±5.7; DS: the benefits of stretching, the impact pre=288.0±5.6, post=288.9±5.5, of stretching on high school athletes is P=.55), strength left leg (CON: poorly studied. Objective: To compare pre=55.6±2.5, post=53.2±2.5; SS: the acute effects of static (SS) and pre=50.6±2.7, post=50.8±2.7; DS: dynamic stretching (DS) on flexibility, pre=56.1±2.6, post=56.7±2.6, P=.38), vertical jump, strength and soreness in strength right leg (CON: pre=54.9 high school athletes. Design: Repeated ±2.5, post=53.4±2.4; SS: pre= 51.5

Journal of Athletic Training S-47 Free Communications, Thematic Poster: Ankle Biomechanics Friday, June 29, 2012, 2:45PM-4:30PM, Room 275; Moderator: Erik Wikstrom, PhD, ATC, FNATA 12021FOBI 12374MONE Increased Forefoot Inversion During groups (α=.05). For post hoc testing, The Reliability and Responsiveness Walking Gait in Individuals with we used 3 Bonferroni adjusted of Gait Initiation Profiles in Those Functional Ankle Instability pairwise comparisons (α=0.0167). with Chronic Ankle Instability Wright CJ, Arnold BL, Ross SE, Results: For the forefoot in the frontal Hartley EM, Hoch MC, McKeon Ketchum JM, Pidcoe PE: Virginia plane, there was a significant group PO: University of Kentucky, Commonwealth University, Lexington, KY; Old Dominion difference at IC (F2,66=4.68, p=0.013; Richmond, VA; Marywood control=-2.17±3.56°,coper=-0.51± University, Norfolk, VA University, Scranton, PA 2.85°, FAI = 0.66±3.03°). Post hoc testing at IC, revealed that individuals Context: Individuals with chronic Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Functional ankle instability with FAI were significantly more ankle instability (CAI) have (FAI), a common sequela to ankle inverted than controls (mean diffe- demonstrated alterations in gait sprain, can limit physical activity and rence= -2.84°, 95% CI=-4.70, -0.98),but initiation (GI) when compared to activities of daily living (ADL) for years copers were not significantly different healthy individuals. While these post-injury. One ADL that may be from the FAI or control groups (coper- differences provide important affected by instability is walking gait. FAI: mean difference= -1.17°, 95% CI= information about sensorimotor Different forefoot and hindfoot -3.04, 0.69; control-coper: mean deficits associated with CAI, the movement patterns between individuals difference=-1.67°, 95% CI= -3.53, 0.20). intersession reliability of the GI with and without FAI during gait may There were no other significant group profile remains unknown in this partially explain reports of instability. differences for forefoot or hindfoot population. Objective: To determine Objective: The purpose was to capture motion (FOREFOOT: sagittal plane IC: the intersession reliability of GI ankle and foot kinematic data during F2,66=0.16, p=0.849, frontal plane TO: measures between two testing sessions walking gait among FAI, copers and F2,66=1.63, p=0.204, sagittal plane TO: in those with CAI. Design: Reliability healthy individuals. Design: 3 group F2,66=1.10, p=0.338; HINDFOOT: frontal study Setting: Laboratory Patients or observational cross-sectional design. plane IC: F2,66=0.59, p=0.556, frontal Other Participants: Twelve

Setting: Sports Medicine Research plane TO: F2,66=0.62, p=0.541, frontal individuals with self-reported CAI (6

Laboratory. Participants: Participants plane TO: F2,66=0.62, p=0.541, sagittal females and 6 males, age =27.4 included 23 individuals with a history plane TO: F2,66=3.08, p=0.052). ±4.5yrs, height=175.4± 10.8cm, of at least 1 ankle sprain and at least 2 Conclusions: We found increased weight= 78.4±12.1 kg, Foot and Ankle episodes of giving-way in the past year forefoot inversion at IC in individuals Ability Measure Sport: 58.6±11.1%) (FAI, Cumberland Ankle Instability with FAI. Previously, increased If a subject reported bilateral CAI, the Tool [CAIT]=20.52±2.94, episodes of inversion error in individuals with FAI self-reported worse limb was tested. giving-way=5.81±8.42 per month), 23 has been thought to partially explain Interventions: Subjects performed subjects with no history of ankle sprain symptoms of instability. However, we barefoot gait initiation on a force plate or instability in their lifetime (controls, found a similar amount of inversion in which captured center of pressure CAIT=28.78±1.78), and 23 individuals copers, despite the fact that they do (COP) data sampled at 500Hz and low with a history of a single ankle sprain not suffer from instability. This may pass filtered at 10 Hz. The subjects and no subsequent episodes of indicate that increased forefoot were instructed to stand with feet instability (copers, CAIT=27.74±1.69). inversion does not contribute shoulder width apart on the force plate. Subjects were matched for age, height substantially to instability, that there When given an audible cue, they were and weight (age=23.3±3.8years, is an inversion threshold effect, or that instructed to take their initial step with height=1.71±0.09m, weight= 69.0± copers mediate instability through the uninvolved limb and then continue 13.7kg). Interventions: Ten trials of some other mechanism. to walk down a pathway at a self- natural walking gait were recorded selected speed. Data was collected on using a ViconMX motion capture two separate sessions separated by 1 system (Oxford, UK) and two Bertec week. Main Outcome Measures: force plates (Columbus, Ohio). Main The GI profile was separated into three Outcome Measures: During walking phases (S1, S2, and S3) based on forefoot and hindfoot sagittal and relevant changes in COP excursions. frontal plane angles at initial contact S1 began from the deviation of normal (IC) and toe-off (TO) were calculated standing balance to the most using the Oxford foot model. For each posterolateral displacement under the variable at each time point we used stepping limb. S2 began from the end separate one-way ANOVAs to compare of S1 to the maximum lateral position S-48 Volume 47 • Number 3 (Supplement) May 2012 12377FOGA under the stance foot. S3 began at the Saggital Summary Kinematics Dorsiflexion, knee flexion, and hip end of S2 and continued until the During Walking Reveal Gait flexion angular changes were vertical ground reaction force dropped Alterations in Those with represented as positive values below 100N; the moment when the Chronic Ankle Instability (summary-flexion) whereas plantar- stance foot left force plate. COP McKeon PO, Hoch MC, Kyoungyu flexion, knee extension, and hip displacement (cm) was calculated as J, Mullineaux DR: University of extension were negative (summary- the sum of resultant vectors of the Kentucky, Lexington, KY; Old extension). In addition, the peak medial-lateral and anterior-posterior Dominion University, Norfolk, VA; vertical ground reaction force (vGRF) excursions for adjacent COP data point University of Incheon, Incheon, was calculated and normalized to body within each phase. The averages of 5 South Korea; University of weight (N/kg) during stance phase. The trials of COPdisplacements for each Lincoln, Lincoln, England ankle, knee, and hip sagittal kinematics phase were used for analyses. were summed for each of the 101 stride Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Intraclass correlation coefficients Context: Gait alterations have been points and group means ± standard (ICC) and standard error of proposed to be contributing factors to error (SE) were calculated across all measurements (SEM) were calculated chronic ankle instability (CAI). The points. Periods of non-overlapping SE to determine the reliability of the majority of investigations have intervals were averaged and group measures between Session 1 and examined differences among individual means were compared using α≤ Session 2. Lastly, the minimum joints of the lower extremity between independent t-tests ( 0.05). Results: detectable change (MDC) was those with and without CAI. By Two periods of non-overlap were calculated for each phase. Alpha-level examining a clinically relevant identified between the CAI and control was set a-priori at p>0.05. Results: summary of lower extremity joint group. From 0-45% (CAI:17.0±6.5º, The results indicate that S1 (Session behaviors during gait, it may be Control:23.5±6.6º, p=0.02) and from 1=7.46±1.98cm, Session 2=7.91± possible to elucidate the link between 72-100% (CAI:44.8±5.8º, Control: 1.68cm, ICC(2,5)=0.84, SEM= gait alterations and CAI. Objective: 53.5±6.4º, p=0.002) of the gait cycle, 0.29cm, MDC=0.42cm, p=0.003), To determine if the summary profile of the CAI group displayed significantly S2(Session 1=19.21±4.29cm, Session sagittal kinematic s during walking less summary flexion values compared 2=20.06±2.92cm, ICC(2,5)=0.88, reveal significant alterations during to the control group. The CAI group SEM=0.44cm, MDC=0.63cm, p= walking gait in those with CAI. Design: also demonstrated a trend toward higher 0.001), and S3 (Session 1=16.08 Case-control study. Setting: Labo- peak vGRF (CAI: 11.93±1.34N/kg, ±1.49cm, Session 2=16.46±1.84cm, ratory. Patients or Other Participants: Control: 11.17± 1.01N/kg, p=0.13), but ICC(2,5)=0.93, SEM=0.12cm, MDC Twelve adults with CAI (7 males, 5 it did not reach significance. Con- =0.17cm, p>0.001) displacement females;age:25.9±3.4years; height: clusions: The use of summary flexion values were highly reliable between the 176.5±8.8cm;weight: 80.3±13.6kg) and and extension profiles of the hip, knee, 2 days of testing. Conclusions: The 12 adults with no ankle sprain history and ankle revealed significant kinematic displacement measures across all GI (7 males, 5 females; age:26.7±4.7years; differences between those with and phases demonstrated excellent height: 71.8±5.8cm; weight:72.5+9.7kg) without CAI. These alterations may intersession reliability with very small participated. The CAI group reported indicate that those with CAI have less MDC values. This information is 9.2±5.5 previous ankle sprains, 5.7±5.4 of an ability to attenuate force upon critically important to the under- episodes of instability in the past 3 impact based on less summary-flexion standing of anticipated responsiveness months, and Foot and Ankle Ability in the stance phase. The alterations in of GI profiles in those with CAI due Measure Sport scores of 66.5±16.5%. the latter part of swing phase may to therapeutic interventions. Whether Subjects were matched by side and indicate a reduced ability to control limb the GI profile is sensitive to change involved limb. Interventions: All placement in preparation for initial due to intervention in this population subjects walked on a treadmill contact. remains unknown. instrumented with force plates at a speed of 1.5m/s. Three-dimensional kinematics of the lower extremity joints were captured for 30s using a 15-camera motion analysis system. Data were time normalized to 101 points from initial- contact (0%) to the subsequent initial- contact of the same limb (100%). Main Outcome Measures: Sagittal hip, knee, and ankle kinematics were calculated for 5 nonconsecutive gait cycles.

Journal of Athletic Training S-49 12135MOBI Effects of Chronic Ankle Instability Rearfoot Medial:Lateral pressure ratio. walking in CAI patients, which has and Ankle Bracing on Plantar A value >1 indicated more medial implications for a mechanism of injury. Pressure Distribution During pressure and a value <1 indicated more There is limited information quantifying Jump-Landing lateral pressure. For each dependant these distributions during landing. Rix J, Yniguez SL, Armstrong CA, variable, a Group by Brace ANOVA was Additionally, the effect fatigue may Pietrosimone BG, Gribble PA: performed. Effect sizes (Cohen’s d) with have on these plantar pressures is University of Toledo, Toledo, OH 95% con-fidence intervals were unknown. Objective: The purpose of calculated using pooled standard this study was to examine the effect of Context: Previous investigation deviations. Significance was set at fatigue on plantar pressure distribution suggests that individuals with chronic P<.05. Results: There was a significant (PPD) in subjects with CAI during a main effect for brace for the Midfoot jump-landing task. Design: Case-

ankle instability (CAI) exhibit more Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 lateral plantar pressure during walking, Medial:Lateral pressure ratio control laboratory study. Setting: which may increase the risk for (F1,18=4.83; P=. 041), such that there Research laboratory. Patients or Other inversion ankle sprain during gait. was increased medial pressure without Participants: Ten physically active However, there is limited information the brace (1.13±0.95) compared to participants with unilateral CAI (6M, quantifying these distributions during with the brace (0.85±0.58). However, 4F; 21.2±1.7yr; 68.6±3.6cm; 167± landing. Bracing is suggested to reduce the effect size was small (d=0.35; 23.9kg) and ten healthy participants risk of ankle injury, especially during 95%CI: -0.55,1.22). Similarly, for the (6M, 4F; 22.2±2.2yr; 69.9±3.7cm; jumping sports. It is unknown if Rearfoot Medial:Lateral pressure ratio, 179.9±21.6kg) volunteered. Inter- bracing impacts plantar pressure there was a significant main effect for ventions: Participants completed one distributions, which may be important brace (F1,18=16.06; P=0.001) such that testing session that consisted of three for injury prevention. Objective: The there was increased medial pressure jump-landing trials before and after a purpose of this study was to examine without the brace (1.02±0.16) compared functional fatigue protocol. The jump- the relationship of ankle bracing on to with the brace (0.88±0.12); with a landing task consisted of a single-leg plantar pressure distribution in subjects strong associated effect size (d=1.03; landing from a jump height equivalent with CAI during a jump-landing task. 95%CI: 0.06,1.91). All other com- to 50% of the participant’s maximum

Design: Case-control laboratory study. parisons were not statistically vertical jump height. (50% Vertmax). Setting: Research laboratory. Patients significant. Conclusions: Previous CAI participants landed on their or Other Participants: Ten research shows increased lateral involved limb, while the control participants with CAI (6M, 4F; pressure during gait in CAI participants participants landed on an assigned 21.2±1.7yr; 68.6±3.6cm; 167±23.9kg) that is theorized to contribute to matched limb. The functional fatigue and ten healthy participants (6M, 4F; increased risk of injury. Our study task was comprised of three stations: 22.2±2.2yr; 69.9±3.7cm; 179.9± suggests that plantar pressure may be Southeast Missouri Agility Drill, 21.6kg), all physically active, distributed more medially during a forward lunges and quick hops at 50% volunteered. Interventions: Partici- landing task, but the application of a brace Vertmax. Participants performed the pants completed one testing session in may translate peak pressures laterally. fatigue intervention until the time to which plantar pressure insoles were Additional research is needed to complete the stations increased by worn inside the shoe to quantify determine how bracing may be able to 50% compared to their fastest time. pressure distributions during reduce ankle injury during dynamic Post-testing was performed imme- performance of a jump-landing task tasks. diately after a fatigued state was with and without the application of an induced. Plantar pressure insoles were 12155MOBI ankle brace. Three trials were worn during pre- and post-testing to The Effects of Fatigue on Plantar performed under each condition, in a quantify the PPD during the landing Pressure Distribution During a randomized order. The task consisted trials. Main Outcome Measures: Peak Jump-landing Task in Participants of a sub-maximal vertical jump (50% PPD’s of the landing foot were used to with Chronic Ankle Instability of maximum jump height) followed by create three dependant variables: Yniguez SL, Rix J, Armstrong CA, a single-leg landing following. CAI Forefoot Medial:Lateral pressure ratio, Pietrosimone BG, Gribble PA: participants landed on their involved Midfoot Medial:Lateral pressure ratio, University of Toledo, Toledo, OH limb, while the control participants Rearfoot Medial: Lateral pressure ratio. landed on a selected matched limb. A value of greater than 1 indicated more Main Outcome Measures: Peak Context: Chronic ankle instability medial pressure and a value of less than plantar pressures from six regions of the (CAI), in conjunction with fatigue, has 1 indicated more lateral pressure. landing foot were used to create three negative consequences on neuro- Separate Group by Time ANOVAs were dependant variables: Forefoot muscular control. Limited investigation performed to evaluate the effects of Medial:Lateral pressure ratio, Midfoot suggests there is an increased lateral fatigue on each dependant variable Medial:Lateral pressure ratio, and distribution of plantar pressure during between the CAI and control S-50 Volume 47 • Number 3 (Supplement) May 2012 participants. Effect sizes (Cohen’s d) sprain within past 6 months and scored potentially increase future risk of were calculated using pooled standard less than 90% on FADI and FADI-S. injury to the unstable ankle. deviations. Significance was set at Interventions: The two independent P<.05. Results: There were no variables were injury history (CAI, NI) 12288MOBI statistically significant Group by Time and type of outer sole (fulcrum, flat). A Shank-Rearfoot Coupling with interactions for any of the variables: fulcrum outer sole was placed on the Chronic Ankle Instability: A Forefoot Medial:Lateral pressure ratio bottom of the participants’ shoe which Vector Coding Variability (F =3.086; p=0.096), Midfoot Medial: forced the ankle into 25° of inversion Analysis 1,18 Herb CC, Chinn L, Dicharry J, Lateral pressure ratio (F1,18 =0.001; p= upon landing from a 27 cm single leg 0.981), Rearfoot Medial:Lateral pressure step down. Participants were also McKeon PO, Hart JM, Hertel J: ratio (F = 0.900; p=0.355). However, tested with a flat outer sole. Ground University of Virginia, 1,18 Charlottesville, VA; University

moderate-strong effect sizes suggest that reaction forces were measured with an Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 pre-fatigue, peak pressures were more AMTI force platform. Fourteen trials, of Kentucky, Lexington, KY medially directed in the CAI group seven with the fulcrum outer sole and compared to the Control group in the seven with the flat outer sole were Context: Altered joint coupling forefoot (CAI: 1.67±0.88; Control: performed on the previously injured leg variability between tibial internal/ 1.15±0.26; d=0.80) and rearfoot (CAI: (CAI group) or matched control leg (NI external rotation and rearfoot inversion/ 1.07±0.19; Control: 0.98±0.13; d=0.77). group). Statistical analysis included a eversion during gait may play a role in Conclusions: CAI patients may have a 2 x 2 ANOVA with repeated measures chronic ankle instability (CAI). different, perhaps more medial, PPD on outer sole condition to analyze the Objective: We aimed to identify during a landing task. This is in contrast difference in landing kinetics between differences in the variability of shank- to previous research showing a more the injury and outer sole variables. rearfoot coupling, as assessed with lateral PPD during gait. The discrepancies Main Outcome Measures: The vector coding variability analysis, between studies may be attributed to task dependent variables were peak vertical throughout the gait cycle between CAI demand differences. and peak anterior/posterior ground and healthy control groups during reaction force (GRF), normalized to barefoot and shod walking and jogging. 12310FOBI multiples of body weight (BW). Time Design: Case-control. Setting: Motion Difference in Landing Kinetics to peak vertical GRF was also measured. analysis laboratory. Patients or Other During Simulated Lateral Ankle Results: For peak vertical GRF, there Participants: Twenty-eight physically Sprain Mechanism Between was no significant interaction (P=.553). active young adults (CAI, n=15, Chronic Ankle Instability and There was a significant main effect for #previous ankle sprains=4.9±2.5; Healthy Participants injury history (NI=1.75+0.37 BW; Control, n=13, #previous ankle Knight A, Hoseney K, McGinley S, CAI=1.38+0.17 BW; P=.034) and outer sprains=0±0) participated. The Foot Hale B: Department of Kinesiology, sole (fulcrum=1.43+0.31 BW; flat= and Ankle Ability Measure (FAAM) Mississippi State University, 1.70+0.38 BW; P=.004). For peak and FAAM-Sport were used to identify Mississippi State, MS anterior/posterior GRF, there was no the level of self-reported function of significant interaction (P=.381). There CAI subjects compared to controls Context: Many people develop chronic was a significant main effect for injury (CAI,FAAM=92.1±5.8%, FAAM- ankle instability (CAI) following a history (NI=0.27+0.07 BW; CAI= S=74.8±13.3%, Control, FAAM= lateral ankle sprain. Altered landing 0.19+0.04 BW; P=.033) and outer sole 100±0.0%, FAAM-S=100±0.0%). Inter- kinetics, especially when the ankle is (fulcrum=0.22+0.07 BW; flat=0.24+0.08 ventions: Subjects walked (1.34m/s) and forced into inversion, may help explain BW; P=.033). For the time to peak then jogged (2.68m/s) for 5 minutes each the high recurrence rate. Objective: To vertical GRF, there was a significant on an instrumented treadmill in both determine if there is a difference in interaction between injury group and barefoot and shod conditions. Main landing kinetics during a simulated outer sole (P=.01), with the CAI group Outcome Measures: Using a 12 camera lateral ankle sprain mechanism having a significantly greater time to motion analysis system, shank rotation between participants with CAI and peak with the fulcrum outer sole and rearfoot inversion/eversion participants with no history of an ankle (148.0+51.6 ms) than the CAI group and kinematic data were collected. Vector sprain. Design: Repeated measures flat outer sole (96.8+33.1ms), the NI coding variability coefficients were design. Setting: Controlled laboratory group and fulcrum outer sole (97.8+33.9 calculated throughout the entire gait setting.Patients or Other Parti- ms), and the NI group and flat outer cycle for 3 consecutive strides using cipants: Twelve volunteers (age= 21.83 sole (94.2+29.4 ms). Conclusions: the Mullineaux method. This method +2.51years;mass=72.42+12.53kg; These differences in forces and loading estimates the between stride variability height=1.74+0.11m), which included 6 with times between the two groups may be in coupling between 2 segments (in our CAI and 6 with no previous ankle injury/ an attempt by the CAI participants to case, shank rotation and rearfoot sprain (NI). CAI participants had one change loading of the unstable ankle, inversion/eversion) with a coefficient moderate ankle sprain with a recurrent and the altered landing kinetics of 0 representing no variability and 1 Journal of Athletic Training S-51 12376MONE representing complete randomness. Explanatory Variables for 3 trials for each variable was calculated At each speed and in both conditions, Performance on the Anterior Reach for each limb. Then the corresponding means and 90% confidence intervals of the Star Excursion Balance Test means for both limbs were pooled and were calculated for each group. Group Everson SJ, McKeon PO: University used for analysis. Dependent variables differences were determined by of Kentucky, Lexington, KY included mean WBLT (cm), mean identifying periods in the gait cycle ANTSEBT reach distance (cm), and the where the confidence intervals did not Context: The anterior reach direction number of errors for the SLBT. Pearson overlap (therefore exact p-values were of the Star Excursion Balance Test Product Moment correlation coeffi- not generated in this analysis). Group (ANTSEBT) has been shown to cients were calculated to examine the means (+SD) were calculated across identify athletes at increased risk of relationships among the WBLT, the these intervals. Results: Group ANTSEBT, and the SLBT. Alpha was suffering a lower extremity injury. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 differences were identified from 76% to Ankle dorsiflexion range of motion and set a priori at p≤0.05. Results: There 78% of the gait cycle (CAI=0.31±0.04, postural control have been proposed to was a significant correlation found for Control=0.25±0.02) in barefoot walking, be explanatory variables for the the WBLT (10.3±3.4cm) and the and from 37% to 59% in shod walking performance on this test, but their ANTSEBT (64.9±5.6cm), r=0.59, r2=0.35, (CAI=0.10±0.01, Control=0.24±0.02). relationships have not been clearly p=0.001). There were no significant No group differences were found during established in the physically active relationships found between the SLBT barefoot or shod jogging. Conclusions: population. Objective: To determine (2.9±2.5 errors) and the WBLT (r=0.14, Our results indicate that individuals whether ankle dorsiflexion and postural r2=0.02, p=0.46) or the ANTSEBT with CAI exhibit alterations in the control are explanatory variables for (r=0.13, r2=0.02, p=0.52). Conclusions: variability of shank-rearfoot coupling performance on the ANTSEBT. The ANTSEBT and the WBLT were during barefoot and shod walking, but Design: Correlation study. Setting: significantly related and thirty-five not while jogging in either condition. Athletic Training Room. Patients or percent of the variance in the ANTSEBT During shod walking, the CAI group Other Participants: Seventeen male could be explained by the WBLT. had less coupling variability during the and 11 female intercollegiate athletes Dorsiflexion is a strong explanatory swing phase compared to controls. (age:19.7±1.5 years, height: 175.4± variable for the ANTSEBT. Conversely, Less variability could indicate a more 9.8cm, weight:64.1±10.6kg) partici- almost no variance could be explained constrained sensorimotor system. pated in the study. All subjects were in either measure by the SLBT. During barefoot walking, coupling free from any lower extremity injury Although postural control is a known variability was higher in the CAI group for at least 6 weeks. Interventions: component of the ANTSEBT, it appears compared to controls which may All testing procedures were the SLBT captures a different aspect of indicate a less constrained sensori- performed on both limbs of each postural control. motor system. The contrasting results subject. Subjects performed 3 trials between barefoot and shod walking of maximum reach in the ANTSEBT on illustrate the importance of each limb. The weight-bearing lunge environmental constraints on motor test (WBLT) was used to measure control variability. When the task DFROM. Subjects performed 3 trials constraint was increased from walking of the WBLT in which they kept their to jogging, subjects may have been test heel firmly planted on the floor forced into a more deterministic and while they flexed their knee to the wall. predictable movement pattern Maximum dorsiflexion was defined as regardless of health status, thus the distance from the great toe to the resulting in similar coupling variability wall based on the furthest distance the between groups. Further research is foot was able to be placed without the needed to determine whether shank- heel lifting off the ground while the rearfoot coupling variability is knee was able to touch the wall. Each modifiable with interventions such as participant performed 4 practice trials therapeutic exercise. of the ANTSEBT and 1 for the WBLT for each limb. ANTSEBT reach distance and WBLT distance were recorded in cm. In addition, all subjects performed the BESS single- limb stance test (SLBT) on a firm surface for 20 seconds. Main Outcome Measures: The mean of the

S-52 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Master Student Award Finalists Wednesday, June 27, 2012, 8:00AM-9:15AM, Room 274; Moderator: Brian Ragan, PhD, ATC 12F07MOBI 12296MONE Self-Described Differences Between leg,” respectively). Data were analyzed Fibular Reposition Taping Legs in Ballet Dancers: Do They using a multivariate repeated measures Facilitates Alpha Motoneuron Relate to Postural Stability and ANOVA. Main Outcome Measures: Pool Excitability of the Soleus Ground Reaction Force Measures? Ground reaction force(GRF) and center in Individuals with Chronic Mertz L, Docherty CL, Donahue M: of pressure(COP) measures were Ankle Instability Indiana University, Bloomington, IN analyzed separately. GRF measures Chou EA, Kim KM, Hertel J, Hart included: maximal vertical GRF JM: University of Virginia, Context: Ballet technique classes are equalized to body weight(N/kg) and Charlottesville, VA Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 designed to train dancers symmetrically time to maximal vertical GRF(sec). but they may actually create a lateral COP measures included: anterior- Context: Arthrogenic muscle inhibition bias. Dancers are aware of this posterior sway(cm), medial-lateral (AMI) has been observed in patients possibility and oftentimes claim to sway(cm), total COP excursion(cm), with chronic ankle instability (CAI). AMI sense differences between their legs. It and average COP velocity(cm/s). prevents complete muscle activation, is unknown if dancers actually are Results: No significant differences and may impede rehabilitation or streng- functionally asymmetrical or how the were identified between the preferred thening efforts. Therefore, intervention dancer’s perceived imbalances between and non-preferred leg in any of the strategies aimed at resolving AMI in legs manifest themselves. Presently, analyses (p>.05). Specifically, there individuals with CAI may have high there are no studies focusing on was no difference between the leg that clinical impact. Fibular reposition tape functional asymmetry of dancers’ legs was perceived stronger compared to the (FRT) has been described as a method that measure balance or ground reaction one that was not (p=.56, maximal GRF used to improve outcomes in patients forces. Objective: To examine ballet for preferred leg=2.32±0.31N/kg vs with ankle sprains. The influence of FRT dancers’ lateral preference through non-preferred leg=2.26±0.38N/kg; on soleus and peroneus longus muscle analyzing their postural stability and time to maximal GRF for preferred function in patients with CAI is ground reaction forces in fifth position leg=0.13±0.02s vs non-preferred unknown. Objective: To compare when landing from dance-specific leg=0.12±0.02s). Additionally, there soleus and peroneus longus muscle jumps. Design: Descriptive laboratory was no difference between the leg that function after the application of FRT study Setting: Research laboratory. was perceived to have better balance in individuals with CAI. Design: Patients or Other Participants: Thirty compared to the one that did not (p=.23, Crossover. Setting: Laboratory. public university ballet majors AP Sway for preferred leg= Patients or Other Participants: volunteered to participate (23 females, 9.46±2.67cm vs non-preferred leg= Twelve subjects with CAI (3 males, 9 7 males; age: 19.6±1.1yrs.; height: 8.28±2.84cm; ML Sway for preferred females; age=21.5±1.6 years; height 169.7±8.7cm; weight: 55.2±8.7kg). All leg=11.52±4.16cm vs non-preferred =173.8±10.4cm; mass= 72.8±16.3kg) subjects had no pre-existing conditions leg=12.06±4.47; COP Length for participated. Interventions: All or injuries that would interfere with preferred leg=61.93±9.02cm vs non- subjects underwent two intervention jumping or balancing ability. Inter- preferred leg=63.48±10.13cm; COP sessions on different days at least one ventions: Subjects wore ballet Velocity for preferred leg=6.55 week apart. During each session, we technique shoes and performed ±0.89cm/s vs non-preferred leg=6.77 performed 2 baseline measures spaced fundamental ballet jumps with one- ±0.99cm/s). Conclusions: Interpre- 5-minutes apart. Peak Hoffmann reflex tation of our results indicates that footed- and two-footed-landings on a (Hmax) and Motor response (Mmax) of force plate. Each subject also dancers’ reported preferences seem to the soleus and peroneus longus and completed a laterality questionnaire that be separate from their actual ability. Volitional (V) wave of the soleus were determined the dancer’s preferred GRF absorption and balance ability in recorded to establish stability of landing leg for ballet, self-identified dancers do not seem to be influenced baseline measures. Treatment (FRT, stronger leg, and self-identified leg with by: (1)which leg the dancer prefers to Sham) was applied via random better balance. The questionnaire had land with, (2)which leg the dancer feels assignment followed immediately by is stronger, or (3)which leg the dancer good day to day reliability another measure of the Hmax, Mmax, and feels has better balance. (ICC(2,1)=0.79, SEM=0.65). All data V-wave. The same examiner who was were grouped according to the blinded to treatment recorded all responses provided in the laterality outcomes, and a opaque sheet was used questionnaire and all comparisons were to blind the intervention during post- made between the leg indicated on the treatment measures. The FRT treatment questionnaire and the other leg (labeled consisted of a manual posterior glide “preferred leg” and “non-preferred of the lateral malleolus held by two Journal of Athletic Training S-53 strips of non-elastic tape around the accessory muscle activation while dependent variable. Re-sults:Knee posterior aspect of the ankle. The sham measuring knee extension torque. extension torque (VI= 2.87±0.93Nm/kg, session used the same tape Objective:To compare quadriceps, PP= 3.40±1.12Nm/kg, P<0.001) and configuration without posterior directed hamstring and lumbar paraspinal quadriceps CAR (VI=84.1±12.0%, force. Individual 2x3 (Intervention X electromyographic (EMG)activation PP=90.2±9.9%, P<0.001) were Time) ANOVAs with repeated measures during the superimposed burst significantly greater in the participant followed by post hoc paired t-tests were technique with and without technique preferred when compared to the verbal performed for statistical analysis. Main based instruction. Design:Crossover, instruction technique. Lumbar

Outcome Measures: The Hmax/Mmax controlled laboratory study. Setting: paraspinal EMG was significantly ratios of the soleus and peroneus longus Laboratory. Patients or Other greater (VI=6.4 ±8.5%, PP=11.9±14.9%, were calculated to represent alpha Participants: Twenty-five healthy, P=0.04) in the participant preferred

motoneuron pool excitability. The V/ recreationally active men and women technique when compared to verbal Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021

Mmax ratios of the soleus were computed (age= 23.8±3.4yr, height= 72.7±14.5cm, instruction technique, howeverthere to indicate volitional activation during a mass= 175.3±9.6kg).Interventions: were no differences in quadriceps EMG maximal isometric soleus contraction. Superimposed burst testing was activation (VI=80.0±81.1%, PP=76.2± Results: There was a significant conductedunder two testing conditions. 79.3%, P=0.65) or hamstring EMG intervention X time interaction for During the participant preferred activation (VI=22.4±16.4%, PP= soleus Hmax/Mmax ratio (F2,22 =3.53, technique (PP), participants were 22.0±19.2%,P=0.58). Conclusions:

P=0.047) and pero-neus longus Hmax/ permitted to use whatever means they Greater knee extension torque and

Mmax ratio (F2,22 =8.07, P=0.002) but not wanted in order to achieve maximal higher CAR values in the PP method for the soleus V/ Mmax ratio (F2,22 =0.99, knee extension torque. Participants may be related to higher EMG activity

P=0.39). The soleus Hmax/Mmax ratio was were allowed to alter trunk angle in the lumbar paraspinals. The use significantly higher after FRT (flexion, extension, and side-bending) ofverbal instruction during the

(Pre=0.53±0.18, Post=0.59±0.17, t11= and grip the stabilizing handles on the superimposed burst technique provides -3.7, P=0.004), but not after Sham taping dynamometer chair without anyfeed- a standardized method for collecting (Pre=0.55±0.21, Post=0.53 ± 0.18, back from the investigator. During the knee extension MVIC and quadriceps t11=1.7,P=0.12). Peroneal Hmax/Mmax verbal instruction technique (VI), CAR data with reduced hamstring and ratio was higher after FRT taping verbal instructions directedthe lumbar paraspinal muscle EMG (Pre=0.22±0.12V, Post=0.25±0.13V, participant to focus on quadriceps activation but without reducing t11=-1.9, P=0.09) but did not reach contraction, maintain upright posture quadriceps EMG activation. statistical significance. Peroneal h:M with appropriate contact between trunk ratio was not different after sham taping and back of the chair, and to exhale 12F16MOSP (Pre=0.33±0.23V, Post= 0.30±0.21V, while contracting.Main Outcome The Effect of Game Penalties on Head Impact Biomechanics in College t11=1.4, P=.20). Conclusions: FRT was Measures: Knee extension maximal Football Players found to increase the soleus Hmax:Mmax volitional isometric contraction ratio, but not the peroneus longus (MVIC) torque, quadriceps CAR and Ocwieja KE, Mihalik JP, Marshall SW, Guskiewicz KM: University of North Hmax:Mmax ratio and the soleus V/Mmax mean root mean square EMG of vastus ratio. These results suggest FRT may be lateralis, biceps femoris, and lumbar Carolina, Chapel Hill, NC an effective modality in disinhibiting paraspinal muscles.CAR was AMI in the soleus for individuals with measured using the SIB technique. Context: Rule changes in college CAI. While participants performed a knee football over the years have been extension MVIC, an electrical stimulus established to help protect athletes 12282MONE was triggered causing a transient from serious injury. Spearing and head- Muscle Activation during the increase in torque known as SIB to-head contact penalties are designed Quadriceps Superimposed Burst torque. Mean MVIC torque was to prevent unnecessary head trauma in Technique measured for the 100ms time epoch college football. To date, objective Roberts D, Kuenze CM, Saliba SA, prior to the SIB and normalized to body quantitative biomechanical measures Hart JM: University of Virginia, mass. Quadriceps CAR was calculated supporting these rules have been Charlottesville, VA as (MVIC/SIB)*100.Averagelumbar reported. Objective: To evaluate the paraspinal, vastus lateralis and biceps effect of penalties on head impact Context:The superimposed burst femoris root mean square EMG biomechanics in college football technique is commonly used to measure activity was measured during the same players. We hypothesized head-related the extent of quadriceps activation via time epoch used to measure knee infractions would result in higher head the central activation ratio (CAR). extensiontorque and normalized linear acceleration, rotational However, CAR has been reported to resting EMG.Five separate paired acceleration, and severity profile overestimate true quadriceps samples t-tests were used to analyze measures. Design: Quasi-experimental activation. This is possibly due to differences between conditions for each prospective cohort. Setting: Field S-54 Volume 47 • Number 3 (Supplement) May 2012 setting. Patients or Other collisions result in higher linear maintenance.After the season Participants: Forty-six Football acceleration and HITsp compared to facemasks were removed; screws were Bowl Subdivision football players legal collisions. Furthermore, removed with a cordless screwdriver participated in our study approximately 1 in 20 collisions result and Quick Release™ mechanismswere (age=20.2±1.3yrs;height= 190.0±6.3 from a spearing, head-to-head contact, removed with a Quick Release™ tool. cm; mass= 106.6±18.8 kg). Inter- and/or facemask penalty. Our results Data collectors were blinded to the ventions: Participants were equipped support the importance of strictly helmet group during face-mask removal. with accelerometer-instrumented enforcing playing rules, and further lend Main Outcome Measures: Dependent helmets (Head Impact Technology support that existing rules are in place variables were hardware and face-mask System) to collect head impact to protect the athlete from needless removal success rateand time biomechanics during all games in a head injury. These data are equally (seconds). Face-masks that could not

single playing season. Multiple camera important to guide athletes to understand be removed within a minute were Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 views were synchronized with the head the ramifications of their actions while recorded as failures, and the impact data. We evaluated all viewable playing, and for coaches to emphasize contributing hardware was noted. An collisions (N=2345) using a proper tackling techniques and skill independent sample Chi-Square was standardized criteria rubric. Collisions development with their players. used to compare removal success rates were assigned as legal collisions or between the groups and variables. head-related infractions, which 12219MOEM Timewas assessed with separate one- included spearing, head-to-head The Effect of Maintenance on way Analysis of Variance. Results: contact, and/or facemask. Main Hardware Removal Success in Overall hardware removal success was Outcome Measures: Dependent Used Football Helmets significantly higher in the maintenance variables included head linear Burroughs SM, Douglas AM, Hickey group (98.9%, 512/520) than the control acceleration (measured in terms of MP, Sefton JM: Auburn University, group (89.6%, 448/500;χ2(1) = 40.634, p< gravity, g, force), head rotational Auburn, AL; Umatilla High School, .001). Quick Release™ mecha- acceleration (rad/s2), and the Head Umatilla, FL; University of Michigan, nisms(χ2(1) = 4.726, p = .03) and screws Impact Technology severity profile Ann Arbor, MI (χ2(1) = 39.268, p< .001) in the maintenance (HITsp). The HITsp is a unitless group had a significantly higher removal composite measure factoring in linear Context:The recommended method of success than the control group. Face- acceleration, rotational acceleration, removing the face-mask from the mask removal success was also Head Injury Criterion, Gadd Severity football helmet of an athlete with a significantly higher in the maintenance Index, and impact location. Data were suspected cervical spine injury is to first group (95.38%, 124/130) than the control analyzed using separate random attempt to remove its attaching group (68%, 85/125; χ2(1) = 32.322, p< intercepts general mixed linear models hardware. Hardware removal failures .001). The mean removal time of the 209 for each dependent variable, occur in used helmets, yet there is no successful trials was 23.32 ± 7.64 seconds incorporating each individual player as research investigating prevention of with no difference between groups. The a repeating factor in the analyses. Only these failures. Objective: To determine mean number of exposures (practices or head impacts exceeding 10 g were the effect of maintenance on the games) between maintenance and face- included in our analyses. Results: removal success rate of screws and mask removal was 10.67 ± 2.34 exposures. Penalties involving head contact were Quick Release™ mechanisms and Conclusions:Hardware maintenance observed in 4.5% (106 of 2345) of all removal time of face-masks from high increased the likelihood that the hardware football collisions. Overall, head school football helmets that have been could be removed. Although there were collisions which should have resulted used for one or more seasons of differences in screw removal success in penalties (31.4 g; 95% CI: 27.5- play.Design: Cross-sectional. Setting: between schools and helmet model within 35.9) had higher linear accelerations Field Study. Participants: 255 football the control group, screws in the than legal collisions (24.1 g; 95% CI: helmets from seven high school teams maintenance group were unaffected by

23.4-24.8) (F2,36=11.26; P<0.001). in Alabama, USAused for a season or school or helmet model. Thus, our Likewise, these head-related more of play;total of 510screws and 510 maintenance procedure increased the collisions (18.5; 95% CI: 16.2-21.1) Quick Release™ mechanisms .Inter- removal success rate of all hardware resulted in higher HITsp measures than vention:The helmets were divided into despitethese influencing factors. the legal collisions (15.1; 95% CI: maintenanceand control groups (130 14.6-15.6) we observed in our study and125 helmets respectively). The

(F2,36=5.01; P=0.012). No significant maintenance grouped received mid- differences in rotational acceleration season maintenance consisting of between legal collisions and head- functionally testing hardware, cleaning related collisions were observed in our allhardware with soap and water, study (F2,36=2.13; P<0.133). Con- andreplacing hardwareas needed. The clusions: Penalties involving head control group helmets received no Journal of Athletic Training S-55 Free Communications, Oral Presentations: Doctoral Student Award Finalists Wednesday, June 27, 2012, 9:30AM-10:45AM, Room 274; Moderator: Brian Ragan, PhD, ATC 12F17DOBI 12286DONE Effects of Chronic Ankle Instability energy dissipation was reported as the Lower Extremity Neuromuscular on Energy Dissipation in the Lower percentage of energy dissipation by Function in Healthy and ACL Extremity each joint over the total energy Reconstructed Individuals Terada M, Pfile KR, Pietrosimone dissipation of all three joints; the ankle, Following a Sub-maximal BG, Gribble PA: University of knee, and hip. The control participants Exercise Protocol Toledo, Toledo, OH were matched by demographic Kuenze C, Hertel J, Hart JM: information with CAI participants, and University of Virginia, Context: Inadequate energy atten- designated a matched limb for data Charlottesville, VA Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 uation capability of the lower extremity analysis. Independent t-tests were joints during landing may influence used to assess differences in each Context:Persistent quadriceps weak- lower extremity injury risk by increasing dependent variable between the CAI ness due to arthrogenic muscle stress placed on static stabilizers. and control groups. Cohen’s d effect inhibition(AMI) has been reported Previous investigations have sizes with associated 95% confidence following anterior cruciate ligament demonstrated alterations in lower interval (CI) were calculated using (ACL) reconstruction. The effects of extremity kinematics and kinetics of the pooled standard deviations. exercise on lower extremity function in patients with chronic ankle instability Significance was set a priori at P<.05. the presence of quadriceps AMI may (CAI). However, energy dissipation Results: The CAI group demonstrated result in neuromuscular adaptations. patterns in the lower extremity have not significantly less percentage of knee Objective: To compare quadriceps been investigated in CAI patients. energy dissipation (CAI=18.65±9.57%, neuromuscular function after exercise

Understanding energy dissipation control =27.25± 16.09%, t36=-2.00, in patients with ACL reconstructed strategies in the lower extremity may P=0.05, d=-0.65, 95% CI: -1.29, 0.02) and knees and healthy matched controls. assist in the development and higher percentage of ankle energy Design:Controlled laboratory study. implementation of more effective dissipation (CAI=54.18±18.91%, control Setting: Laboratory. Patients or Other intervention protocols to modify =40.87 ±18.98%, t36=-2.16, P=0.03, Participants: Fifty-two recreationally alterations in the kinetic-chain d=0.70, 95% CI: 0.03, 1.34) of the total active persons volun-teered to relationship related to CAI. Objective: energy dissipation during the 100ms participate, 26 had a history of To investigate the influence of CAI on immediately following IC compared to unilateral, primary ACL recons-truction energy dissipation patterns in the lower the control group. No significant at least 6 months prior (age=24.2± extremity during a stop-jump task. differences for energy dissipations 4.9yrs, height =171.0± 11.4cm, Design: Case-control study. Setting: were found between groups at any of mass=71.2±12.6kg, 39.2± 44.7 months Research laboratory. Patients or Other the joints during the 50ms and 200ms since surgery) and26 age and gender Participants: Nineteen participants intervals. Conclusion: We found matched controls (age=24.3±4.3yrs, with self-reported CAI (9M, 10F; altered energy dissipation patterns at height =171.9 ±10.3cm,mass=70.9± 20.21±1.69 yrs; 176.12±9.39 cm; the knee and ankle during a stop-jump 13.2kg). Interventions:All participants 73.72±16.75 kg), and 19 healthy control task in the CAI group. These findings performed 30 minutes of continuous participants (9M, 10F; 21.11±4.00 yrs; may provide insight into kinetic exercise involving 5 repeated cycles of 170.51±9.12 cm; 70.86±15.15 kg) alterations that may be associated with aerobic and anaerobic exercises. Each volunteered. Interventions: Partici- CAI. Future research should consider cycle consisted of 5 minutes of uphill pants performed 5 double-leg vertical this information as it may be used to walking (aerobic) and 1 minute of body stop-jump tasks onto a force plate. develop more effective interventions weight squatting and step-ups Kinetics and kinematics were examined to target these potentially modifiable (anaerobic). Main Outcome Measures: with an electromagnetic tracking energy dissipation patterns in those Normalized knee extension maximal system interfaced with a non- with CAI. Supported by the NATA voluntary isometric contraction (MVIC) conductive force plate. Main Foundation Master’s Grant Program. torque, quadriceps central activation Outcomes: Lower extremity joint ratio (CAR), soleus H-reflex and V-wave energy dissipations were calculated for before and after exercise. CAR was the hip, knee, and ankle in the sagittal measured using the superimposed burst plane during 50ms, 100ms, and 200ms technique (SIB). While participants after initial contact (IC) with the force performed maximal isometric knee plate. Energy dissipation values were extension, an electrical stimulus was normalized to the product of body mass triggered causing a transient increase and height (J/N·m). Individual joint in torque (SIB).CARwas calculated as contribution to total lower extremity (MVIC/SIB)*100.H-reflex was S-56 Volume 47 • Number 3 (Supplement) May 2012 12105DODI collected at rest while prone, soleus Examining Morphological Changes group, the number of previous ankle V-wave was collected during a of the Anterior Talofibular Ligament sprains ranged from 1 to 3. Thickness of maximal isometric soleus con- in Health and Previously Sprained the ATFL of the unilateral sprained group traction; both were normalized to peak Ankles ranged from 1.6 mm to 3.3 mm. There was M-response.Four separate inde- Liu K, Gustavsen G, Kaminski TW: a significant difference (p=0.003) in ATFL pendent samples t-tests were used to University of Delaware, Newark, DE thickness of the never sprained ankles analyze pre-exercise differences (2.1mm±0.4mm) compared to previously between groups. Repeated measures Context: Lateral ankle sprains (LAS) are sprained ankles (2.4mm±0.5mm). The 2X2 ANOVA was used for statistical among the most common injuries in previously sprained ankles had a analyseswhilepercentage change(90% sport. The anterior talofibular ligament significantly thicker ligament than the ankles that have never been sprained. Additional confidence intervals) were used to (ATFL) is most susceptible to damage Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 compare the within group effect of during a LAS. While it is understood analysis resulted in no difference in the exercise.Results:Prior to exercise, that following a LAS, scar tissue forms thickness of the ATFL between the 22 ankles healthy participants had significantly within the ligament, little is known about of the never sprained group and the 17 never greater knee extension torque (ACL- the morphological changes in a ligament sprained ankles for the unilateral sprained R= 2.59±0.68Nm/kg; Healthy= 3.35± injury. Objective: To examine if scar group. Conclusions: Since no difference in 0.84Nm/kg, P= 0.001), quadriceps tissue formation increases the ATFL thickness is present prior to injury, it CAR (ACL-R= 75.2±13.4%; Healthy= thickness of the ATFL in those with a can be concluded that morphological 88.0±7.2%, P<0.001), and soleus VM history of an ankle sprain. Design: changes occur in the ATFL after injury. Scar ratio (ACL-R= 11.0±11.2%; Healthy= Within subject, cross-sectional study. tissue formation increases the thickness of 19.1±12.6%, P= 0.02) than ACL-R Setting: Athletic Training Research the ligament. The presence of scar tissue participants.There was a significant Laboratory. Patients or Other Partici- weakens the ligament by reducing its group x time interaction for knee pants: Twenty-eight Division-I toleration for high loads. Therefore, in

extension torque (F(1,50)= 11.16, P= collegiate athletes (18 females, 10 males, addition to the standard rehabilitation after

.002), quadriceps CAR (F(1,50)= 5.01, age=18.7±0.9 yrs., height=173.3±11.4 m, a LAS, clinicians need to emphasize

P= .03), and soleus V:M ratio (F(1,50)= mass=71.8±18.6 kg) participated in this interventions that lessen scar tissue formation 5.331, P= .03). The effect of exercise study. Seventeen subjects presented within the ligament as a part of the was smaller for the ACL-R group when with a history of unilateral ankle sprains rehabilitation process. compared to matched controls for while 11 subjects had never sprained 12269DOIN knee extension torque [ACL-R: %Δ= either ankles. Interventions: Each A Descriptive Analysis of Bone - 4.2 (-8.7,0.3); Healthy: %Δ= -14.2 participant reported the number of Bruise Presence and Severity Based (-18.2, -10.2)], quadriceps CAR sprains for each ankle. Measurements on Location for Patients with Acute [ACL-R:%Δ=-5.1 (-8.0.-2.1); Healthy: for thickness of the ATFL were obtained Knee Injury %Δ = -10.0 ( -13.3,-6.7)], and soleus using musculoskeletal ultrasound. An Hoch JM, Montgomery J, Johnson VM ratio [ACL -R: %Δ= 37.6 image of the ATFL can be viewed using DL, Mattacola CG, Lattermann C: (2.1,73.0); Healthy: %Δ= -24.9 musculoskeletal ultrasound while a University of Kentucky, Lexington, (-38.6,-11.3)]. Conclusions: Patients built-in measuring toll quantifies the KY with ACL-R experienced a different thickness of the ligament. Thickness response to standardized exercise than was measured at the midpoint of the healthy controls. The declines in ligament between the attachments on Context: Bone bruise lesions (BBL) are quadriceps and soleus volitional the lateral malleolus and talus. commonly documented on MRI muscle function were of lower Measurements were taken from each following acute knee injuries. It has magnitude compared to healthy ankle. A paired t-test (p≤0.05)was been hypothesized that alterations to matched controls. This response conducted comparing thickness acute knee ligament injury treatment suggests an adaption experienced by measures of each ankle within the same algorithms should be modified for patients with quadriceps AMI that may subject. Main Outcome Measures: patients with severe BBL. BBL are act to maintain lower extremity History of ankle sprain served as the often not described either in the function during prolonged exercise. independent variable, while the literature or on MRI reports based on This may be due to the presence of dependent variable was the thickness severity. Therefore, before treatment quadriceps muscle dysfunction of the ATFL of both ankles. Results: modifications can be considered, a following ACL-R. For the never sprained group, ATFL better understanding of the presence, thickness ranged from 1.1 mm to 2.6 location, and frequency of severe BBL mm. There was no difference in ATFL in the presence of acute knee ligament thickness between the left and right injury is required. Objective: Our main ankles (p=1.00; L: 1.9mm±0.2mm; R: objective was to present descriptive 1.9mm±0.4mm). For the unilateral sprained statistics of BBL presence and severity Journal of Athletic Training S-57 based on location for patients with acute determine if changes to current (baseline), prior to the first intervention knee ligament injury. Design: Cross- treatment algorithms are necessary. session (pre-intervention), 24-hrs sectional. Setting: Orthopaedic clinic. following the final intervention session Patients or Other Participants: Twenty- 12375DOTE (post-intervention), and 1-wk following the eight subjects (19 males, 9 females, age: A 2-Week Joint Mobilization intervention (follow-up).Separate one-way 21.7+9.2years, height:175.1+12.7cm, Intervention Improves Self- ANOVAs examinedchanges in DROM weight:80.8+22.1kg) participated.. Reported Function, Range of (cm), normalized reach distance on the Subjects had an MRI documenting acute Motion, and Dynamic Balance anterior direction of the SEBT(%), and the knee ligament injury (cruciate or in Those with Chronic Ankle FAAM-S(%).The independent variable collateral ligaments) and an orthopaedic Instability wastime (baseline, pre-intervention, post- physician evaluation <4 weeks following Hoch MC, Mullineaux DR, Andreatta intervention, follow-up). Post-hoc depen- RD, Mattacola CG, English RA,

injury. A total of 1 PCL, 1 MCL and dent t-tests were calculated in the presence Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 26 ACL injuries were included. McKeon JM, McKeon PO: Old of significant time effects. Alpha was set Interventions: Each MRI was reviewed Dominion University, Norfolk, VA; at p ≤0.05 for all analyses. Results: by a musculoskeletal radiologist who was University of Lincoln, Lincoln, Significant time effects were detected for blinded to the subject’s clinical England; University of Kentucky, the FAAM-S (p=0.001), DROM (p presentation. For each subject, the Lexington, KY <0.001), and anterior reach distance number of BBL were identified and lesion (p<0.001). Post-hoc comparisons location was documented (medial femoral Context:A single joint mobilization (JM) determined that there were significant condyle (MFC), lateral femoral condyle treatment produced modest gains in changesfrom baseline topost-intervention (LFC), medial tibial plateau (MTP), and dorsiflexion range of motion (DROM)but measures for the FAAM-S (baseline: lateral tibial plateau (LTP)). Main no improvements in dynamic balance in 56.3±14.7, post-intervention: 73.7±17.7; Outcome Measures: BBL severity was individuals with chronic ankle instability p=0.01), DROM (baseline: 10.9±3.7, post- determined using the Costa-Paz (CAI). Examining the effects of multiple intervention: 12.2±3.7; p<0.001), and Classification (CPC) system (grade 1, 2, JMtreatments on DROM and dynamic anterior reach (baseline: 75.1±5.9, post- or 3). Frequencies were calculated for balanceas well asself-reported function intervention: 78.3±5.6; p=0.001),pre- BBL severity and presence based on would further elucidate the clinical interventionto post-intervention measures location. Percentages for each grade are application of JMin CAI rehabilitation. for the FAAM-S (pre-intervention: presented. Results: A total of 60 BBL Objective:To examine the effect of a 58.6±11.1; p=0.01), DROM (pre- were identified, with 37% occurring on 2-wk talocrural JMintervention on intervention:10.8±3.9cm; p<0.001), and the LTP, 30% occurring on the LFC, and DROM, dynamic balance, and self- anterior reach (pre-intervention:76.2±5.8; the remaining 33% occurring on the MFC reported function in adults with CAI. p=0.001), baseline to follow-up measures and MTP. A total of 40 (68%) BBL were Design:Repeated-measures. Setting: for the FAAM-S (follow-up:74.2±18.9; grade 2, 12 (20%) were grade 3, and 7 Laboratory. Participants: Twelve p=0.01), DROM (follow-up:12.3±3.6; (12%) were grade 1. For grade 1, 43% adults (6 Males, 6 Females; age =27.4±4.3 p<0.001), and anterior reach (follow- were located on the LTP, 29% were years; height= 175.4 ±9.7cm; mass up:78.7±4.9; p=0.001), and from pre- located on the MFC, 14% were located =78.4±11.0kg) with self-reported chronic interventionto follow-up measures for the on the LFC and MTP. For grade 2, 38% ankle instability (CAI) volunteered to FAAM-S (p=0.01), DROM (p<0.001), and were located on the LTP, 33% were participate. Subjects reported a history of at anterior reach (p=0.001). There were no located on the MTP, 23% were located least one ankle sprain, two episodes of ankle changesbetween baseline and pre- on the LFC, and 8% were located on the “giving way” in the past three months, and intervention measures or betweem post- MFC. For grade 3, 67% were located on Foot and Ankle Ability Measure-Sport intervention and follow-up measures for the LFC and 33% were located on the (FAAM-S)scores of ≤ 80%. Interventions: the FAAM-S, DROM, or anterior reach (all LTP. Conclusions: Previous docu- The JMinter-vention consisted of 6 p’s>0.05). Conclusions: The 2-wk mentation of BBL outcomes lacked treatment sessionsover 2 wks in which JMintervention which targeted the identification of the severity of lesions. subjects received 2, 2-min sets of Maitland extensibility of posterior ankle Following acute knee ligament injury, Grade-II talocrural traction and 4, 2-min sets noncontractile structures resulted in a majority of BBL were grade 2. The of Maitland Grade-III anterior-to-posterior significant increases in self-reported most severe BBL (CCP grade 3) were talocrural JM. Main Outcome Measures: function, DROM, and dynamic balancein located primarily on the LFC and the DROM was measured using the weight- subjects with CAI. Therefore, addressing LTP, which is also were BBL are most bearing lunge test, dynamic balance was local impairments in ankle mechanics commonly identified on MRI. Based on assessed with the anterior direction of enhanced patient-oriented and clinician- these findings, future research should theStar Excursion Balance Test (SEBT), oriented measures of function in adults determine if BBL location and severity and self-reported function was documented with CAI. influence patient outcomes in order to with the FAAM-S. These assessments were measured 1-wk before the intervention

S-58 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Clinical Educators’ Influence on Student Development Wednesday, June 27, 2012, 11:00AM-12:00PM, Room 274; Moderator: Paul Geisler, EdD, ATC 12047DOPE 12073MOPE Instilling Foundational Behaviors gathered through an expert-piloted Clinical Preceptors’ Perspectives of Professional Practice in qualitative survey administered via on Clinical Education in Post- Undergraduate Athletic Training Survey Monkey. Focus groups and Professional Athletic Training Students: A Grounded Theory individual interviews were utilized as Education Programs Study member checking after coding of the Phan K, Welch CE, Mutchler JM, O’Brien CW, Keller DW: Seton Hall data. Individuals for these focus groups Van Lunen BL: University of Charleston, Charleston, WV; Old University, South Orange, NJ; and interviews were selected from a Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Marywood University, Scranton, PA convenience sample of research Dominion University, Norfolk, VA participants who indicated interest at Context: There is significant lack of the end of the initial survey. Data was Context: Clinical education (CE) in post- research on how educational programs coded in the tradition of Corbin professional athletic training education are instilling the behaviors from the and Strauss (2008), encompassing is an important aspect to advance Foundational Behaviors of Pro- microanalysis (open and axial coding). clinical knowledge and skills of fessional Practice in their students. Integration of the coded data (selective graduate students. However, little Objective: The purpose of this study coding) was utilized to refine research has been done to assess the was to investigate the implementation categories and link them to a core factors involved in progressing of the Foundational Behaviors of category. This lead to the development graduate students as clinicians. Professional Practice in undergraduate and refining of the emergent theory. Exploring the perspectives of clinical athletic training education program Member checking, reflexivity, and an preceptors (CP) will help to understand curriculums accredited by the external auditor were utilized as what is essential to post-professional Commission on Accreditation of methods of verification. Results: The CE. Objective: To qualitatively Athletic Training Education [CAATE]. core category of student mentoring investigate themes relating to the The researchers specifically intended: through modeling emerged due to its perspectives and experiences of CPs to discover which strategies are being ability to link the emergent categories regarding CE within post-professional utilized by programs in educating and of approved clinical instructor, athletic training education programs in assessing athletic training students program director, and faculty (PPATEP). Design: Consensual in these behaviors; todescribe the instructors. The implicit curriculum qualitative research was used as the confidence of individuals in their emerged as playing a greater rolewhen main approach to explore CPs’ abilities to effectively teach and to instructors instilled their students with experiences regarding CE. An effectively assess these behaviors the behaviors than the explicit emergent design was applied to the within the curriculum to athletic curriculum. Approved clinical semi-structured interview protocol to training students; and to discover if instructors (ACIs)had the greatest allow for flexibility in accordance with individuals responsible for teaching influence on student mentoring emerging results. Randomized and these behaviorsto athletic training through modeling. There was high criterion sampling were utilized to students agree with the current CAATE confidence in program director and solicit participants for the study. Each philosophy of assessment of those faculty ability to mentor through participant had to be currently assigned behaviors. Design: The researchers modeling and variable confidence in as a CP to at least one PPATEP student utilized the qualitative tradition of ACIs ability to mentor through and be employed in their current setting grounded theory. Setting: Institutions modeling. Conclusions: Embedded in for at least 3 years. Setting: Individual that sponsor undergraduate CAATE- this study is the generated grounded phone interviews. Patients or Other accredited programs. Patients or Other theory that student mentoring through Participants: Eleven collegiate CPs (7 Participants: The researchers recruited modeling by approved clinical males, 4 females; age=38±7.3 years; 346 program directors of undergraduate instructors (ACIs) is most critical for years of athletic training experience CAATE-accredited programs through instilling students with the behaviors =15±6.6 years) were interviewed. electronic communication. It was the that comprise the common values of These participants represented eleven goal of the researchers to attain a the athletic training profession. of the sixteen PPATEPs. Data minimal response rate of 10% in order Collection and Analysis: Interview to satisfy the anticipated threshold of transcripts were coded for themes data saturation. This was exceeded with regarding CE at the post-professional a response rate of 26.3% (N=91).Data level. Themes were established based Collection and Analysis: Data was on a consensus process by a 3-person

Journal of Athletic Training S-59 12166FOPE research team. Each research team Evaluating Culminating Clinical examples of how their ACI was a member independently coded the Education Experiences of Senior positive or negative role model and/or data and created a comprehensive Athletic Training Students mentor.We analyzed the data using codebook. The research team then met Aronson PA, Bowman TG: Lynchburg Atlas.ti (version 6.6.15, Atlas.ti GmbH, as a group to discuss and formulate a College, Lynchburg, VA Berlin,Germany)following the principles consensus codebook that appropriately ofa grounded theory approach. We represented the data. To increase Context: Previous research has negotiated over the coding scheme until the trustworthiness of the data, investigated the socialization process of we reached agreement, performed a peer triangulation occurred through using Athletic Training Students (ATSs) debrief, and conducted member checks multiple randomized participants, an during clinical educationand the causes to ensure trustworthiness of the auditor, and member checking. of frustration which develop during results. Results:Three major themes Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Results: Four themes emerged from those clinical education experi- emerged from the data explaining why this investigation: importance of CE, ences.ATSs identify Approved Clinical our participants had overwhelmingly CP responsibilities, CP qualities, and Instructors (ACIs) as mentors and positive culminating clinical education barriers to CE. CPs expressed that CE qualities that allow ACIs to be effective experiences. ATSsenjoy interacting was important for enhancing clinical mentors have also been determined. with clinical instructors who act as skills beyond the entry-level as well as However, the perceptions of ATSs appropriate professional role models. providing opportunities to become regarding their clinical education This theme emerged in several different more comfortable making daily clinical experiences are not fully understood. capacities: preserving appropriate decisions regarding patient care. CPs It is important to investigate ATS professional rapport, demonstrating also conveyed that the role of an perceptions to allow athletic training competence and clinical skills, and effective preceptor involves several educators to provide clinical education through effective communication. Our fundamental responsibilities (eg., experiences that will maximize participants also found value in being promoting autonomy, individualizing learning.Objective: To determine the able to develop their clinical skills with goals & objective) and qualities (eg., perceptions of senior ATSs regarding appropriate situational supervision. student-centered mentoring, exper- their culminating clinical education Finally, ATSs appreciate when ACIs ience, interpersonal skills). Finally, CPs experiences. We were particularly teach them new information by identified several challenges (eg., interested in gaining an understanding stimulating their critical thinking multiple demands, CPs’ lack of time, of senior ATSs as they prepare for skills. Conclusions:To help provide a disconnect between didactic-clinical professional practice.Design: We positive learning environment for collaboration) that impose CE at the used qualitative methods to gain rich senior ATSs, athletic training post-professional level. Conclusions: descriptions of senior ATSs’ administrators should select ACIs who To foster an environment where a perceptions of their final clinical can successfully model professional graduate student can effectively education experience. Setting:Com- responsibilities, presentATSs with develop and build on their entry-level mission on Accreditation of Athletic authentic learning experiences, clinical skills, preceptors should create Training Education (CAATE) ac- andpromote higher-level thinking. We an effective learning environment that credited entry-level Athletic Training believe providing ATSs with exposure provides a balance of autonomy and Education Program (ATEP). Patients or to ACIs who can meet these criteria may supervision. Preceptors should also Other Participants:Eighteen (13 alter persistence decisions and should demonstrate attributes of a clinician, female, 5 male; age=21.68±.89) ATSs be a goal of clinical experiences for all educator, and communicator to be an enrolled in their final year of coursework ATSs. effective mentor to a graduate student. who were completing their culminating Future research should investigate clinical education experience PPATEP students’ perspectives to volunteered to participate. Participants identify aspects of CE that should be came from one CAATE accredited ATEP emphasized and integrated to enhance in the mid-Atlantic region.Data CE at the post-professional level. Collection and Analysis: We asked seniors to evaluate their culminating clinical education experience by completing an open-ended question- naire. Specifically, we asked the participants to explain how they learned the most from their ACI, to describe a situation where their ACI taught them a valuable skill or lesson, and to give

S-60 Volume 47 • Number 3 (Supplement) May 2012 12380FOPE Approved Clinical Instructors Interviews were transcribed verbatim appreciation for that dynamic nature if Influence on Athletic Training and shared with participants prior to they are to persist to graduation and Students’ Development of Passion analysis. Data were analyzed with a eventual professional practice. Future for the Field of Athletic Training grounded theory approach consisting of research should be aimed examining the Dodge TM, Mazerolle SM: Springfield open, axial and selective coding. mentoring practices of expert ACIs with College, Springfield, MA; University Multiple analyst triangulation and a history of assisting their students to of Connecticut, Storrs, CT member checks were included as steps develop passion and excitement for to establish data credibility. Results: athletic training. Context:The Athletic training student Mentoring was characterized by (ATS) who ispassionate and excited modeling passion for athletic training, accurate representation of professional about the field of athletic training Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 islikely to persist to graduation. practice, strong ACI/student commu- Approved clinical instructors (ACIs) nication, and providing students with are capable of exerting significant hands-on experience. Many partic- influence on an ATS, however, very ipants also indicated that two-way little is known about the methods ACIs learning was the most positive attribute utilize to help the ATS develop this pas- associated with being an ACI. However, sion.Objective:Investigate the mod- a common challenge was role strain eling behaviors of ACIs with attention created by clinical teaching and health to their representation of the realistic care responsibilities. Most ACIs aspects of working in the field of indicated that their passion for athletic athletic training.Design:An in- training stemmed from a desire to help vestigativequalitative study utilizing others and the dynamic nature of the one-on-one interviewing. Setting: field, but also indicated that the low pay Athletic Training Education Pro- scale and issues with irregular hours grams.Patients or Other Participants: made it difficult at times to Seventeen ACIs (3 males, 14 model passion for the profession. females)volunteered for this study. The Conclusions: ACIs mentor their participants had an average of 6 ±1.5 students by displaying passion for the years of experience as an ACI, and were field of athletic training and providing engaged in clinical education an them with realistic learning experiences average of 20±3 hours each week. that are aimed at accurately representing Seven of the ACIs worked at the NCAA the profession. Athletic training Division 1 level while 6 worked at the students are urged to challenge their NCAA Division 3 level. The remaining ACIs in ways that result in learning 4 worked at the high school level. opportunities for both parties. The Data Collection and Analysis: Two dynamic nature of athletic training researchers completed one-on-one, in- appears to be an attractor to the person interviews following a semi- profession, but it is a responsibility of structured format with all ACIs. the ACI to help the ATS to develop an

Educators EBF Wednesday, June 27, 2012,12:15PM-1:15PM, Room 274; Moderator: Leamor Kahanov, EdD, ATC

Journal of Athletic Training S-61 Free Communications, Case Studies: Musculoskeletal Conditions Thursday, June 28, 2012, 8:00AM-9:00AM, Room 274; Moderator: Kelli Pugh, MS, ATC 12311C 12314SC Medial Knee Pain in a Collegiate the hospital vital signs remained Bilateral Forearm Compartment Wrestler normal, white blood cell count was Syndrome in a Collegiate Rower Donovan L, Grindstaff TL, Carson reported normal, andthe synovial fluid Thomson KB, Carson E, Chhabra AB: E: University of Virginia, was cultured. The athlete received IV University of Virginia, Charlottesville, Charlottesville,VA; Creighton morphine and Toradol to control the VA University, Omaha, NE pain and was prescribed Percocet (2 tablets PRN every 4 hours) and Background: An 18-year old female Background: A 20 year-old male indomethacin (25 mg tid). On day 5, collegiate rower presented with initial Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 wrestler presented with mild left knee the athlete traveled to hishome complaints of swelling, tightness and pain that started 2 hourspost-practice, university and arrived early morning on cramping in her left forearm with high while at the national tournament. Past Day 6. Upon arrival, he was taken to intensity rowing, but symptoms resolve medical history included a left grade II the emergency department, where his within several minutes after practice. MCL sprain 8 months prior and a left knee was re-aspirated andfluidcultured. The severity of symptoms increased medial meniscus repair 2 years prior. All vital signs remained normal; with higher intensity training on the The athlete did not recall aspecific however, the erythema had spread water and on the rowing ergometer. The mechanism of injury, but described his proximally. Based on clinical consistency of the symptoms gradually knee being subjected to repetitive presentation, the attending orthopedic increased over the next two weeks valgus forces during drills. There was surgeon recommended arthroscopic including slight numbness and tingling no edema, ecchymosis, broken skin,or debridement and irrigation. During the in the hand and fingers. Upon deformity of the knee. Mild tenderness surgery,9 liters of normal saline was examination, point tenderness in both (3/10) was noted over the MCL and used to irrigate the joint, and a hemovac flexor and extensor masses, mild loss medial joint line. Range of motion was was placed in the joint. After surgery, of strength compared bilaterally, and within normal limits and pain free the athlete was placed on IV slight limitation with wrist flexion and except for full passive knee flexion. All chephazolin. On day 8, the culture extension motion were noted. knee special tests were negative except began to growstaphylococcus aureus Neurological symptoms were not the valgus stress test and McMurray’s bacteria, but the species was not yet reproducible upon examination. test were positive for pain. Differential identified. Therefore, the antibiotic was Approximately one month after initial Diagnosis: MCL sprain, medial changed to Vancomycin. Two days later symptoms occurred, the athlete meniscus injury. Treatment: The (day 10), the infection wasidentified as reported having similar symptoms in athlete was referred to the on-site methicillin susceptible staphylococcus her right forearm. No previous history physician whodiagnosed the injury as aureus (MSSA). On day 10, the athletehad of injury to either upper extremity was a mild MCL sprain. The next day, he a central catheter inserted (PICC line) in noted. Differential Diagnosis: Muscle competed in two matches, which did not the right brachial vein that extended to strain, delayed onset muscle soreness, exacerbate his symptoms. Byday4 the the distal superior vena cava, which was blood clot, compartment syndrome. pain increased to (5/10) and a small used to administer chephazolin for 6 Treatment: Initial treatment of knee effusion developed. All vital signs weeks.The athlete was discharged from symptoms included ice and were normal. The athlete was further the hospital on day 10. The athlete was premodulated electrical stimulation, examined by an on-site physician who able to return to fullparticipation after the ultrasound, and deep tissue massage diagnosed the injury as a medial PICC line was removed. Uniqueness: (Graston technique). Compression meniscus tear. The athlete was placed Most joint infections have a mechanism wraps and sleeves would temporary in a knee brace and given crutches for of whichbacteria enters through the joint diminish symptoms during activity and ambulation. By the evening, the pain capsule. In this case, there was no known partially decrease symptoms after increased substantially (10/10), a large disruption of the skin for bacteria to enter activity. After two weeks of treatment knee joint effusion developed, and the joint and the original clinical with no dramatic decrease of erythema formed over the medial knee. examination presented as a mild MCL symptoms, the athlete was referred for The athlete was referred to an on-site sprain. Conclusions: Infections may evaluation by an orthopedic surgeon. physician, who aspirated his left knee initially present as a musculoskeletal Radiographs and MRI were performed and referred him to a localhospital injury making it important for athletic to rule out any bony or soft tissue injury. emergency department. Based on the trainers to serially monitor symptoms. In EMG testing was performed to rule out evolving presentation, the differential this case, the rapid increase in pain and any neurological injury due to diagnosis changed to staphylococcus effusion was atypical for a muscu- numbness and tingling in the left hand. infection, cellulitis, gonococcal loskeletal injury. These tests were also performed on the arthritis, or herpetic arthritis. While in right arm subsequent to symptoms S-62 Volume 47 • Number 3 (Supplement) May 2012 appearing in the contralateral arm. All Surgical intervention may be a area had decreased in size and the tests were normal. Compartment consideration if all conservative diagnosis of stress fracture was made, testing was then performed bilaterally. measures have failed. Rowing as the physician felt that an Osteoid Pre-exercise compartment values were technique should also be evaluated as Osteomawould not have begun to elevated in the following compart- a potential cause of increased grip force resolve on its own that quickly.A bone ments: bilateral superficial volar, right placed on the handle by the athlete. scan completed in early October deep volar, right compartment with Wad confirmed stress fracture diagnosis and of Henry (brachioradialis, extensor carpi 12238MC revealed similar asymptomatic “hot radialis brevis, and extensor carpi Atypical Tibial Stress Fracture spots” in his other leg. The athlete radialis longus). The athlete was then In A Male Collegiate Track and underwent surgery in late October. The placed on an ergometer and asked to Field Thrower size of the affected area was so large Keeler JP, Culton AP, Games KE,

perform a 2,000-meter test at maximal that an intramedullary rod was placed Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 effort. Testing was stopped once peak Sefton JM: Auburn University, vertically down the length of the tibia symptoms were reproduced. Post- Auburn, AL; United States Naval to encourage union since it had not exercise compartment values were Academy, Annapolis, MD resolved in the three months of immediately evaluated. Values were conservative treatment.Uniqueness: elevated in the following compart- Background: A 21 year-old junior male Tibial stress fractures more commonly ments: bilateral superficial volar, track and field javelin thrower reported present in distance runners rather than bilateral deep volar, and right to the athletic training room in April throwers participating in track and field. compartment with Wad of Henry. Final 2010complaining of pain in his anterior Additionally, the fracture was in diagnosis was bilateral chronic lower right leg.The athlete reported athlete’s trail leg, not the more common exertional compartment syndrome symptoms of muscle soreness and plant leg, which is subjected to more (CECS). The athlete was referred to a tightness in the anterior musculature of stress and an additional shearing force. hand surgeon. Since she had not the lower leg that had begun the In this case, the athlete‘s stress fracture responded to conservative treatment previous week, which had escalated to was difficult to diagnose because and wanted to continue to row, surgical “unbearable”.The athlete reported no imaging implied an Osteoid Osteoma options were discussed. The athlete previous history of injury toeither side or Cortical Fibrous Defect, even though decided to have surgery to release of the lower leg, knee or ankle. Upon symptoms were more consistent with a multiple volar and dorsal compartments evaluation, the athlete was diagnosed stress fracture.Conclusion: While a bilaterally. She began a home exercise and treated for medial tibial stress stress fracture is a common injury in program consisting of light range of syndrome.After two weeks of flexibility, track and field athletes, its presentation, motion and strengthening exercises two strengthening, ice massage and non- in this case, was atypical. Char- weeks post-op while at home for winter impact workouts, the pain had not acteristically, pain associated with an break. She was able to start a gradual subsided and athlete was referred to the Osteoid Osteoma is significantly return to ergometer and rowing activity medical facility on campus for reduced with the use of NSAID’s and after six weeks, was back to full activity radiographs. Differential Diagnosis: the pain will worsen at night. These within 10 weeks, and required Medial tibial stress syndrome, Osteoid are two symptoms that can be used to occasional treatment for forearm Osteoma, Cortical Fibrous Defect. distinguish these pathologies. A tightness caused by scar tissue and Treatment: The radiographs revealed Cortical Fibrous defect has no soreness throughout the spring season. a large, darkened, hole, but the cause symptoms until there is a pathologic Uniqueness: CECS is rarely seen in the was inconclusive. The athlete was fracture and while it is more commonly upper extremities, especially in athletes. placed in a walking boot and referred seen in the long bones, it generally A PubMed search for “chronic for further imaging. A Magnetic originates at the insertion site of a exertional compartment syndrome” and resonance imaging (MRI) was tendon or ligament. In this case, there “forearm” resulted in only 19 articles, completed and revealed alarge oblong was no such origin. An Osteoid none of which referenced rowing. The dark space that was interpreted as a Osteoma will generally resolve without lack of previous literature illustrates the benign tumor or Osteoid Osteoma. The treatment over the course of about three uniqueness of such a case in the sport. athlete was instructed to cease activity. years and a Cortical Fibrous Defect will Also, the athlete’s initial symptoms Following the cessation of activity, the require surgery to prevent pathologic were unilateral and only became athlete then underwent right shoulder fractures.Most stress fractures are bilateral after approximately a month. surgery, unrelated to thelower usually treated with rest and limited to Conclusions: While rare, CECS legpain.Three months following the no activity, however there have been should be considered when evaluating surgery, the athlete reported thatthe several other cases,similar to this, of rowers complaining of chronic forearm pain had returned to his lower right leg nonunion stress fractures that have used pain and tightness. Athletes should be during rehabilitation exercises. The intramedullary rods to encourage union. referred for testing to confirm the athlete was scheduled for a follow-up diagnosis prior to surgical intervention. appointment.Radiographs revealed the Journal of Athletic Training S-63 12250MC Arteriovenous Malformation In two Doppler investigationslooking for Leg Of A 17-Year Old Cross a DVT, one without and one with the Country Runner: A Case Report bruising present. Neither investigation Mayer JM, Brucker JB: University of revealed pathology. Still suspecting an Northern Iowa, Cedar Falls, IA Arteriovenous pathology an MRI was performed. A 6.6 cm X 8.8 cmX 2.5 Background: A17-year old male high cm tuft of serpiginous subcutaneous school cross-country athlete reporting vessels was found indicating an generalized shin pain during and after angiodysplasia- venous dysplasia. The running for the past few days. No athlete was then referred to an interventional radiologist to help bruising, swelling or obvious deformity Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 was present. All neurological, manual determine the possibility of muscle and range of motion testswere Embolization. The radiologist deter- within normal limits. Bump test was mined the mass of vessels was positive, compression test and tuning providing blood to surrounding tissues; fork were negative. After 2 weeks of therefore, Embolization was not an conservative treatment between option. A plastic surgeon was then competitive seasons, symptoms consulted.To have enough skin to close returned immediately. Differential the wound after excision two tissue Diagnosis: Medial tibial stress expanders were implanted. After syndrome, exercise induced deep approximately 5 months, 10 months posterior compartment syndrome, tibial after initial visit, the skin was stretched stress fracture, deep vein thrombosis enough to close the area following (DVT) and Arterioveinous Mal- tissue excision. Final inspection of the formation (AVM). Treatment: Imme- excised tissue revealed two AVM diate return of symptoms indicated that masses, one in the skin and medial tibial stress syndrome was subcutaneous tissue and one in unlikely. Additionally, deep posterior themuscular arteries and veins. compartment syndrome was ruled out Uniqueness: In an otherwise healthy because no neurological, circulatory, or active 17-year old two AVMs werefound muscular weaknesses were present. at different depths. These two Thus, tibial stress fracture was extracranial AVMs were caught early considered, so physician referral before obvious deformity or life followed. X-rayswere performed and threatening symptoms were present. no fracture was reported. Athlete was Sclerotherapy or Embolization were not told by the physician to go ahead and an option because the malformations run. Athlete would attempt to run and was providing blood flow to skin and once moderate intensity was reached muscle and would result in necrosis. the athlete would report pain, Conclusion: It is possible for an AVM throbbing/pulsating and a slight to present in young healthy athletes as bruising that was localized to the a chronic overuse injury. In order to superior medial aspect of the shin that achieve early detection it is important would subside within 2 hours following for medical professionals to be aware activity. Athlete was retold to maintain of and to consider an AVM in their exercise intensity within a level that did differential diagnosis. The most not induce pain. During the 4thweek reliable diagnostic tool for detecting an after the initial visit the athlete reported AVM is MRI or CT. It is important for to the athletic training room patients with suspected AVM’s to be immediately following a bout of closely monitored. Treatment can be exercisewhere an increase in very intrusive and lengthy. temperature was palpable and an observable “black and blue” discoloration about 3 inches in diameter in the proximal medial shin was present suggesting the possibility of DVT or AVM. A vascular surgeon performed S-64 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Using Evidence in Clinical Practice Thursday, June 28, 2012, 9:30AM-10:15AM, Room 274; Moderator: Sarah Manspeaker, PhD, ATC 12F25FOHE 12F30FOHE The Clinical Outcomes Research content to the athletic training A Descriptive Analysis of the Athletic Education for Athletic Trainers membership were made through Training Practice-Based Research (CORE-AT) Project: Training creation of a website (coreat.org). Main Network Clinical Researchers for Evidence- Outcome Measures: The primary Valovich McLeod TC, Lam KC, Bay Based Practice educational outcome was the RC, Sauers EL, Snyder AR: A.T. Still Snyder AR, Bay RC, Parsons JT, aggregated COA and EPB course University, Mesa, AZ Sauers EL, Valovich McLeod TC: A.T. cognate grade point average (GPA). Still University, Mesa, AZ Frequency counts regarding total Context: Analysis of healthcare Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 patient encounters and the number of service models requires the collection Context: Evaluating the outcomes of generated PROMs describes the and evaluation of basic practice athletic training services and employing integration of COA into patient care. characterization data. Practice-based evidence-based practice (EBP) in our Total and average number of unique research networks (PBRNs) provide a profession are paramount and have website visitors, total number of framework for gathering data that are been incorporated into the 5th edition website visits, and page views describe useful in characterizing clinical practice. of the Athletic Training Education dissemination effort. Results: The GPA Objective: To describe preliminary Competencies. However, few athletic for the course cognate was 3.71, with practice characterization data from the trainers are educated and trained to all but 1 student completing the entire Athletic Training Practice-Based conduct clinical outcomes research to cognate. Using the CORE-AT EMR, Research Network (AT-PBRN). Design: support EBP, which serves as a major athletic trainers entered over 2,100 Descriptive study. Setting: Secondary barrier to future research efforts and injuries and athletes generated over school athletic training clinics within advancement of the profession. 1,700 PROMs. From the website launch the AT-PBRN. Patients or Other Objective: To 1) educate and train post- (June 2009), the coreat.org website Participants: Clinicians participating in professional athletic training students received 11,544 unique visitors, 20,084 the AT-PBRN and the patients whom in clinical outcomes assessment (COA) visits, and 30,458 page views, they evaluated and treated. Inter- and EBP, 2) integrate electronic medical producing averages of 398, 693, and ventions: A web-based survey was record (EMR) technology into clinical 1,050 each month, respectively. used to obtain data on clinical practice practice for collecting patient-oriented Conclusions: Successful education site (CPS) and clinician characteristics, healthcare outcomes, and 3) disseminate and training of PP-ATEP students was while a web-based electronic medical COA and EBP information to the athletic accomplished through the purposeful record (CORE-AT EMR) was used training profession. Design: Three-year design of a curricular cognate that to obtain patient and practice (2008-2010) educational project. blends didactic and clinical education characteristics via de-identified data Setting: Accredited Post-Professional and utilizes technology to assist with between September 1, 2009-April 1, Athletic Training Education Program concept integration of essential 2011. Main Outcome Measures: (PP-ATEP) and athletic training clinics. elements of health professions Descriptive data regarding CPS and Patients or Other Participants: Three education, as described by the Institute clinician characteristics are reported years of PP-ATEP students (n=25; of Medicine and PEW Health as percentages and frequencies. female=52%) and clinician members of Commission. COA and EBP information Descriptive analysis of patient the Athletic Training Practice Based is being successfully disseminated to encounters and practice characteristics Research Network (AT-PBRN). the broader athletic training community data was performed, with the type of Interventions: PP-ATEP students were through the CORE-AT website. injuries at initial evaluation and the type enrolled in a 5-course COA and EBP Funded by a project grant from the of procedures received at initial curriculum cognate that included National Athletic Trainers’ Association evaluation, daily treatment, and daily clinical outcomes research, EBP, Research and Education Foundation. sign-in reported as percentages and healthcare outcomes, healthcare frequencies. Results: The AT-PBRN information and technology, and consisted of 23 distinct CPSs across 7 patient-centered healthcare courses. states. Most CPSs were associated Technology was integrated through the with a regional coordinator (athletic development of a custom web-based training academic program=13, clinic electronic medical record (EMR) which center=2, hospital center=5) and the contains generic and specific patient- majority were classified as public or rated outcome measures (PROMs). public charter secondary schools Efforts to disseminate COA and EBP (82.6%, n=19). A total of 23 clinicians

Journal of Athletic Training S-65 12081DOHE participated in the AT-PBRN Approved Clinical Instructors’ collective support among colleagues) (males=7, females=16, age= 27.3 Barriers and Accessibility to for implementing EBP. Barriers were ±7.0), with 78.3% (n=18) and 21.7% Evidence For Clinical Decision divided into two categories: support (n=5) holding a Bachelor’s and Making and accessibility to resources barriers Master’s degree, respectively. The Hankemeier DA, Welch CE, Newton and barriers associated with their own majority of clinicians had been EJ, Walter JM, Van Lunen BL: Ball personal skills and attributes. Results: certified for less than 2 years (56.5%, State University, Muncie, IN; Old ACIs largely “disagreed” that both n=13), while 21.7% (n=5) had been Dominion University, Norfolk, VA support (2.4/4.0±.5) and their own certified for 3-5 years, 13.0% (n=3) personal skills (2.3/4.0±.5) were barriers for 6-10 years, and 8.6% (n=2) for 10+ Context: Approved Clinical Instructors encountered in implementing EBP in years. The AT-PBRN documented 2523 their clinical practice. On average, ACIs (ACIs) are asked to provide instruction Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 patients who were treated across 3140 and guidance for students in regards “agreed” that the individual barrier of encounters. Patients had a mean age of to utilizing evidence to guide clinical time (3.2/4.0±.9) prevented them from 15.9±1.3 years and were fairly evenly decision making (CDM). Under- implementing EBP. ACIs “disagreed” distributed across all grade levels. standing the barriers to and that being able to make independent Males (59.4%, n=1500) represented accessibility of evidence to support clinical decisions (2.0/4.0±.8) and the a larger percentage of total patients CDM will be necessary in continuing familiarity with internet databases (2.1/ than females (40.5%, n=1023). Most to move forward in evidence-based 4.0±.8) were barriers. In regards to patients sought care for a current injury practice (EBP) implementation. accessibility, ACIs reported having the (61.3%), followed by preventative Objective: To assess ACIs perceived most direct access to websites and services (24.0%) and new injuries barriers and accessibility to evidence textbooks (98.5%), position statements (14.7%). The most common diagnoses related to CDM. Design: Cross- (95.9%), professional literature (94.0%), included ankle sprain/strain (17.9%), Sectional. Setting: Web-based survey and peer-reviewed journal articles hip sprain/strain (12.5%), concussion conducted spring 2010. Patients or (90.2%). Additionally, ACIs reported (12.0%), contusion (10.0%), and knee Other Participants: ACIs from CAATE limited access to clinical prediction rules pain (2.5%). The most frequent accredited programs (n=266; 11.3% (79.3%), Cochrane databases (78.6%), procedures were AT evaluation response rate; 32.6+8.3 years old; 138 and meta-analyses/systematic reviews (53.9%), hot/cold pack application males, 128 females) were selected from (51.5%). ACIs also reported that they (26.0%), taping/strapping (10.3%), and a convenience sample. Interventions: are unfamiliar or do not utilize Cochrane therapeutic exercise (5.7%). The Program directors of undergraduate databases (72.5%), clinical prediction median number of treatments per athletic training education programs rules (55.6%), or meta-analyses/ injury was 3 (IQR=2, 4; range 2-19). were asked to distribute an e-mail systematic reviews (20.3%). Conclu- Conclusions: These preliminary containing a link to complete the online sions: ACIs perceive time as a barrier findings describe services provided by Evidence Based Concept Assessment and are most unfamiliar with or do not clinicians within the AT-PBRN and (EBCA) and demographic questionnaire utilize resources that contain some of demonstrate the utility of the PBRN to all ACIs associated with their the highest levels of evidence in CDM. model for obtaining clinical practice program. The EBCA consisted of six Educational interventions need to be data. The AT-PBRN provides a clinical sections, but only the perceived developed to promote methods of research infrastructure that can be used barriers (16 Likert scale items) and the accessing and implementing quality to measure clinical outcomes, accessibility (two multi-part questions) information to enhance CDM. Future determine optimal treatments through sections were assessed in this inquiry. research should address mechanisms comparative effectiveness studies, Main Outcome Measures: Descriptive ACIs utilize to integrate evidence-based define athletic training practice statistics were reported as scale values resources into their CDM. characteristics, and estimate the costs (4.0 pts.) for the perceived barriers and associated with the care provided by percentages were presented for athletic trainers. Partially funded by a accessibility. Participants were asked to project grant from the National identify if they have direct access to, Athletic Trainers’ Association and how often they access 10 Research and Education Foundation. commonly used resources (e.g., peer- reviewed journals, Cochrane databases, PubMed) for seeking evidence. Additionally, participants were asked to rate their perceptions (4-point Likert scale) of 16 potential barriers (e.g., time, ability to critically appraise literature,

S-66 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Patellofemoral Pain: Etiology and Intervention Thursday, June 28, 2012, 10:30AM-11:30AM, Room 274; Moderator: Jenny Thorpe, MS, ATC 12192FOBI 12053MOMU Functionally Increased Pain variables also included hip strength Comparative Strength, Endurance Decreases Strength and (pre-post: abduction, extension, and Pain Responses Among Influences Mechanics in external rotation) and peak knee and Therapeutic Patellofemoral Taping Patients with Patellofemoral hip angles and moments in all planes. Techniques Pain Strength was assessed with three, 5- Osorio JA, Vairo GL, Rozea GD, Bazett-Jones DM, Cobb SC, second maximal contractions, norm- Bosha PJ, Millard RL, Aukerman DF, Sebastianelli WJ: Department of O’Connor K, Huddleston W, alized to body mass, and then averaged. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Armstrong B, Earl-Boehm JE: Running mechanics were recorded Kinesiology, The Pennsylvania State University of Wisconsin- with a 3D motion capture system and University, University Park, PA; East Milwaukee, Milwaukee, WI force plate. Moments were Stroudsburg University, East normalized to body mass. Pain was Stroudsburg, PA; Penn State Hershey Context: Patellofemoral pain (PFP) analyzed with a Wilcoxon test. Strength Orthopaedics – State College, State is a common injury that is described and mechanical variables were College, PA as anterior knee pain during activities analyzed with dependent t-tests. The of repetitive flexion. Reduced alpha level was set at p<0.05. Results: Context: Patellofemoral taping strength has been cited as an Pain was significantly increased techniques are performed as a etiological factor in PFP, however, following RSLS during running therapeutic treatment for patello- recent prospective studies have (Baseline: 3.10±2.0, RSLS: 4.38±2.4, femoral dysfunction (PFD). Prior hypothesized that weakness might be p=0.006). Only hip extension strength findings suggest such interventions the result of pain and not the cause of decreased signifi-cantly (Baseline: improve quadriceps performance and it. Objective: To investigate the acute 0.368±0.08, RSLS: 0.326±0.10, perceived pain in PFD patients. effects of increased pain on hip p=0.002). Significant decreases in However, limited evidence exists strength and lower extremity peak hip extension (Baseline: -2.48 detailing the effectiveness of mechanics during running. Design: ±0.62, RSLS: -2.23± 0.65, p<0.001) contemporary kinesiotape, especially Single-session, case series. Setting: and abduction (Baseline: -1.87 when compared to traditional Neuromechanics Laboratory. Pa- ±0.30,RSLS:-1.76± 0.34, p= 0.005) McConnell. Objective: Our primary tients or Other Participants: moments occurred following the aim was to investigate immediate Nineteen participants (10 men, 9 RSLS protocol. No other strength or effects of different patellofemoral women; age=27.3±6.4 years, mechanical changes occurred taping techniques on quadriceps height=173.3±7.1cm, mass =76.5 (p>0.05). Conclusions: Hip function performance and perceived pain in ±12.1 kg) diagnosed with PFP longer was reduced following the RSLS PFD patients. It was hypothesized that than 4 weeks volunteered. Participants protocol, which was accompanied by taping would increase performance were required to have pain during 3 of an increase in pain. This study provides and decrease pain compared to no tape. the following: prolonged sitting, preliminary evidence that pain acutely A secondary aim was to compare running, squatting, stair ambulation. influences hip strength and mechanics, differences between kinesiotape and All participants quantified their pain which could explain the lack of McConnell. Design: Retrospective at a level of at least 3/10 using a visual prospective evidence for hip strength cohort. The independent variable was analog scale (VAS). Interventions: in PFP. These findings of reduced hip taping technique. Setting: Controlled Pain, strength, and lower extremity function are consistent with literature laboratory. Patients or Other running mechanics were assessed of acute injury and experimentally Participants: Twenty (13 women, 7 before and after a repeated single-leg induced knee pain models. Hip men) physically active patients squats (RSLS) intervention. The weakness may be a result, not a cause diagnosed with unilateral acute PFD participant performed 20 repetitions of PFP; however further research is (age = 21.2 ± 2.9 years, height = 1.7.± at a pace of 30/minute and completed necessary. Clinicians should treat hip 0.2 m, mass = 68.1 ± 7.0 kg, Tegner = sets until they reached the pain level weakness, specifically in the gluteus 6.2 ± 1.3, Kujala = 79.0 ± 9.4). experienced during a prolonged run. maximus muscle, concurrently with Interventions: Patients underwent Adequate rest was provided between methods to reduce pain. one bilateral baseline and two sets to reduce the influence of fatigue. unilateral taping testing sessions. Main Outcome Measures: Pain was Taping consisted of the McConnell assessed (VAS) during running before medial glide and NUCAP Medical and after the RSLS intervention, and Upper Knee Spider®. Forty-eight after each RSLS set. Dependent hours separated sessions. Ran- Journal of Athletic Training S-67 12121FOBI domization was used to prevent order A Comparison of Lower knee extensors, hip extensors, hip effects. Main Outcome Measures: Extremity Strength and Static abductors, hip internal rotators, and hip Normalized isokinetic strength and Alignment in Individuals at Risk external rotators were averaged across endurance were assessed at 60 °/s and for Anterior Cruciate Ligament two trials and used for data analysis. Q- 240 °/s respectively using reliable Injury and Individuals at Risk for angle and navicular drop were averaged methods. Pain was measured following Patellofemoral Pain Syndrome across three trials and used for data isokinetics using a standardized visual Boling MC, Padua DA, Marshall SW, analysis. Independent t-tests were analogue scale. One-tail paired t-tests Nguyen A, Cameron KL, Beutler AI: performed to compare mean and peak assessed bilateral baseline differences. University of North Florida, isometric strength, Q-angle, and One-way analyses of variance with Jacksonville, FL; University of North navicular drop between the “at risk PFPS” Tukey’s post hoc test evaluated Carolina, Chapel Hill, NC; College of

and “at risk ACL” groups for males and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 differences among baseline and taping Charleston, Charleston, SC; Keller females separately (α<0.05). Results: sessions for the involved leg. P ≤ 0.05 Army Hospital, West Point, NY; Sixty-five cadets (23 females, 42 males) denoted significance. Results: Data Uniformed Services University of the were diagnosed with an ACL injury (“at met necessary assumptions for Health Sciences, Bethesda, MD risk ACL” group) and 133 cadets (71 statistical analyses. Patients females, 62 males) were diagnosed with demonstrated significant bilateral Context: Those at risk for anterior PFPS (“at risk PFPS” group) during the baseline differences for strength cruciate ligament (ACL) injury and follow-up period. In males, the “at risk (involved = 1.9 ± 0.6 Nm/kg; patellofemoral pain syndrome (PFPS) PFPS” group was significantly weaker uninvolved = 2.1 ± 0.5 Nm/kg; P = are theorized to have similar strength than the “at risk ACL” group for mean 0.001) and endurance (involved = 35.1 deficits and altered static alignments. (0.35±0.08%BW vs. 0.38±0.08%BW; ± 14.3 J/kg; uninvolved = 39.6 ± 13.4 Research has yet to compare these P=0.02) and peak (0.41±0.09%BW vs. J/kg; P = 0.022). Patients also groups to determine if a single 0.46±0.09%BW; P=0.01) hip abduction displayed significant increases in prevention program can be used to strength. In females, the “at risk ACL” strength (McConnell = 2.2 ± 0.6 Nm/ decrease the risk of these injuries. group was significantly weaker than the kg, P = 0.002; Spider® = 2.1 ± 0.5 Nm/ Objective: To compare lower “at risk PFPS” group for peak hip kg, P = 0.003) and endurance extremity isometric strength, Q-angle, extensor strength (0.25±0.07%BW vs. (McConnell = 42.7 ± 14.7 J/kg, P = and navicular drop between individuals 0.29±0.07%BW; P=0.03). There were no 0.003; Spider® = 43.5 ± 11.2 J/kg, P at risk for PFPS and individuals at risk other significant group differences = 0.001) when taped compared to for ACL injury. Design: Cohort. for males and females (P>0.05). baseline. Pain significantly decreased Setting: US Military Academies. Conclusions: With the exception of hip during strength (baseline = 3 ± 2.3 cm; Patients or Other Participants: The abduction strength in males and hip McConnell = 1.9 ± 1.8 cm, P = 0.003; cohort consisted of 5,515 cadets (2,150 extension strength in females, individuals Spider® = 1.7 ± 2.2 cm, P = 0.003) females, 3,365males; height= 173.24± at risk for ACL injury or the development and endurance (baseline = 2.7 ± 2.1 cm; 9.20cm, mass= 71.88± 13.05kg) who of PFPS appear to be have similar lower McConnell = 1.6 ± 1.9 cm, P = 0.001; were freshmen at the time of enroll- extremity strength and anatomical Spider® = 1.2 ± 0.9 cm, P = 0.001) ment in the current investigation. alignment profiles. Based on these measure-ments when taped. No Interventions: Each participant findings, a single injury prevention significant differences existed underwent a baseline assessment of program may be effective in reducing between taping lower extremity isometric strength, Q- both the risk of ACL injury and PFPS. techniques.Conclusions: Patello- angle and navicular drop. Participants Funded by R01-AR050461001 and R03- femoral taping techniques improve performed two trials for each strength AR057489-01A1. quadriceps performance and perceived test and all strength data were pain in unilateral acute PFD patients. normalized to body mass. Three trials 12104FOBI No apparent differences exist between were recorded for Q-angle and navicular Movement Coordination Alterations the Spider® and McConnell medial drop. Following baseline data between the Ankle and Hip during glide. Continued research is necessary collection, participants who did not Stair Descent in Patients with to definitively determine clinical report a history of PFPS or ACL injury, Patellofemoral Pain effectiveness of PFD taping were followed prospectively for a Aminaka N, Pietrosimone BG, interventions. maximum of 4 years to determine those Armstrong CW, Gribble PA: The diagnosed with PFPS (“at risk PFPS” University of Toledo, Toledo, OH group) and those who sustained a non- contact or indirect contact ACL injury Context: Ankle range of motion (“at risk ACL” group). Main Outcome deficits can be related to various acute Measures: Normalized mean and peak and chronic lower extremity isometric strength of the knee flexors, pathologies, including patellofemoral S-68 Volume 47 • Number 3 (Supplement) May 2012 pain (PFP). It has been hypothesized Main Outcome Measures: F1,38=3.556, P= 0.067; DF-KF that ankle dorsiflexion and plantar Dependent variables included MARP DP:Healthy =35.23±2.94°, PFP= flexion can negatively influence and DP of sagittal plane ankle 34.65±2.34°, F1,38=0.664, P=0.420). movement at proximal lower extremity movement relative to knee flexion There were no significant limb joints. However, no study has (DF-KF), to knee valgus (DF-KV), to differences. Con-clusion: Our results investigated movement coordination hip flexion (DF-HF), and to hip suggest that movement coordination between the ankle, hip and knee during abduction (DF-HA) during the stance between the ankle and hip may be a functional task in PFP patients. period. For each dependent variable, more restricted in those with PFP. Objective: To investigate the separate two-way (Group, Limb) Specifically, PFP patients demon- movement coordination of the ankle ANOVA’s were utilized for statistical strated more restricted movement of relative to the knee and hip during stair analysis. Significance was set a priori the ankle in the sagittal plane relative

descent in patients with PFP and at P<0.05 Results: For the ankle-hip to the hip in the frontal plane, and less Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 healthy controls. Design: Case- coordination, there were statistically variability in movement of the ankle control. Setting: Research laboratory. significant group differences in DF- in the sagittal plane relative to the hip Patients or Other Participants: HA MARP (Healthy= 81.83±16.94°, in the sagittal plane. Movement

Twenty PFP (13F/7M, 21.45± PFP= 68.69 ±18.71°, F1,38=15.073, coordination deficits between the 3.90years, 169.96± 10.47cm,71.30 ± P<0.001) and DF-HF DP (Healthy ankle and hip were more accentuated 14.50kg) and twenty healthy parti- =43.99±4.67°, PFP=40.93±5.60°, compared to movement coordination cipants (13F/7M, 21.35±3.76years, F1,38=4.469, P= 0.041). However, DF-HA between the ankle and knee. The 172.21±9.24cm, 69.68± 9.78kg) volun- DP(Healthy =40.31±4.84, PFPF=40.15 results may suggest that PFP patients teered. Interventions: Using 3-D motion ±4.03°, F1,38= 0.022, P=0.883) and DF- display kinematic deficits at joints analysis, joint angles and angular HF MARP (Healthy=54.53±7.29°, PFP= adjacent to the patellofemoral and velocity during stance phase of stair 53.82±8.46°, F1,38=0.093, P=0.762) tibiofemoral joint, which may further descent were obtained to calculate yielded no significant group differ- accentuate the complex nature of this relative phase angles between the ankle ences. Additionally, no statistically pathology. Clinicians may utilize this and knee, and between the ankle and significant group differences were information to develop multi-faceted hip. Mean absolute relative phase observed for ankle-knee coordination approaches when treating patients with (MARP) and deviation phase (DP) were and variability (DF-KV MARP: PFP. obtained to compare ankle-knee and Healthy= 60.73± 16.94°, PFP =64.34 ankle-hip coordination and variability ±18.00°, F1,38=0.695, P=0.41; DF-KV DP: during stance. Lower values indicate Healthy= 38.31±6.92°, PFP= 38.81±5.11°, that the inter-joint movement occurs F1,38=0.109, P=0.743; DF-KF MARP: with more restriction and less variability. Healthy=43.73±5.11°, PFP= 41.03 ±4.98°,

Ankle EBF Thursday, June 28, 2012,5:00PM-6:00PM, Room 274; Moderator: Brian Pietrosimone, PhD, ATC

Journal of Athletic Training S-69 Free Communications, Oral Presentations: Taping and Bracing Friday, June 29, 2012, 8:00AM-9:30AM, Room 274; Moderator: Tim McGuine, PhD, ATC 12284MOPR 12066MOPR Effect of Three Ankle Braces on with repeated measures on brace How Do Taping Methods Affect Range of Motion and Functional condition was performed. In the event Ankle Range of Motion and Performance in Subjects with a of a significant main effect, pairwise Functional Performance History of Ankle Sprains comparisons were used to identify Measures? McDonald J, Chinn L, Donovan L, significant differences between Schulmeyer SJ, Docherty CL, Simon Hart JM, Hertel J: University of specific conditions. Results: J, Schrader J, Grove CA: Indiana Virginia, Charlottesville, VA Compared to the control condition, all University, Bloomington, IN three ankle braces significantly Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context:Prophylactic ankle braces are restricted inversion ROM (p=.008; Context: Ankle injuries are one of the frequently used to prevent ankle sprains control =36.8±10.0°;lace-up=26.6 most common injuries in athletics. during sports participation. Many ±8.9°;semi-rigid= 25.2±10.2°; SAO= Ankle taping methods are commonly different types of ankle braces have 25.9± 11.8°), however there were no used to protect the ankle by restricting been marketed such as lace-up braces, differences between the braces. All range of motion (ROM). It is unclear semi-rigid braces, and the Seattle Ankle three braces also significantly how limiting range of motion will affect Orthosis (SAO). The SAO has straps restricted plantar flexionROM functional performance. Objective: To that attach a cuff around the lower leg (p<.001; control= 50.5±6.8°; lace- analyze how limiting range of motion directly to the lateral aspect of the shoe up=38.0±4.4°; semi-rigid=40.3±5.1°; using different taping methods affects to specifically restrict inversion. Little SAO=43.4±5.0º). The lace-up brace functional performance measures. researchhas been published on the restricted plantar flexion significantly Design: Crossover design. Setting: effects that ankle braces have on more than the SAO (p=.018). All three Laboratory. Patients or Other individuals with a history of previous braces significantly reduced SEBT Participants: Thirty-one physically ankle sprain.Objective:To compare the reach distance in the anterior (p=.005; active college aged individuals (age effects of theSAO,a lace-up brace, and control=65.2±7.7%; lace-up=61.4 19.9±1.0 years; height 179.2±9.4 cm; a semi-rigid brace to an un-braced ±7.9%; semi-rigid=62.1± 6.6%; weight 69.7±13.9 kg) with no history control conditionon measures of ankle SAO=60.1±8.2%) and postero-medial of lower leg or ankle injuries in the last range of motion (ROM) and functional (p=.001; control= 83.2±9.6%; lace- 6 months and no lower extremity performance measures in subjects with up=77.5±11.9%; semi-rigid= 76.8± surgery or fracture in the last a history of ankle sprains. Design: 9.5%; SAO=78.3± 10.9%) directions. year volunteered for the study. Crossover.Setting:Laboratory. Partic- There were no significant main effect Interventions: All subjects completed ipants: Eleven young adults with a for theSEBT posterolateral reach three taping conditions in history of previous ankle sprains(6 (p=.062; control= 82.9±9.6%;lace- a counterbalanced order. Taping males, 5 females; age=22.2±1.7 up=79.0 ±9.4%; semi-rigid= 79.2± conditions included: no tape, all white years;height=174.1±12.4cm; 9.1%; SAO=80.0±9.2%), the SEMO cloth tape, and combination tape using weight=75.0±16.2kg; number of agility test (p=.10; control =11.8 elastic tape for heel locks and figure- previous sprains=3.4±2.3)participated. ±2.0sec;lace-up=12.2±2.0s;semi- 8s and white cloth tape for all other Interventions:Subjects reported to the rigid=12.0±1.9s; SAO=12.1±2.3s), components. Prior to and after each laboratory for a single testing session. vertical jump (p=.09; control = tape condition ankle ROM, Agility T- All subjects were fitted and tested in 43.7±13.4cm;lace-up= 39.5± 12.7 test, and vertical jump tests were each brace condition (SAO, lace-up, cm;semi-rigid =40.6 ±12.9cm; performed. An electric ankle semi-rigid, control) in a randomized SAO=41.3±12.9cm), and single limb goniometer was used to measure ROM order. Subjects wore the same pair of triple hop test(p=.33; control= in four directions: inversion, eversion, standardized cross-training shoes 457.0±111.8cm;lace-up =445.7 ± plantar flexion and dorsiflexion. Agility during all 4 conditions. Main 115.8cm; semi-rigid= 450.3± 122.7 T-test is an agility test consisting of a Outcome Measures: Dependent cm; SAO=449.2±120.9cm). Con- 9.14m sprint, 4.57m side shuffle to the variables were inversion and plantar clusions: The SAO brace affected left, 9.14m side shuffle to the right, 4.57m flexion active ROM; dynamic ROM restriction and functional side shuffle to the left and 9.14m balanceusing the anterior, postero- performance tasks similarly to the backpedal. Time was measured using medial, and posterolateral directions lace-up and semi-rigid braces in an electronic timing system (Brower of the star excursion balance test subjects with a history of lateral ankle Timing Systems, Draper, UT) and the (SEBT); the SEMO agility test; sprain. fastest of three trials was used for maximumvertical jump;and single-leg statistical analysis. Vertical jump was triple hoptest for distance.For each measured using a Vertec (Questec dependent variable,a one way ANOVA Corp., Northridge, CA) and the S-70 Volume 47 • Number 3 (Supplement) May 2012 maximum of three trials was used for in the restriction of ankle ROM. significantly restricted inversion- statistical analysis. We performed Objective: To evaluate the effects of eversion and dorsiflexion-plantar- separate RMANOVAs for agility T- different underwrap conditions on flexion ROM compared to the NT. The test, vertical jump, and ROM data. restricting ankle ROM before and after TSA condition restricted the most Tukey post hoc test was performed on exercise. Design: Cross-sectional inversion-eversion ROM (46.82° all significant findings. Main study. Setting: Research Laboratory ±2.67°), followed by TS (49.29°± Outcome Measures: Vertical jump Patients or Other Participants: 2.64°), and lastly TF (49.74°±2.60°). height(cm), agility T-test time(sec) and Twenty subjects (age 20.8±1.5years; The TSA condition also restricted the ankle ROM(°). Results: We found a height 175.3±9.2cm; mass 74.4±11.8kg) most dorsiflexion-plantarflexion significant difference between the 3 who exercised a minimum of 3x/week for ROM (47.25°±1.60°). The TF (49.93° tape conditions for each ROM at least 30 minutes volunteered for this ± 1.89°) and TS (48.50°±1.81°)

direction (dorsiflexion: F2,60 = 23.17, study. Subjects had no history of ankle conditions restricted similar amounts Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 p=.001, plantarflexion:F2,60=59.91, injury within the previous six months, of ROM, but neither restricted as p=.001, inversion:F2,60=62.09, p= surgery to the lower extremity, or history much ROM as the TSA condition. For

.001, and eversion:F2,60=21.87, of serious medical condition. Inter- inversion-eversion ROM, the TF and p=.001). For each direction, the post- ventions: All subjects participated in TS conditions had loosened hoc tests showed that the white cloth four underwrap conditions: control (no significantly when comparing the post- tape and combination tape conditions tape or underwrap[NT]), tape applied exc measure to the post-tape measure. restricted more ROM than the no tape directly to the skin (TS), tape applied However, the TSA condition was able condition. However, there were no to foam underwrap (TF), and tape to maintain ROM following exercise. significant differences between the applied to self-adherent underwrap Conclusions: Tape to self-adherent white tape and combination tape (TSA). Subjects came to the laboratory underwrap restricts the most range of conditions (p>.05). We also found no four separate days, one for each motion and maintains its restriction significant differences among all 3 condition being tested. Following the after exercise. tape conditions for agility T-test underwrap condition application, a 12061FOPR (F2,60=4.65,p=.01). For vertical jump, closed basket weave taping technique we identified a significant difference was applied to the ankle. Ankle ROM Influence of Ankle Flexion Angle between the 3 tape conditions was measured using an electric ankle on Brace Support of The Ankle- Complex (F2,60=19.54, p=.001). White tape goniometer on three occasions. ROM (53.4±11.7cm) and combination tape was measured before tape application Kovaleski JE, Gurchiek LR, Heitman (53.6±11.6cm) conditions resulted in (pre-tape) and after tape application RJ, Liu W, Hollis JM: University of a decrease in performance when (post-tape). Subjects then performed 30 South Alabama, Mobile, AL; Blue Bay compared to the no tape condition minutes of physical activity including: Research, Navarre, FL (55.7±11.4cm). Conclusions: Both jogging, back-peddling, lateral taping conditions performed similarly shuffling, agility ladder drills, and wall Context:No comprehensive analysis on all tests. These taping methods jumps. Ankle ROM was measured again concerning the effectiveness of ankle could be used interchangeably and after the exercise protocol (post-exc). support on ankle-complex ROM across would result in similar findings related Two separate RMANOVA were a range of flexion angles has been to ROM restriction and functional conducted, for each dependent reported.Objective:To evaluate the performance. variable. Each analysis had two within effect of ankle flexion angle and subject factors (underwrap condition at different types of brace support 12065MOPR four levels: NT, TS, TF, TSA and time at on ankle-complex dorsi-plantar Self-Adherent Underwrap Maintains three levels: pre-tape, post-tape post- flexion ROM and inversion-eversion Range of Motion Restriction After exc). Tukey post hoc analysis was rotation.Design:Cross-sectional Exercise performed on all significant findings. study.Setting: Research laboratory. VanWagoner RV, Docherty CL, Main Outcome Measures: Ankle ROM Participants:The dominant ankle of 22 Simon J: Indiana University, was measured in degrees. Data were female collegiate athletes (20.7 ± 1.2 Bloomington, IN obtained for two directions: inversion- years, 70.2 ± 8.7 kg, 173.2 ± 9.0 eversion range and dorsiflexion- cm).Interventions:Maximal active Context: The use of athletic tape to plantarflexion range. Results: A plantarflexion (PF) and dorsiflexion decrease ankle range of motion (ROM) significant underwrap by time (DF) ROM and inversion-eversion (I- is widespread. Various forms of interaction was discovered for E) load-displacement curves were underwrap are often used with taping collected using a six degrees-of- inversion-eversion (F6,114=33.20, to allow for protection of the underlying p=.001) and dorsiflexion-plantarflexion freedom linkage-instrumented ankle skin. A lack of research exists arthrometer. With the subject wearing (F6,114=54.96, p=.001) motions. Post concerning the most effective form of hoc analysis revealed that overall the her own low-top athletic shoe all ankles underwrap that should be used to aid three different taping conditions underwent loading at 10° dorsiflexion Journal of Athletic Training S-71 (DF), 0° flexion (neutral) and 15° minimal interference in active divided into two categories based on plantarflexion (PF),which was defined plantarflexion/dorsiflexion ROM. taping technique: 5 using McConnell as the zero-load/zero-moment un- taping method and 1 using Kinesio loaded position.Main Outcome 12056MOPR taping method. The McConnell taping Measurements:Maximum achievable Patellar Taping Improved Pain group was further divided into medial angular foot displacement (DF/PF Scores in Patients with (4), neutral (1) and lateral (2) glide ROM)and total I-E ROM during Patellofemoral Pain Syndrome - application techniques. Pain level was loading at 4-Nm. Repeated measures A Systematic Review assessed using a Visual Analogue Scale ANOVA compared ankle-complex Brooks J, Ferrell B, White A, White K, (VAS). Two different scales were used stability among the no brace and braced Linens SW: Georgia State University, depending on the type of study. The ankles(soft-shell [Zoom™];lace-up Atlanta, GA studies that examined pre-tape pain [ASO™];rigid [Active Ankle T2™]) level versus post-tape pain level used Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 across DF, neutral, and PF angles. Context: With society being more a 0-100 VAS, while the studies that Separate single factor ANOVAs were active now than in the past, examined tape versus no tape used a performed to compare differences in patellofemoral pain syndrome (PFPS) 0-10 VAS. Data Synthesis: ankle DF and PF ROM ratios. The ratio has become more prevalent, accounting McConnell taping significantly between the ROM with each brace and for 33% of all knee injuries in females decreased the amount of pain the ROM without each brace was and 18% of all knee injuries in males. experienced by subjects with PFPS calculated and reported as a percentage. PFPS is one of the most common and from 34.9% with neutral glide Significance was set a priori at P< .05. clinically challenging knee pathologies, correction to 50% with the medial glide Results:TheROM ratio showed that found not only in the athletic correction when compared to no tape. the rigid and soft-shell braces provided population, but also in that of the The data pertaining to Kinesio tape was the greatest amount of dorsiflexion general population. It is believed that inconclusive when pre and post pain (88 to 90%) and plantar flexion (90 to this knee pain and discomfort is caused levels were assessed. Conclusions: 95%) (P>.05). Whereas wearing the by abnormal biomechanical factors that Data pertaining to the use of McConnell lace-up brace resulted in significantly change the tracking of the patella taping shows that there was a reducedDF (80.1%) and PF (79.9%) causing a temporary subluxation of the significant decrease in pain in subjects ROMratios (P< .004). A significant patella. This momentary subluxation with PFPS and should be considered flexion angle by support condition leads to an abnormal distribution of for clinical use. There was only a slight interaction effect was found for total shearing and compressive forces on the decrease in pain with the application of I-E rotation (P< 001). Across each patellofemoral joint. A common non- Kinesio tape, but was not significant flexion angle, all braces produced a operative intervention used pre- enough to conclude its effectiveness. significant reductionin ROM when dominantly in the rehabilitation setting Future research should examine pain compared to the no brace trial (P< is taping. Patellar taping techniques reduction effects over time using .001). When comparing the braces are used to provide support to the McConnell taping technique. themselves, the soft-shell and rigid patella during movement. However, braces significantly decreased I-E reports appear inconclusive on its 12037MOPR ROM versus the lace-up brace at each effectiveness. Objective: To investi- Effects of Low-Dye Taping on flexion angle [10° DF: soft-shell (34.7 gate the efficacy of patellar taping to Measures of Static and Dynamic ± 6.6°) and rigid (31.9 ± 7.6°) brace I- reduce pain in subjects with PFPS. Balance in Female Pronators E ROMs were significantly lower than Data Sources: We searched CINHAL, Lougheed CJ, Greenwood LD, the lace-up brace (44.4 ± 10.9°, P< SPORTDiscus, MEDLINE, and Boucher TM: Baylor University, .001)]; [Neutral: soft-shell (37.5 ± PubMed databases through June 2011, Waco, TX; Texas A&M University, 7.8°) and rigid (36.5 ± 8.3°) brace I-E using the key words patella taping and College Station, TX ROMs were significantly lower than pain reduction, patellofemoral pain the lace-up brace (48.9 ± 12.2°, P< syndrome and taping, Kinesio tape Context: Low-dye taping is an .001)]; and [15° PF: soft-shell (40.2 for patellofemoral pain syndrome, effective technique used to provide ± 8.9°) and rigid (40.3 ± 10.4°) brace and patellofemoral taping. Study support for the medial longitudinal I-E ROMs were significantly lower Selection: Criteria for inclusion were arch and to reduce symptoms than the lace-up brace (47.1 ± 12.7°, studies that exclusively recruited associated with excessive pronation of P< .001)]. No significant I-E ROM patients diagnosed with PFPS, applied the foot. While there have been differences were observed between the a taping technique as treatment, and multiple studies performed soft-shell and rigid braces (P> utilized an outcome measure specific investigating the effect of Low-dye .05).Conclusions:The soft-shell and to pain reduction. Data Extraction: taping on postural alterations, there rigid braces provided superior Four investigators identified and have been no investigations on the inversion-eversion rotation support reviewed six studies with an average effects of Low-dye taping on measures across each ankle flexion angle with PEDro score of 6.75/10. Articles were of balance which is an integral part of S-72 Volume 47 • Number 3 (Supplement) May 2012 functional movement. Objective: To foot as seen by the results of the determine the effect of Low-dye taping navicuar drop test. While Low-dye on measures of balance. Design: taping was shown to not affect Crossover study design. Setting: measures of balance as determined by Research laboratory. Patients or the US and SOT of the Neurocom Other Participants: Nineteen Smart Equitest®, more research is healthy, physically active female needed to determine effectiveness of volunteers (age 20.8±1.71 years, Low-dye taping in concern with height 166±5 cm, weight 61.35±8.24 exercise, dynamic balance and kg) who were pronators. Pronation was maintaining foot posture. Low-dye determined by having a 10mm or more taping should continue to be utilized

measurement in the navicular drop test. in the clinical setting when decreases Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Intervention(s): Navicular drop and in navicular drop measurement are measures of balance were assessed in indicated. both feet during a no tape condition and a Low-dye tape condition. Main Outcome Measure(s): Navicular drop was determined from the height (mm) of the navicular bone in sub-talar neutral and in a relaxed stance. Navicular drop measurements were analyzed with a repeated measures ANOVA and independent t-tests were used post-hoc to determine statistical significant differences between specific navicular drop measures. Measures of balance were collected by the Neurocom Smart Equitest® system. Static balance was calculated by utilizing the Unilateral Stance test(US) and dynamic balance via the Sensory Organization Test(SOT). Dependent variables from the balance tests were analyzed with a paired t-test. Results: A significant difference was found in navicular drop measurements between all tape conditions (pre-tape: right foot 13.84±2.06mm, left foot 14.16±2.54mm; post-tape: right 5.11±1.76mm, left 4.95±1.72mm; post-balance: right 7.37±1.83mm, left 8.32±1.70mm). A significant decrease was found between pre-tape and post- tape conditions (right: t=13.206, tα/2= 10.626, P<.001).There was also a significant increase after balance testing (right: t=-5.712, tα/2=-3.096,

P<.001; left: t=-7.221, tα/2=-4.348, P<.001). The increase seen after balance testing was still significantly lower than pre-tape conditions (right: t=10.391, tα/2=7.783, P<.001, left: t=9.114, tα/2=7.189, P<.001). There were no significant differences found between tape conditions for the US or SOT. Conclusions: Low-dye taping significantly alters the posture of the Journal of Athletic Training S-73 Free Communications, Case Studies: General Medical Conditions Friday, June 29, 2012, 9:45AM-11:15AM, Room 274; Moderator: Katie Walsh, EdD, ATC 12344 Cystic Macular Edema and Central injection of bevacizumab, a vascular inhibitor,is most often associated with Retinal Vein Occlusion in a Female endothelial growth factor (VEGF) chemotherapy and not a familiar Collegiate Lacrosse Player: an inhibitor common in the treatment of medication to ATs in the treatment of Uncommon Case of Blurred Vision cancer. To address the inflammation, edema.Conclusions: Though macular Charles-Liscombe RS, Eurillo R, minimize clotting risk, and likelihood edema and retinal vein occlusions are Graham A, Lesperance Greensboro of possible autoimmune involvement, not usually seen in youth and young Orthopaedics; Greensboro College, oral medications also included 20mg adults, they can result in permanent Greensboro, NC predisoneqd, 7.5 mg methotrexate blindness in the affected eye if left weekly, 75 mg cyclosporine bid, 81 untreated. ATs should closely monitor Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Background: A 20-year-old, mg asprinqd, 20 mg Pepcid AC qd, and atraumatic vision changes in their Caucasian, female NCAA Division III 1mg folic acid qd. Patient was patients and refer to an eye care lacrosse player (1.68 m, 58.18 k) advisednot to participate in athletic specialist as appropriate. presented with initial complaints of competition and to avoid valsalvic intermittent blurriness in her right eye pressure. The patient developed 12323MC that was relieved with light finger tip candidiasis as a result of cortico- Medical Clearance and Return to pressure. She reported that her central steroid use and was treated with 150 Play Decisions for a Female Division vision had been diminishing over a mg fluconazole.At week 4, the I Volleyball Player with Wolff- period of 2 weeks as if there was “a patient’s right eye vision returned to Parkinson-White Syndrome film over the right eye”. No MOI or 20/3 and reduced edema, pressure, and Secondi PA, Joseph C, Reber A: pain reported. Patient was a non- hemorrhaging. Analysis of blood University of Central Florida, smoker,reported occasional con- samples on follow-up revealed the Orlando, FL sumption of alcohol, no allergies. patient was heterozygous for Factor V Medications included Ortho Trycyclin Leiden, a genetic mutation associated Background: During the Pre- Lo (norgestimate/ethinyl estradiol) with increased risk of thrombosis. The Participation physical examination for menstrual irregularity. No personal patient was instructed to discontinue process, a 20 year old, female, or family history of eye injury or birth control medications to minimize collegiate volleyball, transfer student- disorders. Upon initial examination, risk of clotting. Injections of athlete from Australia reported a the patient’s pupils were equal, reactive bevacizumabwere to continue at 4 previous diagnosis of Wolff-Parkinson- to light; no noted discolorations or week intervals. The patient was cleared White Syndrome (WPWS). This athlete deformities of the sclera, cornea or to participate in intercollegiate had a catheter ablation procedure at the iris. Eye movements were unaffected. lacrosse with required eye protection. age of 11, but she continues to She demonstrated a significant vision At week 15 (after missing her have episodes of supraventricular deficit (Left - 20/30; Right - 20/200). treatment at week 12), her vision was tachycardia while participating in The patient was referred to an again 20/250 with significant macular athletic activity and at rest. The optometrist for examination on the edema. Following a repeat bevaci- university medical staff has been same day she reported to the AT. zumabinjection, the patient’s vision unsuccessful in retrieving her previous Differential Diagnosis: Myopia, and macular edema returned to normal. medical recordsdue to the date of the Retinal detachment/ necrosis, uveitis, The patient was counseled to minimize procedure and being out-of-country. macular degeneration/edema, central excessive valsalva pressure, continue After an unremarkableElectro- retinal vein occlusion (CRVO). Treat- to monitor vision changes, and cardiogram (ECG), treadmill stress test, ment:Physical exam at the optometrist continue bevacizumab treatments and echocardiogram,the athlete was revealed macular edema, papilitis every 4 weeks. Uniqueness: The cleared for participation by the (degeneration of the optic nerve), and incidence rate of CRVO is less than Cardiologist. Differential Diagnosis: retinal hemorrhage. The patient was 10% in those under 25 and is most Atrial Fibrillation, Atrial Tachycardia, referred the same day to a retinal often a complication of diabetic Sick Sinus Syndrome Treatment:This specialist for further workup. Red cap retinopathy in the elderly. The athlete had her first tachycardia test was positive for diminished optic incidence rate in the general episode three weeks after clearance nerve function. Ocular coherence population is 0.5%. This case is also during volleyball practice. She was tomography and fluorescein angi- unique because the patient was immediately removed from participation ography resulted in a diagnosis of diagnosed as being a heterozygous and moved into the athletic training CRVO with cystic macular edema. In carrier of factor V Leiden increasing room. She was instructed to lay supine order to reduce retinal edema , the her risk of CRVO five to seven and performa valsalva vagal maneuver, patient received 0.05ml intraocular fold.Finally, bevacizumab, a VEGF and the tachycardia episode was S-74 Volume 47 • Number 3 (Supplement) May 2012 successfully broken. This tachycardia treatment has a success rate of 85-90%, Willebrand’s disease, Malignant episode lasted for 4-5 minutes. The however, this athlete continues to have lymphoproliferative and myelo- athlete was returned to participation issues. Additionally, WPWS is an proliferative disease, Leukemia, with a heart rate measuring 90 BPM uncommon cardiac disorder. The Human immunodeficiency virus (HIV) about 10 minutes after the tachycardia incidence of WPWS is between 0.1% infection, H. pylori infection, Cyto- episode subsided. This athlete had a and 0.3% of the general population, and megalovirus (CMV) infection, Hepatitis re-evaluation with the Cardiologist and is even less common in an athletic C infection, lupus erythematosus (SLE), was informed that another episode of population. This is a cardiac condition Drug-induced thrombocytopenia, tachycardia would result in a removal that must be monitored on a daily basis Idiopathic thrombocytopenic purpura from participation and referral to an and needs immediate treatment should (ITP). Treatment: The patient was Electrophysiologist. This athlete an episode oftachycardia occur. hospitalized for 2 days during

sustained another episode of Conclusions:This is an unusual case treatment. Intravenous immunoglobulin Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 tachycardia during participation on a and very rare in the athletic population. G (IVIG) was initiated. Oral prednisone road trip five weeks later. The athlete Even at the risk of having an episode 80mg daily was also initiated with was immediately removed from of tachycardia, athletes who have Protonix 40mg daily to reduce GI participation and brought into locker Wolff-Parkinson-White Syndrome can irritation. A diagnosis of ITP was room. The athlete was again instructed be cleared with proper pre-participation confirmed after other blood disorders to lay supine and perform a valsalva testing and education, supervision were ruled out and bone marrow biopsy vagal maneuver, and the tachycardia while participating,immediate care, and and aspiration demonstrated hemato- was successfully broken in 45-60 post-episode consultations. poietic cells, fat cells, and connective seconds. The athlete was referred for a tissues within normal limits. Platelet consultation with an Electro- 12F03FC count responded well initially to the physiologist one week later. After Idiopathic Thrombocytopenic IVIG but did not respond to the herinitial evaluation and unremarkable Purpura in a Recreational Runner prednisone. A splenectomy was ECG, the Electrophysiologist presented Kahanov L, Eberman LE, Grammer S: scheduled after the patient did not three options for treatment. The athlete Indiana State University, Terre Haute, respond to 2month of prendisone. The could undergo an intracardiac IN patient was provided a third dose of electrophysiology study (EPS) to IVIG 3days prior to the surgery. The determine the accessory pathway in her Background: A 23-year-old college platelet count increased 2days prior to heart’s electrical system, take beta student participating as a recreational the splenectomy with the highest blockers to decrease the electrical runner was referred by her athletic platelet count since the onset of activity of the cardiac rhythm, or wear trainer to urgent care with complaints treatment (75 K/mL). The splenectomy a Holter monitor for 4 weeks, in hopes of excessive bruising of unknown was canceled, and the patient reached of documenting an episode of origin. The patient noticed bruising and and maintained 150 K/mL. Prednisone tachycardia. The EPS is an invasive red marks on her body increasing over was slowly tapered over 3months by 5- procedure that would require time loss a period of 2-days. Bleeding of the lips 10mg per decrease. The patient has during her competitive season and there and gums began 2 days prior. Patient experienced no relapse. Uniqueness: is a lack of research supporting the history indicated no recent illness or This patient demonstrated both ITP-A effectiveness of the use of beta blockers stress other than regular class load. In (adult onset) and ITP-C (childhood to decrease cardiac electrical rhythm. the urgent care, skin demonstrated onset) signs and symptoms where ITP- As a result, the athlete opted for the use diffuse petechiae on the calf and hand C typically occurs with a rapid onset of the Holter monitor.If the athlete has bilaterally with purpura on the back and and resolves within 6 months and IPT- another episode of tachycardia, she is shoulders, epistaxis in the nostrils A is slow onset that is chronic in nature. to remove herself from participation bilaterally, and three bleeding Standard treatment procedures of and record the heart rhythm. ulcerations on the tongue. The corticosteroid and IVIG drug therapy Uniqueness:The athlete is an remaining HEENT was unremarkable. wereinstituted and determined international student and her catheter Cardiopulmonary, musculoskeletal, ineffective prematurely in this patient, ablation procedure was performed 9 neurological, gastrointestinal, which may be due to the onset years ago. As a result, the sports and lymphatic systems were all characterized as ITP-A rather than ITP- medicine staff has not been able to unremarkable. A complete blood count C. The uniqueness of this case may retrieve the records. Until the records (CBC) indicated a platelet count of 1 indicate that practitioners should use are retrieved and reviewed, the K/mL. The remainder of the CBC was both ITP-A and ITP-C diagnostic onset Cardiologist cannot determine which within normal limits. PT/PTT were evaluation for young adults in order to electrical pathway her past catheter within normal limits. Differential successfully diagnose young adults. ablation procedure was performed on Diagnosis: Post-transfusion purpura, Conclusions: ITP has two differing without another EPS. Research has Inherited non-immune thrombocy- onsets based on age of inception. ITP- shown that the catheter ablation topenia, Aplastic anemia, Type IIB von C and ITP-A have identical clinical Journal of Athletic Training S-75 features and treatment regimes, yet accommodation, and convergence his family practice physician on onset and prognosis differ. Athletic testing also noted. Differential September 10, 2011, seven days after trainers should be awareof these Diagnosis: (1) Chronic Otitis Media, onset of unusual and progressive differencesfor continued treatment, (2) Barotrauma, (3) Skull Fracture, (4) symptoms. Subject’s symptoms were monitoring and return to participation Hemotympanum, (5) Intra-tympanic initially characterized by nausea, criteria in the young adult population. hemorrhage. Treatment: CT and MRI persistent ~104° fever, extreme fatigue, In addition, ITP should be added to the with attention to the temporal bones irritability, elevated heart rate (90 bpm), range of general medical clinical showed no fractures or bony and severe headaches. Chest pain and knowledge for referral purposes. abnormalities, ear ossicles intact, no tightness had developed along with Treatment for both ITP-C and ITP-A brain pathology or bleeding noted. liver tenderness, salmon-colored rash should be similar but cautionary in the Abnormal neuropsychological testing involving trunk and extremities, dry

decision to conduct a splenectomy, compared to baseline c/w concussion. cough, sore throat, strawberry tongue, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 particularly with young adults who may Audiology examination was within bright-red rash with sores inside mouth display both ITP-C and ITP-A normal limits. The findings indicated and throat and severely cracked lips. characteristics resulting in spont- intra-tympanic hemorrhaging secon- Blood tests indicated significantly aneous remission. dary to barotrauma caused by helmet- elevated white blood cells, for which to-helmet contact; mastoid contusion. antibiotics were prescribed to treat what 12259FC The patient suffered with post- was thought to be a systemic infection. Ear Trauma: A Case Review of a concussive syndrome for the entire The subject lost 20 pounds in the first 26-Year-Old Male Arena Football season, was referred to Neuro- two weeks. Joint aches persisted with Offensive Lineman with Intra- psychology after 3 weeks, underwent pronounced neck and shoulder pain. Tympanic Hemorrhage Secondary vestibular physical therapy for several Lymph nodes in the neck were swollen to a Concussion months, and is now back to work and with left side measurably larger. Feet Hauth JM, Gloyeske BM, Vanic KA, retired from football. Uniqueness: Intra- exhibited slight purple discoloration Waninger K, Yen D: East Stroudsburg tympanic hemorrhage is a rare diagnosis along with peeling of the skin on soles, University, East Stroudsburg, PA most often caused by a basilar skull palms and fingers. Eyes were very red fracture or barotrauma associated with with significant photophobia. Background: A 26-year-old arena diving or a blast. To the author’s Dizziness, nausea, anorexia, and football offensive lineman participating knowledge no such report exits of an insomnia ensued. Subject’s declining in “bull in the ring” blocking and Intra-tympanic hemorrhage secondary condition prompted a second doctor tackling drill was positioned in the to a helmet-to-helmet blow. Con- visit and referral to an infectious disease center of the “ring” when he was blind- clusions: The tympanic membrane specialist. After examination by the sided by an opposing teammate. He (TM) is a highly vascular membrane infectious disease specialist and a sustained a direct helmet-to-helmet that is very sensitive to variations of consultation with a rheumatologist, the blow to the right temporal area of his atmospheric pressure. Overpressure subject was hospitalized. Differential football helmet. He immediately can enter the external auditory canal, Diagnosis: Mononucleosis, strep removed himself from the drill and stretching and displacing the TM and throat, scarlet fever, rheumatic fever, reported to the athletic trainer for causing injury ranging from intra- bacterial blood infection, toxic shock evaluation. Initial sideline evaluation tympanic hemorrhage in minor cases to syndrome, Kawasaki syndrome, adult- revealed mild headache, mild total TM perforation in powerful blasts. onset Still’s disease, periodic fever confusion, dizziness, photophobia, and This concussed football player was syndrome, aseptic meningitis, Behcet’s tinnitus. The athlete reported no never able to return to play due to his disease, genetic autoimmune in- tenderness over the head, face, neck, concussive symptoms. flammatory reaction, hepatitis, SLE or jaw. Bilateral upper extremity disease, cytomegalovirus, viral strength and reflexes were normal. No 12378FC exanthema, antigen-antibody allergic complaints of hearing difficulties. Acute Illness in a Male High School reactions disorder, Reiter’s syndrome, Initial diagnosis of concussion was Lacrosse Athlete HIV. Treatment: Seven-days after reaffirmed by team physician Blair DF, Madland JM, Byrd CJ, Nixon onset of symptoms, testing was evaluation within 12 hours of initial SE, Harrison CS, Walton MA: negative for mononucleosis and strep. injury. Large post-auricular contusion Wenatchee High School, Wenatchee, A tentative diagnosis of a bacterial over the right mastoid process was WA infection determined and was treated noted from helmet trauma, and diffuse with Azithromycin. After 6 more days, right intra-tympanic hemorrhage was Background: Our subject is a 17 year- no improvement, hepatitis and HIV noted on tympanic membrane old male high school lacrosse athlete testing negative, treatment was initiated examination. No hemorrhage with a history of postconcussive for symptoms for what was thought to (hemotympanum) or effusion of middle syndrome. After examination by the be Kawasaki syndrome. There are no ear. Abnormalities on vestibular testing, athletic trainer, the subject was sent to confirmation tests for Kawasaki S-76 Volume 47 • Number 3 (Supplement) May 2012 12036MC syndrome, an autoimmune inflam- Contagious Skin Infection in a Cephalexin (Keflex) , one gram twice matory reaction affecting medium-sized Division I Collegiate Football daily x 14 days, Mupirocin 2% blood vessels. The cause of Kawasaki Team (Bactoban) topical cream to apply syndrome has not been determined. Bryson EB, Hendrickson CD, three times daily, and Chlorhexadine However, lack of prompt treatment in Johnson PD, Navitskis LB, Schmidt wash (Hibiclens) wash to shower with other Kawasaki cases (more than 10 PW: University of Michigan, Ann twice daily. The football facility days from onset of symptoms) has led Arbor, MI (weight and athletic training rooms, to aortic aneurysms. Subject was locker rooms and showers), was hospitalized and treated with inspected by Certified Athletic intravenous immunoglobulin, at a dose Background: Six healthy collegiate Trainers, doctors and facility staff for of 2g/kg (160g) administered football players presented with assurance of proper cleanliness. The Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 intravenously over a 12-hour period. multiple expanding skin lesions on importance of proper cleaning of This immunoglobulin treatment their extremities over the course of 14 equipment and no sharing of towels, suppressed the immunological days. The first athlete reported with an razors, and personal items were re- reactions causing the inflammatory erythematous, ovoid blistering group emphasized to all football athletes. The response to the blood vessels. Four 325 of lesions on the left proximal upper lesions were to be covered for daily mg. aspirin tablets and one Zantac extremity and described a burning activities and practice until dried, as antacid were also administered every sensation and general discomfort over per recommendations by the team 6-hours in conjunction with the IV the area. He denied that the lesions physicians and dermatologists. immunoglobulin to reduce inflammation were itchy. Despite the initiation of Results: All lesions were improved and fever. The Zantac antacid was used Valtrex(Valocyclovir) by the team and no new lesions had developed to protect the stomach lining from the physician for a presumed herpetic several days into treatment. All of the high dose of aspirin. Septra DS and source, the lesions did not clear and lesions were completely dry and the Doxycycline were administered as a additional smaller circumferentially athletes were cleared to compete precautionary treatment for MRSA– blistering lesions arose adjacent and without wound coverage seven days induced Toxic Shock Syndrome. on the opposite extremity. A second after treatment was initiated. No new Kawasaki syndrome diagnosis was athlete later presented with two athlete cases were reported. confirmed when the subject’s circular-to-ovoid forearm lesions. Uniqueness: Unlike classic impetigo, symptoms significantly resolved One of these lesions was rimmed with a skin infection mostly seen in young several hours after completion of erythema, had a central pallor, noted children caused most commonly by treatment. Uniqueness: An extremely to itch more than burn. Topical streptococcus, bullous impetigo is small number of patients (fewer than fluconazole prescribed by the team characterized by blistering lesions and 100) worldwide have been documented physician for probable tinea is caused by staphylococcus. This with adult Kawasaki syndrome. Adult (ringworm) had no benefit and several infection is contagious and can present rehabilitation strategies and techniques additional lesions developed in the in populations where close contact is are virtually unknown. 15-25% of antecubital fossa. Lesions similar in ubiquitous. Reports of this are pediatric cases result in aortic nature arose on four additional athletes documented in the sport of wrestling, aneurysms, with only 50-75% of those over the next week. They were circular- but an outbreak amongst collegiate cases resolving themselves. Adults to-ovoid with erythematous rims football players is unique. Due to the fare better with only 5% resulting in surrounding a more central pallor or nature of this skin infection, the initial aneurysms. Conclusions: Two months scabbed core and ranged in size from diagnosis is challenging. This skin following the onset, our subject is 0.5cm to 2.5 cm in diameter. These condition can mimic other skin slowly working towards a full recovery, four athletes applied antibiotic infections including herpes and tinea now taking 1300 mg/day of aspirin. At ointment and covered the lesions for corporis. Conclusion: Athletic this point, headaches persist and sleep practice activities as directed by the medicine personnel should be aware patterns are not back to normal. His team physician. Four of the six athletes that bullous impetigo can be a cause eyes are still red and light sensitive. His were offensive lineman frequently in of skin infections in the collegiate palms, fingers soles are still peeling, contact with each other during drills. football environment, and once however, there are no new lesions. The other two were a linebacker and a diagnosed, is responsive to treatment. Given the rarity of Kawasaki syndrome tight end. Dermatology was consulted. Due to the contagious nature of this in adults, there is limited data to predict Treatment: A team of three skin infection, proper diagnosis and a full recovery time frame. dermatologists evaluated the six immediate treatment are needed to student-athletes and upon clinical successfully treat the infection as well examination diagnosed bullous as to prevent its further spread. impetigo. Each athlete was treated with

Journal of Athletic Training S-77 Free Communications, Oral Presentations: Neuromuscular Aspects of Shoulder Injury Friday, June 29, 2012, 11:30AM-1:00PM, Room 274; Moderator: Kevin Laudner, PhD, ATC 12261FOMU The Sleeper Stretch as an Evaluative Measures: Dependent variables itation exercises aim to re-establish Measure – A Preliminary Report included SS values and TUB measures. activation of muscles and force couple Carcia CR, Cacolice PA, Scibek JS: We used descriptive statistics to relationships for stability through Duquesne University, Pittsburgh, PA describe ‘normal SS’ values; paired and whole-body movements. Objective: non-paired t-tests respectively to Determine whether scapular force Context: The sleeper stretch (SS) is a determine if SS values differed between couple activation ratios and individual

commonly used intervention for extremities and gender and correlation muscle activity [upper trapezius (UT), Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 patients and athletes with decreased analyses to determine if SS values were middle trapezius (MT), lower trapezius glenohumeral (GH) internal rotation (IR) related to TUB measures. Results: (LT), and serratus anterior (SA)] differ range of motion (ROM). Recently, Intra-rater reliability for both SS (ICC between functional exercises in GH investigators have identified the SS is [3,k]=0.924) and TUB measures (ICC pathology subjects and healthy a more reliable objective measure of GH [3,k]=0.935) were excellent. The grand controls. Design: Cross-sectional. IR ROM when compared to quantifying SS mean was 48.4±12.5°. SS values on Patients or Other Participants: IR at 90 degrees of abduction. However, the non-dominant side (51.7±10.3°) Forty subjects (GH pathology: n=20; many questions exist regarding the use were greater than those on the dominant age, 23.65 ± 3.25 yrs; height, 170.69 of the SS as an evaluative measure. side (45.2±13.8°) (P=0.001). No ± 11.55 cm; weight, 74.57 ± 13.13 kg Objective: This study had several difference between gender was , Healthy control: n=20; age, 24.80 ± objectives: 1) To identify normal SS apparent on either the dominant 3.59 yrs; height, 172.85 ± 9.01 cm; values in a healthy college age (male=43.2±16.6°; female=47.1±10.3°; weight, 72.78 ± 15.65 kg) of con- population; 2) To determine if SS values P=0.374) or non-dominant (male= venience were tested. Interventions: differed between: a) dominant and non- 50.2±10.7°; female=53.3±10.0°; P=0.348) Participants were screened and placed dominant extremities; b) gender and; 3) side. A fair but statistically significant into GH pathology or healthy control To determine if sleeper stretch values correlation was evident between SS groups. Each participant performed 4 were related to the ability of a subject values and TUB measures on the functional exercises [Bow and Arrow to reach their thumb up their back dominant (r=0.421; P=0.007) but not (BA), External rotation with scapular (TUB). We hypothesized that there non-dominant (r=0.252; P=0.116) side. squeeze (ERSS), Lawnmower, Robbery] would be no difference in SS values Conclusions: SS values are less on the while muscle activity was recorded. The between sides or gender but that SS dominant upper extremity and do not exercise was performed over a 3-second values would be related to TUB differ between healthy male and female period. An accelerometer was used to measures. Design: Descriptive. Setting: college age subjects. SS values are synchronize data. Main Outcome Research laboratory. Patients or Other related to a healthy subject’s ability to Measures: Electromyography (EMG, Participants: A convenience sample of perform a functional IR task (TUB) on Noraxon USA Inc, Scottsdale, AZ) was 40 healthy, recreationally active college the dominant side. These preliminary used to collect muscle activity from UT, aged students (20 male: age=22.1±2.1 data provide a baseline reference to MT, LT, and SA. Integrated EMG years; weight= 84.1± 14.0kg; height= which sport specific and injured (iEMG) was normalized to maximum 181.3±14.8cm; 20 female: age=20.6± populations of a similar age group can voluntary isometric contraction. 1.2years; weight=62.5±7.6kg; height= be compared. Scapular force couple activation ratios 174.0±17.0cm) participated. Inter- were calculated by dividing normalized ventions: First, intra-rater reliability of 12F02MOTE iEMG values of the UT by normalized Altered Scapular Muscle Activation the dependent measures was iEMG values of the MT, LT, and SA to in Individuals with Shoulder established in 10 shoulders. Next, generate ratios UT/MT, UT/LT, and UT/ Pathology Exists During Functional using a standardized protocol, SA, respectively. A ratio value greater Shoulder Exercises we: 1) measured GH IR ROM in degrees than 1 corresponded with more UT Moeller CR, Huxel Bliven K, Snyder using a digital inclinometer (Pro 360, activity and a value less than 1 AR: A. T. Still University, Mesa, AZ; Baseline®, Fabrication Enterprises, represented less UT activity with respect San Diego Chargers Intern, San White Plains, NY) three times bilaterally to the MT, LT, and SA. Exercise x group Diego, CA in the SS position and 2) quantified the repeated measures analysis of variance percentage a subject was able to reach (ANOVA) was used to analyze data. their TUB to the nearest spinous Context: Alterations in scapular Results: UT/MT and UT/LT activation process three times bilaterally with a muscle activation affect stability, ratios were similar during BA and rigid tape measure mirroring previously often occurring with glenohumeral Robbery (p>.05); both had greater published methods. Main Outcome (GH) pathology. Functional rehabil- activation than lawnmower (p<.05) and S-78 Volume 47 • Number 3 (Supplement) May 2012 ERSS (p<.05). A trend for higher UT/ pants: 33 patients (25 males) at the lesions has a positive outcome in SA activation ratios in GH pathology Lexington Clinic (height=176±9cm; approximately 50% of the patients. subjects was found during Robbery weight=83±18kg; age=40±12yrs) Patients should be encouraged to (p=.047). An interaction for UT and MT presenting with shoulder pain were attempt non-operative treatment for revealed more activation in GH enrolled. Patients presenting with at approximately 5 weeks. Although our pathology subjects during Robbery least 3 out of 4 clinical tests or a positive hypothesis was not supported, as (p=.001 and .018, respectively). A trend MRI finding were clinically diagnosed compliance did not reach significance, for less LT activity during Lawnmower to have a SLAP lesion. Interventions: there is a strong trend toward a more (p=.053) was found in GH pathology Patients were prescribed a standardized compliant patient is more likely to have subjects. SA had more activity during rehabilitation protocol and saw a a positive outcome with non-operative ERSS than Robbery (p=.001) and BA physical therapist of their choosing. rehabilitation.

(p=.007). Conclusions: Findings of Patients were instructed to complete Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 increased UT and diminished LT exercises deemed appropriate by their 12283MONE activation align with previous research physical therapist, based on the Shoulder Muscle Activation In using pathologic subjects, evidenced protocol and in accordance with their Individuals With Previous Shoulder by altered scapular force couple symptoms, level of function, Injury activation ratios. Altered muscle and treatment goals. The protocol Muething A, Rupp K, Spiers S, Saliba activation may compromise scapular addressed range of motion limitations SA, Brockmeier S, Hart JM: University stability in GH pathology individuals. and progressed patients through 4 of Virginia, Charlottesville, VA Lawnmower and ERSS exercises elicit levels of exercise: scapular and trunk less UT activation while promoting MT, stabilization; strengthening with a short Context: Muscle activation in patients LT, and SA activity in all three scapular lever arm; strengthening with a long with history of unilateral chronic force couples. Funded by the NATA lever arm; and eccentric/plyometric glenohumeral joint (GHJ) injury may Foundation Masters Grant Program. exercises. Exercise logs and PT notes guide clinicians while developing a were collected from patients at the 6 conservative treatment plan to 12352OTE week physician visit. We performed a strengthen or activate specific muscles Compliance to a Standardized Chi-square test for compliance and a surrounding the GHJ. Objective: To Exercise Protocol Positively Affects Mann-Whitney U test for total weeks investigate activation via surface Patients with Superior Labral in PT with significance set p ≤.05. Main electromyography (sEMG) of 6 muscles Lesions Outcome Measures: Dependent surrounding the GHJ during functional Seekins KA, Moore SD, Uhl TL, variables included total weeks in PT and isometric contractions in individuals Kibler WB: University of Kentucky; compliance to our program. A patient with a history of GHJ injury compared Lexington Clinic Orthopedics-Sports was considered compliant if they to healthy, matched controls. Design: Medicine Center, Lexington, KY performed e”65% of the standardized Case-control. Setting: Research program as determined by reviewing laboratory. Patients or Other Context: Surgical management and patient notes and logs. The Participants: 17 individuals with self- post-operative rehabilitation of independent variable is outcome, based reported unilateral GHJ injury (8 women, Superior Labral Anterior-Posterior on physician recommendation at six 9 men, age: 22.3±2.6 years, height: (SLAP) lesions has been well weeks; those doing well and were to 172.4±8.8 cm, mass: 75.4±16.5 kg, established in the literature with continue rehabilitation (responders) or Western Ontario Shoulder Index generally positive outcomes. Non- those recommended for surgical (WOSI): 618.9±348.348.2) and 17 operative management of SLAP lesions intervention by physician (non- matched controls with no history of is under reported in the literature. It is responders). Physician recommen- shoulder pain or injury (8 women, 9 unknown if patient compliance to a dation for surgery was based on men, age 22.9±3.9 years, height: standardized physical therapy (PT) continued symptoms and functional 170.9±11.3 cm, mass: 73.6±22.9 kg, intervention has a positive effect on deficits, despite conservative WOSI: 35.1±62.4). Interventions: patient outcome, and if so, rehabilitation. Results: 17 (52%) Diagnostic ultrasound images of the how compliance to non-operative patients were deemed ‘responders’ to supraspinatus were taken in relaxed and rehabilitation program affects outcome. the protocol, with 16 (48%) non- contracted states. Manual muscle tests Objective: To determine if patient responders. 12/17 (71%) responders (MMT) were performed in a random compliance has an effect on outcome. were compliant to our protocol, while order consisting of maximal isometric We hypothesize that patients who have only 6/16 (38%) of non-responders were voluntary contractions of the anterior a positive clinical outcome will be compliant (p=.056).Responders were deltoid, upper trapezius, infraspinatus, more compliant with a standardized found to be enrolled in supervised PT lower trapezius, and serratus anterior rehabilitation protocol. Design: longer (5±3weeks) than non-responders for normalization values. We then Prospective cohort, quasi-experimental. (3±3 weeks, p=.047). Conclusions: measured sEMG from each muscle while Setting: Outpatient clinic. Partici- Conservative intervention of SLAP subjects performed 3 5-second Journal of Athletic Training S-79 12172MONE isometric test contractions in an A Comparison of Scapular Muscle isometric contraction (%.s). UT, MT, upright-seated position and the arm Strength and Activation in Patients LT, and SA strength (kg) was measured horizontal to the floor. The test With and Without Glenohumeral during standardized manual muscle contractions were forward flexion, Joint Pathology and Scapular tests (MMTs) using a hand-held scapular plane flexion (i.e. scaption) and Dyskinesis dynamometer. For objective 1, data were abduction, all at 90°. Main Outcome Yamada D, Huxel Bliven K, Moeller analyzed using 2-way ANOVAs. For Measures: Root mean square (RMS) CR, Bay RC, Sauers EL: Arizona objective 2, the predictor variable was on 5 muscles (anterior deltoid, School of Health Sciences, A.T. Still scapular dyskinesis (yes, no). A logistic upper trapezius, infraspinatus, lower University, Mesa, AZ regression was used to identify trapezius, and serratus anterior) and variables associated with scapular ultrasound thickness change [(resting dyskinesis. Alpha was set at d”0.05, Context: Scapular dyskinesis in patients Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 thickness – contracted thickness)/ with glenohumeral (GH) pathology is two-tailed. Results: Twenty-six (62%, resting thickness] of the supraspinatus associated with alterations in strength pathology=11, healthy=15) subjects were the dependent variables. We and activation of upper trapezius (UT), displayed normal scapular motion and normalized sEMG to the ipsilateral side middle trapezius (MT), lower trapezius 16 (38%, pathology=9, healthy=7) to account for side-side differences (LT), and serratus anterior (SA), which displayed scapular dyskinesis. inherent in upper extremity musculature. may compromise scapular stability and Scapular dyskinesis subjects displayed Data were not normally distributed so function. Weighted forward shoulder more SA (32.9±5.7 vs 28.5±5.5 kg, we used Mann-Whitney U tests to flexion (WSFS) is a clinical assessment p=0.021) and LT (14.4±4.4 vs 11.7± 4.0 compare RMS sEMG activity and US for determining presence of scapular kg, p=0.055) strength compared to thickness change scores in injured and dyskinesis. It is unknown which muscle normal scapular motion subjects. healthy joints and Wilcoxon signed- alterations best predict scapular Scapular dyskinesis subjects displayed rank test for comparison of injured to dyskinesis. Objective: 1) Determine lower UT activation during concentric uninjured sides within the injured whether scapular muscle strength and (1491.9±689.4 vs 2817.5±1942.0%.s, group. Results: The anterior deltoid activation differ between subjects with p=0.015) and eccentric (996.7±484.4 vs was significantly less activated during and without GH pathology and scapular 1672.1±997.7%.s, p=0.015) phases of the isometric abduction in injured dyskinesis; 2) Identify muscle strength WFSF compared to normal scapular subjects compared to healthy subjects and activation variables that predict motion subjects. The best predictor (control: 1.18±0.63, injured: 0.76±0.28, scapular dyskinesis. Design: Cross- variables of scapular dyskinesis were P=.018). In injured subjects, the sectional. Setting: Laboratory. Patients SA strength [p=0.045, OR=1.15, 95% C.I. involved limb lower trapezius was or Other Participants: Forty-two (1.00 to 1.32)] and eccentric UT significantly less activated during subjects (GH pathology: n=20; Healthy: activation during the WFSF [p=0.041, scaption (healthy: 2.51±1.31, injured: n=22; Male: n=17; Female: n=25; Age: OR=.998, 95% C.I. (.997 to 1.000), 2.18±.80, P=.022) and abduction 24.2±3.3yrs; Height: 171.7±9.9cm; accounting for 36% of the variance. (healthy: 4.71±5.3, injured: 3.19±.10, Mass: 73.4±14.3kg) of convenience Conclusions: Scapular dyskinesis P=.031) compared to the contralateral were tested. Interventions: Subjects subjects generated more SA and LT side. There were no significant performed 10 repetitions of WSFS strength and lower UT activation than differences in other muscles during the (females: 2.3kg; males: 4.5kg) while normal scapular motion subjects. three isometric tasks or supraspinatus recording muscle activity and visually Higher SA strength and lower UT thickness change between groups or assessing for normal or abnormal activity are predictors of scapular within the injured group. Conclusions: (dyskinesis) scapular motion. For dyskinesis. These results present a Patients with GHJ injury had less objective 1, the independent variables unique profile of specific scapular activated anterior deltoid muscles were status (pathology, healthy) and muscle strength and activation compared to controls and exhibited scapular motion (normal, dyskinesis). variables that contribute most to reduced lower trapezius sEMG For objective 2, the predictor variables scapular dyskinesis, regardless of activation compared to their own were: strength of UT, MT, LT, and SA injury status. contralateral side. The Since these and integrated electromyography muscles have been proposed to work (iEMG) of UT, MT, LT, and SA during synergistically in providing GHJ concentric and eccentric phases of stability, deficits in activation may help WFSF. Main Outcome Measures: guide clinicians in developing Electromyography (EMG, Noraxon USA exercises that may help improve Inc, Scottsdale, AZ) was collected from activation of these muscles in patients UT, MT, LT, and SA during concentric with chronic GHJ injury. and eccentric phases of WFSF. iEMG was normalized to maximum voluntary

S-80 Volume 47 • Number 3 (Supplement) May 2012 12075MOBI The Contribution of the Biceps repetitions) on an isokinetic Brachii on Glenohumeral Muscle dynamometer (180°/sec). Shoulder Activation flexion/abduction and elbow flexion Lisowski JK, Oyama S, Creighton A, strengthwere measured using a hand- Prentice WE, Hibberd EE, Myers JB: held dynamometer before and after the The University of North Carolina at intervention to verify fatigue of the Chapel Hill, Chapel Hill, NC biceps brachii in experimental group participants. Main Outcome Measures: Context: Due to its anatomic location, Changes in mean activation levels of the biceps-labral complex is subjected the biceps brachii and glenohumeral muscles during 0°-30°, 30°-60°, 60°-90°, to compressive and tensile forces Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 during overhead movements, which can and 90°-120° of elevation arcs during contribute to biceps tendon and the elevationtasks before and after the glenoid labral pathologies. These intervention were compared between injuries are commonly treated surgically two groups using a 2-way mixed model by releasing (tenotomy) or relocating ANOVA and post hoc analyses. The (tenodesis) the long head of the biceps changes in three-trial mean of the tendon from its origin on the superior shoulder flexion/abduction and elbow glenoid. Controversy exists whether strength between the experimental and these procedures influence shoulder control groups were compared using function since the active role of biceps independent t-tests. Results: Despite brachii inglenohumeral movement a significant decrease in elbow flexion remains unclear. Objective: To assess strength that was observed after theactiverole of the biceps brachii intervention in the experimental during glenohumeralelevation tasksby group(F(1,28)=41.5, p <0.01), there were observing the activation of gleno- no significant changes inmuscle humeral muscles before and after activity between pre and post fatigue decreasing active contribution of the in the experimental or control group biceps brachii through induced elbow across all muscles examined for both flexion fatigue. Design: Randomized flexion and scaption tasks (p>0.05). control trial. Setting: Research Conclusions: The results indicate that Laboratory. Patients or Other Partici- the active contribution of the biceps is pants: Thirty individuals with no history minimal during the glenohumeral of upper extremity injury in the past 6 elevation tasks. It appears that the months were randomized into surgical procedures that relocate or experimental (n=15, 7 males/8 females, release the biceps tendon from the age: 19.9±1.1yrs; mass: 72.9±11.8kg, glenohumeral joint to treat biceps-labral height: 1.7±0.9m) and control groups complex can be performed without (n=15, 8 males/7 females, age: affecting the activation of the other x20.9±1.9yrs; mass: 70.5±8.0kg, height: shoulder musculature. 1.7±1.0m). Interventions: Assessment ofactivity of the biceps brachii and glenohumeral muscles (anterior deltoid, middle deltoid, posterior deltoid, and infraspinatus) during shoulder elevation tasks (flexion and scaption) were repeated before and after the fatigue protocol was introduced only to experimental group participants. Experimental group participants performed three repeated sets of concentric elbow flexion tasks untilfatigue was reached in each set (torque output dropped below 50% maximal torque for three consecutive

Journal of Athletic Training S-81 Free Communications, Oral Presentations: Modifiable Factors of Lower Extremity Injury Friday, June 29, 2012, 1:15PM-2:30PM, Room 274; Moderator: Steve Zinder, PhD, ATC 12F20DOBI 12198FOBI Modifiable Biomechanical Factors calculated using inverse dynamics to Biomechanical Predictors of Peak Predict Total Lower Extremity produce net joint power curves during Proximal Anterior Tibial Shear Initial Energy Absorption During the landing task. Individual joint initial Force Pre- and Post-Fatigue Landing energy absorptions (INI_EA), calculated McGrath ML, Stergiou N, Blackburn Norcross MF, Lewek MD, Padua DA, by integrating the negative portions of JT, Lewek MD, Giuliani C, Padua DA: Shultz SJ, Weinhold PS, Blackburn the joint power curves during the 100 University of North Carolina, Chapel JT: University of North Carolina at ms following initial contact (IC), were Hill, NC; University of Nebraska at Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Chapel Hill, Chapel Hill, NC; Oregon summated to calculate Total_INI_EA. Omaha, Omaha, NE State University, Corvallis, OR; Sagittal plane hip, knee, and ankle angles University of North Carolina at at IC; sagittal plane angular Context: Peak proximal anterior tibial Greensboro, Greensboro, NC displacements during the loading phase; shear force (PPATSF) represents the and gluteus maximus, quad-riceps, internal force that directly stresses the Context: Greater total sagittal plane hamstrings, and gastrocnemius mean anterior cruciate ligament (ACL). energy absorption during the 100 ms RMS EMG amplitudes from 50 ms Previous studies have examined which immediately following ground contact before to 100 ms after IC, normalized biomechanical factors predict higher (Total_INI_EA) is representative of a to %MVIC ,were also calculated. Four levels of PPATSF during jump-landing. biomechanical landing profile that participants identified as outliers on at No studies have examined which factors likely results in greater ACL loading least one outcome measure during data may increase PPATSF during due to sagittal plane mechanisms. screening were excluded from further unanticipated cutting under both However, it is unknown what analysis. Factor reduction of the fatigued and non-fatigued conditions, modifiable biomechanical factors are fourteen bio-mechanical measures (i.e. which may represent higher-risk predictive of Total_INI_EA , and could strength, EMG, angles at IC, and angular situations for ACL injury. Objective: To be targeted in ACL-injury prevention displacements) was achieved using a determine the relationships between programs. Objective: To identify principal component analysis. Five biomechanical variables and PPATSF modifiable biomechanical predictors principal components (PC) with under fatigued and non-fatigued of Total_INI_EA. Design: Cross- eigenvalues greater than one were conditions during an unanticipated sectional. Setting: Research lab- retained, and Anderson-Rubin sidestep cutting task (CUT). Design: oratory. Patients or Other Partici- component scoreswere generated and Cross-sectional. Setting: Research pants: Seventy-seven healthy, entered into a forward stepwise linear laboratory. Patients of Other Partici- recreationally active volunteers (40 M, regression model to predict pants: Twenty-seven healthy club-sport 37 F; Age = 20.8±2.2 years, Height = Total_INI_EA. Results: Greater scores athletes volunteered for the study (14F, 174.4±9.6 cm, Mass = 70.3±16.2 kg). for PC1, characterized by greater ankle 13M, height=1.75±0.08m, mass= 69.44 Interventions: Peak forces and electro- extension and lesser knee and hip flexion ±9.76kg, age=19.48±1.74years). Inter- myographic(EMG) amplitudes were at IC, and greater ankle flexion ventions: The CUT involved a jump measured during hip and knee extension, displacement, significantly predicted over a hurdle, triggering a randomized knee flexion, and ankle extension greater Total_INI_EA(Adjusted R= 0.056, directional cue. The participant landed (plantarflexion) maximal voluntary p=0.024).Conclusion:Lesser concomitant with the dominant foot on a forceplate isometric contractions (MVIC). hip and knee flexion at IC, greater ankle and cut 60° in the indicated direction. Subjects then performed double-leg extension at IC, and greater ankle flexion Participants then performed the fatigue jump landings during which dominant displacement during landing facilitates protocol, which consisted of sprints, limb EMG and three-dimensional greater Total_INI_EA, and thus side-shuffles, back-peddling, and kinematics and kinetics were potentially increases ACL loading. standing broad jumps. The CUT testing assessedusing an electromagnetic However, as only 5.6% of the variance in procedures were repeated post-fatigue. motion capture system and force Total_INI_EA was accounted for Main Outcome Measures: A 7-camera plate.Main Outcome Measures: Peak by this model, future research should motion capture system and forceplate forcesmeasured during MVICs using a evaluate the predictive value of these were used for data collection. The handheld dynamometer were multiplied biomechanical factors for individual joint following variables were calculated: INI_EA, and how changes in specific by segment length to calculate peak Ankle (ankleIC), knee (kneeIC), hip joint INI_EA may affect Total_INI_EA. torques, and normalized to the product (hipIC), and trunk (trunkIC) flexion at IC; Funded by the NATA Foundation of subject height and weight. Hip, knee, ankle (anklePPATSF), knee (kneePPATSF), hip Doctoral Grant Program. and ankle joint angularvelocities were (hipPPATSF), and trunk (trunkPPATSF) multiplied by net internal joint moments S-82 Volume 47 • Number 3 (Supplement) May 2012 12339MOBI flexion, vertical ground reaction force Relationships between Hip Muscle kinematic variable. Multiple linear Stiffness and Kinematic Factors (VGRF) (VGRFPPATSF), posterior ground regression was also used to evaluate Associated with ACL Injury reaction force (PGRF) (PGRFPPATSF), and the relationships between the knee extension moment (KEM) Cram TR, Norcross MF, Padua DA, combination of hip abductor and Blackburn JT: University of North (KEMPPATSF) at PPATSF; and peak extensor stiffness and each measure of Carolina at Chapel Hill, Chapel Hill, NC values of ankle dorsiflexion (anklePeak), knee valgus motion. Results: knee (kneePeak), hip (hipPeak), and trunk Individuals with greater hip abductor

(trunkPeak) flexion, VGRF (VGRFPeak), Context:Proper hip neuromuscular stiffness displayed lesser peak knee

PGRF (PGRFPeak), and KEM (KEMPeak). control is important for sound knee valgus angles (r = 0.266, p= 0.048) and Force variables were normalized to body kinematics during dynamic tasks. valgus angular displacement (r = mass (%BM), and KEM normalized to 0.370, p= 0.009). Hip extensor Excessive knee valgus motion results Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 body mass*body height (%BM*BH). in ACL loading and is a prospective stiffness in isolation was not correlated Pairwise Pearson correlations with ACL injury risk factor. The hip with knee valgus motion. However,the PPATSF, and stepwise linear regression musculature purportedly limits knee linear combination of hip extensor and analyses with PPATSF as the criterion valgus motion by eccentrically resisting abductor stiffness predicted 36% of the variable, were calculated pre- and post- hip adduction and internal rotation, but variance in knee valgus angle at initial fatigue (≤0.05, regression entry the literature regarding the influences ground contact (p< 0.001) and 29.8% of criterion P≤0.05). Results: Pre-fatigue, of hip muscle strength and activation the variance in knee valgus significant correlations existed between on frontal plane knee loading is displacement (p = 0.006), and the

PPATSF (0.19±0.09%BM) and kneePPATSF equivocal. Stiffness quantifies a multiple regression model for peak knee

(20.0±5.5°, R=-0.685, P<0.001), VGRFPeak muscle’s ability to resist lengthening, valgus angle approached statistical (3.11±0.58%BM, R=0.584, P=0.001), thus greater hip muscle stiffness may significance (R = 0.154, p = 0.065).

VGRFPPATSF (1.10±0.49%BM, R=0.396, limit ACL loading and injury riskby Conclusions: Our findings suggest a

P=0.041), PGRFPPATSF (-0.38±0.28%BM, limiting hip adduction and internal link between hip muscle stiffness and

R=-0.393, P=0.043), and PGRFPeak rotation, and therefore, knee valgus. knee valgus motion. Specifically, (-0.63±0.32%BM, R=-0.380, P=0.050). Objective: To explore the relationships individuals with greater hip muscle

KneePPATSF, VGRFpeak, ankleIC, and kneeIC between hip muscle stiffness and lower stiffness display lower extremity predicted 77.6% of the variance in extremity kinematics during a dynamic biomechanics which may place them at

PPATSF (F4,22=19.076, P<0.001). Post- task. We hypothesized that individuals a lesser risk of ACL injury compared to fatigue, significant correlations existed with greater hip abductor and extensor individuals with more compliant hip between PPATSF (0.24±0.07%BM) and stiffness would display lesserknee musculature. Muscle stiffness can be

VGRFPPTASF (0.95±0.46%BM, R=0.450, valgus motion during a jump landing altered via training, thus enhancing hip

P=0.019) and anklePeak (-3.19±6.54°, task.Design:Cross-sectional. Setting: muscle stiffness may be an important

R=-0.400, P=0.039). VGRFPPATSF Research laboratory. Participants: addition to future ACL injury predicted 20.3% of the variance Forty healthy,recreationally active prevention programs. in PPATSF (F1,25=6.348, P=0.019). volunteers (20 males, 20 females; age= Conclusions: Fatigue appears to alter 20±2years, height= 173±9cm, mass= 12126FOBI the relationships between PPATSF and 71±15kg) participated in this investi- There are No Sex Differences in the several kinematic and kinetic variables. gation. Intervention:Hip abductor and Landing Biomechanics of Youth Post-fatigue, the moderate correlation extensor stiffness were assessed from Soccer Athletes between ankle dorsiflexion angle and the damping effect these muscle groups Stephenson LJ, DiStefano LJ, Padua PPATSF, and the loss of any correlation imposed on oscillatory hip motion DA: University of North Carolina, between knee flexion and PPATSF, following perturbation.Hip and knee Chapel Hill, NC; Stony Brook suggests an altered neuromuscular kinematics were assessed during a University, Stony Brook, NY; response to activity. Other factors double-leg jump landing task via an University of Connecticut, Storrs, CT account for almost 80% of the variance electromagnetic motion capture system. in PPATSF post-fatigue, suggesting Main Outcome Measures:Hip muscle Context: Postpubertal females have neuromuscular variables not captured stiffness was normalized to subject been shown to have different landing in this study may play a greater role in mass (N/m·kg-1). Knee valgus angles biomechanics than males, which may developing PPATSF under fatigued at initial ground contact, peakvalgus put them at increased risk for ACL conditions. ACL injury prevention angles, and valgus angular injury. Limited knowledge is available programs should consider taking displacements during the loading phase regarding sex differences and landing alternate approaches to reducing of the jump landing task were biomechanics in younger populations. PPATSF and ACL strain under fatigued calculated. Simple correlations were Objective: To determine if there are sex and non-fatigued conditions. used to evaluate relationships between differences in youth soccer athletes’ hip muscle stiffness and each landing biomechanics. Design: Cross- Journal of Athletic Training S-83 sectional. Setting: Research laboratory. position. This suggests that injury dimentional Motion Analysis software. Participants: Sixty healthy soccer prevention programs should be Markers on the patella and dorsum of athletes (females: n=25, age=10±1 implemented in this age group to the great toe were highlighted, and years,height=140.34±6.48cm, encourage proper landing technique connected with a segmental line. RTF mass=33.06±5.03kg; males: n=35, before sex differences emerge. participants visualized their 3- age=10±1 years, height=143.03±6.23cm, dimensional model on a 107cm monitor, mass=34.42±5.34kg) volunteered to 12142DOBI and were instructed to align the participate. Interventions: One set of Changes in Sagittal Plane highlighted knee-foot segment with a three trials of a jump-landing task was Kinematics during Jump Landing stationary vertical reference line in the performed during a single test session. Immediately Following frontal plane during landing. Control The task required participants to jump Implementation of Real Time participants received no feedback and Feedback

forward from a 30cm high box placed a sat quietly for 10 minutes. Main Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 distance of half their height away from Ericksen HM, Lepley AS, Doebel SC, Outcome Measures: Participants a force plate, land with their dominant Armstrong CW, Pfile KR, Gribble PA, performed three pre-intervention jumps foot on the force plate, and immediately Pietrosimone BG: University of and three post-intervention jumps jump for maximal vertical height. An Toledo, Toledo, OH consisting of a forward jump off a 30cm optical three-dimensional motion box transitioning into a maximal vertical analysis system and a force plate Context: Suboptimal lower extremity jump. Change scores from baseline were measured lower extremity kinematics biomechanics during jump-landing may calculated for all three groups. A one- and kinetics. Main Outcome Measures: lead to various lower extremity joint way ANOVA with Tukey post hoc Dependent variables included sagittal injuries. Clinician provided feedback comparisons and standardized effect and frontal plane knee angles at initial has positively altered landing sizes (Cohen’s d) with 95% confidence contact and peak values over the biomechanics in the frontal and sagittal intervals (CI) were used to assess stance phase. Peak vertical (VGRF), planes. However, the use of technology change scores in hip flexion, knee posterior (PGRF), and anterior (AGRF) in an effort to allow the participant to flexion and knee abduction angles. ground reaction forces (PGRF), internal make real time biomechanical Alpha was set a priori at P<0.05. knee extension moment, and external adjustments during landing has not Results: A significant difference was knee valgus moment over the stance been evaluated. Objective: Determine observed between groups for hip phase were also measured. Forces were the immediate effects of real time flexion (F2,19=4.63, P=0.02) and knee normalized to body weight and feedback (RTF) and traditional feedback flexion (F2,19=10.02, P=0.001). Hip flexion moments were normalized to body (TF) on sagittal and frontal plane in the TF group (5.95±8.17) was greater weight and height. Separate one-way landing kinematics compared to a than the control (-2.16±3.01, P=0.03, analyses of variance were performed on control condition. Design: Single d=1.36, CI: 0.16, 2.39). Knee flexion was the dependent variables to assess blinded, randomized controlled trial. greater for TF (11.199±10.06, P=0.001, group differences between males and Setting: Research laboratory. Patients d=2.08, CI:1.96,0.63) and RTF (6.93±5.82, females (α≤.05) and descriptive or other Participants: Twenty-two P=0.015, d=2.27, CI: 2.14, 0.65) compared statistics were used to identify mean physically active females with no to controls (-4.33±4.07). Knee abduction values. Results: No significant history of lower extremity injury were was not significant between groups differences were observed (P>0.05) in randomized into 3 groups (RTF: n=7, (F2,19=2.10, P=0.15).Conclusion: Both our main outcome measures. A 21.0±1.5yrs, 165.5±5.6cm, 65.0±8.8kg; RTF and TF had a significant immediate descriptive analysis of kinematic TF: n=7, 20.7±2.2yrs, 165.1±5.5cm, effect on sagittal plane landing variables revealed that at initial contact 62.0±3.5kg; Control: n=8, 21.25±1.2yrs, biomechanics compared to control, participants landed with 17.96±6.3° of 162.6±6.8cm, 66.0±18.5kg). Interven- while changes in the frontal plane were knee flexion and 0.537±3.77° of knee tions: RTF and TF participants not significantly different. Fontal plane valgus and peaked at 76.23±9.11° of completed three sets of six jump- changes may require more training in knee flexion and 5.51±8.21° of knee landing trials (18 total) off a 30cm box. order for participants to make changes valgus during the jump landing task. Both intervention groups were provided in landing strategies. Descriptive analysis of normalized peak standardized feedback, using verbal kinetic variables revealed VGRF= 3.59 cues and visual representation of ±0.786%BW, AGRF= 0.383± 0.253% correct landing biomechanics, from a BW, and PGRF=-1.32± 0.318%BW. single clinician pertaining to each set Conclusion: Male and female of jumps. Additionally, participants in prepubertal soccer players are not the RTF group were equipped with significantly different in their retroreflective markers positioned on biomechanical landing strategies and the lower extremity and lower extremity tend to land in an extended knee kinematics were analyzed with 3-

S-84 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Adolescent Musculoskeletal Studies Friday, June 29, 2012, 2:45PM-4:00PM, Room 274; Moderator: Jon Almquist, ATC 12122SC 12328C Congenital Absence of Pectoralis and to continue to decrease athlete’s Asymptomatic Juvenile Major in a High School Athlete signs and symptoms. For competition Osteochondritis Dissecans in a Frymyer JL, Felton SD, Bloom K: and practice, athlete wore a Sully Middle School Athlete Naples Community Hospital, Naples, Shoulder Stabilizer the remainder of the Brownell EH, Butterfield TA: FL; Florida Gulf Coast University, season. Following the regular season, University of Kentucky, Lexington, Fort Myers, FL athlete underwent arthroscopic surgery KY to repair Bankart Lesion The athlete Background: Athlete is a 16-year old underwent extensive rehabilitation Background: A 12 year-old male Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 right-handed male high school football following surgery and has made a full middle school football athlete with no athlete. Athlete reported to Athletic recovery. Athlete still presented with left past medical history of knee injuries, Trainer (ATC) post practice horizontal adduction strength deficit. was tackled by two teammates during complaining of his left shoulder Uniqueness: Shoulder subluxations and football practice on 8/16/11, forcing his “popping in and out” during practice accompanying Labrum tears are injuries right tibia into internal rotation. He contact drills. Athlete denies any prior often seen in the athletic population; reported feeling and hearing a “pop” at shoulder history or problems. Athlete however, the congenital absence of a moment the right knee impacted the was examined by ATC. Physical muscle is rare. A review of the literature ground. On field evaluation revealed examination revealed concavity of the did indicate that the most frequently active and passive knee ROM were left pectoral region with no other involved muscle that is congenitally WNL bilaterally. Inspection and deformities noted. Athlete was point absent is the pectoralis muscle with the palpation revealed no gross deformity, tender over the anterior shoulder congenital absence of the trapezius with swelling and tenderness over the complex, biceps tendon and posterior muscle a distant second. As indicated in medial and lateral tibiofemoral joint lines. joint capsule with mild swelling noted. this case, a contributing factor to the initial Varus/valgus stress test, anterior Obvious weakness and pain were noted shoulder subluxation was the lacking drawer, posterior drawer, and in active and resistive shoulder flexion, anterior musculature which led to altered Lachman’s, were all negative for laxity extension and internal and external mechanics at the Glenohumeral joint but positive for pain. After being rotation, other weakness noted in making the athlete susceptible to shoulder assisted off the field, active and biceps flexion and horizontal injury. The lack of anterior shoulder passive ROM of the right knee were adduction. Orthopedic special testes musculature was a contributing factor for significantly diminished, and no further revealed (-) Anterior Apprehension test, the posterior shoulder joint injury. A special tests were performed due to (+) Posterior Apprehension test, (+) review of the literature suggested that pain. After evaluation, he was given an Relocation test for pain, (-) Speed’s those individuals suffering from a ACE wrap, ice, crutches and in- Test, (+) Crank Test. Differential congenital absence of the pectoralis have structed to make an appointment with Diagnosis: Biceps Strain, Rotator Cuff demonstrated, on isokinetic testing, a 20- a physician the next morning. Strain, Glenohumeral Subluxation, 30% decrease in shoulder horizontal Differential Diagnosis: Bone Labrum Pathology, 3rd degree Pectoralis adduction strength with even larger contusion, medial/lateral mensical tear, Strain Treatment: Initial treatment strength deficits noted when the MCL sprain, LCL sprain. Treatment: consisted of pain and swelling control congenital abnormality affected the non- Physician’s exam of the right knee through ice and electrical modalities. dominant shoulder. Conclusions: This revealed a mild effusion, 0-100º ROM, The athlete was then referred to Team case highlights an athlete suffering from lateral joint line pain, patellar border Physician. Diagnostic imaging a posterior shoulder joint pathology and pain, and a positive McMurray’s test. consisted of X-ray and MRI which subsequent Bankart Lesion of the Glenoid Lachman’s, anterior/posterior drawer, revealed a congenital absence of the Labrum. It also highlights the athlete who and varus/valgus stress tests were all sternal portion of the pectoralis major. presented with a congenital absence of negative. Attending fellow and MRI further revealedBankart lesion of the Pectoralis Major Muscle that was physician suspected a meniscal tear the Glenoid Labrum with accom- participating asympto-matically prior to after the exam and review of negative panying swelling indicating Posterior the posterior shoulder injury. As noted, radiographs. Same day MRI revealed Glenohumeral joint sprain. Athlete was the absence of the muscle did produce a medial femoral condyle bone bruise with treated conservatively for two weeks horizontal adduction strength deficit that low-grade sprain of medial collateral with progressing strength and range of was believed to be associated with the ligament, partial thickness tear of motion (ROM) exercises. The athlete shoulder injury. The athlete has made a popliteus tendon and popliteus sprain was then able to return to participation full recovery post surgically. at myotendinous junction, and a low- with treatment and rehabilitation grade sprain of lateral collateral continued to address strength deficits ligament. In addition, the athlete had Journal of Athletic Training S-85 an insidious but stable osteochondritis recognize the signs and symptoms of revealed noticeable calf atrophyand dissecans the lateral aspect of the the insidious disease, and do not rule tenderness over the anteriomedial and medial femoral condyle, with overlying out JOCD as a diagnosis for chronic anterolateral ankle, Achilles insertion, cartilage intact that was unrelated to mild knee pain. and foot dorsum. Pain was noted at the injury. Final injury diagnosis was rest and walking on heels and posterolateral corner sprain with 12336MC toes.Radiographs revealed no abnor- anteromedial bone contusion. The Long-Standing, Recurrent Foot and malities and a repeat MRI was not patient was fitted for a TROM brace Ankle Pain in an Adolescent Athlete ordered. Athlete was again diagnosed locked in full extension, non-weight Whittington AG, Butterfield TA, with Sever’s disease and prescribed 12 bearing on crutches. On 8/24/11, Medina McKeon JM: University of weeks ofphysical rehabilitation. At therapy commenced with the brace in Kentucky, Lexington, KY completion, she had good improvement,

full extension. On 9/08/11, the athlete no pain over the Achilles, andwas Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 exhibited knee ROM from 0-130 º, with Background:In October 2009, a 13 released for gradual return to sportswith no instability or increased swelling year-old volleyball athlete presented follow-up as needed.In October 2010, since first visit, and the brace was then with right ankle pain.She had a history she presented again with similar pain unlocked for daily ambulation in the of 2 lateral ankle sprains sustained in (7-9/10) in her right foot and ankle.Pain TROM. On 10/5/11, the patient had October 2008. Subsequently, she was present at rest and with palpation gained full AROM and began agility hadongoingpain over the Achilles in the Achilles tendon, medial arch, exercises. He was cleared to return to tendon insertion and anteriortalofibular posterior tibialis tendon, and navicular. play on 10/19/11, provided he wore a ligament (ATFL). Evaluation revealed There was no significant edema or hinged knee brace. Uniqueness: no obvious deformity or discoloration deformity. Differential Diagnosis: Juvenile osteochondritis dissecans of the lower leg, ankle, or foot. Achilles tendinopathy, plantar fasciitis, (JOCD) presents with vague knee pain Musculature of the lower-leg was posterior impingement, Sever’s and occasional mechanical symptoms, symmetrical bilaterally. She was point disease, stress fractures. Treat- such as popping and locking. Diagnosis tender along the Achilles tendon from ment:MRI revealed persistent patchy can take up to 14 months due to the the musculotendinous junctionto osteoedema with subtle “picture mild pain with which patients present. insertion, ATFL, and plantar fascia. frame” appearance of the distial tibia, It is more prevalent in males, with the Active and resistive ankle ROMs tarsals (calcaneus, cuneiforms, most common site for OCD being the wereWNL, with pain during plantar navicular, and cuboids), with small lateral aspect of the medial femoral flexion and toe flexion. Passive focal capsulitis of the metatarso- condyle, affecting up to 70 percent of dorsiflexion produced pain.Anterior phalangeal joints. The athlete was patients. This patient’s asymptomatic drawer, Thompson test, talar tilt, and diagnosed with Reflex Sympathetic JOCD was discovered after he suffered navicular drop evaluationwere Dystrophy (RSD). She was referred acute knee internal trauma, allowing it negative. On referral, physician to a pediatric orthopedist and was to be treated before it progressed. evaluation revealed tenderness over the further diagnosed with Type I RSD. Conclusions: JOCD does not ATFL, Achilles tendon insertion, and Uniqueness:Type I RSD, also known consistently appear on radiographs; plantar fascia,with decreased dorsi- complex regional pain syndrome therefore MRI is the accepted imaging flexion. Radiographs were normal, (CRPS), is a rare, chronic, progressive in literature for diagnosing lesions. with no evidence of fracture or disease that is the result of an injury However, there are no established degenerative changes. Magnetic or immobilization, with no identifiable clinical guidelines for the treatment of resonance imaging (MRI)revealed mild nerve damage. It is characterized by JOCD lesions. Treatment for stable tendinosis of the peroneus longus pain disproportionate to theinjury with lesions is activity restriction and tendon, and an os trigonum. She was swelling and neurovascular changes in immobilization based on symptoms. diagnosed with plantar fasciitis, the affected area. Rareamong children, Nonoperative protocols are reported to posterior impingement,Sever’s Disease, the average diagnosis age is 42 years. have success rates of 50-94 percent. and residual ATFL discomfort. She was Pathophysiology is not completely This patient was treated conservatively placed in a walking boot for 4 weeks, understood, but central nervous system with immobilization and activity prescribed physical rehabilitation, hypersensitization, surgery, immune restriction to treat both acute and and permitted to participate as processes, and musculoskeletal injury, insidious knee injuries. He successfully tolerated without the boot. In March may be contributing factors. participated in his first football game 2010,symptoms returned following Additionally, RSD has been postulated on 10/25/11. Athletic trainers working softball tryouts. Physician re- as a differential diagnoses among with sports that expose athletes to examinationrevealed that current adolescents with Sever’s Disease. repetitive trauma and shear forces diagnoses were consistent with Radiographs typically reveal patchy should be aware that these are prior.She was again placed in a walking osteoporosis, but changesseen contributing mechanisms to OCD. It boot and referredto a foot and ankle between tendinitis to patchy is important that athletic trainers specialist.This evaluation in May 2010 osteoedema between the initial and S-86 Volume 47 • Number 3 (Supplement) May 2012 repeat MRI shows the progressive, elbow at 0°, 30°, or 60°. Plain sporting activities. Also as stress physiologic changes not seen by plain radiographs of the right elbow were reactions and fractures are typically radiographs.Conclusions: The rarity ordered by the physician and revealed seen in an older population. Con- and complexity of RSD leaves athletic an incomplete intra-articular fracture of clusion: With the increasing trainers with a lack of familiarity and the olecranon and soft tissue swelling popularity of competitive sports at understanding of its clinical presen- about the posterior elbow. It was younger ages, it is important to be tation. For a patient who fails to determined the fracture was chronic and aware of stress and overuse injuries in improve with treatment, persistent un-related to the recent trauma. The a pediatric population. These stresses pain conditions, such as RSD, must be athlete was diagnosed with a forearm to skeletally immature bones can lead considered. Prognosis tends to be contusion and an olecranon stress to more serious injuries in this better with early diagnosis of RSD, and fracture, placed in a sling, and withheld population.

subsequent appropriate treatment from athletic activity. A two week Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 tends to lead to better patient follow-up with repeat radiographs was 12271SC outcomes. scheduled with an orthopaedic Foot Drop in a Growing Athlete surgeon. This exam revealed the patient Leake ML, Peljovich AE, Willimon 12041SC was asymptomatic with full ROM and SC: Children’s Healthcare of Atlanta Elbow Injury in an Adolescent no pain. Plain radiographs showed the Sports Medicine, Atlanta, GA Baseball Player lucency to be less clear with an Waugh AM, Hosey RG: University increase in sclerosis along the Background: 10y/o male soccer of Kentucky, Department of margins. The orthopaedic confirmed player presents two weeks after the Orthopaedic Surgery and Sports the assessment of an olecranon stress insidious onset of foot drop. The Medicine, Lexington, KY fracture. At this time the treatment athlete recalls two months of plan was to discontinue use of the sling anterolateral leg and knee pain after Background: A 12yo baseball player and to allow the athlete to begin playing soccer. Physical exam of with no history of upper extremity injury football activity at the 1 month mark cardiovascular, spine, and upper presented with a primary complaint of in a hinged elbow brace for protection. extremities are normal and forearm and elbow 7/10 pain after being He was instructed to stop activity if symmetrical. Obvious steppage gait is hit by a pitch. There was no obvious any symptoms returned. In addition, it noted with no antalgia. No visible or deformity by visual inspection or was recommended that the athlete palpable deformities are about the palpation. He was point tender about abstained from pitching/throwing for spine or the affected lower extremity. the proximal ulna at the site of contact. 3 months and follow-up in 1 month There is no evidence of muscle The athlete had full active and passive with the primary care sports medicine contraction (0/5) of the tibialis ROM of the shoulder, elbow and wrist. physician. At the 2 month follow-up anterior (TA) or extensor hallucis However, ROM of the elbow was exam the follow-up xrays revealed longus (EHL) muscles of the left painful. . There was not a report of interval healing of the fracture site. In lower leg. Ankle eversion strength is numbness or pain radiating to the hand. addition, the athlete reported he slightly weak (-4/5) with normal Initial treatment consisted of ice and tolerated football activity and strength of the posterior tibialis and over the counter analgesics for remained asymptomatic. The athlete flexor hallucis longus muscles. treatment of swelling and pain, and was released to football activity as Reflexes are normal. Sensory testing activity as tolerated. Differential tolerated in the brace and refrain from reveals abnormal sensation to light- Diagnosis: Contusion, Ulna fracture, pitching/throwing. The athlete was not touch in the dorsum of the foot and UCL Sprain, Epicondylitis Treatment: planning to participate in baseball first web space. Percussion and com- The athlete was referred to a primary through the winter follow-up was pression of the popliteal fossa creates care sports medicine physician 10 days scheduled for 2 months. At that time radiating discomfort down the leg. post injury. At that time the athlete radiographs showed a healed fracture. Ligamentous examination of the knee reported continued but lessening pain The athlete was released to play is normal. Vascular exam is normal. 2/10 that increased with throwing. The basketball and will be begin a throwing There is no evidence of proximal physician exam revealed mild swelling program at 6 months. Uniqueness: An tibiofibular joint instability. Differ- about the elbow with pain focused in asymptomatic stress fracture was ential Diagnosis: peroneal nerve the forearm. Distal pulses were 2+ and diagnosed due to an unrelated injury contusion, anueurysm, tumor, spinal sensation was intact throughout the in a young adolescent athlete. Due to cord lesion Treatment: Plain upper extremity. Flexion, extension, the incomplete nature of the stress radiographs showed normal physes and pronation, and supination of the wrist fracture this was able to heal without no evidence of fracture, dislocation, were full and pain free. Elbow ROM surgical intervention. Had this not been lytic or blastic lesion about the knee. was full, however, hyperextension was detected early, the fracture would have EMG-NCV results showed high grade painful. Varus and Valgus maneuvers did likely worsened requiring fixation due peroneal nerve compression. MRI not elicit pain or instability of the to the athlete’s participation in showed an intraneural ganglion cyst of Journal of Athletic Training S-87 the common peroneal nerve of this case raises awareness for the originating at the proximal tibiofibular differential diagnoses of foot drop in joint extending proximally 11.6cm athletes. Without diagnostic imaging, within the common peroneal nerve. ganglion cysts are difficult to identify Final diagnosis was foot drop due to and therefore should always be common peroneal nerve palsy included in the differential diagnosis secondary to proximal tibiofibular as a cause of lower extremity neuro- joint ganglion cyst. Surgical logic dysfunction. Early recognition intervention was indicated and and referral is critical to optimize included peroneal nerve neurolysis, expedient treatment and the chance for resection of the articular branch of the neurologic recovery.

common peroneal nerve and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 decompression of ganglion cyst of peroneal nerve. Post-operatively the athlete was allowed to weight bear with crutches for three weeks with full-time ankle-foot orthosis (AFO) wear. Immediately post-operatively the athlete reported the return of normal sensation throughout the dorsum of the foot. Physical therapy was utilized to regain knee motion, muscle strength and to maintain ankle flexibility. He has no post-operative pain and participates in activities of daily living. TA or EHL muscles have exhibited no signs of return of function at 2months post-operatively but it is estimated to require a minimum of 4 months before fasciculations may be detected due to the length of nerve regeneration required. He is permitted to gradually return to sport as tolerated and is to wear his AFO at all times. Unique- ness: Ganglion cysts causing neurological deficits of the lower extremity are rare, highly variable, and difficult to diagnose (Schrijaver et. al, 1998). Of ganglion cysts in the lower extremity, 33% of them involve the knee (Das et. al, 2008). Peripheral nerve compression due to ganglia is rarely reported in the literature, especially of the lower extremity (Greer-Bayramoglu et. al, 1998). Surgical intervention is usually necessary. Nerve recovery is heavily dependent on a timely and accurate diagnosis (Schrijaver et. al, 1998, Greer-Bayramoglu et. al, 1998). Prognosis for return to sport correlates with age, severity of nerve compression, and time to de- compression (Schrijaver et. al, 1998). Conclusions: The absence of trauma, injury as well as overall presentation

S-88 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Improving Cryotherapy Efficacy Wednesday, June 27, 2012, 8:00AM-9:15AM, Room 260-267; Moderator: TBA 12251FOTH Effect of Exercise Before an Ice respectively. Interface temperatures temperature, as well as to compare IM Bag Treatment on Quadriceps were affected by the interaction of temperature 90 min post-treatment Interface and Intramuscular Exercise Condition and Time (P< using two common cryotherapy Temperatures Following .001). Interface Cycle Immediate modalities, a crushed ice bag (CIB) and Application temperature (5.2°C) was 2.2°C cold water immersion (CWI). We Brucker JB, Hirano T, Neibert PJ: warmer than the Rest Immediate hypothesized that CWI would cause University of Northern Iowa, Cedar temperature (P< .05). Within 10 IM temperature to decrease in a Falls, IA minutes the interface Cycle shorter time and remain lower at the temperature (21.4°C) was 4.3°C end of a rewarming period. Design: Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Ice bags are often applied warmer, and thereafter the difference Cross-over. Setting: Research following exercise. It is known that steadily decreased to 1.2°C at the 120- laboratory. Patients or Other exercise before cooling speeds heat minute time(P<.05), where the Participants: 18 healthy subjects, 7 removal from deep tissues, but it is not Cycleinterface temperature was males (age= 22.8±2.0 years, known if superficial and deep post- 29.4°C. Intramuscular temperatures height=180.3±8.2 cm, mass=84.9 treatment temperatures are affected by were also affected by the interaction ±17.9 kg, medial calf adipose the precedingexercise.Objective: of Exercise Condition and Time (P< thickness =1.4±.58 cm) and 11 Determine if exercise before an ice .001). The intramuscular Cycle females (age=21.8 ±1.3 years, height bag Tx effects interface and intra- temperature sat the Immediate =163.0±4.9 cm, mass=57.3±5.7 kg, muscular rewarming.Design: Cross- (26.1°C), 10-minute (25.9°C), and medial calf adipose thickness=1.8±.39 over Setting: Laboratory. Par- 120-minute (32.5°C) timeswere cm) volunteered to participate. ticipants: Twelve physically active similar to the Rest intramuscular Interventions: Subjects received 2 males (21.8 ± 1.7y, ht: 183.3 ± 8.8cm, temperature. At the other Times cryotherapy treatments in a randomly mass: 87.4 ± 12.2kg: skinfold: 23.6 ± intramuscular Cycle temperatures allocated order (CIB or CWI) 3.3mm). Intervention: During 2 ranged from 2.2°C-1.2°C warmer than separated by at least 72 h. CIB sessions separated by at least 48 hours the Rest (P< .05). Conclusion: After consisted of 1500 mL crushed ice in a participants either rested supine (Rest) stationary cycling interface and 38x51 cm flexible plastic bag with or stationary biked (Cycle) at 70%- intramuscular temperatures of the excess air evacuated and secured with 80% of their Karvonen predicted thigh rewarm quicker following a 30- elastic wrap at a standardized pressure exercise heart rate for 30 minutes. minute, 1-kg wetted ice bag at the medial head of the Immediately following the exercise application. gastrocnemius. CWI consisted of condition a wetted ice bag (2000mL crushed ice and cold water in a 38 L ice with 300mL water) was 12279DOTH tub maintained at 12°C and stirred compressed to the right anterior mid- Intramuscular Temperature frequently, with the lower leg fully thigh until intramuscular temperature Changes During and After Two immersed. Each cold modality was was 10°C below baseline. Tempera- Different Cryotherapy applied until IM temperature decreased tures were collected immediately after Interventions 8°C below baseline. IM temperature ice bag applicationand every 10 Rupp KA, Herman D, Saliba SA: was monitored at the medial head of minutes for 120 minutesfollowing University of Virginia, the gastrocnemius using an implantable application. Independent variables Charlottesville, VA thermocouple inserted 1 cm below were Exercise Condition (Rest subcutaneous adipose tissue measured &Cycle), and Time (Immediate, 10, Context: Cryotherapy is commonly prior to intervention with diagnostic 20, 30, 40, 50, 60, 70, 80, 90, 100, used in athletics to treat pain from ultrasound. Main Outcome 110, & 120 minutes). Main Outcome muscle injuries. Cooler intramuscular Measures: The primary outcome of Measures: Interface and intra- (IM) temperatures may reduce this study was time to decrease IM muscular (2cm + ½ skinfold) metabolism to create a beneficial temperature 8°C below baseline temperatures to the nearest 0.1°C. Ata environment for healing. Cryotherapy during each inter-vention. A secondary priori of .05,repeated measures modalities that decrease IM outcome was IM temperature at the ANOVAs and Tukey-Kramer MC tests temperature quickly may be more end of a 90 min rewarming period in were performed on interface and intra- beneficial in the treatment of muscle each condition. Paired t-tests were muscular temperatures separ-ately. injuries and associated pain. used to examine time to decrease Results: Rest and Cycle intramuscular Objective: To compare the amount of during intervention and IM temperature temperatures took 73 minutes and 31 time required to decrease IM after rewarming. Results: The time minutes to reach 10°C below baseline, temperature 8°C below baseline to reach an 8°C reduction in IM Journal of Athletic Training S-89 temperature was similar between CIB groups (Low or High) for one of the durations werewithin the proposed (44.1±22.7 min) and CWI (39.0±14.8 following body parts: anterior application guidelines (ATF 15 min; Calf min, P=.338). IM tempera-ture talofibular ligament (ATF), medial calf 15-25 min; Delt: 25-40min; High Thigh: remained significantly colder at 90 (Calf), middle deltoid muscle (Delt), 40 min; Low Thigh: 25 min). Funded by min post-CWI (30.2°C±2.1°C) or anterior thigh (Thigh). Skinfold GLATA GordyStoddard Research compared to 90 min post-CIB (32.5°C groups were specific to the body part Assistance Award. ±2.9, P=.001). Conclusions: There and based on existing skinfold data. was no difference in the time required Individuals withcold allergies, 12197FOTH to reduce IM temperature 8°C when abnormal circulation, abnormal The Effectiveness of 2 Forms of measured at 1 cm below adipose tissue sensation, or reported orthopedic Cryotherapy Through Various using CIB and CWI. However, IM injury in the past 6 months, were Common Barriers Tsang KKW, Johnson S: California

temperature remained significantly excluded. Interventions: A 2x4 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 colder for at least 90 min following factorial design guided this study. State University Fullerton, Fullerton, CWI intervention. This study provides Independent variables were skinfold CA clinicians with information that may group (High v. Low) and body part (ATF, guide treatment modality decisions Calf, Delt, or Thigh). An im-plantable Context: A therapeutic effect of and allow researchers to begin to thermocouple (Physiotemp, IT-21), cryotherapy is pain relief via a develop cryotherapy prescription. connected to an Iso-Thermex,was decrease in superficial nociceptive placed 0.5-cm or 1.0-cm deep to the fiber conduction. Research literature 12044FOCE subcutaneous adipose tissue for the indicate optimal analgesic effects are Cryotherapy Durations for a ATF and muscles, respectively. After established between 13.6-15.6 °C. It Standard 7°C Decrease in baseline temperature was established, can be deduced that the practice of Different Body Parts a 0.75-kg crushed, ice-bagwas secured applying an ice bag over a dry barrier Jutte LS, Long BC: Ball State using an elastic wrap until tissue would not result in the therapeutic University, Muncie IN; Xavier temperature decreased 7°C. Main temperature range needed to attain University, Cincinnati OH; Outcome Measures: The dependent desired physiological effects. Oklahoma State University, variable was timeto decrease tissue Objective: The purpose of the study Stillwater, OK temperature7°C. Data were analyzed was to examine the effects on skin with an ANOVA, followed by Tukey- temperature by two different forms of Context: To assess cryotherapy’s Kramer post-hoc testing. The P-value cryotherapy applied through different effectiveness using clinical outcome was set at .05. Results:An interaction barriers (t-shirt, elastic bandage, measures, treatmentsettings must occurred between skinfold group and control). Design: Crossover study. Setting: Research laboratory. provide a standardized physiological body part (F3,16=16.04, P<.001; effect, i.e. similar temperature β<.001). In the Thigh, the High Patients or Other Participants: 18 decrease, in all patients. Tissue depth, skinfold group (35.33±17.74-min) participants (males= 10, females = 8) i.e. overlying skinfold measurement, took longer to cool than the Low (age = 23.2 ±3.1 years, mass= 69.7 accounts for ~50% of the temperature skinfold group (3.00±0.50-min; ±12.2 kg, height= 169.5 ±8.6 cm) with decreasevariability during cryotherapy. Tukey-Kramer P<.05). The High Thigh no history of current or recent upper Based on existingtissue cooling and group took longer to cool than the extremity injury. Interventions: skinfold data, theoretical cryotherapy High ATF (6.83±7.11min), Delt Independent variables: cryotherapy duration guidelines were developed to (13.67±8.75min), and Calf (9.17± agent/mode [Game Ready™ (GR), ice produce a standard 7°C decrease for 2.0min) groups,as well as the Low ATF bag (IC)] and barrier condition [t-shirt various body parts. These guidelines (6.83±7.11min), Delt (11.00± 6.00 (TS), elastic bandage (EW), control need to be validated. Objective: The min), and Calf (18.83± 5.77min) (CO)]. Operational definitions: GR purpose of this study was todetermine groups (Tukey-Kramer P<.05). (pressure=off, coldest wrap temper- the time to decrease muscle and Regardless of skinfold group, the ature=2 °C), IC (plastic bag filled with ligamentous temperature 7°C in four Thigh took longer to cool approximately 1 kg of crushed ice), TS body parts in individuals with both high (19.17±17.75min) than the Ankle (agent applied over one layer of a cotton t-shirt sleeve), EW (agent and low skinfold measurements. (8.16±6.02min) (F3,16=4.17; P=.023; Design: Descriptive laboratory study. β=0.75; Tukey-Kramer P<.05). applied over two layers of a standard Setting: Athletic Training Research Conclusions: Only the thigh elastic bandage), and CO (agent Laboratory. Patients or Other requiresdifferent application durations applied directly to the body). Participants: Twenty-four, healthy based on tissue depth. To achieve Participants were randomly assigned adults (F=9, M=15; Age=25±5.6 similar tissue cooling, clinicians to either the GR or IC group and the years;Height=1.75±0.9m; Mass= should use longer cryotherapy order of barrier conditions was also 81.6±12.5kg) volunteered. Each was durationsfor the thigh than the ankle. randomized. Each subject completed stratified into one of two skinfold In addition, the body part application three treatment sessions over a three- S-90 Volume 47 • Number 3 (Supplement) May 2012 12237FOTH day period. Surface skin temperature Cold Perception, Surface, conditions. Interface tempera-ture fell was assessed using a thermistor (409B, Subcutaneous and Intramuscular to -11.4±1.1°C and re-warmedwithin Measurement Specialties Inc., Dayton, Temperatures Produced by 4-5 minutes. SubQ temperaturefell to OH) and digital monitor (Model 401, Gebauer Pain Ease® Topical 28.1±1.0°C. IM temperature fell to Yellow Springs Instruments, Yellow Vapocoolant Spray 33.1±0.5°C. A main effect was Springs, OH). Readings were Merrick MA, Martin KM: The Ohio observed for spray duration on cold conducted every 2.5 minutes over a State University, Columbus, OH perception (4sec = 3.9/10, 10 sec = thirty-minute application period and 5.9/10, p<0.001) and on lowest for thirty-minutes post-application. Context: Vapocoolant spraysrapidly temperature at all 3 depths (surface Main Outcome Measures: De- cool the skin, providing brief local 4sec = -9.4± 0.7°C, 10sec = 13.4 pendent variable: skin temperature ±0.4°C, p=0.001; SubQ 4sec = anesthesia for injections and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (°C). A three-way mixed factor [2 intravenous cannulation as well as 30.5±.6°C, 10sec = 25.7± 0.5°C (group) x 3 (condition) x 25 (time)] management of minor sports injuries ,p<0.001; IM 4sec = 33.5±.3°C, 10 repeated measures ANOVA was used and spray & stretch. Temperature sec = 32.7±.3°C , p= 0.05). A main to assess differences between effects in humans and effects of effect for nozzle was observed on cold treatment groups. The level was set a commonly used nozzle types, spray perception (stream = 4.1/10, mist = priori at .05 and interactions were distances or spray durations have never 5.7/10, p=0.003) and on lowest analyzed using Tukey HSD test. been previously reported. Objective: temperature at only surface (stream = Results: An interaction was found To describe cold perception and -7.5±0.6°C, mist = -15.4± 0.7°C, between cryotherapy agents for CO temperature effects of Pain- p<0.001) and SubQ depths (stream = and EW barriers at various time periods Ease®.Design:crossover design. 29.3±0.5°C, mist = 26.9± 0.6°C,p (F=2.208, P < .001). After twenty Setting: research laboratory Patients =0.03). All 3 subjects receiving mist minutes of application, IC resulted in or Other Participants:convenience nozzle/5in/10sec had adverse skin lower temperatures than GR in the CO sample of 10 healthy participants (age reactions consistent with mild (9.40 ±4.5 °C and 13.61 ±2.7 °C, =22.3±1.9yrs).Interventions:PainEase® frostbite and the condition was respectively) and EW (17.80 ±2.7 °C was applied to the proximal forearm terminated. Temperature for it were and 21.25 ±2.3 °C, respectively) under 8 experimental conditions on -17.9±1.4°C.Conclusions: Pain conditions. Temperatures in the TS different days at least 48 hrs apart. Ease® cools skin to well below condition were not different between Conditions were determined using a freezing re-gardless of application IC and GR (16.47 ±4.9 °C and 17.72 2x2x2 repeated measures factorial technique. This does not produce skin ±3.1 °C, respectively, P = .71). based on clinical use instructions. injury except in a single condition Conclusions: Game Ready™ and Independent variables were: nozzle (mist, 5in, 10sec). Temperature standard ice packs are effective type (mist & stream), spray duration changes at SubQ (~-5.9°C) and IM (~ cryotherapy agents in attaining (4 & 10 seconds) and spray distance -1.4°C) are small, short lived and may therapeutic superficial tissue (7.6cm [3 in]&12.7cm [5 in]). Order not be clinically meaningful. Mist temperatures when applied without a of testing was determined using a nozzle produces much colder barrier. The utilization of a dry barrier balanced Latin Square. Main temperaturesand feels colder with cold modalities remains Outcome Measures: Ambient and regardless of spray distance or unwarranted, as they appear to hinder interface temperature were measured duration. Spraying for 10sec feels the abstraction of heat thereby not using surface thermocouples. colder and is colder than 4sec. attaining the temperature decrease Subcutaneous and 1cm intramuscular Spraying for 10 seconds with the mist needed to reduce nociceptive fiber temperature were measured using nozzle should not be used clinically. conduction. sterile implantable thermocouples inserted via cannulae.Temperatures were recorded at 1 sec intervals for 500 sec.Cold severity perception was measured via 10cm Visual Analog Scale.Data were analyzed via repeated measures MANOVA with Sidak adjusted pairwise comparisons with α=0.05. Results: Ambient (25.9± 0.4°C, p=0.79) and baseline temperatures (surface 31.1±0.4°C, SubQ 34.0±0.4°C, IM 34.5±.4°C, p=0.68) did not differ across

Journal of Athletic Training S-91 Free Communications, Oral Presentations: Current Modality Trends Wednesday, June 27, 2012, 9:30AM-10:30AM, Room 260-267; Moderator: Mark Merrick, PhD, ATC 12F22DOTH 12023DOTH Cold Perception, Surface, temperatures (surface 30.3±1.18°C, Surface Temperature, Sensation Subcutaneous and Intramuscular SubQ 33.3±0.9°C, IM 33.5±.1.1°C, of Pressure, and Hamstring Temperatures Produced by p=0.68) did not differ across Flexibility are not Influenced by Gebauer Ethyl Chloride Topical conditions. Averaged across Counterirritants Vapocoolant Spray conditions, interface temperature was Akehi K, Long BC: Oklahoma State Martin KM, Merrick MA: The Ohio -8.9±1.3°C, SubQ temperature University, Stillwater, OK State University, Columbus, OH was30.7±1.1°C and IM temperature was 32.3±0.6°C. For interface Context: Many health care profess- Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Vapocoolant sprays rapidly temperature, a nozzleX distance X ionals incorporate the use of topical cool the skin, providing brief local duration interaction effectoccured counterirritants for pain relief. It is anesthesia for injections and (p=0.007). Pairwise comparisons hypothesized that counterirritants intravenous cannulation as well as showed(mist,7in,4sec) did not numb the skin and increase tissue management of minor sports injuries produce interface temperatures below temperature, thereby increasing tissue and spray & stretch. Temperature freezing (3.05±1.6°C) and was warmer extensibility. Objective:The purpose effects in humans and effects of than other conditions (ranged -6.27°C of the study was to determine if a commonly used nozzle types, spray to -14.00°C). A main effect for nozzle counterirritant influencedsurface distances or spray durations have never (p=0.004) showed that stream temperature, sensation of pressure been previously reported.Objective: (-10.94±0.9°C) was colder than mist (i.e. numbness), or hamstring To describe cold perception and (-6.89±0.6°C). A main effect for flexibility. Design:Descriptive temperature effects of Ethyl Chloride. distance (p=0.007) showed that 3 in laboratory study. Setting: Applied Design:crossover design Setting: (-10.55± 0.7°C) colder than 7 in Musculoskeletal and Human research laboratory Patients or Other (-7.27±0.7°C). A main effect for Physiology Laboratory. Part- Participants: convenience sample of duration (p<0.001) showed 4 sec icipants: Thirty college aged 10 healthy participants (age=21.9±2.4 (-6.65±0.9°C) was warmer than individuals(age=21.17±3.84, ht= yr).Interventions: Ethyl Chloride was spraying until skin blanched (-11.18 169.16 ±10.26cm, mass= 73.06± applied to the proximal forearm in 8 ±0.5°C). Subcutaneously, a single main 16.52kg) with no lower extremity experimental conditions on different effect for spray duration (p=0.037) injuries in the last 6 months and less days with at least 48 hrs between. showed 4 sec (31.37± 0.4°C) was than 90° of hamstring flexibility were Conditions were determined using a warmer than spraying until the skin recruited. Interventions: A 2x3x3 2x2x2 repeated measures factorial blanched (30.12±0.7°C). No effect double-blind repeated measure design based on clinical use instructions. was observed intramuscularly guided data collection. The Independent variables were: nozzle (p=.912).For cold perception, a main independent variables were treatment type (mist & stream), spray duration effect for distance (p= 0.015)showed3 (3cc of a counterirritant (Flexall (4 & 10 sec [or until skin blanching]) in (4.9/10±0.3) feels colder than 7 in 454®), a placebo (lotion with pepper- and spray distance (7.6cm [3 (3.75/10±0.5). A main effect for mint oil), and nothing (control)), time in]&17.8cm [7 in]). Treatment order duration (p<0.001) showedspraying (pre- & post-treatment), and day (1st, was determined using a balanced Latin until the skin blanched (5.34/10±0.4) 2nd, & 3rd). Subjects were randomly Square. Main Outcome Measures: feels colder than 4 sec (3.3/10 assigned to a treatment order prior to Ambient and interface temperature ±0.4).Conclusions: Other than lying supine on a plinth with their hips were measured using surface (mist,7in,4sec), Ethyl Chloride cools and non-dominant leg secured with thermocouples. Subcutaneous and skin to well below freezing without straps. Subjects then received surface 1cm intramuscular temperature were causing skin injury. Temperature temperature and sensation of pressure measured using sterile implantable changes at SubQ (~-2.8°C) and IM measures followed by hip flexion thermocouples inserted via cannulae. (~-1.1°C) are small, short lived and range of motion (ROM) measures. Temperatures were recorded at 1 sec may not be clinically meaningful. Surface temperature was taken with a intervals for 500 sec.Cold severity surface copper-constant thermo- perception was measured via 10cm couple secured with surgical tape at the Visual Analog Scale. Data were center point between the gluteal analyzed via repeated measures crease and popliteal fossa. Sensation MANOVA with Sidak adjusted of pressure was obtained using pairwise comparisons with Simmons-Winstein monofilaments. ˜=0.05.Results: Ambient (25.5 Monofilaments were applied directly ±0.5°C, p=0.52) and baseline to the skin until it bent and held for S-92 Volume 47 • Number 3 (Supplement) May 2012 approximately 1.5 seconds. We may reduce or block US energy, Arnica cream=67% and 74%, measured hip flexion ROM by therefore reducing ability of US to Australian Dream=54% and 80%, applying a bubble inclinometer to the reach the tissues. Objective: To Bengay=37% and 55%, MediPeds subject’sthigh based on the baseline determine the relative acoustic Footcare=126 and 101%, Neuragen Bubble Inclinometer Measurement transmission allowed by various agents PN=76% and 90%, Octogen=38% and Chart. Following all baseline data, we at 1MHz and 3MHz frequencies. 47%, and Thera-Gesic=52% and 73%. applied 1 of the 3 treatments before Design: Descriptive. Setting: Conclusions: Topical agents aseries of 3 30-second hamstring Laboratory. Patients or Other suspended in aqueous gels were stretches. Immediately following the Participants: There were no human generally effective in transmitting 3rd stretch,we performed all participants in this study. Separate ultrasound energy, while many cream posttreatment measures. Main topical agents (gel-based n=6, cream- based agents were less effective,

Outcome Measures:The dependent based n=7) were tested. Inter- particularly at 1 MHz frequency. Many Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 variables were surface temperature, vention(s): A thickness of 1 mm of agents that are commonly used to sensation of pressure, and hip flexion each preparation was placed in an provide a sensory effect, such as ROM measured before and after each individual plastic Petri dish that was topical analgesics and counter- treatment on each day.Results:Range placed over a transducer surface irritants in cream form, may block US of motion increased between connected to an acrylic holder for an transmission. Agents that reduce US pretreatment and posttreatment Ohmic US power meter. Continuous transmission may lead to little

(F1,21=104.03; P=.001). Application of US was administered through each treatment effect of phonophoresis to the counterirritant did not influence preparation at 1.2 W/cm2 at both the patient and potential damage to the

ROM (F2,21=0.09; P=.9), surface 1MHz and 3MHz frequencies for 30 US equipment. We recommend that

temperature (F2,21=0.56; P=.58) or seconds. Main Outcome Measures: clinicians use gel-based agents at 3 sensation of pressure (F2,21=0.29; Percent of transmission of US energy MHz frequency for best US P=.75). There was no difference in relative to commercial US gel was the transmission. surface temperature or sensation of dependent variable. Planned ob- pressure between pretreatment and servational comparisons were made at 12178DOTH posttreatment times or days (both; both 1MHz and 3MHz frequencies. An Near-infrared Light Therapy Tukey-Kramer P> .05).Conclu- arbitrary cutoff of greater than or less Attenuates Strength Loss sions:Three cc of a counterirritant than 70% was used to determine following Eccentric Exercise (Flexall454®) does not influence effectiveness of the coupling medium of the Biceps Brachii surface temperature,sensation of as a transmitter of US energy. Larkin KA, Christou EA, Tillman pressure, or hip flexion ROM Mediums with relative transmission MD, George SZ, Borsa PA: immediately following a series of greater than 70% were considered University of Florida, Gainesville, three 30 second stretches to the good mediums for phonophoresis, FL hamstring muscle group in individuals while those with transmission less than who have less than 90° of hamstring 70% were considered poor mediums. Context: Near-infrared (NIR) light flexibility. Any value over 100% represented therapy is purported to act as an higher US transmission compared to ergogenic aid in delaying the onset and 12297MOTH commercial gel. Results: Inferential extent of muscle fatigue during Relative Transmission of statistics assume that a sample is exercise. Attenuating the onset and Coupling Media and Medications randomly selected from a population, extent of muscle fatigue would be Commonly Used in Phonophoresis but our samples were chosen based on beneficial during rehabilitation when Cage SA, Rupp KA, Castel JC, Saliba common use by athletic trainers, not impaired muscle function is one of the EN, Hertel J, Saliba SA: University random selection. Instead, descriptive greatest limitations to recovery. of Virginia, Charlottesville, VA; comparisons of transmission through However, no studies have quantified Accelerated Care Plus, Inc., Reno, topical preparations were made. fatigue responses to NIR light therapy. NV Coefficients of variation (CV) were Objective: The primary objective of calculated to quantify stability of this investigation was to evaluate the Context: Phonophoresis is measures. CV ranges for 1MHz (0.00- ergogenic effect of NIR light therapy commonly utilized in sports medicine 0.09) and 3MHz (0.00-0.05) indicated on skeletal muscle function. Design: and uses therapeutic ultrasound (US) very stable measurements. Gel-based Cross-over, repeated measures, sham to improve transdermal absorption of agents tested at 1MHz and 3MHz were: controlled design. Each subject topically applied agents. Previous Arnica gel=97% and 110%, Biofreeze received each treatment dose in random reports of treatment success have been =60% and 79%, Capzasin=70% and order followed by an exercise induced inconsistent, creating a need to 93%, Cobroxin=76% and 91%, and fatigue protocol for the biceps brachii investigate the methods used with Solarcaine=70% and 101%. Cream- muscle. Setting: Controlled phonophoresis. Some topical agents based agents at 1MHz and 3MHz were: laboratory setting. Participants: Journal of Athletic Training S-93 Thirty-nine subjects, comprised of healthy men (n=21) and women (n=18) aged 18-35 years (Avg. age = 20.0 ± 0.164, Avg. height = 1.691 m ± 0.018, Avg. weight= 68.414 kg ± 1.824, Avg. BMI = 23.804 ± 0.368) with no current history of injury to the upper extremity. Interventions: A class 4 laser that emitted NIR light was used to treat the biceps brachii muscle. Each participant received both an

active and a sham laser treatment in Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 random order. Active laser was administered to the biceps for 4 minutes with a cumulative dose of 360 Joules.Sham laser treatment was identical to the active treatment except no power was emitted from the laser diode.Subjects then underwent a fatigue protocol on an isokinetic dynamometer. Each subject per- formed 3 sets of 20 concentric (45 deg/s) and eccentric (60 deg/s) contractions using the biceps brachii muscle. Main Outcome Measures: The dependent variables were strength loss or fatigue index, number of repetitions to fatigue, and pain reporting. Strength loss indices were calculated by dividing the post- exercise isometric strength value (Nm) with the pre-exercise value multiplied by 100.ANOVA with repeated measures were used to analyze changes in these measures between treatments at pre-exercise and immediately at post-exercise. Results: Strength loss index for the active laser (0.56 ± 0.13) treatmentwas significantly less compared to the sham laser (0.61±

0.12) treatment [F(1,38) = 4.07,p= 0.05]. Conclusions: Subjects receiving the active laser treatment were able to resist fatigue at a greater extent than when they received the sham laser treatment. Our findings implicate NIR light therapy as an effective ergogenic aid capable of attenuating strength loss and resisting muscle fatigue during resistance exercise.

S-94 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Characteristics of Overhead Athletes Wednesday, June 27, 2012, 10:45AM-12:00PM, Room 260-267; Moderator: Jason Scibek, PhD, ATC 12015FOMU 12180FONE Forearm Rotational Motion and total arc of motion for the dominant Recovery of Upper-extremity Adaptations among Baseball and non-dominant arms of the position Joint Position Sense Acuity in Pitchers and Position Players players were 70.3°±8.0°, 81.6°±7.2°, Softball Athletes After a Laudner KG, Lynall R, Williams JG, 152.0°±9.8° and 72.6° ±5.6°, 81.4°±6.1°, Functional Fatigue Protocol Meister K: Illinois State University, 154.0°±7.6°, respectively. There were no Tripp BL, Tripp PM, Yochem EM, Normal, IL; Texas Metroplex significant differences between the Uhl TL: University of Florida, Institute for Sports Medicine and pitchers and position players for either Gainesville, FL; University of Utah, Orthopedics, Arlington, TX forearm pronation (p>.01), supination Salt Lake City, UT; University of Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (p>.30), or total arc of motion (p>.01). Kentucky, Lexington, KY Context: Due to the repetitive nature However, the pit-chers did have of the baseball throwing motion, many significantly less pronation ROM Context: Research suggests that chronic adaptations have been (p=.001, effect size=.48) and total arc fatigue hampers upper-extremity joint identified in the throwing shoulder of of motion (p=.001, effect size=.36) position sense in baseball players. baseball players. However, little in their throwing elbow compared to This insight helps guide injury research has investigated what their non-throwing elbow. There was prevention and rehabilitation adaptations may occur in forearm no signi-ficant difference bilaterally protocols. However, little evidence rotation among and between baseball for supination (p=.88) among the has examined such effects in softball pitchers and position players. pitchers. The position players had a athletes. Objective: To evaluate the Objective: To determine the within- significant difference in their bilateral effects of functional fatigue and the group and between-group range of total arc of motion (p=.001, effect rate of recovery of upper-extremity motion (ROM) differences in forearm size=.20), but no differences in position reproduction in softball pronation, supination, and total arc of pronation (p=.07) or supination athletes. Design: We used a repeated motion in a group of baseball pitchers (p=.82). Conclusions: The sig- measures design to compare prefatigue and a group of position players. nificantly less amount of forearm position reproduction acuity with Design: Cross-sectional. Setting: pronation in the throwing arm of measures taken after a throwing fatigue Athletic training room. Participants: pitchers may occur due to the large protocol (0, 4, 7, and 10 minutes). Fifty professional baseball pitchers eccentric forces produced by the Setting: Controlled, labo-ratory. (age=22.1±2.2years, height= 188.5 supinator muscles as the elbow Participants: 15 healthy female ±5.7 cm, mass=87.4±8.7 kg) and 43 pronates during the follow-through and collegiate softball athletes (age, position players (age=22.9±4.7 years, deceleration phases of the throwing 19.1±1.2 years; height, 167.8±8.2 cm; height =183.8±5.1 cm, mass= 86.7 motion. The accumulation of these mass, 65.2±7.3 kg) volunteered. ±7.2 kg) volunteered to participate. All eccentric forces may result in Inter-ventions: During the fatigue participants had no recent history (past shortened supinator muscle length and protocol, athletes assumed a single- 2 years) of upper extremity pathology a subsequent decrease in pronation knee stance and threw at a target every or any previous surgery. Inter- ROM. Although both pitchers and 5 seconds with maximum velocity. ventions: We measured bilateral position players had a statistically Subjects rated their perceived exertion elbow pronation, supination, and total significant decrease in total arc of after every 20 throws using BORG’s arc of motion using a digital motion in the throwing elbow scale. We considered athletes fatigued inclinometer. We used 2-tailed t tests compared to the non-throwing elbow, when they reported an exertion level with a Bonferroni correction (p<.004) the small effect sizes indicate these above 14. Main Outcome Measures: to determine if any differences existed differences may not be clinically Using an electromagnetic tracking between and within the pitchers and significant. These forearm ROM system, we recorded position of the position players. Main Outcome adaptations should to be taken into thorax and dominant-side hand, Measures: Dependent variables consideration in the prevention, forearm, humerus, and scapula. included forearm pronation ROM, evaluation, and treatment of elbow Dependent variables included 3- supination ROM, and total arc of injuries among baseball players. dimensional variable error (3DVE) of motion. Results: Pronation, supina- the scapulothoracic, glenohumeral, tion, and total arc of motion for the elbow and wrist joints and end point dominant and non-dominant arms of (hand-to-thorax position) measured the pitchers were 72.5°±8.1°, during reproduction of two arm 82.5°±6.5°, 154.9°±11.4° and 76.4°± positions (arm-cock, ball-release). 7.7°, 82.6°±5.5°, 159.0°±10.9°, Blindfolded subjects assumed a single- respectively. Pronation, supination, knee stance during position Journal of Athletic Training S-95 12185FOMU reproduction tests. Measures were A Comparison of Scapular were the mean upward rotation at the taken prefatigue, immediately Upward Rotation four positions of humeral elevation postfatigue (PF-1), and 4 (PF-2), 7(PF betweenOverhead Athletes, (rest, 60°, 90° and 120°). For each -3) and 10 (PF-4) minutes after Non-Overhead Athletes and dependent variable, the influence of fatigue. To observe differences over Non-Athletes group on the mean upward rotation was time, we used Friedman’s test Tucker WS, Ingram RL, Shimozawa compared using a one-way ANOVA. (α=P<0.05). Where differences were Y: University of Central Arkansas, The alpha level was set at p<0.05. significant, a post hoc Dunn’s test Conway, AR; Georgia Southern Results: The analysis revealed compared prefatigue to each University, Statesboro, GA; A.T. statistical differences at rest postfatigue 3DVE measure, P<0.05. Still University, Mesa, AZ (F2,38=7.750; p=0.002), 60° (F2,38= Results: Friedman’s test revealed a 6.408; p=0.004), 90° (F =17.055;

2,38 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 significant change in acuity for each Context: Lack of adequate scapular p<0.001) and 120° (F2,38=14.689; joint and end point position at arm- upward rotation has been associated p<0.001).A Scheffe’s post hoc cock and ball-release (P<0.001) with chronic shoulder injuries. analysis revealed at restupward except wrist acuity at ball-release Previous research on healthy overhead rotation for the overhead group (P=0.07). For the arm-cock position, athletesfound differences in scapular (1.7±4.9°) was significantly greater Dunn’s test revealed significant upward rotation between baseball compared to the non-athlete group increases in 3DVE from prefatigue to pitchers and position players, and (-5.9±5.4°). At 60°, upward rotation PF-1 for scapulothoracic (5±2° to differences in the dominant arm verses for the overhead (5.5±5.1°) and non- 12±5°), glenohumeral (8±3° to the non-dominant arm. It is unclear if overhead groups (6.6±5.1°) were 19±4°), elbow (23±4° to 33±9°), wrist scapular upward rotation differences significantly greater compared to the (16±5° to 20±6°) and endpoint exist between healthy overhead non-athlete group (-0.6±6.4°). At 90°, (9±6mm to 20±12mm). Scapulo- athletes, non-overhead athletes and the overhead(21.5±4.3°) and non- throacic (9±3°) and wrist (19±5°) non-athletes. Objective: To assess overhead groups(23.4±5.1°)were acuity remained significantly affected scapular upward rotation differences significantly greater compared to the at PF-2. Glenohumeral acuity (17±6°) between healthy male overhead non-athlete group (12.3±5.9°). At remained diminished at PF-3, before athletes, non-overhead athletes and 120°, the overhead(38.0±2.8°) and recovering at PF-4. Analysis of acuity non-athletes.Design: One-between non-overhead groups(40.4±6.1°)were at the ball-release position indicated (group) comparison.Setting: Con- significantly greater compared to the significant differences between trolled laboratory environment. non-athlete group (31.1±4.2°). prefatigue and PF-1 for scapulo- Patients or Other Partici- Conclusions: The overhead and non- thoracic (12±3° to17± 5°), gleno- pants:Thirty-nine males with no overhead groups demonstrated greater humeral (21±6° to 29±9°), elbow history of shoulder injury participated scapular upward rotation at 60°, 90° (28±7 to 36±8°), wrist (17±3 to in this study: 13 intercollegiate and 120° of humeral elevation when 22±7°) and endpoint (24±11 to overhead athletes (19.8±1.4 y, compared to the non-athlete 45±13mm) 3DVE. Recovery of elbow 181.8±6.6 cm, 88.4±8.4 kg), 13 group.Regular upper body resistance 3DVE was evident only after PF-2 intercollegiate non-overhead athletes training performed by the overhead and (32±8°). Conclusions: After 4 to 7 (20.8±1.3 y, 178.9±5.9 cm, 83.4±15.6 non-overhead athletes may have minutes of recovery, position kg) and 13 recreationally fit non- resulted in increased force production reproduction acuity for both arm athletes (21.8±0.8 y, 178.9±6.8 cm, by the serratus anterior, upper positions recovered in each joint and 89.1±11.4 kg). Interventions: Static trapezius and lower trapezius. In overall endpoint position. Position scapular upward rotation was measured addition to injury status,scapular reproduction deficits following on the throwing dominant arm with a upward rotation may be influenced by fatigue in collegiate baseball athletes digital protractor while subjects were physical activity. Establishing have been previously reported. Our at rest and at 60°, 90° and 120° of generalized standard ranges of results suggest that acuity in collegiate humeral elevation in the scapular motionfor scapular upward rotation softball athletes recovers in a similar plane. Three trials were performed at may not be possible. Routine timeframe. These data suggest that each position with a 30 second rest assessment is recommended to neuromuscular recovery requires 4 to period between each trial. Order of identify abnormalities or changes in 7 minutes after a fatiguing bout of position was randomized. The three scapular upward rotation. throwing. upward rotation measurements at each position were averaged. The independent variable was group (overhead, non-overhead and non- athlete). Main Outcome Measures:The dependent variables S-96 Volume 47 • Number 3 (Supplement) May 2012 12190DONE 12236FOMU Shoulder Stiffness Adaptations in performed for active and short range Relationship Between Dynamic Division I Collegiate Baseball GH stiffness. Pearson product Acromiohumeral Interval and Players moment correlation coefficients Scapulohumeral Rhythm in Thomas SJ, Swanik CB, Kaminski assessed the relationships between GH Overhead Athletes Between 0 TW, Swanik KA, Higginson JS, stiffness and PCT. Main Outcome and 60 Nazarian L, Kelly JD: University of Measures: GH stiffness was Thompson MD, Landin DL: Pennsylvania, Philadelphia, PA; measured with the subject lying prone. Louisiana State University; Baton University of Delaware, Newark, The shoulder and elbow were Rouge, LA DE; Neumann University, Aston, positioned in the 90°/90° position with PA; Thomas Jefferson Hospital, 0° of external rotation (ER). Subjects Context: Previous research has linked Philadelphia, PA were asked to maintain an isometric alterations in scapulohumeral rhythm Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 ER contraction of 50% MVIC. The (SHR) with shoulder injuries and Context: During the deceleration SPAD then rotated their arm 20° into subacromial impingement. Previous phase of the overhead throw, energy IR. PCT was measured from an upright in-vivo investigations of SHR and absorption must be distributed across seated position with the shoulder in 0° acromiohumeral interval (AHI) are musculotendinous and capsulo- abduction and neutral rotation. limited and may not accurately ligamentous tissue within a limited Results: The dominant arm (DA) had represent dynamic shoulder range of motion, to minimize the significantly greater active and short kinematics. Objective: To determine likelihood of injurious stress. This is range GH stiffness compared to the if SHR between 0° - 30° and 30° - 60° largely accomplished through non-dominant arm (NDA) (DA=1.65 are related to AHI in overhead athletes exquisite neuromuscular control, ±0.17Nm/°, NDA =1.56± 0.10Nm/°, during dynamic scaption. Design: which regulates glenohumeral (GH) p=0.008; DA= 2.09± 0.52Nm/°, Descriptive cohort study design. stiffness characteristics. While the NDA= 1.93± 0.39Nm/°, p=0.041) Setting: Athletic training facility. posterior rotator cuff and scapular respectively. Active GH stiffness was Participants: Fortyfive male and stabilizing muscles can stiffen to significantly correlated with PCT female, collegiate overhead athletes optimize dynamic restraint, thickening (0.297, p=0.047), however short (age = 19.6±0.8 years, mass = 77.0± of the posterior capsule may also be range GH stiffness was not 11.6 kg, height = 1.72±.08 m) with no critical to static restraint. Objective: significantly correlated with PCT history of surgery or current injury To compare active and short range GH (0.114, p=0.452). Conclusions: involving their dominant arm. stiffness and examine its correlation Healthy collegiate baseball players Interventions: Participants per- to posterior capsule thickness (PCT). present with adaptations of their formed three trials each of an Design: A single group post test only. stiffness regulation strategies. There unloaded and loaded scaption exercise Setting: This study was performed in were also correlations between from 0°-90° while seated. Amount of a controlled laboratory setting. stiffness and morphologic changes. load during the weighted scaption Patients or Other Participants: Our results support the theory that PCT exercise was normalized based on Twenty-three division one collegiate has an impact on the energy absorption anthropometric data for each baseball players (age = 19.5± 1.4 years, capabilities of the shoulder during the participant. True anterior-posterior mass = 89.2± 5.9 kg, height = 186.6± deceleration phase of throwing. It also fluoroscopic images of the 4.0 cm) with no current injury or seems that tightening of the series glenohumeral joint were captured in surgery in the past eight months. elastic component within the posterior real time video during the second trial Interventions: Independent variables rotator cuff may be causing the of each condition. Video was captured were arm (dominant and non- increase in short range stiffness on the at 30 frames per second with a dominant). Active and short range GH dominant arm. 1000x1000 pixel resolution, stiffness was measured by a transferred via a digital video customized Stiffness and Proprio- recording device to a personal ception Assessment Device (SPAD). computer and analyzed using OsiriX Stiffness was defined as the change in software. Pearson correlations were torque over the change in position. calculated for SHR 0°- 30° and AHI at Active stiffness was measured from 30° and for SHR 30°- 60° and AHI at the start of internal rotation (IR) to the 60° during loaded and unloaded point of peak torque. Short range scaption. Main Outcome Measures: stiffness was measured from the start AHI was measured as the smallest of IR to 3° of motion. PCT was vertical distance between the inferior measured with an ultrasound system acromion and superior humeral head. (Sonosite Titan, Sonosite Inc., Bothell, AHI values were recorded at two WA). Paired sample t-tests were humeralthoracic elevation positions Journal of Athletic Training S-97 (30° and 60°). Scapular upward rotation unloaded (R = -.105, p=.491), 30° loaded was determined using differences in (R = .157, p=.308) and 60° loaded (R = - glenoid inclination angles, the angle .102, p=.505). A fair, significant between a vertical line and the inferior association was observed at 60° and superior glenoid tubercle. SHR was unloaded (R=.341,p=.022) Conclusions: calculated as the amount of humeral- SHR and AHI do not appear related thoracic elevation relative to scapular during dynamic motion between 0° and upward rotation within the selected 60° in healthy, overhead athletes. The range. One investigator (MT) performed significant association between SHR all measurements. Results: SHR 0° - 30° 30°-60° and AHI during unloaded was 9.17±12.1 (unloaded) and 4.40±4.4 scaption at 60° only accounts for 12%

(loaded). AHI at 30° was 6.9±2.2 mm of the variance. Large SHR variability Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (unloaded) and 6.78±2.3 mm (loaded). was observed which might make SHR 30° - 60° was 6.17±11.8 (unloaded) statistical and clinical applications and 8.58±4.2 (loaded). AHI at 60° was difficult. 4.40±1.6 mm (unloaded) and 3.67±1.3 mm (loaded). Poor, non-significant associations were observed at 30°

Shoulder EBF Wednesday, June 27, 2012, 12:15PM-1:15PM, Room 275; Moderator: Paul Borsa, PhD, ATC

S-98 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Epidemiology of Injury in Youth Sports Thursday, June 28, 2012, 8:00 AM-9:00 AM, Room 260-267; Moderator: Kristin Kucera, PhD, ATC 12239DOIN 12179OOIN Injury and Illness Epidemiology variable of interest was included, Orthopedic Injuries Sustained at a University-Based Summer totaling 11,826 cases. Cases for pre- in an Athletic Environment Sports Camp Program existing conditions were excluded. Classified as Trauma at a Oller DM, Vairo GL, Messina RM, Data Collection and Analysis: Data Pediatric Hospital from 2004 Montalvo AM, Sebastianelli WJ, from cases were applied to the to 2010 Buckley WE: Athletic Training & National Athletic Injury/Illness Rogers KJ, Hochstuhl D, Elwell S, Sports Medicine Research Reporting System case report form, O’Brien K, Shah SA: Alfred I duPont Laboratory, Department of and coded accordingly. Frequency Hospital for Children, Wilmington, Kinesiology, Pennsylvania State counts were conducted for DE Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 University, University Park, PA; independent variables (sport, gender) Penn State Orthopaedics and Sports and dependent variables (body part, Context: The rationale for the study Medicine, State College, PA injury/illness type, treatment). Camp was to document orthopedic trauma enrollment was utilized to calculate the related athletic injuries that occurred Context: While numerous epide- rates of contacts and injury/illness. through a pediatric emergency miology studies have been conducted Chi-square tests were calculated to department (ED) over a seven year at the high school and collegiate levels, determine statistical significance of period. Objective: To review distri- there is a dearth of similar information observed frequencies by sport and by bution of sports and type of orthopedic available to guide the delivery of gender. P < 0.05 indicated statistical trauma with subsequent care. Design: sports medicine services provided at significance. Results: Preliminary Retro-spective review of medical summer sports camps. Given the data demonstrate an AT/ATS- charts. Setting: Pediatric hospital. popularity of participation at such participant contact rate of 27.05/100 Patients or Other Participants: camps and the frequency with which camp participants and injury/illness Patients between the ages of 1 – 19 ATs are hired to provide medical rate of 11.09/100 camp participants. years of age from 2004 to 2010. coverage, injury and illness Golf represented the lowest injury/ Interventions: All E codes were information can prove to be invaluable. illness rate, 0.21/100 camp searched. All Orthopedic injury Objective: This novel study aims to participants, while rugby represented diagnosises were included. No person describe the injury and illness the highest, 71.96/100 camp was excluded based on age, gender, or experience of youth sports camp participants. Lower extremity injuries race. Main Outcome Measures: participants at a university-based comprised the majority injuries by The outcome measures were the summer sports camp program over a body part for male (45.2%) and trauma E codes, sex, age, location of 4-year period. Design: Descriptive females (47.8%). Males participating injury, prior history, mechanism of epidemiology study. Setting: The study in basketball or soccer were more injury, trauma classification, sport, was conducted at a large university which likely to sustain joint injuries (68.6% orthopedic injury and joint, medical houses approximately 80 camps for 22 and 70.8%, respectively), while males injury and area, diagnosis number, and sports over a 12 week period each participating in football were more surgery. Frequency and descriptive summer. ATs and ATSs are hired in the likely to sustain musculotendinous statistics were calculated using SPSS capacity of sports heath technicians and injuries (53.9%), a statistically 17 (SPSS Inc., Chicago, IL). Results: sports heath aides, respectively. They are significant finding (p < 0.001). Five hundred and forty one patients responsible for documenting all AT/ATS- Conclusions: Injury/illness rate, type, were identified as having an injury participant contacts, per job description. and location vary by camp participant related to sports; 429 were male, and A contact is defined as a single event in gender and sport. The differences 112 were female and average age was which an AT/ATS and camp participant observed among the variables of 13 years. Intake status was: (1) interact for medical attention, e.g. injury interest demonstrate potential admitted (265); (2) transferred and assessment, delivery of treatment. differences in the medical needs of admitted (240); (3) transferred (36); Patients or Other Participants: camp participants. The data can be and (4) death (0). Number of previous Male and female athletes ages 10 utilized to provide a practical facilities was: 0 (259), 1 (277), and 2 through 17 years participating at a reference to make clinical decisions, (5). Two highest E-codes were fall university-based summer sports camp such as determining staffing needs or from collision in sport (231) and program served as the target injury-preventions strategies to struck accidentally in sport (118). The population. Enrollment for 2008 employ. most common mechanism of injury through 2011 was 43,852 camp (MOI) was player to player contact participants. Per camp injury/illness (254). The balance of MOIs were logs, any case documenting at least one contact with playing surface (193), Journal of Athletic Training S-99 contact with playing apparatus (61), schools. Objective: To examine the 73%(2A), 62%(1A-smallest) reported and no contact (22). Four highest relationship between the existence of an AT in their school. 4A(65% school- locations were: football field (97); AT services in high schools and factors based; 30% clinic,hospital,university- soccer field (37), home (38), and suggested by literature to be related. based); 3A(36% school-based; 50% street (35). Thirty-five people had a Design: Cross-sectional study. clinic,hospital,university-based); prior history of the same injury. Setting: Mailed/emailed survey. 2A(30% school-based; 43% clinic, Thirty-two different sports were Participants: 63%(166/263) of SC hospital,university-based); 1A(15% implicated in injuries seen in the ED - high schools. Intervention(s): SC school-based; 46% clinic, hospital, the most common were: football high schools were surveyed regarding university-based). Frequency of AT’s (155), soccer (64), and basketball (56). existence of AT services and six in School’s by Sports Medicine The occurrences of orthopedic and factors suggested by literature to be Supply Budget: For schools with AT’s,

non-orthopedic injuries were 479 and related to AT services (independent 16%($0-$1000), 45% ($1001- Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 116 respectively. Sixty patients had variables): school size, setting, $3500), 25%($3501-$8000), 14% both an orthopedic and medical injury. poverty, public/private status, (>$8000). Schools with school-based Elbow (71) and forearm (70) fractures proximity to medical facility, and AT’s, 7%($0-$1000), 32% ($1001- were the most frequent orthopedic budget for sports medicine supplies. $3500), 34%($3501-$8000), 27% injuries. The most common non- After pilot-testing, data were collected (>$8000). For schools with a clinic, orthopedic injuries were concussions via a systematic, modified-Dillman hospital, university-based AT 25%($0- (60) and spleen laceration (16). One approach. Test-retest reliability was $1000), 56%($1001-$3500), 18% Hundred and two patients had multiple strong (r=.89). Main Outcome ($3501-$8000), 0% (>$8000). For injuries: 2 (72), 3 (16), 4 (19), 5 (2), Measure(s): Presence and source of schools without an AT 68%($0- 6 (2), and 8 (1). Surgical intervention AT services served as dependent $1000), 24%($1001-$3500), 8% occurred in 58% of the cases. variables. SPSS was used to calculate ($3501-$8000), and 0%(>$8000). Conclusions: This study has updated frequencies and chi-square analysis. Conclusions: In SC high school a previous study for pediatric athletic Results: Chi-square analysis athletics school setting, size, and injury trauma frequency and related identified significant relationships sports medicine supply budget were treatment for both orthopedic and between presence of an athletic trainer related to the presence and source of medical injuries. This study demon- and school setting(Χ2=16.28,P=.001), the AT services. These results provide strated that patients may experience size(Χ2=16.63,P=.002), and sports guidance for decision-makers (school multiple injuries (102 patients) and medicine supply budget(Χ2= 38.49, administrators and legislators) and orthopedic and medical injury P=.001). Significant relationships those who influence decision-makers simultaneously (60). This study may were also identified between the (parents and athletes) in identifying lead to further understanding of the source of athletic training services and disparities in access to healthcare in prevalence of traumatic athletic injury school size Χ2 = 29.89,P<.001), high school sports and improving the in this population with subsequent setting (Χ2= 20.32, P=.002), and medical care provided for inter- prevention strategies. sports medicine supply budget(Χ2= scholastic athletes. 70.58,P<.001). No relation-ship was 12054FOIN identified between presence or source 12363DOIN Factors Related to the Disparity of AT services and a school’s rate of Lower Extremity Injury Rates in Access to Athletic Training free/reduced lunch program qualifiers, in Children and Adolescents: A Services in South Carolina High proximity to medical facility, or public Systematic Review School Athletics Programs private status. Frequency of AT’s in Tritsch AJ, Pye ML, Shultz SJ: Wham, GS, Saunders, RP, Mensch, Schools by Setting: 97%(suburban), University of North Carolina at JW: University of South Carolina, 89%(city), 74%(small towns), and Greensboro, Greensboro, NC Columbia, SC; Pelion High School, 57%(country) reported an AT in their Pelion, SC school. 57% of suburban schools had Context: Increased incidence of sport school-based AT’s; 40% were clinic, related injuries coincide with Context: Employing athletic hospital, university-based. 45% of increased participation in sports. Yet, trainers(AT) has long been city schools had school-based AT’s; currently not clear is whether children recommended as a solution for 44% were clinic, hospital ,university- are suffering different sport-related improving medical care in high school based. 32% of small towns had injuries than adults, and whether the sports. Recent research suggests a school-based AT’s; 42% were clinic, types and location of injuries in disparity in the medical care provided hospital,university-based. 17% of children change throughout by South Carolina(SC) schools based rural schools had school-based AT’s; maturation. Objective: To examine on access to AT services; however, no 40% were clinic,hospital,university- lower extremity injury rates in research has examined factors related based. Frequency of AT’s in Schools children and adolescents, and to the existence of AT services in by Size: 95%(4A-largest), 86%(3A), determine if sport-related lower S-100 Volume 47 • Number 3 (Supplement) May 2012 extremity injury rates and types The most commonly injured body part change during the adolescent years. was the ankle regardless of age group. Data Sources: PubMed and Web of The majority of severe injuries were Science databases were syste- sustained at the knee. Conclusions: matically searched for articles Difficulties arise in comparing published between 1985 and 2010 existing literature on injury using the search terms injury occurrence in adolescence due to epidemiology, children OR youth OR inconsistencies in the definition of adolescent, sport OR physical injury, methods of computing injury activity. Study Selection: Pro- rate, and breakdown of age groups spective, retrospective, and cross- across studies. This has resulted in

sectional epidemiological studies calls for a worldwide adoption of a Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 were included if they reported and common injury reporting model to stratified lower extremity injury rate enhance our ability to compare injury or percentage (two or more body parts) risk and occurrence across sports and by age or maturation (two or more ages. Clinicians should remain groups). Studies that reported injury cognizant of the increased occurrence rate but did not break results down by of sprains/strains throughout age or maturation were excluded. Also childhood and adolescence. excluded were studies related to traumatic injury (such as car accidents), skiing or snowboarding, ice hockey/skating, and disease, as the mechanism and surface differences were outside of the scope of the current review. Thirteen studies that reported sport-related injury rates stratified by one or more age groups and that fell within the age range of 5- 19 years were included. Data Extraction: Two reviewers inde- pendently assessed all possible studies for inclusion and evaluated study quality. Injury rate, injury type, body part, and age were extracted from tables, figures, and text of the included studies. A critical appraisal tool was used to assess methodological soundness of epidemiological studies, with the average score awarded being 20.2 out of 37 possible points (range: 14-27). Data Synthesis: Among the 13 included studies, inconsistencies in injury definitions, age stratification, injury rate definitions, and injury rate computations prevented us from performing a meta-analysis. The only consistent trend in injury type was found in population based studies, where there was an increased percentage of sprains/strains and a decrease in fractures with age. Sprains/strains represented 11.0- 32.9% of all injuries in 5-11 years old and increased to 21.4-44.4% in 15-18 year olds (an increase of 11.5-17.7%).

Journal of Athletic Training S-101 Free Communications, Oral Presentations: Clinical Assessments Thursday, June 28, 2012, 9:15AM-10:30AM, Room 260-267; Moderator: David Bell, PhD, ATC 12144MOMU 12306MOSP Intra-rater and Inter-rater scores of 6 to 9, normal with scores Normative Baseline Values for Reliability of the Five Image- of 0 to 5, supinated with scores of -1 Balance Error Scoring System in Based Criteria of the Foot to -4, or highly supinated with scores Healthy Male and Female High ≤ Posture Index-6 of -5. To assess inter-rater reliability, School Athletes during 2010-2011 Wittwer A, Terada M, Pietrosimone Intraclass Correlation Coefficients Wahl TP, Cleary MC, Oshiro RS, (ICC ) with 95% confidence intervals BG, Gribble PA: University of 3,k Kocher MH, Furutani TM, Toledo, Toledo, OH (CI) were calculated for the average Goeckeritz LM, Kanaoka FPI scores for the three assessments T,Freemyer, B, Murata NM, Stickley

for each investigator. Cohen’s kappa Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: The Foot Posture Index-6 CD, Kimura, IF: Department of coefficient was used to examine the (FPI-6) is considered a simple Kinesiology and Rehabilitation amount of agreement for classification quantification tool to assess static foot Sciences, University of Hawaii at of foot posture between the two raters. alignment. Direct patient contact is Manoa, Honolulu, HI; State of The intra-rater reliability (ICC ) of required for assessment of one of the 3,k Hawaii Department of Education, the average FPI scores for two raters six criteria that comprise the FPI-6; Honolulu, HI for each posture assessment was the remaining five criteria may be determined. Significance was set a evaluated using still-frame photo- Context: Assessment of postural priori at P < 0.05. Results: The inter- graphs. While direct visual observation stability is an important part of rater reliability was moderate for both is typically performed for this concussion evaluation and a left (ICC =0.614,95%CI; 0.195, assessment, it may not be necessary 3,2 comprehensive concussion manage- 0.807) and right feet (ICC for a clinician to be physically present 3,2 ment program (CMP). Baseline values =0.576,95%CI;-0.065, 0.813). For the at the examination if the image-based for balance testing are an important classification of foot posture based on criteria are utilized. This may allow piece of data when making return to raw scores, the amount of agreement clinicians to save assessment time, and participation (RTP) decisions, and may between two raters was poor for both multiple clinicians to evaluate large not always be available. Using age and left (Κ=-0.186) and right (K=-0.099) groups of patients quickly. Although gender-specific norms may be useful feet. The intra-rater reliability was both intra-and inter-rater reliability of cases where no baseline data exist. excellent for both left (ICC the FPI-6 have been investigated, 3,2 Age-stratified normative values for the =0.956,95%CI; 0.925, 0.975) and reliability using only these five image- Balance Error Scoring System (BESS) right feet (ICC =0.959, 95%CI; based criteria has not been established. 3,2 forhigh school athletes have not been 0.931, 0.977). Conclusions: Excel- Objective: To establish the inter- and previously reported. Objective: To lent intra-rater and moderate inter- intra-rater reliability of 5 image-based determine differencesin age and to rater reliability was found using only criteria from the FPI-6. Design: provide normative values for BESS the five image-based criteria of the Descriptive laboratory study. Setting: baseline scores in healthy high school FPI-6. However, the classification of Research laboratory. Participants: athletes. Design: Retrospective foot posture did not improve the Forty participants (23F, 17M; cross-sectional study. Setting: amount of agreement between raters. 23.67±8.49yrs; 64.59±14.43kg; Controlled environment free of Therefore, caution is needed when 166.07±11.79cm) volunteered. Inter- external stimuli in 28participating high interpreting FPI scores from five ventions: Participants main-tained a schools. Starting in 2010, baseline image-based criteria. relaxed stance with double-limb concussion testing was implemented support while an investigator took by a statewide CMP led by a contingent three photos of the posterior ankle, of athletic trainers funded by the State talonavicular joint, and medial of Hawaii Department of Health. longitudinal arch. Main Outcomes: Partici-pants:De-identified data from Using the photographs, two baseline BESS tests from school year investigators assessed the five image- 2010-2011 for 2,825[age=15.5±1.2 based criteria of the FPI-6 for both years old (y/o), females (F) n=979, feet of 40 participants on three males (M) n=1,846] high school occasions separated by a day. Each athletes free of injury and not currently criterion was scored on a scale of -2 in a balance or postural stability to +2, with a total FPI score ranging training program. Interventions: from +10 to -10. Each participant’s Baseline BESS testing for all contact foot was classified as highly pronated sport athletes was administered in a with a score of 10, pronated with setting of 8 participants per group. S-102 Volume 47 • Number 3 (Supplement) May 2012 12149MOIN Baseline BESS scores were video Landing Error Scoring System: poor (>6). Main Outcome Measures: recorded and scored by two athletic Describing Sex Differences in a Dependent variables were the 17 LESS trainers(interrater reliability=.87) Traditional College Athletics scoring items (SI), OS, and LPG. For prior to the competitive season. Main Setting. sex comparisons, chi-square tests were Outcome Measures: Total error King CE, Valovich McLeod TC, Bay used for each SI and for the LPG and an score on the BESS was compared RC, Lam KC: A.T. Still University, independent-samples t-test was used using univariate analysis of variance on Mesa, AZ for the OS. Alpha was p<.05. Results: gender (M,F) andthree age groups (13- Females more frequently demonstrated 14y/o n=851, 15-16y/o n=1,526, and Context: The Landing Error Scoring a knee valgus angle at initial contact 2 17-18y/o n=448).Mean, standard System (LESS) is a standardized (female=60.0%, male=30.0%, x = 21.197, deviation (SD), and 95% confidence p<.001), knee valgus angle at maximum clinical tool used to assess movement Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 intervals were reported. Results:No patterns during a jump-landing task and knee flexion (female =61.8%, male=46.6%, x2=24.377, p<.001) and significant (F1=.066, p=.798, power = to identify individuals who may be at .058) differences in baseline BESS risk for knee injuries. While the LESS frontal plane movement during the scores were found between males has been used to assess landing patterns jump-landing task (female=98.0%, male=88.9%, x2 = 7.134, p=.009) as (17.55±6.60, CI=17.26-17.93) and in military cadets and youth soccer 1 females (17.68±6.79, CI=17.02- players, little is known of its use in a compared to males. Females also demonstrated a higher OS than males 18.01).Significantly(F2=5.874, traditional college athletics setting. p=.003) higher baseline BESS scores Objective: To describe sex (females=5.8±2.3, males=5.1±2.5, p=.04). were found for13-14y/o (18.19±6.60, differences in landing movements in Females and males did not differ 2 CI=17.73-18.72) compared to15-16y/ collegiate athletes using the LESS. significantly on LPG (x =4.766, p=.19): o (17.37±6.65, CI=17.04-17.74) Design: Cross-sectional. Setting: females (excellent=25.7%, good=15.8%, and17-18y/o (17.22± 6.76, CI=16.34- College athletic training facilities. moderate=14.9%, poor=43.6%) and 17.71). Conclusions: In our sub- Patients or Other Participants: A males (excellent=39.7%, good= stantial sample of high school athletes, convenience sample of 101 female 13.8%, moderate=12.1%, poor= we found no gender differences and (age=19.1±1.1years, height= 167.6± 34.5%). Conclusions: Our results that younger athletes (13-14y/o) 8.4 cm, mass=63.5 ±8.8 kg) and 116 corroborate previous reports that committed more errors than older male (age=19.4±1.5 years, height= females display more improper jump- athletes. These findings support the 181.4±8.5 cm, mass=76.7 ±10.7 kg) landing movements than males, recommendation that baseline BESS athletes participating in ten particularly on the frontal plane. scores be obtained every two years intercollegiate sports. Interventions: Although there was a statistically during high school matriculation. Sex of participant was the independent significant difference in OS between Regardless of gender, for the majority variable. Participants performed three sexes, the difference was minimal and of high school athletes in this sample, trials of a standardized jump-landing is likely not clinically significant. In baselineBESS values were similar for task that was videotaped from the contrast to previous reports on military older (15-18 y/o) high school frontal and sagittal views and later cadets, we did not find a difference in athletes, indicating that the BESS was scored using the LESS. The LESS is a LPG between sexes. Further investi- a robust balance test in this setting. In valid and reliable (interrater gation is required to better interpret cases where no baseline exists, reliability=.84) 17-item scoring the LESS in the traditional college normative datamay help health care system that evaluates landing athletics setting. providers interpret anormal baseline characteristics (eg, foot position, foot range of BESS scores for high school contact, stance width, ankle plantar athletes or when determining if flexion, knee flexion, knee valgus, baseline scores seem reasonably valid. trunk flexion) at two discrete time points (initial ground contact, maximum knee flexion) on a binary scale (error, no error). Each trial produces a total score and the mean of all total scores represents an overall score (OS), with higher scores indicating poorer landing patterns. OSs were classified into one of four previously reported landing pattern groups (LPG): excellent (≤4), good (>4 to ≤5), moderate (>5 to ≤6) and

Journal of Athletic Training S-103 12224MONE 12147MOIN Effects of Hyperthermia, System (BESS) three times per Knee Injury History Does Not Hypohydration and Fatigue on session: before exercise (PRE), after Influence Jump-Landing Patterns: the Balance Error Scoring System exercise (POST), and after recovery A Clinical Evaluation VanSumeren MM, DiStefano LJ, (REC). The BESS requires individuals Kulow SM, Valovich McLeod TC, Karslo R, DeMartini JK, Huggins to maintain a static position in six Bay RC, Hackett G, Lam KC: A.T. RA, Stearns RL, Armstrong LE, stance-surface conditions: three Still University, Mesa, AZ; Grand Maresh CM, Casa DJ: University stances (double-leg, single-leg, Canyon University, Phoenix, AZ of Connecticut, Storrs, CT tandem), two surfaces (FIRM, FOAM). A single rater scored all trials from Context: The clinical evaluation of Context:Poor balance may increase videotape. Main Outcome jump-landing patterns is important for Measures: BESS scores from each lower extremity injury risk. Fatigue identifying individuals who may be at Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 and hypohydration have been shown to stance-surface condition were risk for lower extremity injuries, individually impair balance perfor- summed to produce a total BESS particularly at the knee. The Landing mance, but it is unknown how these score. A repeated measures analysis of Error Scoring System (LESS) has been factors affect balance together, orin variance with a Tukey HSD post hoc reported to be a valid and reliable addition to hyperthermia. Fatigue, test evaluated differences between method of clinically assessing jump- hypohydration, and hyperthermia time (PRE, POST, REC) and condition landing patterns. However, there is commonly occur together during sport (EUT, EUH, HYT, HYH) for BESS limited information regarding the participation so it is important to total score (α≤.05). Results:Body influence of a previous injury on jump- understand how they may influence mass loss differed across sessions, landing patterns as evaluated by the possibleinjury risk. Objective: which confirmed hypohydration status LESS. Objective: To determine Evaluate the effects of hyperthermia, (EUT:0.10±0.90%, EUH:-1.30± whether jump-landing movements and hypo-hydration, and fatigue on 0.85%, HYT:-3.80±1.22%, HYH:- scores, as assessed by the LESS, differ balance. Design: Crossover trial. 5.66 ±1.57%,). A main effect for based on knee injury history. Design:

Setting: Research laboratory. condition was observed (F(3,33)=3.79, Cross-sectional. Setting: College Patients or Other Partici- p=.02).HYH (9.53±3.56) resulted in athletic training facilities. Patients pants:Twelve trained healthy male a higher BESS score than EUT or Other Participants: Inter- subjects (age=20±2 yrs, height (7.67±2.80) and EUH (8.17±3.17) and collegiate athletes who had a history =182±8 cm, body mass=74.0±8.2 kg, higher scores were present during HYT of a severe knee injury (SKI), defined (8.89±3.31) compared with EUT. body fat=9±3%, VO2max= 57.0 ± 6.0 as an injury causing loss of mL·kg-1·min-1) volunteered to partici- Regardless of condition, POST participation for ≥10 days (male=12, pate. Interventions: Participants resulted in higher scores compared to female=25, age= 19.2±1.7 years, completed four randomized test PRE (7.85±2.70) and REC (8.23± height= 174.4±10.7 cm, mass= 71.3± sessions based on environmental 3.17) (F(2,22)=7.99, p=.002). Con- 13.6 kg), a mild knee injury (MKI), conditions and hydration status clusions: Hypohydration, especially defined as an injury causing loss of (Euhydrated Temperate (EUT), in a hot environment, impaired balance participation for >1 but <10 days Euhydrated Hot (EUH), Hypohydrated ability. Fatigue also impaired balance (male=15, female=16, age= 19.1±1.1 Temperate (HYT), Hypohydrated Hot ability after 90 minutes of exercise. years, height= 174.5±11.7 cm, mass= (HYH)). Temperate and hot conditions These findings suggest that hydration 70.0± 11.4 kg), and no knee injury were performed in 18±0.2ºC, during physical activity in the heatis (NKI) (male=89, female=58, 50±3.5% relative humidity (RH), and critical to decrease risk of injury. age=19.3±1.3 years, height= 175.2± 34±0.3ºC, 45±4.5% RH, respectively. These findings should also be 10.9 cm, mass=70.8±11.5 kg). Inter- Hypo-hydration consisted of 22-hour considered during post-concussion ventions: The independent variable fluid restriction prior to and during the balance assessments. was knee injury group. Participants session. Euhydration consisted of were videotaped from the frontal and consuming oral fluids ad libitum the sagittal views while performing three day prior to the session and equal to trials of a standardized jump-landing the subject’s sweat rate during the task. Videos were later scored using session. Subjects performed a 90- the LESS (interrater reliability=.84), minute treadmill exercise protocol a 17-item, binary scoring system that (1.34-1.78 m·s-1; 5% grade) while counts the number of jump-landing carrying a 20.5 kg rucksack, followed errors (eg, knee valgus angle, foot by a 60-minute recovery period of position, stance width) an individual quiet sitting in the test environment. commits at initial ground contact and Balance was videotaped and assessed at maximum knee flexion. Each trial using the Balance Error Scoring produces a total score and the mean S-104 Volume 47 • Number 3 (Supplement) May 2012 of all total scores represents an overall score (OS), with higher scores indicating poorer landing patterns. OSs were classified into one of four previously reported landing pattern groups (LPG): excellent (≤4), good (>4 to ≤5), moderate (>5 to ≤6), poor (>6). Main Outcome Measures: Dependent variables were the 17 LESS scoring items (SI), the OS, and the LPG. For group comparisons, chi-

square tests were used for each SI and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 for the LPG and a one-way ANOVA with multiple comparisons was used for the OS. Alpha was p<.05. Results: SKI group (51.1%) landed with a knee valgus angle at initial contact more frequently (x2=7.02, p=.03) than MKI (49.1%) and NKI (31.5%). There were no other group differences (p>.05) observed for the remaining LIs, the OS, or the LPG. Conclusions: Our results suggest that landing patterns and LESS scores do not differ based on a previous knee injury. While previous studies have reported sex differences, little is known about other potential group differences (eg, sport, age-group, lower extremity injury history). Future studies should continue investigating the sensitivity of the LESS in capturing potential group differences and risk factors that may be important in developing preventative programs for lower extremity injuries.

Journal of Athletic Training S-105 Free Communications, Oral Presentations: Protective Equipment Thursday, June 28, 2012, 10:45AM-11:30AM, Room 260-267; Moderator: Mike Kordecki, DPT, SCS, ATC 12370OOEM 12371OOEM Facemask Removal is Safer than an investigator stabilized the model’s Deflation of Air Bladders Slows Helmet Removal in American head. A six-camera three-dimensional Emergency Football Helmet Football motion system, and a three-point one- Removal Day MA, Swartz EE, Beltz EM, segment marker set were used to record Beltz EM, Decoster LC, Day MA, Decoster LC, Mihalik JP: University motion of the head. Main Outcome Swartz EE, Mihalik JP: University of New Hampshire, Durham, NH; Measures: Dependent variables of New Hampshire, Durham, NH; New Hampshire Musculoskeletal included head excursion in degrees New Hampshire Musculoskeletal Institute, Manchester, NH; (computed by subtracting minimum Institute, Manchester, NH; University of North Carolina, position from maximum position) in University of North Carolina, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Chapel Hill, NC each of the three planes (sagittal, frontal, Chapel Hill, NC transverse), and time. A 2x2 (removal Context: In cases of possible cervical technique x helmet type) within-subjects Context: Sports medicine professionals spine injury, athletic trainers must be repeated measures ANOVA was required to manage spine-injured prepared to achieve rapid airway employed for each dependent variable. athletes must gain quick airway access access while concurrently restricting Results: We observed a main effect for while avoiding iatrogenic sequelae. cervical spine motion. Facemask removal technique across sagittal (F1,16= This is complicated in equipment- removal, rather than helmet removal, 309.83; P<0.001), frontal (F1,16= intensive sports (e.g., football) where is recommended to achieve this. 194.52; P<0.001), and transverse protective equipment inhibits airway

However, to date this recommendation (F1,16=356.73; P<0.001) planes of access. In many instances, helmet is solely supported by radiologic motion, such that facemask removal— removal is required to adequately evidence of cervical spine alignment regardless of helmet type—resulted in access the athlete’s airway. It has been with and without football equipment less motion (sagittal=3.9°±0.2°; suggested helmet air bladders be in place. No studies of the motion frontal=2.4°±0.1°; transverse= 2.7°± deflated to decrease the difficulty of created by facemask and helmet 0.1°) than helmet removal (sagittal helmet removal. However, no data exists removal have been reported. =18.5°±0.9°; frontal =7.4°± 0.4°; to support this recommendation. Objective: To compare three- transverse=10.3°±0.4°). We also Objective: To determine the difficulty dimensional head motion and time of observed a main effect of helmet type and total time of helmet removal (HR) facemask (FMR) and helmet removal (F1,16=9.15; P=0.008), such that across two different helmet styles and (HR) in two helmet styles. We removing Revolution helmets resulted deflation status (inflated or deflated). hypothesized that FMR would take in less frontal plane motion (4.5°±0.3°) Design: Repeated measures cohort less time and create less motion than than VSR4 helmets (5.4°±0.2°). Main study. Setting: Controlled laboratory.

HR. Design: Repeated measures. effects of helmet type (F1,16=71.43; Participants: Twenty-two certified Setting: Controlled laboratory. P<0.001) and removal technique athletic trainers (15 males, 7 females;

Participants: Seventeen certified (F1,16=121.39; P<0.001) for time were age=33.9±10.5 yrs; experience athletic trainers (11 males, 6 females; observed. Revolution helmets =11.4±10.0 yrs; height=172±9.4 cm; age=32.5±9.4 yrs; experience (50.0±2.7sec) were removed more mass=76.7±14.9 kg). All participants =9.8±8.7 yrs certified; height= quickly than VSR4 helmets (83.6 were free from upper extremity or 171.3±9.0 cm; mass= 76.4± 14.9 kg). ±5.0sec). The facemask removal central nervous system pathology for All participants were free from upper technique was completed in less time 6 months and provided informed extremity or central nervous system (37.4±1.3sec) than the helmet removal consent. Interventions: Independent pathology for 6 months and provided technique (96.1±6.1sec). Con- variables consisted of helmet type informed consent. Interventions: clusions: Removing a facemask (Riddell Revolution—REV—or Independent variables consisted of provides faster airway access with less VSR4) and bladder deflation status. removal technique (FMR or HR), and motion in all three planes than After familiarization, participants helmet type (Riddell Revolution— removing a helmet in Riddell conducted two successful trials in REV—or VSR4). After familiar-ization, Revolution and VSR4 helmets. This random order for each of four helmet participants conducted 2 successful validates current recommen-dations. removal conditions (REV-Inflated; trials for each of four conditions in Both removal techniques were REV-Deflated; VSR4-Inflated; VSR4- random order (REV-FMR; REV-HR; achieved quicker with Revolution Deflated). Helmets were removed VSR4-FMR; VSR4-HR). Helmets and helmets than VSR4 helmets, from a live model wearing a properly facemasks were removed from a live suggesting that recent helmet designs fitted helmet and shoulder pads. An model wearing a properly fitted helmet improve airway access times. investigator assisted in stabilizing the and shoulder pads. The participant and model’s head. When ready, participants S-106 Volume 47 • Number 3 (Supplement) May 2012 12300MOPR cut chinstraps, removed cheek pads Effect of Mouthguard Use on point Likert questionnaire regarding, (VSR4 model only), deflated Anaerobic Exercise Performance effort, performance, comfort, accessible bladders with an inflation Bradley L, Harrison B, Hertel J, breathability, and function of each needle (deflation trials only), removed Hoard B, Weltman AL, Saliba SA: mouthguard were also collected the helmet, and then regained manual University of Virginia, following each test, then analyzed with stabilization of the head. Total time Charlottesville, VA a Chi Square Test. Results: Perfor- was recorded with a digital stopwatch. mance was not different among the The perceived level of difficulty for Context: Mouthguards are required three conditions on measures of HR by the participant was recorded for many sports. When not mandated, meters covered (no mouthguard: 578.2 after each trial using a modified Borg their use is often encouraged to ± 305.3m; boil-and-bite: 550.9 ± CR-10 scale (RPE). Main Outcome 290.5m; custom: 574.6 ± 322.5m,

prevent injury. The three primary Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Measures: Dependent variables categories of mouthguards are: stock, P=0.40) or final level attempted (no included total time and perceived mouth formed boil-and-bite, and mouthguard: level 14.4 ± 1.2; boil- difficulty. A 2x2 (helmet type x custom. While there are benefits to and-bite: level 14.3 ± 1.1; custom: deflation status) within-subjects mouthguard use, compliance is an level 14.3 ± 1.2, P=0.25). The repeated measures ANOVA was issue because of complaints regarding distribution of scores on the employed for each dependent variable. discomfort, difficulty speaking and questionnaire differed between the Results: We did not observe breathing, cost, and fear of poor boil and bite versus custom or no significant helmet type x deflation performance. Objective: The purpose mouthguard in questions pertaining to status interactions for time of this study was to determine whether ability to give full effort (no (F =14.81; P=0.834) or RPE mouthguard: median = 6; boil-and-bite: 1,21 boil-and-bite or custom fit mouth- (F =1.82; P=0.192). We observed a 5; custom: 6, P=.02);and comfort (no 1,21 guards affect exercise performance main effect for deflation status and to examine attitudes toward mouthguard: median = 6; boil-and-bite: (F =18.81; P<0.001), such that 5; custom: 6, P=.01). While the ability 1,21 different mouthguards compared to a inflated helmets—regardless of no mouthguard condition. Design: to speak (no mouthguard: median = 7; type—required less removal time Crossover. Setting: University boil-and-bite: 3; custom: 6, P<.001); (81.5±5.2 sec) than deflated helmets gymnasium Patients or Other and breathe (no mouthguard: median (96.1±4.9 sec). We also observed main Participants: Twenty-two healthy = 7; boil-and-bite: 3; custom: 6, effects of helmet type for time adults who participated in P<.001)had significantly different less (F =131.51; P<0.001) and RPE favorable distributions on boil-and- 1,21 cardiovascular activity for at least 30 (F =13.89; P=0.001), such that bite versus no mouthguard and boil- 1,21 minutes 3 times per week volunteered Revolution helmets required less time (12 females, 10 males; mean age= 22 and-bite versus custom mouthguard and were easier (time=59.7±3.7 sec; ± 2.5 years, height=169.9 ± 12.9 cm, conditions. Conclusions: While no RPE=3.2±0.2) to remove than VSR4 and mass=73.4 ± 17.7 kg). Inter- performance effects were found, helmets (time=118.0±6.7 sec; vention(s): Participants completed athlete perceptions of decreased RPE=4.2±0.3). Conclusions: Helmet the Yo-Yo Intermittent Recovery Test comfort and breathability were air bladder deflation prolonged the Level 1 (YIRT1) in 3 different observed when using the boil-and- time required to remove the helmets conditions: no mouthguard, boil-and- bitemouthguards. Participants did not in our study. Additionally, it is not bite mouthguard, and custom perceive the custom mouthguards possible to access every air bladder in mouthguard. The order or conditions negatively, and there were no a supine athlete. In combination, our was randomized and testing in each qualitative differences compared to results do not support deflating the condition occurred on different days. the control condition when using a helmet air bladders prior to helmet Main Outcome Measures: Meters custom mouthguard during a maximal removal. traveled and final level of the YIRT1 performance exercise event. attempted were recorded and analyzed using an ANOVA. Scores from a 7-

Wound Management EBF Thursday, June 28, 2012, 5:00PM-6:00PM, Room 275; Moderator: Bernadette Buckley, PhD, ATC

Journal of Athletic Training S-107 Free Communications, Oral Presentations: Core Stability Friday, June 29, 2012, 8:00AM-9:15AM, Room 260-267; Moderator: Matt Gage, PhD, ATC 12129MOTE 12322MOMU Effects of Core Stability Training lunges onto an unstable surface, and Muscle Activation during the on Dynamic Postural Control and single leg squats. The control group Active Straight Leg Raise and Global Core Muscular Endurance refrained from new physical activity Double Straight Leg Lowering McCaskey DA, Armstrong CW, Pfile during the 4-week period. Main Tests KR, Pietrosimone BG, Gribble PA: Outcome Measures: Dynamic Callahan ME, Gage M, Ferng SF, University of Toledo, Toledo, OH stability was assessed using the Nesser T: Benedictine College, average of three trials for each reach Atchison, KS; Indiana State Context: It has long been thought that direction, normalized to leg length University, Terre Haute, IN Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 strength and endurance of core (%). The global core muscle en- muscles relates to dynamic stability, durance tests were measured in Context: Low back pain is a common and deficits influence the probability seconds. Each dependant variable was medical condition that exists in of lower extremity injury. A limited represented as a pre-post change from athletic and general populations. Δ number of controlled studies exist that baseline ( ). For each outcome, an However diagnosing low back pain is substantiate this clinical focus. independent t-test was performed. difficult for clinicians because no gold Examining dynamic stability and core Additionally, effect sizes (Cohen’s d) standard clinical test has been muscle endurance is an important step with associated 95% confidence established. Limited research has towards determining the efficacy of intervals were calculated. Signifi- assessed muscle activation during core stability training (CST) programs. cance was set a priori at P<.05. commonly used clinical tests that Objective: To determine if dynamic Results: Participants in the CST group evaluate low back pain. Objective: To postural stability and global core had significantly greater pre-post assess muscle activation during the muscle endurance may be improved improvements compared to the double straight leg lowering (DSLL) through CST. Design: Randomized control group in the posteriorlateral and active straight leg raise tests. The controlled trial. Setting: Research reach (t25=2.91 ; P=0.007; CST: active straight leg raise was performed Δ Δ laboratory. Patients or Other 9.58± 6.46%; Control: 2.23± bilaterally. Design: Within subject Participants: Twenty-seven healthy, 6.63%; d=1.12, 95%CI: 0.28,1.90), cohort study. Setting: Neuro- physically active, female volunteers posterior-medial reach (t25=2.15 ; P= mechanics Research Laboratory. Δ were randomly assigned to a CST 0.042; CST: 5.27±7.18%; Control: Participants: Thirty healthy, Δ (n=13; 21.50±1.50yrs; 163.07 ±6.35 -0.99±7.91%; d=0.83, 95%CI: physically active, college aged (173.5 cm; 60.57±9.95kg) or a control group 0.02,1.59), right-side bridge (t25=2.46 + 9.15cm, 73.9 + 17.1kg, 21 + 2yrs) Δ (n=14; 22.10±1.30yrs; 167.74 ±6.88 ; P =0.021 ; CST: 14.54±15.10sec; participants were recruited from a Δ cm; 68.46±15.88kg). Interventions: Control: -2.50±20.22sec; d=0.95, university campus. Intervention: Dynamic stability and core muscle 95%CI: 0.13, 1.17) and left-side Muscle activation was assessed endurance were assessed before and bridge (t25=3.44 ; P= .002; CST: bilaterally during the DSLL, right active Δ Δ after a 4-week intervention period in 20.92 ±15.68sec; Control: -1.86± straight leg raise (RASLR), and left all participants. Dynamic stability was 18.46 sec; d=1.33, 95%CI: 0.46, active straight leg raise (LASLR) during assessed with the anterior, posterior- 2.11). Conclusion: Dynamic stability one data collection session. The order medial and posteriorlateral reaches of and global core muscle endurance of clinical tests was counterbalanced. the Star Excursion Balance test were improved after a 4-week core Main Outcome Measures: The (SEBT). Standing on the dominant stability training program in healthy dependent variable was muscle limb, three trials were completed in females. Future research will need to activation. Muscle activation (mean and each direction. Global core muscle determine if similar interventions can peak) of the transverse abdominis / endurance was assessed with trunk be useful at preventing injury and internal oblique (TrA/IO), external flexor and extensor endurance tests, improving outcomes for rehabilitation oblique (EO), and rectus abdominis (RA) and left-side and right-side bridge of injured populations. were measured using the Myomonitor tests. During each test, participants IV (Delsys, Boston, MA) during the assumed and held the test position for DSLL, RASLR, and LASLR. Inde- as long as possible. The CST group pendent samples t-tests were used to participated in 4 weeks of supervised assess muscle activation differences CST consisting of: single-leg bridging between the clinical tests. Results: No (left, right, prone and supine), back differences were observed in the TrA/ extension on a physioball, supine knee IO between the DSLL and ASLR. Greater raise with physioball under shoulders, mean muscle activation was observed in seated marching on the physioball, the EO (right- p = 0.006; left- p S-108 Volume 47 • Number 3 (Supplement) May 2012 =0.020) and RA (right- p =0.004; left- plane hip strength and recruitment are and hip exercise compliance rate and p=0.044) during the DSLL than the reported to modulate knee kinematics the isokinetic hip abductor peak torque RASLR. The EO (right- p= 0.044; left p related to injury risk during dynamic change was0.59 (p= 0.005).Con- =0.003) and right RA (p = 0.002) had movements. Meta-analytic reports clusions:A supervised progressive greater mean muscle activation during indicate that the efficacy of integrative trunk and hip focused INT for twice per the DSLL than the LASLR. Greater peak neuromuscular training (INT) is week for ten weeks enhanced hip EO (right- p = 0.016; left- p =0.028) and strongly associated with compliance abductor strength in young female right RA (p= 0.003) muscle activation and dosage to the prescribed athletes. A significant association was was observed during the RASLR than the programming. Objective:To investi- found between the hip abductor DSLL. The left TrA/IO had greater peak gate the association of compliance strength improvement and the trunk and (p= 0.012) muscle activation during the anddosage with a trunk and hip focused hip focused INT compliance. An

LASLR than the RASLR. Greater peak INT to improve isokinetic hip abductor apparent dose-response relation-ship Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 muscle activation was observed in the strength in young female athletes. was observed with increased INT left EO (p = 0.005) and right RA (p = Design: Controlled laboratory. sessions and specific trunk and hip 0.001) during the LASLR and DSLL. The Setting:High school and research focused exercises completed andthe right TrA/IO (p = 0.045) had greater laboratory. Participants: Twenty-one greater hip abductor strength improve- mean muscle activation during the high school female volleyball players ment.Adaptations from trunk and hip RASLR than the LASLR. The left TrA/ (mean age 15.6±1.4 years, weight focused training that improve hip IO (p = 0.012) had greater mean muscle 64.0±7.4 kg, height 171.5±7.0 cm) were abductor strength and recruitment may activation during the LASLR than the recruited.Seven untrained subjects were be protective against high knee RASLR. Conclusion: Greater TrA/IO included in the analysis to serve as the abduction/valgus loading during muscle activation was observed during “zero” compliance cohort. Inter- dynamic movements, and potentially the active straight leg raise than the ventions: A five phase supervised reduce ACL and patellofemoral injury DSLL. The DSLL activated the EO and progressive trunk and hip focused INT risk in young female athletes. RA more than the ASLR. Activation program aimed to improve trunk and hip patterns vary depending on which leg strength, power, and dynamic 12285MONE is raised during the ASLR. Greater stabilization was implemented twice a Isometric Hamstrings to TrA/IO muscle activation was observed week for ten weeks in addition to a Quadriceps Mean Torque Ratio on the lifting leg side. This data suggest routine strength training, which was after Exercise in Persons with a that clinicians may want to use the performed once per week.Main History of Low Back Pain active straight leg raise test to assess Outcome Measures: Bilateral Lockerby M, Kuenze CM, Hertel J, a patient’s TrA/IO muscle activation isokinetic hip abductor peak torque at Hart JM: University of Virginia, while the DSLL appears to be better at 120°/second was measured at pre- and Charlottesville, VA assessing EO and RA muscle post-intervention by the Biodex 3 activation. system. To analyze dosage effect of Context:Non-specific Low back the trunk and hip focused INT on pain(LBP) is a problem for active 12319DOTE isokinetic hip abductor peak persons due to high prevalence and Effect of Dosage ofTrunk and Hip torque,both INT session and specific recurrence.Muscle weakness and Integrative Neuromuscular trunk and hip exercise compliance imbalance is common in those with Training on Hip Abductor rateswere recorded. Pearson LBP. The role of hamstring and Strength Development in Female correlation coefficients were quadriceps function over the course of Athletes calculated to evaluate the association exercise has been implicated as a Sugimoto D, Myer GD, Hewett TE: between INT session compliance, causative factor in recurrent episodes Cincinnati Children’s Hospital specific trunk and hip exercise of LBP in active individuals. Medical Center, Cincinnati, OH; compliance and changes in isokinetic Objective: To compare hamstring to University of Kentucky, Lexington, hip abductor peak torque. Results: The quadriceps(H:Q) isometric mean KY; Ohio State University, participants demonstrated a 9.3% torque ratios, mean biceps femoris Columbus, OH increases in isokinetic hip abductor EMG activation, and mean vastus peak torque at post-testing (52.8±9.3 lateralis EMG activation in Context:Recent studies demonstrate ft-lbs) compared to the pre-testing participants with and without LBP the mechanistic link between reduced values (48.3±9.6 ft-lbs; 95% afterexercise. Design: controlled proximal neuromuscular controland confidence interval [1.4, 7.6]).The laboratory study. Setting: Research increased risk for knee injuries correlation coefficient (r) between the laboratory. Patients or Other including anterior cruciate ligament INT session compliance rate and the Participants: 34 recreationally active (ACL) and patellofemoral injuries in isokinetic hip abductor peak torque participants; 17 with recurrent female athletes. In addition, specific changewas0.56(p=0.009). Similarly, episodes of LBP: age=22.8±3.6yrs, proximal controllers such as frontal the rvalue between the specific trunk height=169.7±10.6cm, weight=68.7± Journal of Athletic Training S-109 12.8kg) and 17 matched controls. clusions:Thirty minutes of low intensity torque, and surface electromyographic Participants with LBP had experienced aerobic and anaerobic exercises did not (EMG) root mean square activation of at least 3 episodes of non-specific LBP result in an altered response for the lateral hamstring and lateral in the past 12 months (at least 1 in the patients with recurrent episodes of LBP quadriceps during a 5-second maximal past 6 months) Interventions: Partici- when compared to controls. Since isometric contraction were recorded pants performed 30 minutes of previos studies have observed altered before and immediately after aerobic submaximal exercise including 5 responses following continuous exercise. Session 2: Subjects returned repeating cycles of low intensity aerobic exercise, this exercise protocol 48 hours following exercise for a anaerobic and aerobic exercise. The may provide a way for patients with LBP repeat measure of active hamstring aerobic component of each cycle to exercise while avoiding potentially stiffness. Active hamstring stiffness consisted of 5 minutes of uphill walking different responses. was calculated using a published

withgraduallyincreasing incline (1 formula utilizing the dampened Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 degree per minute, maximum 15 degrees 12301MONE frequency of oscillation. For this of incline) immediately followed by 1 Increased Active Hamstring measure, subjects lay prone on a minuteofcontinuous body weight squats Stiffness 48 Hours After Exercise treatment table with the knee and hip step-up exercises.Main Outcome in Females with Recurrent Low flexed to 30 degrees. While the subject Measures: Patients performed a 5 Back Pain held their shank-foot segment parallel second seated knee extension and knee Bedard RJ, Kim KM, Grindstaff TL, to the floor (with external weight equal flexion maximal voluntary isometric Hart JM: University of Virginia, to 10% subjects’ mass fixed to the contraction with the knee bent to 60- Charlottesville VA; Creighton ankle), a sudden downward perturba-tion degrees. Mean isometric torque was University, Omaha, NE was applied causing the knee to extend. measured during the middle 3 seconds The dampened frequency of oscillations of each contraction and normalized to Context: Patients with repeated was measured as the time between body mass. A ratio of mean knee episodes of low back pain (LBP) acceleration peaks as the subject flexion torque to mean knee extension experience neuromuscular adaptations recovered from the per-turbation. torque was then generated. Mean during aerobic exercise due to poor Average, normalized knee extension vastus lateralis and biceps femoris core stability. Deteriorated quadriceps and flexion isometric torque was root mean squared EMG activity was neuromuscular function after exercise calculated for the middle 3-seconds of measured during the same time epoch have been reported in LBP patients a 5-second isometric contraction at 60- used to measure mean isometric however, the response of the degrees of knee flexion. One-way torque. Three separate 2 (Group: hamstrings is unclear. Objective: To ANCOVAs were used to compare post- healthy, LBP) x 2 (Time: pre-exercise, compare active hamstring stiffness in exercise session 1 and session 2 post-exercise) repeated measures female subjects with and without a measures between groups. The baseline ANOVAs were used to analyze history of LBP after a standardized 20- values were used as a covariate. Results: differences between groups before and minutes of aerobic exercise. Design: When adjusted for baseline scores, there after exercise. Results: There was no Case-control. Setting: Laboratory. were no group differences in active significant groupXtime interaction for Patients or Other Participants: hamstring stiffness immediately H:Q mean isometric torque Twelve females with a history of following exercise (LBP=41.4 ratio(Healthy: pre-exercise= 0.64± recurrent episodes of LBP (age= ±17.2Nm/rad, Control =32.9±8.0Nm/ 0.13, post-exercise=0.68±0.33; LBP: 22.4±2.1yrs; mass= 67.1±11.8 kg; rad, P=.39). There were no differences pre-exercise=0.55±0.11,post- height= 167.9± 8cm) and 12 matched in EMG activation or normalized torque exercise=0.53±0.16, p=0.89) or main healthy females (age=21.7± 1.7yrs; immediately after exercise. However, effect for time(P= 0.25) however, mass= 61.4±8.8kg; height= 165.6± the LBP group exhibited significantly there was a significant main effect for 7.3cm) participated. Interventions: increased hamstring active stiffness 48- group indicating significantly lower Partici-pants walked approximately hours post-exercise (40.2±16.3Nm/rad) H:Q ratio in participants with LBP 4.8kph for 20-minutes on a treadmill. compared to controls (27.9±7.0Nm/rad, compared to controls(P=0.05). There The treadmill incline was raised 1% P=.03). Conclusions: Females with was no significant groupXtime grade per minute. During the last 5- LBP presented greater active hamstring interaction (P=0.23) or group main minutes, participants adjusted the stiffness at 48 hours after aerobic effect (P=0.90) for mean hamstring incline of the treadmill so they would exercise. This may be an adaptive EMG activation however, a significant maintain a moderate level of perceived response of the hamstrings to exercise increase was seen following exercise exertion through the end of the in patients with recurrent LBP who may for all(P=0.01). There was no exercise protocol. Main Outcome have poor strength and endurance in the significant groupXtime interaction Measures: Each participant muscles that support the lumbo-pelvic- (P=0.66), group main effect(P= 0.52) completed 2 testing sessions. Session hip regions. or time main effect(P=0.08) for mean 1: Active hamstring stiffness, maximum quadriceps EMG activation. Con- knee extension and flexion isometric S-110 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Effects of Concussion on Gait and Balance Friday, June 29, 2012, 9:30AM-10:45AM, Room 260-267; Moderator: Johna Mihalik, PhD, ATC 12018FOSP Acute Concussion Impairs Dual cycle in single support and percentage about the interactive effects of age and Task Gait Performance of the gait cycle in swing phase and sex on symptoms, neurocognitive Buckley TA, Munkasy BA: Georgia were compared between groups by t- testing (NCT), and postural stability. Southern University, Statesboro, GA tests. Results: The post-concussion Objective: The purpose of the study participants demonstrated a conser- was to examine sex and age differences Context: Acute concussion impairs vative gait pattern including significant in symptoms, NCT, and postural reductions, compared to control stability following concussion. We both postural control and cognitive Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 processing; however, these two participants, in gait velocity (1.21 + hypothesized that males and younger neurological components are typically 0.17m/s and 1.37 + 0.16m/s, p= athletes would have worse symptoms, tested independently. Recent studies 0.010), stride length (1.33 + 0.13m NCT, and postural. Design: have suggested dual task assessment, and 1.42 + 0.11m, p=0.043), single Prospective cohort study Setting: the simultaneous challenge of support phase (37.9 + 1.4% and 39.0 This study was performed in a maintaining postural stability while + 1.1%, p=0.025), and swing phase controlled laboratory setting. performing a cognitive task, may be an (37.9 + 1.4% and 39.0 + 1.3%, Patients or Other Participants: A effective method of identifying post- p=0.034). There was no difference in total of 222 concussed athletes from concussion neurological impairments. heel-to-heel base of support (15.8 + a multi-state, two-year study Objective: The purpose of this study 6.4cm and 14.4 + 4.3cm, p=.448). volunteered to participate and were was to identify impairments in postural Conclusion: The results of this study classified as college males (n= 37,age control during dual task gait. We suggest that the addition of a cognitive =19.5+1.08 years, mass =93.8+15.6 hypothesized post-concussion partici- task impairs gait performance kg, height =183.8+7.24 cm), college pants would demonstrate a conserva- following a sports-related concussion. females (n =35 , age =18.9+1.55 tive gait pattern. Design: Cross Previous studies utilizing dual task gait years, mass =66.7+9.1 kg, height sectional. Setting: Biomechanics assessment involved the time =170.3+8.22 cm) high school males laboratory. Patients or Other consuming process of complete (n=121 , age =15.5+1.19 years, mass Participants: The concussion group biomechanical marker set-up; however =76.6+15.5 kg, height =176.6 +7.59 consisted of 17 student-athletes (age: these results suggest that these cm), high school females (n= 31,age 19.7 + 1.5 years, height: 1.73 + 0.15 impairments can be identified with an =15.4+1.22 years, mass =63.9+10.4 m, weight: 89.9 + 7.9kg) who had re- instrumented walkway. These findings kg, height =164.4+7.13 cm). Inter- cently suffered a concussion (13/17 support the recent trend in the ventions: The independent variables in Grade II, Cantu Evidence Based literature to assess both the cognitive this study were time (baseline, 2, 7, Grading scale) and 17 gender matched and postural control systems and 14 days post-concussion), sex control participants (age: 20.6 + 1.2 simultaneously following a con- (male, female), and age (high school, years, height: 1.74 + 0.89m, weight: cussion. college). Partici-pants completed the 79.5 + 4.5kg) who had never suffered Immediate Post-concussion Assess- a concussion. Interventions: All 12063FOSP ment and Cognitive Test (ImPACT) and The Role of Age and Sex on participants completed five trials of Post-concussion Symptom Scale Symptoms, Neurocognitive dual task gait utilizing working (PCSS) at baseline; and at 2, 7, and 14 Performance, and Postural memory challenges: days of the week days post-con-cussion. Participants Stability in Athletes following backwards, months of the year completed the Balance Error Scoring Concussion backwards, subtraction by 7, spelling System (BESS) at 1, 2, and 3 days post- Covassin T, Elbin RJ, Parker T, a 5 letter word backwards, and concussion. Main Outcome Harris W, Kontos A: Michigan State consecutive addition. All concussion Measures: Dependent variables University, East Lansing, MI; UPMC participants were tested within 24 included ImPACT composite scores Sports Medicine Concussion hours of suffering the concussion. (verbal/ visual memory, reaction time, Program; University of Pittsburgh Main Outcome Measures: Gait processing speed), PCSS scores, and School of Medicine, Pittsburgh, PA; trials were performed on a 4.9m BESS scores. A 4 (time) x 2 (sex) x 2 Grand Valley State University, instrumented walkway which has (age) repeated measures ANOVA was Allendale, MI previously been identified as both valid performed to compare group and reliable. The dependent variables differences in concussion symptoms of interest included gait velocity, Context: Research has shown age and and ImPACT composite scores and stride length, heel-to-heel base of sex differences in concussion another 3 (time) x 2 (sex) x 2 (age) support, and percentage of the gait outcomes. However, little is known ANOVA was performed to compare Journal of Athletic Training S-111 group differences in BESS scores. concussed athletes. Objective: To with an a priori alpha level of Post-hoc comparisons were determine if neurocognitive and 0.05.Results: Despite reporting performed using Tukey’s HSD, and a postural control performance differ symptom resolution, the concussed priori statistical significance was set between asymptomatic concussed group performed significantly worse at = 0.05, and the Bonferroni was athletes and non-concussed controls. than the control group on applied for multiple comparisons. Design: Prospective cohort design. Psychomotor Speed(Concussed= Results: Females performed worse Setting: Clinical research laboratory. -1.8±11.7; Control=8.2±13.8; F1,43= than males on visual memory Patients or Other Participants: 6.9, P=0.012). The concussed group

(M=65.1+15.7: 70.1+15.4, F(1,118), Forty-three Division I collegiate presented with trends toward poorer 3.95, P=.049, η2= .032) and reported student-athletes were assigned to our performance compared to the control more symptoms (M=14.4+6.7: 10.1+ concussed group (n=27; male=14, group on Pro-cessing speed (Con- η2 10.3, F(1,118), 4.53, P=.035, =.037). female=13; age= 19.4 ±1.1 yrs; cussed=0.89±10.2; Control =8.7± Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 High school athletes performed worse height=177.4±10.9 cm; mass= 78.3± 17.0; F1,43=3.7, P= 0.062). No other than college athletes on verbal (M= 14.3 kg) or non-concussed control significant differences were observed.

78.8+12.5: 82.7+13.7, F(3,116), 8.03, group (n=18; male=7, female=11; Conclu-sions: Athletes denying P= .001, η2= .171) and visual age=18.3±0.6 yrs; height=171.3±7.9 symptoms following concussion may

(M=65.8+16.1: 69.4+15.6, F(3,116), cm; mass= 68.6± 11.0 kg). still present with declines in select 3.64, P=.02, η2= .09) memory. High Interventions: Between 2010-2011, neurocognitive domains as measured school males scored worse on the 438 student-athletes completed a by CNSVS. Our results agree with BESS than college males (M= 18.8 preseason baseline postural control previous studies using different

+8.4: 13.0+6.8, F(1,111), 7.29, P=.008, exam (SOT; Sensory Organization neurocognitive test batteries and η2= .061). College females scored Test), a computerized neurocognitive support the use of computerized worse on the BESS than high school test (CNSVS; CNS Vital Signs), and a neurocognitive testing as a means of females (M=21.1+6.9: 16.9+8.7, graded symptom checklist as part of identifying declines in performance P=.008). Conclusions: The findings an on-going concussion management after self-reported symptom from the current study suggest that program. Twenty-seven athletes were resolution. A graded symptom concussed high school and collegiate later diagnosed with a sport-related checklist should not be used in athletes exhibit different outcomes concussion, and completed post-injury isolation, but incorporated as part of a following concussion. Specifically, testing once the athlete reported multifaceted approach to concussion age and sex should be considered when resolution of concussion-related evaluation. Future research is interpreting symptoms, NCT, and symptoms (7.5±4.1 days post-injury, necessary to determine whether the postural instability following 137.6±109.2 days post-baseline). observed differences in asymptomatic concussion. Eighteen non-concussed control concussed athletes performance athletescompleted a post-test exceeds reliable change indices, 12318DOSP approximately 10-weeks (69.9±1.6 indicating clinically meaningful Neurocognition and Postural days) after baseline. Athletes were declines in neurocognitive Control of Asymptomatic considered asymptomatic at post-test performance on CNSVS. Concussed Athletes Compared to if their total symptom severity score Healthy Controls was no greater than 2 points higher than Schmidt JD, Register-Mihalik JK, their baseline. Post-test symptom Mihalik JP, Guskiewicz KM: The severity scores did not differ between University of North Carolina, Chapel groups (F1,43=1.3, p=0.266). Main Hill, NC Outcome Measures: Change scores (post-test score – baseline score)were Context: Previous studies suggest computed for the SOT composite that concussed athletes may present score and the following with postural control and CNSVSStandard Scores: Composite neurocognitive deficits despite memory, Psychomotor speed, reporting full resolution of Reaction time, Complex attention, concussion-related symptoms. Cognitive flexibility, Processing Relying solely on a concussed speed, Executive functioning, and athlete’s reported symptoms could Reasoning. Positive values prompta premature return to play prior represented improvements and to full recovery. Further research is negative values represent declines. necessary to determine if other Separate one-way ANOVA models concussion assessment tools identify were used to assess between-group similar deficits in asymptomatic differences for each outcome measure S-112 Volume 47 • Number 3 (Supplement) May 2012 12019MOSP Dynamic Postural Control is Not were set-up with 39 retroreflective of the Balance Error Scoring System Impaired in Individuals with markers to calculate kinematic data (BESS) performed on a portable force Multiple Concussions (100 Hz). Main Outcome platform system that has been newly Krazeise DA, Munkasy BA, Joyner Measures: The dependent variables of introduced to the sports medicine AB, Buckley TA: Webber interest included displacements of the community. The system allows for an International University, Babson COP during the anticipatory postural objective assessment of sensory and Park, FL; Georgia Southern adjustment phase, the initial step voluntary motor control of balance. University, Statesboro, GA characteristics, and the separation of Objective: To determine if baseline the COP-COM at the conclusion of the postural control values measured by Context: Recent evidence has single stance phase of the initial step. the SET differ based on concussion Dependent variables were compared history. Design: Cross-sectional. suggested that a history of multiple Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 concussions, typically defined as three between groups with one-way Setting: High school and collegiate or more, may result in long-term ANOVAs. Results: There were no athletic training facilities.Patients or neurological impairments. The between group differences, between Other Participants: Interscholastic influence of multiple concussions on concussion and control respectively, and Inter-collegiate athletes with postural control during transitional for posterior COP displacement (5.24 (n=30, age= 19.2±1.3 years, height= movements has not previously been + 1.14cm and 4.88 + 1.10cm, p=0.48), 176.8± 13.7 cm, mass=76.2±13.5 kg) investigated. Gait initiation, literally lateral COP displacement (6.01 + and without (n=175, age=19.4±1.3 the act of starting to walk, has 1.07cm and 6.54 + 0.97cm, p=0.26), years, height= 174.9±10.7 cm, mass= successfully identified impairments in initial step length (0.64 + 0.04m and 70.2± 11.9 kg) a self-report history of postural control in a wide range of 0.61 + 0.06m, p=0.21), initial step con-cussion.Interventions: The inde- patient populations with neurological velocity (0.67 + 0.06m/s and 0.65 + pendent variable was concussion pathologies. Objective: The purpose 0.04m/s, p=0.60), or peak separation history; positive vs. negative. All of this study was to investigate of the COP-COM (30.7 + 3.2cm and participants completed the SET, which performance of cued gait initiation in 30.2 + 2.7cm, p=0.68). Conclusion: involves 6 20-second balance tests individuals with a self-reported history The results of this study suggest that, with eyes closed, using the stances of of three or more concussions. We during the transitional movement of the BESS: double-leg firm (DFi), hypothesized that individuals with a gait initiation, there were no single-leg firm (SFi), tandem firm, history of multiple concussions would differences in dynamic postural (TFi), double-leg foam (DFo), single- reduce the displacement of the center- stability in individuals who had leg foam (SFo), and tandem foam of-pressure (COP) and restrict the suffered at least three previous con- (TFo). Main Outcome Measures: separation of the center-of-mass cussions. It is possible that, at these The dependent variable was sway (COM) and COP. Design: Cross relatively young ages, the multiple velocity (SV)for each of the 6 SET sectional. Setting: Biomechanics concussion individuals have sufficient conditions. A composite SET sway laboratory. Patients or Other compensatory mechanisms available velocity variable was also analyzed. Participants: Ten individuals, current to offset any early neurological Sway velocity (deg/sec) is defined or recent student-athletes with a impairments, if present, which would asthe ratio of the distance traveled by history of at least three self-reported impair postural control. the center of gravity to the time of the concussions (6M/4F, age: 20.6 + 1.2 trial. A higher score indicates more years, ht: 1.77 + 0.12m, wt: 83.8 + 12160MONE sway (worse balance). A 2 (group) by Does Concussion History Affect 23.9kg, 3.5 + 1.0 previous con- 6 (condition) repeated measures Postural Control As Measured By cussions, range: 3 – 6) were closely analysis of variance was used to the Stability Evaluation Test? matched to 10 current student-athletes evaluate differences in SV. An Corvo MA, Williams TA, Lam KC, (6M/4F, age: 20.5 + 1.6, ht: 1.76 + independent t-test assessed Valovich McLeod TC: A.T. Still 0.11m, wt: 83.6 + 23.0 kg) of the same differences in the composite SV University Mesa, AZ sport with no self-reported history of variable. Results:The interaction for concussion or likely concussion SV was not significant (P=.526), nor symptoms; direct or indirect head Context:Concussion is a complex was the main effect for group impacts associated with loss of pathophysiological process that injury (P=.190). There was a significant main consciousness, post-traumatic can affect memory, judgment, reflexes, effect for condition (P<.001) with DFi amnesia, or similar. Interventions: speech, balance, and coordination. (0.74±0.20deg/sec)

the SET may be a useful clinical tool Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 in assessing postural stability in the athletic population. However, more studies need to be conducted to gain a better understanding of its use in the sports medicine community. Further work should continue to evaluate the utility of the SET for the evaluation of postural control in athletes following concussion and musculoskeletal injuries.

S-114 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Lower Extremity Rehabilitation Friday, June 29, 2012, 11:00AM-12:30PM, Room 260-267; Moderator: Kate Jackson Pfile, PhD, ATC 12F14FOTE 12289FONE The Effect of a 4-Week Wobble limb with FAI for a total of 40 seconds. Quadriceps Central Activation Board Rehabilitation Program Both groups were posttested 4 weeks Ratios Following 2-weeks of on Improving Functional Ankle after their pretest. A two (group: CON, Rehabilitation Exercises Instability REH) by two (test: pre, post) repeated Augmented with Cryotherapy Linens SW, Ross SE, Arnold BL: measure ANOVA was used for data Hart JM, Kuenze CM, Diduch DR, Georgia State University, Atlanta, analysis (α=.05). Tukey’s HSD post- Ingersoll CD: University of Virginia, GA; Virginia Commonwealth hoc tests were conducted on Charlottesville, VA University, Richmond, VA significant interactions. Main Outcome Measures: Dependent Context: Persistent muscle weakness Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Rehabilitation protocols measure was CAIT score. A higher following ACL reconstruction may be using multiple exercises have been score indicated improved self- due to underlying activation failure and shown to improve balance and decrease reported functional stability. Results: arthrogenic muscle inhibition (AMI). ankle sprain incidence in individuals Main effect for time was significant Knee joint cryotherapy has been with functional ankle instability (FAI). (P=0.021), but main effect for group shown to improve quadriceps function While these outcomes are desired, was not (P=0.06). A significant group transiently in those with AMI thereby evidence is lacking on how each by test interaction was found providing an opportunity to improve specific exercise in rehabilitation (REHpre=16.79±4.90, REHpost =22.86 quadriceps muscle activation and programs contribute to improving ±4.83, CONpre=17.00±4.59, CONpos strength in ACL reconstructed self-reported outcomes. Self- t=16.43±6.03; F(1,26)=8.88, P=0.006). patients.Objective:To compare perceived functional instability Post-hoc testing showed that groups quadriceps strength and central following an injury is important to were not different at pretest. Posttest activation a before and after an quantify confidence in one’s ability to score for the REH group was greater intervention with or without knee joint return to competition. Objective: To than pretest score; the CON group did cryotherapy. Design: Randomized, quantify improvements in self- not improve at posttest. Lastly, Blinded Clinical Trial. Setting: reported functional instability using a posttest score for the REH group was Laboratory. Patients or Other single ankle rehabilitation exercise as greater than the pre- and post- test Participants: Thirty patients a therapeutic intervention. Design: scores for the CON group. (27.3±11.4years, 167.4±8.8cm, 73.3± Prospective, randomized controlled Conclusions: Wobble board rehabi- 12.2kg) with primary, unilateral ACL experimental design. Setting: litation improved self-reported reconstruction at least 6 months prior Research laboratory. Patients or functional stability in subjects with and with measurable quadriceps central Other Participants: Twenty-eight FAI. We suggest utilizing this wobble activation failure (defined as a central subjects with “giving way” and a history board program to improve self- activation ratio <90%. Interven- of ankle sprains (i.e. FAI) were perceived functional stability. Future tions:Patients were randomly participants. Fourteen subjects research should examine how long the allocated to 1 of 3 groups. Exercise (170.22±8.71 cm, 75.57±13.55 kg, improvements in self-reported group(EXER): patients attended four, 22.94±2.77 yrs) were randomly functional stability last (ie. 1 month, 2-hour supervised exercise sessions assigned to a rehabilitation group 6 months, 1 year). Funded by the NATA over a 2-week period consisting of (REH) and fourteen subjects Foundation Doctoral Grant Program. traditional weight bearing and non- (168.57±9.81 cm, 77.19±19.93 kg, weight bearing resistance exercises. 23.18±3.64 yrs) were randomly Cryotherapy+Exercise group (CRYO assigned to a control group (CON). +EXERC): patients received a 20- Interventions: Completion of the minute knee joint cryptherapy Cumberland Ankle Instability Tool treatment (an ice bag secured to the (CAIT) was either followed by 4 weeks anterior and posterior knee with a with no intervention for CON subjects compression wrap) and then or wobble board training for REH performed the same exercise program subjects. Rehabilitation protocol as mentioned above. Cryotherapy consisted of 3 sessions per week. Group(CRYO): patients received a 20 Subjects performed 5 wobble board minute knee joint cryotherapy repetitions, with each repetition treatment during each session. All consisting of alternating 10 seconds patients were given a home program of clockwise circles and 10 seconds with a compliance log matching group of counterclockwise circles on the assignment. Main Outcome Mea- Journal of Athletic Training S-115 sures:A blinded assessor measured patients with inhibited quadriceps daily living & fitness level. Muscle knee extension maximal volitional following ACL reconstruction. activation was assessed pre-and post- isometric contraction (MVIC) torque training during a single-leg drop and quadriceps CAR before and after 12324DONE landing. Main Outcome Measures: the 2-week exercise period using the The Effect of an Eight-Week Muscle activation was the dependent superimposed burst technique. An Abdominal Training Program on variable. The Myomonitor IV (Delsys, external stimulus was applied to the Muscle Activation in Healthy and Boston, MA) was used to measure quadriceps during the MVIC causing a Chronic Ankle Instability Subjects muscle activation of the transverse brief increase in torque (SIB torque). Gage MJ, Hopkins, JT, Seeley, MK, abdominus/internal oblique (TrA/IO), Central activation ratio (CAR) was Draper, DD, Hunter, I, Feland, JB, external oblique (EO), gluteus medius calculated as [MVIC/MVIC+ SIB) Myrer, JW, Sudweeks, RR: Indiana (GMed), & vastus medialis (VM). State University, Terre Haute, IN;

*100]. We used an ANCOVA Muscle activation was normalized Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (covariate=baseline measure) to Brigham Young University, Provo, using maximal voluntary contractions. compare CAR and MVIC torque UT A repeated measures ANOVA was used following the intervention period. to analyze normalized muscle Post hoc tukey’s LSD determined Context: Chronic ankle instability activation. Post-hoc testing with a differences between groups. Data are (CAI) subjects have demonstrated Bonnforoni adjustment determined presented as adjusted (ADJ) means altered lower extremity muscle differences between & within groups. ±standard deviationand average activation. Increased lower extremity Results: Normalized mean pre- percent change from baseline-post muscle activation was observed during training (Control– TrA/IO; intervention with associated [95% previous research when the transverse 311.7±176.2: EO; 194.5±101.8: confidence intervals]. Results: abdominus was voluntarily contracted GMed; 91.2±69.0: VM; 520.5±719.5, Quadriceps CAR following the 2 week during a prone hip extension. CAI- TrA/IO; 855.0± 1038.2: EO; intervention period were significantly Abdominal training has been theorized 328.4±163.6: GMed; 109.4±62.2: different among the treatment groups to decrease the risk of lower extremity VM; 611.3±478.4, Healthy- TrA/IO;

(F2,26=3.47, P=0.046). CAR ADJ in the injuries. The affect abdominal training 503.6±481.5: EO; 148.7±56.3:

CRYO+EXERC group (CAR ADJ= has on abdominal & lower extremity GMed; 65.6±29.9: VM; 665.8±726.5) 88.1± 2.3%, 17.7%[7.6,27.8]) was muscle activation is unknown. & post-training (Control- TrA/ significantly higher than the CRYO Objective: To determine if abdominal IO;378.7±510.3: EO; 138.3±97.1: group (CAR ADJ =79.4±2.3%, 2.75%[- training changes abdominal or lower GMed; 70.5±20.0: VM; 202.6±82.7, 5.1,10.6], P=0.01) but there was no extremity muscle activation during a CAI– TrA/IO; 365.0± 292.3: EO; difference between the CRYO group single-leg drop landing. Design: A 3 x 287.9±602.5: GMed; 91.8±43.6: VM; and EXERC group(CAR ADJ 2 (group x time) cohort design. 219.7±145.8, Healthy– TrA/IO; =84.3±2.4%, 16.2%[2.7,29.7], P= Setting: Biomechanics Laboratory. 332.8±572.3: EO; 127.7±187.0: 0.26) or the EXERC and CRYO Patients or Other Participants: GMed; 50.2±23.4: VM; 157.4±66.7) +EXERC group (P=0.16). There was Sixty subjects were divided into three muscle activation (%) were measured. also significant differences in adjusted groups (Control, Healthy, and CAI). Before training the CAI group had means for normalized MVIC among Subjects in the Control and Healthy greater activation than the Control the treatment groups (F2,26=3.42, groups did not have a history of ankle (TrA/IO; p= 0.039: EO; p= 0.002) & P=0.048). Normalized MVIC in the instability. Nineteen Control (22± Healthy groups (EO; p< 0.001: GMed;

CRYO+EXERC (MVICADJ =2.1 3yrs, 74.1±13.8kg, 172.6± 11.3cm), p= 0.040). Muscle activation ±.13Nm/kg,38.2% [18.2,58.1])group 21 CAI (22±2yrs, 77.6± 14.0kg, decreased following training in the CAI was significantly higher than the 175.4± 12.3cm), & 20 Healthy (23 (TrA/IO; p= 0.003: VM; p= 0.020) &

EXERC (MVIC ADJ=1.71±.13Nm/kg, ±3yrs, 70.9 ±15.6kg, 172.2± 8.9cm) Healthy (VM; p= 0.02) groups. The 16.8%[-2.1,35.8], P=0.029) and subjects participated. Subjects were CAI group had greater activation than

CRYO (MVICADJ=1.75±.12Nm/kg, matched by gender, height, and leg the Healthy (EO; p= 0.020: GMed; p= 15.5%[-1.8,32.8], P=0.035) groups. dominance. CAI subjects self-reported 0.002) group following training. There were no differences in a history of CAI & functional ankle Conclusions: CAI subjects utilize normalized MVIC between the instability. The Ankle Instability Index their abdominal muscles more than EXERC and CRYO groups (P=0.889). & Functional Ankle Ability Measure healthy subjects during a dynamic task Conclusions:The strategic imple- confirmed CAI & functional ankle to maintain postural control. Eight mentation of knee joint cryotherapy instability respectively. Inter- weeks of abdominal training may immediately prior to controlled, low ventions: The CAI & Healthy groups improve abdominal & lower extremity intensity rehabilitation exercises participated in an 8 week abdominal neuromuscular efficiency. appears to facilitate strength gains in training program while the Control group maintained their activities of

S-116 Volume 47 • Number 3 (Supplement) May 2012 12367FOBI 12117MOTH The Influence of Age on the documented or was reported by the Effects of Therapeutic Modalities Effectiveness of Neuromuscular corresponding author on follow-up on Altering Quadriceps Training to Reduce Anterior contact. Data Extraction: Number of Activation: A Systematic Review Cruciate Ligament Injury in ACL injuries, the number of subjects Harkey MS, Gribble PA, Female Athletes: A Meta-Analysis and the age of participants for Pietrosimone BG: The University Myer GD, Sugimoto D, Hewett TE: intervention and control groups were of Toledo, Toledo, OH Cincinnati Children’s Hospital extracted. The age of participants Medical Center, Cincinnati, OH; (mean or ranged data) were analyzed Context: Neuromuscular alterations, University of Kentucky, Lexington, with dichotomous categorization such as decreased voluntary KY; The Ohio State University, (≤18yrs vs >18yrs) and aggregated into quadriceps activation, are commonly Columbus, OH tertiary categories of early associated with multiple knee Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 adult(>20yrs), late teens(18-20yrs), pathologies. Traditional rehabilitation Context: Sports related injuries to the or mid teens(14-18 yrs).A meta- often fails to address this neuro- anterior cruciate ligament (ACL) analysis with odds ratio(OR) was used muscular impairment, leaving the joint increase during adolescence and peak to compare a ratio of ACL injuries susceptible to further injury. Recent in incidence during the mid to late between intervention and control research has been conducted to teens for females. In response to the groups among differing age develop interventions to improve evidenced high rates of injuries, categorizations. Data Synthesis: quadriceps activation, yet, partly due neuromuscular training (NMT) Eleven of 528 studies were included. to a lack of knowledge regarding programs are often prescribed to Results are presented as OR intervention efficacy, these reduce the ACL injury incidence in [95%Confidence Intervals]. The therapeutic modalities have been slow these populations. Longitudinal bio- dichotomous analysis demonstrated to translate into clinical practice. mechanical investigations indicate that statistically lower ACL injuries(OR Additionally, it remains unknown a potential window of opportunity is 0.26: [0.16,0.43])in ≤18yrscompared which modalities are most effective in present prior to the peak injury to >18yrs(OR 0.81: [0.53,1.25]) improving voluntary quadriceps incidence, which would be optimal group. The tertiary analysis indicated activation. Objective: To determine timing for the initiation of integrative statistically lower ACL injuries in the magnitude of the effect of various NMT in female athletes. However, the youngest age group(OR 0.26: [0.16, therapeutic modalities on voluntary influence the timing of initiation of 0.43]) compared to late teens(OR quadriceps activation. Data Sources: these programs on the efficacy of ACL 0.48: [0.21,1.07]) and early adult(OR The Web of Science and PubMed injury reduction has yet to be 1.00: [0.59,1.70])participants under- databases were searched between the evaluated. Objective: To syst- going NMT. Conclusions: The years of 1950 and 2011 with the ematically review and synthesize the findings of this meta-analysis revealed keywords “quadriceps activation”, scientific literature in regards to the an age related association between “disinhibitory”, and an exhaustive list influence of age of NMT imple- NMT implementation and reduction of of potential modalities. Study mentation on the effectiveness for ACL incidence. Both biomechanical Selection: The initial search query reduction of ACL injury incidence. and the current epidemiological data included 9,319 studies. Studies that Data Sources: A computerized search indicate that the potential window of evaluated the implementation of a was performed using PubMed, opportunity for optimized ACL injury therapeutic modality on volitional CINHAL, Health source, Medline, risk reduction may be prior to the quadriceps activation using the central SPORT Discus, (1995-2010)in onset of neuromuscular deficits and activation ratio or the interpolated September, 2011. Key words were peak knee injury incidence in females. twitch testing methods were retained. “anterior cruciate ligament,” “ACL,” Specifically, it may be optimal to Pertinent studies were cross- “prospective,” “neuromuscular,” initiate integrative NMT programs referenced for relevant articles, “training,” “female,” and “prevention during pre-adolescence, prior to the leaving 9 studies that met our .”Language was limited to English. period of altered mechanics that inclusion criteria. Data Extraction: Abstracts and unpublished data were increase injury risk. Voluntary quadriceps activation, excluded. Study Selection: Criteria expressed as a percentage of complete for inclusion required that 1)number activation, was our main outcome of ACL injuries were reported, 2)a measure. We extracted voluntary NMT program was utilized, 3)females quadriceps activation means and were included as participants, standard deviations measured at 4)studies used pro-spective, baseline and at all available post- controlled trials, and 5)age of the intervention time points. Studies were participants to the program was assigned a PEDro score, with

Journal of Athletic Training S-117 12291MONE agreement from two investigators. Data Effect of Textured Insoles on static postural control at 2-week follow- Synthesis: The 9 studies (mean Static Balance in Individuals with up for both groups (textured: pre=9.2 PEDro=6.8±0.8) were grouped into a History of Lateral Ankle Sprain ±2.6s, immediate=10.3±3.6s, 2-week= five categories based on the modalities Dartt CE, Cosby NL, Saliba SA, 10.8±3.1s; sham: pre= 8.7±3.3s, that were evaluated including: manual Hertel J: University of Virginia, immediate=10.2±3.8s, 2-week= therapy (3 studies), transcutaneous Charlottesville, VA; Point Loma 9.8±3.1s). We did not observe any electrical nerve stimulation (TENS;2 Nazarene University, San Diego, CA significant group by time interaction, studies), cryotherapy (2 studies), group or time main effects for the mean neuromuscular electrical nerve Context: Textured insoles have been of the TTBAP minima (p=0.30, p=0.47, stimulation (NMES;2 studies), and shown to improve postural control p=0.08, respect-ively). There was no transcranial magnetic stimulation significant group by time interaction, measurements in healthy individuals, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (TMS;1 study). Cohen’s effect sizes however it is not clear if these group or time main effect for the mean (d=posttest–pretest/pooled standard improvements are seen in individuals of the TTBML minima (p=0.23, p=0.65, deviation) with 95% confidence with existing postural control p=0.39, respectively) or the SD of the intervals (CI) were calculated for each deficits.Objective:To examine the TTBML minima (p=0.37, p=0.85, modality at all time points to allow for effect of textured and non-textured p=0.33, respectively). Descriptive comparisons of immediate and insoles on static balance in individuals measures were as follows for the mean sustained effects. TENS demonstrated with a history of ankle sprains. of the TTBAP minima (textured: the strongest immediate effects Design: Single-blinded randomized pre=14.3 ±3.6s, immediate =16.7± (d=1.03; 95% CI 0.06,1.92) at 45- controlled trialSetting: Laboratory. 6.1s, 2-week= 17.2±5.2s; sham: minutes following initial application, Patients or Other Participants: pre=14.2± 5.5s, immediate =15.2± as well as sustained strong and Twenty-two individuals (10 females, 4.3s, 2-week= 14.6±3.5s), the mean of definitive effects at four weeks 12males, age=22.3±3.7years, height= the TTBML minima (textured: pre=5.2 (d=1.81; 0.80,2.68) following a TENS 175.6± 11.5cm, mass=74.2±15.1kg) ±1.2s, immediate=6.4±2.1s, 2- and exercise intervention. NMES with a history of one or more lateral week=5.9± 1.6s; sham: pre=5.6± 1.9s, produced weak to strong effects (range ankle sprains (mean number of ankle immediate =5.5±1.4s, 2-week= d=0.20-1.87) over a period of three sprains within the last year=3.8±2.5). 5.6±1.4s), and the SD of the TTBML weeks to six months. Cryotherapy Interventions: A ¾ length textured minima (textured: pre=4.0±1.4s, (d=0.5; -0.35,1.35) and TMS (d=0.54; insole with raised rubber nodules immediate=5.0±2.0s, 2-week= 4.4± -0.33,1.37) had moderate immediate shaped to the contours of the foot and 1.4s; sham: pre=4.4 ±1.6s, immediate effects for improved voluntary a smooth ¾ length insole made of =4.4±1.0s, 2-week= 4.1 ±1.2s). quadriceps activation, while manual 1.5mm thick closed cell foam served Conclusions:A 2-week textured therapy, particularly joint manipu- as the intervention and sham insole intervention did not improve lations (d=0.38;-0.35,1.09) elicited treatments, respectively.Following a 2 static balance in subjects with a history only weak immediate effects. day accommodation period, subjects of ankle sprainsignificantly better than Conclusions: TENS demonstrated the wore their prescribed insoles at least an untextured insole intervention. greatest immediate and sustained 6 hours per day for two weeks. Main Improvements in TTBAP variability effects in quadriceps activation, and Outcome Measures: The mean and were observed in both groups, may be the best current choice for standard deviation (SD) of the time to indicating a potential learning effect improving quadriceps activation boundary (TTB) minima in the and the need for a true control clinically. NMES produced a wide anteroposterior (AP) and mediolateral conditionin future investigations. range of effects (weak–strong), which (ML) directions was assessed during may limit current conclusions on the 10 second trials of unilateral quiet efficacy of this modality for improving stance while shod and with eyes open. quadriceps activation. More research Measurements were recorded at needs to be compiled for TMS, baseline, immediately following cryotherapy, and manual therapy to insole insertion, and at 2-week follow- determine the extent of the immediate up.For each measure, a 2x3 (groupby and sustained effects. time) ANOVA with repeated measures was calculated. Results:There was no significant group by time interaction or group main effect for the SD of the TTBAP minima (p=0.79, p=0.70, respectively), however a significant time main effect (p=0.05) was observed indicating an improvement in S-118 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Instructional Strategies in Athletic Training Education Friday, June 29, 2012, 12:45PM-1:30PM, Room 260-267; Moderator: Andy Winterstein, PhD, ATC 12247FOPE 12088FOPE Students’ Perceptions of an SP case was appropriately challenging Comparing Instructional Methods Integrated Standardized Patient (#7). A Table of specifications (ToS) in the Knowledge Acquisition of Program established content validity; a panel of Musculoskeletal Anatomy in Fincher AL, Krawietz PK, Resch JE, experts established face validity. Athletic Training Students Trowbridge CA: The University of Descriptive statistics were used to Rothbard M: Southern Connecticut Texas at Arlington, Arlington, TX analyze group responses to survey State University, New Haven, CT items. An ANOVA was used to Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Standardized patients (SPs) determine group differ-ences between Context: The importance and are used to teach and assess commun- CPEs conducted with theatre and 4th difficulty of teaching and learning ication, clinical evaluation and clinical year AT students. Levene’s test musculo-skeletal anatomy has been decision-making skills of students assessed homogeneity of variance. All documented previously. Little is enrolled in health related programs. analyses were conducted with =.05. recorded about the selection and Little research exists examining the Results: The measures of the case implementation of instructional effectiveness of this pedagogical being challenging and realistic were strategies to improve knowledge approach with Athletic Training (AT) excluded due to significant a lack of acquisition of anatomy in athletic students. Objective: To investigate AT homogeneity of variance pre- and post- training students (ATS). Objective: To students’ perceptions of SPs and their transformation of the data. Overall, compare the effect of traditional benefit to developing/refining students agreed the SP experience was instructional methods (lecture, communication, history taking, beneficial for developing/refining models, and charts) with traditional physical assessment, and clinical history taking (4.16 ± 0.834), instructional methods plus a computer diagnosis skills. Design: Cross- communication (4.36 ± 0.685), based instruction (CBI) simulation sectional. Setting: Research Labo- physical assessment (4.23± 0.782), program on knowledge acquisition of ratory. Patients or Other Parti- and clinical diagnosis (4.18 ± 0.922) musculoskeletal anatomy in under- cipants: Forty-four undergraduate AT skills. Seventy-five percent (n=33) of graduate ATS. Design: A quasi- students (6 fourth-year, 14 third-year, students strongly agreed (n=11) or experimental, pre-test post-test 24 second-year) from a 4-year CAATE agreed (n=22) that their SP case was counterbalanced comparison design. accredited Athletic Training Education appropriately challenging. Forty-seven Participants were randomly assigned Program (ATEP). Interventions: A SP percent (n=21) of students were to one of two conditions. Group one program was integrated across the confident in their clinical diagnosis of received traditional instructional curriculum using theatre students and the SP case. AT students who had methods only for lower extremity fourth-year AT students as trained SPs. theatre students as SPs experienced course content and traditional AT students completed a clinical greater confidence in their clinical instructional methods plus the CBI practice exam (CPE) involving a lower diagnosis (F(1,43) = 5.12, p=.029). simulation for upper extremity course extremity injury presented by a SP. Conclusions: Our results support the content. Group two participated in Theatre student SPs presented a 1° use of SP in ATEPs. Overall, our reverse order. Setting: A 3-credit muscle strain case to second- and findings suggest AT students perceive undergraduate Anatomy and Physiol- fourth-year students. Fourth-year SPs to be beneficial in helping develop/ ogy I course at a public university. student SPs presented a medial tibial refine clinical evaluation and patient Participants: A con-venience sample stress syndrome case to third-year communication skills. of 24 ATS was used. Students were students. Main Outcome Measures: eligible to participate if seeking a A Likert type scale (range 1-5; Bachelor of Science degree, and no 5=strongly agree, 1=strongly dis- prior university-level A&P course- agree). Survey items assessed whether work. A majority of participants the SP case was realistic (#1); whether (70.8%) were 19 years of age or students perceived the SP experience younger and had earned 0-29 credits beneficial for developing/refining (77.1%). There were slightly more history taking (#2), communication men (56.3%) than women (43.8%). (#3), physical assessment (#4), and Interventions: A CBI simulated clinical diagnosis (#5) skills; whether cadaver dissection program consisting students were confident in their of dissection, animation, imaging, and clinical diagnosis (#6); and whether the self testing modules. Main Outcome

Journal of Athletic Training S-119 12034FOPE Measures: Student scores on pre and Using StudyMate® and Online (time) effects assessed pre, post, and post-test upper and lower extremity Flashcards in a CPR Course Does follow-up exam scores. Main multiple choice and practical Not Improve Learning Outcomes Outcome Measures: The average of examinations (split half correlation or Retention two American Red Cross exams; 1) coefficient =.784). T-tests and Berry DC, Berry LM: Saginaw Valley CPR exam and 2) AED exam was used repeated measures ANOVA with alpha State University, University Center, to calculate a combined exam score levels of .05 were used to determine MI administered at three time intervals; significant differences between the pre, post and 6 weeks follow-up. two conditions. Results: For the lower Context: Teaching strategies/ Results: Pre-test combined exam extremity there was a significant main activities such as games and puzzles scores for the control, online effect for written and practical flashcard, StudyMate® groups were can promote student interest in Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 examination scores (F=263.24, learning in different educational 57.97±11.23, 61.20±12.81 and P<.001) and a significant test score by domains. However, these pedagogical 63.59±16.37 respectively. Post-test intervention interaction (F=15.60, tools have not examined the potential combined exam scores for the control, P<.001). Post hoc testing revealed that for student learning and retention in a online flashcard, StudyMate® groups test scores were significantly greater cardiopulmonary resuscitation (CPR) were 82.80±7.74, 84.76.20±9.64 and (t=2.75, p=.012, ES=1.12) in the CBI and Automated External Defibrillation 87.32 ±8.36 respectively. Six week group (M=36.67, SD=5.55) compared (AED) course. Objective: To examine follow-up combined exam scores for to the traditional group (M=30.67, the effectiveness of online flashcards the control, online flashcard, SD=4.69).There were no significant and StudyMate® as pedagogical tools StudyMate® groups were 83.60±8.57, differences in the pre-test scores (t=- to improve learning outcomes and 88.00±8.56 and 87.59 ±7.33 .529, p=.602) between the CBI retention of cognitive knowledge respectively. A repeated measures (M=19, SD=4.69) and traditional related to CPR and AEDs. Design: ANOVA with a Huynh Feldt correction (M=19.92, SD=3.75) groups. For the Repeated measures. Setting: Uni- revealed a significant main effect for upper extremity there was a significant versity classroom. Participants: time (F1.69,74.6= 131.56, P < 0.001) on main effect for written and practical Forty-seven undergraduate students exam scores. All groups increased examination scores (F=246.33, (males=16, females=31; 20.15±2.8 their examination scores from pre P<.001) and a significant test score by years of age) enrolled in two CPR for (60.92±2.01 SE) to post (84.96±1.25 intervention interaction (F=196.02, the Professional Rescuer courses SE) and follow-up (86.40±1.19 SE). P<.001). Post hoc testing revealed that taught by the same instructor Results revealed no significant test scores were significantly greater participated in the study. Inter- interaction or group main effect. (t=3.17, P=.004, ES=1.29) in the CBI ventions: Students in each class were Conclusions: The results of the study group (M=39, SD=3.16) compared to randomly assigned to three groups; indicated that the use StudyMate® and the traditional group (M=31.42, control (n=15), online flashcards (n= online flashcards in a CPR for the SD=7.66).There were no differences 15) and StudyMate® (n=17). One- Professional Rescuer course as in the pre-test scores (t =-.219, hundred and forty six terms/concepts pedagogical tools does not improve P=.829) between the CBI (M=18.67, related to CPR and AEDs considered overall exam scores compared to SD=4.4) and traditional (M=19.17, important by the instructor were used traditional methods of studying SD=6.59) groups. Conclusions: Both to construct the StudyMate® (control). Further research is groups of participants had increases in (Respondus, Inc.) and online necessary to examine the effects of pre-post test scores; however, flashcards (Flashcard Exchange©, StudyMate® and online flashcard for participants utilizing traditional Tuolumne Technology Group; http:// student test performance as well as instructional methods plus CBI had www.flashcardexchange. com). examine students’ perceptions and greater post-test scores. The addition Students in both treatment groups were preferences for these pedagogical tool of a CBI simulated cadaver dissection asked to spend a minimum of 60 as learning activities. improved knowledge acquisition of minutes studying with their lower and upper extremity pedagogical tool one week prior to the musculoskeletal anatomy in post-test. The control group received undergraduate ATS. Further work is no access to neither program and was needed to determine why this effect asked to prepare for the midterm using occurred. their own study habits. Each group received identical course information. Repeated measures of analysis of variance (ANOVA) with between- subjects (group) and within-subjects

S-120 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Oral Presentations: Employment Issues in Athletic Training Friday, June 29, 2012, 1:45PM-2:45PM, Room 260-267; Moderator: Tory Lindley, MA, ATC 12006SOHE 12218FOHE Perceptions of Female Athletic mentorship reflects the participant’s Likelihood of High Burnout Training Students on Motherhood acknowledgement that a female Among Certified Athletic in the Division I Clinical Setting mentor who is successful balancing the Trainers in Various Job Settings Gavin KE: Mazerolle SM.Villanova roles of mother and athletic trainer, Naugle KN, Behar-Horenstein LS, University, Philadelphia, PA; would impact their ability to follow Dodd VJ, Tillman MD, Borsa PB: University of Connecticut, Storrs, their lead. The final theme, work life University of Florida, Gainesville, CT balance strategies illustrates the FL participant’s discussion of the need to Context: Attrition issues, particularly have a plan in place to meet the Context: Athletic Trainers work in a Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 of female athletic trainers, have been demands of both home and work wide variety of job settings and a concern for the profession of athletic life.Conclusions:Comparable to depending on the job setting may be at training. Motherhood appears to play other research it appears as though a higher risk for job burnout. The a catalyst in turnover for the female, clinical setting, particularly the investigation of the relationship especially if employed at the Division secondary school level, is perceived between job setting and level of I College level. A majority of the to provide a more suitable work burnout may produce interventions to literature examining this topic environment for the female athletic reduce setting specific factors that however examines the perspectives of trainer. Our results also coincide with cause job burnout and reduce the those employed rather than those who research, which identifies that working dangers of having a medical are preparing to enter the profession. professionals work life balance professional experience burnout while Objective: The purpose of this study priorities lie with employment working with patients. Objective: To was to evaluate perceptions of arrangements, such as flexibility and determine the difference in burnout motherhood and retention in athletic hours worked, as well as parenting scores relating to setting in District 9 training from the student. De- responsibilities, which includes (SEATA) of the NATA. Design: A sign:Structured, online asyn-chronous childcare responsibilities. As more cross sectional web-based survey interviews. Setting: Commission on female professionals, such as this design determined whether levels of Accredited Athletic Training Education cohort of young, continue to stay burnout differ between athletic (CAATE) Programs in the Division I optimistic and believe they can trainers who work in upper colleges setting. Patients or Other Parti- balance both roles successfully (Division I and II), high schools, and cipants:Eighteen female athletic without sacrificing one over the other, clinical settings (physical therapy or training students (sophomores =5; it is conceivable for athletic training hospital clinics). Setting: District 9 juniors=6; seniors =7) volun-teered. to be a viable profession that includes of the National Athletic Trainers’ Average age of the participants was mothers. Mentorship was one of the Association (NATA) Participants: 21±1. All were full-time students who most valuable tools for persistence in Convenience sample of athletic were taking a full-academic load in the profession; future investigations trainers listed in the SEATA district or athletic training, which included a should evaluate the direct influence of District 9 mailing list (n=1560) clinical practicum experience. Data those female students who have had a (128=college, 139=high school, Collection and Analysis: Partici- female mentor with children as this 70=clinic). Interventions: Subjects pants responded to a series of cohort was deficient in this experience completed demographic questions questions by journaling their thoughts as only a few were able to directly work (hours worked per week, year’s and experiences. Participant checks alongside a female athletic trainer with experience, and gender) and the 12- and peer review were included as steps a family. item Copenhagen Burnout Inventory to establish data credibility. The data (CBI) through an online survey. was analyzed borrowing from the Permission was obtained and the CBI principles of general inductive is valid and reliable (Kristenson 2005). approach. Results:The first theme Main Outcome Measures: Burnout clinical setting, speaks to the scores were calculated from the 3 participant’s beliefs that work life subsections (work, personal and balance and retention in athletic client) of the CBI. A corresponding training requires an employment CBI burnout score of greater than 50 setting, which fosters a family-friendly is considered high burnout. Results: atmosphere and a work schedule, A one-way ANOVA showed that a including travel that allows for more significant difference between burnout time at home. The second theme, levels occurs among settings (p=.001), Journal of Athletic Training S-121 with college (M=43.32±16.88) and based survey. Patients or Other highest OKn (4.83±1.48, 95%CI= high school (M=44.47±16.53). Participants: Fifty-eight of 171 4.44-5.22) and CIK (3.21/4.0±0.68) Athletic trainers reporting higher employers (33.9% response rate) scores on questions regarding burnout than clinic athletic trainers from a convenience sample from the professional ATEPs. Educators (M=35.22 ±18.39). Logistic re- NATA public vacancy notice (37 males, achieved the highest OKn scores gression indicated that after 21 females age=42.67±9.35) (38 (10.85±1.77, 95%CI=9.76-11.92) and controlling for gender, year’s clinicians, 13 educators, and 7 also reported the highest overall CIK experience, hours worked, and age, administrators) participated in the scores indicating they were college athletic trainers were 2.24 study. Interventions: Participants “extremely confident” (3.72/4.0 times more likely to report a high level were sent an e-mail asking them to ±0.36). Conclusions: The primary of burnout (score >50) compared to complete the online survey consisting finding of this study is that employers

clinic athletic trainers [p=.046, odds of: (1) five, 4-point Likert scale items are only moderately familiar with Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 ratio (OR): 2.24, 95% confidence assessing PK of professional ATEPs, differences between ATEPs. interval (CI): 1.02-4.94]. Additionally, professional master’s ATEPs, and Employers are familiar with desired high school athletic trainers were 3.15 post-professional ATEPs (PPATEPs); hiring characteristics and criteria, but times more likely to report a high level (2) thirteen multiple-choice questions their limited knowledge regarding the of burnout compared to clinic athletic to assess OKn; (3) thirteen 4-point differences between ATEPs indicates trainers [p=.004, odds ratio (OR): Likert scale items to assess CIK for they do not fully comprehend which 3.15, 95% confidence interval (CI): each OKn question. Reliability from programs exemplify these quali- 1.47-6.86].Conclusions: Based on an unrelated pilot sample (n=13) for fications. While future research these results, the setting of employ- the OKn section was determined to be should involve a larger sample size of ment is a possible factor related to excellent; percent agreement averaged employers, it is necessary to educate burnout in athletic trainers. More 96% with a range of 83.33%-100%. employers about the qualifications of specifically, athletic trainers working Main Outcome Measures: OKn graduates from differing programs. in high level colleges and high school scores were tabulated by awarding 1 settings are more likely to experience point for each correct answer with a 12163FOHE a high level of burnout compared to maximum score of 13. OKn Reliability and Validity of an those working in clinic settings. Future subsection scores were also created Instrument Identifying the research should expand beyond for all questions pertaining to OKn of Predictors of Career Intent District 9 and include more levels of professional ATEPs (6 questions), Among Athletic Trainers job settings like industrial setting professional master’s ATEPs (7 Goodman A, Mazerolle S, athletic trainers and all the levels of questions), and PPATEPs (7 Rabinowitz E: Appalachian State college sports (D I, II, III). questions). Some OKn questions University, Boone, NC; University assessed knowledge of both of Connecticut, Storrs, CT 12074MOHE professional and professional master’s Employers’ Knowledge and ATEPs and were awarded 1 point Context: Little is known as to what Confidence Concerning Athletic within each subsection. PK and CIK predicts an athletic trainer’s (AT’s) Training Education Programs: A scores were achieved by totaling all intent to stay in a position, a setting, Descriptive Study values and then calculating the average or the entire AT profession (i.e., career Schendel AL, Welch CE, Van Lunen value back to the Likert composite intent). Currently, no instrument is BL: Old Dominion University, score (total divided by 4). A higher available to measure AT career intent. Norfolk, VA score indicated the participant had a Objective: To develop an instrument higher perceived knowledge or higher identifying the variables that predict AT Context: Identifying employers’ confidence in their responses to the career intent in order to evaluate the current knowledge of athletic training OKn questions. Means and standard fit of an established turnover model in education programs (ATEPs) is deviations were calculated for all AT. Design: Descriptive study. essential before researchers can responses; 95% confidence intervals Setting: All AT professional settings accurately investigate the quali- (CI) were calculated for OKn scores. nation-wide. Patients or Other fications, attributes, and types of Results: Participants’ PK scores Participants: Instrument design experience employers prefer their indicated they perceived themselves as experts and experts in 8 AT employees to possess. Objective: To “moderately knowledgeable” of ATEPs professional settings participated in assess employers’ perceived (3.04/4.0±0.70). Overall OKn scores face (n = 6) and content validity (n = knowledge (PK), objective knowledge were 8.47±2.64 (95%CI=7.77-9.16), 11) testing. ATs employed in full-time (OKn), and confidence in their while overall CIK scores (3.21/ AT positions participated in pilot knowledge (CIK) regarding various 4.0±0.68) indicated participants were testing: Pilot test 1 (n = 47) and pilot ATEPs. Design: Cross-sectional “moderately confident” in their OKn test 2 (n = 150). Main Outcome descriptive survey. Setting: Web- responses. Employers achieved the Measure(s): We created the Athletic S-122 Volume 47 • Number 3 (Supplement) May 2012 Training Career Intent Survey (ATCIS) Alpha coefficient for pilot test 2 was from previous instruments used to test = 0.922 (62 items). Removal of low the Price-Mueller model of turnover items improved the Alpha ( = 0.936; in other health care fields (e.g., nursing 45 items). The exploratory factor and physicians). Our initial ATCIS analysis revealed the presence of 4 measured career intent and 18 components accounting for 51% of individual, environmental and job the variance. These 4 components structure variables. The survey included career/job engagement contained 23 demographic and 108 (30.1%), supervisory support (8.4%), career intent items. We conducted 2 pay and promotion (6.6%) and co- field tests to assess face and content worker support (5.9%), and reduced

validity, and reliability analyses on 2 the ATCIS to 40 career intent items Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 separate on-line survey pilot tests measuring 14 variables. Con- using a Cronbach set a priori at 0.80 clusions: Creation of the ATCIS is an and item-to-total correlations. We also important first step in understanding performed an exploratory factor ATs’ intent stay in or leave a certain analysis on pilot test 2 to evaluate position, a certain setting, or the entire construct validity. Results: Our first profession. We subjected the ATCIS field test demonstrated face validity to rigorous testing and demonstrate it with minor changes. In our second to be both valid and highly reliable. field test for content validity, items Future ATCIS research should include averaging below 5.7 on a 7-point larger samples to evaluate these Likert scale of item-appropriateness predictors of AT career intent. were discarded or modified. The Longitudinal studies incorporating the Cronbach’s Alpha coefficient for pilot ATCIS could assist in establishing a test 1 was = 0.793 (77 items). We model of AT turnover. then removed or modified items with negative or low (< 0.3) item-total correlations. The initial Cronbach’s

Journal of Athletic Training S-123 Free Communications, Poster Presentations: Undergraduate Poster Award Finalists Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12046UOMU 12110UOBI Bilateral Comparison of Shoulder all measurements. The average of the Hip Range of Motion Predicts Kinematics in Collegiate three trials for each measurement was Dynamic Lower Extremity Volleyball Players calculated. The side and order of Alignment in Adolescent Athletes Brewer ME, Tucker WS: University measurements were randomized. The Hunnicutt JL, Nguyen A, DiStefano of Central Arkansas, Conway, AR independent variable was side LJ, Buckley B, Boling MC: College (dominant and non-dominant). Main of Charleston, Charleston, SC; Context: Changes to the shoulder Outcome Measures: The dependant University of Connecticut, Storrs, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 complex, such as postural impairment, variables were the bilateral mean CT; University of North Florida, muscle length and scapular dyskinesis, measurements for scapular upward Jacksonville, FL have been associated with shoulder rotation at rest, 60°, 90° and 120°, injuries in overhead athletes. It is anterior scapular position, gleno- Context: ACL injuries are increasing unknown if some amount of change in humeral internal rotation and in adolescent athletes, while the shoulder kinematics is normal as a glenohumeral external rotation. The factors that increase risk of injury result of participating in an overhead influence of side for each dependent remain unknown. Differences in hip sport regardless of the presence of variable was compared using paired rotation range of motion (ROM) have shoulder injury. Objective: To samples t-tests with an adjusted alpha been theorized to contribute to compare bilateral scapular upward level (p<0.007). Results: Statistical dynamic alignments known to increase rotation, anterior scapular position, analysis revealed anterior scapular the risk of ACL injury. While this glenohumeral internal rotation and position (t14=3.646; p=0.003) was relationship has been observed in the glenohumeral external rotation in significantly greater on the dominant adult population, there is little research healthy elite volleyball players prior side (5.9±1.1cm) compared to the investigating the influence of hip ROM to pre-season. Design: Within non-dominant side (5.0±1.2cm). on dynamic joint angles in the subject. Setting: Controlled Gleno-humeral internal rotation (t14= adolescent athlete. Objective: To laboratory environment. Patients or -3.689; p=0.002) was significantly determine the influence of hip ROM Other Participants: Fifteen female greater on the non-dominant side on frontal and transverse plane hip and collegiate volleyball athletes (19.0± (74.6±7.2°) compared to the dominant knee joint angles during a double-leg 1.2 y, 175.4±5.5 cm, 71.5±9.2 kg) with side (66.2± 8.2°). There were no jump landing (JL) task in adolescent no history of shoulder injury significant differences for gleno- athletes. Design: Cross-Sectional. participated in this study. Inter- humeral external rotation (t14= 1.212; Setting: High school athlete ventions: Static scapular upward p=0.245) or scapular upward rotation screening. Patients or Other rotation was measured at rest, 60°, 90° at rest (t14=1.417; p=0.178), 60 Participants: Forty seven male and 120° of humeral elevation in the (t14=0.075; p=0.942), 90 (t14=-0.205; (15.6±1.2yrs, 178.3±8.6cm, 72.1± scapular plane with an electrical p=0.840) and 120 (t14=0.590; p= 11.7kg) and twenty six female inclinometer. Anterior scapular 0.564). Conclusions: Bilateral (16.0±1.1yrs, 166.2±9.0cm, 60.3± position was measured using the differences in anterior scapular 9.0kg) adolescent athletes volunteered pectoralis minor length test. While the position and glenohumeral internal as part of a larger, multi-center risk subject laid in a supine position, the rotation were evident. Measurements factor screening project. Inter- distance in centimeters from the table were taken on healthy participants ventions: Hip internal (HIR) and hip to the posterior aspect of the acromion prior to pre-season. It is possible these external (HER) rotation range of process was measured with a modified kinematic differences are normal motion were measured with a digital triangle. For glenohumeral internal adaptations associated with inclinometer during three trials on the rotation and external rotation, subjects participation in an overhead sport or dominant limb by a clinician with precursors to shoulder injury. A laid in a supine position with the known reliability (ICC2,k>0.85). The shoulder abducted to 90 and the elbow longitudinal study where shoulder JL task required participants to jump flexed to 90°. Maximum passive kinematics of overhead athletes are forward from a 30cm height at a glenohumeral internal rotation and tracked over the course of a season is distance of half their body height and glenohumeral external rotation were warranted. perform a maximal vertical jump upon measured with a digital protractor landing. A three-dimensional motion placed in-line with the olecranon analysis system assessed hip and knee process and ulnar styloid process. kinematics during three JL trials on the Three trials were performed on the dominant limb. Main Outcome dominant and non-dominant arms for Measures: Frontal and transverse S-124 Volume 47 • Number 3 (Supplement) May 2012 12112UOIN plane hip and knee joint angles were A Comparison of Functional with a total possible composite score extracted at initial contact (GRF>10N) Movement ScreenTM and Star of 21 points indicating a perfect and joint excursions were calculated Excursion Balance Test performance. In each SEBT reach by subtracting the initial contact joint Performance Among Female direction, the average of three trials angle from the peak angle determined Collegiate Athletes were recorded in centimeters and during the deceleration phase (initial Dahlmann EJ, Hoffman AL, Pfile expressed as a percentage of the stance contact to peak knee flexion) of the KR, Pietrosimone BG, Harkey M, limb length (%MAXD). The left and JL task. Average hip ROM over each Ericksen HH, Lepley AS, Luc B, right sides were not statistically of the three measurements and average McLeod MM, Morrell M, Nelson different for any of the directions, so joint angles over the three JL trials B, Stout M, Sugiura S, Terada M, the performance scores were averaged were calculated for analyses. Separate Gribble PA; University of Toledo, for the two sides for each athlete and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 step-wise linear regressions were Toledo, OH used for further analysis. The three performed to determine the extent to %MAXD values (anterior, poster- which the hip ROM measures Context: Previous investigations iormedial, posterior-lateral) were predicted frontal and transverse plane suggest performance on the averaged to create a composite reach hip and knee joint angles in males and Functional Movement Screen score One-way ANOVAs were females. Results: In males, more HER (FMSTM) and Star Excursion Balance performed to compare mean (35.3±9.5°) predicted more knee Test (SEBT) may provide predictive composite scores across sports, with valgus angle at initial contact capabilities for acute lower extremity LSD post-hoc testing applied. Effect (-4.5±5.0°) explaining 8.6% of the injury in selected male athletes, but sizes (Cohen’s d) with 95% variance (P=0.046). In females, more little information exists to establish the confidence intervals (CI) were HER (31.3±9.7°) predicted less knee effectiveness of acute injury calculated using pooled standard valgus at initial contact (-6.3±3.7°; prediction among female collegiate deviations. Signi-ficance was set at 2 ≤ R =0.253, P=0.009), less knee valgus athletes. Furthermore, it is unknown P 0.05. Results: A significant 2 excursion (-6.5±5.6°; R =0.267, if published baseline scores of these difference was observed between P=0.006), and less knee external two performance tests should be the sports for the FMS (F2,51=3.46, rotation excursion (-8.4±6.7°; R2= standard for collegiate female athletes, P=0.039) and SEBT (F2,51=3.46, 0.219, P=0.016) during the JL task. specifically those participating in P=0.045) composite scores. Post hoc Conclusions: Decreases in hip basketball, soccer, and volleyball. testing supported that, for the FMS, external range of motion influence Objective: To determine if baseline soccer players (17.21 ±1.72) scored knee joint angles and motions during scores for FMSTM and SEBT are higher than basketball (15.64±2.56; a JL task. This may in part be due to similar for female collegiate athletes LSD=0.025; d=0.76, 95%CI: 0.06, the changes in the length-tension participating in basketball, soccer and 1.42) and volleyball players (15.88 relationship of the surrounding volleyball. Design: Cohort. Setting: ±1.89; LSD=0.045; d=0.75, 95% muscles, which can lead to dynamic Athletic training clinic. Patients or CI:0.08, 1.38 ). Similar-ly, for the mal-alignments known to be predictive Other Participants: Fifty-four SEBT composite score, soccer players of ACL injury. Ongoing research will Division I women’s collegiate athletes (83.68±6.34%) scored higher than examine whether these range of from basketball (N=14; 19.71± basketball (78.60±8.46%; LSD= motion differences increase the risk 1.54yrs, 179.43±7.16cm, 73.39± 0.031; d=0.71, 95%CI: 0.02, 1.38 ) of ACL injury in adolescent athletes. 14.80kg), soccer (N=24; 19.33± and volleyball players (79.15 ±5.90%; Supported by University of North 1.20yrs, 166.69±4.78cm, 60.97± LSD=0.045; d=0.73, 95%CI: 0.06, Florida Faculty Development 5.53kg), and volleyball (N=16; 19.38 1.37 ). Conclusion: Female soccer TM Research Grant ±1.15yrs,179.10±7.14cm, players scored better on the FMS 70.99±6.92kg) teams volunteered. and SEBT compared with basketball Interventions: Prior to their 2011 and volleyball players. Additionally, respective seasons, all participants these scores vary from published pre- performed all seven stations of the season assessments of other athletes FMSTM (deep squat, hurdle step, in-line and sex, suggesting different lunge, shoulder mobility, active standardized comparison scores may straight leg raise, trunk stability push- be needed for different sports and up, and rotary stability); and the genders. Clinicians are encouraged to anterior, posteriormedial, and utilize specific scoring standards that posteriorlateral directions of the will help to identify and treat potential SEBT, assessed bilaterally. Main injury among athletes. Outcome Measures: Each station of the FMSTM is scored on a 0-3 scale, Journal of Athletic Training S-125 12174UOBI 12195UOTE Relationship Between Static plane hip and knee joint angles were Performance Technology: Effects Lower Extremity Alignment and extracted at initial contact (GRF>10N) of EFX® on Static & Dynamic Landing Mechanics in Adolescent and joint excursions were calculated Balance Athletes by subtracting the initial contact joint Cardoza LM, Tsang KKW, Boroian Rabe JT, Nguyen A, DiStefano LJ, angle from the peak angle determined DT, Kaufman MA: California State Buckley BD, Boling MC: College during the deceleration phase (initial University Fullerton, Fullerton, CA of Charleston, Charleston, SC; contact to peak knee flexion) of the University of Connecticut, Storrs, JL task. LEA values were averaged over Context: The popularity of “wearable” CT; University of North Florida, the three measurements and joint performance technology continues to Jacksonville, FL angles were averaged over the three JL grow in athletic arenas and the general trials. Separate step-wise linear community. These items, commonly Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: It is theorized that abnormal regressions determined the extent to marketed as silicone bracelets and static lower extremity alignment which static LEA predicted frontal and necklaces, are touted to improve (LEA) may contribute to dynamic mal- transverse plane hip and knee joint physical performance. Objective: To alignments known to increase the risk angles for males and females. examine the effects of a commercial of knee injuries. Limited research Results: In males, greater GR sporting goods accessory, EFX® exists examining the relationship (0.21±2.0°, R2=0.143, P=.010) and (www.efxusa.com), on static (S) and 2 between LEA and dynamic joint greater QA (12.5±11.5°, R change dynamic (D) balance. Design: Two motions; particularly during functional =0.102, P=.022) combined to predict separate studies are presented (S) & tasks observed to increase injury. greater knee valgus excursion (D), both utilizing double blinded Moreover, limited research has (-8.9±6.4°) explaining 24.5% of the crossover study. Setting: Research examined these relationships in the variance (P=0.003). Greater ND laboratory. Patients or Other adolescent athlete where early (6.7±4.0°) in males predicted less hip Participants: All subjects presented detection of risk factors and adduction at initial contact (-5.2±6.0°, with no current or recent history of subsequent preventative measures may R2=0.09, P=.045) but greater hip lower extremity injury or neural be beneficial. Objective: To adduction excursion (10.8±6.7°, cognitive impairment. (S) 25 partici- determine the influence of static LEA R2=0.112, P=0.026). In females, less pants (males = 9, females = 16) (age on frontal and transverse plane hip and PA (10.9±4.5°) predicted greater hip = 21.8 ±2.6 years, mass = 66.9 ±13.6 knee joint angles during a double-leg internal rotation excursion (10.8± kg, height = 167.6 ±8.9 cm). (D) 30 jump landing (JL) in adolescent 7.2°, R2=0.187, P=0.035). Con- participants (males = 17, females = athletes. Design: Cross-Sectional. clusions: Static LEA appears to be 13) (age = 21.9 ±3.1 years, mass = Setting: High school athlete associated with hip and knee joint 73.2 ±16.0 kg, height = 170.9 ±8.1 screening. Patients or Other angles during a JL task. However, the cm). Interventions: EFX® is a readily Participants: Forty-five male relationships were relatively weak with available commercial product that (15.6±1.3yrs, 178.0±8.4cm, 72.0± 75% of the variance left unexplained. contains a plastic holographic dot. For 11.7kg) and twenty-four female These findings suggest that static LEA both studies the independent variable (15.9±1.1yrs, 165.7±8.4cm, 59.7± alone may not contribute to was treatment condition: activated dot 9.1kg) adolescent athletes volunteered differences in lower extremity (EFX), non-activated dot (XFE), and as part of a larger, multi-center risk kinematics during landing tasks. no dot (CO). The order of treatment factor screening project. Inter- Ongoing research will examine the condition was randomized for each ventions: Clinical measures of pelvic role of other neuro-muscular and subject. The subject and test angle (PA), genu recurvatum (GR), and anatomical factors that may influence administrator were blinded to the order navicular drop (ND) were measured on joint kinematics during functional of the treatment conditions. (S) the dominant limb by a clinician with tasks in adolescents. Supported by Participants completed one testing University of North Florida Faculty known reliability (ICC2,k>0.87). session consisting of a static balance Tibiofemoral angle (TFA) and Q-angle Development Research Grant. task under the three conditions. (QA) were assessed using an electro- Participants were instructed to stand magnetic tracking system. The JL task on their dominant leg for 15 seconds consisted of landing on a force plate and remain as still as possible. A force from a height of 30cm and rebounding platform (AMTI, Inc., Watertown, MA) vertically for maximum height. A was used to assess static balance at a three-dimensional motion analysis sample rate of 1500 Hz. (D) system was used to assess hip and knee Participants completed one testing kinematics during three JL trials on the session consisting of a dynamic dominant limb. Main Outcome balance task under the three Measures: Frontal and transverse conditions. A Y-Balance Test Kit S-126 Volume 47 • Number 3 (Supplement) May 2012 (Perform Better, Cranston, RI) was used to assess dynamic balance. Main Outcome Measures: Dependent variables for: (S) total range (mm) of Center of Pressure in the frontal (COPX) and sagittal (COPY) planes; (D) reach distance (cm) in different directions (anterior, posterior, lateral). An ANOVA with repeated measures was used to assess differences between treatment conditions for each study.

Results: (S) No differences between Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 treatment conditions (mean ±SD) occurred for Center of Pressure: COPX (EFX 29.02 ±4.2, XFE 30.13 ±6.6, CO 29.93 ±6.2, P = .622), COPY (EFX 39.11 ±5.9, XFE 40.04 ±10.4, CO 38.43 ±9.0, P = .672); (D) No differences between treatment conditions (mean ±SD) occurred for balance: Anterior (EFX 59.16 ±7.0, XFE 58.43 ±7.1, CO 59.33 ±6.7, P = .256), Posterior (EFX 73.88 ±10.1, XFE 73.47 ±10.3, CO 74.02 ±9.5, P = .791), and Lateral (EFX 70.49 ±9.5, XFE 69.79 ±8.8, CO 70.39 ±8.3, P = .678). Conclusions: Our results indicate balance, static and dynamic, is not improved with EFX®. These findings do not support anecdotal claims provided by manufacturers, client testimonials, and marketing materials.

Journal of Athletic Training S-127 Free Communications, Poster Presentations: Master Poster Award Finalists Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F06MOTE 12205MOSP Effect of Implement Assisted Soft any treatment (baseline) and following Evaluating Concussion-Related Tissue Mobilization on Iliotibial each treatment on days 1, 2, 3, 4. Three Symptom Characteristics Using Band Tightness trials of the hip adduction test were the Theory of Unpleasant Heyer KM, Docherty CL, Donahue completed during each test period and Symptoms M, Schrader JW: Indiana University, the average was used for statistical Divers CK, Bartholomew M, Bloomington, IN analysis. A repeated measures ANOVA Farnsworth JL, Nickels SJ, with 1 within-subjects factor (test at 5 McElhiney D, Ragan BG: Ohio Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: The iliotibial band is a levels [baseline, day 1, day 2, day 3, University, Division of Athletic common site of fascial restriction in day 4]) and 1 between-subjects factor Training, Athens, OH; Marietta the lower extremity. Implement (group at 3 levels [GT, GS, control]). College, Marietta, OH assisted soft tissue mobilization Bonferroni post-hoc testing was (IASTM) techniques have been created conducted on any significant findings Context: Self-reported symptoms are to ease the stress on clinicians’ hands with a priori alpha level P<.05. Main currently the focus of concussion while reducing fascial adhesions. Outcome Measures: Leg hip diagnosis and management. Research Objective: To determine if two adduction(p ) was measured using an has identified the 22 most common IASTM techniques, specifically Acumar Digital Inclinometer concussion-related symptoms that Graston Technique® and Gua Sha, (Lafayette Instrument Company, only measure the severity of the influence iliotibial band flexibility. Lafayette, IN) during a modified symptoms. The Theory of Unpleasant Design: Randomized controlled Ober’s test. Results: A significant test Symptoms (TUS), developed from clinical trial. Setting: Research by group interaction was identified nursing literature, has identified laboratory. Patients or Other (F8,228= 2.12, p=0.03). Specifically, the symptoms to have four characteristics: ® Participants: Sixty physically active Graston Technique group had frequency, severity, bothersomeness, college students (age 20.7± 2.4 years, improved range of motion after each and affect. Evaluating concussion- height 173.6±9.4 cm, mass 73.0±13.0 day of treatment (baseline= 20.2°± related symp-toms using the TUS may kg, 37 male, 23 female) with no history 0.9°, Day 4=27.0° ± 1.1°). The Gua provide useful information on of IT band syndrome or patellofemoral Sha group also had improved range of symptoms and their management. pain syndrome volunteered to motion after treatment on days 2, 3, Objective: Using three of the four participate in this study. Subjects were and 4(baseline=20.0°±0.9°, Day measureable characteristics (fre- required to have restricted hip 4=23.6° ± 1.1°). No changes in range quency, severity, and bother- adduction range of motion of 26º or of motion were identified between the someness) based on the TUS to less. Interventions: Subjects parti- test days of the control group determine the relationship of self- cipated in 4 testing days, each 48-72 (baseline=20.4°±0.9°, Day 4=22.4° ± reported concussion symptoms. hours apart. Subjects were randomly 1.1°). Conclusions: Significant Design: Observational design. assigned to one of three treatment improvements in hip adduction range Setting: Athletic Training Facility. groups: Gua Sha (GS), Graston of motion occurred for both the Patients or Other Participants: ® Technique®(GT), and a control/sham Graston Technique group and Gua Sha Thirteen participants volunteered for group. On each day, subjects received group; however the Graston this study (4 females, 9 males) with a ® the treatment specific to their group Technique group demonstrated mean age of 19.7 ± 0.9 years. All assignment. The GT group (n=20) greater magnitude of improvement participants were active members of a received an IT band specific protocol over the test period. collegiate division I, III, or club sport consisting of an active warm-up, team. Interventions: A self-reported IASTM using the GT instruments, symptom assessment was developed strengthening exercise, stretching, and using the TUS for the 22 common cryotherapy per recommended concussion-related symptoms that protocol. The GS group (n=20) was evaluate frequency, severity, and treated with uni-directional stroking bothersomeness. The characteristics over the treatment area with a Gua Sha were adopted from symptom scales tool per recommended protocol. The currently used to measure other control group (n=20) received an 8 chronic diseases. Frequency was minute sham microcurrent treatment. measured on a 4-point likert scale from Hip adduction was measured using the never to always. Severity was measured Ober’s test on 5 occasions: prior to on a 3-point likert scale from not at S-128 Volume 47 • Number 3 (Supplement) May 2012 12216MOSP all to a great deal. Bothersomeness was The Relationships Between High from the SOT, and the ImPACT measured on a 5-point likert scale from and Low Symptom Responders on composite scores for verbal and visual not at all to extremely. The char- ImPACT and NeuroCom Scores memory, visual motor and reaction acteristic affect was not measured Curry PR, Rosen AB, Lee HR, Miles time. Results: High responders for because it is too highly personalized. JD, Courson RW, Piland SG, symptom severity (n=26) had Participants completed the symptom Macciocchi S, Ferrara MS: significantly declined scores in verbal assessment immediately following the University of Georgia, Athens, GA; memory (F1,55=7.27; P=.009), visual initial injury until the patient became University of Southern Mississippi, memory (F1,55 =4.42; P=.040), asymptomatic (up to four days post Hattiesburg, MS; Shepherd Center, reaction time(F1,55=6.00; P=.018), injury). Main Outcome Measures: Atlanta, GA SOT mean stability(F1,51=6.71; The dependent variables were the total P=.012), and SOT visual (F1,51=8.79; Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 scores for each of the three symptom Context: Computerized neuro- P=.005) compared to low responders characteristics. The relationships of psychological testing, postural (n=31). Mean time to become self- the three characteristics were stability testing and self-reported report symptom free was 12.50 ± 7.4 evaluated with correlations. Signifi- symptomology are all used in a days for high severity responders and cance was set a priori at alpha level comprehensive concussion assess- 8.70 ± 5.3 days for low responders. <0.05. Descriptive statistics for ment plan. Few studies have looked at High responders for symptom symptom characteristic totals for the the clinical relevance between high and duration (n=27) had significantly first four days following the injury low symptom responders and their declined verbal memory (F1,52=5.83; were calculated. Results: The char- performance on a neuropsychological P=.019), visual memory (F1,52=4.09; acteristics severity and bother- and postural balance assessment. P=.048), reaction time (F1,52=8.22; someness (r=0.93; P<0.05) and Objective: To determine the relation- P=.006), SOT mean stability severity and symptom frequency ships between ImPACT and the (F1,45=6.10; P=.017), and SOT visual (r=0.94; P<0.05) were highly NeuroCom sensory organization test (F1,45=5.13; P=.028) scores compared correlated. The characteristics (SOT) and self-reported symptom- to low responders (n=27). Mean time frequency and bothersomeness were ology at 24-hours post-concussion. to become self-report symptom free also highly correlated (r=0.98; Design: Cross sectional study from was 12.83 ± 7.2 days for high duration P<0.05). The mean symptom totals 2004 - 2011. Setting: Research responders and 8.29 ± 5.2 days for low for frequency over four days were laboratory. Patients or Other responders. Conclusions: Our 20.5±9.2, 10.3±8.2, 9.2±6.3, and Participants: 119 collegiate athletes results show that high symptom 7.8±5.1. The mean symptom totals for diagnosed with a concussion (80 male, responders demonstrated a significant severity over four days were 14.0±6.5, 39 female): age 20.34 ± 1.44 years. decline in ImPACT and NeuroCom 6.3±6.1, 7.2±7.0, and 4.8±4.7. The Interventions: All participants were scores compared to low symptom mean symptom totals for bother- evaluated approximately 24 hours responders, in the first 24 hours post- someness over four days were post-concussion on the ImPACT concussion. While this is not an 23.1±11.8, 10.3±10.2, 7.2±7.3 and neuropsychological test, NeuroCom unexpected finding, our data demon- 6.6±5.3. Conclusions: The three postural stability assessment using the strates that those with a greater symptom measurable symptom characteristics SOT and Head Injury Scale (HIS) to response were more impaired on typical were highly related providing no assess self-reported symptomology. measures used for concussion unique additional information. It is The HIS consists of 22 symptoms, assessment. Further, those who had important to note that these results are which assess symptom duration (1-6 higher self-report symptoms tended to only based on immediately following rating scale) and symptom severity (0- take more time until symptom-free. an injury and in the early stages of 6 rating scale). Low responders were While self-report symptoms are one part recovery (first four days). The TUS defined as approximately the lower of a comprehensive concussion may provide more useful information 25% of duration scores (≤12) and management plan, we advocate a multi- for the long-term concussion severity scores (≤11). Whereas, high faceted approach to include management cases. Additional responders were defined as neuropsychological testing and postural research in the acute phase is approximately the upper 25% of stability assessment. warranted to better understand duration scores (≥30) and severity symptom load. scores (≥33). Significance was set a priori at P<.05. Main Outcome Measures: Twenty-two self-reported symptoms ranked in severity and duration; mean stability and the SOT sub scores of somatosensory, visual, vestibular and visual conflict scores Journal of Athletic Training S-129 12246MOMU 12346MOMU Does Severity of a Previous generalized linear models with inverse Relationship Between Lower Lower Extremity Injury Influence Gaussian distributions were used Extremity Functional Outcomes Health-Related Quality of Life? following reflection transformation of in Preoperative Knee Patients St. Thomas S, Snyder AR, Bay RC, dependent variables for group Morris LM, Howard JS, Radtke AR, Lam KC: A.T. Still University, Mesa, comparisons. Group differences were Mattacola CG, Medina McKeon JM, AZ evaluated with pairwise comparisons English RA: University of Kentucky, (Bonferroni) (alpha=p<.05). Means Lexington, KY; Charleston Southern Context: Evaluation of health-related and standard deviations are reported University, North Charleston, SC quality of life (HRQOL), through the for all dependent variables. Results: use of patient-rated outcome measures Significant differences were found Context: There is little research in the between groups for BP (NIH= (PROMs), ensures comprehensive literature describing performance Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 patient care. While the literature 90.6±23.3; MIH=88.5±19.5; SIH= based functional tests for preoperative suggests that sport-related injury 80.9±27.8) and MH (NIH= 79.7±17.1; knee patients that can be categorized impacts both physical and mental MIH=79.3±15.1; SIH= 73.7±20.1), as low to moderate difficulty. domains of HRQOL, few have studied with the SIH group reporting lower Objective: Our purpose was to whether previous history of injury scores than the MIH (p<.028) and the determine the feasibility of results in a long-term impact on NIH (p<.022) groups on BP and MH, incorporating performance based HRQOL. Objective: To determine respectively. The NIH group reported measures preoperatively, and to whether severity of a previous lower significantly higher scores on PF establish the relationship between extremity (LE) injury impacts the (98.8±6.5; p=.028) and RP (94.3± these measures for the development of HRQOL of collegiate athletes. 14.9; p=.022) than the SIH group preoperative functional assessment Design: Cross-sectional. Setting: (PF=96.6±9.7; RP=88.7±18.0), but recommendations. Design: Obser- Athletic training facilities. Patients the MIH group did not significantly vational study. Setting: Musculo- or Other Participants: Medically- (p>.05) differ from the NIH and SIH skeletal Laboratory. Patients: Fifteen cleared, interscholastic athletes were groups (PF=96.5±12.0; RP=92.7± patient volunteers (5 females, 10 classified into three groups based on 11.4). No significant differences males 30+10 years, 180+10 cm, and self-report of a previous LE (ankle, (p>.05) were noted for the remaining 86+18kg) who reported seeking lower leg, knee, hip) injury: no injury subscales: GH (NIH=84.5±19.0; medical care for a knee injury history (NIH) (n=85, males=67.1%, MIH=84.9±15.5; SIH=84.4±13.7), VT requiring surgery. Patients with a age= 19.4±1.4 yrs, height=176.1±11.9 (NIH=70.0±21.6; MIH=69.8±17.7; history of surgery or recent injury to cm, weight=71.2±12.2 kg); mild injury SIH=68.1±20.2), SF (NIH=90.9±16.2; the contralateral limb were excluded. history (MIH) (n=72, males=52.1%, MIH=87.2±17.7; SIH=86.6±23.6), Interventions: Participants per- age=19.2±1.3 yrs, height=175.8±11.4 RE (NIH=92.8±14.6; MIH=90.3 formed the Star Excursion Balance cm, weight=71.0±13.6 kg); severe ±13.7; SIH=88.7±18.6). Conclu- Test(SEBT), Four Square Step Test injury history (SIH) (n=119, males sions: Our results indicate that LE (FSST), and Step-down test. Unilateral =47.4%, age=19.4±1.6 yrs, height injury history may influence HRQOL, Stance with eyes open(USEO) and =174.3±10.9 cm, weight= 71.1±12.7 especially in pain and mental health eyes closed(USEC), Step Up/Over, and kg). MIH and SIH were defined as domains. Previous LE injuries may Forward Lunge were performed on history of an injury that resulted in >1 produce long-term impact on health NeuroCom Long Forceplate. The but <10 days, and >10 days of missed status that extends beyond physical uninvolved limb was tested first for all athletic participation, respectively. injury recovery and return-to-play. unilateral functional assessments. A Interventions: The independent While those with severe injury 30s rest was provided between each variable was injury history group. histories reported lower physical trial, and a 60s rest was provided Participants completed the Short function than those without injury between tests. The order of assess- Form 12 (SF-12), a valid and reliable histories, both scores were high and ment was counterbalanced between PROM, during a single testing session. differences may lack clinical forceplate and non-forceplate Main Outcome Measures: De- meaningfulness. Future studies should measures. Main Outcome Mea- pendent variables included the 8 SF- investigate how injury history impacts sures: Feasibility was determined 12 subscale scores: physical function the HRQOL of newly suffered injuries. based on the percentage of participants (PF), role physical (RP), bodily pain that could complete the assessment. (BP), general health (GH), vitality Pearson Correlation Coefficients (VT), social functioning (SF), role were used to evaluate the relationship emotional (RE), and mental health between all tests on the involved limb. (MH). Higher scores suggest better Results: The FSST, SEBT, Step Up/ HRQOL. To account for negatively Over, and Forward Lunge had 100% skewed score distributions, feasibility. The USEO had 93% S-130 Volume 47 • Number 3 (Supplement) May 2012 feasibility, USEC and the Step-down had 80% feasibility. The following correlations for SEBT reach measures were observed: SEBT anterior was correlated to posterior-lateral (r=.69, p=.005) and posterior-medial (r=.52, p=.045); SEBT posterior-lateral and posterior-medial (r=.77, p=.005) were moderately correlated. The SEBT anterior reach distance was correlated to several of the functional

tests, including Forward Lunge Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 distance (r=.62, p=.013), FSST time (r=-.55, p=.033), and Step-down repetitions (r=.78, p=.001). Forward Lunge distance also correlated with the SEBT posterior-lateral reach (r=.61, p=.015), SEBT posterior-medial reach (r=0.52, p=0.049) and Step-down repetitions (r=.71, p=.003). Step- down repetitions also correlated with SEBT posterior-lateral reach (r=.64, p=.010) and SEBT posterior medial reach (r=0.52, p=0.44). There were no significant correlations between USEO or USEC and any other assessment. Conclusions: All directions of the SEBT, Forward Lunge Distance, and Step-down test repetitions were correlated with one another suggesting redundancy in these tests. However, the lower preoperative feasibility of the Step- down test may be evidence of a more challenging task toward which patients can be progressed. The SEBT anterior and FSST were related and all patients were capable of completing these tests prior to surgery thus providing a measure that can be assessed post- surgically to document rehabilitative progress. We propose that the FSST, SEBT anterior, and the Step-down test can be implemented with progressing difficulty throughout rehabilitation as useful assessment tools in a variety of knee patients.

Journal of Athletic Training S-131 Free Communications, Poster Presentations: Doctoral Poster Award Finalists Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F15DOPE Effectiveness of an Evidence- included within the ten modules. Test- after the implementation of an Based Practice Educational retest reliability was calculated using educational intervention. Future Intervention for Athletic scores attained from the control group research should determine whether Trainers: A Randomized and was determined to be strong increased knowledge of EBP impacts Controlled Trial (r=0.75, P<0.001). Main Outcome ATs’ daily clinical decision-making. Welch CE, Van Lunen BL, Measures: Independent variables Hankemeier DA: Old Dominion consisted of group (control, 12008DOMU University, Norfolk, VA; Ball experimental) and time (pre- Quadriceps Performance Profiles Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 State University, Muncie, IN assessment, post-assessment). De- and Associations to Subjective pendent variables were the scores Outcome Measures in Patients Context: As evidence-based practice calculated from participant responses. 12-36 Months Post-Ipsilateral (EBP) becomes a necessity in athletic Knowledge scores were tabulated by Hamstring Tendons Anterior training, the effectiveness of EBP awarding 1 point for the correct answer Cruciate Ligament educational interventions to enhance with a maximum achievable score of Reconstruction knowledge must be investigated. 60. Between and within group Vairo GL, Miller SJ, McBrier NM, Online modules are available to the differences were calculated (SPSS Sebastianelli WJ, Sherbondy PS, National Athletic Trainers’ Association 16.0) using a 2x2 repeated measure Buckley WE: Athletic Training & membership and are a mechanism to ANOVA ( P≤0.05). In the presence of Sports Medicine Research educate athletic trainers (AT) on the an interaction or main effect, post-hoc Laboratory, Department of various concepts of EBP. Objective: t-tests and Hedge’s g effect size (g) Kinesiology, Department of To assess the effect of an EBP with 95% confidence intervals (CI) Orthopaedics and Rehabilitation, educational intervention on enhancing were calculated. Results: A significant The Pennsylvania State University, ATs’ knowledge of EBP concepts. group x time interaction (P<0.001) University Park, PA; Health Science Design: Randomized controlled trial. was reported. No differences were Department, Lock Haven University Setting: Online educational modules identified between groups (M = of Pennsylvania Clearfield Campus, CPre Clearfield, PA and knowledge assessment. Patients 30.12±5.73, MEPre= 30.65± 5.93) or Other Participants: 164 of 473 during the pre-assessment (P= ATs (34.67% response rate) com- 0.839;g=0.09,CI= -0.22-0.40); how- Context: Primary harvest of the prising professional AT students, ever, the experimental group (MEPost ipsilateral hamstring tendons autograft graduate students, clinical instructors/ =36.35±8.58) obtained signifi-cantly for anterior cruciate ligament (ACL) preceptors, educators, and clinicians higher scores (P=0.013; g=0.71, reconstruction has become prevalent were randomized into a control group CI=0.39-1.02) on the post-assessment among orthopaedic surgeons. We (40 males, 42 females, age= 34.51± compared to the control group previously reported knee flexor

10.60) or experimental group (33 (MCPost=30.99±6.33). No differences deficits in patients following this males, 49 females, age= 34.26 ±9.89). were identified between time instances operative technique. However, limited Interventions: Ten online modules within the control group (P=0.080;g= evidence exists in related patients for were developed and consisted of -0.14,CI= -0.45-0.16); however ensuing quadriceps performance, information pertaining to important the experimental group obtained which is a predictor to knee health- concepts (eg., literature searching, significantly higher scores on the post- related quality of life (HRQL) post- levels of evidence, disablement assessment than the pre-assessment ACL recon-struction. Objective: Our models) involved in the EBP process. (P<0.001; g=0.77, CI=0.45-1.09). A primary aim was to profile knee ATs were solicited via email to significant time main effect extensor responses to ipsilateral participate in this investigation. Both (P<0.001) and group main effect semitendinosus and gracilis (STG) groups completed the Evidence- (P=0.002) were also reported. autograft ACL reconstruction in Based Practice Knowledge Assess- Conclusions: An educational physically active patients that ment prior to and following the intervention consisting of ten online demonstrated hamstrings performance intervention phase. During the modules is an effective mechanism to insufficiencies 12-36 months intervention phase, the experimental increase ATs knowledge of foun- following surgery. Based on prior group had access to the online modules dational EBP concepts. However, ATs research, we hypothesized patients for a 4-week period. The assessment may not be integrating EBP into daily would display quadriceps performance consisted of 60 multiple-choice clinical practice, which may explain deficits for the involved leg compared questions pertaining to information why EBP knowledge is lacking even to uninvolved and healthy matched S-132 Volume 47 • Number 3 (Supplement) May 2012 control legs. A secondary aim was to subscale score and extensor peak summer, and fall seasons. Main explore associations among subjective moment indicates patients perceived Outcome Measures: Change in outcome measures and objective better subjective athletic outcomes humeral retrotorsion between spring of quadriceps performance. Design: with lesser quadriceps strength in the 2010 and 2011 was calculated. A total Retrospective cohort, Level 2b presence of hamstrings weakness. Our numbers of seasons that participants 1) evidence. Setting: A controlled findings advocate continued in- played baseball and 2) pitched on research laboratory. Patients or vestigation for determining factors organized teams in 2010 were calculated Other Participants: Fifteen (1 man, associated with knee HRQL in ACL from the questionnaire responses. 14 women) patients (age = 21.2 ± 2.6 reconstructed patients. Funded by the Change in humeral retrotorsion was years, height = 1.7 ± 0.1 m, mass = Pennsylvania Athletic Trainers’ compared between 1) participants who 68.7 ± 12.6 kg, Tegner = 6.9 ± 1.6) Society, Inc. Supported Research played baseball in 1, 2, and 3 seasons,

27.5 ± 10.9 months postsurgery were Grant and 2) participants who pitched in 0, 1, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 matched to 15 (1 man, 14 women) 2, and 3 seasons using 2 separate one- healthy matched control participants 12060DOMU way ANOVA. Additionally, using a (age = 21 ± 1.1 years, height = 1.6 ± Effects of Baseball Participation minimal detectable difference of 6.4° 0.1 m, mass = 67.4 ± 10.3 kg, Tegner and Pitching on Humeral (calculated from 2.3° standard error of = 6.3 ± 1.3). Interventions: The Retrotorsion in High School measure-ment) as a threshold criterion, independent variable was the operative Baseball Players association between proportion of technique. Isokinetic strength and Oyama S, Hibberd EE, Myers JB: participants with increased (change> endurance were measured at angular Department of Exercise and Sport 6.4°) and decreased (change<-6.4°) velocities of 60 º/s and 240 º/s Science, University of North humeral retrotorsion and baseball respectively using reliable methods. Carolina at Chapel Hill, Chapel participation/pitching were evaluated Subjective measures included the Hill, NC using Fisher’s exact tests. Results: reliable Knee Outcome Survey (KOS) There were no significant changes in and Knee Injury and Osteoarthritis Context: Torsional stress placed on humeral retrotorsion between Outcome Score (KOOS). Respective baseball players’ dominant limb during participants who played baseball in 1,

one-tail dependent and independent t- throwing/pitching has been theorized 2, and 3 seasons (F(2,97)=1.0, p=.36), or tests were calculated to determine to negate or reverse the de-rotation of between participants who pitched in 0,

within patient and between participant the humerus that naturally occurs 1, 2, and 3 seasons (F(2,97)=0.02, differences. Correlation coefficients during skeletal maturity. As a result, p=.89). Humeral retrotorsion were computed among the KOS and baseball players’ dominant limbs decreased in 18 (16.7%) and increased KOOS to quadriceps performance. P demonstrate increased humeral in 17 (15.7%) participants. However, < 0.05 denoted statistical significance. retrotorsion. However, no study has these changes were not associated with Main Outcome Measures: De- investigated the effects of baseball numbers of seasons participants played pendent variables included: participation and pitching on changes baseball (p=.34) or pitched (p=.91) in normalized peak moment and total in humeral retrotorsion using a 2010. Conclusions: Understanding work; time to peak moment; angle of longitudinal study design. Objective: the effects of participation and peak moment; KOS and KOOS To investigate the effects of baseball pitching on humeral retrotorsion is subscale scores. Results: Data were participation and pitching on changes important since skeletal adaptation or normally distributed. Patients in humeral retrotorsion over a 1-year lack-thereof has been linked to upper demonstrated a significant difference period in high school baseball players. extremity pain/injury in overhead for angle of peak moment with the Design: Longitudinal study design. athletes. Our results indicate that involved (73.0 ± 11.9 °) compared to Setting: High school baseball teams. humeral retrotorsion may increase or uninvolved (77.4 ± 12.1 °) leg (P = Patients or Other Participants: A decrease over a 1-year period in some 0.022). Patients also displayed a total of 339 baseball players were high school baseball players, yet these significant correlation among the tested in spring of 2010. Data from changes may not be related to baseball KOOS Sports subscale score and 100 returners with complete data participation or pitching. This may be extensor strength (r = -0.533, P = (age=16.1±0.8years, height= 180.4 attributed to the fact that participants 0.041) for the involved leg. All other ±6.4cm, mass= 74.9± 10.9kg) were were approaching the end of skeletal measures were insignificant (P > analyzed. Interventions: Humeral maturity and that majority of skeletal 0.05). Conclusions: The shallower retrotorsion was measured in spring of adaptation due to baseball angle of extensor peak moment may 2010 and 2011 using a digital participation/pitching occurs at a be attributed to hamstrings inclinometer and diagnostic younger age. A longitudinal study antagonistic deficits to quadriceps ultrasound. Participants also examining the effects of participation/ induced knee extension associated completed a questionnaire to report pitching on humeral retrotorsion in with donor-site morbidity. An inverse their baseball participation and younger participants is warranted. relationship among the KOOS Sports pitching during the 2010 spring, Journal of Athletic Training S-133 12109DOIN Critical Review of Self-Reported classification rate of 85%, while the recreationally active individuals (male: FAI Measures: AII, CAIT, IdFAI CAIT and AII resulted in an overall n=15, age= 26±4y, ht=180.7±11.9cm, Donahue M, Simon J, Docherty CL: correct classification of 68% and mass= 80.7±12.2kg; female: n=15, Indiana University, Bloomington, IN 82%, respectively. Subjects in the age= 21 ±2y, ht=166.6±8.4cm, mass= MC_FAI group (unstable group) were 64.5 ±7.9kg) participated. Inter- Context: Functional Ankle Instability correctly classified 78% by the IDFAI ventions: Three anterior thigh (½ the (FAI) lacks a gold standard measure or (16.36±5.54), 49% by the CAIT distance between ASIS and base of the universally accepted inclusion criteria. (21.81±5.82), and 78% by the AII patella) skinfold measurements were As a result a wide variety of self- (mean score 4.38±1.85). Subjects averaged for each participant. Subjects reported ankle instability measures were correctly classified in the no lay supine while a multi-probe was MC_FAI group (stable group) 90% of inserted into the thigh at the skinfold have been developed for use in FAI Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 research. Recent research has the time by the IdFAI (5.15±4.71), 84% measurement site. The multi-probe advocated the combined usage of the by CAIT (26.50±8.22), and 81% by recorded intramuscular temperature at Ankle Instability Instrument (AII) and the AII (mean score 1.38±1.57). 4.0cm, 3.25cm, and 2.5cm below the Cumberland Ankle Instability Tool Sensitivity was similar for AII (0.79, skin surface. Temperatures were (CAIT) to properly identify people CI: 0.75-0.82) and the CAIT (0.73, CI: recorded at each depth every 10 min with FAI. Additionally, the 0.68-0.78) but slightly higher for the during a 10 min baseline, 60 min ice Identification of Functional Ankle IdFAI (0.87, CI: 0.84-0.90). While bag (1kg) application, and 30 min re- Instability (IdFAI) is a recently specificity for the AII (0.84, CI: 0.81- warming. Ice bags were shaken every introduced questionnaire designed 0.87) and IdFAI (0.83, CI: 0.79-0.85) 5 minutes. Data were analyzed using specifically to identify FAI. were similar, and the CAIT (0.66, CI: three (one for each thermocouple Objective: Determine which ankle 0.63-0.70) was notably lower. depth) 2 (gender) x 10 (time) repeated instability instrument (AII, CAIT, Conclusions: This analysis illustrates measures ANOVAs with Greenhouse- IdFAI) best classifies subjects based that IdFAI is a good overall option Geisser corrections. These pro- on a minimum accepted criteria for available for classification of ankle cedures were repeated with average FAI. Design: Cross-sectional study stability status by self-reported skinfold thickness as a covariate. Setting: University classroom questionnaire. The IdFAI is new Multiple independent sample t-tests Participants: One thousand one questionnaire but these finding identify were performed to determine where hundred and thirty five college aged that it: 1.) demonstrated a higher differences occurred and effect sizes subjects (573 males, 536 females, overall correct classification (ES) with effect size confidence 19.56 ± 2.05 years) were recruited percentage and 2.) has better overall intervals (in brackets) were calculated. from a large Midwestern university sensitivity and specificity. Funded by Significance was accepted when population. Individuals with a history the NATA Foundation General Grant P≤0.05. Main Outcome Measures: of lower limb fracture were excluded. Program. Temperature (°C). Results: Male Interventions: The independent skinfolds (13.0±5.3mm) differed variables were the score on the AII, 12158DOTH from female skinfolds (25.4±6.1mm; CAIT, and IdFAI. Subjects were asked Gender Plays a Role in Deep P<0.001, ES=2.14 [1.24 to 3.03]). to complete all three questionnaires in Tissue Cooling Independent of Subjects did not differ at the beginning one testing session and were instructed Skinfold Thickness of ice application (4cm: males = to complete each questionnaire for Hawkins JR, Miller KC: Brigham 36.8±0.4°C, females = 36.9±0.5°C, their dominant limb. Main Outcome Young University, Provo, UT; Illinois P=0.64; 3.25cm: males = 36.4±0.4°C, Measures: A discriminant function State University, Normal, IL; North females = 36.6±0.7°C, P=.31; 2.5cm: analysis was conducted to measure the Dakota State University, Fargo, ND males = 36.2±0.5°C, females = 36.6± ability of the predictor variables (AII, 1.0°C, P=0.21). At 4cm, a gender* CAIT, IdFAI) to classify subject by Context: Scientists have observed time interaction was observed ankle stability status (grouping thicker skinfolds delay intramuscular (P<0.001). Males differed from variable). The group variable was tissue cooling. These studies have not females after 60 min of icing created based on the previously examined the influence of gender on (32.0±0.7°C vs. 33.3±1.2°C; ES=1.23 established minimum acceptable tissue cooling though females [0.45 to 2.01]) and throughout criteria for FAI (MC_FAI). This commonly have thicker skinfolds. rewarming (10 min: 31.2±0.8°C vs. criterion was established as at least one Objective: To determine what role 32.4±1.5°C, ES=1.01 [0.25 to 1.77]; ankle sprain and at least one episode gender plays in tissue cooling, when 20 min: 30.8±0.8°C vs. 32.2±1.4°C, of giving way. In addition, sensitivity controlling for skinfold thickness. ES=1.29 [0.51 to 2.08]; 30 min: and specificity were calculated for all Design: Cross-sectional study. 31.1±0.8°C vs. 32.4±1.4°C, ES=1.18 predictors. Results: The use of the Setting: Laboratory. Patients or [0.41 to 1.96]). A gender*time IdFAI yielded an overall correct Other Participants: Thirty interaction was also observed at S-134 Volume 47 • Number 3 (Supplement) May 2012 3.25cm (P=0.02). Males differed from females after 40 min of icing (31.9±1.0°C vs. 32.4±1.6°C; ES=0.44 [-0.29 to 1.16]), after 60 min of icing (29.6±1.1°C vs. 30.8±1.8°C; ES=0.74 [0.00 to 1.48]), and throughout rewarming (10 min: 28.7±1.1°C vs. 29.9±1.9°C, ES=0.77 [0.03 to 1.51]; 20 min: 28.6±1.1°C vs. 30.1±1.8°C, ES=1.03 [0.27 to 1.79]; 30 min: 29.2±1.1°C vs. 30.6±1.7°C, ES=0.96

[0.20 to 1.71]). At 2.5cm, there was Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 no interaction (P=0.15) or gender (P=0.19) effect, only a time effect (P<0.001). Conclusions: At deeper intramuscular depths (i.e., 3.25 and 4cm), and with a 60 min ice application, males cooled faster than females, irrespective of skinfold. Additional research is needed to explain why males cooled faster than females and whether these observations have clinical sig- nificance.

Journal of Athletic Training S-135 Free Communications, Poster Presentations: General Grant Program, NATA Foundation Funded Research Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00 AM-1:00 PM; Authors present June 28, 10:00AM-11:30AM 12F01DOCE Inhibition of TGF-b Following fiber size and morphology. Eccentric Muscle Injury Results Differences between groups at each in an Initial Improvement but time point were tested using t-tests. Long Term Deficit in Force Results: Compared with mice that Production received sham IgG, muscles from mice

Mendias CL, Gumucio JP: receiving the TGF-b inhibitor showed Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 University of Michigan, Ann a greater recovery in force at 3 and 7 Arbor, MI days post-injury. However, mice that received sham IgG had a full recovery Context: Transforming growth factor- of force production while mice that beta (TGF-b) is a cytokine that can received the TGF-b inhibitor had not cause fibrosis and inflammation fully recovered at the 21 day time following injury in a variety of tissues. point. TGF-b inhibition protected Previous studies in our lab have shown muscles from atrophy and had more that treating skeletal muscles with centrally located nuclei, suggesting TGF-b results in a dramatic enhanced early regeneration of muscle accumulation of type I collagen, fibers at 3 and 7 days post-injury. For substantial muscle fiber atrophy and a the same time points, compared with marked decrease in force production. mice that received sham IgG, muscles Inhibiting TGF-b might improve the treated with TGF-b inhibitor exhibited treatment of eccentric muscle less injury-induced atrophy and an injuries. Objective: Our objective was attenuation of collagen I signal. to investigate whether the inhibition of Interestingly, at 21 days post-injury, TGF-b would enhance the recovery of although the fibers appear to be muscle following eccentric regenerated and the amount of ECM contraction-induced injury. We around the muscle fibers was not hypothesized that inhibiting TGF-b different, appearance of the ECM from after eccentric muscle injury would the TGF-b inhibitor treated muscles improve the recovery of force appeared mottled and ruffled compared production by limiting the to controls. Conclusions: The results accumulation of fibrotic scar tissue from the current study indicate that and preventing atrophy of muscle inhibiting TGF-b during the initial fibers. Design: Animal-model study. stages of muscle injury results in a Setting: Controlled laboratory. short-term improvement in muscle Patients or Other Participants: N/ function, but a long-term deficit in A. Interventions: Mice were force production. While further subjected to a contraction-induced studies are necessary, the mottled injury protocol of their ankle dorsi- appearance of the ECM at 21 days flexors and allowed to recover for a suggests that matrix proteins might period of 3, 7 or 21 days. A mono- play an important role in supporting a clonal antibody that inhibits TGF-b full regenerative response. Funded by (1D11) was given to the experimental the NATA Foundation General Grant group, while the control group Program. received sham immunoglobulin injections (MOPC21). Main Outcome Measures: Peak isometric force production was measured and compared to the pre-injury value. EDL muscles were then removed for immunohistochemistry to analyze

S-136 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Performance Enhancement Technology Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F09 12F11MOTE The Effect of Kinesio Tape on difference between the target and Kinesiotape Does Not Increase Force Sense in People with reproduction force was used to Glenohumeral Internal and Functional Ankle Instability calculate an error score. Force sense External Range of Motion of the Garcia WL: Washington State testing was conducted on all subjects Shoulder University, Pullman, WA on four occasions: baseline, Renner CM, Ujino A, Kahanov L, immediately after tape application (or Eberman LE, Demchak D: Indiana Context: Previous research testing the rest), 72 hours after tape application State University, Terre Haute, IN Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 effect of Kinesio Tape (KT) on (or rest), immediately following tape proprioception has shown conflicting removal (or rest). A two-factor Context: Kinesio tape (KT) is results. Force sense is a method of Repeated Measures Analysis of theorized to restore correct muscle evaluating proprioception of the ankle. Variance (RMANOVA) with one function, improve blood and lymphatic To date, this measure has not been used between subjects factor (group at three flow, decrease pain, and correct in the KT research. Objective: To levels) and one within subjects factor malaligned joints. Literature indicates evaluate the effect of KT on force (time at four levels) was calculated. A that KTimproves proprioception, sense errors in subjects with Tukey post-hoc analysis was musculature strength, and perceptions functional ankle instability (FAI). performed on any significant findings. of pain, but range of motion (ROM), Design: Controlled laboratory study. Alpha level was set at p<.05. Main specifically of the shoulder has yet to Setting: Research Laboratory Outcome Measures: Force sense be assessed. Objective: To determine Patients or Other Participants: errors in Newtons(N). Results: the effects of KT on shoulderROM arc Forty subjects volunteered to Results of the RMANOVA revealed a pre and post KT treatment. Design: participate in this study. Twenty significant time by group interaction We used an experimental, pretest- subjects (6 male, 14 female, 22.0± (F6,111=2.4, p=.03). Specifically, the posttest randomized-groups design to 2.6yrs, 169.8±9.1cm, 69.0± 14.8kg) FAI-S group demonstrated decreased evaluate the effect of KT. Setting: who had healthy ankles were included force sense errors after wearing the Data collectionoccurredin auniversity in the control group. Twenty subjects KT for 72 hours (2.2±1.4N) compared research laboratory. Participants: (8 male, 12 female, 21.0± 1.4yrs, to baseline (3.0±0.9N). The decreased Healthy volunteers(n=45; males=17, 172.0±9.3cm, 74.4± 12.4kg) who had errors were maintained in the FAI-S females=28) between the ages of 18- FAI were included in the injured group. group even after the KT was removed 40 completed the investigation. All FAI subjects had a history of a (1.9±0.9N). Conversely, neither the Interventions: Independent variables lateral ankle sprain and frequent control or FAI-M groups showed any consisted of treatment at two levels: (weekly) episodes of ankle giving way. changes in force sense errors at any KT and no KT. Participants were The FAI subjects were further divided of the test times (p>.05). Con- randomly assigned to two groups into 10 subjects with severe FAI (FAI- clusion: We found that wearing KT (control=22, KT=23). We measured S) and 10 subjects with mild FAI (FAI- decreased force sense errors in baseline glenohumeral internal M) based on the baseline propri- subjects with severe FAI. The rotation (IR) and external rotation (ER) oceptive deficits. Interventions: KT decreased errors were maintained in the control group on day one and re- was applied to the FAI ankle of the FAI- even after the tape was removed. measured on day four. We measured S and FAI-M subjects using the KT group baseline IR and ER on day standard lateral ankle sprain tape one prior to and following the application identified in the Kinesio® application of KT and then again on day Perfect Taping Manual. Subjects in the four pre and post-removal of the KT.IR control group received no tape and ERwas measured three times for application, but “rested” during the each measurement pre/post with an tape application time. Ankle inclinometer while supine. Interrater proprioception was measured using reliability or ROM measurement with force sense testing at 30% of eversion the inclinometer was strong (IR MVIC. Using a load cell (Sensotec, r=0.91, ER r=0.96).We applied the Columbus, OH), subjects were asked tape in two strips, one I-shaped to to produce the target force using a stabilize the scapula and one Y-shaped visual cue and hold the force for 5 around the infraspinatus and seconds, relax, and then reproduce the suppraspinatus. Main Outcome force without a visual cue. The Measures: We calculated frequencies Journal of Athletic Training S-137 and means to assess demographic data. the 4 individual components of the significant difference among the 9

We analyzed the data using two closed basket-weave ankle taping (HS, taping conditions (F8,152=6.83, p=.01). separate ANOVA to identify the HL, SU, F8) are most effective in However, differences were only differences between gender and the restricting ankle motion. 2.)To identified between NT(15.81o ±3.81) control/KT group ROM arc and establish which combination of and SU/F8/HL(11.33o± 3.21) and between pre and post treatment components is most effective at CBW(11.45o±3.44). Dorsiflexion control/KT treatment groups. restricting ankle motion. Design: results yielded a significant difference

Results: We observed no differences Cross-sectional study. Setting: among the 9 taping conditions. (F8,152 in shoulder ROM arc between the Research laboratory. Participants: = 16.03, p =.01) The post hoc test control and KT treatment groups. Twenty healthy participants (8 males/ identified a significant difference Significant differences between the 12 females, 19.8±1.7 years, 172.5± between NT and all 9 tape conditions.

control and KT treatment groups did 10.3cm, 70.0±12.7kg) with no history Conclusion: Generally, the com- Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 not exist for shoulder ROM arc pre and of lower extremity surgery and no ponents and combination of com- post intervention (P<.05). Significant lower extremity injury within six ponents of the closed basketweave differences between genders in the months of testing volunteered to ankle technique effectively restrict control and KT group were identified participate. Interventions: Nine range of motion at the ankle. However, on day 4 for females in the KT group taping conditions were applied to the these findings suggest that the pre tape removal (F1,44=7.47, p=0.008). dominant leg of each subject. horseshoe component could be Shoulder ROM arc measurements Conditions included: no tape(NT), removed from the closed basketweave indicate that females have a greater Horseshoes (HS), Stirrups(SU), Heel- ankle taping method due to its inability shoulder ROM arc (125.00±SD) locks(HL), Figure-8’s(F8), HL/F8, to effectively restrict inversion or compared to men (115.00±SD) for day SU/HS, SU/HS/F8, and the complete plantarflexion range of motion. 4 pre KT tape removal. Conclusions: closed basketweave(CBW). For each Resultssuggest that KT has no effect taping conditions two heel and lace 12119MOTE on shoulder ROM arc. Interestingly pads(Mueller) were placed on the ankle Five-Toed Socks Do Not Alter females displayed a significant followed by adhesive tape spray(Super Reflex Excitability in Ankle increase in ROM arc withKT after the Tape Adherent). Then a single layer of Stabilizing Muscles 4 days of treatment, returning to a non- foam pre-wrap (Mueller) was applied Itano K, Shinohara J, Gribble PA, effect upon tape removal. KT may have in a circular pattern followed by two Pfile KR, Pietrosimone BG: some beneficial properties while on anchor strips using 1½ inch cloth University of Toledo, Toledo, OH the patient; however differences in athletic tape(Zonas), one at the base male and female shoulder ROM arc pre of the gastrocnemius and another at Context: Postural control deficits tape removal should be assessed for the base of the metatarsals. Then each contribute to disability in various the effect of tape placement or physical tape condition was applied. Ankle range patient populations as well as activity. Although KT use for ROM of motion was measured using an ankle impacting optimal physical may not be effective, KT may have an electrogoniometer after each tape performance in healthy athletes. Five- effect on blood flow and pain and condition. Main Outcome Measure: toed socks with plantar tactile (FTST) should be evaluated. Ankle range of motion(°) was enhancement have been hypothesized measured in four motions: eversion, to improve postural control by 12062 inversion, dorsiflexion, and plantar- increasing afferent signals from Assessing the Effectiveness of the flexion. Four repeated measures plantar cutaneous mechanoreceptors. Stirrup, Horseshoe, Heel-lock, ANOVA, one for each direction, were Currently, it remains unknown if these and Figure-8 Components of the conducted on the taping conditions. A socks alter reflex excitability in ankle Closed Basketweave Ankle Taping Tukey post hoc test was conducted on stabilizing musculature, which could Method in Various Combinations any significant findings. A priori alpha be a potential mechanism explaining Peters J, Docherty C, Donahue M: level was set at p<.05. Results: For gross neuromuscular improvements, Indiana University, Bloomington, IN inversion and plantarflexion, a such as postural control, from wearing significant difference was displayed these socks. Objective: To determine Context: The most widely accepted among the 9 taping conditions. if FTST and five-toed socks without adhesive taping method used to treat tactile enhancement (FTS) alter reflex (F8,152=28.40, p=.01 and F8,152=29.78, and prevent lateral ankle sprains is the p=.01, respectively). For both of these excitability in the tibialis anterior closed basket-weave ankle taping. directions a difference was found (TA), fibularis longus (FL), and soleus Despite being the most common between NT (inversion: 32.1o ±5.8, muscles during double limb stance technique, little research exists plantarflexion: 28.4o±5.4) and all other compared to wearing regular socks regarding the effectiveness of the tape conditions except HS (inversion: (RS) or no socks (NS) in healthy components of this method. 28.7o±6.2, plantarflexion: 26.9o±4.7). participants. Design: Crossover. Objective: 1.)To establish which of Eversion results also showed a Setting: Research Laboratory. S-138 Volume 47 • Number 3 (Supplement) May 2012 12137DOTE Patients or Other Participants: Effects of Five-Toed Socks on condition. Ground reaction forces were Fourteen participants (5 males, 9 Dynamic Postural Control and used to calculate Resultant VectorTime females; age 22.9±3.4 years; height Subjective Characteristics during to Stabilization (RVTTS, seconds), with 170.1±7.3 cm, weight 67.6±9.5 kg; Jump-Landing in Individuals with longer values indicative of poorer BMI 23.4±3.5) completed all 4 Chronic Ankle Instability dynamic stability.After the jump- sessions. Interventions: Pre and post- Shinohara J, Armstrong CW, landing procedure was com-pleted in test measurements were conducted on Pietrosimone BG, Pfile KR, Tevald each sock condition, three separate 10- 4 separate days, within a 7 day window, MA, Gribble PA: KyusyuKyoritu point visual analogue scale measures in which 1 of the 4 sock conditions was University, Fukuoka, Japan; The were completed asking about subjective applied (FTST, FTS, RS, NS). The order University of Toledo, Toledo, OH characteristics concerning: 1) perceived of sock condition was randomized and comfort (PC), 2) per-ceived stability Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 measurements were performed at the Context:Previous studies have (PS), and 3) perceivedconfidence (PC)in same time each day. For reflex testing, demonstrated that wearing five-toed protect-ing the ankle from a potential a 1ms square wave stimulus of various socks with multiple rubber bits on the injurious situation. Main Outcome Mea- intensity was applied to the sciatic foot sole (FTS) improves static and sure(s):The dependent variables nerve complex in the popliteal fossa dynamic postural controlin individuals werethe dynamic postural control in a manner that could elicited with chronic ankle instability (CAI), measure (RVTTS) and the subjective maximal reflex measurements in the possibly through enhanced plantar characteristics(PC, PS and PC). The TA, FL and soleus musculature of the tactile feedback and foot gripping. independent variable was the sock dominant leg for each individual. However, it is unclear if FTS have condition (FTS, RS). For each Surface electromyography was used to similar effects on dynamic postural dependent variable (RVTTS, PC, PS, record these measurements as control during activities such as a PC), a separate paired t-test was participants stood in double limb jump-landing task. Additionally, self- performed for comparison between support. Main Outcome Measures: reported subjective character- the sock conditions.Significance was Maximal Hoffmann reflexes isticsconcerning comfort, stability, set a priori at P≤0.05.Results: PS was normalized to a maximal muscle and confidence in preventingan ankle significantly higher in FTS (4.83± responses (H:M) were collected. injury when wearing FRB have not been 1.83) than RS (3.54±1.77; t1,22=3.89, Percent change scores were calculated considered.Objective:To assess the P=0.01), as was PC (FTS=4.48±1.80, from pre and posttest H:M effect of FTS on dynamic postural RS=2.96±1.99, t1,22=4.22, P=0.01). measurements in each session. This controland subjectivefeelings during a No significant difference was allowed for the assessment of the jump-landing task among individuals observed for PC (FTS=5.63±1.13, change in H:M caused by the sock withCAI.Design:Crossover design. RS=5.67±1.71, t1,22=-0.13, P=0.90 ) conditions above the normal variation Setting:Research laboratory. Pa- or RVTTS (FTS=2.17±0.41, RS= in reflex excitability evaluated in the tients or Other Participants: 2.18±0.07, t1,22=-1.04, P=0.31). Con- NS condition. Separate, 1x4 ANOVAs Twenty-four participants with CAI clusions:These results indicate were used to evaluate differences in (8M, 16F: 20.6±2.1yrs, 167.1 ±10.1 thatwearing FTS is associated with H:M percent change between sock cm,65.7±11.6kg) volunteered. Inter- improved perceivedstabilityand conditions in each muscle. Alpha levels ventions:Participants completed a confidence in protecting the ankle ≤ were set a priori at P 0.05. Results: one-time testing session to quantify from a potential injurious situation There were no significant differences dynamic postural control and during jump-landing. However, in H:M percent change scores between subjective feelingsofcomfort, sta- dynamic postural control, as measured sock conditions for tibialis anterior bility, and confidence in protecting the by RVTTS was not influenced with the (FTST=5.62±20.23%, FTS= 0.33± ankle from a potential injurious FTS. The subjectively assessed 24.61%, RS=6.92±26.32%, NS= situationunder two sock conditions: positive benefits with FTS may provide 8.59±33.66%; F3, 55=0.252, P= FTS and regular socks (RS). The order some direction for utilizing these as 0.86%), fibularis longus (FTST= of the sock condition was randomized an intervention for CAI. 7.07±26.73%, FTS= 14.56±28.51%, and athletic shoes were worn for all RS=1.01±27.82%, NS=0.4±29.17; F3, testing. The jump-landing task 55=.77, P=.56), or soleus H:M ratio consisted of a single-leg landing from (FTST=9.77±17%, FTS= 10.9± 50% of the participant’s maximum 37.06%, RS=0.86±17.68%, NS= jump height. Participants jumped off 13.09±45.71%; F3, 55=0.40, P=0.76). both feet, reached up and touched the Conclusion: Spinal reflexes of ankle indicated marker, and landed on a stabilizing muscles were not altered forceplate onthetesting limb. Three during double limb support in healthy trials were performed with each sock

Journal of Athletic Training S-139 12186DOPR Kinesio®tape Application Does before KT application (T1), include improving proprioception and Not Improve Shoulder immediately post-application (T2), 24- providing mechanical support; Proprioception or Strength 48hrs post-application (T3) (KT however, little evidence exists as to the in Healthy, Physically Active removed after this test session), and efficacy of this taping. Previous Participants 24-48hrs post-removal (T4). KT was research refutes claims of pro- Keenan KA, Chu YC, Pederson JJ, applied by a Certified Kinesio®tape prioceptive benefits; however, it is Abt JP, Sell TC, Lovalekar MT, Practitioner. Variables were analyzed unclear how Kinesio® tape, as applied Lephart SM: Neuromuscular using Friedman’s analysis of variance. to the lower leg, may affect forces and Research Laboratory, Department Statistical significance was set at pressures of the foot. Objective: To of Sports Medicine and Nutrition, p<0.05 a priori. Main Outcome examine the effects of lower leg School of Health and Rehabilitation Measures: For TTDPMD, mean Kinesio® taping on plantar forces and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Sciences, University of Pittsburgh, absolute error in degrees was pressures in a group of healthy Pittsburgh, PA calculated for shoulder IR/ER. Peak subjects. Design: Pre-test post-test. torque was averaged normalized to Setting: Biomechanics Laboratory. Context: Kinesio®tape (KT) is used body weight (%BW) for shoulder IR/ Patients or Other Participants: clinically to treat a wide range of ER. Results: There were no Twenty physically active subjects (10 conditions, from musculoskeletal significant differences in TTDPMD male, 10 female) with no history of injuries to myofascial restrictions, into IR (T1=3.92°±4.89°, T2=4.36° exercise-related leg pain volunteered with reported effects of pain reduction, ±6.02°, T3=3.03°±2.16°, T4=3.30° for this study (20.2±1.5yrs, inhibition or facilitation of motor ±5.00°, p=0.198) or ER (T1=3.67°± 173.2±11.7cm 76.9± 14.4kg). Inter- activity, enhancement of proprio- 5.12°, T2=3.87°±4.32°, T3=2.66°± ventions: Subjects were asked to walk ceptive feedback, and promotion of 3.43°, T4= 2.98°± 3.33°,p =0.494) or barefoot across a Tekscan, Inc. postural alignment and joint stability. for shoulder IR (T1= 34.0 ±15.4%, (Boston, MA) pressure mat system Despite the growing use of KT, there T2=32.0±12.7%, T3= 34.3± 16.5%, under one of 3 conditions: prior to is little evidence-based research to T4=34.5±14.3%, p=0.218) or ER tape application (PRE), immediately support or refute these claims. strength (T1=29.0 ±8.5%, T2=28.9 following application of Kinesio® Objective: To determine the effect ±10.6%, T3=29.0 ±10.6%, T4=29.4 tape to the lower leg (KT-I), and of KT on shoulder proprioception and ±10.6%, p=0.476) across all time following 24 hours of Kinesio® tape strength in healthy individuals and to points. Conclusions: The application use (KT-24). Tape was applied directly determine if the effects are time- of KT to the shoulder in healthy, to the skin from the superior third of dependent. Design: Quasi- physically active individuals does not the medial tibia to the arch of the foot experimental repeated measures study. appear to aid or impair shoulder at 75% tension. Five trials were Setting: Research laboratory. proprioceptive ability or strength. collected for each condition to ensure Participants: Data were collected on Future research should explore if a reliable recording. Main Outcome 10 healthy, physically active similar results can be replicated in Measures: Each trial was partitioned participants (age=25.78±3.78 years, subjects with shoulder pathology as so that the foot was divided into six height=1.69±0.09 m, mass=67.18 well as in other joints and conditions areas: medial rearfoot, lateral rearfoot, ±14.25 kg). All subjects were free of in order to support the clinical use of medial midfoot, lateral midfoot, current medical or musculoskeletal KT. Supported by Freddie H. Fu, MD medial forefoot, and lateral forefoot. shoulder pathology and had no previous Graduate Research Award & University The dependent variables included peak history of major shoulder pathology. of Pittsburgh, School of Health & force (N) and pressure (kPa), mean Interventions: Shoulder proprio- Rehabilitation Sciences Research force (N) and pressure (kPa), and time- ception was assessed using an Development Fund to-peak force (% stance) and pressure isokinetic dynamometer operating in (% stance). A repeated-measures the passive mode (0.25°/s) for 12187UOPR analysis of variance was used to Lower-Leg Kinesio® Tape threshold to detect passive motion and determine if dependent variables Application Reduces Rate of direction (TTDPMD) into shoulder differed between tape conditions and Loading in Healthy Subjects internal/external rotation (IR/ER, 3 foot areas (α=0.05). Results: There Griebert MC, Needle AR, Kaminski repetitions each). Isokinetic shoulder was a significant main effect of foot TW: University of Delaware, IR/ER strength was assessed using an area for all variables (F>169.0, Newark, DE isokinetic dynamometer (60°/s, 5 p<0.001). Additionally, a significant repetitions each). All tests were main effect of condition was observed performed on the dominant side (arm Context: Kinesio® taping is a method for time-to-peak force (F=4.60, with which would use to maximally that has become widely used in sports p=0.011), and time-to-peak pressure throw a ball). Participants were tested medicine over recent years for various (F=3.58, p=0.029). Post-hoc tests at four time points: immediately pathologies. Some proposed uses revealed that time-to-peak force did S-140 Volume 47 • Number 3 (Supplement) May 2012 not change from PRE (39.5±23.5%) to commonly available in the form of continues to grow, warranting further K-I (41.3±23.6%, p=0.16), but had a silicone bracelets and necklaces each investigation. significant decrease at KT-24 containing a plastic holographic dot. (42.4±23.6%, p=0.008). A similar According to manufacturer in- 12194UOTE effect was observed for time-to-peak formation, each dot is “programmed The Impact of EFX® on ImPACT™ pressure at PRE (40.8±25.0%), KT-I with algorithms and frequencies that Kaufman MA, Tsang KKW, Cardoza (42.9±25.7%), and KT-24 (43.8± interact positively with the energy field LM: California State University 25.7%, p=0.026). Conclusions: Our at the cellular level”. Independent Fullerton, Fullerton, CA results suggest that prolonged use of variable was treatment condition: Kinesio® tape on the lower leg may activated dot (EFX), non-activated dot Context: Performance technology reduce the rate of loading throughout (XFE), and no dot (CO). Participants products embedded in silicone

the foot. While research has supported completed one testing session that bracelets and necklaces are becoming Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 a mechanical effect of Kinesio® tape consisted of performing isokinetic increasingly popular with active on various joints, this study does not testing under the three conditions. For individuals in the recreational and appear to support that finding as initial each condition, subjects completed competitive athletic communities. application of the tape did not produce one set of five repetitions at the speeds Reports from users have indicated an effect. However, changes in timing of 60°, 180°, 300°·s-1. An isokinetic benefits in physical performance (e.g., of peak force and pressures suggest dynamometer (Biodex, Shirley, NY) balance, strength) and cognitive the tape may have a neuromuscular was used to assess concentric knee functions (e.g., alertness, con- effect. Future research should assess extension (quadriceps) and flexion centration). Objective: The purpose of how muscle activity is altered by tape (hamstring) muscle strengths. Main this research study was to examine the use, and how this effect may be Outcome Measures: Dependent effects of EFX® (www.efxusa.com) on beneficial in pathological populations. variables for strength: peak torque cognition. Design: Double blinded (N·m) for quadriceps and hamstring crossover study. Setting: Research 12193UOTE muscles. An ANOVA with repeated laboratory. Patients or Other ® The Influence of EFX on measures was used to assess Participants: 30 healthy participants Isokinetic Strength differences between treatment (males = 10, females = 20) (age = Boroian DT, Tsang KKW: California conditions on peak torque. Results: 21.67 ±2.4 years, mass = 67.6 ±13.2 State University Fullerton, Fullerton, No differences between treatment kg, height = 167.7 ±8.5 cm) with no CA conditions (mean ±SD) were found for history of current or recent head injury. peak torque: quadriceps 60°·s-1 (EFX Interventions: EFX® is a commercial Context: Muscle strength is an 154.2 ±50.2, XFE 149.6 ±46.5, CO product, commonly marketed as important physiological factor that can 151.3 ±50.1, P = .538, 1-β= .850), silicone bracelets and necklaces, affect performance in dynamic 180°·s-1 (EFX 109.5 ±34.2, XFE 108.4 available via sporting goods environments such as athletic ±36.1, CO 108.6 ±33.9, P = .831, 1-β= department stores, sporting events, and competition and physical recreation. .922), 300°·s-1 (EFX 79.1 ±26.9, XFE the Internet. Each item contains a Intuitively reasoned, an increase in 79.3 ±26.6, CO 79.4 ±24.8, P = .976, 1- plastic dot that is reported to be muscle strength is associated with an β= .946); hamstring(s) 60°·s-1 (EFX “embedded with wearable holographic improvement in performance. Ob- 81.5 ±24.7, XFE 79.7 ±24.1, CO 80.6 technology”. Independent variable was jective: This research study examined ±25.1, P = .599, 1-β= .869), 180°·s-1 treatment condition: activated dot the effects of a commercial sporting (EFX 55.6 ±18.9, XFE 54.5 ±18.8, CO (EFX), non-activated dot (XFE), and goods accessory, EFX® (www.efxusa. 54.8 ±18.4, P = .540, 1-β= .851), no dot (CO). Participants completed com), on muscle strength. Design: 300°·s-1 (EFX 39.1 ±15.4, XFE 39.2 one testing session consisting of a Double blinded crossover study. ±14.8, CO 40.0 ±15.2, P = .623, 1-β= computerized program (ImPACT™) Setting: Research laboratory. .876). Conclusions: Our results under the three conditions. The order Patients or Other Participants: 30 indicate isokinetic strength of the of treatment condition was healthy participants (males = 17, quadriceps and hamstring muscles randomized for each subject. Both the females = 13) (age = 21.9 ±3.1 years, were not improved with the subject and test administrator were mass = 73.2 ±16.0 kg, height = 170.9 incorporation of the EFX® dot. The blinded to the order of the treatment ±8.1 cm) with no history of current or effectiveness of EFX® and other conditions. ImPACT™ (ImPACT recent injury involving their lower similar products are supported Applications, Inc.) is a commercially extremities. Interventions: EFX® is a primarily through theoretical models available computerized program commercial product that is readily provided by manufacturers and commonly utilized as part of the available to the general public as an testimonials from clients. While the neurocognitive assessment and accessory via sporting goods research evidence does not seem to management of concussions. Subjects department stores, sporting events, and support anecdotal claims, popularity complete six different modules from the Internet. The products are of “wearable” performance technology which composite scores are calculated Journal of Athletic Training S-141 12379FOEX for measurements of memory, The Ability of Instrument TL and CL were collected 24 and 48 reaction time, and processing speed. Assisted Soft Tissue Mobilization hours following IASTM. Muscle Main Outcome Measures: De- to Attenuate Inflammation and samples were evaluated for inflam- pendent variables: composite scores Symptoms of Muscle Damage matory markers Interluekin- 6 (IL-6) for ImPACT™: Verbal Memory after an Eccentric Exercise and Tumor Necrosis Factor- (TNF-α) (VRM), Visual Memory (VSM), Visual Protocol using Western Immuno-blotting. Motor Speed (VMS), Reaction Time Vardiman JP, Horinek RJ, Results:Subjects ROM was signifi- (RT), and Impulse Control (IC). An McCartney MK, Graham ZA, cantly greater (p<0.05) in the TL ANOVA with repeated measures was Moodie NJ, Gallagher PM: The (129.67±15.7 and 128.2±17.7 used to assess differences between University of Kansas, Lawrence, degrees) compared to the CL (117.8 ± treatment conditions. Results: No KS; Rockhurst University, 21.9, and 117.9±22.4 degrees) 24 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 differences between treatment Kansas City, MO hours and 48 hours following IASTM. conditions (mean ±SD) occurred for There was no significant difference ImPACT™: VRM (EFX 87.80 ±8.91, Context:It is common practice to found for 1RM, PT, IL-6 or TNF-α XFE 87.60 ±11.55, CO 85.97 ±10.23, incorporate manual therapy between the TL and CL at similar time P = .521, 1-β= .85), VSM (EFX 75.70 techniques; such as stretching, points. Conclusions:Though ROM ±14.57, XFE 76.83 ±12.50, CO 72.90 massage and soft tissue mobilization was the only marker that significantly ±15.19, P = .238, 1-β= .70), VMS into treatment protocols for athletes improved following IASTM, the mean (EFX 37.17 ±7.06, XFE 38.02 ±6.83, suffering from symptoms of muscle 1RM was higher in the TL (87.8±19.2, CO 37.69 ±6.90, P = .666, 1-β= .89), damage following eccentric 81.1±24.7 and 88.9±23.7 lbs) RT (EFX 0.552 ±0.05, XFE 0.560 exercise(EE). A common treatment compared to the CL (78.9±18.3, ±0.05, CO 0.550 ±0.078, P = .598, 1- used for treatment of these symptoms 72.2±26.8, and 70.0±24.5 lbs) β= .87), IC (EFX 5.93 ±4.2, XFE 7.80 is Instrument Assisted Soft Tissue immediately following, 24 and ±8.35, CO 5.60 ±3.23,P=.108,1- Mobilization (IASTM). Objective: 48hours after IASTM.These data β=.61). Conclusions: Our results The purpose of this study was to indicate that a subject suffering from indicate cognition was not improved determine the ability of IASTM to functional deficits, such as decreased with the EFX® product. While most attenuate inflammation, and its effect ROM and decreased strength,would other studies have examined the on range of motion(ROM), pressure potentially benefit from IASTM effects of “performance technology” tolerance(PT) and 1 repetition treament. products on physical performance, our max(1RM) after an EE protocol. results are unique as they target Design: Repeated measures design. variables of cognitive function. Our Setting:Research laboratory.Partici- results do not support the positive pants:Nine recreationally active, testimonial claims but it should be college aged males (18-24 years, noted no negative or hindered 175.8±5.6cm, 73.3±14.9kg). Inter- performance was demonstrated. ventions:Subjects ROM was Further investigation should be measured using a standard handheld conducted to elucidate the influence goniometer, PT was measured using a of a “ceiling effect” with performance handheld pressure algometer (Wagner technology products. Instruments, Greenwich, CT) the EEwas administered using a leg extension machine (Universal Weight Training, Inc., Cedar Rapids, IA). EE consisted of 7 sets of 10, single leg repetitions performed eccentrically at 120% of their 1RM. Twenty-four hours following the EE each subject received IASTM protocol (Graston Technique®, Indianapolis, IN) to the treatment leg (TL) while the other leg was used for the control leg (CL). Main Outcome Measures:The subject’s ROM, 1RM and PT were measured at BL, 24, 48 and 72 hours followingEE. Muscle biopsies in the

S-142 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Assessment and Effects of Hydration Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12049MOEX 12107DOEX Digital and Clinical Refractometers are measured by USG and OSM. USG was Effects of Hyperthermia, Valid Instruments for the Measure of evaluated by a handheld clinical Hypohydration, and Fatigue on Hydration Status refractometer, pen style digital Mood and Reaction Time in Two Niemann AJ, Yeargin SW, Eberman refractometer, and midget urinometer. Environments LE, Adams HM, Mata HL, Dziedzicki The gold standard OSM was calculated DeMartini JK, DiStefano LJ, Casa DJ: Indiana State University, Terre by a freezing point depression DJ, Huggins RA, Karslo R, Stearns Haute, IN osmometer. Z scores were calculated RL, Armstrong LE, Maresh CM: for each instrument and Pearson University of Connecticut, Storrs, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Although some instruments product-moment correlation coeffi- CT have been validated for clinical cients were evaluated to examine the measure of hydration status, new and relationship between each instrument Context: Limited research has currently invalid instruments are of USG and OSM. Results: Strong evaluated combined effects of available for purchase and clinical use. significant correlations were hyperthermia, hypohydration, and Athletic trainers commonly use these identified for the digital refractometer fatigue on cognition. Objective: instruments to assess hydration status (r=0.814, p< 0.001) and handheld cli- Determine individual and combined for weight checks and body mass loss nical refractometer (r=0.943, p< effects of hyperthermia, hypo- charts due to their ease of use. 0.001) with OSM. A weak statistically hydration, and fatigue on profile of However, the validity of these popular insignificant correlation was mood states (POMS) and reaction instruments has not yet been established between the midget time (RT) during a scanning visual established. Ob-jective: To determine urinometer (r=0.133, p< 0.142) and vigilance test. Design: Randomized the validity of urine specific gravity OSM. Average hydration status controlled trial. Setting: Climate (USG) for the assessment of hydration indicated variability among some of controlled chamber. Patients or status via the following instruments: the instruments: digital refractometer Other Participants: Twelve males handheld clinical refractometer, pen USG=1.0194±0.0075, clinical (Mean±SD: age=20±2y, height= style digital refractometer, and midget refractometer USG=1.020±0.007, 182±8cm, body mass=74.0±8.2kg, urinometer as compared to the gold urinometer USG=1.028±0.091, body fat=9±3%, VO2max=57.0±6.0 mL standard urine osmometer (OSMO). osmometer OSM=743±271) Con- ·kg-1·min-1) volunteered for parti- Design: De-scriptive diagnostic clusions: Handheld clinical refrac- cipation. Interventions: Participants validity study. Setting: Biochemical tometry can be used confidently for completed four, 90-minute treadmill research laboratory. Patients or assessing hydration status as it shows bouts (1.34-1.78m·s-1; 5% grade) Other Participants: Healthy active a strong significant correlation with followed by 60-minutes of quiet men and women (n=108; mean the gold standard osmometer, which is sitting under two hydration states and age=22±4yrs; self reported height= consistent with previous literature. two environmental conditions: 174±20cm and mass= 75±17kg) were Additionally, the use of the pen style euhydrated temperate (EUT), hypo- recruited among faculty and students digital refractometer showed a strong, hydrated temperate (HYT), euhydrated on a university campus. Inter- significant correlation with the gold hot (EUH), hypohydrated hot (HYH). ventions: The independent variable standard osmometer and provides Temperate and hot conditions were was instrument type with four levels: clinicians with another option for the performed in 18±0.2ºC, 50±3.5%RH, osmometer, handheld clinical clinical assessment of USG and and 34±0.3ºC, 45±4.5%RH, re- refractometer, pen style digital hydration status. The findings of this spectively. Hypohydration consisted refractometer, and midget urinometer. also study suggest that the use of a of 22-hour fluid restriction prior to After recruitment, participants midget urinometer should be the trial and during the trial, while completed an informed consent and a performed with extreme caution, as it euhydration consisted of consuming short health history questionnaire to showed a weak correlation with the oral fluids ad libitum the day prior to rule out any exclusionary criteria such gold standard osmometer, indicating it the trial and equal to the subject’s sweat as kidney disease or chronic urinary might not provide accurate results rate during the trial. Outcome tract infection. Participants were then when used to determine hydration measures were recorded prior to the given a clean standard urine cup and status. exercise bout (PRE), immediately asked to provide as much sample as following the exercise bout (POST), possible, providing more than one cup and immediately following 60-minutes when possible. Main Outcome of recovery (REC). POMSdata were Measures: Hydration status was analyzed via one-way repeated Journal of Athletic Training S-143 12168MOEX measures ANOVA, and RT data were Sweat Rate and Sweat-Electrolyte ≥30mEq.L-1 as a high sweat [Na+] and analyzed via two-way (condition X Composition in Athletes with ≥24mEq.L-1 as a high sweat [Cl- time) repeated measures ANOVA and Recurrent Cramping Versus ].Fisher’s Exact Test demonstrated a Tukey post-hoc tests.Significance was non-Cramping Matches statistically significant difference in set a priori at p<0.05.Main Outcome Townsend RC, McDermott BP: frequency of high sweat [Na+] and Measures: POMS and RT. Results: University of Tennessee at sweat [Cl-] between groups (1-sided Significant change scores for POMS Chattanooga, Chattanooga, TN p=.008). These values demonstrated from PRE to POST included: “total identical 0.77 (CI: 0.50-0.92) mood dis-turbance” was higher in Context: There are currently two sensitivity and 0.77 (CI: 0.50-0.92) HYHcompared to EUT, HYT, and EUH prevailing theories on the cause of specificity in predicting EP athletes. (35±21 vs. 3±10, 3±16, 16±26, This represented a diagnostic odds exercise-associated muscle cramps Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 respectively; p<0.001), “fatigue- (EAMC); neuromuscular fatigue and ratio of 11.1 (CI: 1.8-68.9) for both inertia” was higher in HYH compared electrolyte depletion. Particularly, sweat [Na+] and sweat [Cl-]. to EUT and HYT (13±4 vs. 3±3 and electrolyte depletion research has Conclusions: Our data suggests that 4±5, respectively; p=0.004), focused on sodium losses increasing increased sweat [Na+] and sweat [Cl-] “confusion-bewilderment” was higher EAMC risk. Objective: The purpose predispose athletes to EAMC. Sweat in HYH compared to EUT and HYT of this study was to compare sweat rate rate and sweat [K+] appear less (5±5 vs. 0±2 and 0±3, respectively; and sweat electrolyte concentrations predictive in classifying athletes as EP. p<0.001), and “depres-sion-dejection” in EAMCprone (EP) athletes to Patients with repeated episodes of was higher in HYH compared to HYT matched controls (MC).Design: EAMC warrant sweat-electrolyte (6±7 vs. -1±3; p=0.004). Significant Cross-sectional case control. analysis and/or NaCl supplementation change scores for POMS from PRE Setting: Observational. Patients or to prevent cramping. to REC included: “fatigue-inertia” was Other Participants: Twenty-six male higher in HYH compared to EUT, HYT, physically active subjects (21 ± 8y, 12321MOEX and EUH (10±3 vs. 2±3, 3±5, 3±7; 97.1 ± 19.6kg, 14.1 ± 3.4% body fat) Serum Creatine Kinase Levels in p<0.001) and “total mood disturbance” voluntarily partici-pated. Each EP was NCAA Football Players During was higher in HYH compared to HYT matched with a MC according to age, Preseason Now that an (18±18 vs.-3±20; p=0.004). No body mass,% body fat, gender, sport, Acclimatization Time Period is significant change scores were position, and heat-acclimatization. Mandated observed POST to REC(p>0.05).A Interventions: Participants com- Marcinek T, Morrison KE, Fowkes significant time main effect occurred pleted a scheduled workout or practice. Godek S, McCann J, Hallah N: HEAT for RT (p=0.002). RT was slower at Pre- and Post-exercise body mass Institute at West Chester University, POST compared to PRE (p<0.001) and were assessed using a standard scale West Chester, PA; 3B Orthopaedics, REC (p=0.041). No significant and subsequent sweat rate was Pennsylvania Hospital, Philadelphia, difference occurred between PRE and calculated. Standard sweat patch PA REC (p>0.05). Conclusions: collection and ion-specific electrolyte Combined effects of hypohydration analysis were used to quantify sweat Context: One consequence of and hyperthermia had additive negative electrolyte concentrations. Main practicing football during pre-season effects on changes in mood state after Outcome Measures: Sweat rate, in warm, humid environments is exercise. In addition, 90-minutes of sweat [Na+], sweat [K+], sweat [Cl- rhabdomyolysis, as documented by exercise resulted in slower RT ].Results: EP was matched to MC elevated serum creatine kinase (CK). regardless of hydration state and with no significant differences in age, CK was measured in collegiate environmental condition; however body mass or body fat % (p>.05). football players during the first 10 days these negative effects subsided after Sweat rate was not significantly of pre-season two-a-day practices 60 minutes of recovery. Therefore, it different between EP (2.09 ± 0.97L.h- prior to the NCAA mandating an appears that fatigue had the greatest 1) and MC (1.81 ± 0.77L.h-1; p=.433). acclimatization time period in 2003. effect on RT and could potentially Sweat [Na+] (EP: 48.58 ± 26.58mEq.L- This study found CK levels of 5125 ± increase the risk of injury in athletes. 1 vs MC: 30.01 ± 20.36 mEq.L-1; 5518 U·L-1 in the morning of the 4th p=.057), sweat [K+] (EP: 5.66 ± day and 3370 ±3660 U·L-1 in the 0.84mEq.L-1 vs MC: 6.30± 1.50 morning of the 7th day, which were mEq.L-1; p=.212), and sweat [Cl-] (EP: significantly elevated from baseline 38.87 ± 23.97mEq.L-1 vs MC:24.01 measures (204 ± 67 U·L-1). Ob- ±18.7mEq.L-1; p=.091) were not jective: To determine if partici-pation significantly different between groups. in pre-season football practices Receiver operator characteristic results in elevated serum CK now that analysis identified a cut point of the NCAA mandated a 5-day acclima- S-144 Volume 47 • Number 3 (Supplement) May 2012 tization period. An additional goal was come Measures: Serum CK levels and to evaluate the influence of body mass BMI. Results: Compared to baseline index (BMI) on serum CK levels. We (299±205 U·L-1), serum CK was hypothesized that serum CK would significantly higher on day 4 increase over the course of the ten (1497±1098 U·L-1,P<.05), day 7 days of training camp, especially after (1773±10981405 U·L-1,P<.01) and the start of two-a-day practices. day 10 (1463±1074 U·L-1,P<.05), but Design: Observational Cohort Study. did not differ between days 4, 7 and Setting: Data was collected at an 10. No correlation was found between NCAA Division II University during BMI and serum CK (P=0.41). training camp in August. Patients or Conclusion: Serum CK was

Other Participants: Twelve NCAA significantly elevated (on day 4) during Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Division II football players volunteered the 5-day acclimatization period in for participation (age: 22.1±.9y, mass: collegiate football players, and 101.8±20.5kg, height: 182.3±4.7cm, remained elevated in the morning of BSA: 3.33±.17m², BMI: 30.4±5kg· the 7th and 10th day. However, m²-1). Intervention: Eight cc of blood compared to results from similar data was drawn from an antecubital vein the collection prior to the NCAA mandated day before the 1st preseason practice acclimatization period, CK was (baseline) and again on the morning of substantially lower (by 71% on day 4 the 4th, 7th and 10th day. After clotting, and 47% on day 7). Although results the blood was spun on-site and the indicate that rhabdomyolysis still serum was separated, placed in occurs in collegiate football players cryovials and refrigerated until assay. during pre-season, the magnitude was Subject height and weight were less compared to data prior to the 2003 obtained at baseline to calculate BMI. acclimatization guidelines. Of note, A one-way ANOVA was used to assess the highest CK values the morning of for differences in CK over time and Day 7 followed the first day of twice- Pearson’s correlation was used to a-day practices (one with full contact) determine if there was a relationship on day 6. between BMI and CK. Main Out-

Journal of Athletic Training S-145 Free Communications, Poster Presentations: Lower Extremity Biomechanics Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F19DOBI 12048D ONE Influence of Lean Mass on Lower 1) for the hip (HEA), knee (KEA), and Quadriceps Strength is Associated Extremity Energetic Capabilities ankle (AEA), as well as total (hip + with Knee Flexion Angles and during Landing knee + ankle) EA (TEA) were Moments During Dynamic Montgomery MM, Shultz SJ, calculated from the kinematic and Landing Following Anterior Schmitz RJ: California State kinetic data during the initial Cruciate Ligament University, Northridge, deceleration phase of the drop jump Reconstruction Northridge, CA; The University landing. Linear regressions examined Lepley LK, Palmieri-Smith RM: of North Carolina at Greensboro, the extent to which LELM predicted University of Michigan, Ann Arbor, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Greensboro, NC each EA variable within sex. A MI mediation analysis using a non- Context: Less lean mass relative to parametric bootstrapping procedure Context: Maximizing quadriceps total body mass may limit one’s ability then examined whether these function following anterior cruciate to produce adequate muscle torques to relationships were mediated by ligament reconstruction (ACLr) is a safely control landing from a jump, QuadECC and HamECC. Results: challenge for clinicians and patients thus increasing the risk for injury. As Means±SD were 23.6±2.9 and alike. Quadriceps weakness often less strength has been implicated as a 29.1±2.3% (LELM), 15.0±2.7 and persists following rehabilitation and is factor in greater landing stiffness and 17.3±2.6J*N-1*m-1 (TEA), 2.7±1.3 considered to influence knee reduced energy absorption capabilities and 3.9±1.7J*N-1*m-1 (HEA), mechanics during walking gait. Little in females, it remains unknown 9.1±2.6 and 9.8±2.6J*N-1*m-1 is known, however, about the whether the underlying influence of (KEA), 3.1±1.4 and 3.7±1.2J*N-1*m- relationship between quadriceps available lean mass drives these 1 (AEA), 3.2±0.5 and 3.9±0.7Nm*kg- strength and knee mechanics during relationships and in part, explains 1 (QuadECC), and 2.0±0.3 and dynamic sport-like movement post- commonly observed sex differences in 2.5±0.3Nm*kg-1 (HamECC) for ACLr. As many individuals return to landing mechanics associated with females and males, respectively. activity following ACLr, it is important injury risk. Objective: To determine LELM was a significant predictor of to identify whether quadriceps the effect of lower extremity lean mass KEA (R2= 0.136, p=0.02) in females, strength influences knee mechanics (LELM) and maximal eccentric thigh but not in males (R2= -0.028; p=0.81). during sport-like activity. Objective: muscle strength capabilities on lower QuadECC was a significant mediator To determine the relationship between extremity energy absorption (EA) of the effect of LELM on TEA for quadriceps strength and knee strategies during landing. We expected females (ab= 0.177, 95% C.I.= [0.01, mechanics during a single-leg landing that LELM would be a significant 0.42]), but not for any individual joint. task post-ACLr. Design: Descriptive positive predictor of EA and that these HamECC was a significant mediator of laboratory study. Setting: University relationships would be mediated by the relationship between LELM and Laboratory. Patients or Other eccentric strength. Design: De- HEA in females (ab= 0.208, 95% C.I.= Participants: Twenty-four individuals scriptive Cohort. Setting: Controlled [0.07, 0.41]). No significant relation- (14 male, 10 female; age: 19.38± Laboratory. Patients or Other ships were observed in males. 5.40yrs; height: 1.76±0.09m; mass: Participants: 35 female (1.67±0.1m, Conclusions: LELM was a more 74.87±11.73kg) post-ACLr (7.6±1.36 65.3± 6.6kg, 21.6± 3.6yrs) and 35 important determinant to energy mo) were tested upon being cleared to male (1.78±0.1m, 74.7±8.9kg, absorption capabilities for females; return to activity. Interventions: 20.9±2.9 yrs) athletes. Interventions: however, maximal eccentric strength Three-dimensional knee bio- Participants were assessed for LELM mediated the relationship only with mechanics were recorded during a using dual-energy x-ray absorptio- TEA. Neither LELM nor maximal single-leg land-and-cut maneuver. metry, maximal eccentric quadriceps eccentric strength predicted landing Isokinetic quadriceps strength was and hamstring strength with an energetics in males. More work is assessed using a dynamometer at 60°/ isokinetic dynamometer at 180 deg/s, needed to investigate the underlying second. Main Outcome Measures: and lower extremity biomechanics sex-specific mechanisms which Peak stance sagittal plane kinematics during a drop jump landing task. Main determine energy absorption and kinetics were calculated using a Outcome Measures: LELM (%) and capabilities and the associated standard inverse dynamics approach. peak eccentric quadriceps (QuadECC; implications for ACL injury risk. Kinetic outputs were normalized to Nm*kg-1) and hamstring (HamECC; Supported by NFL Charities Grant. subject body mass and height and Nm*kg-1) torques were normalized to represented as external moments. body mass. Normalized EA (J*N-1*m- Three maximal knee extension trials S-146 Volume 47 • Number 3 (Supplement) May 2012 were averaged and normalized to subject unknown. Objective: To examine the CON=-90.72±15.51, p=.006) and body mass to quantify quadriceps effect of prior meniscal injury on 50% of stance (MEN=-53.36±14.23 strength. Linear regressions were used lower extremity biomechanics during and -67.29±20.81, p=.006) compared to examine the relationship between a double leg jump-landing task. to the CON group. The injured limb quadriceps strength and knee moments Design: Cross-sectional. Setting: displayed a significant group-by-time and quadriceps strength and knee Research laboratory. Participants: interaction for VGRF (p=.04), angles. Results: Quadriceps strength 5,919 healthy physically active however post-hoc testing was non- was found to be associated with knee participants were enrolled in this study significant (p=.015). Results suggest flexion moments (R2=0.320, b=0.445, and a total of 5,333 (3,237 males, a trend toward greater VGRF in the P=0.004) and angles (R2=0.247, b= - 2,096 females) were included in this injured limb of the MEN (1.42±.72) 12.633, P=0.013). Con-clusions: Our analysis. Those with prior meniscal compared to CON group (1.27±.55).

results suggest that greater quadriceps injuries (MEN) (n=99, age=18.88 Conclusions: Our findings indicate Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 strength is associated with larger knee ±1.04years, height =173.82±9.08cm, that individuals with prior meniscal flexion angles and torques during a mass= 74.00 ±13.64kg) and those with injury utilize greater hip and knee single-leg landing. Specifically, when no prior history of knee related injury flexion on the uninjured limb during a normalized quadriceps strength (CON) (n=4,893, age=18.73±0.90 jump-landing task in comparison to increased by 1 Nm/kg, knee flexion years, height=173.08±9.17cm, mass= healthy controls. Traumatic meniscal moments increased by 0.45 Nm/kg*m 71.30 ±12.43kg) at the time of testing lesions typically occur in young active and knee flexion angles increased by were identified using a self-report individuals who wish to return to sport 12.6 degrees. These results reinforce the questionnaire. Interventions: Kine- following injury; therefore identifying importance of maximizing quadriceps matic and kinetic data were collected and improving potential compensations strength post-ACLr, and help to provide during three double leg jump-landing after meniscal injury may be an evidence that quadriceps strength, in trials using an electromagnetic motion important component in preventing part, contributes to alterations in knee capture system and forceplate. All future injury and delaying the onset of mechanics during a sport-like measures were collected on the osteoarthritis. Funded by the NIAMS maneuver. Supported by NIH Grant participant’s dominant kicking leg. The Division of the National Institutes of K08 AR053152-01A2 and the MEN group was subdivided into those Health, #RO1-AR050461001. University of Michigan’s Rackham instrumented on their injured limb School of Graduate Studies. (INJ) or uninjured limb (UNINJ) for 12083MOBI analyses. Main Outcome Measures: Effect of Playing Surface on Hip 12076DOBI Three-dimensional hip and knee joint and Knee Kinematics in Healthy Biomechanical Differences Exist angles, three-dimensional internal Female Soccer Players in the Injured and Uninjured Limb knee joint moments, and vertical Fraley AL, Goerger BM, Zinder SM, of Individuals with Prior ground reaction force (VGRF) values Fava NM, Lewek MD: Sports Meniscal Injury were identified at the following time Medicine Research Laboratory, The Begalle RL, Padua DA, Boling MC, points of the jump landing task; 0%, University of North Carolina at Goerger BM, Beutler AI, Marshall 15%, 50% and 85%. These time points Chapel Hill, Chapel Hill, NC SW: Sports Medicine Research correspond to initial contact, weight Laboratory, University of North acceptance, maximal knee flexion and Context: Playing surface is thought to Carolina, Chapel Hill, NC; ascent phases of the jump-landing task. alter lower extremity kinematics and University of North Florida, Separate mixed-model repeated influence the risk of noncontact Jacksonville, FL; Uniformed measures ANOVA were performed to anterior cruciate ligament (ACL) Services University of the Health compare the biomechanical variables injury. However, there has been Sciences, Bethesda, MD between groups (MEN, CON) across limited research examining the effect each time point of the jump-landing of playing surface on hip and knee Context: Meniscal injuries are a task (0%,15%,50%,85%). Post-hoc kinematics. Objective: To determine primary risk factor for early onset analy-ses involved independent if hip and knee kinematics during a knee osteoarthritis, leading to a samples t-tests with a Bonferroni jump landing cutting task differ lifetime of pain and dysfunction. correction (α≤0.0125). Results: between 3rd generation artificial turf Asymmetrical lower extremity Significant differences between the and natural grass playing surfaces in biomechanics have been identified MEN and CON group were identified unimpaired females. Design: following other knee injuries that in the uninjured limb. Specifically, the Repeated measures design. Setting: potentially contribute to poor uninjured limb of the MEN group Sport practice fields. Participants: outcomes and progression of displayed greater knee flexion at 50% Twenty-seven female Division I varsity osteoarthritis post injury. However, of stance (MEN=97.31±18.73; and club soccer athletes (17 varsity, 10 the effects of isolated meniscal injury CON= 81.66± 13.91,p=.007) and greater club; age = 20.0±1.4 years; height = on lower extremity biomechanics are hip flexion at 15% (MEN=-69.25±8.69, 167.5±6.5 cm; mass = 65.2±11.1 kg; Journal of Athletic Training S-147 years playing competitively = 11.6 for noncontact ACL injury. Such work was used to prevent order effects. ±3.3years).Interventions: Partici- is important to determine the optimal Main Outcome Measures: Knee pants performed a 90° cutting playing surfaces for practices and taping condition was the independent maneuver immediately after landing games to minimize noncontact variable. Dependent variables included from a box jump on natural grass and injuries. single-leg balance reach distances as 3rd generation artificial turf. Hip and well as pain and quadriceps knee kinematics were assessed using 12085UOMU neuromuscular activity during the an electromagnetic motion analysis Comparative Dynamic Balance, balance task. Reach distances were system. Force sensitive resistors Pain and Neuromuscular normalized to leg-length (% LL). Pain placed in the shoe were used to define Responses Among Therapeutic was gauged via a standard visual analog initial ground contact. Main Outcome Patellofemoral Taping Techniques scale measured in centimeters (cm). Poole KL, Vairo GL, Miller SJ,

Measures: Hip and knee kinematics Quadriceps neuromuscular activity Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 in all three planes of motion were Bosha PJ, Millard RL, Aukerman DF, was nor-malized to maximal volitional assessed at initial contact and peak Sebastianelli WJ: Athletic Training isometric contraction (%MVIC). One- knee flexion of landing. Excursion was Research Laboratory, Department of tail paired t-tests were calculated to calculated as the angular change from Kinesiology, University Park, PA; determine bilateral baseline sta- initial contact to the time corre- Penn State Hershey Orthopaedics - tistically significant differences. One- sponding with peak knee flexion. State College, State College, PA way analyses of variance with Tukey’s Values were averaged across trials for post hoc test was calculated to each surface condition. Paired samples Context: Nonoperative treatment of determine statistically significant t-tests were used to compare joint patellofemoral dysfunction (PFD)is differences among knee conditions angles at initial contact and peak knee commonly considered the typical (baseline, McConnell and Spider®) flexion, as well as excursion values, standard of care for symptomatic for the involved leg. P ≤ 0.05 denoted between conditions. The significance patients. Previous research has shown statistical significance. Results: Data level was set a priori at an alpha of that patellofemoral taping techniques met assumptions for statistical analyses. 0.05. Results: Joint angles at peak improve quadriceps function and pain. Lesser baseline reach distances were knee flexion and excursion values However, limited evidence exists recorded for the involved (72.14 ± 6.0 differed significantly between comparing the effectiveness of %LL) compared to uninvolved (74.14 ± surfaces. Specifically, participants different taping techniques. 6.0 %LL) leg (P =0.014). Patients showed greater hip adduction (Grass: Objective: To compare dynamic displayed increased reach distances with -3.2±6.6, Turf: 0.8± 7.0; P = 0.005) balance, pain and neuromuscular the involved leg under McConnell and less hip external rotation (Grass: responses in physically active patients (75.65 ± 7.3 %LL, P =0.002) and -5.6±8.2, Turf: -2.7±7.7; P = 0.007) diagnosed with acute unilateral PFD Spider® (75.39 ± 6.5 %LL, P = 0.005) on artificial turf at peak knee flexion, after undergoing two different conditions compared to baseline (72.14 while exhibiting greater excursion in therapeutic taping techniques. We ± 6.0 %LL).Pain also decreased under the frontal plane at the knee on grass hypothesized that taping conditions McConnell (1.16 ± 1.2cm,P = 0.001) (Grass: 9.0±7.4, Turf: 6.5±5.1; P = would yield improved outcomes and Spider® (1.04 ± 1.03cm, P = 0.001) 0.050). There was no difference compared to no tape. Design: conditions compared to baseline (1.95 between surfaces at initial contact (P Retrospective cohort (2b evidence). ± 1.4cm). Vastus medialis activation > 0.05). At peak knee flexion, there Setting: Controlled laboratory. increased under the McConnell was no difference at the hip in the Patients or Other Participants: condition (17.63 ± 7.6 %MVIC) sagittal plane (P > 0.05) and at the knee Twenty (7 men and 13 women) patients compared to baseline (14.68 ± 7.8 (P > 0.05). Excursion values showed (age = 21.2 ± 2.9 years, height = 1.69 %MVIC, P =0.015). Furthermore, no difference at the hip (P > 0.05) and ± 0.2m, mass = 68.11 ± 11.6kg, Tegner there was a difference in vastus at the knee in the sagittal (P > 0.05) = 6.25 ± 1.3, Kujala = 78.9 ± 9.38). medialis activation between and transverse (P > 0.05) planes. Patients with history of traumatic McConnell (17.63 ± 7.6 %MVIC) and Conclusions: Playing surface injury to either lower extremity were Spider® (14.36 ± 8.2 %MVIC) significantly affected hip and knee excluded. Interventions: Patients condition (P=0.026). Other com- kinematics in this sample of female underwent one bilateral baseline parisons were statistically in- soccer players. Nevertheless, these testing session and two unilateral significant. Conclusion: Our findings findings did not support our taping (McConnell medial glide and suggest both McConnell and Spider® expectations that the hip and knee NUCAP Medical Upper Knee taping techniques improve outcome would adopt a position of increased Spider®) sessions. Forty-eight hours measures in acute PFD patients. ACL loading while on artificial turf. separated sessions. Randomization However, further research is warranted However, future studies should address to investigate the efficacy of such the clinical importance of these interventions. findings and their influence on the risk S-148 Volume 47 • Number 3 (Supplement) May 2012 12108FOBI Deficits in Jump Landing limb x 100). The individual com-ponents positively alter landing biomechanics, Mechanics After ACL of the LESS were graded and summed yet the use of technology in an effort Reconstruction to create the total LESS score. A group to allow for the participant to make Bell DR, Smith MD, Olson ME, (2-levels) by limb (2-levels) repeated instantaneous biomechanical adjust- Fischer AL: University of measures ANOVA was used to analyze ments during landing has not been Wisconsin-Madison, Madison, WI VGRF and post-hoc testing was evaluated. Objective: Determine the performed if necessary. Independent immediate effects of real time Context: Anterior cruciate ligament samples t-tests were used to compare feedback (RTF) and traditional verbal (ACL) injuries are one of the most LESS score and VGRF index between feedback (TF) interventions on common knee injuries in sport. For groups.A pearson correlation Landing Error Scoring System (LESS) coefficient was computed between scores compared to a control those able to return to sport, up to 25% Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 will experience a second ACL injury LESS score and VGRF index condition. Design: Single Blinded, in either the ipsilateral or contralateral (α<0.05).Results: A significant randomized controlled trial. Setting: Research laboratory. Patients or limb. Post-reconstruction landing interaction (P=.03, F(1,25)=5.2) was force adaptations and clinical observed for VGRF.Tukey post hoc Other Participants: Twenty-four movement assessments may provide testing revealed the uninvolved limb in physically active female participants insight as to why second ACL injury the ACLR group had greater VGRF with no history of lower extremity rates are so high. Objective: To compared to the involved limb injury volunteered and were ran- determine if (1) peak vertical ground (Uninvolved: 2.3±.6BW, Involved: domized into 3 groups (RTF: n=8, reaction forces (VGRF) differs 1.9±.6BW) and both limbs in the age=21.0±1.4yrs, height=164±5.1cm, between limbs and groups (ACL control group (Dominant: 1.9±.4BW, mass=65.1±8.2kg; TF: n=8, age= reconstructed (ACLR) vs. controls), Nondominant: 1.9±.3BW). The ACLR 20.9±2.1yrs, height=165±5.2cm, (2) Landing Error Scoring System group had higher LESS score (ACLR: mass=61.6±3.4kg; Control: n=8, age (LESS) score and VGRF index differ 6.5±1.9errors, Control: 4.6±1.4errors, =22.7±3.5yrs, height=166.6±6.2cm, weight=68.6±14.2kg).Inter- between groups, and (3) determine if P=.007, t(1,25)=-2.9) and lower VGRF a relationship exists between LESS index (Control: 104.8±22.3%LSI, ventions: All participants completed three sets of six jump-landing trials score and VGRF index. Design: ACLR: 85.7±15.4%LSI, P=.02, t(1,25)= Cross-sectional. Setting: Laboratory. 2.6) compared to controls. LESS score (18 total) off a 30cm box. Participants Patients or Other Participants: and VGRF index had a negative in the RTF and TF groups were Thirteen volunteers with unilateral relationship (r=-.39, P=.04). provided standardized feedback, using ACLR(170.5±4.0cm, 70.7±11.4kg, Conclusions: ACLR individuals land verbal cues and visual representation 19.2±1.4yrs) and 14 healthy controls asymmetrically and have worse body of correct landing biomechanics, from (166.5±7.5cm, 64.7 ±8.2kg, 20.3± control. ACLR individuals have a single clinician before each set of 1.7yrs). Interventions: All individuals difficulty controlling the lower jumps. Participants in the RTF group completed 3 trials of a jump landing extremity during high risk landing were equipped with retroreflective off a 12 inch high box placed 50% of maneuvers even after completion of a markers positioned on the lower their height from force plates. rehabilitation program. Interventions extremity. Using Cortex software and Participants jumped forward off the to address these issues could lower 3-dimentional Motion Analysis, box, landed on the plates, and second ACL injury rates. Funding: UW markers on the middle of the patella immediately jumped for height. Force Sports Medicine Research Fund. and the dorsum of the great toe of the plates recorded VGRF and standard right limb were highlighted in color, video cameras recorded frontal and 12114MOBI and connected with a segment line. RTF Immediate Effects of Real Time sagittal plane views during landings. participants were able to visualize Feedback During Jump-Landing Videos were reviewed and paused at their 3-dimensional model on a 107cm on the Landing Error Scoring different time points to assess lower monitor, and were instructed to align System extremity postures using standardized the highlighted knee-foot segment with Doebel SC, Ericksen HM, Lepley LESS scoring criteria. Main a stationary vertical reference line in AS, Strouse A, Pfile KR, Gribble Outcome Measures: Peak VGRF was the frontal plane during landing. PA, Pietrosimone BG: University normalized to body weight (BW). Control participants received no of Toledo, Toledo, OH Limbs were matched between groups feedback while performing the 18 box such that the involved and uninvolved jumps. Main Outcome Measures: limbs in the ACLR group were matched Context: Suboptimal lower extremity All participants performed the LESS to dominant and nondominant limbs in biomechanics during jump-landing testing protocol at baseline and the control group, respectively.A may lead to various lower extremity immediately following the inter- VGRF limb symmetry index (%LSI) joint injuries. Clinician provided vention, consisting of a forward jump was created (involved limb/uninvolved feedback has been used previously to off a 30cm box transitioning into a Journal of Athletic Training S-149 maximal vertical jump. Trials were School. Patients or Other Parti- Conclusions:Medial knee displace- recorded in the frontal and sagittal cipants:Thirty-eight males (Age= ment appears to be partly explained by planes using two-dimensional video 16±1yrs, Mass= 69.4±13.4kg, Height gluteus maximus weakness and greater and evaluated with the LESS scoring =177.5±10.7cm) and twenty-eight hip abduction range of motion. These criteria by two blinded independent females (Age= 16±1yrs, Mass= findings suggest that other factors, assessors. Delta scores from baseline 58.4±6.6kg, Height= 164.3± 7.2cm) such as poor neuromuscular control, were calculated for all three groups. volunteered to participate in this study. may be more important than strength Independent t-tests and effect sizes Interventions:Participants com- and flexibility for predicting medial (Cohen’s d) were performed to assess pleted three trials of a standardized knee displacement in adolescents. change scores in the LESS for specific jump landing task that required them comparisons (TF v. control; RTF v. to jump forward from a 30-cm high 12320MONE Assessment of Muscle Activation

control). Alpha was set at P<0.05 a box a distance of half their height and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 priori. Results: LESS score did not jump for maximal vertical height Between Genders During a Drop significantly change following TF immediately upon landing. An Jump Task with an External (-0.63±2.5) compared to control electromagnetic motion analysis Motivator Lattimer LJ, Gage MJ, Demchak TJ, (0.57±1.8; t14=-1.05, P=0.32, d= system and force plate collected -0.54, 95% confidence interval: -1.54 three-dimensional lower extremity Dominguese DJ: Lakehead to 0.52). LESS scored decreased kinematics and ground reaction forces University, Thunder Bay, ON; Indiana significantly following RTF (-1.37 during the jump landing task. Isometric State University, Terre Haute, IN ±1.5) compared to control (0.57±1.8; strength of the hip abductors, gluteus Context: Females are 6-8 times more t14=-2.27, P=0.04, d=-1.2, -2.22 to maximus, hip internal rotators andhip -0.4). Conclusion: RTF decreased external rotators was assessed using a likely to suffer a non-contact ACL LESS score and had a strong effect for hand-held dynamometer. A digital injury than males competing in the immediately improving LESS score inclinometer was used to evaluate hip same activities. Non-contact ACL compared to the control. TF showed abduction, hip internal rotation, and hip injuries are common in sports that no immediate effect. Further study is external rotation range of motion. Two involve jumping, cutting, rapid warranted to determine the clinical trials of each flexibility and strength deceleration, and/or quick changes in impact of the addition of RTF in measure were recorded. Main direction. Literature is limited on pre- making biomechanical corrections Outcome Measures: Medial knee and post-landing muscle activation during landing. displacement was measured as the among gender during a functional drop knee joint center displacement jump followed by another task 12225FOBI between initial contact (ground (external motivator). Objective: The Influence of Hip Strength and reaction force>10N) and maximum purpose of this study was to examine Range of Motion on Medial Knee knee flexion. The average value for muscle activation pre- and post- Displacement in High School MKD, and the strength and range of landing between genders during a Athletes motion measures was used for the functional drop jump with an external DiStefano LJ, Boling MC, Buckley analyses. Pearson correlation motivator (target height). Design: A B, Trojian TH, Joseph MF, Varone coefficients were calculated to comparison design was used to assess AN, Nguyen A: University of evaluate the relationship between sex, muscle activation differences between Connecticut, Storrs, CT; University the flexibility and strength measures genders. Setting: Bio-mechanics of North Florida, Jacksonville, FL; and MKD. A stepwise linear regression laboratory. Patients or Other College of Charleston, Charleston, was performed to determine the Participants: Twenty eight healthy SC influence of sex, lower extremity physically active participants were strength, and flexibility on MKD recruited to participate in this study. Context:Medial knee displacement, (α≤.05). Results: Decreased hip Fourteen males (22±3yrs, 78.8±7.6kg, or dynamic knee valgus, is often abduction strength (r= -0.23, p=.03), 78.5±4.8cm) and females (22±2yrs, reported as a possible risk factor for decreased gluteus maximus strength 66.7±7.8kg, 65.0±5.2cm) were anterior cruciate ligament (ACL) (r=-0.25, p=.02), greater hip internal matched according to gender and leg injury and patellofemoral pain rotation range of motion (r=0.23, dominance. Leg dominance was syndrome. Knowledge about p=.03) and greater hip abduction range defined as the plant leg during kicking. contributing factors for medial knee of motion (r=0.28, p=.01) were Interventions: Drop jump landings displacement (MKD) is limited, significantly correlated with greater with an external motivator were especially in an adolescent population. MKD displacement. Greater hip performed from a 30cm box onto a Objective:To determine if sex, lower abduction range of motion and force platform followed by an extremity muscle strength and decreased gluteus maximus strength immediate jump to reach for the target flexibility predict MKD. Design: significantly predicted greater MKD height on the external motivator that Cross-sectional. Setting:High displacement (R2=0.16, p=.004). was placed anterior/lateral at a S-150 Volume 47 • Number 3 (Supplement) May 2012 12106DOBI 40°angle from the force platform. This Variability of Postural Control is variability of a time series and is more set-up replicated a common Not Affected by Previous ACL sensitive to differences in postural mechanism of injury for non-contact Injury control than traditional measures. A ACL injuries. The target height was Goerger BM, Padua DA, Frank BS, value closer to 0 indicates a more 75% of the participants’ maximal Begalle RS, Beutler AI, Marshall regular time series, and a value closer vertical jump. Main Outcome SW: Sports Medicine Research to 2 indicates a more random time Measures: The dependent variable was Laboratory, University of North series. Differences in variability of muscle activation. Muscle activation Carolina, Chapel Hill, NC; postural control for the AP and ML was measured using the Myomonitor Uniformed Services University of direction were determined using two IV (Delsys, Boston, MA). Mean and the Health Sciences, Bethesda, MD 2x2 (Group x Leg) mixed model peak normalized muscle activation of ANOVAs. Post-hoc analyses were Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 the transverse abdominus and internal Context: Previous research indicates performed for any significant main or oblique (TrA/IO), rectus abdominus differences in postural control exist interaction effects using Tukey’s HSD (RA), vastus lateralis (VL), biceps following ACL injury and (á£0.05). Results: The ACLR group femoris (BF) and gluteus medius reconstruction (ACLR). Measures of demonstrated similar ApEn values (GMed) were assessed. Muscle variability may be more sensitive to between limbs in the AP (AP: activation was assessed before differences that exist in postural INJ=0.85±0.12 UNINJ=0.92±0.14) (100ms) and after (250ms) initial control following ACL injury. and the ML (ML: INJ=1.17±0.13 contact. Maximal voluntary Objective: To determine if UNINJ=1.15±0.14) directions. The contractions were used to normalize individuals with ACLR display CON group demonstrated similar muscle activation data. Independent t- differences in the variability of values (AP: DOM=0.91±0.15 tests were used to compare differences postural control between limbs and as NONDOM=0.91±0.20) (ML: DOM= in muscle activation between gender compared to healthy controls. 1.17±0.14 NONDOM =1.18± 0.14). (pre-initial contact and post-initial Setting: Sports Medicine Research No significant differences were found contact). Results: No differences Laboratory. Participants: Fifty-two for the main effect of Group (AP: were observed in mean (TrA/IO- p = physically active individuals p=0.60, ML: p=0.70), Leg (AP: p= 0.184; RA- p = 0.894; VL- p = 0.985; participated in this study, 18 with a 0.21, ML: p=0.95), or interaction BF- p = 0.973; GMed- p = 0.661) & history of ACL injury and ACL effect of Group x Leg (AP: p=0.16, peak (TrA/IO- p = 0.389; RA- p = reconstruction (ACLR Group: Males ML: p=0.23). Conclusions: 0.829; VL- p = 0.424; BF- p = 0.671; = 11, Females = 7; Height = Differences in the variability of GMed- p = 0.949) muscle activation 71.56±8.68 cm, Mass = 74.66±10.34 postural control during single-leg before landing. Differences were not kg) and 34 healthy controls with no balance do not exist in those with a observed in mean (TrA/IO- p = 0.352; history of ACL injury or recon- history of ACL injury and RA- p = 0.998; VL- p = 0.527; BF- p struction (CON Group: Males = 16, reconstruction. Bilateral differences = 0.916; GMed- p = 0.820) & peak Females = 18; Height = 171.11± do not exist in healthy individuals (TrA/IO- p = 0.344; RA- p = 0.903; 10.09 cm, Mass = 73.22±14.23 kg) either. Therefore, while previous VL- p = 0.196; BF- p = 0.824; GMed- Interventions: All participants research indicates postural control is p = 0.674) muscle activation following performed single-leg balance atop a affected by ACL injury, a lack of initial contact. Conclusions: This data force plate that recorded center of difference in variability may indicate contradicts previous research that pressure (CoP) trajectories. The task that the ability to respond to internal reported gender differences in muscle was performed bilaterally, and two, or external perturbations is not. activation during a functional task. It twenty second trials were performed Funding for this study provided by the appears that an external motivator may for each leg. A trial was considered National Academy of Sports Medicine. influence a patient’s muscle successful if the participant was able recruitment and may be a factor to to complete the task without raising include in injury prevention programs. their hands off their hips, without touching down with the non-test leg, and did not lift the foot of their test leg off of the force plate. Main Outcome Measures: The variability of the CoP trajectory in the anterior- posterior (AP) and medial-lateral (ML) direction was quantified using the nonlinear measure of Approximate Entropy (ApEn). ApEn quantifies the

Journal of Athletic Training S-151 12208DOBI Sagittal Plane Ankle system. Ankle dorsiflexion displace- Displacement is Associated with ment was calculated as the difference Hip and Knee Internal Rotation between the joint angle at initial foot Angle During Stair Descent in contact and the peak dorsiflexion Females with Patellofemoral during the stance phase. The stance Pain phase was defined as the time from Goto S, Schwane BG, Goerger BM, initial contact of the foot to toe off of Aguilar AJ, Blackburn JT, Padua DA: the affected limb. Peak hip internal Sports Medicine Research rotation (HIR), hip adduction (HAD), Laboratory, University of North knee internal rotation (KIR), and Carolina at Chapel Hill, Chapel Hill, abduction (KAB) angles were also Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 NC measured during the stance phase. All dependent variables were averaged Context: Limited passive ankle across the 3 trials. Pearson Product dorsiflexion range of motion is Moment Correlation Coefficients associated with patellofemoral pain were calculated to identify the linear (PFP). However, the mechanism by relationship between ankle dorsi- which limited ankle dorsiflexion range flexion displacement and the other of motion may lead to PFP is not clear. dependent variables in the PFP Healthy individuals with increased (α<0.05). Results: The participants medial knee displacement also with PFP demonstrated significant demonstrate limited passive ankle correlations between ankle dorsi- dorsiflexion range of motion; however, flexion displacement and peak HIR research has not investigated ankle (r=0.36, p=0.12) and KIR (-r= 0.50, dorsiflexion motion during functional p=0.02). However, there were no tasks or in those with PFP. Objective: significant correlations with peak To examine the relationship between HAD (r=0.09, p=0.71) and KAB (r= ankle dorsiflexion displacement and 0.07, p=0.78). Discussion: De- hip and knee frontal and transverse creased ankle dorsiflexion displace- plane kinematics during a stair descent ment was associated with increased task in females with PFP. Design: HIR and KIR in the participants with Cross-sectional correlational. PFP. Excessive HIR has been Setting: Research laboratory. associated with PFP by increasing Patients or Other Participants: lateral patellofemoral joint loading Twenty female volunteered for this and KIR has been theorized to occur study (20 PFP: Age= 22.2±3.1years, as a coupled motion with HIR. These Ht= 164.5 ±9.2cm, Mass= 63.5± findings suggest that limited ankle 13.7Kg). Inclu-sion criteria for PFP dorsiflexion motion may facilitate included the following: at least 2 compensatory increases in HIR and months of anterior, lateral, or retro KIR in those with PFP. Future research patellar pain during jogging, hopping, investigating interventions to increase ascent and descent during stair ankle dorsiflexion displacement in climbing, kneeling, squatting, those with PFP is warranted. kneeling, and sitting for a long period of time with knee flexed, free from other lower extremity injuries within 6 months prior to the testing, and negative findings on examination of ligaments, menisci, bursa, and synovial plica. Interventions: All participants performed 3 stair descent trials at a standardized speed. Three-dimen- sional lower extremity kinematics were assessed using a 7-camera infrared optical motion capture

S-152 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Ankle/Lower Leg Injury Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12154MONE 12173MOIN The Influence of Dorsiflexion on attached to the dorsal surface of Lower Leg Anterior and Lateral Dynamic Stability in Individuals participant’s foot. Main Outcomes: Intracompartmental Pressure with Chronic Ankle Instability Three trials of the anterior reach of Changes Before and After Classic Wells AM, Terada M, Harkey MS, SEBT were reported as a percentage of Versus Skate Nordic Rollerskiing McLeod MM, Pietrosimone BG, limb length of the participant in Collegiate Nordic Skiers Gribble PA: University of Toledo, (%MAXD). The WB-DF measures were Woods KM, Shultz BB, Petron DJ, Toledo, OH reported as the distance (cm) of the great Hayes BT, Hicks-Little CA: toe from the wall without the heel lifting Department of Exercise and Sport Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Context: Deficits in ankle off the ground. OKC-DF was measured Science, The University of Utah, dorsiflexion and decreased reach at the point of participant perceived Salt Lake City, UT; Department of distance in the anterior direction of the maximum active dorsiflexion ROM Orthopedics, The University of star excursion balance test (SEBT) (degrees). Individual means of three Utah, Salt Lake City, UT have been documented separately in trials for each measure were used for chronic ankle instability (CAI) analysis. Pearson product moment Context: Increasing awareness of patients. Previous findings have correlations were used to assess the chronic exertional compartment suggested that deficits in weight- relationship among dependent variables. syndrome (CECS) among Nordic bearing dorsiflexion (WB-DF) may Significance was set a priori at P<0.05. skiers warrants the need for specific negatively influence dynamic balance Results: WB-DF was significantly and analysis of intracompartmental measured with the anterior reach moderately correlated (r=0.626, pressures (ICPs) before and after distance of the Star Excursion Balance R2=0.390, p=0.026) with %MAXD. Nordic skiing. Objective: The purpose Test (SEBT) in individuals without OKC-DF was weakly correlated with of this study was to determine if lower ankle pathology; but it is unknown if %MAXD (r=0.090, R2=0.010, P= leg anterior and lateral ICPs are this correlation exists in CAI patients. 0.402) as well as with WB-DF(r= 0.293, increased after a 20-minute Nordic Additionally, assessing ankle dorsi- R2=0.09, P=0.206). Conclusion: We rollerskiing time-trial, and to flexion range of motion (ROM) using report a moderate correlation between determine if a difference exists the weight-bearing lunge test (WBLT) the SEBT and the WBLT in participants between post exercise ICPs for classic to measure WB-DF has been with CAI, which is consistent with versus skate rollerskiing. Design: suggested to be a viable alternative to previous reports of similar comparisons Mixed Factorial Repeated-Measures open kinetic chain (OKC-DF) among healthy subjects. Therefore, the Design. Setting: Outdoor, paved goniometric measurements of ankle amount of WB-DF availability on the exercise loop. Patients or Other dorsiflexion. However, there is little WBLT appears to influence anterior Participants: Seven collegiate evidence to substantiate any cor- %MAXD of the SEBT in CAI patients. Nordic skiers with no history of knee, relation between the two measures. We observed that OKC-DF measure was lower leg, or ankle surgery participated Objective: To determine if the anterior weakly correlated with anterior reach in the study (3 men, 4 women; age = reach of the SEBT is correlated with distance of SEBT and WB-DF measures. 22.71 ± 1.38 yrs, height = 175.36 ± WB-DF and OKC-DF in individuals with This suggests that WB-DF may not be 6.33 cm, mass = 71.71 ± 6.58 kg). All CAI; and to determine if the WB-DF related with OKC-DF. Perhaps the WB- partici-pants averaged 500-600 measure is correlated with the OKC-DF DF may be more suitable for making training hours per year, were registered measure. Design: Descriptive labora- comparisons with dynamic tasks such as with the International Ski Federation tory study. Setting: Research Labora- the SEBT. (FIS), had trained using both the classic tory. Participants: Ten participants with Nordic skiing technique and skate self-reported CAI (3M, 7F; 20.40± Nordic skiing technique for at least the 1.78yrs; 167.27±9.16cm; 68.42± past 12 months, and had trained in the 14.67kg) volunteered. Interventions: United States for at least 85% of the Participants performed three trials each time over the past 12 months. of the SEBT in the anterior direction, the Interventions: Independent variables WBLT, and active OKC-DF seated on a were Nordic ski technique (classic and table with an extended knee. The SEBT skate), gender (male or female), and and WBLT measures were performed time (pre exercise, 1-minute post- using the injured limb of the participants. exercise, and 5-minutes postexercise). The OKC-DF measurement was Main Outcome Measures: Anterior performed with a bubble inclinometer and lateral compartment ICPs (mmHg), Journal of Athletic Training S-153 12188FONE and lower leg pain were measured. Ankle Copers Exhibit a force (%). Results: A significant main Results: Results showed an increase Heightened Sense of Force effect of group was observed for in ICPs for all participants for both Swanik CB, Needle AR: University variable error at 30% MVIC (F=4.47, anterior and lateral compartments (p of Delaware, Newark, DE p=0.01). Post-hoc tests revealed = 0.000 and p= 0.002, respectively), variable error was lower in both COP regardless of technique. A three-way Context: Previous research has (11.7±7.9%, p=0.005) and UNS interaction between time, technique, focused on sensory deficits after ankle (15.0±8.8%, p=0.04) when compared and gender was found for the anterior sprains that originate from denervated to CON (21.2±10.9%). No other and lateral compartments and capsuloligamentous tissue; however variables were significantly different. subjective per-ception of lower leg less attention has been directed Conclusions: Although previous pain. The males showed statistical research suggests that unstable ankles towards the potential compensatory Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 have diminished force sense, those significance for the anterior (t(6) = role of intact musculotendinous findings were not supported in this 8.434, p < 0.05) and lateral (t(6) = receptors. The capacity to perceive 3.076, p < 0.05) ICPs between joint loads accurately and respond with study. Our results suggest that both baseline and 1-minute post exercise adequate muscular tension is important copers and individuals with unstable when using the classic technique to the dynamic restraint mechanisms ankles have an improved ability to versus the skate technique. Although and restoration of functional joint match ankle loads when compared to not statistically significant, the stability. While studies have suggested healthy ankles, as measured through females showed higher anterior and that force sense is impaired in subjects variable error. The ankle copers were lateral ICPs at 1-minute post exercise with functional ankle instability, no the most consistent at matching when using the skate technique versus previous studies have investigated accurate force repro-duction. No the classic technique. The males’ ankle “copers;” those patients who previous studies have investigated subjective perception of pain was have sprained their ankle, but do not force sense in a group of copers. This statistically greater at 1-minute post suffer from repetitive ”giving way” data suggests that the heightened exercise during classic rollerskiing events (functional instability). perception from intact musculo- versus skate rollerskiing, whereas the Objective: To investigate deficits in tendinous receptors and/or the females’ subjective perception of pain force sense in healthy, unstable ankles, neuromuscular control of joint loading was statistically greater at 1-minute as well as a group of copers. Design: may be compensatory adaptation/s post exercise during skate rollerskiing Post-test only with comparison after trauma to capsuloligamentous versus classic rollerskiing. Con- groups. Setting: University tissue and denervation of the receptors clusions: Our results suggest that Laboratory. Subjects: 76 subjects within static stabilizers. Nordic skiing contributes to increases (22.4±3.3yrs; 172.3±10.0cm; 72.9± in ICPs which may lead to the 17.3kg) participated in this study. 12189DONE Reactive Joint Stiffness is development of CECS. Additonally, Subjects were stratified into three Impaired in Functionally there may be a potential gender affect groups using the Cumberland Ankle Unstable Ankles between the Nordic skiing techniques. Instability Tool (CAIT): controls Needle AR, Swanik CB: University This is the first study of its kind on (CON, n=20), unstable (UNS, n=19), of Delaware, Newark, DE Nordic skiing and CECS. These results copers (COP, n=19),. Interventions: help provide greater knowledge Subjects were tested for pronation regarding the present phenomenon in force sense at 30 and 50 percent of Context: While many individuals with which Nordic athletes commonly their maximum voluntary isometric ankle sprains complain of sudden experience increases in the anterior contraction (MVIC) on a custom-built “roll-over” events, no data exists and lateral compartments during ski device. Subjects were allowed practice quantifying the reactive stiffening activity, particularly during classic with visual feedback of force prior to properties that could resist these rollerskiing and skate skiing over icy the first trial, but no feedback was injurious forces during unanticipated snow. provided between trials. Subjects were loading. Optimal stiffness regulation instructed to exert their target torque, may be dependent on different static depress a hand-switch, and then hold and dynamic restraint characteristics the ankle at that torque for 2 seconds. to stabilize the joint while the ankle Main Outcome Measures: De- undergoes forced supination range of pendent variables included relative motion. Moreover, there are certain error [(matched torque-target torque)/ individuals who can cope with an ankle target torque, %], the variable error sprain and avoid functional instability; (standard deviation of relative error, yet limited data is available on these %), time to matched force (s), and patients. Objective: To determine coefficient of variation of matched the effect of varying degrees of S-154 Volume 47 • Number 3 (Supplement) May 2012 functional stability on stiffening eccentric lengthening. Additionally, variable, the average of the three regulation strategies at the ankle joint. copers were observed to have less peak measurements was used for analysis. Design: Post-test only with comparison stiffness than healthy and unstable Within each limb, Pearson’s product groups. Setting: University laboratory. ankles, indicating a degree of moment coefficients were used to Subjects: Eighty-one subjects compliance that may aid in the examine relationships between (22.3±3.1yrs; 171.2 ±9.7cm; 71.8± absorption of energy throughout the measures of dorsiflexion ROM and 17.4kg) provided 96 ankles for this perturbation range. This data indicates a posterior talar glide and displacement study. Ankles were stratified into 3 need to examine the neuromechanical measures. Results: Means and standard groups using the Cumberland Ankle relationship between innate properties deviations on the injured and uninjured Instability Tool (CAIT): controls (CON, of the joint and the central nervous limbs, respectively, were: SSK n=69), copers (COP, n=29), mildly system. (3.5º±7.2º, 14.2º±6.1º), PBK (2.9º±

functionally unstable (SPR, n=27), and 6.8º, 14.9 º±6.4º), STSK (22.4º±7.4º, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 functionally unstable ankles (UNS, 12294DOMU 34.8º±6.1º), STBK (23.4º±7.4º, 37.3º n=28). Interventions: Subjects were Relationships between Measures ±7.2º), PTGT (11.6º±4.2º, 17.1º± 6.0º), position-ed in a custom built stiffness of Posterior Talar Glide and and displacement (5.4º±3.0mm, device that generated a rapid 20° Ankle Dorsiflexion Range of 5.1º±3.0mm). In the injured limbs, there supination perturbation to the ankle joint. Motion in Patients with Acute was a weak but significant positive Subjects exerted a pronation force at Ankle Sprains correlation between talar glide as 30% of their maximum, and then reacted Cosby NL, Grindstaff TL, Saliba assessed with the PTGT and dorsiflexion with maximal resistance as quickly as S, Hart JM, Hertel J: Point Loma ROM in the SSK and STSK positions possible when a supination perturbation Nazarene University, San Diego, (r=.36, p=.04; r=.38, p=.03, respective- was sensed. Main Outcome Measures: CA; University of Virginia, ly) and moderate positive correlation Normalized ankle joint stiffness Charlottesville, VA between the PTGT and the STBK (Δtorque/Δrotation, Nm/°/kg) was position (r=.45, p=.008). We also calculated at the short range (0-3°), mid- Context: Limitations in dorsiflexion observed a moderate positive correlation range (0-10°), peak (0°-Peak Torque) range of motion (ROM) are common between posterior talar displacement as and total (0-20°). A 2-way repeated- following lateral ankle sprain. It has been assessed with the ankle arthrometer and measures analysis of variance was used hypothesized that limitations in dorsiflexion ROM (PBK r=.54, to compare differences between groups dorsiflexion ROM are associated with p=0.007; STBK r=.42, p=0.045) on the and stiffness ranges. Results: A restrictions in posterior talar glide, injured limb. In the uninjured limbs, significant group by range interaction however little is known about the moderate positive correlations were was observed (F=2.40, p=0.01). Across relationships between the two. established between PTGT and all groups, short-range stiffness Objective: To examine the relationships dorsiflexion ROM in the SSK, PBK and (0.099±0.04in-lb/°/kg) was signifi- between four different dorsiflexion STSK positions (r=.45, p=.008; r= .47, cantly higher than mid-range ROM measurements and posterior talar p=.007, r=.40, p=.02, respectively). No (0.051±0.02in-lb/°/kg), total (0.043± glide in patients with subacute lateral significant correlations were identified 0.02in-lb/°/kg), and peak stiffness ankle sprain. Design: Descriptive between posterior talar displacement as (0.047±0.02in-lb/°/kg, p<.001). laboratory study. Setting: Laboratory. assessed with the ankle arthrometer and Pairwise comparisons revealed CON Patients or Other Participants: dorsiflexion ROM in the uninjured limbs had significantly greater short-range and Thirty-four patients (19 male, 15 female, (p>.05). Conclusions: Restrictions in mid-range stiffness than UNS (p=0.046, age=22.4±4.2years, height =174.4± posterior talar glide when assessed p=0.023) and SPR (p= 0.032, p=0.048). 10.7cm, mass=75.7±11.7kg) with grade manually (PTGT) and with an Additionally, COP had significantly I or II subacute ankle sprains partici- instrumented device (ankle arthro- lower peak stiffness than CON pated. Interventions: Measurements meter) were positively correlated with (p=0.047) and UNS (p=0.032). were taken on both the injured and limitations in dorsiflexion ROM in the Conclusions: Our data suggests that uninjured limbs of subjects an average injured and uninjured limbs of patients mildly and highly unstable ankles have of 4.3±2.6 days after ankle sprain. Main with subacute ankle sprains. These diminished reactive stiffening properties Outcome Measures: Four different results provide evidence of a direct when compared to healthy ankles. These dorsiflexion ROM measurements were relationship between arthrokinematic differences could be representative of taken (seated straight knee (SSK), prone and osteokinematic restrictions in alterations to both static and dynamic bent knee (PBK), standing straight knee patients recovering from ankle sprains. restraint mechanisms. Lower short- (STSK) and standing bent knee (STBK)). Clinical evaluation that includes an range stiffness has been associated with Posterior talar glide was assessed assessment of non-contractile com- parallel and series elastic components manually using the posterior talar glide ponents following an ankle sprain may of the muscle, while lower mid-range test (PTGT) and posterior talar help guide treatment and rehabilitation stiffness would result from the displacement was assessed with an ankle decisions. regulation of cross-bridge cycling during arthrometer. For each dependent Journal of Athletic Training S-155 Free Communications, Poster Presentations: Preventative Interventions and Training Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F21MONE 12134FOTE The Effectiveness of (DJT) software to measure knee Improved Dynamic Balance Neuromuscular Training on separation relative to hip width at Pre- Following a Lower Extremity Modifiable Anterior Cruciate Land, Landing, and Take-Off. The tests Neuromuscular Control Program Ligament Injury Risk Factors were repeated after the completion of in Division I Women’s Basketball Gabler CM, David SD, Howe CA, training. Three 2x2 repeated measures Players White J, Ragan BG: Division of ANOVA with an intent to treat approach Pfile KR, Pietrosimone BG, Gribble Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Athletic Training, Ohio University, were calculated for knee separation at PA, Buskirk GE, Meserth SM: Athens, OH Pre-Land, Landing, and Take-Off University of Toledo, Toledo, OH (alpha<0.05) Results: There was no Context: Approximately 80% of ACL significant interaction for Pre-Land Context: Deficits in dynamic balance, knee separation (F = 0.05; P>0.05). injuries are linked to noncontact 1,27 specifically, in the anterior reach mechanisms, and more than 70% NMT baseline group mean knee direction of the Star Excursion occur when landing from a jump. separation was 61.1 ± 0.2% and RT was Balance Test (SEBT), have been used Females have more risk factors and 53.9 ± 0.1%. After training, NMT knee to predict acute lower extremity sustain 4-6 times more ACL injuries separation was 58.5 ± 0.1% and RT injury. Interventions targeting than males. Neuromuscular training knee separation was 50.9 ± 0.1%. neuromuscular control have (NMT) programs have been shown to There was no significant interaction demonstrated improved dynamic (F = 0.43; P>0.05) for Landing knee reduce the rate of female ACL injuries 1,27 balance as measured by the SEBT. by modifying risk factors. However, a separation. NMT baseline mean knee However, the duration in which major problem with this research is it separation at Landing was 49.6 ± 0.2% improved dynamic balance can be lacks adequate control groups, making and RT was 41.4 ± 0.1%. After training, sustained following completion of an it difficult to determine whether these NMT knee separation was 45.0 ± 0.2% intervention remains unknown. benefits are due to the NMT program and RT separation was 39.1 ± 0.2%. Objective: To determine whether or an increase in exercise workload. There was no significant interaction dynamic balance can be improved and for Take-Off knee separation (F = Objective: To evaluate the effective- 1,27 maintained over the duration of a ness of a NMT program on a 0.42; P>0.05). Prior to training, the competitive basketball season modifiable ACL risk factor relative to NMT group’s mean knee separation at following a 6-week neuromuscular a resistance training (RT) program of Take-off was 47.7 ± 0.2% and RT was control intervention. Design: equal volume and frequency of 39.0 ± 0.1%; following training NMT Controlled Laboratory Study. Setting: exercise in females. Design: Single- mean knee separation was 45.5 ± 0.2% Research Laboratory. Patients or blinded randomized clinical trial and RT was 38.9 ± 0.1%. Conclu- Other Participants: Eleven Division (Identifier: NCT01433718). Setting: sions: Our results suggest that there I female basketball players (19.40 Laboratory testing; training sessions was no additional benefit from NMT +1.35 yrs; 178.05+7.52 cm, were performed in a fitness facility. in knee separation index during the 72.86+10.70 kg) volunteered. Inter- Patients or Other Participants: DJT relative to a comparable control. vention(s): Participants were tested at Female college underclassmen (N=29; Additional research is needed to three separate sessions: baseline; Age=18.8±0.7 years; Height= 116.1 determine if the reduction of ACL immediately following the 6-week ±7.4 cm; Weight=61.7±8.9 kg) volun- injuries is still present when compared training session (POST1) and 9 months teered for this study. Participants were to adequate controls. Funded by the following baseline (POST2). During assigned to the NMT or RT group by NATA Foundation Masters Grant each session, participants performed covariate adaptive randomization for Program. three trials of the anterior, Body Mass Index and athletic posteriormedial and posteriorlateral experience. Interventions: Partici- reaches of the SEBT using each limb. pants performed either NMT or RT The order of testing for limb and SEBT consisting of 3 training sessions per directions was randomized. The week for 6-weeks of equivalent neuromuscular control and plyometric exercise volume and frequency after training program consisted of 18 baseline testing (NMT: n=15; RT: sessions over a 6-week period, n=14). Main Outcome Measures: supervised and progressed by 2 Landing mechanics were analyzed Certified Athletic Trainers. The using Sportmetrics drop jump test exercises focused on improving lower S-156 Volume 47 • Number 3 (Supplement) May 2012 12181 extremity neuromuscular control and The Effects of Dynamic Warm-Up, from each protocol. The significance emphasized proper landing techniques. and the Combination of Dynamic level was set at ≤0.05. IRB approval Main Outcome Measures: The and Static Warm-Up on Sprint was obtained prior to data collection. average of the 3 test trials for each leg Performance Times in Collegiate Main Outcome Measure: Two 60m was reported as a percentage of leg Power Athletes maximum effort standing start sprints, length. An average of the normalized Christ EM, Cable AL, North JB, recorded by two researchers using a scores for both limbs in all three Stevens SW: The University of standard stopwatch (Accusplit Pro directions (anterior, posteriormedial, Findlay, Findlay, OH Survivor 601X 3V). A stop watch has posterior-lateral) was used for been determined to be valid and analysis. A composite score was Context: Better ways for athletes to reliable. The average time for the created by averaging the normalized fastest trial was calculated from both warm-up and prepare for events could Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 values from the three measured reach directly affect performance and injury researchers and used for analysis. directions to create a single prevention. Athletic trainers with Inter-tester reliability of trials was normalized value. Imputed means were knowledge and understanding of warm- excellent with ICC(3,k)=0.983 over all calculated for two participants at one up procedures could influence injury trials and days. Results: Descriptive time point (one for POST1 and one for prevention. Objective: To determine statistics were as follows: Dynamic POST2) who were unable to the effects of dynamic warm-up and warm up 8.61± 0.5 s, Combination participate due to injury. Four separate the combination of static stretching warm up 8.65±0.49 s, Control 8.77± 1x3 repeated measures analysis of and dynamic warm up on sprint 0.49 s. There was a significant variance tests were performed to performance times in collegiate difference between conditions F identify differences over time in the 4 power athletes. Design: Randomized ( 2,46)= 5.41,α =0.048. Using a normalized reach values (anterior, Cross-over Clinical Trial Setting: pairwise comparison, the dynamic posteriormedial, posterior-lateral, Controlled environment on a 200 m warm-up was .04 s faster than the composite). Post-hoc dependent t- indoor track. Patients or other combination warm up which was not tests were performed to determine if participants: 24 healthy, NCAA II significantly different (p=.364). The posttests differed from pretest values. collegiate baseball, softball and track dynamic condition was .16 s faster A priori significance level was set at and field athletes (12M, 12F, than the control (p=.009). The P<0.05. Results: The mean for Age=19.46±1.38yr, HT= 1.72± .11M, combination warm-up was .12 s faster anterior and composite reach were WT=69.46± 13.61 kg). Intervention: when compared to the control significantly different over time Subjects reported for three testing (p=0.03) Conclusions: The two best

(F2,10=5.16, P= 0.016; F2,10=6.96, P= sessions, performing one of three 25 warm up options to optimize per- 0.005 respectively). Baseline anterior minute warm-up protocols (dynamic formance are dynamic or combination reach (63.37+3.18%) was sig- warm-up, combination warm-up, and warm up. During dynamic warm up, nificantly lower than POST1 control) during each testing session. subjects were exposed to movement

(65.36+2.88%; t10=-2.71, P= 0.022) The order of protocols was patterns used during sprints; their

and POST2 (66.21+5.27%; t10=-2.69, counterbalanced to decrease any bodies may adapt quicker leading to P=.023). Similarly, baseline com- cumulative effect. Subjects completed decreased sprint time. The com- posite reach (70.41+4.08%) was a 5 minute jog at a self-determined bination warm-up is good for athletes lower than POST1 (73.38+419%; pace as a general warm-up. The preferring a static stretch.

t10=-3.75, P= 0.011) and POST2 dynamic warm-up included 2 x 20 m 12184UOMU (74.2+4.77%; t10=-3.78, P=.004). bouts of straight leg skips, walking high Conclusions: Dynamic balance can knees, running high knees, and flick The Influence of Athletic be improved and sustained through a backs with 10 s rest between sets, Participation on the Degree competitive athletic season following finishing with 2 x 50 m striders. The of Change of Scapular Upward a 6-week neuromuscular control combination warm-up included 3 x 30 Rotation intervention. Lower extremity sec stretches alternating legs, Ingram RL, Tucker WS, Shimozawa neuromuscular control training including standing gastrocnemius, Y: University of Central Arkansas, produces long term benefits in lying straight leg raise, standing quad, Conway, AR; Georgia Southern improved dynamic balance. Future gluteus, and static lunges, followed by University, Statesboro, GA; A.T. research will need to determine if the dynamic warm-up protocol. Still University, Mesa, AZ improvement in dynamic stability will Control subjects completed the 5 be beneficial for injury risk reduction. minute jog, sat for 15 minutes then Context: Athletic participation completed the striders. Statistical characteristics, such as the sport and analysis included a repeated measures position played, have been found to 1x3 ANOVA with pairwise comparison affect static scapular upward rotation. comparing subjects to their own times However, previous studies have used Journal of Athletic Training S-157 the static scapular upward rotation analysis revealed a significant main randomly assigned to the level surface measurements taken at specific effect within the position intervals SLS (LSS, n=10; 20.89+ 1.76yrs, positions of humeral elevation to make (F2,72=70.564; p<0.001). Pairwise 168.3+8.4cm, 68.68+ 9.85kg), the comparisons. It is unclear if the comparisons determined interval 3 decline surface SLS (DSS, n=10; degree at which scapular upward (17.4±4.9°) was significantly greater 20.89+2.84yrs, 171.94+8.7cm, 70.18 rotation changes from position to than interval 2 (15.3±4.3°) and interval +13.38kg) or control (CON, n=6; position is different between groups 1 (5.6±4.9°), while interval 2 was 20.83+2.92yrs, 166.33 + 5.98 cm, with various athletic participation significantly greater than interval 1. 66.43+8.84kg). Two participants were characteristics. Objective: To assess There was no main effect for group excluded after missing >25% of the position interval degree of change (F2,36 =2.253; p<0.120) and there was exercise sessions. Interventions: of scapular upward rotation between no group X position interval Pretest-posttest measures of strength

healthy male overhead athletes, non- interaction (F4,72=2.042; p<0.098). and functional performance included Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 overhead athletes and non-athletes. Conclusions: Differences in the a modified Star Excursion Balance Test Design: One-between (group), one- degree of change of scapular upward in anterior (YANT), posteriolateral within (position interval) mixed rotation within the three position (YPL), and posteriomedial (YPM) model. Setting: Controlled intervals were evident. Previous directions, Step-Up-and-Over-Test laboratory environment. Patients or research determined differences in (SUO, NeuroCom, Inc), single leg hop Other Participants: Thirty-nine static scapular upward rotation (SLH), single leg triple hop (SL3H) males with no history of shoulder between groups with various athletic and peak torque at 60 degrees/second injury participated in this study: 13 participation characteristics. However, (Biodex, Inc). Participants completed intercollegiate overhead athletes the current study found the position practice trials of all tests to familiarize (19.8±1.4 y, 181.8±6.6 cm, 88.4±8.4 interval degree of change of scapular themselves with the exercises and kg), 13 intercollegiate non-overhead upward rotation between healthy equipment. Participants assigned to athletes (20.8±1.3 y, 178.9±5.9 cm, overhead athletes, non-overhead LSS or DSS (15° angle) performed 83.4±15.6 kg) and 13 recreationally fit athletes and non-athletes to be similar. 3x15 repetitions, twice/day, 3 days/ non-athletes (21.8±0.8 y, 178.9±6.8 Future research should investigate the week for 6 weeks, with bodyweight cm, 89.1±11.4 kg). Interventions: degree of change of scapular upward resistance only. Exercise sessions Static scapular upward rotation was rotation in an injured population to were supervised. All participants were measured on the throwing dominant determine if a similar outcome exists. encouraged to maintain normal arm with a digital protractor while physical activity for the duration of subjects were at rest and at 60°, 90° 12209FOTE this study. Main Outcome Mea- and 120° of humeral elevation in the The Effect of Surface Angle on a sures: The dependent variables were scapular plane. Three trials were Six-Week Single Leg Squat the change scores for normalized performed at each position with a 30 Exercise Program. YANT, YPL, and YPM, SUO Lift-up second rest period between each trial. Newsham KR, Bennett JE, Howell and Impact Indices (LI and II, Order of position was randomized. The TG: Saint Louis University, St. respectively), SLH, SL3H, and peak three upward rotation measurements at Louis, MO torque at 60 degrees/second. ANOVA each position were averaged. For each was utilized to compare the groups subject, the average upward rotation Context: Single leg squat (SLS) is with a Bonferroni post-hoc analysis. measurement at each position was utilized in rehabilitation of lower Alpha was set at .05. Results: We subtracted from the average upward extremity injuries. A SLS performed found no significant differences rotation measurement at the on a declined angled surface (DSS) between groups in regard to changes subsequent position to yield a degree increases quadriceps activity and is in functional performance measures. of change at three position intervals: recommended for treating patellar All groups had negligible decreases in 60°-rest=interval 1, 90°-60°=interval tendinopathy. Little is known regarding LI and II (LSS -2.0+9.8; DSS 2 and 120°-90° =interval 3. The the efficacy of SLS or DSS in regard -0.66+7.66; CON -1.83+9.43; p= independent variables were group to strength or functional performance. .945; LSS -1.44+7.6; DSS -2.66+9.19; (overhead, non-overhead and non- Objective: To evaluate the effect of CON -6.5+5.2; p=.468, respectively). athlete) and position interval (interval surface angle during SLS on Changes in SLH and SL3H were not 1, interval 2 and interval 3). Main quadriceps strength and functional statistically significant (SLH: LSS Outcome Measures: The dependent performance. Design: Randomized 5.45+7.47; DSS 5.44+10.21; CON variables were the degrees of change control trial. Setting: Research 15.18+12.59, p=.140; SL3H: LSS of scapular upward rotation at the three laboratory. Patients or Other 13.46+18.82; DSS 14.67+16.98; position intervals. A one-between, one- Participants: Twenty-six healthy, CON 27.58+24.70, p=.364). No within repeated measures ANOVA was physically-active, volunteers were significant differences were identified performed. Level of significance was stratified according to injury history between groups for YANT (LSS p<.05. Results: The statistical and physical-activity level, and then -1.82+4.12; DSS 7.66+15.26; CON S-158 Volume 47 • Number 3 (Supplement) May 2012 4.29+9.83, p=.198), YPL (LSS 19.5+10.45; and ascent of each squat was maintained healthcare professional, however, little DSS 11.14+7.57; CON 14.82+7.17, by a metronome set at 60bps. The is known about what can be done to p=.516) or YPM (LSS 12.64+13.5; DSS middle three repetitions of each set prevent injuries in these underserved 9.99+17.27; CON 15.39+7.14, p=.765). were analyzed. Main Outcome locations. Objective: To determine The only significant difference between Measures: The dependent variables the feasibility of implementing an groups was the change in peak torque were joint angles at peak knee flexion injury prevention program for boys and at 60 degree/second with the control for the hip and knee in the sagittal, girls basketball teams at rural, group demonstrating greater change frontal, and transverse planes. underserved Kentucky high schools. than either of the treatment groups (LSS Dependent t-tests were used for Design: Cohort study. Setting: Field- -2.044+15.11, DSS -7.48+9.95, CON analysis. The alpha level was set at testing. Patients or Other 12.433+2.78, p= 0.24). Conclusions: A p<0.05. Results: Significant Participants: Four rural inter-

six week training program of differences between FSD and LSD scholastic high school basketball Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 bodyweight exercise was not sufficient were found. At the knee, significantly teams in Kentucky that included 2 to improve strength or functional greater flexion (FSD: 73.9+5.9°, boy’s teams (Team A n=19, Team B performance measures included in this LSD: 68.4+4.3°, p=0.002), adduction n=11), 2 girls teams (Team C n=18, study. Further research with overload (FSD: 9.22+2.8°, LSD: 6.02+4.3°, Team D n=9) and 4 coaches 2 males training is recommended. p=0.003), and external rotation (FSD: (Teams A, B) and 2 females (Teams C 5.49+6.9°, LSD: 7.61+6.4°, p=0.008) and D). Interventions: Each coach 12241DOBI was produced during the FSD than was given an injury prevention program Hip and Knee Joint Kinematics LSD. At the hip, the FSD resulted in that utilized evidence-based exercises. During Lateral- and Front-Single greater hip adduction (FSD: Coaches were provided with exercise Leg Stepdowns 13.7+6.9°, LSD: 11.6+6.5°, p=0.012) descriptions and a video demonstrating Thorpe JL, Oblak PA, Bazett-Jones but not different in hip flexion (FSD: each exercise. An athletic trainer DM, Earl-Boehm JE: University of 37.8+11.3°, LSD: 38.9+12.2°, instructed coaches on proper technique Wisconsin-Milwaukee, Milwaukee, p=0.491) or internal rotation (FSD: and commonly made errors. Coaches WI 3.95+4.5°, LSD: 5.15+6.2°, p=0.288). were instructed to implement the Conclusions: The FSD task resulted exercise program three times per week Context: Single-leg stepdowns are in greater knee and hip angles when throughout the course of the season. commonly used in rehabilitation of compared to the LSD completed from A log of practice, games, and exercise various injuries involving the lower the same height. The FSD is a more sessions was documented by the extremity, and can be performed to the demanding task and requires greater coaches and submitted once a week. front (FSD) or laterally (LSD). control of the limb, specifically in the Single-limb postural control was Research has shown that the frontal plane. Clinicians would be assessed pre- and post-intervention implementation of FSD within a advised to use an FSD when attempting using measures of Time-to-Boundary rehabilitation protocol is effective in to screen for poor proximal control of (TTB). Each subject was tested decreasing the symptoms of patello- the femur and possibly injuries like bilaterally for 3 trials of 10s and the femoral pain and improving proximal patellofemoral pain or illiotibial band mean was taken for each limb. Main strength; however, there is no research syndrome. Clinicians may also wish to Outcome Measures: The dependent identifying the biomechanical progress patients through rehabil- variables were the compliance rate to differences between the FSD and the itation starting with the LSD and complete the exercise program three LSD. Objective: To compare 3D moving to the FSD. times per week, percentage of subjects kinematics during performance of the that drop-out and TTB measures. FSD and LSD. Design: Repeated 12315DOTE Compliance was calculated by number measures. Setting: Neuromechanics The Feasibility of Implementing of sessions completed divided by Laboratory. Subjects: Ten healthy an Injury Prevention Program in number of sessions proposed. participants (7 females, 3 males; age High School Basketball Players Acceptable compliance was set at 90% 21.3+2.2 years, height=171.9+4.6 cm, Silkman CS, McKeon JM, McKeon a priori. T-tests were used to measure mass=69.4+4.7 kg) with no history of PO, Mattacola CG, Lattermann C: the differences in TTB pre to post for lower extremity pathology of the University of Kentucky, Lexington, each team. Results: Overall, the dominant limb or balance disorders KY compliance rate was 65%± 0.10. Team volunteered. Interventions: The C met adequate compliance levels at independent variable was the direction Context: In rural and low-income 96%± 0.10, while Teams A, B, and D of squat performed (LSD, FSD). After areas, access to health care is limited resulted in unacceptable compliance completing several practice trials, and injury prevention programs are not rates 53%± 0.20, 49%± 0.30, and participants performed three sets of readily available. Balance training has 88%± 0.20 respectively. Drop-out rate five repetitions of each squat from a been shown to reduce ankle and knee was less than 1%. An increase in the 6-inch box. The timing of the descent injuries under the supervision of a anterior/posterior TTB standard Journal of Athletic Training S-159 deviation of the minima of the right leg last 6 months, no prior head injury, no individuals with concussion is (2.88 ± 0.41, p= 0.05) and a trend in neurological condition or balance unknown and warrants investigation. increased postural control for the problems. Interventions: All subjects absolute minimum in the anterior/ com-pleted the Sensory Organization 12345DOPR posterior direction of the right leg Test (SOT), Adaptation Test (ADT), and Improvements in Muscular (1.47± 0.22 p= 0.09) for Team C were the Modified Clinical Test of Sensory Endurance Following a Baseball present. However, TTB measures did Interaction on Balance (mCTSIB) onthe Specific Strengthening Program not change significantly for Teams A, NeuroCom® Smart Balance System. in High School Baseball Players B, or D. Conclusions: The incon- Each subject’s standing balance was Moore SD, Uhl TL, Haegele LE, sistency among the four teams tested under two visual testing Kibler WB: University of Kentucky, indicates that this program is feasible conditions: (1) standard testing methods Lexington, KY; Shoulder Center of Kentucky, Lexington, KY

and able to increase postural control without specific instructions given to the Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 for certain coaches, but not overall. subject to focus the visual field at a Factors such as gym schedule, school specific location, and (2) visual Context: Preventative strengthening cancellations, and other unforeseen distraction through optical flow motion. programs for adolescent baseball circumstances might have played a role A computer-generated optical flow players have been suggested, but little to reduce compliance and effective- pattern was used as the visual distraction empirical data exist regarding their ness of the program. stimulus. Testing procedures were effectiveness for this population. counter-balanced for order of the testing Objective: To determine changes in (standard protocol or visual distraction) upper extremity muscular endurance in 12316DOSP and for the order of each balance test adolescent baseball players during an Visual Distraction Does Not (SOT, ADT, mCTSIB).Main Outcome 8 week pre-season training regimen Alter Static or Dynamic Upright Measures: Composite equilibrium with follow up at 20 weeks, which Postural Stability in Healthy score (weighted average of all the represented the start of the spring Subjects scores), sensory systems preference baseball season. Secondarily, changes Cripps AE, Livingston SC: University (degree to which subject relies on visual, in strength, range of motion and in- of Kentucky, Lexington, KY vestibular, or somatosensory infor- season time lost to injury were mation) from the SOT; magnitude of examined. Design: Pre-test post-test. Context: An individual’s ability to response for the ADT; and mean center Setting: Sports medicine clinic. maintain upright standing balance of gravity sway velocity for the mCTSIB. Participants: 14 baseball players involves the integration of visual, Results: The presence of visual (age=16±2yr; ht=182±8cm; mass= vestibular, and somatosensory infor- distraction had no significant effect on 75±11kg; 11 pitchers/catchers) with no mation.Visual stimuli must be accurately upright postural stability asmeasured by recent injury were tested at 4, 8 and perceived and processed for an individual the SOT composite equilibrium scores 20 weeks. Interventions: Participants attended three supervised training to maintain normal postural stability ( t20=1.228,p=0.234, 95% confidence during alterations of the visual interval [CI],-0.90-3.47), SOT sensory sessions/week. Strengthening of the scapular, rotator cuff and forearm environment. There is little research analysis [somato-sensory (t20=0.997, documenting the impact of visual p=0.331, 95% CI,-0.01-0.02), visual muscles was performed using a stair- step progression emphasizing distraction (i.e. optical flow motion) on (t20= 0.852 p=0.404, 95% CI,-0.04- repetition over load. Additional static or dynamic standing balance 0.08), vestibular (t20=0.930, p=0.364, among healthy subjects. Symptoms that 95% CI,-0.22-0.06), sensory system conditioning for the lower extremity (LE) was imple-mented for major affect the visual system following a preference (t20=0.726, p=.476, 95% concussion may influence an athlete’s CI,-0.32-0.07)],ADTmagnitude of muscle groups using body weight and elastic resistance. Main Outcome ability to decipher which information is response (toes up t20=-0.710, p=0.486,, Measures: Internal rotation (IR) and important and true and which information 95% CI,-7.87-3.87; toes down t20=0.403, is incorrect. Objective: To identify the p=0.691,95% CI.-2.66-3.94) and external rotation (ER) strength and influence of visual distraction on mCTSIB mean center of gravity sway motion were assessed at 90° abduction. Posterior shoulder standing balance and postural stability in velocity (t20=-0.418, p= 0.680, 95% CI, normal, healthy subjects during static -0.06-0.04). Conclusions: Visual endurance test (PSET), measured in and dynamic balance tasks. Design: A distraction had no significant effect on Nm, required the participant to ran-domized,crossover study design was standing balance and postural stability perform repetitions to failure of prone used. Setting: University research in the presence of altered optical flow. horizontal abduction to 90° using 2% laboratory. Patients or Other Healthy subjects were able to of their body. PSET reliability was Participants: Twenty-one healthy disregard visual distraction and performed a priori (ICC=.81, subjects (age 22.10 ±1.61; 9males, maintain upright balance. The influence SEM=13.7Nm). Maximum distance 12females) with no history of lower of visual distraction on static and hopped on a single leg was used to extremity injury or surgery within the dynamic standing balance among evaluate LE strength. Separate mixed S-160 Volume 47 • Number 3 (Supplement) May 2012 model linear analyses were performed for each variable, followed by a Bonferroni post-hoc analysis as appropriate (α≤.05). Results: Posterior shoulder endurance improved (p<.001), increasing from 437±209Nm at baseline to 941±472Nm at 4 weeks (p=.001) and remained elevated throughout the program. Single leg hop work improved bilaterally (p<.001),

increasing from 1006±278Nm to Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 1505±354Nm in the lead leg and from 959±271Nm to 1451±362Nm in the stance leg at 4 weeks (p<.001) and remained elevated throughout the program. IR ROM, total arc of motion (ER+IR) and ER/IR strength ratio did not change over the course of the program (p>.05). For the 13 participants who played spring baseball, the total player-games for the 10 week season equaled 270 exposures. Three participants sustained injury during the season (sprained ankle, back muscle strain, hamstring strain), for a total of 7 games missed due to injury. No shoulder or elbow injuries were reported. Conclusions: While muscular endurance increased, strength did not, which reflects the specificity of training of this program toward endurance and is likely due to the pre- existing high strength ratio in this cohort. These findings indicate clinicians should address both strength and endurance as separate constructs. Assessment and training of endurance is of particular importance given the documented link between arm fatigue and shoulder pain in throwers. This study describes a simple clinical measurement of shoulder endurance. Finally, this evidence suggests that participants in the pre-season training program were adequately prepared for the season and incurred minimal time loss due to injury.

Journal of Athletic Training S-161 Free Communications, Poster Presentations: Physiological Effects of Cryotherapy Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12228FOTH 12277DOTH The Effect of Different Cold and ECG and automated blood pressure Time for a Paradigm Shift? The Compression Treatment device. A hand-held probe was placed Role of Cryotherapy on Protocols on Femoral Artery on the skin over the common femoral Microvascular Perfusion Blood Flow and Tissue artery where Doppler ultrasound Selkow NM, Herman DC, Liu Z, Hart Temperature in Healthy Subjects measures of femoral blood velocity JM, Hertel J, Saliba S: Illinois State Trowbridge CA, Keller DM: The and femoral diameter were used to University, Normal, IL; University of University of Texas, Arlington, calculate FBF. Measurements were Virginia, Charlottesville, VA Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Arlington, TX taken at predetermined time points from both the cryotherapy treated leg Context: A main rationale for using Context: Cryotherapy and com- and the non-treated leg. Main cryotherapy after acute injury is to pression are recommended for the Outcome Measures: TIM and TSK (°C), decrease blood flow in the cooled area control of hemorrhage and MAP (mmHg), and change from as decreased blood flow may attenuate inflammation. However, limited baseline for FBF (ml/min) inflammation and hasten recovery information exists comparing tissue (Mean±SE). Separate 2-way repeated from injury. It is unknown whether temperature decreases and global measure ANOVAs with levels cryo-therapy results in decreased blood flow changes using various including treatment (GR1/GR2), leg blood flow in skeletal muscle with treatment protocols. Objective: To (treated and non-treated), and/or time delayed onset muscle soreness examine the effects of two Game (0, 15, 30, 45, 60, 75, 90, 105,120 (DOMS). Objective: To examine the

Ready® treatments with cyclical minutes) were used. TIM, TSK, and MAP effect of repeated cryotherapy cooling/pneumatic compression (on) were analyzed with 2 x 9 (treatment x interventions on microvascular and passive recovery (off) [30 on/30 time), FBF was analyzed using a 2 x 9 perfusion and pain in the 48 hours after off/30 on/30 off (GR1) and 30 on/90 (leg x time) and with a 2 x 9 (treatment eccentric exercise to the gastroc- off (GR2)] on intramuscular tem- x time) for treated leg. Alpha set a nemius utilizing a DOMS model. priori at 0.05. Results: For GR1, T perature (TIM), skin surface temper- IM Design: Randomized controlled was colder for 45-120 minutes ature (TSK), mean arterial blood laboratory study. Setting: Laboratory. pressure (MAP), and femoral artery compared to GR2 (p<0.05). Maximum Patients or Other Participants: blood flow (FBF). Design: Within TIM change from baseline (GR1: Eighteen healthy participants repeated measure designs. Setting: -9.9±1.2 vs GR2:-5.8±0.98°C) volunteered (3M, 15F; Age: 22.2±2.2 Controlled laboratory setting. occurred at 90 minutes. For MAP, years; Height: 166.0±11.9 cm; Participants: Seven males (age= there were no significant treatment or Weight: 69.4±25.0 kg). Inter- 22±2 yr, mass=88±11 kg, height= time differences (p>0.05). The vention(s): Subjects performed 100 183±6 cm, thigh skinfold=16.6±7.1 average change for FBF for the treated heel-lowering exercises off a step in mm) volunteered. All had no current leg was not significantly different a sequence of 50 repetitions, 5- injury involving their lower extremity (p=0.52) between GR1 (-121±15.4 minutes rest, 50 repetitions to the beat and were not taking prescription ml/min)andGR2 (-159± 23.2 ml/min), of a metronome. Subjects were medications. Interventions: Game but for both treatments the cooled leg randomized to one of three Ready® with ice water and knee/thigh exhibited greater reductions in blood intervention groups (cryotherapy, sleeve with medium pneumatic flow when compared to the control leg sham, control). A 750g ice bag was compression (5-50 mmHg) was used. (p=0.02). Conclusions: Cycled cold used for cryotherapy, a 750g bag of Knee sleeve was left in place during water and compression produced candy corn was used for the sham, and passive recovery. GR1 was delivered significant decreases in both femoral a towel was used for the control. using a manufacturer preset for two blood flow and tissue temperature. Treatments were applied to the successive cycles and GR2 was However, more research is warranted exercised leg after the microvascular delivered using 30 on/90 off. A to clarify the time course and perfusion measurement immediately thermocouple inserted 1.5cm below magnitude of these changes in injured following exercise and 10, 24, and 34 the subcutaneous adipose layer tissue. hours after exercise. Main Outcome sampled TIM and a surface thermo- Measures: Perfusion measurements couple sampled TSK. Thermocouples (blood volume (dB), blood flow (dB/ were interfaced to a computer through sec), and blood flow velocity (sec-1)) an Isothermex®. Heart rate and blood were taken using contrast-enhanced pressure were collected using a 3-lead ultrasound at baseline, immediately

S-162 Volume 47 • Number 3 (Supplement) May 2012 12280MOTH after exercise (within 5 min), immediately Effect of Cryotherapy on Delayed- at baseline, 10, 24, 34, 48, 72, and 96 after initial treatment, and 48 hours after Onset Muscle Soreness hours after the initial exercise. exercise. Microvascular perfusion was Shulby AC, Selkow NM, Hart JM, Comparisons were made at all time measured at a 1cm depth into the medial Saliba SA: University of Virginia, points using a bootstrapping method of gastrocnemius. Visual analog scale Charlottesville, VA; Illinois State 95% confidence intervals for each (VAS) scores (mm) for pain were taken University, Normal, IL measure. Results: Sta-tistically at baseline, 10, 24, 34, and 48 hours after significant differences were found exercise. Separate intervention by time Context: After acute injury, between groups when the confidence repeated measures ANOVAs were cryotherapy is typically the first line intervals did not overlap. The only calculated for each dependent variable. of defense against pain, swelling, and variables where CIs did not overlap

Results: There were no significant functional deficits. Cryotherapy is were calf girth and self-reported Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 interactions for the microvascular believed to attenuate the inflammatory function. The ice group had decreased perfusion measures, however, process and speed recovery time. calf girth compared to the control significant time main effects for blood Most research has focused on a single group at 48 hr (Ice: 33.7cm (32.9 - volume and blood flow (p<.001) were application of ice or cold-water 34.4); Control: 35.4cm (34.7-36.2)), found. Baseline volume (5.9±1.3 dB) immersion.However, clinically, 72 hr (Ice: 33.9cm (33.0-34.7); and flow (2.3±0.4 dB/sec) measurements several cryotherapy applications are Control: 35.6cm (34.8-36.3)), and 96 hr were significantly less than applied over consecutive days to (Ice: 33.6cm (32.9-34.3); Control: measurements immediately post- minimize the effects of injury. 35.5cm (34.6-36.3)). However, girth for exercise (12.2±3.3 dB, 4.52±1.05 dB/ Objective:To determine whether two the control group at baseline was slightly sec), post-intervention (11.5±3.3 dB, cryotherapy interventions a day for higher than the cryotherapy group and 4.1±0.9 dB/sec) and at 48 hours two days would improve the signs and girth at 48, 72, and 96 hours did not (11.8±3.1 dB, 4.4±1.0 dB/sec). There symptoms of delayed-onset muscle change from baseline for either group. was a signi-ficant intervention by time soreness (DOMS) in the gastroc- The ice group also had decreased self- interaction for VAS scores (p=.009). nemius over 96 hours. Design: reported function at 10 hours compared Pain was significantly less at 34 hours Descriptive laboratory study. Setting: to the control group (Ice: 93% (94.1- (22.3 ±12.8 mm) and 48 hours Laboratory. Patients or Other 98.4); Control:99.4% (98.8-100.0)). (29.8±117 mm) for the cryotherapy Participants: Thirty-six healthy Conclusions:While statistically group compared to control (38.3±14.6 subjects volunteered to participate (8 significant, there were no clinically mm and 52.5±15.1 mm, respectively). M, 28 F; Age: 23.4 ± 3.2 years; Height: important differences between groups Cryotherapy VAS scores were also 168.0 ± 11.9cm; Weight: 68.3 ± 15.4 on the treatment of DOMS. Sequential less at 34 hours compared to sham kg). Inter-vention(s): Subjects cryotherapy treatments, initiated (45.50±14.16 mm). Conclusions: performed unilateral eccentric immediately after eccentric exercise, With DOMS in the gastrocnemius, exercises on a randomly selected leg. did not affect outcomes of pain, point four applications of cryotherapy did Calf-lowering repetitions were tenderness, ROM, strength or function. not affect microvascular perfusion performed from a raised exercise step over 48 hours however, cryotherapy to the beat of a metronome. The 12299MOEX did decrease pain. These results eccentric portion of the exercise Blood Lactate Responses to Cold challenge the longstanding hypothesis lasted 3 seconds. The sequence was 50 Water Immersion and Biking that ice decreases intramuscular blood repetitions, 5 minutes rest, and 50 compared to Controls in flow to cooled areas. A paradigm shift repetitions. Immediately after the Professional Ice Hockey Players may be needed as the clinical benefits exercise, either a 750g-crushed ice bag after High Intensity Skating of cryotherapy after muscle injury or towel (control intervention) was McCann J, Fowkes Godek S, may be primarily due to sensory randomly applied to the gastrocnemius McCrossin J, Raffa S, Morrison effects. in a prone positionfor a pre- K: HEAT Institute at West Chester determined amount of time based on University, West Chester, PA; skinfold thickness. The intervention Philadelphia Flyers, Voorhees, NJ was againapplied 10, 24, and 34hours after the initial exercise. Main Context: Blood lactate recovery is Outcome Measures: Calf girth (cm), important after high-intensity dorsiflexion range of motion (°), anaerobic exercise common to ice plantarflexion strength (kg), pain on a hockey. Previous research has visual analogue scale (mm), point investigated the effects of biking or tenderness (kg/cm2), and self-reported cold-water immersion versus controls function using the Lower Extremity on post exercise recovery of blood Function Scale (%)were all measured lactate. However, a comparison study Journal of Athletic Training S-163 of cold-water emersion and biking treatment (pre-treatment) and at 5- treatments on blood lactate have not post, 10-post and 15-post initiation of been evaluated in professional ice treatment. Main Outcome hockey players. Objective: To Measures: Blood lactate (mmol• examine the effects of cold-water l-1).Results: No differences in immersion (CWI), stationary cycling physical characteristics were found (Bike), and seated recovery between groups. Blood lactate (Control)after high-intensity skating increased from baseline (3.1 ± 1.3 on blood lactate levels immediately mmol•l-1) to post-exercise (11.4 ± 4 prior to treatment (pre-treatment) and mmol•l-1), P< 0.001, however no at 5 (5-post), 10 (10-post) and 15 (15- differences were found between

post) min post treatment. We groups at baseline or post-exercise.At Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 hypothesized that Bike would produce 5-post blood lactate was different a greater reduction in blood lactate from Control (9.7 ± 2.4 mmol•l-1) in compared with CWI orControl. Bike (7.9 ± 2.5 mmol• l-1) and CWI Design: Randomized Control Clinical (7.7 ± 2.1 mmol•l-1), P=.01. There Trial.Setting: Professional ice hockey were no group differ-ences at 10-post, training facility. Patients or Other P=.08, and only Bike (5.9 ± 2.6 Partici-pants: Sixty professional ice mmol•l-1) was different from Control hockey players (age: 24.1 ± 5.2y (8 ± 2.1 mmol•l-1) at 15-post, P = .02. weight: 90.5±7.5kg and height: Conclusions: The results suggest that 185±5.4cm) randomly divided into after 5 min of treatment both biking three experimental groups participated and cold-water immersion facilitate a in the study. Interventions: Blood greater reduction in blood lactate lactate was measured via fingerstick compared to seated rest. After 15 min technique prior to and then of treatment, only Bike was immediately following an anaerobic significantly different from Control, on-ice 3 min skating test in full hockey however, our research protocol equipment. After exercise, players included only 8 min of CWI because immediately returned to the locker- it is the typical length of time these room, removed their equipment and players remain in cold water post reported to their assigned treatment exercise. Both Bike and CWI appear which was either Control (15 min to facilitate the removal of lactate seated rest), CWI (8 min cold water at from the blood after high-intensity 11pC immersion to ASIS level and skating in elite ice hockey players then 7 min standing) or Bike (15 min however, additional research should stationary cycling at 70% MHR). evaluate a longer period of time for Blood lactate was measured by lactate CWI post exercise. analyzer (Accutrend) before and after exercise, and then immediately before

S-164 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Measurement Assessment (Validity & Reliability) Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F12MOIN 12F13FOIN Impact of Mental Toughness completed online. Participants The Mental, Emotional and Training on Psychological and completed questionnaires assessing Bodily Toughness Inventory Physical Predictors of Illness mental toughness (MeB-Tough), mood (MeBTough): Construct Validity and Injury state (Profile of Mood States), Evidence Visram A, Fitzgerald K, Snook depression (Beck Depression Snook EM, Visram A, Masse H:

EM: Department of Kinesiology, Inventory), perceived stress (Perceived Department of Kinesiology, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 University of Massachusetts, Stress Scale), physical symptoms University of Massachusetts Amherst, MA (Cohen-Hoberman Inventory of Physical Amherst, MA Symptoms), and burnout (Athletic Context: Intense training for Burnout Questionnaire) prior to and at Context: Mental toughness, the prolonged periods of time without the conclusion of the program. Main ability to perform at one’s best adequate recovery can result in Outcome Measures: Total scores regardless of the circumstances, is a psychological problems and increased from the six questionnaires were modifiable cognitive trait and an susceptibility to illness and injury in compared to determine if the Mental essential psychological attribute for collegiate athletes. Mental toughness, Toughness Training Program improved successful athletes. The Mental, the ability to perform in the upper mental toughness, mood state, Emotional, and Bodily Toughness range of one’s ability regardless of the depression, and perceived stress and Inventory (MeBTough) is a recently situation, is a modifiable psycho-logical reduced physical symptoms and developed measure of mental construct that can influence cognitive burnout. A Repeated Measures ANOVA toughness with good psychometric appraisal, and is one of the most was used to evaluate the effectiveness properties. However, additional important characteristics that an athlete of the program. Results: Mental validity evidence for the MeBTough is can possess. Altering an athlete’s toughness levels were significantly needed. Objective: To provide interpretation of stressful situations increased in the intervention group evidence of construct validity for the through mental toughness training could (F=7.08,p=.01), and the training led to MeBTough by examining the relation- potentially change how the athlete significant reductions in total mood ship between mental toughness and evaluates his/her ability to handle the disturbance (F=5.98,p=.02), depre- other psychological (mood state, stressors of training and competition, ssion (F=4.87, p=.04), and total depression, perceived stress, athlete and may attenuate the negative number of physical symptoms burnout) and physical (physical psychological outcomes that are experienced (F=5.77, p=.02). symptoms) variables that are associated with increased risk of Perceived stress and athlete burnout associated with successful sport developing illnesses and injuries. were not significantly changed by the performance.Design: Cross-sectional Objective: To implement a 6-week training. Conclusions: The Mental study. Setting: Smith College personalized Mental Toughness Training Toughness Training Program led to an (Division III private institution). Program and evaluate its impact on increase in mental toughness levels, Patients or Other Participants: 47 mental toughness, mood state, and was able to significantly reduce female student athletes (19.3±1.4 depression, perceived stress, physical levels of mood disturbance, years of age) on Smith College varsity symptoms, and athlete burnout in depression, and physical symptoms in athletic teams. Interventions: Parti- Division III athletes. Design: Ran- Division III female athletes. These cipants completed the MeBTough, domized nested design. Setting: Smith findings show that mental toughness along with measures of mood state College (Division III private institution). training had a positive effect on (Profile of Mood States), depression Patients or Other Participants: 36 psychological and physical variables (Beck Depression Inventory), female student athletes (19.3±1.4 years that have been associated with perceived stress (Perceived Stress old)on the Smith College varsity Field increased risk of injury and illness in Scale), physical symptoms (Cohen- Hockey (n=15) and Soccer (n=21) collegiate athletes. Further research Hoberman Inventory of Physical teams. Interventions: Participants were examining how mental toughness Symptoms), and athlete burnout randomly assigned by team to the 6-week training affects psychological and (Athletic Burnout Questionnaire). Mental Toughness Training Program physical variables in other samples Main Outcome Measures: Spearman (field hockey) or wait-list control (males, Division I athletes) is Rho correlations were calculated condition (soccer). The Mental warranted. Funded by the NATA among the scores from the measures Toughness Training Program involved Foundation Masters Grant Program. to determine if mental toughness is daily psychological skills training Journal of Athletic Training S-165 associated with these psychological questions to be answered because of RM ANOVA and violating important and physical variables.The MeBTough the ability to examine the individual assumptions that must be met. By was expected to have negative growth trajectories as opposed to using the HLM, more detailed research correlations with mood disturbance, simply comparing group means. This questions can be answered without the perceived stress, depression, burnout, statistical analysis also does not strict assumptions as seen in the RM and physical symptoms, and finding possess the strict assumptions that the ANOVA. such relationshipswould provide RM ANOVA does. Data Sources: All evidence of construct validity for the original research articles published in 12038FOHE measure. Results: Mental toughness the JAT from 2005-2010 (N=218) The Use of a Customized, Web- was significantly correlated with total were coded for general research based Electronic Medical Record mood disturbance (ρ=-.51 p<.001), design according to the new by Athletic Trainers in the ρ Secondary School Setting:

depression ( =-.49, p<.001), per- nomenclature set forth by the editorial Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 ceived stress (ρ=-.53,p<.001), and board and Dr. Hertel in the JAT May Preferences, Usability, and athlete burnout (ρ=-.46, p=.001). 2010 issue. Secondly, the same Barriers to Use Total number of physical symptoms studies were coded for a more specific Huxel Bliven K, Parsons JT, was not significantly correlated with design (longitudinal, pre-post, Anderson B, Bay RC, Lam KC, mental toughness, but it did have repeated measures, or other). Study Snyder AR, Sauers EL, Valovich significant positive correlations with Selection: From this classification, McLeod TC: Arizona School of all of the other measures. Con- 52 of the 218 studies were longitudinal Health Sciences, A.T. Still clusions: Higher levels of mental designs. Fifty of the 52 studies used University, Mesa, AZ toughness were associated with lower the RM ANOVA to analyze the data. levels of mood disturbance, de- More specifically, 24 of the 52 Context: National recommendations pression, perceived stress, and athlete longitudinal studies were classified as call for clinicians to document patient burnout in Division III female athletes. crossover studies using Dr. Hertel’s care using electronic medical records These findings provide additional nomenclature. These 24 studies served (EMR). Clinician preference, construct validity evidence for the as the sampling frame for the data perceived usability, and barriers to the MeBTough, and indicate that the collection of this work. Data use of EMRs impacts adoption and MeBTough provides a good assess- Extraction: Through a random should be routinely assessed to ment of mental toughness. sampling procedure, 18 corresponding optimize utilization. Objective: authors were contacted through e- Assess athletic trainers’ (AT) 12011DOHE mail. Nine authors were willing to preferences and perceived usability of Examining the Experimental provide the de-identified data current and proposed EMR Designs and Statistical Analyses requested for the first RM ANOVA components on clinical practice, and of Athletic Training over the presented in the journal article. Data identify barriers to routine EMR use. Past Six Years Synthesis: All 9datasets were coded Design: Cross-sectional. Setting: Lininger MR, Spybrook JK: to insure confidentiality. Following Web-based survey of secondary Western Michigan University, descriptive statistics, the RM ANOVA school ATs utilizing a custom web- Kalamazoo, MI was completed as described in the based EMR. Patients or Other published article. The reanalysis Participants: Of the 25 ATs using the Context: The most common method results were then compared with the custom web-based EMR for at least 1 to analyze data from longitudinal findings presented in the JAT. Only 1 year in a secondary school setting, a designs in athletic training is with the of the articles mentioned assumption voluntary sample of 22 (88%) repeated measures analysis of variance testing. In all nine datasets, the completed the survey (male=8; female (RM ANOVA). There may be concern assumption of sphericity was violated =14; age=25.4±3.0 yrs). Inter- with this analytical technique due to yet the analysis continued. Next, an ventions: The survey contained 25 the numerous assumptions that must HLM was used to reexamine the same questions in 5 categories: demo- be met for the results to be valid. data. The HLM reanalysis revealed that graphic, perceived usability of current Objective: The purpose was to the data could be more appropriately EMR components, perceived usability examine an alternative statistical modeled since only 1 of the datasets of EMR on job performance, method for data from longitudinal was linear. This allowed for more perceived usability of proposed EMR designs in athletic training compared detailed research questions to be components, and perceived barriers to to the traditional RM ANOVA. I answered such a show did individuals EMR use. Main Outcome Measures: proposed using the hierarchical linear growth trajectoriesin the treatment Dependent variables were: perceived model (HLM) which has been more condition compare to the control usability or barrier, measured as the commonly used, with success, in other condition. Conclusions: The major degree to which respondents agreed or health care fields. Using the HLM finding of this work was that in the past disagreed with statements using a allows for more detailed research 6 years, many authors are utilizing the Likert Scale ranging from 1 (strongly S-166 Volume 47 • Number 3 (Supplement) May 2012 12070MOBI disagree) to 5 (strongly agree). A Riding Hand Effect on Postural participant’s COG as “right” or “left” descriptive analysis was used to report Sway and Center of Gravity in sided. To understand the effect of responses. Results: Seventeen (77.3%) Professional Rodeo Cowboy’s handedness on COG, a 2X2 Chi square respondents held a bachelor’s degree, 19 Association Bull Riders analysis was performed for each (86.4%) were AT certified <4 yrs, and Ready ST, Ransone JW, Vela LI: balance condition. PS was established 16 (72.7%) had previous EMR Texas State University, San Marcos, using a postural sway index from the experience. The majority of respondents TX; Coffeyville Community m-CTSIB. To understand the effect of (71.9%) “agreed”/“strongly agreed” that College, Coffeyville, KS handedness on postural sway index, the each of the 12 current EMR authors ran 4 separate independent components was useful in practice. The Context: Bull riding requires great samples t-test for each balance most useful components were: injury condition. A Bonferroni correction for

skill and strength and is one of the Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 evaluation forms (4.1±0.7); injury most dangerous sports in which to multiple comparisons used for an a demographic forms (3.9±0.8); daily compete. To stay atop a bucking bull, priori level of significance of patient sign-in sheets (3.9±0.9); and, a bull rider’s center of gravity (COG) p=0.0125. Results: There were no daily treatment progress notes must be maintained over the bull. A differences between right and left (3.8±0.9). The least useful features compromised COG could place the handed rodeo athletes in regards to the were the automated diagnostic (ICD- rider at a great disadvantage and at postural sway index. T-tests results 9) and treatment (CPT) codes increased risk for injury due to an under the eyes open firm condition (3.2±1.3). The majority of respondents unplanned dismount. Anecdotal (t20=2.432, p=0.042), eyes closed (57.6%) “agreed”/“strongly agreed” beliefs amongst bull riders suggest firm condition (t20=1.350, p=0.216), that the EMR enhances effectiveness, that bull riding handedness may play a eyes open foam surface (t20=1.064, improves job performance, makes role in altering COG. Objective: The p=0.300), and eyes closed foam (t20= doing the job easier, and is generally purpose of this study was to determine -0.396, p=0.696) surface were not advantageous to the job. Clinicians if preferred riding hand had an effect significant. There were no differences rated the EMR’s ability to help on COG or postural sway (PS) in in center of gravity plots between right accomplish work tasks more quickly professional bull riders. Design: and left handed bull riders under the χ2 as 2.7±1.1, with 7 (31.8%) agreeing Field Laboratory. Setting: Balance eyes open firm condition ( =2.148, and 10 (45.4%) disagreeing. Perceived tests along with a riding preference p=.143), eyes closed firm condition χ2 usefulness of 8 proposed EMR questionnaire were completed at the ( =0.42, p=0.838), eyes open foam χ2 components was greatest for: patient San Antonio Rodeo and Stock Show. ( = 0.003, p=.958), and eyes closed χ2 registration (4.5±0.8); coach reports Patients or Other Participants: foam condition ( = 0.003, p= .958). (4.4±0.5); “quick” notes tool Twenty-two male Professional Rodeo Conclusion: No relationship existed (4.2±0.7); and body region evaluation Cowboy’s Association Bull Riders between handedness and balance in this forms (4.2±0.9). Primary barriers to (weight=70.94±7.08kg; height = study, but further research on balance routine EMR use were: form length 69.1±2.6 cm; age = 24±3.02 years; in functional positions should be and/or completion times (3.9±0.9 to professional rodeo experience = conducted. 4.1±0.8); patient non-compliance with 5.9±2.9 years; total rodeo experience 12196UODI form completion (4.1±.09); and peers/ = 14.2±4.7 years) volunteered to A Comparison of Traditional and co-workers not using the EMR participate in the study. Inter- Modified Volumetric Techniques (3.5±1.2). Internet and/or computer ventions: Participants were tested for Wilson KD, Tsang KKW, Jaramillo access (2.1±1.3 to 2.5±1.1) were not PS and COG with the modified ER: California State University identified as obstacles to routine EMR Clinical Test of Sensory Integration Fullerton, Fullerton, CA use, although additional computers and Balance (m-CTSIB) test of the would improve utilization (3.4±1.4). Biodex Balance System SDin an Con-clusions: The custom web- unshod bipedal stance under four Context: Water volumetry is based EMR was perceived as useful and testing conditions with three, 20- considered the “Gold Standard” for beneficial to clinical practice. second trials: eyes open firm surface, girth assessment in clinical health care Primary barriers to EMR use in the eyes closed firm surface, eyes open practices. Volumetry allows the secondary school setting are time/ foam surface and eyes closed foam clinician to monitor changes in length of required elements and social surface. Participants also completed swelling (an indicator of tissue influences, which are potentially a three question survey about riding healing) and make appropriate modifiable factors. Consistent with technique.Main Outcome Mea- treatment decisions. Traditional water national healthcare recommendations, sures: Two judges independently volumetry involves immersion of a ATs should be encouraged to document coded the PS plots (κ=1.00) to body segment (e.g., ankle, arm) into a patient care using an EMR. establish COG location by analyzing container of water and measurement the plots and classifying the of the displaced water via graduated Journal of Athletic Training S-167 cylinders. Accuracy of these = .99; TRD (E1 487.82 ±174.5, E2 487.24 Pivot Test. All tests were completed measurements is limited by the quality ±174.8 mL), ICC = .99; between MOD in full pads with sticks to simulate and readability of the graduated (475.41 ±171.0 mL), TRD (487.53 ±174.6 game situation and speed. Each test cylinders. Objective: The purpose of mL), ICC = .99. The SEM calculated for was completed three times with a 30 this study was to compare a modified MOD was 5.41 mL and 9.56 mL for TRD. second rest between trials and each protocol to traditional water Conclusions: Our results indicate the successive task. Data was collected volumetry. Design: Reliability study. modified volumetry protocol provides at the site over two separate three week Setting: Research laboratory. measurements that are very similar to periods. For each testing session, the Patients or Other Participants: 2 the traditional “Gold Standard” first week consisted of a training examiners (mean age = 25 years) with technique. Moreover, the smaller SEM session followed by the second week no previous volumetric assessment calculated for the modified protocol of data collection and then another experience performed measurements indicates measurements are closer to data collection a week later. Intraclass Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 on 26 volunteer models. Inter- actual values than the traditional Correlation Coefficients (ICC3,1) was ventions: Independent variables were technique. Empirical evidence used for test-retest reliability, with examiners (E1, E2) and volumetry suggests that the modified protocol Standard Error of Measurement protocols (modified, traditional). The requires less equipment, consists of (SEM) and Methodological Error. same volumetric tank was used for all fewer steps, and could effectively Main Outcome Measures: Three measurements (Foot Model; Wisdom replace traditional volumetry maximal attempts with the best time King, Oceanside, CA). Traditional assessment. recorded in seconds for the volumetry (TRD) required the Acceleration test, Top Speed test, S displaced water to be transferred from 12214FOMU cornering test, On Ice Quickness, On the collection vessel to a standard 500 Test Re-Test Reliability of on Ice Ice Leg Quickness and Pivot Test. mL graduated cylinder (with 5 mL Exercises for Functional Ice Results: The S Cornering Test had the Hockey Return to Play Battery increments) for measurement. The highest ICC (ICC3,1=.882, SEM = .104 modified protocol (MOD) involved Sandrey MA, Games J: West sec) followed by the Top Speed test Virginia University, Morgantown, weighing the displaced water with a (ICC3,1 =.841, SEM=.155 sec), On Ice WV standard digital scale (CHAMP II, leg Quickness Test (ICC3,1= .780, OHAUS, Pine Brook, NJ) instead of SEM=.220 sec), the Pivot Shift graduated cylinders. Each examiner Context: Functional screening tests (ICC3,1= .778, SEM=.165 sec), and the was provided with instructions and have been established for ice hockey, On Ice Quickness test (ICC3,1 = .721, demonstrations of both protocols, but it is unknown if they are SEM=.098 sec). The lowest ICC was familiarized with equipment, and specifically used as criteria for return for the Acceleration Test (ICC3,1 = practice opportunities. Feedback and to play. The on ice activities .608, SEM= .06 sec). Methodological corrections were provided only during established in the functional ice error ranged from .018% to .38%. practice trials. Each examiner hockey return to play battery has been Based on the low SEM results, there performed three trials of both used as criteria for return to play but would be minimal variation of the protocols on the same ankle of the reliability for this test is unknown. measurements expected on a day to volunteer models. The order of Objective: To establish reliability for day basis. Conclusion: The exercises volumetry protocol was randomized the Functional Ice Hockey Return to established in FIHRPB are reliable for each model. Main Outcome Play Battery (FIHRPB). Design: A tests when used for return to play from Measures: Dependent variable: prospective test re-test design. ice hockey injuries. Further research displaced water (mL). Intrarater (IAR) Setting: A Division I club ice hockey needs to be conducted on the validity and interrater (IER) reliability for each team. Patients and Other Parti- of FIHRPB since moderate to good protocol and between protocols were cipants: A total of 23 participants reliability was established with low evaluated using intraclass correlation from a D-I club hockey team (age= methodological error. coefficients formula ICC (2,1). In 20.39±1.85 yrs, mass= 81.23±6.69 addition, the standard error of kg, height=184.01±5.10 cm)) volun- measurement (SEM) was calculated teered. All participants included in the for each protocol. Results: All values study encompassed a variety of ice presented as mean ±SD (mL). IAR and hockey positions that were free of IER were found to be very high: IAR lower extremity injury for the previous E1 MOD (474.84 ±171.5 mL), ICC = 6 months. Interventions: The .99; TRD (487.82 ±174.5 mL), ICC = participants were asked to complete .99; E2 MOD (475.98 ±170.7 mL), the on ice tests in the FIHRPB which ICC = .99, TRD (487.24 ±174.8 mL), included the Acceleration test, Top ICC = .99; IER MOD (E1 474.84 Speed test, S cornering test, On Ice ±171.5, E2 475.98 ±170.7 mL), ICC Quickness, On Ice Leg Quickness and S-168 Volume 47 • Number 3 (Supplement) May 2012 12232DOEX Tracking Distance in Division I (-0.02km; 95%CI -0.09 to 0.05) and MM phase of their menstrual cycle (MC), Men’s Soccer: A Comparison of was (0.01km; 95%CI -0.05 to 0.07). The however, prior investigations often Global Positioning Systems DC measured with the two devices was lacked validated assessment tools to Huggins RA, Willis LR, Pryor RR, similar (p = 0.11).Mean total DC for the characterize MC phase. Objective: To Stearns RL, DeMartini JK, Johnson six practices, one game, and combined evaluate the accuracy, sensitivity, and EC, Pagnotta KD, Lopez RM,Casa practices and game as indicated by the specificity of an algorithm designed to DJ: University of Connecticut, GT was (10.0± 2.34km, 11.15± 3.73km, retrospectively classify an athlete’s Storrs, CT 10.17± 2.60km) respectively, and for MC phase at the time of a “mock” MM (9.30± 2.35km, 11.27± 5.54km, injury based on historic MC Context: Calculating distance covered 9.60 ± 3.07km). The % change information and salivary progesterone between MM and GT were (-7.5, 1.0, (P4) concentration. Design: (DC)during team sports such as Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 soccer is important to athletic trainers, -5.9%) for practices, game, and Prospective cohort with nested coaches, and researchers when practice/game combined. MM-GT retrospective assessment of MC estimating or obtaining specific mean differences for DC in practice, phase. Setting: Academic research training volumes, athletic game and practice/game combined laboratory. Participants: Thirty-one performances and rehabilitation goals. were (-0.70± 0.66km,p ≤ .05; 0.12 ± healthy, female collegiate athletes (18- Previously this calculation of DC has 2.05km, p = 0.84;-0.56± 1.02km; p ≤ 24 years) with normal MC history and proven difficult to obtain. Due to .05), respectively. Correlations no prescription medications including recent technological advances in the between the devices for practice, game hormonal contraception. Inter- area of global positioning systems and practice/game combined were ventions: Subjects attended 8 visits (GPS), the ability to measure distance r2=(0.96, 0.98, and 0.93), respectively. over one completeMC, with one visit in a team sport setting is now feasible. Conclusion: The distances reported randomly assigned as the mock injury Currently, no research exists by the two devices were similar during date. Saliva samples were obtained at comparing different GPS measure- the game, however during practice and each visit, and serum samples obtained ment devices during Division I soccer. practice/game combined comparisons, every other visit. Ovulation date was Objective: The purpose of this the devices were found to be ascertained with daily urinary LH observational research was to describe significantly different. It should be detection tests and serum P4. MC the accuracy and compare two noted that clinically the differences information was acquired by an common GPS devices currently on the between the two devices are very small investigator blinded to all other market (one less expensive$300/unit, indicating that they are useful aspects of the study via a Hormonal and one expensive $2000/unit), used measurement tools for determining History Questionnaire (HHQ) for quantifying exercise distance. distance, performance and training administered at a randomized time Design: Observational field research. volume. point (1-45 days)after the mock injury Setting: Outdoor soccer field. date. At the completion of data Patients or Other Participants: 12365FOIN collection, four clinical experts Twenty-one male NCAA Division I Validation of an Algorithm to examined HHQ information and a soccer players (age, 20± 1y; height, Predict Ovulatory Status at the single salivary progesterone con- 187.5± 2cm; mass, 76.2 ± 5.6kg) Time of Injury centration obtained after the mock Interventions: Participants com- Tourville KJ, Tourville TW, Knudsen injury. They then retrospectively pleted six practices (98.9 ±21.9min) EJ, Shultz SJ, Bernstein IM, Vacek classified each subject’s MC phase at and one game(113 min)on a standard PM, Holterman LA, Smith HC, the time the mock injury occurred grass soccer field. DC was collected Slauterbeck JR, Hardy DM, Johnson (consistent with case-control using two different GPS devices, the RJ, Beynnon BD: University of investigations). Expert and algorithm less expensive Timex Global Vermont College of Medicine, classification results were compared Trainer®(GT) and the more expensive Burlington, VT; University of North using Kappa statistics. Sensitivity and Catapult Minimax®(MM). Addition- Carolina at Greensboro, Greensboro, specificity were determined by ally, accuracy was determined in a NC; Texas Tech University, Lubbock, comparing classification results to separate pilot testing session on a TX known MC phase at the time of the standard outdoor running track with all mock injury based on ovulation date. subjects running in the innermost lane. Context: Women are 2-8 times more Results: Fourteen subjects (45%) had Main Outcome Measure: Paired likely to sustain an anterior cruciate an ovulatory cycles; consequently, sample t-tests were performed to ligament (ACL) injury than men. The only 2 subjects were confirmed to be analyze differences between mean DC mechanisms for this disparity are post-ovulatory at the time of their as measured by both GPS devices. unclear. There is consensus in the assigned mock injury date. The Alpha level was set at 0.05 a priori. literature that women are at increased algorithm correctly classified MC Results: The accuracy of GT was risk of injury during the pre-ovulatory phase at the time of mock injury for Journal of Athletic Training S-169 74%of subjects, with 76% specificity and 50% sensitivity for the pre- ovulatory phase. The experts correctly classified MC phase for 71-74% of subjects, with 72-76% specificity and 0.50-1.00% sensitivity. Agreement between expert and algorithm phase classifications ranged from 81% (Kappa = 0.50) to 93% (Kappa = 0.83). Conclusion: The algorithm and experts did not accurately predict MC phase at the time of injury. Sensitivity Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 of the post ovulatory phase could not be adequately assessed due to the high number of anovulatory cycles, and consequently low number of subjects with mock injury dates in the post- ovulatory phase. Our findings raise questions regarding the accuracy of MC phase classification of young athletes in other investigations, particularly in a population with a high occurrence of anovulatory cycles.

S-170 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Issues In A.T. Education Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12071FOPE The Acquisition, Retention, and Measures: We used separate paired- that lead to feelings of frustration while Application of Knowledge sample t tests to compare mean pre- completing an entry-level ATEP.

Following a Conference test and posttest1 exam scores to Design: We used qualitative methods Workshop Attended by Athletic determine knowledge acquisition as to gain rich description of the factors

Trainers well as mean posttest1 and posttest2 involved in student frustration while Doherty-Restrepo JL, Hughes BJ, exam scores to determine knowledge completing an ATEP. Setting: Pitney WA, Cheatham SW: Florida retention. Our a priori level was set at National Athletic Trainers’ Association International University; University P=<.05.The knowledge application (NATA) accredited Post-Professional Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 of Central Missouri, Warrensburg, survey responses were analyzed with Education Program. Patients or MO; Northern Illinois University, descriptive data. Results: Mean Other Participants: Fourteen (12 DeKalb, IL; California State knowledge scores increased signi- female, 2 male; age = 22.21±1.05 University, Dominguez Hills, CA ficantly from baseline (6.22 ± 1.35) years) successful graduates of

to posttest1 (7.44 ± 1.24), t(22)=3.88, accredited undergraduate entry-level Context: Continuing education is P=.001 (effect size, d=.90). Parti- ATEPs currently enrolled in an NATA required for athletic trainers (ATs) to cipants retained their knowledge as the accredited Post-Professional Educa- mean posttest score (7.22 ± 1.48) was tion Program volunteered to maintain their credential yet little is 2 known regarding its efficacy and not significantly different from the participate. The participants graduated posttest score, t(8)=0.61, P=.559. from 14 different ATEPs located in 6 application to clinical practice. 1 Objective: To assess ATs’ acquisition, The survey results indicated that 89% out of the 10 NATA districts. The retention, and application of (n=8/9) of participants agreed that not participants’ ATEPs also represented knowledge following a conference only did they retain their knowledge all three major Carnegie classi- workshop. Design: Cohort pre-test, and skills, but they were also able fications (6 from research insti- post-test design. Setting: Differential integrate those skills into clinical tutions, 6 from master’s institutions, diagnosis of the hip joint workshop practice and improve patient care. and 2 from baccalaureate insti- presented at the Mid America Athletic Conclusions: The eight-hour tutions).Data Collection and Trainers’ Association Annual Meeting. workshop with combined lecture and Analysis: We conducted semi- Patients or Other Participants: A hands-on activity was effective in structured interviews, transcribed the sample of 23 ATs (10 female, 13 male; facilitating the acquisition and interviews verbatim, and analyzed data age 36.6 ± 9.6) who registered for the retention of these ATs’ knowledge and with a grounded theory approach workshop and volunteered to skills, which were applied to clinical utilizing open, axial, and selective participate in the study. Interventions: practice to improve patient care. coding procedures. We used NVivo An eight-hour workshop including (version 8, QSR International Pty Ltd, 12165DOHE lecture and hands-on lab activities was Cambridge, MA)computer software to Frustrations Among Graduates of experienced by the participants. A 10- facilitate the coding procedure. To Athletic Training Education item multiple-choice exam was ensure trustworthiness of the data, we Programs created by the workshop instructor negotiated over the coding scheme Bowman TG, Dodge TM: Lynchburg specifically for the workshop and its until we came to agreement, com- College, Lynchburg, VA; Springfield content was validated by an expert pleted peer debriefs, and performed College, Springfield, MA panel. The exam was administered at member checks. Results: Four three time points: prior to (baseline), themes emerged from the data. Context: Although previous research Athletic training student frustrations immediately following (posttest1), and 4-weeks after the workshop has begun to identify sources of appear to stem from the amount of athletic training student stress, the stress involved in completing an ATEP (posttest2). A 3-item survey with five responses ranging from “strongly specific reasons for frustrations that leading to anxiety and feelings of being agree” to “strongly disagree” was used occur while students are completing overwhelmed. The interactions to obtain an understanding of the an athletic training education program students have with classmates, faculty, participants’ application of the (ATEP) are not yet fully understood. and ACIs can also be a source of knowledge gained from the workshop. It is important for athletic training frustration for AT students. This survey was administered at the educators to understand sources of Monotonous clinical experiences student frustration to provide a often left students feeling disengaged. same time as posttest2. The survey’s content validity was examined by a supportive learning environment. Students questioned entering the three member panel. Main Outcome Objective: To determine the factors profession of AT because of the fear Journal of Athletic Training S-171 of work-life balance problems and low certified ATs was obtained from the sponsibility’ 39 (8.9%) respondents. compensation. Conclusions: Based on National Athletic Trainers’ Associ- The overall sample mean GPA was our results, we believe frustrations can ation. Newly certified AT were 3.47±0.30 and BOC attempts ranged be avoided by providing a supportive considered to be within two years post- from one to more than four, 299 learning environment for athletic graduation from an entry-level CAATE (69.9%) passed in one attempt, 74 training students. Instructors should accredited program and currently (17.3%) two, 33 (7.7%) three, 13 support their students by validating employed as an AT. A total of 428 ATs (3%) four and 9 (2.1%) in more than their membership in the ATEP as this (n=136 males, n=292 females) four attempts. Conclusions: Entry- validation will help students to responded, producing a response rate level ATs appear satisfied with their understand their roles and thrive in the of 25%. Interventions: Respondent’s clinical education preparation. educational program. Faculty, staff and sex, grade point average (GPA), and Respondents felt the least adequately

ACIs are encouraged to communicate Board of Certification (BOC) exam prepared in the professional practice Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 effectively and make student attempts were recorded. A perceived domain of ‘organization and expectations clear as this practice will adequacy and confidence to practice administration. The results suggest help to motivate students to persist. questionnaire using a 5-point Likert that athletic training students are Providing students with appropriate scale was constructed based around the receiving adequate clinical education clinical education experiences that are professional practice domains. An experience, which establishes characterized by graded autonomy can expert panel examined the validity of confidence to practice athletic training keep learning exciting. Finally, we the instrument. A test re-test reliability after graduation. believe that student interactions with pilot study was conducted with a professional mentors and role models convenient sample of 45 athletic 12243MOHE that highlight the dynamic nature of the training graduate students. Pilot data Clinical Satisfaction Levels of athletic training field will foster analysis revealed Cronbach’s alpha National Athletic Trainers’ feelings of excitement about pursuing 0.86 and interclass correlation of 0.87. AssociationAccredited Post- a career in athletic training. The survey was administered using Professional Athletic Training SurveyMonkey and was distributed by Graduates 12213 initial and follow-up e-mails. Main Catalano NA, Arman TS, Walter Entry-Level Athletic Trainers’ Outcome Measures: Responses were JM, Hankemeier DA, Manspeaker Perceived Adequacy of Clinical scored and transformed into SA, Van Lunen BL: Old Dominion Education in Preparation for ‘adequate/confident,’ ‘neutral,’ or University, Norfolk, VA Confident Professional Practice ‘inadequate/not confident.’ Scores Shinew KA, Weade R, Krause BA, were totaled for perceived adequacy Context: Limited information exists Martin R, Wan G, Ragan BG: and confidence to practice athletic concerning the satisfaction of Division of Athletic Training, Ohio training, along with each professional graduates from National Athletic University, Athens, OH; Gladys W practice domain. Descriptive statistics Trainers’ Association Accredited Post- and David H Patton College of were used to evaluate the adequacy and Pro-fessional Athletic Training Education and Human Services, confident percentages. Pearson Education Programs (PPATEP) related Ohio University, Athens, OH correlations evaluated the relation- to clinical education. Outcome ships between overall adequacy and measuresof satisfaction scores are Context: Athletic training clinical confidence. Results: Three hundred necessary to evaluate the clinical education research is primarily seventy-three (87.1%) respondents aspects of these programs. Objective: centered on clinical instructors and perceived their overall clinical To identify various aspects of clinical charac-teristics of clinical settings, education adequate and 414 (96.7%) satisfaction for 2009-2010 graduates with a paucity of data focused on the felt confident to practice athletic of NATA Accredited PPATEPs. athletic training student as a learner training. The relationship between Design: Cross-sectional. Setting: within the clinical setting. Athletic perceived adequacy and confidence to Online survey instrument. Patients or training students’ perception of practice AT was significant (r =0.74; Other Participants: Electronic mail clinical education adequacy has been P<0.05). The highest adequacy rating addresses for the 2009-2010 PPATEP largely ignored. Objective: To among the professional practice graduates (n = 307) were gathered examine the perceptions of newly domains were; prevention 393 from the NATA online member certified athletic trainers (ATs) (89.7%), evaluation and diagnosis 396 directory database. Of the 307 regarding the adequacy of their clinical (90.4%), immediate care 387 (88.4%), graduates, 40 e-mail addresses were education in preparation for confident and treatment, rehabilitation and either invalid or unobtainable, entry-level professional practice. reconditioning 364 (83.1%). Showing therefore 267 graduates were invited Design: Cross Sectional. Setting: highest inadequacy rating were to participate. One hundred six(65 Online survey. Participants: A sample ‘organization and administration’ 46 female: age= 24.91 ±1.7yrs; 41 male: of 1920 email addresses of newly (10.5%) and ‘professional re- age =26.05 ±2.25 yrs) graduates (2009 S-172 Volume 47 • Number 3 (Supplement) May 2012 graduates = 50; 2010 graduates = 56) areas such as mentorship received from weekly studying for exam).Main completed the survey (39.7% the primary clinical mentor and formal Outcome Measures: The dependent response rate). Intervention: An and informal feedback received about variable was BOC™ score and the initial email that contained a performance at the clinical placement independent variables were HRST© description of the importance of the are deficient. Future research should sub-scale scores. A simultaneous research study, the URL survey involve the examination of strategies multiple regression analysis was hyperlink, the estimated time to to improve clinical mentorship and conducted to determine which of the complete the survey (30 minutes), and feedback for PPATEP students. HSRT© sub-scales were significant a request for partici-pation was sent to predictors of BOC™exam per- participants with a follow up e-mail 12252FOHE formance. Results: Correlation sent out once per week for the four The Impact of Clinical Reasoning analysis revealed that deductive Skills on BOC Examination

weeks of data collection. The survey reasoning, analysis and interpretation, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 instrument was created using Inquisite Performance and inference scale scores were 9.5 Corporate Survey Builder. Main Weiss WM, Neibert PJ: University significantly and positively related to Outcome Measures: Demographic of Northern Iowa, Cedar Falls, IA BOC™ exam score. Correlations information and satisfaction scores were moderately low (r=.29-.35).The (Likert scale 1-5) related to Context: Athletic Training candidates multiple regression was significant: components of the clinical education face a challenging task on the path to F(5,65)=3.49, p<.01, with 21% of the plan were obtained and analyzed using becoming a certified athletic trainer. variance being explained by HRST SPSS (Version 17.0, PASW Inc. Uncertainty surrounds the pro- sub-scale scores. The inference scale Chicago IL). This information related fessional community as to why certain score emerged as the only significant to supervision levels and contact time candidates, who otherwise perform predictor of BOC™ exam score with clinical staff, hours spent within soundly both academically and (β=.36). Thus, higher performance on clinical practice, formal and informal clinically, struggle to be successful on the inference scale predicted higher feedback received about performance the certification exam. Clinical BOC™ exam scores. Conclusions: during the clinical experience and reasoning skills are at the heart of The results indicate that the clinical mentorship received from the primary judicious athletic training practice and reasoning skill of inference is a strong mentor. Nonparametric statistics were entry into this practice. The predictor of BOC™ exam per- used to assess relationships and assessment of clinical reasoning skills formance. Inference skills are used to differences (p<.05). Results: All is an important facet of understanding identify and secure elements needed graduates of 2009 and 2010 NATA why certain candidates fail to pass the to draw reasonable conclusions, to Accredited PPATEPs were found to be national certification exam in Athletic form conjectures and hypotheses. at least very satisfied (4.27/ Training. Objective: The purpose of Therefore, AT educators should focus 5.0±.91)with their overall clinical this study is to determine whether more of their instructional energies on education plan. There were no clinical reasoning skills, as measured clinical case studies as a means to differences in overall satisfaction by the Health Sciences Reasoning develop and foster clinical reasoning scores between number of hours per Test© (HSRT), is correlated to BOC™ skills. week (<20 or >20) spent at the clinical certification exam performance for placement (p=0.142). A positive Athletic Training candidates. Further, 12254UOPE correlation (r=.287, p=.003) was does subscale performance on the Predicting Athletic Training found between level of satisfaction HSRT© in the areas of inductive Students’ Commitment to ATEP with formal and informal feedback reasoning, deductive reasoning, Burton MJ, Weiss WM, Neibert PJ, about performance during the clinical analysis, inference, and evaluation Putney EE: University of Northern experience and how often participants predict a candidate’s certification Iowa, Cedar Falls, IA had direct contact with their clinical exam score. Design: Non- supervisor. A positive correlation experimental design. Setting: Self- Context: In order for athletic training (r=.510, p= <.001) also existed reported online instrument. Patients students to be successful in any between the level of satisfaction with or Other Participants: A total of 71 athletic training education program the mentorship that participants candidates taking the BOC™ exam for (ATEP), a certain level of commitment received from their primary clinical the first time in June 2011(47 females; to the program and profession is mentor and how often participants had 24 males; Age= 22.77± 1.758 years). required. According to the Sport direct contact with their clinical Interventions: All the candidates Commitment Model (SCM), supervisor. Conclusions: These completed the online HSRT©. commitment to an activity can be results suggest that graduates of NATA Participants self-reported their determined based on specific Accredited PPATEPs are generally BOC™ exam scores and other predictors, including enjoyment, satisfied in most areas of their clinical demographic information (level of investments, perceived benefits and education, however satisfaction in ATEP, GPA, age, sex, time spent costs, attractive alternatives, and Journal of Athletic Training S-173 social constraints and support. graduate from the ATEP. Conclusions: females, 2 did not indicate gender) Objective: The purpose of this study The SCM may provide a theoretical enrolled in the final semester of three was to determine the salient predictors framework in which to predict ATEP different ATEPs (n=11 from an entry- of commitment to ATEP, and to students’ commitment to the program, level master’s ATEP in District 3, n=14 determine differences among those as well as behavioral commitment from an undergraduate ATEP in District students who continued, graduated, and (e.g., stay/leave behavior). By 2, n=11 from an undergraduate ATEP in quit ATEP. Design: Cross-sectional, enhancing perceptions of liking, fun, District 4) volunteered to participate in survey. Setting: Surveys were and pleasure and fostering perceived this study. Subjects were recruited by completed during a course lecture at investments, ATEP programs may their respective program directors to the mid-point of the fall academic increase students’ psychological and participate. 24 (67%) of participants semester. Patients or Other behavioral commitment. Future completed all aspects of the study and

Participants: A total of 99 male and research should explore SCM 23 (96%) of those passed the BOC exam Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 female athletic training students constructs as a way of predicting ATEP on the first attempt. Interventions: participated (n = 18, 3rd year; n = 24, students’ graduation rates, BOC Participants completed a basic 2nd year; n = 26, 1st year; and n = 31 scores, and work as an ATC demographic survey and provided the prospective). Participants ranged in professional. investigator with personal contact age from 18 -24 years of age (M = information in order to obtain their self- 20.10, SD = 1.28 ). Approximately one 12373FOPE reported BOC exam scores. Program year later, 71 students were still in the Health Science Reasoning Test directors administered the HSRT (KR- major, 18 had graduated, and 10 had Scores and California Critical 20 = .81) and CCTDI (Cronbach’s alpha quit or switched majors. Inter- Thinking Disposition Inventory = .90) concurrently to students in the ventions: Previously validated Scores Do Not Predict Scores on spring of 2011. Participants took the measures were used to assess students’ the Board of Certification BOC exam in April, June, or August, perceptions of enjoyment, attractive Examination 2011. Main Outcome Measures: The alternatives, investments, social Henning JM: University of North total scores for the CCTDI and HSRT constraints and support, benefits and Carolina at Greensboro, Greensboro, were correlated to determine the costs, and commitment to ATEP. All NC; High Point University, High concurrent validity of administering measures demonstrated adequate Point, NC these tests on the same day. A linear reliability for the current sample (α = regression was used to determine the .71 - .93). Main Outcome Measures: Context: Grade point average (GPA) predictive validity of GPA, HSRT A simultaneous multiple regression has been demonstrated as the primary scores, CCTDI scores on BOC scores. was conducted to determine which of predictor of success on the Board of Results: Participants scored between the SCM determinants predicted ATEP Certification (BOC) examination for the 63rd and 70th percentile on the HSRT commitment. Additionally, a MAN- entry-level athletic trainers. This finding (M=21.17±3.58) and had moderate OVA was conducted to determine has not been re-examined since the BOC CCTDI scores (M=296.64±26.81). differences on SCM constructs revised its testing format to include a There was no statistically significant between graduating, current, and broader variety of test items. Assuming correlation between CCTDI and HSRT discontinued students. Results: The that the BOC exam assesses a snapshot scores or between both test and BOC multiple regression was significant: F of critical thinking there may be other scores. There was a positive correlation (5, 93) = 36.65, p < .001, with 66% of standardized assessment tools designed between GPA (M= 3.47±.25) and BOC the variance of ATEP commitment to measure those constructs that could scores (M= 572.25±39.50), r=.55, being accounted for by the predictors. predict success on the exam. Objective: p=0.005. GPA was also the only Perceived enjoyment (β = .50) and To determine concurrent validity of the predictor of BOC scores R2=.31, investments (β = .26) emerged as the Health Science Reasoning Test (HSRT) F(1,22)=9.69, p=.005. Conclusions: significant predictors, with higher and California Critical Thinking This pilot study suggests that there is perceptions of enjoyment and Disposition Inventory (CCTDI) in an no concurrent validity between the investments predicting higher ATEP athletic training student population. To HSRT and CCTDI in athletic training commitment. The MANOVA was also determine the predictive validity of grade students in their final semester of significant: Wilks’ = .75, F (12, 182) point average (GPA), scores on the study. In addition, GPAappears to be the = 2.41, p < .01, with 25% of the HSRT, and scores on the CCTDI on primary predictor of success on the variance being accounted for by group determining BOC scores. Design: BOC exam; however, the small sample (graduated v. current v. quit). Post-hoc Cross-sectional study. Setting: One size limits the generalizability of this analyses revealed that students entry-level master’s and two finding. currently involved in ATEP reported undergraduate athletic training education significantly higher commitment and program (ATEP). Participants: A enjoyment, and lower perceived costs convenience sample of 36 athletic than students who were preparing to training students (n=16 males, n= 18 S-174 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Concussion in Sport Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12F08DOSP 12020MOSP Evaluation of Neuropsychological Measures: Dependent variables were Concussion Management Practice and Attentional Disturbances the ImPACT composite scores, the Patterns Amongst NCAA Division Following Concussion in High alerting, orienting, and conflict effects I AthleticTrainers School Athletes derived from the ANT, and the switch Kelly KC, Jordan EM, Joyner AB, Howell DR, Osternig LR, van cost calculated from the TS. A two-way, Buckley TA: Georgia Southern Donkelaar P, Chou L-S: University mixed effects ANOVA was performed University, Statesboro, GA of Oregon, Eugene, OR to determine differences between rd groups across time. Results: Context: The 3 International Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Concussion in Sport (CIS) Consensus Context: Recent research has focused Concussion subjects performed Statement on the management of on the role that computerized significantly worse on the visual sports-related concussions was cognitive testing plays in the diagnosis, memory composite of ImPACT (mean released in 2009 and included specific treatment, and decisions related to difference=17.1; SError=4.73; P= recommendations on the identi- returning to physical activity following .002) and the switch cost component fication and management of sports concussion 1–3. However, little of the TS (mean difference=21.77; related concussions. Previous reports investigation has been done testing the SError =6.79; P=.004) within 72 hours on athletic trainers practice patterns, attentional deficits of high school aged of injury. Symptom score group conducted prior to the release of the athletes recovery. Objective: The differences were present up to one 3rd CIS, had identified a gradually purpose of this study is to identify week after injury (mean difference increasing objective assessment differences in tracking recovery for =26.98; SError=6.93; P= .001). protocol and more conservative two months after concussion with Conclusions: This investigation management than earlier reports. three assessments which examine elucidates the inability of concussed Objective: The purpose of this study different levels of cognitive function. high school athletes to effectively was to identify current concussion As sport-related concussion research switch their attention between tasks management practice patterns amongst in the adolescent population is limited initially after concussion. While NCAA Division I athletic trainers. 4, this study seeks to enhance our symptom monitoring continues to be Design: Cross sectional internet understanding of the effect of a tool to detect deficits, other based survey. Setting: Population concussion on different components objective measures are needed to based survey. Patients or Other of attentional function and examine detect subtle cognitive changes Participants: Every NCAA Division their respective recovery curves. Such following concussion over an extended I full time athletic trainer with a information would allow us to identify period of time post-injury. The switch publically available email address measures of cognitive function which cost and visual memory group (1,895) was sent an email with a link sensitively reflect functional recovery differences demonstrate two measures to the survey; however 121 email and provide clinicians objective which detect disturbances after addresses were invalid, leaving 1,774 evidence to optimize timing of return- concussion in high school athletes. potential participants. There were 610 to-normal activity decisions. Design: Attentional testing revealed similar responses (34.4% response rate). The Cohort study. Setting: Within a differences as ImPACT, but through an respondents average athletic training visually enclosed space in a laboratory, individualized analysis, certain experience was 11.7 + 8.7 years, most cognitive disturbances after con- subjects showed prolonged signs of (89%, 544/610) has earned a master’s cussion were assessed using three impairment following concussion degree, reported a mean of 2.9 + 3.3 different computerized tests: ImPACT, indicating long term deficits when concussion related CEUs in the Attentional Network Test (ANT), and analyzed on an individual basis. previous three years and evaluated a Task Switching Test (TS). Patients: Therefore, the TS may prove to be an mean of 5.3 + 3.7 concussions per High school athletes who suffered a easily administered and useful clinical year. Interventions: The 58-item concussion in the Eugene area were test sensitive to the disturbances seen survey was reviewed for face validity identified by a certified Athletic after concussion in the adolescent by content experts and reliability was Trainer. Each of the concussion population. Funded by the NATA established, using Cronbach’s alpha, subjects (n=12) were matched with a Foundation Master’s Grant Program. with a pilot assessment of 10 certified healthy control (n=12) and underwent athletic trainers. Main Outcome examination in the following time Measures: Dependent variables of increments: within 72 hours, one week, interest included the descriptive two weeks, one month, and two months statistics of common concussion post injury. Main Outcome Journal of Athletic Training S-175 12045MOSP assessment techniques. Respondents Concussion Assessment and Participants reported observing were classified as employing a Management Techniques 10.8±11.0 concussions per year, with multifaceted approach if they utilized Employed by Athletic Trainers the majority occurring in football as least two objective assessment Lynall RC, Laudner KG, Mihalik JP, (27.1%). Clinical examination techniques. Results: The majority of Stanek J: Illinois State University, (70.6%) was the most commonly respondents (87.2%; 532/610) Normal, IL; The University of North reported means for evaluating and utilized a multifaceted initial Carolina at Chapel Hill, Chapel Hill, diagnosing concussion. Less than half assessment and most (74.8%; 456/ NC of our respondents employ the 610) utilized at least three objective Standardized Assessment of techniques when evaluating a potential Context: Understanding the practices Concussion (44.4%), any variation of concussion. The most commonly currently employed by athletic trainers the Romberg test (43.8%), and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 utilized tool was a symptom checklist (ATs) will allow clinicians to identify computerized neuropsychological (93.6%; 483/516) followed by potential strategies for enhancing the testing (43.6%). Clinical examination cognitive assessment (90.7%), quality of care provided to patients. (73.4%), return-to-participation balance testing (86.3%) and the least Objective: To assess current clinical guidelines (67.7%), physician commonly utilized objective tool was concussion diagnostic and return-to- recommendation(62.7%), and player neuropsychological testing (79.5%; participation practices among ATs symptom self-report (42.5%) 419/527). Few respondents (36%; working in a variety of settings and contributed to ATs’ return-to- 187/520) utilized concussion grading with different patient populations. participation decisions. Only 21% of scales. To determine when an Design: Cross-sectional. Setting: ATs reported using all 3 recommended individual is cleared to return to Each participant electronically domains of the concussion battery participation, the majority of completed the online survey at a (symptom checklist, neuropsycho- respondents (77%; 470/610) reported preferred location. Patients or Other logical assessment, and postural utilizing a multi-faceted approach. The Participants: A link to the survey was stability test).Fifty-three percent most common return-to-participation randomly sent via email to a reported using at least 2 methods, 75% objective assessments included convenience sample of3,222NATA reported using at least one 1 method, symptom checklists (90.3%; 439/ members. One thousand fifty-three and 25% did not report using any 486), neuropsychological testing certified ATs (32.7%) responded to the methods. Conclusions: Our study (73.8%; 361/489), balance testing survey (11.2±9.1 years AT experience) demonstrated a growth in the number (67.4%; 341/507), and cognitive with the majority of our respondents of ATs incorporating objective clinical testing (58.8%; 294/500). Finally, the working in high schools (39.0%) and measures of concussion as a part of majority of respondents reported sports medicine clinics (14.1%). their concussion management performing baseline testing, on at least Interventions: Prospective parti- protocols compared to previous one occasion, of neuropsychological cipants received electronic research. The number of ATs reporting testing (90%; 371/412), balance correspondence informing them of the the use of neuropsychological testing testing (74.0%; 370/500), and study purpose and provided a link to in managing concussions has cognitive testing (72.2%; 285/395). the online survey instrument. A increased threefold. Conversely, fewer Conclusion: The results of this study reminder email was sent approximately ATs reported using a standard clinical indicate the majority of NCAA 6 weeks later, and the survey remained examination in their concussion Division I athletic trainers utilize a online for a total of8 weeks. Main assessment. These findings suggest multi-faceted approach to both acute Outcome Measure(s): Survey that while an increasing body of sport- concussion assessment and questions addressed athletic training related concussion research exists, determining return-to-participation experience and primary patient ATs must continue to improve upon status and also conduct extensive populations (e.g. sports) served. We their use of both objective concussion baseline testing. Finally, these findings collected information on the annual assessment tools and the standard show a continued increase in the rate number of concussions evaluated and clinical examination. of athletic trainers utilizing objective tools employed to diagnose, manage, assessments and multi-faceted and safely return an athlete to approaches to concussion management participation. We surveyed partici- over the last decade. pants on their familiarization and use of current research and recom- mendations in informing their concussion management protocols Descriptive statistics were computed for each variable. Results:

S-176 Volume 47 • Number 3 (Supplement) May 2012 12052OOSP 12140MOSP Gender Differences in Concussion symptomatic from a possible Validation of Physical Activity as Reporting Prevalence Across concussion. Binomial regression a Functional Outcome Measure Games and Practices Among a models [Prevalence Ratios (PR) and Following a Concussion Sample of High School Athletes 95% Confidence Intervals (CI)] were Nickels SJ, Farnsworth JL, Register-Mihalik JK, Valovich used to analyze the influence of gender Bartholomew M, McElhiney D, McLeod TC, Linnan L, Mueller FO, (males vs. females) on the concussion Ragan BG: Ohio University, Marshall SW, Guskiewicz KM: The reporting measures. Results: Only Division of Athletic Training, Athens, University of North Carolina at 40% of concussion events and 13% of OH; Marietta College, Marietta, OH Chapel Hill, Chapel Hill, NC; A.T. bell ringer events in the sample were Still University, Mesa, AZ reportedly disclosed following Context: Diagnosis and management possible concussive injury as of concussions rely heavily on Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Purpose: Gender differences con- described in a previous study. Males impairment (cognitive, neurologic, cerning concussion outcomes have (41.1%, 39/95) were more likely to equilibrium) and the presence of been debated. While some studies have report continuing in a game while symptoms, with little emphasis placed shown a higher rate of concussions in symptomatic (PR=1.98, 95% CI: 1.15, on function. The World Health females, there is little empirical 3.41) than females (20.6%, 13/63). Organization defines function as a evidence whether concussion Males (27.9%, 26/93) and females person’s movement within their reporting differs between gender and (22.6%, 14.62) were equally likely to environment. A person’s movement is across different environmental continue to participate in a practice also considered physical activity which contexts. Objective: To examine the while symptomatic (PR=1.24, 95% can be measured using a small, influence of gender on concussion CI: 0.70, 2.18). A trend towards males objective accelerometer. Physical reporting across games and practices (24.2%, 67/277) being more likely to activity (PA) and step counts (SC) may in a sample of high school athletes. report in games than females (14.3%, be useful measurement tools for Design: A cross-sectional survey 6/42) was observed (PR=1.69, 95% assessing function. Objective: To design. Setting: The pre-validated CI: 0.78, 3.66). However, in practices validate the use of an accelerometer’s survey instrument was completed at the trend was reversed with males PA and SC as functional outcome the athletes’ homes. Patients or (10.7%, 31/289) being less likely to measures following a concussion. Other Participants: A convenience report (PR=0.61, 95% CI: 0.31, 1.19) Design: Observational matched-pair. sample of 162 high school athletes (98 than females (17.7%, 9/51). Setting: Clinical athletic training males, 64 females; age=15.7±1.4) Conclusions: Context (practice vs. community under free-living con- completed the survey. Interventions: game) may affect concussion- ditions. Patients or Other Parti- Athletes attended a school-based reporting decisions of males and cipants: Twenty-three adult partici- meeting and received a packet females differently. Clinicians should pants (n=23; n=14 concussed, n=9 containing the pre-validated survey and be aware of these contextual matched control; age: mean ± SD, consent documents to take home, differences in reporting and educate 19.65±1.1yrs) volunteered for this complete, and return via mail. The coaches and athletes about the study. The healthy controls were criterion variable was gender (male/ importance of reporting potential matched for age, sex, athletic position, female). Main Outcome Measures: concussive events, regardless of the perceived physical activity level, and Self-report concussion reporting context. Efforts should be directed area of academic study. Inter- history was used to obtain all outcome towards making both practice and ventions: Participants wore an measures. Concussion reporting was game settings, environments in which Actigraph GT3X+ accelerometer on defined as indicating reporting a athletes feel comfortable about right hip either after sustaining a recalled concussion or “bell ringer” to reporting their injuries. concussion or being identified as a a coach or medical professional. healthy control for over a week Concussion reporting measures (Concussed: 9.29±2.6days, Control: included: 1) proportion of con- 7.89±1.6days). Acceler-ometers have cussions and “bell ringers” reported been shown to be reliable and validated during practices; 2) proportion of in various patient populations. Main concussions and “bell ringers” Outcome Measures: Dependent reported during games; 3) proportion variables were mean PA and SC for of athletes who disclosed continuing symptomatic days, for asymptomatic to participate in a game while days and for controls. Within the symptomatic from a possible concussion group, differences in PA concussion; and 4) proportion of and SC for symptomatic days and athletes who disclosed continuing to asymptomatic days were evaluated participate in a practice while using paired t-test. Differences in PA Journal of Athletic Training S-177 12176FOSP and SC for the concussed group and Changes in Means and Factor (84.1±15.3) to D3 post-concussion healthy controls were evaluated for Structure of Multidimensional (73.0±23.4), as did Cognitive symptomatic days and asymptomatic Fatigue Following Sport-Related (82.6±17.9 to 71.6±23,4); both days using an independent t-test. Concussion p<0.001. Sleep did not change Significance was set a priori at alpha Bay RC, Lam KC, Valovich McLeod (70.0±18.5 to 70.6±23.0) during this level <0.05 with Bonferroni TC: A.T. Still University, Mesa, AZ period. By D10, all scores had adjustment. Results: There was a increased significantly (p<0.05) above significant difference in PA counts Context: Fatigue is a common, long- BL: General (90.7±14.9), Cognitive between symptomatic and asympto- term symptom of sport-related (87±17.3) and Sleep (88.2±13.9).The 2 matic (t13 = -2.369; P<0.05), but not concussions. Yet, little is known about CFA model fit the data well (X = 32.5 for SC (t = -1.826; P>0.05). Con- (21), p=0.052, GFI=.95, RMSEA 13 changes in fatigue following injury. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 cussed participants while symptomatic Objective: To assess changes in =.074). The average factor loading at had a mean PA count of 285366.9 fatigue-specific health-related quality BL was .67,at D3,.86 and at D10, .78. ±113213 and a mean SC of 8175.43 of life (HRQOL), as measured by the The General (r=.54),Sleep (r=.57) and ±3476.1. Once asymptomatic, mean Pediatric Quality of Life Inventory Cognitive (r=.41) scales were PA counts increased to 352827.4 (PedsQL) Multidimensional Fatigue substantially correlated across D3 and ±90979 and mean SC increased to Scale (MFS), in concussed high D10. Modifications indices identified 9721±3380. There was a significant school athletes from baseline to 10 moderate correlations for Cognition difference in PA counts between days post-concussion. Design: from BL to D3 (r=.46) and BL to D10 symptomatic concussed and healthy Cohort. Setting: High school athletic (r=.53) (all, p<0.001).The correla- controls (t21 = -2.092; P< 0.05), but training facilities. Patients or Other tional structure of fatigue changed not for SC (t21 = -1.192; P>0.05). Participants: A convenience sample over time. All factor loadings at D3 There was no difference between of 100adolescent athletes (84 males, were significantly different from those asymptomatic concussed and healthy 16females,age=15.5±1.9; grade= at BL (p<0.001). At D10, factor controls in PA counts (t21= -0.717; 9.1±.94)who suffered a sport-related loadings for Sleep and Cognitive

P>0.05) or SC (t21= -0.079; P>0.05). concussion that was diagnosed by an remained different from BL Mean PA and SC for healthy controls athletic trainer. Interventions: The (p<0.01).Conclusions: General and were similar to asymptomatic independent variable was time. Cognitive subscale scores fell concussed with a mean PA count of Participants completed the MFS substantially following post- 381496.9±97646 and SC of 9828.78 during a single-session at pre-season concussive injury, but increased ±2837. Conclusions: The results baseline (BL) and two time points significantly above BL by D10. The provide evidence for the use of PA following concussion: Day 3 (D3) and CFA strongly supported the validity of counts as a functional outcome Day 10 (D10). The MFS is a valid and the MFS in high school athletes. The measure during concussion recovery. reliable measure of fatigue-specific correlational structure of the MFS PA counts of the concussed group, HRQOL in pediatric patients and changed over time, indicating that the once asymptomatic, reflect values that includes three subscales: General three scales should be interpreted mimic healthy controls, concluding Fatigue (General), Sleep/Rest Fatigue independently. All mean scale scores that an increase in PA counts in (Sleep) and Cognitive Fatigue increased from D3 to D10, but conjunction with symptom and (Cognitive). Lower subscale scores General and Sleep deficits persisted cognitive based tools can assist indicating lower fatigue-specific from D3 to D10. Cognitive deficits athletic trainers with return to play HRQOL. Main Outcome Measures: persisted across all measurement decisions following a concussion. The dependent variables were the three periods. Funded by a grant from the MFS subscale scores at BL, D3 and National Operating Committee on D10.Generalized estimating equations Standards for Athletic Equipment based on an inverse Gaussian (NOCSAE). distribution, autocorrelation structure and robust estimators were used to assess change over time. Bonferroni comparisons evaluated pairwise differences (p<.05, two-tailed). Confirmatory factor analysis (CFA) based on an asymptotically distribution free model estimated changes in the factor structure over time. Results: Mean values (±SD) for General dropped significantly from BL S-178 Volume 47 • Number 3 (Supplement) May 2012 Free Communications, Poster Presentations: Epidemiology in Orthopedics Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12064FOIN Prevalence of Functional Ankle Participants who were identified as important for successful imple- Instability in a College Age having FAI had an average score of mentation and efficacy of ACL IPP. Population 16.5 (SD = 4.8) on the IdFAI and Objective: 1) Describe youth soccer Docherty CL, Simon J, Donahue M: subjects who were identified as not coaches’ attitudes and beliefs toward Indiana University, Bloomington, IN having FAI had an average score of 4.2 ACL IPP. 2) Describe youth soccer (SD= 3.6). Additionally, 1006 (56%) coaches’ compliance with an ACL IPP Context: Functional Ankle Instability of the participants had a history of a after attending an educational Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 (FAI) is a condition that often occurs lateral ankle sprain. Of the participates workshop and receipt of supplemental following a lateral ankle sprain. FAI with a history of a lateral ankle sprain, instructional materials. Design: is typically determined through a self- 678 (67%) were identified as having Cross-sectional. Setting: Soccer reported feeling of instability during FAI, while the other 328 (33%) were complex. Patients or Other Parti- activities of daily life or athletic not identified as having FAI. Chi- cipants: A convenient sample of 39 participation. While numerous authors square test of independence yielded no soccer coaches (age: 34.67±9.57 yrs.) report the frequent occurrence of this significant relationship between of elite-level youth soccer club teams. χ2 condition, limited work has been done gender and presence of FAI ( (1) = Interventions: Youth soccer coaches identifying the prevalence of FAI. .08, p=.78). Specifically, 45% (n=379 were administered a 25-item survey Objective: To determine the of the 847) of the men had FAI and evaluating their attitudes and beliefs prevalence of FAI in a college age 44% (n= 403 of the 914) of the women toward ACL IPP after a 45-minute population. Design: Cross Sectional had FAI. Conclusions: FAI is a rela- educational meeting on the im- Study Setting: Classroom setting tively common pathology affecting portance of ACL IPP and specific ACL Patients or Other Participants: We approximately 45% of the sample IPP exercises to perform. Coaches recruited 1,788 subjects (847 males, population. Of the participants who were also provided with additional 914 females, 19.5±1.8 years) to had a history of a lateral ankle sprain, resources for implementing an ACL participate in this study. Participants approximately two-thirds of them IPP (exercise manuals, coaching cue had to be enrolled in the local went on to have FAI. Finally, FAI seems cards, and videos). Compliance with university and have no history of lower to affect men and women equally. the ACL IPP was monitored 3-weeks leg fractures to volunteer for the study. later. Main Outcome Measures: 12145DOBI Interventions: All subjects completed Survey questions were categorized into Description of Youth Soccer the Identification of Functional Ankle 4 domains of attitudes and beliefs Coaches’ Attitudes and Beliefs Instability (IdFAI) questionnaire on toward ACL IPP: (1) time devotion, (2) Regarding ACL Injury Prevention one occasion. The IdFAI is a 10 item comfort level implementing ACL IPP, Programming and Program questionnaire that was specifically (3) likelihood of implementing ACL Compliance. developed to identify people with FAI. IPP, (4) perceived effectiveness of Frank BS, Register-Mihalik JK, Scores on the IdFAI range from 0 to ACL IPP. Responses were scored based Marshall SW, Spang JT, Begalle 37. A score of 11 or higher on the on a 5-point Likert scale (1-strongly RS, Padua DA: Sports Medicine IdFAI indicates the participant has FAI. disagree to 5-strongly agree). Research Laboratory, University Test-retest reliability of the IdFAI is Compliance was assessed as a of North Carolina at Chapel Hill, excellent (ICC =0.92, SEM=2.21). dichotomous outcome completion/no 2,1 Chapel Hill, NC Frequencies were used to determine completion) and expressed as a prevalence of FAI. Means and standard percentage of teams performing the deviations were also calculated on the Context: Anterior Cruciate Ligament ACL IPP. Descriptive statistics were IdFAI score. A Chi-square test of (ACL) injury prevention programs computed for each variable to independence was calculated (ACL IPP) are effective at decreasing determine coaches’ attitudes, beliefs, comparing the frequency of FAI in men injury risk in youth soccer players. and compliance regarding an ACL IPP. and women. Main Outcome However, the efficacy of an ACL IPP Results: 92.1% of coaches agreed or Measures: Dependent variables were: is dependent on successful strongly agreed to devote 15 minutes presence or absence of FAI, history of compliance in the target population. In to an ACL IPP during practice a lateral ankle sprain, score of the youth soccer, the coach is primarily (agreement =4.47 ±0.73). 97.3% of IdFAI, and gender. Results: In this responsible for implementing an ACL coaches agreed or strongly agreed to sample, 799 participants (45%) were IPP. Thus, understanding factors that being comfortable implementing an identified as having FAI and the influence youth soccer coaches’ ACL IPP if given instruction remaining 989 (55%) did not have FAI. compliance with an ACL IPP may be (agreement =4.50±0.56). 84.6% of Journal of Athletic Training S-179 coaches agreed or strongly agreed to ACL Study: A collaborative multi-site for females (39.1%) compared to implement a daily ACL IPP in the prospective cohort study. Baseline males (18.0%) for all LE injuries and upcoming season (agreement JUMP-ACL survey data linked to specific injuries. Cadets with a =4.37±0.71). 79.5% of coaches incident lower extremity injuries previous history of LE or lower leg agreed or strongly agreed that an ACL ascertained via the Defense Medical injury were at increased risk for a IPP would reduce injury (agreement Surveillance System (DMSS). DMSS medically treated LE injury (risk ratio =4.05±0.66). Compliance with the records all clinic visits of a medical [RR]=1.71, 95% CI: 1.57, 1.86) and ACL IPP was 53% at the 3-week nature. Setting: The three largest U.S. lower leg injury (RR=1.57, 95% CI: follow-up period. Conclusions: military academies. Participants: 1.45, 1.71), respectively. Stronger Soccer coaches are generally First year cadets (n=9,811) enrolled associations were observed for agreeable to implementing an ACL 2005 to 2008 in JUMP-ACL. specific injuries including the ankle

IPP, and believe these programs can Interventions: Self-reported prior (RR=2.79, 95% CI: 2.44, 3.19). Con- Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 reduce injury risk. However, coaches’ injuries to the lower extremity or clusions: Injury history upon entry attitudes and beliefs do not appear to lower leg in the past 6 months. into the academy is strongly associated directly translate to ACL IPP Additionally, the following specific with medically-treated LE injuries implementation, as only 53% teams injuries: ankle sprain, shin splints, during Cadet Basic Training. These had adopted the ACL IPP after 3-weeks. lower limb stress fracture, hip injury, results provide a baseline activity and Future research identifying factors to and knee sprain. Main Outcomes injury profile for first year military increase coaches’ ACL IPP Measures: Medically treated injuries cadets that academy health care compliance is warranted. Funding of the lower extremity during Cadet providers can use to target prevention provided by the Injury Prevention Basic Training, obtained from the efforts. Research Center at the University of DMSS injury surveillance system. North Carolina at Chapel Hill and the Acute injuries (ICD-9 codes in the 12253FOTE National Academy of Sports Medicine 800-900s) included: fracture, Psychosocial Rehabilitation dislocations, and sprains/strains. Experiences of the ACL 12161FOIN Injury-related musculoskeletal Reconstructed Athlete Baseline Factors Associated with injuries (ICD-9 codes in the 700s) Neibert PJ: University of Northern Incident Lower Extremity Injury included: inflammation and pain Iowa, Cedar Falls, IA during Cadet Basic Training (overuse), joint derangement, stress among Military Academy Cadets: fracture, sprain/strain/rupture, or Context: The majority of research on the JUMP-ACL Study dislocation. To minimize duplicate the rehabilitation process, for the ACL Kucera KL, Marshall SW, Wolf SH, counting from multiple medical reconstructed athlete, has focused on Padua DA, Beutler AI: Division of encounters per event, encounters for physical rehabilitation. There is very Occupational and Environmental the same three-digit ICD-9 code within little research on the psychosocial Medicine, Duke University Medical 60 days of the first encounter were aspect of the ACL reconstructed Center, Durham, NC; The University excluded. Risk ratios and 95% athlete’s rehabilitation experience. of North Carolina at Chapel Hill, confidence intervals were calculated Objective: To explore the ACL Chapel Hill, NC; The Uniformed with multivariate general log-binomial reconstructed athlete’s psychosocial Services University of the Health regression models adjusted for gender, rehabilitation experiences. Further, to Sciences, Department of Family age, prep academy attendance, discover the psychosocial support Medicine, Bethesda, MD academy, and previous injury history. mechanisms utilized during the Results: During Basic Cadet Training rehabilitation process. Design: Context: Characterizing the (July and August), there were a total Descriptive qualitative method of relationship between baseline injury of 1,438 medically treated acute LE inquiry with a grounded theory history and subsequent injury among injuries and 1,719 LE muscu- approach. Setting: Structured physically-active collegiate-age youth loskeletal-related injury conditions. personal interviews were conducted may provide important information to The most frequent types of acute with NCAA Division I collegiate guide injury preventive measures. injuries was ankle and lower leg athletes in the Midwest. Patients or Military academies provide access to sprains/strains (38.7%) and Other Participants:9 NCAA large numbers of physically-active unspecified lower extremity sprains/ Division I athletes (5 males, 4 females; collegiate-age youth. Objective: To strains (34.9%). Overuse injuries were 19.33 ± 1.035 years old),attending 4 determine the association between the the most frequent types of different institutions in the Midwest baseline factors and incident lower musculoskeletal-related conditions who have completed their rehabi- extremity injury (LE) during Cadet (89.6%). The overall risk of incident litation for an ACL reconstructed knee Basic Training (typically July 1 to medically treated LE injury during were interviewed. Data Collection August 31) among first year military basic training was 23.2% (95% CI: and Analysis: Data was collected via academy cadets. Design: The JUMP- 22.3%, 24.0%). Injury risk was greater recorded personal interviews. Data was S-180 Volume 47 • Number 3 (Supplement) May 2012 analyzed through the constant shop facility, and team pits at various drivers identified their biggest comparative method of grounded race tracks. Patients or Other Parti- concerns for future injuries as “fire/ theory. Data triangulation, member cipants: Forty short track stock car burns” or “head and neck injuries.” checking, and peer-review strategies drivers (age = 35.91 ± 13.4 years; Drivers identified wearing proper were used to ensure trustworthiness of height 178.51 ± 7.39 cm; weight 86.20 racing attire, head and neck restraints, the data. Results: Athletes reported ± 16.67 kg; racing experience = 13.58 and “safer barriers” as some ways to that their relationship with their AT was ± 11.30 years; age at start of their prevent stock car racing injuries. A the most important psychosocial racing career = 21.39 ± 9.53 years) variety of other data were obtained. support mechanism during the participated in this study. The sample Conclusions: Understanding the rehabilitation process. Athletes viewed population included drivers from 27 different types of injuries that stock their AT as a psychologically stabilizing different states in the United States of car drivers face can help the athletic

force. The ATs ability to encourage, America who raced in several different trainer understand the needs of these Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 reassure and relate to the rehabilitation racing classes on dirt and/or asphalt athletes. This information will allow process was paramount. In addition to tracks. Criterion sampling was used athletic trainers to correctly evaluate the AT support, the athletes reported during an internet search to compile a and treat potential injuries of the that support from the coaching staff list of drivers that competed in either participants in this rapidly growing was also an important psychosocial dirt or asphalt short track stock car sport. support mechanism. One participant racing. Drivers were then randomly reported that the lack of psychosocial selected and their participation was 12275UOPR support from the coaching staff was elicited via email. The number of Use of Head and Neck Injury psychologically detrimental to her participants in this study was guided by Prevention Devices in Stock Car rehabilitation experience. These data saturation. Data Collection and Racing psychosocial support mechanisms Analysis: Participants completed Gatzke BR, Azmus E, Ebben WP: were crucial in helping the athlete to either telephone or in-person inter- University of Wisconsin-Parkside, deal with the psychological aspect of views averaging 48.0 ± 9.0 minutes. Kenosha, WI their rehabilitation experience. The interview included questions from Conclusions: My findings are the Stock Car Driver Survey which Context: Head and neck (HAN) consistent with the psychosocial included open ended questions, fixed injuries are somewhat common and literature that illustrates the crucial choice, and 10 point Likert scale sometimes lethal in stock car racing. role ATs/coaches play as a items. Questions were asked in A variety of devices have been psychosocial support during the several categories including racing designed with the goal of preventing rehabilitation process and the related injuries, medical attention injuries and death. Objective: This importance of this relationship to required, ongoing physical problems, study assessed stock car drivers athlete/patient. Future researchers future injury concerns, and injury concerns about, and use of, head and should take a closer look at the prevention. The answers to open neck injury prevention devices perceptions of NCAA Division I ended questions were transcribed (HANIPD).Design: Cross-sectional coaches’ role in the psychosocial verbatim and analyzed using inductive survey. Setting: Population based. support of the athlete during the content analysis. Results: Subjects Patients or Other Participants: rehabilitation process. identified a variety of racing injuries Fifty one stock car drivers (age organized according to higher order =34.51±11.67 years; racing exper- 12260UOBI themes with the most common falling ience=11.78±8.16 years) served as Qualitative Analysis of Injuries in into the categories of “back/torso,” participants. The sample included Stock Car Racing “upper body,” and “head” related drivers from 14 different states in the Suchomel TJ, Ebben WP: University injuries. Various injuries included USA who raced in a variety of classes. of Wisconsin-La Crosse, La Crosse, “back pain due to jolts”, “ruptured Criterion sampling was used during an WI; University of Wisconsin- tendon from the steering wheel”, and internet search to compile a list of Parkside, Kenosha, WI “concussions.” The majority of drivers, who were then randomly subjects who required medical selected. The number of participants Context: Athletic trainers work with attention for injuries either received in this study was guided by data athletes in variety of sports. Despite emergency medical service help at the saturation. Interventions: Data were being a popular sport, little is known race track for injuries such as collected through an online Survey of about the injuries that occur during “concussions”, “ACL injuries”, and the Use of Head and Neck Restraint stock car racing. Objective: To “dislocated shoulders”, or were Devices in Stock Car Racing. Main examine the injuries of short track hospitalized. The most common Outcome Measures: Quantitative stock car drivers. Design: Grounded ongoing injuries were identified as data were analyzed using a Pearson’s theory. Setting: University exercise “back pain”, “neck pain”, and “wrist and correlation coefficient to assess the science laboratory, stock car racing hand problems”. The vast majority of relationships between the driver’s Journal of Athletic Training S-181 12293OIN Likert scale ratings of their concern Comparison of Hamstring Strain practice segment (warmup, individual about HAN injuries, the importance of Incidence and Injury Patterns drills, team drills, conditioning), time using a HANIPD, how often they wear Between Male and Female of game (warmup/first half, second a HANIPD, and the cost of their stock Intercollegiate Soccer Athletes half/overtime), event type (game, car. Qualitative data, such as the Cross KM, Saliba S, Gurka KK, practice), field location (offense, driver’s response to open ended Conaway M, Hertel J: UVA- defense), player position (forward, questions regarding use and type of Healthsouth Physical Therapy, midfield, defender), injury mecha- HANIPD, injury occurrence, and Charlottesville, VA; University of nism, and soccer activity (shooting/ HANIPD likes and dislikes were Virginia, Charlottesville, VA; West passing, defending, running, ball analyzed using inductive content Virginia University, Morgantown, handling).Results: Males were 64% analysis. Results: Significant (p≤ WV more likely than females to sustain a Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 0.01) correlations were found between hamstring strain.(IRR=1.64; 95% CI: concern about HAN injuries and how Context: Hamstring strains have high 1.37-1.96). Men had significantly important it is to use a HANIPD prevalence and recurrence rates among higher rates of hamstring strains than (R=0.79) and how often the drivers soccer players, and male soccer women during competitions (IRR= used a HANIPD(R=0.47), as well as players have a higher incidence rate of 2.42;95%CI: 1.82-3.23), practices between how important it is to use the hamstring strains than female players. (IRR= 1.34; 95%CI:1.06-1.68), and HANIPD and how often they wore the Currently, no data exists that compares the inseason (IRR=1.98;95%CI: 1.56- device (R=0.61). No correlation was the incidence rates at different times 2.52). There was no significant found (p> 0.05) between the cost of of soccer participation or describes difference in hamstring strain their stock car and any variable. the injury event patterns separately for incidence during the preseason Results of qualitative analysis first-time and recurrent hamstring (IRR=1.04; 95%CI: 0.79-1.37).Males revealed the main reason the drivers strains between males and females. had a significantly higher proportion used the HANIPD was concern over Objective: To compare the hamstring of recurrent hamstring strains injury or death. While most drivers did strain incidence between sexes during compared to females (M=22%, not have injuries, several attributed different event types and times of F=12%, p=0.003). There were no their safety to the HANIPD. For season and to describe and compare significant differences in the drivers who experienced injuries, most the injury event patterns of first-time distribution of strains within the injury had neck or back injuries including and recurrent hamstring strains event factors between the sexes for pulled or sore neck muscles, ligament between male and female college first-time or recurrent hamstring problems, and whiplash. Cost was the soccer athletes. Design: Descriptive strains. Conclusions: Males, com- main reason for not using a HANIPD. epidemiology study. Setting: Field pared to females, were more likely to Other dislikes about the HANIPD research of NCAA men’s and women’s sustain a hamstring strain during included limited vision due to soccer teams. Patients or Other games, practices and the inseason. restricted head movement, difficulty Participants: The participants were Also, males had a higher frequency of putting it on and taking it off, and collegiate soccer athletes who recurrent hamstring strains. While discomfort. A variety of other data incurred a hamstring strain that was there were no significant differences were gathered. Conclusions: Athletic recorded in the NCAA Injury in the hamstring strain event factors trainers are uniquely qualified to serve Surveillance System between 2004- between sexes for first-time or this population of athletes and thus 2009.(males: first-time= 242, recurrent injuries, common patterns should be knowledgeable about recurrent=67; females: first-time= emerged to describe all hamstring HANIPD, help identify the pros and 176,recurrent=24). Main Outcome strains. These findings provide cons of HANIPD, educate drivers Measures: Incidence rate ratios evidence to assist in the development about the role these devices play in (IRRs) compared the incidence of of preventive and rehabilitative injury prevention, and serve in the role hamstring strains between the sexes in exercise programs as well as further of treating head and neck injuries when total and during competitions, research on hamstring strains. they occur. practices, the preseason and the in season. To examine differences in injury events factors between male and female soccer players, Chi-Square tests were used to compare the national estimated frequencies of hamstring strains that occurred within levels of the following variables: season (preseason, in season, postseason),

S-182 Volume 47 • Number 3 (Supplement) May 2012 12356OOIN The Incidence of Injury Among 1.09, 1.54) among men when compared Male and Female Intercollegiate to women; however, the distribution of Rugby Players injuries varied by sex. The incidence Peck KY, Johnston DA, Owens BD, rate for ACL injury among female rugby Cameron KL: United States Military players was 5.3 times (95% CI: 1.33, 30.53) Academy, West Point, NY higher when compared to males. In contrast, males were 2.5 times (95% CI: Context: The NCAA currently 2.41, 2.67) more likely to sustain a fracture classifies women’s rugby as an than females. The rate of acromio- emerging sport. However, very few clavicular joint injury was also 2.2 times (95% CI: 1.03, 5.19) higher among studies have examined injury rates in Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 women’s collegiate rugby and even less males when compared to females. have compared injury rates between While the rates of concussion were female and male American players. similar between males and females, Objective: The purpose of this study males were 5.3 times (95% CI: 2.22, was to compare injury rates between 17.79) more likely to sustain a facial female and male intercollegiate club injury, 2.5 (95% CI: 0.92, 8.39) times rugby players at a United States Service more likely to experience an eye injury, Academy. Design: Injury surveillance and11.3 times (95% CI: 10.74, 11.87) data were collected and reviewed over more likely to sustain a head injury other five academic years from August 2006 than concussion. Finally, males were through June 2011. All athletes 6.5 times (95% CI: 2.65, 20.91) more received their care through a closed likely to have an open wound than healthcare system and all injuries females. Conclusions: The results of requiring medical attention were this study illustrate some key documented in an injury surveillance differences in injury patterns between database. As a result, nearly all injuries female and male American rugby players. experienced by rugby players during These differences may reflect distinct the study period were documented. playing styles which could be the result Injury was defined as an event of the American football backgrounds occurring during rugby training or which are common among many male competition which required attention players. from a medical provider. The Academy requires strict adherence to accountability; therefore, exposure data was available through roster and attendance records for all rugby participants during the study period. Setting: US Service Academy. Participants: Participants were college rugby players. There were 129 females and 240 males that participated during the five year study period. Main Outcome Measures: The primary outcome of interest was the incidence rate (IR) of injury during the study period per 1000 player-days. We calculated rate ratios (RR) using a poison distribution to compare the rates by sex. Results: During the study period there were 200 injuries documented among females (IR=2.91) and 459 injuries among males (IR=3.77). The overall incidence rate for injury was 30% higher (95% CI:

Journal of Athletic Training S-183 Free Communications, Poster Presentations: Osteoarthritis Exhibit Hall; Wednesday, June 27, 10:00AM-5:00PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12005FOBI 12229FOEX Post-Traumatic Ankle were recorded at three points during The Relationship between Osteoarthritis Influences Stair the gait cycle. Specifically, the peak Intensity of Physical Activity Ascent & Descent Kinetics vGRF was recorded during weight and Knee Osteoarthritis Wikstrom EA, Anderson RB, acceptance (F1) and during terminal Development Hubbard-Turner TJ: University of stance (F2). Similarly, the unloading Hubbard-Turner T, Turner MJ: North Carolina at Charlotte, force during midstance (Fmin) was University of North Carolina at Charlotte, NC; OrthoCarolina Foot also recorded. Both the raw and Charlotte, Charlotte, NC & Ankle Institute, Charlotte, NC normalized vGRF outcomes were then Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 submitted to independent sample t- Context: Knee osteoarthritis (OA) is Context: Post-traumatic ankle tests to determine group differences. known to progressively worsen with osteoarthritis (PTAO) is a condition Results: Demographic characteristics aging. Previous research has reported characterized by pain and disability and did not differ between the groups physical activity across the lifespan is often the result of a ligamentous (p>0.05). During stair ascent, may have a protective effect on knee injury or fracture to the ankle joint significantly higher raw F1 vGRF joint degeneration. Currently, the complex. Research has consistently (PTOA: 707±105N, Control: amount or intensity of physical activity identified significant increases in 518±114N), raw F2 vGRF (PTOA: and its relationship with knee OA is clinical disablement but only recently 718±81N, Control: 599±111N), and unknown. Objective: To determine if begun to systematically quantify normalized F1 VGRF (PTOA: there is a relationship between sensorimotor dysfunction in this 1.03±0.28%, Control: 0.65±0.28%) intensity of physical activity and knee population. To date, those with PTAO were observed in those with PTAO OA development. Design: Pro- have been shown to have a number of (p≤0.03). Similarly, a statistical trend spective randomized control clinical sensorimotor impairments. However, (p=0.07) was observed for normalized trial. Setting: Controlled, research no investigation has quantified how F2 vGRF in those with PTAO (PTOA: laboratory. Participants: Thirty PTAO affects sensorimotor function 1.05±0.27%, Control: 0.76±0.29%). C57Bl/6J mice were monitored during activities that are not No group differences were observed beginning at three months of age until completed over level ground. raw or normalized Fmin during stair the end of their lifespan. Inter- Objective: To determine if PTAO ascent (P>0.05). During stair descent, ventions: Mice were randomly influences the kinetic patterns of stair significantly higher raw F1 vGRF allocated to a cage with a running ascent and descent relative to age (PTOA: 912±163N, Control: 666± wheel (RUN group, fifteen mice (eight matched controls. Design: Case- 225N) and normalized F1 vGRF male and seven female)) or no running control. Setting: Controlled, (PTOA: 1.37±0.38%, Control: 0.67± wheel (control, fifteen mice (seven research laboratory. Participants: 0.25%) were observed in those with male and eight female)). Wheel Nine subjects with unilateral PTAO PTAO (p≤0.02). No group differences running activity was measured with a (age: 51.8±10.5 years, height: were observed raw or normalized F2 magnetic sensor and digital odometer 171.9±9.9cm, weight: 75.2±16.3 kg) or Fmin during stair descent (P>0.05). and has been reported as a reliable and and eight age- matched controls (age: Conclusions: The results suggest that valid measure of physical activity in 52.8±11.9 years, height: 172.1± those with PTAO use different kinetic mice. Daily distance and duration were 11.3cm, weight: 83.6± 23.4 kg) volun- patterns to ascend and descend stairs. measured and average running speed teered to participate. Interventions: Specifically, these kinetic patterns was calculated for each week of the Each subject com-pleted a total of 5 suggest that those with PTAO have a entire lifespan. A diagnostic ascents and 5 descents on a custom reduced ability to attenuate weight ultrasound (SONOS 5500 Ultrasound built stair case that housed an acceptance while navigating stairs. and 15-6L ultrasound probe) was used embedded force plate within the Further, these findings are consistent to measure medial and lateral knee second step. All trials were conducted with previously identified sensori- joint space in both hind limbs every so that the PTAO subjects struck the motor impairments during level month. Main Outcome Measures: force plate with their involved limb ground ambulation in this population. Medial and lateral knee joint space while the controls subjects struck the (cm) in both hindlimbs were measured force plate with their matched limb as a marker for the development of OA which was based on limb dominance. on all 30 mice every 4 weeks of their Main Outcome Measures: Raw and lifespan. Each mouse was anesthetized normalized, relative to body weight, with isoflurane gas. The mouse was vertical ground reaction forces (vGRF) then shaved and ultrasound gel was S-184 Volume 47 • Number 3 (Supplement) May 2012 applied to the medial and lateral aspect purpose of this study was to provide (t=4.72, p=0.001), as well as the of both hindlimbs. Diagnostic normative data for the KOOS and WOMAC Stiffness (t=2.93, p=0.004) ultrasound (SONOS 5500, Agilent WOMAC in a young and athletic and Function (t=2.27, p=0.024) sub- Technologies, Andover MD) with a population, and to compare scores scales, were significantly lower

SONOS 15-6L ultrasound probe was between subjects with a history of knee for males who reported a history of knee utilized to image both hindlimbs. ligament injury and those with no prior ligament injury. Only Knee Related Distance, duration, and speed were history. Design: Cross Sectional. QOL was significantly lower (t=3.51, recorded every week in the RUN Setting: US Service Academy. p=0.039) among females with a history group. Results: Across the lifespan, Participants:1177 college freshman of prior knee ligament injury. When there were no significant relationships entering a US Service Academy in June values for the KOOS were compared to between distance (p = .084), duration 2011. Methods: All subjects were previously published norms, scores were

(p = .511), and speed (p = .125) with healthy and had been medically significantly higher for males only. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 hindlimb joint space. Daily distance screened to meet the physical Conclusions: Norms for the KOOS averaged 2.74 km/day +1.92, duration induction standards for military among males in this young and physically average 109.9 min day+ 72.6 and service. The outcome measures of active population were significantly speed averaged 23.75 m/min + 6.20 interest were administered within the higher than those previously published. across the lifespan. Right medial joint first week of arriving at the Academy. Despite meeting the medical standards space averaged .19mm+ .04, left A prior history of knee ligament injury for military service, subjects with a medial averaged .19mm + .03, right was docu-mented at the time of history of knee ligament injury had lateral averaged .19mm + .04, left administration. We calculated mean significantly lower KOOS and WOMAC lateral averaged .18mm + .04 across scale scores along with standard scores upon entry to military service. the lifespan. Conclusions: This strain deviations for the KOOS and WOMAC of mice is genetically identical and among those with no prior history of 12128MOTE may account for the lack of a knee joint injury. We also compared Efficacy of Anterior Cruciate significant relationship. C57Bl/6J mean scale scores for those with a Ligament Reconstruction in the mice are known to be moderately history of knee ligament injury to Prevention of Knee active. Other strains of mice are those with no prior history using Osteoarthritis: A Numbers known to have significantly higher and independent t-tests. Similarly, we Needed to Treat Analysis lower levels of activity. Comparing compared the results for the current Luc BA, Pfile KR, Gribble PA, different strains of mice (low active, study with previously published norms. Pietrosimone BG: University of high active) and knee OA development Main Outcome Measures: The Knee Toledo, Toledo, OH may give a better indication of the Injury and Osteoarthritis Outcome impact of intensity of physical activity. Score (KOOS) and the Western Context: Anterior cruciate ligament Ontario and McMaster Universities reconstruction (ACL-R) is primarily 12087OOMU Arthritis Index (WOMAC). Results: performed to improve knee joint Normative Values for a Young Among the 1177 subjects, 971 were stability, while secondarily it has been Athletic Population on the KOOS males (18.8, ±0.9 years) and the hypothesized to benefit long-term and WOMAC: History of Knee remaining 206 were females (18.7, joint health by decreasing the risk of Ligament Injury is Associated ±0.8 years). Among the males, 139 developing post-traumatic knee with Lower Scores reported a prior history of knee osteoarthritis (OA). A systematic Cameron KL, Thompson BS, Peck ligament injury and 33 females evaluation of the current literature has KY, Owens BD, Marshall SW, reported a similar history. For those not been performed to determine the Svoboda SJ: Keller Army Hospital, with no history of injury, the mean effect of ACL-R on joint preservation. United States Military Academy, scale score for the five KOOS sub- Knowing the prophylactic nature of West Point, NY; University of North scales by sex were: Pain ACL-R on knee OA is imperative for Carolina at Chapel Hill, Chapel Hill, (M=97.47±6.27; F=95.90±7.98), understanding the true benefits of this NC Symptoms (M=93.96 ±7.98; F= intervention. Objective: Determine 92.90±8.99), Activities of Daily the preventive nature of ACL-R Context: The use of patient reported Living (M=98.86±3.83; F=97.92 compared to patients who remain ACL outcome measures to assess clinical ±4.80), Sports/Recreation Function deficient (ACL-D) in the development outcomes following injury and surgery (M=94.89±10.14; F=92.74 ±12.94) of knee OA. Sources: An exhaustive have become common in treating and Knee Related QOL (M= 92.62 search was performed using the Web young athletes with orthopaedic ±11.20; F=90.51±13.84). All KOOS of Science database from 1960 injuries; however, normative data for sub-scale scores including Pain through August 2011 with the search these measures is limited and often (t=2.64, p=0.009), Symptoms (t=4.27, terms“osteoarthritis”, “meni- includes a wide range of ages and p=0.001), ADL (t=2.27, p=0.024), sectomy”, “anterior cruciate activity levels. Objective: The SRF (t=1.95, p=0.053), and KRQOL ligament”, “ACL reconstruction”, Journal of Athletic Training S-185 and “ACL deficient”. Study isolated ACL rupture may increase the high school or equivalent education, Selection: Sixteen studies reporting risk of OA development compared to 93% knee osteoarthritis, and 77% the incidence of tibiofemoral OA in those not receiving reconstruction. moderate-severe radiographic osteo- ACL-R patients and/or ACL-D patients arthritis. Interventions: Four inter- using radiographic assessments were 12182FOIN view-based questionnaires were used included. Potential studies were Medication and Supplement Use to obtain information about the excluded if OA incidence data was not for Managing Joint Symptoms participant’s health history and provided or if patients presented with Among Patients with Knee and pharmacological/supplemental use. OA at the time of ACL injury. Study Hip Osteoarthritis: A Cross- The questionnaires were developed by limitations included wide ranging sectional Study the research team and reviewed by two patient populations, age, activity level, Driban JB, Boehret SA, statisticians. All of the questionnaires and follow-up time. OA grading scales Balasubramanian E, Cattano NM, were administered by one investigator. Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 were also not consistent across all Glutting J, Sitler MR: Division of The interviewer practiced the studies, yet we were not concerned Rheumatology, Tufts Medical Center, procedures and data coding on 18 non- about the grade of OA, rather the Boston, MA; Department of study patients with knee osteoarthritis presence of the disease. Data Kinesiology, Temple University, prior to starting the study. Main Extraction: Two investigators Philadelphia, PA; Department of Outcome Measures: The question- assessed study methods through the Orthopaedic Surgery, Temple naires were an item-by-item design, Critical Appraisal Skills Program. The University Hospital, Philadelphia, where each question could be scored number of patients with radio- PA; Department of Sports Medicine, individually. Logistic regression graphically diagnosed knee OA were West Chester University, West models and Fisher Exact Tests were extracted from the total patients with Chester, PA; School of Education, performed to determine factors that ACL-D and ACL-R in each study. University of Delaware, Newark, DE; may be associated with negative Additionally, the added risk of College of Health Professions and behaviors related to medication/ concomitant meniscal injury was Social Work, Temple University, supplement use. Odds ratios (OR) and analyzed. Data Synthesis: Numbers Philadelphia, PA 95% confidence intervals (CI) were needed to treat (NNT; Numbers calculated for significant findings. Needed to Treat to Benefit =NNTB and Context: Osteoarthritis is an Results: Among the 162 participants, a Harm=NNTH), and relative risk increasing concern among aging majority reported professionally-guided reduction (RRR; relative risk athletes with a history of joint trauma recommendations and over 40% increase=RRI), with associated 95% or participation in high-risk sports reported at least one self-guided confidence intervals were calculated (e.g., soccer). To educate our patients intervention. 37 participants reported for three separate groups including; 1) about safe and effective methods to dual-use during the same day, and among subgroup of patients with meniscal and alleviate joint symptoms it is important those, 15 reported dual-use at the same ACL injury, 2) subgroup of patients to understand how patients with hip and time. Use of multiple medications or with isolated ACL injury, 3) total knee osteoarthritis manage their supplements in one day was more patients (groups 1 and 2). Patients with symptoms. Objective: The purpose of common among participants who a menisectomy and ACL-R yielded the study was to determine the reported osteoarthritis at multiple joints NNTB of 6 (NNTB 18.98 to 3.54) with professionally-guided and self-guided (OR [95%CI]=2.48 [1.03 to 5.96]) but an RRR of 29% (RRR 9% to 48%). medication use for joint pain less common among participants who Isolated ACL-R yielded a NNTH of 29 management among patients with knee did not complete high school (OR (NNTH 9.3 to •to NNTB 24.88) with and/or hip osteoarthritis. Design: [95%CI]=0.26 [0.08 to 0.83]). Overall, a RRI of 67% (RRI:17% to 83%). In Cross-sectional study. Setting: Urban 28% of participants reported their total, NNTB for patients receiving an hospital-based outpatient orthopedic intervention as ineffective, sought an ACL-R was 44 (NNTB 11.4 to •to practice. Patients: A convenience alternative method to achieve NNTH 23.66) with a RRR of 6% (RRR sample of 184 patients with a primary symptomatic relief, or were prescribed 23% to RRI 11%). Conclusions: complaint of hip or knee osteoarthritis a stronger medication. Participants Overall the ACL-R intervention does was asked to participate. 22 who reported not always taking their not seem to be particularly effective participants were excluded or declined medication consistently for 2 weeks at preventing tibiofemoral OA. participate. Hence, 162 patients were were more likely to report their However, when a meniscal injury, included in the study: 67% female, medication as ineffective (OR [95% requiring meniscectomy, is present in 73% African descent, 59±10 years of CI]=2.87 [1.19 to 6.92]). Conclu- combination with an ACL rupture, age, body mass index = 35.1±7.6 kg/ sions: It is important for clinicians to ACL-R seems to be beneficial in m2, 57% report-ing a history of sport discuss with patients how to preventing OA. Conversely, this data participation, 48% high school or effectively manage multiple joint indicates that ACL-R following equivalent education, 27% less than a symptoms, the importance of taking

S-186 Volume 47 • Number 3 (Supplement) May 2012 medications as prescribed, and what placed on ice, and transported to the they should do if they believe a laboratory. Serum was separated and treatment is ineffective or their placed in a-80°C freezer prior to medication runs out. analysis. ELISA tests were run for human sCOMP. Serum COMP values 12290 are expressed as ng/mL. The The Influence of Exercise independent variable was time. Main Intensity on Serum Cartilage Outcome Measures: Serum COMP Oligomeric Matrix Protein values and weekly minutes of (sCOMP) participation served as the dependent Mateer JL, Hoch JM, Mattacola variables and were investigated over CG, Li HF, Bush HM, Lattermann

time using linear mixed models with Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 C: University of Kentucky, random coefficients. Alpha was set at Lexington, KY p<0.05. Values are presented as mean±SD. Results: Baseline(T0) Context: Serum cartilage oligomeric sCOMP values were 1249±227ng/ matrix protein(sCOMP) is a mL. The total amount of minutes biomarker elicited during cartilage engaged in physical activity ranged degradation. Increases in sCOMP have from 330-840. For practice draws T1- been reported following single bouts T8, the highest sCOMP value was of physical activity and over the 1596± 287ng/mL(T7) in which the duration of an athletic season. participants exhibited the greatest However, it is unknown what effects amount of athletic activity(840 exercise intensity has on sCOMP minutes). Additionally, sCOMP values levels when measured serially over returned to levels similar to baseline time. Objective: To determine the in T9(1313±294ng/mL) and T10 influence of exercise intensity on (1275±174ng/mL)following cessa- sCOMP levels over the course of a tion of intense physical activity. The soccer season. Design: Repeated- results of the mixed model analysis measures longitudinal cohort study. was significant, p=0.025. This analysis Setting: Laboratory. Patients or determined that for every 100 minute Other Participants: Six female increase in athletic activity, the average Division-I soccer athletes (age:18.8 sCOMP levels increased by 53ng/ ±1.3 years; height: 168.9± 4.2cm; mL(95% confidence interval: 8.4- weight:67.1±7.4kgs) participated in 11 98.4ng/mL). Conclusions: The weekly(T0-T10) data collection results of this study demonstrated that sessions. Subjects were included if exercise intensity (measured in they participated in the 2011 spring minutes), does influence changes in soccer season and had no history of sCOMP levels. Therefore, increases in lower extremity surgery. Inter- intense physical activity result in ventions: For the duration of the greater sCOMP levels. These findings spring soccer season(T1-T8), minutes indicate that exercise intensity should of participation in practice, agility, be considered when monitoring lifting, conditioning, and game play sCOMP values in a physically active were documented each day and cohort. Future studies are necessary summed on a weekly basis. The week to determine if changes in this prior to participation(T0) and the biomarker are representing a weeks following participation(T9-10) physiologic increase in cartilage served as controls as there was no turnover, or irreversible changes to the formal athletic participation during articular cartilage. these weeks. No data was collected for session T4. At each data collection session, subjects remained seated for 30 minutes before serum collection. Following the rest period, serum was collected from the antecubital vein,

Journal of Athletic Training S-187 Free Communications, Poster Presentations: Case Studies Exhibit Hall; Wednesday, June 27, 10 AM-5 PM; Thursday, June 28, 10:00AM-5:00PM; Friday, June 29, 10:00AM-1:00PM; Authors present June 28, 10:00AM-11:30AM 12202UC 12084SC Ankle Dislocation with the field and immobilized. The patient Severe Presentation of an Maisonneuve Fracture: A Case was then referred to the emergency Electrolyte Imbalance in a High Report department and ultimately admitted for School Athlete Tracz A, Powers ME: Marist surgical intervention. The distal Cox SJ, Felton SD, Frymyer JL: College, Poughkeepsie, NY; tibiofibular joint was stabilized with Naples Community Hospital, University of Maryland, two screws inserted through the distal Naples, FL; Florida Gulf Coast Baltimore, MD fibula extending through the University, Fort Myers, FL Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 syndesmosis and into the tibia. The Background: We present the case of tibial malleolar fracture was fixated Background: Athlete is a 16-year old an ankle dislocation complicated by a with two more screw inserted directly male high school football athlete in unique proximal fibula fracture in a into the medial malleolus from the South Florida. The athlete completed high school football athlete. A healthy distal end. Following surgery, the an evening football competition, mid sixteen year old male running back patient was placed non-weightbearing season, and collapsed post-game suffered a direct blow to the lower in a short leg cast for eight weeks walking into locker room. The extremity while being tackled. The followed by a program of therapeutic Athletic Trainer (ATC) was called to tackler landed on the posterior aspect exercise to restore range of motion, the scene. Athlete was lying supine of the patient’s left ankle and foot, strength, and neuromuscular control. having difficulty breathing. He denied causing the lower leg to internally Uniqueness: While distal fractures any injury during the game and denied rotate while the foot remained in a associated with ankle dislocations are hitting his head at time of collapse. fixed position on the ground. Upon common, proximal fractures are not. Family was present and denied any examination, a gross ankle deformity Maisonnueve fractures of the proximal other relevant medical history was noted as the foot remained in an fibula are associated with disruption of concerning the athlete. ATC conducted externally rotated and pronated the tibiofibular syndesmosis, but are a general evaluation. Athlete’s BP was position. Distal circulation, sensation, often missed during physical and 128/78, HR was 117, with respirations and motor function were present radiographic exam. While most rapid and shallow. Within five minutes however the patient was experiencing Maisonneuve fractures occur distal to of initial collapse, athlete reported a significant amount of pain. The team the head of the fibula, the present injury neck pain. ATC initiated inline cervical physician diagnosed the injury on the occurred at the fibular head itself. neck stabilization while another ATC field as a talocrural dislocation and Conclusions: Despite the location of on site began palpating cervical spine performed a closed reduction at that the Maisonneuve fracture, surgical which revealed C5 and C6 point time. Distal circulation, sensation, and management of the injury was not tenderness and EMS was summoned. motor function remained present after different than if it had been it its Athlete was beginning to display reduction however significant swelling typical location. The presence of a decreased consciousness and was present. Nothing else was Maisonneuve fracture implies alertness, numbness and tingling in remarkable at that time. The ankle was ligamentous ankle injury with potential facial region, along with bilateral then immobilized with a rigid splint and instability not always apparent on extremity numbness in arms and legs. the patient was referred to the static radiographs. It is imperative that Athlete started to display decerebrate emergency department for further clinicians are familiar with this injury posturing. Differential Diagnosis: diagnostic testing. At the emergency and its clinical and radiographic Subdural Hematoma, Upper Motor department, radiographs confirmed presentation. If not managed properly, Neuron Lesion, Cervical Spine that the patient had suffered an anterior permanent disability and dysfunction Fracture, Cervical Spine Sprain, talocrural dislocation with successful could result. Early surgical inter- Dehydration Treatment: Initial reduction and revealed an associated vention is recommended due to the treatment consisted of maintaining fracture of the medial malleolus. A potential instability associated with cervical spine stabilization, controlling fracture at the proximal fibular head such an injury. In the present case, athlete’s anxiety and accessory was also noted. Differential Diag- surgery and rehabilitation produced movements. EMS arrived and assisted nosis: Talus fracture, tibia fracture, satisfactory results as athlete was able with proper spine board transport of Weber or other fibula fracture, Pott’s to return to play the following season. the athlete. Athlete was transported to or Dupuyten’s fracture, lateral local Emergency Room. During collateral ligament sprain, deltoid transport athlete was infused with two ligament sprain, syndesmosis sprain. 1000 mL of normal saline intra- Treatment: The ankle was reduced on venously. At ER, athlete underwent S-188 Volume 47 • Number 3 (Supplement) May 2012 diagnostic examinations which however, without proper referral, the nondisplaced distal fibula fracture. The included radiographs, EKG, CBC, and outcome could have been more severe. patient was placed in a nonweight- other laboratory diagnostic tests. The case also highlights the importance bearing cast and instructed to return 1 Radiographs and EKG were WNL. of critically evaluating the entire week later while performing toe CBC was WNL, but the electrolyte episode. The athlete’s blood results wiggles in the meantime. The patient screen indicated low potassium levels would have been different if taken returned 11 days later for removal of and marginally acceptable sodium immediately prior to IV admini- cast and reexamination. His pain level levels. At the time of the CBC, the stration, most likely also revealing low and localization was consistent with athlete had received two liters of sodium levels. Care should be taken initial evaluation. Range of motion normal saline IV fluids which likely when administering supplemental continued to be limited with residual elevated the sodium levels and the potassium as this can lead to cardiac edema present. A positive tinel’s sign

subsequent electrolyte screen was arrest. By supplementing the athlete at the left fibular head was noted with Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 within an acceptable range. Athlete was with sodium, potassium reabsorption prolonging decreased sensations of the discharged following evaluation from is maintained, thus preventing dorsal aspect of the foot. X-rays were physician and instructed to follow-up hypokalemia. retaken revealing the questionable with Pediatrician to reconduct CBC nondisplaced fracture of the distal and Laboratory diagnostic tests four 12010SC fibula. Patient was placed in a walking days post initial episode. The follow- Ankle Sprain Leads to Chronic boot, given a physical therapy up tests were WNL and athlete was Regional Pain Syndrome in prescription, and scheduled for a officially diagnosed as suffering from Football Player follow up visit in 2 weeks. The patient transient hypokalemia secondary to Ridgeway J, Hosey R, Staley T: returned 14 days later for reevaluation. dehydration. Athlete was cleared for University of Kentucky A significant bluish purple dis- full participation and has had no further Orthopaedic Surgery and Sports coloration of his foot was noted in a episodes or problems. Following Medicine, Lexington, KY gravity dependent position. The patient return to participation, the ATC began had neurologic symptoms of preventatively supplementing the Background: A 17 year old male high dysesthesia over the lateral foot that athlete with 2 TSP of table salt in grape school football player presented to the does not follow dermatomal patterns juice prior to game competition. This outpatient clinic with a chief with the decreased range of motion of supports an action outlined in the NATA complaint of left ankle pain. Patient the ankle. A MRI, that was ordered by Fluid Replacement for Athletes described an inversion ankle injury his PCP, showed a subacute tear of the Position Statement, suggesting the during a game 7 days prior with no anterior talofibular ligament and bone inclusion of sodium chloride treat- history of previous injuries. Since the marrow edema of the bilateral malleoli ment in extreme heat environments. injury, the patient said he had been , talus, and calcaneus consistent with a This plan of action was collaborated nonweightbearing while applying ice, healing contusion. A secondary with the physician based on the consuming ibuprofen, and going to diagnosis was imparted of a lateral physiological properties of sodium therapy. Pain was listed at a 6 on a 10 ankle sprain with the beginning chloride to promote acceptable point scale with tenderness around the development of chronic regional pain potassium reabsorption. Athlete has lateral ankle with neither proximally syndrome. The patient was instructed anecdotally stated he has felt the best nor distally radiating pain. Edema was to continue physical therapy, given a he ever has following competition and noted around the lateral aspect of the plastic type ankle brace to assist with has had no further heat related ankle with ecchymosis along the his drop foot, and scheduled for an problems or complaints. Uniqueness: lateral aspect of the foot. Range of EMG and nerve conduction study. The Neurological symptoms are often a motion was limited due to pain with a patient returned 5 days later. The EMG result of cervical neck injuries or a decreased sensation on the dorsal and nerve conduction study resulted as compounding factor with athletes aspect of the foot. The posterior tibia normal with the decreased range of suffering from heat stroke. In this and dorsalis pedis pulses were motion noted. The discoloration case, the athlete had no cervical neck palpatable. Differential Diagnosis: appeared vasomotor in nature. Some trauma or initial signs of heat related Possible injuries include lateral ankle of his numbness has resolved. A final illness. The neurological signs and sprain, distal fibula fracture, diagnosis of a lateral ankle sprain with symptoms experienced were a result syndesmotic sprain, osteochondral chronic regional pain syndrome was of the electrolyte imbalance; thus defect, and peroneal tendon strain. given, while instructed to continue presenting signs and symptoms not Treatment: X-rays showed a possible physical therapy and change his plastic commonly associated with initial heat nondisplaced fracture of the distal type ankle brace to a lace up style ankle related illnesses. Conclusions: This fibula, due to changes in the cortex, brace. Uniqueness: With only an case highlights the diagnosis of an with no widening of the ankle joint. occurrence of 26.2 per 100,000 athlete suffering from hypokalemia. Initially, the patient was diagnosed with annually, chronic regional pain The athlete has made a full recovery; a lateral ankle sprain with a possible syndrome rarely develops from an Journal of Athletic Training S-189 associated trauma. Conclusions: a month later (August 2011), he denied He was cleared to return to football in Inversion ankle sprains rarely change any post-concussion symptoms. He November 2011, but did not return into a disorder that is more debilitating sustained another concussion during since only two games remained in the than originally perceived. However, the first week of formal practice with season. His headache and con- signs and symptoms that are atypical severe symptoms. Following this centration difficulties lasted nearly of an inversion ankle sprain need to be concussion, he “came clean” admitting two months. His cardiologist taken into account for other the symptoms from the camp diagnosed his hypertension as essential developments that might arise. concussion had not previously resolved. and recommended controlling with When school started, his friends noticed continued exercise, proper nutrition, 12055OC a difference in his personality with mood and medication. With his concussion Hypertension Exacerbates swings and increased emotions. He had symptoms gone and blood pressure Symptoms of Concussion in High

difficulty hard time remembering under control, he had been working out Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 School Football Player conversations with his friends. Because regularly and planning to return to Freed SD, Blair DF, Walton MA, of his inability to concentrate, he football for the 2012 season. However, Harrison CS, Madland JM: dropped his two most difficult classes. there are some unresolved health Wenatchee Valley Medical Center/ Other physical symptoms, such as issues including his multiple Wenatchee High School, Wenatchee, headache, also continued. Diffe- concussions and chest pain episodes WA rential Diagnosis: essential hyper- that need to be addressed. tension, malignant hypertension, Background: Our subject is a 16 concussion, hypertrophic cardio- 12028FC year-old male American football myopathy, renal artery stenosis Great Toe Pain in a High School linebacker (height: 183.3 cm., weight: Treatment: When the initial dose of Football Player 89 kg). In May 2011, our subject lisinopril was not effective, the dose Storvsed JR, Zimmerman J: Eastern checked his blood pressure “as a joke” was increased to 10 mg and finally to Illinois University, Charleston, IL; on an automated supermarket sphyg- 20 mg. In September 2011, the Carle Foundation Hospital, Urbana, momanometer. His systolic pressure lisinopril was still not effective in IL was 160 mm/Hg. He then visited a lowering the blood pressure. A switch physician to investigate his hyper- to a calcium-channel blocker, Background: A 17 year old high school tension as part of his sports physical. amlodipine (5 mg daily) was made. football player reported with insidious The physician did not clear him for Amlodipine has been effective in onset of pain in and around the left sports because of his elevated blood controlling his hypertension. We great toe. He stated that he had been pressure. He then consulted his family noted a relationship in the reduction treated for ‘turf toe’ in the same foot physician who referred him to a of his headache symptoms (one month during the previous football season but pediatric cardiologist. Our subject has post-concussion) and the lowering of that had resolved following completion a family history of hypertension on his his blood pressure with the amlodipine. of the football season. The athlete paternal side. The subject indicated he His echocardiogram revealed no stated the he participated in both occasionally experienced chest cardiac abnormalities. His pediatric basketball and track seasons with no discomfort lasting a few seconds per cardiologist referred him to a complaint. Upon resuming football episode. There was not a history of nephrologist for two separate related activities during the summer, dependent edema, dyspnea with ultrasound evaluations. Both of which the pain gradually increased to the point exertion, or syncope; however, he did revealed no abnormalities of his in which he was unable to run due to have occasional orthostatic dizziness. kidneys that might be causing the the severity of the pain. Upon He had a history of a significant hypertension. An imPACT neuro- evaluation, the athlete presented with concussion in 2008 while skate psychological test was administered on a neutral arch but did present with boarding. He experienced vision November 3, 2011 with results equal keratosis around the fist ray, first issues and prolonged symptoms to his 2009 baseline. Uniqueness: It metatarsophalangeal joint and 1st following this event. In June 2011, his is the concurring opinion of his metatarsal head. The athlete did report cardiologist prescribed an ACE physicians that his hypertension may that he has been treated for inhibitor, lisinopril, starting with 5 mg have played a role in the exacerbating hyperkeratoic lesions previously. The daily to control his hypertension. In his concussion symptoms. This drives athlete was point tender over the 1st July 2011, in spite of a still slightly home the point that athletic trainers metatarsophalangeal joint, the base of elevated blood pressure, he was need to consider other underlying the distal 1st metatarsal and the cleared to participate in a summer issues that can intensify concussive seasmoid bones. The athlete football camp. He sustained another symptoms. In his case, his hyper- complained of pain with valgus and concussion during this camp and was tension may have been issue in varus stress test at the 1st removed from competition for the prolonging his headache and other metatarsophalangeal joint. He also had week. When fall practice began nearly concussive symptoms. Conclusions: pain with active and resistive great toe S-190 Volume 47 • Number 3 (Supplement) May 2012 flexion and with passive great toe intending to continue his football pain was elicited. He also could extension. Differential Diagnosis: career at the collegiate level. perform biceps and triceps strengthen- Hallux rigidus, 1st metatarsophalangeal ing,along with seated rows using joint sprain (turf toe), sesamoiditis, 12007SC elastic tubing. At two weeks repeat x- bipartite sesamoid, sesamoid fracture. First Rib Fracture in a Collegiate rays revealed continued fracture line Treatment: Protective taping for 1st Football Player with no evidence of bony union and the metatarsophalangeal sprain did not Casmus R, Rider S, Latimer H, Ginn athlete was point tender over the relieve pain. Athlete was seen by team A: Catawba College, Salisbury, NC superior trapezius muscle. He also had physician. X-ray was inconclusive for pain with resisted cervical motion. sesamoid fracture. MRI revealed early Background: A 20 year-old male There was no neurovascular com- avascular necrosis and an occult football player was struck to the right promise to the upper extremity. When shoulder during a kick-off return drill fracture of the medial sesamoid. The not participating in therapy, the athlete Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 lateral sesamoid was within normal during a collegiate football practice. was instructed to wear the arm sling limits. The athlete was referred to a The athlete complained of immediate and refrain from overhead activity. podiatrist to discuss surgical pain and also pain with forward flexion. Repeat x-rays at six weeks showed intervention. Based on consultation The initial exam revealed anterior significant boney calcification with podiatrist, it was determined that shoulder pain and the inability to beginning to occur at the fracture site. the athlete could return to football forward flex and abduct the shoulder At ten weeks, x-rays showed the activities with the understanding that with applied resistance. The athlete had fracture site with full boney union. he may a have periodic episodes of no pain to palpation over the AC joint, Uniqueness: According to the pain that could limit his full activity but curiously had moderate pain along literature, first rib fracture injuries are level. It was also suggested to the the distal scapula. No tenderness along the rarest of all all rib injuries. The athlete that he continue to tape his the cervical spine and moderate pain mechanism of injury is similar to that great toe along with a donut pad over along the superior trapezius. He had which causes AC sprains and clavicle the involved sesamoid. Both doctors full cervical spine range of motion. fractures. First rib fractures often also suggested that if possible, he There was no clavicle pain or result from severe direct trauma to the should remove the football cleat deformity. No glenohumeral instability chest and upper torso.A thorough located in that area to eliminate any noted and glenoid labrum test were literature search revealed few articles potential irritation. Uniqueness: deferred. There was no pain with relating to acute isolated first rib Avascular necrosis is not commonly respiration and no neurovascular fracture injuries, particularly in associated with the sesamoids and is symptoms present. Differential athletes. First rib fractures can occur usually the last diagnosis of plantar Diagnosis: shoulder contusion, in throwing athletes and present as a pain to the first metatarsophalangeal muscular strain to the superior stress fracture. First rib stress joint. Typically the patient will trapezius, AC joint sprain, scapula fractures may often present with complain of pain on the plantar aspect fracture, clavicle fracture, or rib associated scapular pain. Most authors of the first metatarso-phalangeal joint. fracture. Treatment: The athlete was recommend conservative treatment of A pedal exam can show edema and treated with ice and placed in an arm first rib fracture injuries. Con- erythema to the involved area. Pain will sling and referred the next day to the clusions: This case demonstrates the be elicited with palpation of the area team physician for evaluation and x- necessity of prompt recognition and and with passive range of motion. ray. The next day, x-rays revealed a treatment of an unusual rib injury Aggravating factors include the use of transverse fracture to the first rib. The diagnosed as a fracture. It also high-heeled shoes and repetitive athlete remained in the arm sling and supports the non-operative manage- stresses to the sesamoid complex. withheld from football activity but ment and care of first rib fracture Conclusions: With conservative permitted to ride a stationary bike for injuries. Proper care and rehabili- treatment, the athlete has had minimal exercise. The use of thermal tation is required for return to active complaints of great toe pain. The modalities began 72 hours post- participation in athletic activities with athlete has continued to have his great trauma. At 10 days the athlete was this type of injury. Because of the toe taped for each practice and game, pain-free with gleno-humeral range of time loss from football activity, the but it appears that the removal of the motion and began rotator cuff athlete successfully applied for a football cleat immediately under the exercises with the elbow adducted medical hardship waiver. The athlete at area of the sesamoid has provided the using elastic tubing. Gleno-humeral this time is asymptomatic and has most relief. Upon conclusion of the joint distraction was noted to be returned to all athletic and daily living football season, the athlete will return aggravating and therefore was to be activities. for follow-up with the podiatrist to avoided. The athlete could begin determine whether surgical inter- forward and lateral raises dumb- vention is necessary. The athlete is bellsraises from 45-90 degrees as no

Journal of Athletic Training S-191 12350MC Management of a Case of Common Patients receiving IVIG are not able to appropriate times depending on their Variable Immune Deficiency in a complete physical activity for 24 hours sport, as well as making the proper Collegiate Gymnast post-treatment. Side effects of IVIG medical referrals when athletes have DeSantis BM: University of treatment are generally mild and persistent or recurrent cold or flu-like Kentucky, Lexington, KY include headaches, short term fatigue, symptoms. chills, and nausea. Some serious side Background: The athlete is an effects, although less common, 12141MC Objective Assessment of Function eighteen-year-old female inter- include transmission of hepatitis C and following Head Injury using collegiate gymnast who began meningitis, renal failure, and Movement and Activity in gymnastics at age 4. Between ages 5 anaphylaxis. Along with IVIG treat- ment, many patients are given diuretics Physical Space (MAPS) Scores: to 9 shebegan having recurrent cases Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 A Case Report of sinusitis,bronchitis (three as well. This can cause an imbalance Farnsworth JL, Nickels SJ, episodes), pneumonia (2 episodes), of sodium and potassium levels within McElhiney D, Bartholomew M, and had her tonsils removed. Her the body, making patients more David SD, Ragan BG: Ohio parents and coaches noticed that she susceptible to muscle cramps and University, Division of Athletic was more fatigued with participating dehydration. Uniqueness: The esti- Training, Athens, OH; Marietta in gymnastics. She did not respond mated prevalence of CVIDin the College, Marietta, OH well to treatment with over-the- general population is 1 in 20,000 to counter medications or antibiotics. At 100,000 people. CVID statistics in age 9, she was referred to an infectious collegiate athletes are unknown Background: A 21 year old NCAA disease specialist and lab studies because often this condition is not Division III women’s soccer revealed depressed levels of IgG diagnosed until adulthood. For- midfielder suffered a blow to the back (immunoglobulin gamma) concen- tunately, IVIG treatment greatly of the head from an opponent’s trations. IgG is an antibody found in increases a person’s quality of life and shoulder while participating in an away human blood that plays three main reduces the risk of persistent infection match. There was no athletic trainer roles in adaptive immunity: ( 1) neu- by way of passive immunity. Donor present to immediately diagnose the tralizes foreign antigens through direct antibodies protect the patient receiving injury. The patient reported to the binding, (2) alters antigens to allow for IVIG treatment because patients with athletic training room the following phagocyte engulfment, and (3) triggers CVID are not able to produce enough day complaining of a headache, release of cytokines and chemokines antibodies on their own. IVIG does not “pressure in the head”, dizziness, to destroy foreign antigens. Normal eliminate CVID nor does it completely confusion, not “feeling right”, light IgG values range between 700- 1400 abolish the risk of infection. For this sensitivity, feeling “slowed down”, mg/dl; this athlete’s initial IgG values reason, many children with this difficulty concentrating and were around300 mg/dl. Differential disease are removed from public remembering, fatigue, drowsiness, and Diagnosis: Bone marrow deficiency, schools and extra-curricular activities. being emotional. A thorough head and leukemia, immune deficiency. The cost of IVIG treatments are cervical spine examination was Laboratory tests confirmed that the between $10,000- $15,000per performed. Vital signs and cranial athlete was positive for Common treatment. Conclusions: CVID is a nerve function were within normal Variable Immune Deficiency (CVID). very rare condition found in the limits. The Sport Concussion CVID occurs due to a genetic mutation general public and even less common Assessment Tool 2 (SCAT2) was in the blood with an idiopathic in athletes. Athletic trainers who are administered post-injury yielding a etiology. In patients with CVID, the managing athletes with CVID need to total score of 67 of 105, substantially immune system does not produce pay close attention to the athlete’s lower than her baseline score of 98 of enough antibodies to destroy invading daily health status. If not properly 105. The purpose of this case report microorganisms that can cause managed, e.g. an athlete misses an IVIG is to highlight the use of an objective bacterial and viral infections, thus, treatment, athletes with CVID can functional measure, the Movement and increasing susceptibility to infection. suffer serious consequences such as Activity in Physical Space (MAPS) Treatment: The athlete was treated persistent infections, splenomegaly, scores following injury. Differential with an antibody-replenishing and uncommonly, death from even Diagnosis: Concussion, mild treatment known as intravenous mild upper respiratory infections. traumatic brain injury, intracranial immunoglobulins (IVIG) every 21 Good communication between the hemorrhage. Treatment: The athlete days; this IVIG includes Gammagard, athlete and athletic trainer is was removed from activities. Benadryl, and Solu-Cortef. The imperative. Athletic trainers can help Symptoms were monitored based on immunoglobulins are pooled from athletes with CVID manage their the Zurich guidelines. She was also thousands of donors who have been condition by teaching them to properly instructed to wear a beeper sized screened for various diseases. monitor hydration levels at accelerometer on her hip and to carry S-192 Volume 47 • Number 3 (Supplement) May 2012 an on-person Global Positioning inverse relationship between respectively) circular mass protruding System (GPS) receiver at all times for symptoms and function. In situations from the right lateral abdominal wall. 10 days except for when sleeping or where accuracy of reported symptoms Also noted were several small bathing. These devices measure may be a concern, this measure may abrasions and one healing laceration physical activity (intensity) each provide a way to verify the validity of, along with evidence of ecchymosis minute and location (latitude/ or raise doubts, about self-reported around the mass. The patient was non- longitude). Daily MAPS scores were symptoms. Current concussion tender to palpation; however, calculated by combining data from the assessment tools focus on symptoms adhesions were noted within the GPS and accelerometer for each day and impairments and are largely center. There were no functional during the recovery period to assess subjective in nature. MAPS scores restrictions or inhibition in breathing. the patient’s level of function in free- present an objective way for athletic A rehabilitation protocol to reduce the

living conditions. She was asymp- trainers to measure athlete function mass’ size included: therapeutic Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 tomatic five days after the injury and following concussion, which may be ultrasound (avoiding open wounds) at began a gradual return to play protocol used as part of the return to play 3.3 MHz (20% duty cycle; spatial on day six. This protocol involved light decision. average intensity=1.3 W/cm2) to activity that progressed to moderate/ 12035UC facilitate healing and promote blood vigorous activity and finally returning Diagnosis and Management of a flow and manual therapy. Manual to practice (day nine) following Lateral Abdominal Wall therapy consisted of superficial and clearance by a physician. The MAPS Hematoma After a Motorcycle deep effleurage massage to encourage data, representing the patient’s Accident: A Case Study venous and lymphatic return. A interaction within her environment, Welser JA, Sanislo HN, Berry DC, lymphatic corrective Kinesio®-taping were analyzed to provide an objective Berry LM, Slater L: Saginaw Valley application to the lateral abdominal measure of function following injury. State University, University Center, wall to create space and provide a Uniqueness: We monitored the MI; Physical Therapy & Rehab channel for fluid to move towards the patient’s function during the Specialist, Midland, MI lymph nodes was also initiated. Eight concussion recovery process using treatments later the mass measured GPS and accelerometers creating Background: The purpose of this 22.5 cm x 18.9 cm (inferior-superior MAPS scores. This novel approach to case report is to document the and medial-lateral, respectively). The measuring function following injury treatment and outcome of a right patient was referred to a Certified may provide a useful complimentary lateral abdominal wall hematoma in a Lymphedema Specialist. Following tool to objectively determine return to 28-year-old male, Caucasian the physical examination the specialist play status. In this case the patient’s Information Systems Analyst. The recommend a course of decongestive symptom totals for the four patient was involved in a non-fatal therapy and manual lymph drainage. symptomatic days were 82, 39, 49, and motorcycle ejection after colliding The lymphatic drainage techniques 36 (mean 51.5). Her MAPS scores for with another vehicle, landing chest used were “Stirring the Well” and days 2-4 were 865.2, 815.4, and first on the pavement. Evaluated at the “Opening the Trenches”. After four 1022.1 (No MAPS score was emergency department, diagnostic treatments the hematoma demon- calculated for day one because it was testing (MRI and radiographs) for strated some reduction in size, 19 cm not a full day). Her mean MAPS visceral and bony trauma was negative. x 18cm (inferior-superior and medial- functional score while symptomatic He was released that evening. After lateral, respectively). The patient was was 900.9, and while asymptomatic twenty-four hours a large hematoma educated on how to perform the 2734.9 representing a three-fold had formed; 6-8 hours later it had technique at home and reported being increase. An interesting observation begun to harden. On follow-up with his compliant; however, no significant was that on day three she attended a primary physician 12 days later his reduction in mass size occurred. volleyball game which increased her diagnosis was a right lateral abdominal Uniqueness: The formation of lateral symptoms. This increase in symptoms wall hematoma and the patient was abdominal wall hematomas are not was also reflected in her MAPS score referred to physical therapy for commonly reported in the literature, for that day which decreased from 865 evaluation and treatment. Differential and typically are managed though to 815. Conclusions: GPS and Diagnosis: Fibromatosis, abdominal surgical intervention due to the lack of accelerometers were used to observe wall herniation, abdominal wall progress with conservative treatment. the patient’s physical activity in a free- rupture, abdominal aneurysm, rib Other reported cases that present with living environment, allowing for an fracture, peritonitis, intra-abdominal hematomas of this size eventually objective measure of function during or subcutaneous hematoma. Treat- encapsulate around the necrotic tissue recovery. MAPS scores were low ment: Examination by an athletic thereby making it impossible for while she was symptomatic and trainer/physical therapist revealed a conservative treatment alone to increased as she became asympto- moderately sized, 23.1 cm x 18 cm resolve the condition. In this case, the matic. In this case, we saw the expected (inferior-superior, medial-lateral, referring physician opted for a Journal of Athletic Training S-193 conservative approach rather than an care physician did not reveal any atrioventricular block with mild mitral invasive surgical procedure. And while cardiac abnormalities. Differential valve regurgitation, the patient was the decongestive therapy and manual Diagnosis: congenital heart defect able to participate for an entire season. lymph drainage demonstrated some (atrial/ventricular septal defect), heart This case is also unique because she improvements in mass size compared muscle condition (myocarditis, did not present with significant to therapeutic ultrasound and cardiomyopathy), heart murmur symptoms during the season, did not Kinesio®-taping alone, the overall (mitral valve prolapse/regurgitation/ notify any medical professionals when improvement has not shown stenosis, aortic stenosis/sclerosis/ she noticed any abnormal heart significant signs of resolution. Further regurgitation), Arrythmia (Supra- rhythms, and was cleared for care will likely be warranted to aid in ventricular tachycardia, proxysmal unrestricted activity pending careful the resolution of the hematoma supraventricular tachycardia, sinus monitoring by the athletic trainer.

because conservative treatment alone tachycardia, bundle-branch block, Conclusion: If a cardiac condition is Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 has not been successful. Con- atrial fibrillation). Treatment: After present, it will most often be found clusions: Certified athletic trainers the initial consultation with the primary during the pre-participation screening are well trained in the management of care physician, she was referred to a process. In this instance however, the localized hematomas to the cardiologist. The cardiologist ordered condition was not identified during the extremities caused by blunt force a 24-hour Holter test which indicated pre-participation screening and the trauma from projectiles, equipment, a heart rate of 38-126 bpm with an athlete participated without identi- and other athlete-to-athlete contact. average of 65 bpm. Also, the 24-hour fication of the condition. Although However, lateral abdominal walls Holter test revealed a 1o and 2o many medical organizations do not hematomas, such as the one presented atrioventricular block, a disruption of support advanced cardiovascular in this case offer a unique experience nerve conduction in the heart that screening for athletic participation, because of the mechanism of the resulted in pauses, as well as 341 more thorough cardiac screenings may injury, the extent of the condition and isolated premature ventricular be necessary for athletic trainers to failure to resolve with conservative contractions, which were asympto- adequately identify and prevent sudden care. In situations where conservative matic and occurred mostly during cardiac pathologies that may arise. care fails to resolve the condition, sleep. Furthermore, the 24-hour Advanced cardiovascular screenings referral to appropriate healthcare Holter test revealed 5 episodes of could be performed during pre- providers for further evaluation and tachycardia, 33 episodes of brady- participation screenings to ensure safe alternative therapy or surgical cardia, and 130 pauses greater than 2 participation. Additionally, athletic intervention may be necessary. seconds, with the longest pause being participants should be educated about 2.2 seconds. Further diagnostic the warning signs and symptoms of 12094UC testing included an electrocardiogram cardiovascular conditions so that they Abnormal Heart Rhythm in to evaluate the electrical activity and may feel comfortable reporting them Collegiate Female Basketball an echocardiogram to evaluate the to their athletic trainer or other Player ventricles and valve functions. The appropriate health care providers. As Hallissey H, Wright T, Rothbard M, electrocardiogram was within normal such, this case demonstrates that Dale A: Southern Connecticut State limits; however, the echocardiogram athletic trainers will have exposure to University, New Haven, CT revealed minor mitral valve patients suffering from cardiovascular regurgitation with normal mitral valve conditions and should be able to Background: A 21-year-old female appearance, trace tricuspid valve identify, educate, and monitor basketball guard presented with an regurgitation with normal appearance, participants with cardiac symptoms unstable heart rhythm that was and trace pulmonic valve regurgitation which may include sweating, pallor, identified after volunteering in an with normal appearance. Upon palpitations, anxiety, exertional or non- exercise physiology experimental completion of diagnostic testing, the exertional chest pain, dizziness, study. Physical examination identified cardiologist diagnosed the condition nausea, dyspnea, hypertension, a slight pause in between heartbeats. as 1o and 2o atrioventricular block with hypotension, epigastric pain, as well as The patient stated that this occurred mild mitral valve regurgitation. After being asymptomatic. regularly, but did not report it to the discussing the diagnoses, the patient team’s medical staff. She was was not prescribed medication and was subsequently removed from subsequently cleared for unrestricted participation and referred to campus activity pending careful monitoring by health services. The patient’s family the athletic trainer. Uniqueness: and personal medical history was not Cardiac conditions are unique in significant for cardiac conditions and collegiate athletes and can jeopardize the pre-participation physical an athlete’s career and life. Despite examination performed by her primary being diagnosed with 1o and 2o S-194 Volume 47 • Number 3 (Supplement) May 2012 12003UC 12102MC Fibromyalgia in a 19 yo College items rating their ability (0=Always to Scaphoid Cyst in a Collegiate Student 3=Never) to perform activities. The Softball Pitcher Moore J, Demchak TJ: Indiana State overall score on this section has been Platt BC, Brown CN, Ferrara M, University, Terre Haute, IN used as a subjective measure of the Ward K: The University of Georgia, patients function, the lower the score Athens, GA; Athens Orthopedic Background: 19 y.o., female Hispanic the grater the function. The following Clinic, Athens, GA college student. Patient reported she measures were used to determine the was seeing counselor for depression effect of the laser treatment: number Background: A 20-year-old female and had general pain and fatigue for last of painful sites, pain levels pre- and softball pitcher presented complaining 3 months. Palpation of American post LASER treatment at each site, and of moderate to severe left wrist pain weekly FIQ scores. Pre-treatment FIQ College of Rheumatology patient rated at an 8/10 over the scaphoid Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 sensitivity points and sham point 82, after first treatment it decreased navicular bone upon awakening. There identified 14 hypersensitive areas of to 67, after the second week (4 laser was no mechanism of injury and the pain. Sham points were negative. treatments) the FIQ score was 23 and athlete had no history of left wrist Differential Diagnosis: Fibro- the total number of active tender points injury. Physical examination revealed myalgia or Rheumatoid Arthritis. decreased from 14 to 6. SADL scores long bone compression test, lunate Treatment: Physician diagnosed decreased from 20 to 5. Treatments dislocation test, and flick test were all patient with fibromyalgia. Treatment were not given for two weeks due to negative and Phalen’s and Tinel’s tests consisted of low level Laser therapy patient unable to attend therapy. were positive for possible median twice per week. Each treatment day During this time the FIQ scores nerve compression. Cause of the com- the patient identified areas of increased to 33.86 and the number of pression was unknown, as resistive sensitivity using standard fibromyalgia active points increased to 14. However, range of motion revealed good strength sensitivity chart which consists of 18 the SADL score decreased to 0. The in all planes of motion, with pain of 8/ points from the American College of immediate effect of the LASER 10 resulting from pronation and Rheumatology Widespread pain index treatment was seen in the average extension of the wrist. Active and (WPI). The patient rated pain level (1- decrease of 3.5 points on pain scale passive pronation and extension also 10) for each sensitivity point pre- and from pre- to post- LASER treatment. resulted in 8/10 pain, and the athlete post-LASER treatment. LASER Uniqueness: According to the had complained of pain catching the treatment consisted of Sweep program American College of Rheumatology, ball during this motion as well. No (5-1000 Hz) 2 minutes each tender fibromyalgia currently affects 2-5% other motions caused a painful response. spot. The low level laser used a LASER of the population with onset occurring The athlete complained of numbness and Shower consisting of six 50W Laser typically in middle adulthood. Our tingling through the left hand and fingers, diodes (905 nm) and four 25W patient was 19 years old, which is quite particularly through the innervation of Infrared diode (660nm). A total of 4 young for adult Fibromyalgia. the median nerve, but no myotome or treatment sessions (2/wk for two However, Juvenile Primary Fibro- dermatome deficiencies could be found. weeks) were given. Additionally, the myalgia Syndrome (JPFS) occurs in as A cock up splint was used on the left patient completed a Fibromyalgia high as 6% of the population with a wrist for four days, which relieved Impact Questionnaire (FIQ) each week mean onset of 12 years old. There is numbness and tingling through the to determine the effect of the LASER an increase in JPFS which occurs fingers, but did not decrease pain treatment on the patient’s daily life. during high school aged children. It is substantially. The athlete was then The FIQ is a standard questionnaire possible that as an athletic trainer you referred to an orthopedic Physician used to determine the impact of may treat an athlete that was diagnosed Assistant. Differential Diagnosis: fibromyalgia on the patient’s daily life with fibromyalgia. Typically, patients Differential diagnoses included and is a composite score out of 100. are prescribed pain medication scaphoid navicular fracture, scaphoid The FIQ consists of 10 questions that (Lexicaor Nerotin) to control pain cyst, separation of the scapholunate score the patients physical impair- levels. We used LASER treatment junction, lunate dislocation, extensor ment, feel good, work missed, do regimen. We used a non-pharma- strain, pronator strain, and median work, pain, fatigue, rested, stiffness, cological LASER as our primary nerve compression due to an awkward anxiety, and depression. The lower the treatment which significantly sleeping position. Treatment: X-ray score the better the patient feels on a decreased the patient’s pain and and Magnetic Resonance Imaging daily basis. The average fibromyalgia increased her function. Conclusions: (MRI) results after 4 days in a cock up patient scores around 50 and severely LASER is a viable non-pharma- splint revealed a large cyst over the afflicted patients are approximately cological treatment to reduce pain and scaphoid bone, and a Computerized 70. Subjective Activity of Daily Living increase function in patients with Tomography (CT) scan showed no (SADL) subscale from the FIQ uses the Fibromyalgia. evidence of fracture. The athlete was first question which consists of 11 placed in a thumb spica brace for two Journal of Athletic Training S-195 weeks, followed by progression back right, 180° on the left; 160° abduction properly treat and hopefully prevent into activity as long as her symptoms on the right, 180° on the left; 80° further injury. When symptoms fail to did not increase. She was also external rotation on the right, 80° on resolve additional imaging may be informed by both the physician and the the left; and internal rotation reached needed. Conclusions: This case athletic trainer she was at higher risk T10 on the right and left. He had a report involves a 23 year old college of fracture because of the cyst. At this positive O’Brien’s test and cross arm football player who sustained a time the athlete is no longer with the adduction produced pain and fracture to his acromion. He was not team. Uniqueness: The athlete had no discomfort at the acromion area. All properly diagnosed immediately and mechanism of injury or previous other special tests performed were developed a nonunion. Eventually he history of wrist pain, and the cyst was negative. The patient had full and underwent an open reduction and located on the athlete’s glove hand. symmetric sensation, motor function internal fixation of a non-union at the

Also, the athlete had neurological and reflexes of the upper extremities. acromion approximately one year after Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 symptoms indicative of possible carpal Differential Diagnosis: Acromial the initial injury. Postoperatively he tunnel syndrome, yet MRI results did nonunion, glenoid labrum tear, worked with a physical therapist to not specify entrapment of the median acromioclavicular joint pathology, regain active and passive motion of the nerve, and a cock up splint relieved rotator cuff tendonitis. Treatment: right shoulder and remained protected symptoms. Conclusions: The fact Plain radiographs and an MRI revealed in his sling for 6 weeks postop. At 8 that there was no mechanism involved a hypertrophic non-union of the right weeks,he will begin strengthening of and the athlete had no history illustrate acromion, splitting of the deltoid the shoulder. It is expected that he will the importance for a complete and fibers attaching at this site, a chronic return to normal functionality, range thorough history and medical AC joint separation with superior of motion, and sports at approximately examination. Imaging and painful displacement, and an anterior labrum 4 months from his date of surgery. range of motion proved to be very tear with a paralabral ganglion cyst. important in the diagnosis of this Having failed non-operative treatment, 12210OC condition. This athlete was at the patient underwent a right shoulder Case of Sternoclavicular increased risk for fracture because of arthroscopy with an anterior labral Reconstruction in a Male the cyst, which presented like a repair. This was followed by anopen Professional Rescue Diver neurologic condition. reduction and internal fixationof the Dee AE, Petre B, Ashton J, Hackett acromial nonunion with rigid plating TR: The Steadman Clinic, Vail, CO 12245C and local bone grafting.While Nonunion of Acromial Fracture: preparing the acromial nonunion site, Background: This case is of a 59 year an Unusual Cause of Shoulder significant amounts of soft tissue and old male, right-hand dominant, Pain in a College Football Player mature bony callus were found professional rescue diver with severe Hart VB, Millett PJ: The Steadman between the two bone fragments. This sternoclavicular joint (SCJ) pain. He Clinic, Vail, CO was removed and the bone was sustained a fall into a man hole at work debrided to a bleeding bone surface. that resulted in an anterior SCJ Background: A 23 year old male Following open reduction and internal dislocation and rotator cuff tear. He college football player suffered a fixation with a locking plate and screws, underwent a right arthroscopic direct hit to his right shoulder from a bone graft substitute and the supraspinatus and infraspinatus rotator another player resulting in severe pain. previously debrided bone fragment cuff repair followed by an open repair He was diagnosed with a sprained were used to fill the nonunion site. The of the subscapularis, subacromial shoulder. He had previously seen AC joint was not treated at the same decompression, distal clavicle another orthopedic surgeon for this time so as not to destabilize or resection, open biceps tenodesis and injury and received a cortisone devascularize the site further. a debridement of a type 2 SLAP lesion injection as well as formalized Uniqueness: Acromion fractures are on June 30, 2010 at a separate clinic. physical therapy for three weeks. rare fractures accounting for less than Several months after the procedure, However, he never fully returned to his one percentof all fractures. They debilitating SCJ pain was still present. original strength and functionality. He present with similar symptoms to the He had multiple injections and an had no other significant past medical more common AC joint sprain, and extensive course of physical therapy, history. At the time of presentation he therefore could be overlooked. This all of which provided minimal pain complained of pain, weakness, case involved a patient whom was relief. Finally, two separate treatment stiffness, popping and catching in the diagnosed with a sprain of the AC joint options were discussed; continuation right shoulder. On physical exam- without radiographic evaluation. This of his current protocol or an additional ination, he was tender to palpation at led to a symptomatic nonunion of the procedure consisting of a medial the right acromion and acromio- acromial fracture. It is important to clavicle excision. The patient clavicular joint. His active range of complete a thorough evaluation of presented to the Steadman Clinic for motion measured 175° flexion on the orthopaedic injuries in order to a second opinion on March 23, 2011. S-196 Volume 47 • Number 3 (Supplement) May 2012 Upon initial evaluation; right SCJ pain few cases have used reconstruction as week post injury were negative but was reported ranging from 4/10 at rest a means of a SCJ corrective pro- functional improvements were minimal. to 8/10 at its worst on the visual analog cedure. Conclusions: Seventeen The orthopedist ordered a magnetic scale. He was tender to palpation over months following the initial injury and resonance imaging (MRI) which then the SCJ and anterior protrusion of the 3 months post-surgery the patient is revealed an os acromiale injury. Surgery medial clavicle was noted. Full progressing well and anticipating a was delayed to consult with experts shoulder range of motion (ROM) was return to rescue diving. Conservative regarding this type of injury. Nine weeks symmetric bilaterally, and 5/5 manual management is beneficial for those post diagnosis, an open reduction internal muscle testing of rotator cuff strength patients presenting with classic fixation (ORIF) was performed using a with the exception of infraspinatus; 4+/ pathology. However, when patients calcium bone graft and two cannulated 5 with pain, were measured. Diffe- have exhausted conservative treat- screws. Acute post surgical management

rential Diagnosis: Sternoclavicular ments surgical options may need to be consisted of ice, pain medication, and a Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 dislocation, sternoclavicular sublux- explored. The traditional surgical limited ROM brace. Early treatment and ation, sternoclavicular sprain, SCJ method of medial clavicle excision rehabilitation focused on passive arthritis, and clavicle pain secondary alone has variable results. This ROMbelow 90°. Ten days post surgery to surgery. Treatment: X-ray and CT innovative approach of reconstructing the athlete began riding a stationary bike were obtained. Two views of the the SCJ with an autograph more and lower body weight lifting. One clavicle revealed abnormal alignment closely recreates native anatomy, thus month follow-up an x-ray revealed good of the SCJ. The CT showed extensive allowing the patient to return to their bone healing, prompting the orthopedist degenerative changes of the SC joint. full occupation and leisure/athletic to discontinue the athletes’ use of the The patient was diagnosed with SCJ activities. brace. He began using tubing below 90° dislocation/pain and was given several and continued with cardio and lower body options of treatment with SC 12326FC lifting. Rapid gains were noted and reconstruction being one of them. Os Acromiale in a Collegiate heprogressed to overhead rehabilitation After failing numerous conservative Basketball Player: A Case Report activity. Rehabilitation stressed treatments over 14 months, previous Stilger VG, Meador RE, Bal GK: resistance tubing, light weight training, surgery, and an inability to return to West Virginia University, and scapular stabilizer strengthening. The work, the patient underwent a Morgantown, WV athlete had full ROM 2 ½ months post sternoclavicular reconstruction with a surgery, prompting the orthopedist to palmaris longus autograft on August Background: A 20 year-old male allow some basketball activity. Four 30th, 2011. The patient is now three collegiate basketball player sustained months post surgery he passed all ROM months status post reconstruction and an injury to his dominant left shoulder and functional testing and was cleared is currently undergoing physical during an away game. While dribbling for full basketball activity, and at six therapy with no complications and through the lane, he collided with an months was granted his full release. minimal pain. Uniqueness: The SCJ opposing player and immediately fell is one of the least commonly to the court in extreme pain. An initial 12095MC dislocated joints in the body, evaluation by the certified athletic Non-Surgical Management and constituting only about 3% of all trainer revealed point tenderness over Rehabilitation of Labral Tears in shoulder pathology. Trauma to the acromioclavicular and glenohumeral Division III Overhead Athletes: posterior-lateral shoulder providing a joints and difficulty with all muscle Clinical Case Series medial force into the glenohumeral testing due to pain. Paresthesia down Rosen MJ, Reed JL, Linens SW: joint is transmitted to the SC joint and the left upper extremity was noted and Emory University, Atlanta, GA; is the most common means of a his range of motion (ROM) was limited Georgia State University, Atlanta, GA traumatic SC injury. It is most often due to pain. Special tests were in- seen in young males due to conclusive as generalized pain and Background: Four individual cases of participation in extreme activities. discomfort were present. The athlete was overhead athletes at a Division III Sternoclavicular dislocation/sublux- then examined by the opposing team’s institution presented with shoulder ation is frequently treated my means orthopedist who diagnosed the injury as pain. Case 1: Twenty year old of rest, physical therapy, steroid a rotator cuff contusion. Differential volleyball player complained of injections, and in severe cases of pain Diagnosis: Acromioclavicular separa- dominant shoulder pain with overhead and dysfunction by means of surgical tion, rotator cuff contusion, rotator cuff activity in April 2011. History of intervention. Due to the important strain, labral tear, glenohumeral sublux- partial biceps tendon tear in 2007 and vascular structures located posterior ation. Treatment: Early treatment had treated with cortisone injection. No to the SCJ, surgery is seldom required. limited results and functionally he was complications until 2011 spring If surgery is required, classically the ineffective due to significant pain with season. No history of dislocation or operation of choice is excision of the activity. However, the athlete had a great subluxation. Significant pain, clicking, middle third of the clavicle. However, desire to return to play. Initial x-rays one and popping in anterior shoulder with Journal of Athletic Training S-197 overhead activity, Positive Empty Can, included D1 and D2 flexion/extension and the bilateral ankle ligaments. Full Can, O’Brien’s, and Neer tests. patterns, internal and external rotation, Neurological symptoms such as Case 2: Twenty-one year old baseball perturbations, push up plus, and tingling and mild numbness were also pitcher presented with dominant isometric strength. The goals of phase reported that radiated into the foot and anterior shoulder pain in August 2011 three included increasing endurance toes. Neurologic symptoms subsided with overhead activity and activities of and progressing back to sport specific after approximately 10minutes. She was daily living. History of dislocation with activity; phase lasted two weeks until placed in an immobilizer and was non- spontaneous reduction in December return to play. Exercises included weight bearing (NWB). Differential 2010.Threw 6 innings during 2011 plyometrics and eccentric external Diagnosis: Grade II medial collateral season with mild discomfort. Did not rotation with resistance. Results: The ligament (MCL) sprain, patellar participate in baseball during Summer complete rehabilitation and throwing subluxation, proximal tibia fracture,

2011. Presented with general shoulder progression programs were com- medial ankle sprain, lateral ankle Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 weakness secondary to pain and pleted successfully by all patients in sprain, fibular head fracture with positive Apprehension test. Case 3: three and a half to four months. associated Peroneal Nerve involve- Nineteen year old baseball pitcher Uniqueness: The uniqueness of these ment. Treatment: Athlete received an reported traumatic fall with anterior four cases lies in the fact that they MRI which revealed a compression and lateral shoulder pain in August were all athletes playing overhead fracture of the anterior medial tibial 2011. Pain with throwing more than sports with confirmed gleno- plateau, near complete tear of the sixty feet, positive Empty Can and humerallabral tears. All four chose MCL, and increased signal in the Hawkins test for pain. Case conservative treatment, and were all posterior cruciate ligament (PCL). 4:Nineteen year old softball catcher able to continue to participate at a high Radiographic exam of the ankle suffered a non-dominant glenohumeral level of competition with minimal pain revealed no fractures. Athlete was subluxation in April 2010. She and setbacks. Conclusions: The NWB for four weeks and engaged in a reported back in Fall 2010, after diagnosis of labral tears is commonly rehabilitation program to decrease working with a physical therapist at regarded as a necessary surgical repair pain and swelling and increase range home, with no pain and was cleared for if full return to play is anticipated. of motion at the knee and ankle. At full participation. February 2011, These cases indicate that proper five weeks post injury substantial patient subluxed again after falling. conservative care, with adequate time improve-ments have been observed. Positive Posterior Labrum, for progressions, can allow an athlete Pain has decreased from 9/10 to 1/10 Impingement, and Apprehension tests. to return to play without surgery, and in the knee and ankle, and active range Variety of MRI and physician still return to pre-injury functional of motion for knee flexion has confirmed glenohumerallabral tears in status. increased to 120°. Two weeks of dominant and non-dominant shoulders. immobilization resulted in left side Treatment: All athletes opted for 12124UC atrophy, which has been resolved with conservative management. Rehabil- Acute Traumatic Multi-joint isometric and isotonic exercises. The itation was completed with a physical Injuries in a Division I Female ankle sprain has recovered to a fully therapist and certified athletic trainers Soccer Athlete functional level. Uniqueness: This five to six days a week. Patients were Klics ME, Passarette AM, Mitchell athlete sustained substantial injuries to restricted to no overhead motion for BJ, Stephenson LJ: Stony Brook the knee and ankle joints as a result of the first three to four weeks of University, Stony Brook, NY one MOI. Typically, high forces and rehabilitation. Throwing progressions velocities, such as those in a motor were implemented at two and half to Background: An 18 year old Division I vehicle accident, cause these types of three months after beginning the female soccer forward with no previous injuries but this mechanism displayed rehabilitation program. All patients history of injury to her left side collided fairly low forces and velocities in were re-evaluated on a weekly basis. with a goalie during game play. Athlete comparison. The presentation of the The goals of the first phase of rehab was unable to report a detailed injury is also unique due to the pain included reducing pain, increasing mechanism of injury(MOI). The athlete pattern and remarkable sensitivity to range of motion, and regaining presented to the athletic trainer palpation of the entire lower leg. Due neuromuscular control of serratus complaining of pain from her left knee to the unique presentation of these anterior and lower trapezius muscles to her left ankle with immediate injuries, radiographic imaging was and lasted three to five days. Exercises moderate swelling and no associated required to confirm the extent of the included scaption, Ts and Ys and discoloration or deformity. Palpation injuries sustained in the knee and ankle. sidelying external rotation progressing revealed severetenderness along all Based on the diagnosis of an MCL from body weight to five pounds. medial knee structures, lateral knee sprain, it is assumed that a valgus force Phase two lasted one to two weeks. The structures, patellar tendon, medial and was applied to the knee. In addition, it goals of this phase included increasing lateral hamstring tendons, in the can be assumed that there was an strength and proprioception. Exercises popliteal fossa, along the tibia, fibula, associated rotational mechanism that S-198 Volume 47 • Number 3 (Supplement) May 2012 caused the compression of the femur Diagnosis: patellar dislocation, reconstruction. His return to activity on the tibia and subsequently the patellar instability, patellar fracture, did not elicit any pain or apprehension. anterior medial tibial plateau fracture. patellar tendon tear, medial patello- Uniqueness: MPFL ruptures in It is interesting to note that the femoral ligament sprain, osteo- conjunction with medial collateral anterior cruciate ligament (ACL) was chondral lesion, femoral osteo- ligament pathologies are unique in not damaged with the rotational condylar contusion, medial mensical athletics. Specifically, in this case, the mechanism, as this is the most tear, and medial collateral ligament injury was difficult to diagnose on common mechanism of an ACL sprain. sprain. Treatment: The patient was initial evaluation because the reported Conclusions: It is possible for multi- iced, elevated, wrapped with a symptoms and obvious deformity joint injuries to occur in an athletic compression bandage, placed into a overshadowed the ligamentous environment as a result of one MOI. straight leg knee immobilizer, involvement. Furthermore, the MRI

Athletic movements are by nature instructed to ambulate utilizing non- did not reveal the displaced fragment Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 multiplanar, and subsequently athletes weight bearing crutch gait pattern, and of the patella, which would indicate the are at risk for sustaining multiple diagnosed with a patellar dislocation requirement of surgical intervention. injuries as a result of one mechanism. and medial collateral ligament sprain Conclusion: Patellofemoral injuries A comprehensive examination that by the team orthopedic surgeon. An are a common knee pathology and can includes radiographic imaging is MRI was ordered. The results affect prepubescent children through necessary to rule out differential indicated a lateral patellar dislocation, adults. The MPFL secures the patella diagnoses, and should include the anterolateral distal femoral contusion to the medial aspect of the knee and is joints above and below the injury site with no osteochondral lesion of the frequently injured as a result of a lateral so that an accurate diagnosis can be patella, and a grade III medial subluxation. Predisposing factors reached. patellofemoral ligament (MPFL) relevant to this case included sprain. The patient was placed on a hypermobility caused by hamstring and 12093UC rehabilitation program prior to surgery iliotibial band tightness. Prompt Knee Pain in Collegiate Football consisting of thermal agents, ROM recognition and management of acute Player exercises, and massage to reduce pain patellofemoral pathologies are crucial Armenti B, Reppe K, Rothbard M, and edema. Status post two weeks the for reducing further stress on other Nelson C: Southern Connecticut patient underwent MPFL recon- joint structures. Tearing of the MPFL State University, New Haven, CT struction. During surgery, a patellar can lead to decreased mechanical knee bone fragment was discovered within extensor mechanism efficiency, Background: A 22 year old male the edema and removed. The initial degrading of the femoral and patellar defensive end reported sharp post-operative rehabilitation program articular surfaces, and mechanical and anteromedial left knee pain upon consisted of wound management, use anatomical instabilities. Surgical making a tackle during a game. Visual of a rehabilitative patellar stabilization intervention reduces the risk of inspection during the on-site brace, electrotherapy, and therapeutic recurrence by over 30% and is usually evaluation revealed a lateral patellar exercise program to decrease pain and indicated to diminish joint dislocation. The team physician edema, and increase neuromuscular pathomechanical and functional relocated the patella on the field. The coordination, proprioception and range limitations. patient was placed in a functional of motion. Four weeks post- patellar stabilization brace, and was reconstruction, a more aggressive 12027FC cleared to return to competition. rehabilitation program was imple- Isolated Capitate Fracture in a Upon returning to the game, the patient mented to further improve Collegiate Women’s Lacrosse demonstrated a positive antalgic gait. proprioception and range of motion Player He limped off the field complaining and restore muscular strength, Gardiner-Shires AM, Katolik LI: of severe knee pain. A second endurance, and power. Thirteen weeks West Chester University, West examination on the sideline revealed post-reconstruction, the patient Chester, PA; Philadelphia Hand positive edema and ecchymosis, progressed to jogging on a treadmill Center, Philadelphia, PA medial joint tenderness, and limited to restore cardiovascular endurance. active ROM. Valgus stress test was Sixteen weeks post-reconstruction, Background: On February 3rd 2011 a negative at 0°; however, at 30° a the patient was functionally stable and 17-year old female collegiate lacrosse positive test elicited a soft end feel. was prescribed sport-specific player tripped over a teammate’s foot The patellar apprehension and glide activities that included team during an indoor pre-season practice. tests were positive for patellar conditioning drills to restore speed, The athlete landed on flexed knees and instability. The patient’s medical agility, and power. The patient was outstretched hands. Her momentum history was not significant for cleared by the team physician and fully caused her to lacerate her chin. Wrist traumatic injuries to the involved knee returned to athletic activities evaluation revealed mild non-specific or surrounding area. Differential approximately 24 weeks post- tenderness (4/10) along the left distal Journal of Athletic Training S-199 radioulnar joint and distal carpal follow up MRI indicated the capitate his right arm. Strength assessment bones. No tenderness upon palpation is fully healed. The athlete currently indicated normal strength in the left of the right wrist. Bilateral wrist reports no pain and continues full arm but on the right side the athlete flexion and extension AROM and participation in lacrosse. Unique- was limited to grip strength in right PROM were WNL with pain (4/10). ness: Isolated capitate fractures are hand. The athlete had a previous All other AROM and PROM were extremely rare, comprising about 1- medical history of a herniated lumbar WNL bilaterally. MMT were 5/5 in all 2% of carpal fractures. They typically disc at L4/L5 region and also had a directions bilaterally. Radioulnar occur as a result of high energy trauma history of left shoulder contusion and percussion and compression tests and are almost exclusively associated abnormally-formed glenoid fossa. The were negative bilaterally. The athlete with fracture of the scaphoid waist athlete was spine boarded and reported a previous history of a left occurring as a trans scaphoid trans transported to the local Emergency

wrist fracture in elementary school. capitate variant of the perilunate Department Differential Diagnosis: Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 She was referred to the emergency dislocation. This athlete had no pain cervical spine fracture, cervical spine room for stitches and instructed to in the area of the capitate. Tenderness ligamentous sprain, spinal cord injury, follow up with the athletic training was generalized in the early stages and concussion, shoulder dislocation or staff the next day. Differential later localized to the scaphoid. Initial fracture. Treatment: A CT scan of Diagnosis: Wrist and/or hand sprain, x-rays were negative, which is brain and neck read unremarkable and contusion, fracture. Treatment: The uncommon in capitate fractures. Upon thus ruling out cervical spinal injuries. athlete received 7 stitches in her chin. follow up with the specialist this The athlete had persistent deficits in Due to her mild left wrist pain, A/P and athlete presented with no pain or his right arm (deltoids, biceps, scaphoid x-ray views were conducted limitations in activities of daily living infraspinatus) but recovered some and were negative. The following day or lacrosse. Capitate fractures often sensation and function in fingers (5/5 she presented with mild left wrist have poor outcomes because early finger flexors, extensors, abductors) swelling in the area of the dorsal wrist diagnosis and cast immobilization are 2 days S/P and was presumed to have and anatomical snuff box. She was the preferred treatment. Capitate suffered a brachial plexus injury. The tender to palpate (5/10) along the fractures are commonly unstable and athlete spent a week in the hospital for palmar and dorsal scaphoid and lunate delayed union, non-union, and continued neurology consultations. bones. Due to the likelihood of avascular necrosis are possible The athlete was discharged when scaphoid fractures not being present complications. In this case the athlete medically stable and cleared by in initial x-rays the athlete participated had no complications despite late radiology with close outpatient follow in daily and lacrosse activities as diagnosis, continued participation in up. The final diagnosis was a right tolerated with soft or orthoplast splint lacrosse with moderate bracing and no brachial plexus injury, specifically a C5 protection. On approximately March change in activities of daily living. nerve root avulsion and a partial C6 1st the athlete continued to complain Conclusions: Wrist and hand injuries nerve root avulsion. The initial of left wrist pain localized to the area are often missed on initial imaging. treatment plan called foredema of the scaphoid. The athlete was This case highlights the importance of reduction and occupational/physical evaluated by the team physician and an follow-up radiology when wrist pain therapy. Medications were prescribed MRI of the left wrist was ordered to persists. The athlete was fortunate to for pain and causalgia. The subsequent rule out a scaphoid fracture. The MRI have such a positive outcome despite four month period showed minimal revealed a non-displaced fracture of having an isolated capitate fracture. recovery. The patient was informed of the left capitate. She was referred to surgical options and risks and an orthopedic hand specialist. Due to 12266UC ultimately consented to surgery. The insurance limitations and schedule Cervical Neuropathy in a Division pre-surgical plan was for a right conflicts she was unable to see the I Football Player supraclavicular exploration of C5-6 specialist until early May 2011. Galeazzi BL, DiNapoli D, Cordone with inoperative testing. The plan Evaluation revealed no point J, Straub SJ: Quinnipiac University, included nerve grafting within the tenderness, deformity, swelling, or Hamden, CT; Yale University, New shoulder; axillary nerve, through discoloration in the capitate. ROM and Haven, CT posterior division upper trunk and strength of the left wrist and hand were suprascapular nerve with ulnar and WNL. Despite the positive MRI the Background: A 21 year old outside sural nerve grafts from either one or physician allowed the athlete to linebacker spear tackled an opposing both legs as necessary. Surgery was discontinue wearing the splints athlete causing left lateral cervical performed at approximately 5 months because pain with activity had flexion and depression of hisshoulder. status-post. The actual reconstruction resolved. His recommendations were: The athlete was face down on field and consisted of a sural nerve graft that ran repeat the MRI in 4 weeks and avoid initially had a short loss of from the C5 nerve root to supra- push-ups due to compressive forces consciousness. The athlete stated spinatus nerve and to posterior division placed on the wrist and hand. The numerous times he was unable to feel of upper trunk of the right brachial S-200 Volume 47 • Number 3 (Supplement) May 2012 12090UC plexus and a double Oberlin’s Thoracic Pain in a Collegiate reduction in forced vital capacity and procedure. It was estimated that over Runner total lung capacity implying re- the next 2 years, the athlete would Sweeney C, Rothbard M, Morin striction. The patient was diagnosed regain useful shoulder stability and G: Southern Connecticut State with restricted right lung disease and elbow flexion. At follow-up appoint- University, New Haven, CT referred back to the orthopedist. Status ment 5 months S/P reconstructive post two months, plain film radio- surgery, EMG indicated minor Background: A 22 year-old female graphs were taken and identified an reinnervation to the supraspinatus and runner presented with chronic increase in the thoracic (51°) with no no reinnervation to deltoid or elbow respiratory difficulty, unremitting changes to the lumbar (43°) curve. The flexors. He also demonstrated nearly lateral right dorsal thorax pain, finger orthopedist definitively diagnosed the full antigravity elbow flexion and mild patient with restrictive right lung tip pallor, and numbness in the upper Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 gravity eliminated external rotation of extremities. Pain quotient was disease, thoracic outlet syndrome, and shoulder. The patient did demonstrate described as 5/10 at rest, 7/10 with Raynauds’s disease secondary to her anti-gravity elbow flexion with inspiration, and 8/10 during and after progressive structural scoliosis and shoulder internally rotated. Gravity activity. Physical examination revealed concluded that her condition would eliminated position was full with a a right hump of the thoracic cage in continue to deteriorate without smooth arc of motion. Numbness and the flexed position, palpable surgical intervention. A posterior T5- pain were still present. The patient was tenderness between ribs 3-6, sensory L1 interbody vertebral fusion was referred to hand therapy to assist with and motor deficits of the left lateral performed. A postoperative right lung functional activities. The current goal upper arm, and a weak radial pulse. pleural effusion developed resulting in is to continue to re-educate and lift a ROM testing revealed full trunk further dyspnea. An ultrasound-guided 5 lb back pack with right hand by 14 flexion, but limited extension, left and thoracentesis removed 1.4 L of fluid. months post injury. . Uniqueness: right rotation and side bending. The Three months postoperative pul- While 65% of collegiate football patient’s medical history was monary function test demonstrated an athletes are reported to suffer brachial significant for structural scoliosis and increase of 1 L in total lung capacity. plexus injuries at some point in in their hypermobility that was diagnosed at Five months post-operative the patient careers, the more common the age of 13 with a 36° thoracic and continues to progress with full body mechanism of nerve root avulsion are 33°lumbar curve. Later radiographs and respiratory rehabilitation and is motorcycle accidents. The reported taken at the age of 20 revealed an expected to make a full recovery. incidences of brachial plexopathies increase in the thoracic (40°) and Uniqueness: This case is unique with nerve root avulsions in football lumbar (43°) curves. Previous because the patient’s increasing are limited. Conclusions: While treatment consisted of 3½ years of thoracic scoliotic curve was the brachial plexus injuries are common rehabilitation starting at age 18 underlying cause of her chronic is football, the avulsion of a nerve root focusing on strengthening and manual respiratory difficulty. The progression is rare. Conservative treatment options therapy including mobilizations and of scoliosis characteristically may be long due to the lengthy time traction to alleviate symptoms. discontinues when growth is com- period of nerve regeneration. When Differential Diagnosis: Rheumatoid pleted; however, in this case further conservative measures fail, nerve arthritis, asthma, pulmonary embolism, increases were due to inherent spinal grafting must be considered. Complete thoracic outlet syndrome, Raynaud’s instability. As the vertebral bodies recovery may be difficult; clearly disease, and restrictive lung disease. involved in the scoliosis rotated, the defined limited functional activities Treatment: After the initial spinous processes deviated toward the may be more appropriate long term evaluation, the patient was referred to concave side of the curve, and the ribs goals. her PCP. The PCP ordered an MRI that followed the rotation of the vertebrae. revealed degenerative discs at C2-C3 This rotation placed a 30% restriction and C5-C6, and minimal bulging at L2- on the right lung and as the thoracic L3; however, results were inconclusive curve gradually increased, the to the chief complaint. The patient was pulmonary restriction would have as referred to an orthopedic spine well. Conclusions: Restrictive lung specialist who prescribed an NSAID, disease is caused by a deformity of the ordered blood tests which ruled out chest wall. Changes to the thoracic rheumatoid pathology, and referral to cavity associated with significant a pulmonologist. The pulmonologist scoliosis can dramatically affect ordered a chest x-ray and a pulmonary respiratory function. Due to the rarity function test. Radiographs were of this condition, clinicians must be unremarkable; however, the pulmonary aware of a patient’s medical history and function test revealed consistent its potential to affect a patient’s future Journal of Athletic Training S-201 12359UC health. Proper evaluation, manage- ORIF was performed to stabilize the Giardiasis in a Female Field ment, and intervention of scoliosis distal tibia and fibula and bone Hockey Player have the capacity to limit the fragments were excised from the Wagner J, Berkey E, Latch G, debilitating nature of the condition to ankle joint. Athlete was placed in a Chandler C, Cicia K, Moffit D: facilitate the continuation of a fiberglass cast for three months and Temple University, Philadelphia, PA physically active lifestyle. was non weight bearing (NWB). Upon cast removal athlete was placed in a Background:A 19-year-old female, 12159UC walking boot and NWB exercises were Division I field hockey player A Distal Fibula and Pilon initiated. Athlete preformed active presented with a headache, light- Fracture with a Dislocated ankle range of motion, strengthening headedness, dizziness, muscle Proximal Fibular Head in a for quadriceps and intrinsic muscles soreness, fatigue, and vomiting in mid- Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Collegiate Softball Athlete of the foot. After one week of August. Her glands were not swollen, Smith JC, Ribbons KL, Stephenson rehabilitation the athlete began and her throat appeared to look normal. LJ: Stony Brook University, Stony progressive resistive ankle exercises. She had been complaining of upper Brook, NY After two weeks the athlete was able quadrant pain resulting in a loss of to walk without walking boot for short appetite, which followed with a weight Background: An 18 year old female distances and was placed in an air cast loss of about 10 pounds in approxi- softball outfielder with a previous splint. At six months status post ORIF mately 2 weeks. Differential Diag- history of proximal fibular subluxation a jogging protocol was initiated; at nosis:Amoebiasis,Ascariasis, E. Coli injured her left leg during sliding drills which point she demonstrated hip Infection, elminthiasis, Hookworm, performed at full speed on field turf. external rotation during the swing Salmonella Infection, Schistosoma While sliding her left, tuck, leg became phase and engaged in gait training that Mansoni, Stomach Flu, and Traveler’s lodged in the turf forcing her knee into includes augmented feedback during Diarrhea. Treatment: The team external rotation and ankle into straight-ahead jogging and sport physician was present in the athletic eversion and plantar flexion. Athlete specific motions. Athlete continues training room during the initial experienced substantial pain and had an to complain of substantial bone related evaluation. After splenomegaly was obvious deformity at the ankle with pain when jogging. Uniqueness: The ruled out, blood tests were ordered foot in eversion and protruding of the type of injury sustained most including a complete blood count lateral malleolus. The proximal fibular commonly occurs in high velocity, high (CBC) differential, electrolytes, blood deformity was obstructed by her force impacts such as a motor vehicle urea nitrogen (BUN), and creatinine. athletic apparel .On-field evaluation accident, and most typically involves The athlete was given an IV of revealed a possible distal fibular an open fracture. This athlete Phenergan and Zantac 50 mg to help fracture with neurovascular status sustained her injuries during with her stomachache, but she had an intact. Athlete had a positive squeeze participation in an athletic event with allergic reaction to the Phenergan. She test with pain proximally and distally. relatively low forces and velocities, was then given an IV of Benadryl, which Athlete was extremely tender to and all fractures were closed. The helped to decrease her symptoms after palpate around ankle and fibular head nature of this injury has resulted in an hour. When the athlete was feeling and could not plantar or dorsiflex. The increased proximal tibiofibular and well enough to return home, her athlete’s cleat was removed with ankle mortise joint play which mother picked her up; however, on shears and a vacuum splint was applied. decreases stability at the ankle joint. their way home the athlete began Athlete was immediately referred to Even with ORIF this athlete displays having symptoms again, so she was emergency department; Differential biomechanical dysfunction that needs rushed to the emergency room. At the Diagnosis: Grade III deltoid ligament to be addressed with functional emergency room, all tests came back sprain, tibial plateau fracture, assessments and neuromuscular normal and a stomach ulcer was ruled syndesmotic sprain, proximal fibular rehabilitation that includes augmented out. Her personal physician ordered head dislocation, fracture of distal feedback. Conclusion: It is important an endoscopy that showed no inflam- tibia, fracture of distal fibula. to recognize that playing surface can mation or other abnormalities. A stool Treatment: Diagnostic imaging from have an effect on the type and severity sample was subsequently ordered, MRIs and CT scan revealed a of injury sustained during athletic which determined that the athlete had dislocated proximal fibular head, practices. When an athlete sustains a giardiasis. She was treated with a class closed distal fibular and pilon ankle severe injury to the structures of the of anti-biotics called Nitroimidazole. fracture, and a grade II PCL sprain. The ankle mortise and knee, any alterations Metronidazole is the most commonly fibular head was initially reduced and in gait biomechanics must be used antibiotic in this class. athlete was placed in a fiberglass cast recognized and addressed to improve Metronidazole enters the parasite cell for approximately two weeks to allow function and allow for return to play. and becomes active. Once active, the for swelling to decrease. A surgical antibiotic results in cell death. S-202 Volume 47 • Number 3 (Supplement) May 2012 12307MC Uniqueness: Giardiasis is common in The Role of Foot Core Training was prescribed a foot orthotic, ankle people who travel to undeveloped or in a Recalcitrant Foot and Ankle stirrup, and advanced his strengthening developing countries due to poor Condition exercises. Upon follow-up evalua- sanitation. Drinking unpurified water Black WS, Hartley EM, McKeon tionon 01/12/11 the physician noted from streams or lakes, eating PO: University of Kentucky, that the patient was unable to perform uncooked or unpeeled fruits and Lexington, KY a single-leg heel raise. At the follow- vegetables, and improper hand washing up evaluationon 03/09/11, the patient techniques can lead to infection. Any Background: Patient was a 32 year could complete a single-leg heel raise water that is possibly contaminated old male recreational basketball player. to 1 inch from the floor and was told should be boiled before consumption. He rolled his ankle while landing on to progress his strengthening Individuals should use bottled water exercises. Upon follow-up evalua- another player’s foot during a Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 for activities such as tooth brushing, basketball game in September 2009. tionon 05/04/11, the physician stated making ice, and cleaning food. He saw a physician on 01/26/10 com- that the patient could initiate the Antibiotics cannot prevent giardiasis plaining of pain at the base of the 5th single-leg heel raise, but could not or other intestinal infections, but is metatarsal from the initial injury in perform the full heel raise. In August recommended at the onset of September. The physician prescribed 2011, the patient sought out treatment symptoms. Giardiasis may create crutches and referred him to sports from an AT at the middle school where challenges for treatment in pregnant medicine. He saw the sports medicine he coached. The AT noticed deficits in women because there is no optimal physician on 02/02/10 where he was the patient’s intrinsic foot muscles combination of therapeutic agents. The diagnosed with peroneal tendinopathy (foot core) and prescribed short foot patient was unaware of drinking any and plantar fasciitis. He was prescribed exercises. Short foot exercises are a contaminated water and had not rehabilitation to work on dynamic unique treatment that involves traveled to any countries where ankle stabilization exercises. The activating the foot core to increase the contaminated water would be an issue. Her patient’s conditionwas recalcitrant and medial longitudinal archby narrowing immune system may have been weakened he sought out another physician on 06/ or shortening of the foot while the toes due to a case of mononucleosis that she 11/10. The physician diagnosed him remain relaxed. The exercises begin experienced 3 to 4 months prior to this with an ankle sprain and secondary with a modeling of the medial incident. Conclusions: Giardiasis is plantar fasciitis and prescribed 3 longitudinal arch and progress to a rare disease that can be mistaken for weeks of non-weightbearing with ankle tightening the arch while walking and many other intestinal pathologies. and foot immobilization. Upon running. Each week, the patient When traveling, especially to evaluation on 07/02/10, the patient was completed the Foot and Ankle Ability undeveloped countries, extreme removed from the immobilization and Measure Activities of Daily Living caution should be taken when prescribed home exercises and (FAAM ADL) and FAAM sport along consuming water and food. Proper meloxicam. Again, the patient’s with his level of pain. After 5 weeks hygiene should be maintained to condition did not improve andhe saw of foot core exercises, the patient decrease the chance of contracting the another physician on 09/08/10 who, showed improvement in pain levels and parasite G. Lamblia. After onset of based on evaluation and diagnosis, overall function (Week 3: FAAM symptoms, the patient should be ordered an MRI and prescribed an air ADL=61%, FAAM sport=21%, concerned about hydration and splint. The MRI revealed posterior pain=5/10, ADL function=84%, Sport electrolyte balances. Individuals tibialis tendinopathy, mild function=70%, function=abnormal; diagnosed with giardiasis should tendinopathy involving the flexor Week 4:FAAM ADL=71%, FAAM refrain from attending work or school tendons and peroneal tendons, plantar sport=21%, pain=4/10, ADL function to prevent the spread of infection. fasciitis, osteochondral lesion of the =87%, sport function=70%, function Severe cases require hospitalization, lateral talar dome, and joint effusion =nearly normal; Week 5: FAAM mainly due to dehydration. Athletic involving the tibiotalar and subtalar ADL=73%, FAAM sport=50%, pain= trainers should be aware of rare joints. On 09/29/10, the patient was 0/10, ADL function=88%, sport conditions like giardiasis because it diagnosed with tibialis posterior function=77%, function=nearly can lead to malabsorption, dehydration, tendon dysfunction. Differential normal). Upon follow-up evaluation and weight loss. It is important to Diagnosis: Plantar fasciitis, peroneal on 09/21/11, the physician stated that maintain proper hygiene techniques to tendinopathy, lateral ankle sprain, the patient could perform a full single limit the possibility of spreading the tibialis posterior tendon dysfunction leg heel raise and was released from parasite. Treatment: The patient was the physician’s care. Uniqueness:The prescribed a walking boot, crutches, patient had minor improvements when and strengthening exercises for 4 performing standard rehabilitation. weeks following the MRI. Upon With the supplementation of the short follow-up evaluation on 10/27/10, he foot exercises, he was able to progress Journal of Athletic Training S-203 12203UC more rapidly and vastly.The addition of of the fibular styloid process at the Bilateral Tri-Compartment foot core training increased his daily fabellofibular ligament insertion. All Exercise Induced Compartment and functional sport outcomes as well other anatomical structures including Syndrome in a Collegiate as decreased his level of pain. the cruciate ligaments, collateral Distance Runner: A Case Report Conclusions: Foot core training can ligaments and menisci, as well as the McMullen S, Powers ME: Marist be an effective supplementary inter- lateral ligamentous complex (biceps College, Poughkeepsie, NY; vention to traditional home exercises femoris tendon, popliteus tendon and University of Toledo, Toledo, OH programs when treating tibialis popliteal fibular ligament) were intact posterior tendon dysfunction. and within normal limits. The patient Background: We present a case of a continued with a conservative treat- collegiate female distance runner who 12234SC ment plan of immobilization and

developed compartment syndrome Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Isolated Fibular Avulsion returned to the clinic two weeks later bilaterally in her anterior, lateral, and Fracture in Female Basketball for repeat radiographs. The repeat deep posterior compartments. An 18 Player images showed no further dis- year old female collegiate distance- Dhuy EB, Jagger JA: University of placement of the avulsion fracture and runner with no prior history of lower Kentucky Orthopeadic Surgery and slight increased density in the area of leg injury progressively developed Sports Medicine, Lexington, KY the fracture indicating a healing traditional symptoms of lower leg response. The athlete progressed to exercise induced compartment Background: An 18 year old female full weight bearing within the brace and syndrome (EICS). These symptoms basketball player reported to the began physical therapy (PT) four worsened over the course of orthopedic clinic with right knee pain. weeks after the initial injury. Two approximately seven months from the The athlete was non-weight bearing weeks later, the athlete reported back end of her freshman Outdoor Track (NWB) with the use of crutches. Two to the clinic with no tenderness over season to the beginning of her days prior, the athlete described a the proximal fibular head. She had sophomore Indoor Track season. The hyperextension injury while coming begun ambulating without pain and has patient was very conscious of the down from a rebound. She presents progressed well in PT. She had no guidelines for changing training shoes with lateral knee pain which was complaints of instability. She was then every 300-500 miles and remained in the tenderness to palpation, slight knee placed in a neoprene hinged sleeve and same model shoe when purchasing new effusion and loss of range of motion told to continue with PT. The athlete ones. She was very attentive to making due to pain. She has no joint line was able to return to full activity within sure her training contained a consistent tenderness. On physical evaluation, 6 weeks without any complications. variety of hills, running on both sides of Lachman’s test, anterior drawer, Uniqueness: In this case, the athlete the road, pavement and trail mileage, and Apley’s compression test, and valgus sustained a fibular avulsion fracture followed the normal training progression stress test were all negative. The only which is typically indicative further in workout types. The patient claimed test that elicited pain was soft tissue impairment. Both the to have been running about 30 miles per hyperextension with a varus stress clinical exam and the MRI showed that week as a senior in high school, which load. Radiographs were ordered and the avulsion fracture was isolated with progressed to about 50 miles per week reviewed. Differential Diagnosis: no other internal derangement.Con- during her freshman year of cross- Possible injuries include fibular clusions: Hyperextension knee country and continued throughout the collateral ligament sprain, hamstring injuries commonly cause a variety of Indoor and Outdoor track seasons. It was tendon strain, lateral meniscus tear, ligamentous and meniscal damage. at this point that she began to notice some posterior cruciate ligament rupture, Due to the sole injury to fibular head, tightness and sharp pain posteriorly in posterior lateral corner tear and fibular return to play was possible within a her lower leg. The pain gradually head fracture. Treatment: The month and a half. It is important to increased and spread to other radiographs showed a minimally follow the clinical exam as well as compartments within both lower legs displaced, fibular styloid fracture of image results so that a proper treatment until the patient could no longer tolerate the right knee. The patient was placed plan can decrease the time out of the pain during training. The symptoms in a knee immobilizer, locked at 30 activity. progressed to the common compart- degrees of flexion. She was instructed ment syndrome symptoms of pressure to remain NWB, ice for 20 minutes sensation, increased pain with activity, three times a day, and report back to and eventually peripheral neurological the clinic in two days. An MRI was symptoms. The patient was referred to ordered to rule out further soft tissue a physician who diagnosed her with internal derangement, including a bilateral compartment syndrome using posterolateral corner injury. The MRI a slit catheter technique. Differential results indicated an avulsion fracture Diagnosis: Medial tibial stress S-204 Volume 47 • Number 3 (Supplement) May 2012 12383FC syndrome, tibial or fibular stress A Recalcitrant Skin Lesion and athlete initially was placed on oral fracture, lower leg muscle strain, deep Subsequent Infection in a Cefalexin (Keflex) 250mg three times vein thrombosis. Treatment: The Recreational Intramural Male per day for 10 days along with patient was initially instructed to Athlete: A Case Report Mupirocin 2% topical ointment; decrease training volume and was Leone JE, Gray KA: Bridgewater however on day 6 the patient returned managed with conservative treatment State University, Bridgewater, MA; to the athletic training staff inquiring including heat and stretching prior to Southern Illinois University about the lesion. It was noted the training and cryotherapy afterwards. Carbondale, Carbondale, IL lesion had increased to 8.5cm x 6cm Myofascial release techniques were also although signs of active infection performed. The symptoms eventually Background: A 35 year old seemed to be controlled. Due to the limited the patient to pool-running, nature of the lesion, the patient’s recreational intramural male athlete Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 biking, and elliptical training. Due to the presented to the athletic training primary care physician was alerted and severity of the symptoms and poor medical staff in late Fall 2010 with an a referral to a dermatologist was made. results of conservative treatment, a insidious skin lesion of unknown The oral Cefalexin was continued, but single incision fasciotomy was origin on his right lateral malleolus. the Mupirocin ointment was discon- performed to reduce compartment There was no apparent mechanism of tinued as it was felt to have irritated pressure approximately one month injury or trauma to the area that the the lesion. Inspection by the derma- following diagnosis. The patient was patient could recall. Prior pertinent tologist confirmed a bacterial non-weight bearing with the use of a medical history revealed a skin lesion infection, but the etiology of the lesion wheelchair initially for three days seven years prior on his left lower leg, was endemic to the patient; he was following surgery. She progressed to full however, based on the patient’s diagnosed with a ceramide deficiency weight bearing and began a rehabilitation description, this lesion presented which caused the itching and scaling. program for range of motion and differently. The patient appeared Because the patient scratched the area strength. The patient slowly returned to healthy, in good physical condition, and a secondary infection was created. The running approximately two months after reported no other relevant health patient was instructed to take note of surgery however she was instructed to issues or conditions. The patient any signs of further infection and begin stay on soft grass surfaces and utilizing reported the lesion to be itchy and a course of using Ceravé™ topical the treadmill to avoid excessive impact slightly painful to the touch as well as cream three times daily to help stress. At seven months post-surgery, his ankle feeling “swollen”. Upon moisturize and replace the deficient the athlete was fully participating in inspection by the athletic trainer the ceramides. Clobetasol propionate 5% cross-country and at this time has not examination revealed a 4.5cm x 2.2cm also was used twice daily to limit the reported any symptoms related to lesion over the right lateral malleolus. inflammation. Additionally, the patient EICS. Uniqueness: Of the usual Diffuse swelling as well as signs of an was instructed to partake in a diet rich in distance runner overuse injuries, active infection were noted in the healthy oils such as omega-3s and olive exercise induced compartment entirety of the ankle. No other scars oil. Upon initiating this new course of syndrome (EICS) is one of the more or markings were noted in the area. treatment the patient’s symptoms uncommon. The involvement of three The lesion itself was flat, warm to the resolved and no further lesions were compartments is even more un- touch and crusted over with areas of noted at a three- and six-month follow- common. This is usually a result of desqamatous skin along with purulent up. Uniqueness: Skin disorders are trauma. Conclusion: Although many drainage. There was no detectable common in athletes; however, this form distance-running coaches increase odor. A bacterial infection was of an autoimmune ceramide deficiency training volume conservatively by suspected at this time and due to the is relatively uncommon in healthy season, they should also be aware of the size and active appearance, the lesion athletic populations. Conclusions: volume’s overall progression over the was protected from the environment Ceramides are a family of lipid course of multiple seasons. Athletic with a protective covering and the molecules that serve diverse functions trainers should also become patient was referred to his primary in the skin including maintenance of progressively more investigative as care physician for further evaluation. cell walls. Occasionally, some people conservative treatments fail and look Differential Diagnosis: Bacterial fail to produce enough of these toward ruling out more serious infection (methicillin resistant substances leading to skin irritation conditions such as EICS as the signs and staphylococcus aureus), insect bite and subsequent lesions. Athletic symptoms spread further throughout the (several types), diabetes mellitus trainers need to be well-versed in not lower leg. This case should also serve (types I and II), squamous cell just apparent causes of skin ailments as an article of awareness to coaches and carcinoma, xerosis, eczema, leprosy, such as the active infection in this case, clinicians of rarer overuse injuries such psoriasis, contact dermatitis, atopic but also the root causes of skin as EICS. dermatitis, seborrheic dermatitis, pathologies. ceramide deficiency. Treatment: The Journal of Athletic Training S-205 12082UC 12059FC Type I Complex Regional Pain discretion of the athletic trainer. The Cavernous Malformation in a Syndrome: Reflex Sympathetic patient partici-pated in a rigorous Minor League Baseball Athlete Dystrophy in a Female Collegiate rehabilitation protocol with the athletic Felton SD, Pearson BP, Galamay Soccer Player trainer that included treadmill running, J, Riera P: Florida Gulf Coast Kuhar KE, Plos JM: Western ankle ROM, calf strengthen-ing University, Fort Myers, FL; Illinois University, Macomb, IL exercises, and high repetition repetitive Boston Red Sox, Fort Myers, FL exercises such as jumping and bounding. Background: An 18-year-old female Rehab also included the use of rough Background: A 19 year-old male collegiate soccer player reported to fabric to desensitize the area. The patient minor league baseball athlete reported the athletic training room complaining was returned to full activity 9 months to the Athletic Training Room following the initial diagnosis of the of intense ankle pain (pain scale 8/10), complaining of numbness and tingling Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 6 weeks after suffering from an avulsion fracture. To date the athlete still in his right hand extending distally avulsion fracture of the right lateral experiences sensitivity to cold and through his digits. Athlete had prior malleolus. Physical findings from the touch, atrophy of the right gastroc- history of right shoulder labrum athletic trainer’s examination were soleus muscle, numbness and tingling of surgery, so when referred to the Team negative for the existence of a new injury the fourth and fifth digits in the right Physician for evaluation, it was that would account for the athlete’s pain foot, and a palpable temperature believed athlete was experiencing so the athlete was referred to the team difference between the right and left some associated neurological pain podiatrist for x-rays and reevaluation of lower extremities. Uniqueness: The from re-acclimatization of the the initial injury. The results of the x- incidence rate of RSD is approxi-mately shoulder to throwing. Three days rays were negative and further evaluation 26 people per 100,000 annually. following the physician exam, athlete by the podiatrist coincided with the Although RSD can occur at any age, the reported back to the Athletic Trainer athletic trainer’s insignificant findings. median age of onset is between 46-51 complaining of increased neurological The athlete was diagnosed with overuse years. The signs and symptoms often signs and symptoms, notably, he stated due to early return to play and issued mimic other condi-tions so RSD is often that the morning prior to practice he conservative treatment of rest, ice, and misdiagnosed until it is in the late stages. was feeling heaviness in his right leg, prescription naproxen as a pain Typically the pain of RSD coincides with then during practice athlete noted total medication. Over the next 3-4 weeks, the an injury. In this case, the athlete did not right sided heaviness. Athletic Trainer, athlete began experiencing hyper- present with RSD signs and symptoms in consultation with Team Physician, sensitivity to touch (allodynia) and ice, until 6 weeks post the initial injury. The referred athlete to a Neurologist for atrophy of the gastroc-soleus complex, early detection of RSD by the athletic continued follow-up. Differential paresthesia in the fourth and fifth toes trainer led to an early diagnosis that Diagnosis: Ulnar Neuritis, Brachial of the right foot, and a palpable skin slowed the progression of the condition Plexus Injury, Shoulder Strain, temperature difference between the and allowed the athlete to receive the Thoracic Outlet Syndrome, Cervical right and left lower extremities. At this treatment needed for recovery. Disc Pathology. Treatment: Neuro- time, the athletic trainer recognized the Conclusions: Type I Complex logist ordered an MRI which revealed potential signs of Reflex Sympathetic Regional Pain Syndrome (also known a mass, a Cavernous Malformation, Dystrophy (RSD) and referred the as RSD) is a chronic pain syndrome adjacent to the brainstem. It was noted athlete for further consult by the that can occur in any one of any age that the mass was a small bleed and was podiatrist and a sports medicine following an injury or surgical responsible for symptoms that athlete physician. Differential Diagnosis: procedure. The signs and symptoms of was experiencing. At the time, the Anterior compartment syndrome, occult RSD can mimic the clinical features Neurologist suggested that the risks of fracture, deep vein thrombosis, of many different injuries and can vary surgery outweighed the benefits, and erythromelalgia (Mitchell’s Disease), from patient to patient. There are no the likelihood of the athlete Raynaud’s phenomenon. Treatment: gold standard diagnostic criteria or experiencing another bleed was less Initial treatment included a bone scan that tests that have been validated for the that 20%. The plan was to monitor resulted in minimal abnormalities that diagnosis of RSD. Therefore, athletic athlete and slowly return him to did not confirm the RSD diagnosis. Upon trainers must recognize that the participation. Athlete was held from consult with a panel of specialists cardinal sign of RSD is chronic pain practice the next day and within 24 (anesthesiologists, orthopedic surgeons, that is disproportionately increased in hours of the examination by the podiatrists and other healthcare comparison to the severity of an injury Neurologist; the athlete once again providers), RSD was concluded as the so early detection, immediate referral, began to experience increased signs diagnosis. Sub-sequent treatment and proper treatment of RSD can be and symptoms. Symptoms included included pain medication (Nortriptyline, provided. left ear hearing loss, blurriness and Gabapentin, Ultram, and Zanaflex) and loss of vision of his left eye. Athlete instruction to ease back into play at the began to develop a facial droop and lost S-206 Volume 47 • Number 3 (Supplement) May 2012 motor function of his right leg. During trainers to recognize signs and extension for 12 weeks except during Neurologist follow-up, it was decided symptoms of conditions that are not rehabil-itation. His weight-bearing surgery had to be performed to seen daily in the athletic training room status progressed from non-weight remove the Cavernous Malformation and be able to make the appropriate bearing (NWB) (2 weeks), to 50% (7 due to the escalation of signs and referral to diagnose the condition and weeks), to full (3 weeks in immobi- symptoms. Prior to the surgery, ensure successful outcomes. lizer). ROM was initiated gradually follow-up MRI and CT scan were after 2 weeks and progressed over the performed to define exact location of 12312SC next 10 weeks. At 6 weeks post-op, the Cavernous Malfor-mation, in Patella Fracture in a Collegiate the patient’s active ROM was 0-65° and relation to the bleeding cavity, and the Football Player ultimately 130° of flexion. NWB proximity of the lesion to the Pugh KF, Diduch DR, Baker lower extremity strengthening was brainstem. It was decided the safest AG: University of Virginia, initiated 2 weeks post-op and Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 route for surgery was through the Charlottesville, VA progressed within ROM and weight middle cerebellar peduncle. In this bearing restrictions. Serial x-rays and case, the Cavernous Malformation was Background: A 20 year-old African- a CT scan showed that despite resected com-pletely, as indicated by American male wide receiver prolonged post-operative restrictions, post-operative MRI. Athlete began in- presented with a right knee effusion the patient had a non-union. Despite patient rehabilitation immediately and no known mechanism of injury. He this, his pain was well controlled and post-operatively. Athlete began to had been participating fully in spring he could begin running 4 months post- relearn activities of daily living. football activities. The patient had a op. The patient progressed to football Within two weeks of the surgery, past medical history of left knee specific agility drills before athlete was able to walk utilizing a medial menisectomy 18 months prior experiencing hardware failure with walker and continue to work on without complications. Subjectively, fracture displacement 5 months post- walking without assistance. 4 weeks he complained of right knee op. The patient underwent a second post-surgery, athlete was walking “tightness” secondary to effusion, and surgery for ORIF revision of the without assistance and by 5 weeks discomfort around the patella while patella, bone grafting, partial excision post-surgery, he began to jog with running. The patella was ballotable and of the patella fragments with assistance. After 10 weeks of not tender to palpation. There was no advancement of the patellar tendon and rehabilitation at the neurological joint line tenderness, crepitus, or repair through longitudinal drill holes. rehabilitation hospital, athlete mechanical symptoms. Clinical exam The fracture fixation was more rejoined the athletic training staff at revealed full active range of motion complex, involving 2 K-wires, a Luque the team’s training complex and began (ROM) and 5/5 strength with resisted wire, and a screw through the proximal to work on baseball specific skills. knee flexion and extension. tibia to serve as an anchor point for Athlete returned to live pitching 16 Ligamentous exam demon-strated a figure 8 tensioning of the patella. He months following surgery. Athlete stable knee and McMurray’s exam was is still early in the process of continues to progress well and is slated negative. Differential Diagnosis: rehabilitation but is regaining motion for full return to 2012 spring training. Chondral defect, meniscal injury, as expected. Uniqueness: Patella Uniqueness: Cavernous Mal- patella fracture. Treatment: The stress fractures are rare. This formations are among the rarest forms patient was referred to an orthopedist condition has been described in several of intracranial vascular malformations. for evaluation, who confirmed the groups, including: adolescent athletes, In fact, this condition affects previous exam. X-rays revealed a patients with cerebral palsy, patients approximately 0.5% of the worldwide chronic, displaced, comminuted, who have had ACL reconstruction population. If these lesions begin to transverse patella fracture. The patient using bone-patellar tendon-bone bleed, they can cause severe functional was noted to have an unusually long grafting, and patients with patella disturbances or death; therefore, patella with alta positioning. Due to resurfacing during total knee successful recognition and manage- the bony displacement, this fracture arthroplasty. Patella fractures are ment of the lesion is imperative. was treated with an open reduction typically described as a result of a Conclusions: This case highlights the internal fixation (ORIF) using 2 direct blow, or associated with rupture diagnosis of an athlete with Cavernous longitudinal cannulated screws plus of the patella retinaculum following a Malformation and the subsequent fiberwire tension band, and 1 oblique sudden, violent quadriceps con- successful treatment. This condition screw. The fibrous tissue between the traction. This case describes an older and other unique diseases are fragments was removed and bone athlete with no known mechanism of conditions that athletic trainers should grafting performed. The length of the injury or prodromal symptoms. The be aware of; however, it is not patella and comminuted nature of the fibrous non-union presented a expected that athletic trainers are fracture made successful fixation challenge to successful outcome. experts with every rare medical difficult. Following surgery, the patient Conclusions: This case presents the condition. It is important for athletic wore a knee immobilizer locked in recognition and treatment of a patella Journal of Athletic Training S-207 stress fracture in a patient with no acute testing and blood work and results into place and those involved with the mechanism of injury or prodromal again were negative. A colonoscopy situation should learn how they can symptoms. Although infrequent, and endoscopy were then ordered provide the athlete the best care and patella stress fractures should be athlete was required to stop eating two environment for her illness. As a result included in the differential diagnosis days prior to her test. The tests could of her nutritional adjustments she does of knee injury. Rehabilitation of this not be completed as a result of a large not plan on returning to play but hopes injury presents a challenge to amount of food found undigested in to adjust daily to her new found way clinicians in terms of regaining flexion her stomach and large intestine. of life. post-operatively while allowing Results from these tests led the appropriate healing of the fracture site. Gastroenterologist to believe she was 12362UC suffering from gastroparesis which Grade 1 Chondrosarcoma in a 12263UC Collegiate Volleyball Player

results in the delayed emptying of Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Gastrointestinal Pain in a stomach contents leading to the Kelley CD, Kunkel L: Texas Division 1 Rugby Athlete decline in her digestion process thus Wesleyan University, Fort Worth, TX O’Brien T, Musella D, Botto T, causing fermentation of food in the White D: Quinnipiac University, stomach. Using the results of this test Background: A 19-year-old, 5’10”, Hamden, CT she was officially diagnosed with 150lb Hispanic female collegiate gastroparesis. Athlete was given a volleyball player was suffering a Background: 20 YO, female Division prescription for diphenoxylate/ gradual onset of right shoulder pain. 1 collegiate rugby player who began atropine 2.5mg and sought consultation The team’s athletic trainer performed showing symptoms of illness after with a nutritionist. Uniqueness: a complete musculoskeletal evaluation Christmas break in January 2011 while Athlete’s case of gastroparesis was of the patient, and made a clinical beginning preseason for rugby. Initial idiopathic. Causes for idiopathic diagnosis of a grade 1 acromio- symptoms included severe stomach gastroparesis are still largely unknown. clavicular joint sprain of the right pain, nausea and vomiting. She was an Gastroparesis tends to be an illness shoulder. After two weeks of active participant in sports since that affects people who have been treatment, rehabilitation, and reduced childhood and was accustomed to the suffering from diabetesfor a minimum activity, the patient’s pain had not conditioning requirement of sports 10 years (Camilleri et al). In this case decreased. She was then referred to the activities and denied having any the athlete is not diabetic but is team orthopedic surgeon. Bilateral x- previous history of this illness and/or classified as having pre-diabetic rays revealed a bony abnormality on stomach condition. The athlete does numbers. The majority of patients the left humerus. The patient had not present a unique set of risk factors suffering from gastroparesis are older displayed signs or symptoms of including hypothyroidism, and females (82%) with the mean onset discomfort or pain when the left polycystic ovarian syndrome as well about 34yrs of age (Soykan et al). shoulder and arm were evaluated. The as being diagnosed with pre-diabetic Conclusions: Athletes may suffer patient was withheld from all activity numbers.The athlete was referred to from underlying conditions that are until MRI imaging was completed and the physician and a series of general never truly recognized before their reviewed by an orthopedic oncologist. medical tests were ordered. While onset. For this athlete, a slight illness Differential Diagnosis: Bony the tests were being completed the presented an environment for a abnormality, chondrosarcoma, osteo- athlete was allowed to continue significant illness to be revealed. She porosis, osteosarcoma, fibrosarcoma. playing and would leave practice as has begun working alongside a sports Treatment: The patient was seen by necessary when feeling sick. nutritionist at school and now has a an orthopedic oncologist who Differential Diagnosis: Parasite, flu, specific diet to eat which includes a determined the diagnosis of stomach virus, and gastroparesis. list of safe foods that are easier for osteosarcoma. The patient was then Treatment: Athlete underwent a series her body to properly digest. Even with sent to a cancer center where a needle of tests to determine the cause of her medication the athlete is unable to biopsy, contrast MRI, chest x-ray, stomach pain and nausea. Complete digest many foods and still suffers bone scan, and blood tests were series of blood work was done and from an upset stomach from time to performed. Test results indicated the examined. Tests revealed abnormally time. The long term goal is to maintain patient’s final diagnosis of grade 1 high liver levels while her parasite proper nutrition and to remember that chondrosarcoma in the left proximal tests came back negative. Athlete everything is based upon personal humerus. The patient was disqualified returned to playing as tolerated but was tolerance. There is trial and error from volleyball due to the risk of still experiencing an upset stomach period with the goal of finding what her fracture and spread of the cancer cells. regularly and opted to head home for body can and cannot tolerate. More She will receive surgery to remove the a second opinion from her personal observation and testing will be needed tumor following her fall semester of gastroenterologist. Her physician to help this athlete return to a normal school. Uniqueness: The patient’s went through his own sets of parasite life. A support system should be put initial injury was an acromioclavicuar S-208 Volume 47 • Number 3 (Supplement) May 2012 joint sprain of the right shoulder, and fracture, transverse process fracture, Lastly, based on the literature, she showed no signs or symptoms of vertebral arch fracture, spinal ligament management for this pathology required pathology to her left shoulder. Also, sprain, facet casulary sprain, erector an additional 6 weeks of non-operative chondrosarcoma is usually diagnosed spinae (iliocostalis, longissimus, and bracing due to a lack of complete in adults over the age of 40, and rarely spinalis) strain, and internal organ osseous healing. Conclusion: In the occurs in children or adolescents. derangement. Treatment: After initial sport of gymnastics, when situations Conclusion: This case report evaluation, emergency medical go awry in the air, gymnasts are emphasizes the importance of bilateral services was summoned, the patient instructed to perform a tuck and roll comparisons of injuries and was immobilized with a full backboard, maneuver to ensure a safe landing to persistence to look beyond the primary and transported to a local emergency prevent injury. Unfortunately, the injury for other ailments. Athletic medical facility for further evaluation. gymnast could not complete this

trainers and other allied healthcare Thoracolumbar radiographs were maneuver in sufficient time, causing Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 professionals need to perform obtained and revealed a decreased injury. The mechanism of injury in this consistent and in depth evaluations of anterior border vertebral height case is very important to recognize in the injuries they come in contact with without subsequent interspinal space order to identify the clinical because some patients may have a increases. She was diagnosed with a presentation, give appropriate condition that displays no signs or T12 and L1 compression fracture and immediate care, and provide proper symptoms until aggravated or seen was placed in a thoracolumbar sacral post-injury management. Thoraco- through further studies. orthosis (TLSO). Early rehabilitation lumbar fracture management can consisted of spinal immobilization to include non-operative bracing for 12092UC relieve pain, spasms, and soft tissue neurologically intact pathologies. Thoracolumbar Pain in a Female restrictions for 12 weeks. Status post Disability from this pathology can last Collegiate Gymnast 12 weeks, the patient was removed up to 6 months. With no neurologic Almeida M, Stobierski R, Rothbard from the TLSO and a more aggressive damage, patients may return to full M, Hannah C: Southern Connecticut rehabilitation program was im- athletic participation provided they are State University, New Haven, CT plemented which included restoring free of pain during activity and core hip muscle balance, flexibility, stability and strength is adequate to Background: A 22 y/o female strength, and muscular endurance. meet the specific demands of the gymnast complained of immediate Status post 18 weeks, the patient was participant’s activity. severe sharp thoracolumbar pain functionally stable and core without the presence of radiating pain, stabilization and strengthening with unusual sounds, or sensations application for gymnastic activities secondary to landing on her was incorporated into the thoracolumbar spine forcing spinal rehabilitation program. Status post 26 hyperflexion after failing to perform weeks, the patient was discharged from a full twisting front tuck somersault rehabilitation; however, she was unable from the balance beam. The patient was to return to competitive gymnastics unable to walk and reported that pain due to the exceptional physical and was aggravated by movement and mental demands of the sport. alleviated by rest. Visual inspection Uniqueness: Thoracolumbar spinal revealed patient apprehension for fractures are very rare in athletics. movement without the presence of Common causes are high velocity swelling or deformity. Physical high-energy impacts such as car examination elicited palpable accidents. Other susceptible pop- tenderness over the thoracolumbar ulations are older individuals with spinous processes with associated osteoporosis or spinal tumors, and in spinal extensor muscle spasm. Range younger individuals with a history of of motion was severely restricted by steroid use. Specifically, in this case, pain and spasms and subsequently not the young and otherwise healthy patient performed. Neurological screening suffered a career ending injury. Also, was able to rule out associated spinal the mechanism of injury was very cord injury. The patient’s medical unique. The dismount caused her torso history was not significant for to remain in motion, forcing the spine traumatic injuries to the spine or in hyperflexion, resulting in the surrounding area. Differential fracture. Furthermore, this pathology Diagnosis: vertebral body com- did not affect ligamentous stability or pression fracture, spinous process cause secondary spinal cord injury. Journal of Athletic Training S-209 Bradley L, S-107 Cross KM, S-182 Author Index Brawford AM, S-42 Culton AP, S-63 Brewer ME, S-124 Curry PR, S-129 A Brockmeier S, S-79 Brodeur J, S-14 D Abshire SM, S-46 Brooks J, S-72 Dahlmann EJ, S-125 Abt JP, S-31, S-140 Brown CN, S-31, S-32, S-33, S-195 Dale A, S-194 Adams H, S-23 Brown M, S-43 Dartt CE, S-118 Adams HM, S-16, S-143 Brownell EH, S-85 David SD, S-29, S-156, S-192 Adams WM, S-25 Brucker JB, S-64, S-89 Day MA, S-106 Aguilar AJ, S-19, S-152 Bryson EB, S-77 Decoster LC, S-106 Akehi K, S-92 Buckley B, S-124, S-150 Dee AE, S-196 Almeida M, S-209 Buckley BD, S-40, S-126 DeMartini JK, S-26, S-104, S-143, S-169 Aminaka N, S-68 Buckley TA, S-111, S-113, S-175 Demchak D, S-137 Anderson B, S-166 Buckley W, S-132 Demchak TJ, S-150, S-195 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Anderson RB, S-184 Buckley WE, S-99, S-132 DeSantis BM, S-192 Andreatta RD, S-58 Burkholder R, S-22 Dhuy EB, S-204 Arman TS, S-172 Burroughs SM, S-55 Dicharry J, S-51 Armenti B, S-199 Burton MJ, S-173 Diduch DR, S-115, S-207 Armstrong B, S-67 Bush HM, S-187 DiNapoli, D, S-200 Armstrong CA, S-50 Buskirk GE, S-156 DiStefano LJ, S-40, S-104, S-124, S-126, S-143, Armstrong CW, S-36, S-68, S-84, S-108, S-139 Butterfield TA, S-46, S-85, S-86 S-150 Armstrong LE, S-104, S-143 Byrd CJ, S-76 Divers CK, S-128 Arnold BL, S-48, S-115 Docherty C, S-138 Aronson PA, S-60 C Docherty CL, S-33, S-53, S-70, S-71, S-128, Ashton J, S-196 Cable AL, S-157 S-134, S-179 Aukerman DF, S-67, S-148 Cacolice PA, S-78 Dodd VJ, S-121 Azmus E, S-181 Cage SA, S-93 Dodge TM, S-61, S-171 B Callahan ME, S-108 Doebel SC, S-20, S-84, S-149 Cameron KL, S-68, S-183, S-185 Doherty-Restrepo JL, S-171 Bahhur NO, S-36 Carcia CR, S-78 Dominguese DJ, S-150 Baker AG, S-207 Cardoza LM, S-126 Donahue M, S-33, S-53, S-128, S-134, S-138, Bal GK, S-197 Carr KE, S-35 S-179 Balam T, S-27 Carson E, S-62 Donovan L, S-62, S-70 Balasubramanian E, S-186 Casa DJ, S-25, S-26, S-104, S-143, S-169 Dorshimer GR, S-22 Bartholomew M, S-128, S-177, S-192 Casmus R, S-191 Douglas AM, S-55 Bartolozzi AR, S-22, S-23 Castel JC, S-93 Draper DD, S-116 Bay RC, S-12, S-28, S-30, S-65, S-80, S-103, Caswell A, S-13 Draper R, S-13 S-104, S-130, S-166, S-178 Catalano NA, S-172 Driban JB, S-186 Bazett-Jones D, S-18 Cattano NM, S-186 Dupont-Versteegden EE, S-46 Bazett-Jones DM, S-67, S-159 Chandler C, S-202 Dziedzicki DJ, S-17, S-143 Bedard RJ, S-110 Chang P, S-14 Begalle RL, S-147 Charles-Liscombe RS, S-74 E Begalle RS, S-151, S-179 Chaudhari A, S-42 Earl-Boehm JE, S-18, S-67, S-159 Behar-Horenstein LS, S-121 Cheatham SW, S-171 Ebben WP, S-181 Bell DR, S-149 Chhabra A, S-12 Eberman LE, S-16, S-17, S-23, S-75, S-137, S-143 Beltz EM, S-106 Chhabra AB, S-62 Elbin RJ, S-111 Bennett JE, S-158 Chinn L, S-51, S-70 Elwell S, S-99 Berkey E, S-202 Chou EA, S-53 Emory C, S-18 Bernstein IM, S-169 Chou L-S, S-175 English RA, S-58, S-130 Berry DC, S-120, S-193 Christ EM, S-157 Enz J, S-47 Berry LM, S-120, S-193 Christou EA, S-93 Ericksen HH, S-43, S-125 Beutler AI, S-18, S-68, S-147, S-151, S-180 Chu YC, S-140 Ericksen HM, S-20, S-44, S-84, S-149 Beynnon BD, S-169 Cicia K, S-202 Eurillo R, S-74 Black WS, S-203 Cleary MA, S-11, S-16 Everson SJ, S-52 Blackburn JT, S-19, S-20, S-82, S-83, S-152 Cleary MC, S-14, S-102 Blair DF, S-76, S-190 Clifton DR, S-41 F Bloom, K, S-85 Cobb SC, S-67 Farnsworth JL, S-128, S-177, S-192 Boehret SA, S-186 Conaway M, S-182 Fava NM, S-147 Bolgla L, S-18 Condon S, S-22 Feland JB, S-116 Boling MC, S-18, S-40, S-68, S-124, S-126, S-147, Cordone J, S-200 Felton SD, S-85, S-188, S-206 S-150 Cortes N, S-44 Ferber R, S-18 Borchers J, S-42 Corvo MA, S-113 Ferng SF, S-108 Boroian DT, S-126, S-141 Cosby NL, S-118, S-155 Ferrara M, S-195 Borsa PA, S-93 Courson RW, S-129 Ferrara MS, S-11, S-129 Borsa PB, S-121 Covassin T, S-111 Ferrell B, S-72 Bosha PJ, S-67, S-148 Cox SJ, S-188 Fincher AL, S-119 Botto T, S-208 Cram TR, S-83 Fischer AL, S-149 Boucher TM, S-72 Creighton A, S-81 Fitzgerald K, S-165 Bowman TG, S-60, S-171 Cripps AE, S-160 Ford A, S-44 S-210 Volume 47 • Number 3 (Supplement) May 2012 Fowkes Godek S, S-22, S-23, S-144, S-163 Harrison B, S-107 Johnson RJ, S-169 Fraley AL, S-147 Harrison BC, S-41 Johnson S, S-90 Frank BS, S-151, S-179 Harrison CS, S-76, S-190 Johnston DA, S-183 Freed SD, S-190 Hart JM, S-37, S-41, S-51, S-53, S-54, S-56, S-70, Jordan EM, S-175 Freemyer B, S-102 S-79, S-109, S-110, S-115, S-155, S-162, Joseph C, S-74 Frymyer JL, S-85, S-188 S-163 Joseph MF, S-150 Furutani TM, S-11, S-14, S-102 Hart VB, S-196 Joshi M, S-18 Hartley EM, S-48, S-203 Joyner AB, S-113, S-175 G Hauth JM, S-76 Jutte LS, S-90 Gabler CM, S-156 Hawkins JR, S-134 K Gage M, S-108 Hayes BT, S-153 Gage MJ, S-116, S-150 Heitman RJ, S-71 Kahanov L, S-17, S-23, S-75, S-137 Galamay J, S-206 Hematomas Kaminski TW, S-57, S-97, S-140 Galeazzi BL, S-200 abdominal wall Kanaoka T, S-11, S-14, S-102

Gallagher PM, S-142 motorcyclist, S-193 Karslo R, S-104, S-143 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Games J, S-168 Hendrickson CD, S-77 Katolik LI, S-199 Games KE, S-63 Henning JM, S-174 Kaufman MA, S-126 Garcia WL, S-137 Herb CC, S-51 Keeler JP, S-63 Gardiner-Shires AM, S-199 Herman D, S-89 Keenan KA, S-31, S-140 Gatzke BR, S-181 Herman DC, S-162 Keene KL, S-40 Gavin KE, S-121 Hertel J, S-37, S-41, S-44, S-51, S-53, S-56, S-70, Keller DM, S-162 George SZ, S-93 S-93, S-107, S-109, S-118, S-155, S-162, Keller DW, S-59 Ginn A, S-191 S-182 Kelley CD, S-208 Gioia GA, S-12 Hetzel SJ, S-35 Kelly JD, S-97 Giuliani C, S-82 Hewett TE, S-109, S-117 Kelly KC, S-175 Gloyeske BM, S-76 Heyer KM, S-128 Ketchum JM, S-48 Glutting J, S-186 Hibberd EE, S-81, S-133 Kibler WB, S-79, S-160 Godek JJ, S-23 Hickey MP, S-55 Kim KM, S-37, S-53, S-110 Goeckeritz LM, S-11, S-14, S-102 Hicks-Little CA, S-153 Kimura IF, S-14, S-102 Goerger BM, S-18, S-19, S-20, S-147, S-151, Higginson JS, S-97 King CE, S-103 S-152 Hirano T, S-89 Klics ME, S-198 Goodman A, S-122 Hoard B, S-107 Knight A, S-51 Goto S, S-19, S-152 Hoch JM, S-57, S-187 Knudsen EJ, S-169 Graham A, S-74 Hoch MC, S-48, S-49, S-58 Ko JP, S-31, S-32, S-33 Graham ZA, S-142 Hochstuhl D, S-99 Kocher MH, S-11, S-14, S-102 Grammer S, S-75 Hoffman AL, S-125 Kontos A, S-111 Gray KA, S-205 Hollis JM, S-71 Kovaleski JE, S-71 Greenwood LD, S-72 Holterman LA, S-169 Krause BA, S-172 Gribble PA, S-20, S-34, S-36, S-38, S-43, S-44, Homan KJ, S-20 Krawietz PK, S-119 S-50, S-56, S-68, S-84, S-102, S-108, S-117, Hopkins JT, S-116 Krazeise DA, S-113 S-125, S-138, S-139, S-149, S-153, S-156, Horinek RJ, S-142 Kucera KL, S-180 S-185 Hoseney K, S-51 Kuenze C, S-56 Griebert MC, S-140 Hosey R, S-189 Kuenze CM, S-54, S-109, S-115 Grindstaff TL, S-38, S-62, S-110, S-155 Hosey RG, S-87 Kuhar KE, S-206 Grooms D, S-42, S-44 Howard JS, S-130 Kulow SM, S-104 Grove CA, S-70 Howard, JS, S-40 Kunkel L, S-208 Guadagno J, S-25 Howe CA, S-156 Kyoungyu J, S-49 Gumucio JP, S-136 Howell DR, S-175 Gurchiek LR, S-71 Howell TG, S-158 L Hubbard-Turner T, S-184 Gurka KK, S-182 Lam KC, S-28, S-29, S-65, S-103, S-104, S-113, Hubbard-Turner TJ, S-184 Guskiewicz KM, S-12, S-54, S-112, S-177 S-130, S-166, S-178 Huddleston W, S-67 Gustavsen G, S-57 Landin DL, S-97 Huggins RA, S-26, S-104, S-143, S-169 Landis M, S-23 H Hughes BJ, S-171 Larkin KA, S-93 Hunnicutt JL, S-124 Hackett G, S-104 Latch G, S-202 Hunter I, S-116 Hackett TR, S-196 Latimer H, S-191 Huxel Bliven K, S-27, S-78, S-80, S-166 Haegele LE, S-160 Lattermann C, S-57, S-159, S-187 Hafner R, S-34 I Lattimer LJ, S-150 Hale B, S-51 Laudner KG, S-95, S-176 Hallah N, S-144 Ingebretsen J, S-23 Leake ML, S-87 Hallissey H, S-194 Ingersoll CD, S-37, S-115 Leaver-Dunn D, S-22 Hamer JL, S-16 Ingram RL, S-96, S-157 Lebeda M, S-14 Hammond N, S-13 Itano K, S-138 Lechtenberg J, S-27 Hamstra-Wright K, S-18 J Lee HR, S-129 Hankemeier DA, S-66, S-132, S-172 Leone JE, S-205 Hannah C, S-209 Jagger JA, S-204 Lephart SM, S-31, S-140 Hardy DM, S-169 Jaramillo ER, S-167 Lepley AS, S-20, S-36, S-43, S-44, S-84, S-125, Harkey M, S-125 Johnson DL, S-57 S-149 Harkey MS, S-117, S-153 Johnson EC, S-169 Lepley LK, S-146 Harris W, S-111 Johnson PD, S-77 Lewek MD, S-82, S-147

Journal of Athletic Training S-211 Lewis DW, S-22 Mertz L, S-53 Oshiro RS, S-11, S-14, S-102 Leyer B, S-13 Meserth SM, S-156 Osorio JA, S-67 Li HF, S-187 Messina RM, S-99 Osternig LR, S-175 Linens SW, S-72, S-115, S-197 Mihalik JP, S-12, S-54, S-106, S-112, S-176 Owens BD, S-183, S-185 Lininger, MR, S-166 Miles JD, S-129 Oyama S, S-81, S-133 Linnan L, S-177 Millard RL, S-67, S-148 Lisowski JK, S-81 Miller KC, S-134 P Littleton AC, S-12 Miller M, S-42 Padua DA, S-18, S-19, S-68, S-82, S-83, S-147, Liu K, S-57 Miller MM, S-44 S-151, S-152, S-179, S-180 Liu W, S-71 Miller SJ, S-132, S-148 Pagnotta KD, S-25, S-26, S-169 Liu Z, S-162 Millett PJ, S-196 Palmieri-Smith RM, S-146 Livingston SC, S-160 Mitchell BJ, S-198 Parker T, S-111 Lockerby M, S-109 Moeller CR, S-78, S-80 Parsons JT, S-30, S-65, S-166 Long BC, S-46, S-90, S-92 Moffit D, S-202 Passarette AM, S-198

Lopez RM, S-169 Mohr AM, S-46 Pearson BP, S-206 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Lougheed CJ, S-72 Montalvo AM, S-99 Peck KY, S-183, S-185 Lovalekar MT, S-31, S-140 Montgomery J, S-57 Pederson JJ, S-31, S-140 Luc B, S-125 Montgomery MM, S-146 Peduzzi C, S-22 Luc BA, S-185 Moodie NJ, S-142 Peljovich AE, S-87 Lynall R, S-95 Moore J, S-195 Peters J, S-138 Lynall RC, S-176 Moore SD, S-79, S-160 Petre B, S-196 M Morin G, S-201 Petron DJ, S-153 Morrell M, S-125 Pfile KR, S-20, S-43, S-44, S-56, S-84, S-108, Macciocchi S, S-129 Morris LM, S-40, S-130 S-125, S-138, S-139, S-149, S-156, S-185 Macciocchi SN, S-11 Morrison K, S-163 Phan K, S-59 Madland JM, S-76, S-190 Morrison KE, S-22, S-144 Pidcoe PE, S-48 Manspeaker SA, S-172 Mueller FO, S-177 Pietrosimone BG, S-20, S-34, S-36, S-43, S-44, Marcinek T, S-144 Muething A, S-79 S-50, S-56, S-68, S-84, S-102, S-108, S-117, Maresh CM, S-26, S-104, S-143 Mullineaux DR, S-49, S-58 S-125, S-138, S-139, S-149, S-153, S-156, Marshall SW, S-18, S-54, S-68, S-147, S-151, Munkasy BA, S-111, S-113 S-185 S-177, S-179, S-180, S-185 Munõz CX, S-26 Piland SG, S-129 Martin KM, S-91, S-92 Murata NM, S-11, S-14, S-102 Pitney WA, S-171 Martin R, S-172 Murray AM, S-36 Platt BC, S-195 Masse H, S-165 Musella D, S-208 Plos JM, S-206 Mata H, S-17 Mutchler JM, S-59 Poole KL, S-148 Mata HL, S-16, S-143 Myer GD, S-109, S-117 Powers ME, S-188, S-204 Mateer JL, S-187 Myers JB, S-81, S-133 Prentice WE, S-20, S-81 Mattacola CG, S-40, S-57, S-58, S-130, S-159, Myrer JW, S-116 Pryor RR, S-169 S-187 N Pugh KF, S-207 Mayer JM, S-64 Putney EE, S-173 Mayfield RM, S-12, S-30 Naugle KN, S-121 Pye ML, S-100 Mazerolle S, S-122 Navitskis LB, S-77 Mazerolle SM, S-25, S-61, S-121 Nazarian L, S-97 R Mc Elhiney D, S-192 Needle AR, S-140, S-154 Rabe JT, S-126 McBrier NM, S-132 Neibert PJ, S-89, S-173, S-180 Rabinowitz E, S-122 McCann J, S-144, S-163 Nelson B, S-125 Radtke AR, S-40, S-130 McCartney MK, S-142 Nelson C, S-199 Raffa S, S-163 McCaskey DA, S-108 Nesser T, S-108 Ragan BG, S-15, S-29, S-128, S-156, S-172, S-177, McCrossin J, S-163 Newsham KR, S-158 S-192 McDermott BP, S-25, S-144 Newton EJ, S-66 Rancourt CS, S-23 McDonald J, S-70 Nguyen A, S-40, S-68, S-124, S-126, S-150 Ransone JW, S-167 McElhiney D, S-15, S-128, S-177 Nickels SJ, S-128, S-177, S-192 Ready ST, S-167 McGinley S, S-51 Nickelson J, S-22 Reber A, S-74 McGrath BT, S-25 Niemann AJ, S-16, S-143 Reed JL, S-197 McGrath ML, S-82 Nixon SE, S-76 Register-Mihalik JK, S-12, S-112, S-177, S-179 McGuine TA, S-35 Norcross MF, S-20, S-82, S-83 Renner CM, S-137 McGuire GM, S-16 North JB, S-157 Reppe K, S-199 McKeon JM, S-58, S-159 O Resch JE, S-11, S-119 McKeon PO, S-48, S-49, S-51, S-52, S-58, S-159, Ribbons KL, S-202 S-203 Oblak P, S-18 Rider S, S-191 McLeod MM, S-34, S-38, S-43, S-44, S-125, Oblak PA, S-159 Ridgeway J, S-189 S-153 O’Brien CW, S-59 Riera P, S-206 McMullen S, S-204 O’Brien K, S-99 Rix J, S-50 Meador RE, S-197 O’Brien T, S-208 Roberts D, S-54 Medina McKeon JM, S-86, S-130 O’Connor K, S-67 Rogers KJ, S-99 Meister K, S-95 Ocwieja KE, S-54 Rosen AB, S-31, S-32, S-33, S-129 Mendias CL, S-136 Oller DM, S-99 Rosen MJ, S-197 Mensch JW, S-100 Olson ME, S-149 Ross SE, S-48, S-115 Merrick MA, S-91, S-92 Onate J, S-42, S-44 Rothbard M, S-119, S-194, S-199, S-201, S-209

S-212 Volume 47 • Number 3 (Supplement) May 2012 Rozea GD, S-67 Straub, SJ, S-200 Waters CM, S-46 Rupp K, S-79 Strouse A, S-149 Waugh AM, S-87 Rupp KA, S-89, S-93 Strouse AM, S-20 Weade R, S-172 Ryan ED, S-46 Suchomel TJ, S-181 Weinhold PS, S-82 Sudweeks RR, S-116 Weiss WM, S-173 S Sugimoto D, S-109, S-117 Welch CE, S-59, S-66, S-122, S-132 Saliba EN, S-93 Sugiura S, S-125 Wells AM, S-153 Saliba S, S-155, S-162, S-182 Svoboda SJ, S-185 Welser JA, S-193 Saliba SA, S-37, S-54, S-79, S-89, S-93, S-107, Swanik CB, S-97, S-154 Weltman AL, S-107 S-118, S-163 Swanik KA, S-97 Wham GS, S-100 Sandrey MA, S-168 Swartz EE, S-106 White A, S-72 Sanislo HN, S-193 Sweeney C, S-201 White D, S-208 Sauers EL, S-65, S-80, S-166 T White J, S-156 Saunders RP, S-100 White K, S-72

Schendel AL, S-122 Terada M, S-43, S-44, S-56, S-102, S-125, S-153 Whittington AG, S-86 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 Schmidt JD, S-12, S-112 Tevald MA, S-139 Wikstrom EA, S-184 Schmidt PW, S-77 Thomas SJ, S-97 Williams JG, S-95 Schmitt L, S-42 Thompson BS, S-185 Williams TA, S-113 Schmitz RJ, S-146 Thompson MD, S-97 Willimon SC, S-87 Schrader J, S-70 Thomson KB, S-62 Willis LR, S-169 Schrader JW, S-128 Thorpe JL, S-159 Wilson KD, S-167 Schroeder M, S-42, S-44 Threlkeld AJ, S-38 Winterstein AP, S-35 Schulmeyer SJ, S-70 Tillman MD, S-93, S-121 Wittwer A, S-102 Schwane BG, S-19, S-152 Torres-McGehee T, S-22 Wolf SH, S-180 Scibek JS, S-78 Tourville KJ, S-169 Woods KM, S-153 Scott CB, S-13 Tourville TW, S-169 Wright CJ, S-48 Sebastianelli WJ, S-67, S-99, S-132, S-148 Townsend RC, S-144 Wright T, S-194 Secondi PA, S-74 Tracz A, S-188 Y Seekins KA, S-79 Tripp BL, S-95 Seeley MK, S-116 Tripp PM, S-95 Yakuboff MK, S-12 Sefton JM, S-55, S-63 Tritsch AJ, S-100 Yamada D, S-80 Selkow NM, S-162, S-163 Trojian TH, S-150 Yanda A, S-29 Sell TC, S-31, S-140 Trowbridge CA, S-119, S-162 Yeargin SW, S-16, S-143 Shah SA, S-99 Tsang KKW, S-90, S-126, S-141, S-167 Yen D, S-76 Sherbondy PS, S-132 Tucker WS, S-96, S-124, S-157 Yniguez SL, S-50 Shimozawa Y, S-96, S-157 Turner MJ, S-184 Yochem EM, S-95 Shinew KA, S-172 Shinohara J, S-138, S-139 U Z Shulby AC, S-163 Uhl TL, S-79, S-95, S-160 Zimmerman J, S-190 Shultz BB, S-153 Ujino A, S-137 Zinder SM, S-147 Shultz SJ, S-82, S-100, S-146, S-169 Usdan S, S-22 Silkman CS, S-159 Uyeno RK, S-11 Simon J, S-33, S-70, S-71, S-134, S-179 Sitler MR, S-186 V Slater L, S-193 Vacek PM, S-169 Slauterbeck JR, S-169 Vairo GL, S-67, S-99, S-132, S-148 Smith DB, S-46 Valovich McLeod TC, S-12, S-28, S-29, S-30, Smith HC, S-169 S-65, S-103, S-104, S-113, S-166, S-177, Smith JB, S-14 S-178 Smith JC, S-202 van Donkelaar P, S-175 Smith MD, S-149 Van Lunen B, S-44 Snook EM, S-13, S-14, S-165 Van Lunen BL, S-42, S-59, S-66, S-122, S-132 Snyder AR, S-30, S-65, S-78, S-130, S-166 Vanic KA, S-76 Snyder Valier AR, S-28, S-47 VanSumeren MM, S-104 Sooy J, S-14 VanWagoner RV, S-71 Spang JT, S-179 Vardiman JP, S-142 Spiers S, S-79 Varone AN, S-40, S-150 Spybrook JK, S-166 Vela LI, S-167 St. Thomas S, S-130 Visram A, S-165 Staley T, S-189 Volk B, S-26 Stanek J, S-176 Stearns RL, S-26, S-104, S-143, S-169 W Stephenson LJ, S-198, S-202 Stergiou N, S-82 Wagner J, S-202 Stevens SW, S-157 Wahl TP, S-11, S-14, S-102 Stickley CD, S-14, S-102 Waicus KM, S-12 Stilger VG, S-197 Walter JM, S-66, S-172 Stobierski R, S-209 Walton MA, S-76, S-190 Stone DA, S-31 Wan G, S-172 Storvsed JR, S-190 Waninger K, S-76 Stout M, S-125 Ward K, S-195 Journal of Athletic Training S-213 flexion angle neuromuscular training, S-117 Subject Index brace support, S-71 youth soccer coaches, S-179 injuries injury risk factors A Star Excursion Balance Test, S-44 lower extremity static alignment, S-68 injury predictor lower extremity strength, S-68 Abdomen Functional Movement Screen, S-43 neuromuscular training, S-156 muscle training instability reconstruction ankle instability, S-116 abdominal training, S-116 jump landings, S-149 wall hematoma college-aged population, S-179 knee flexion angle, S-146 motorcyclist, S-193 cryotherapy, S-37 knee flexion movement, S-146 Acromioclavicular joint dorsiflexion, S-153 landings, S-146 acromiohumeral interval dynamic balance, S-58 lower extremity neuromuscular function, overhead athletes, S-97 dynamic stability, S-31, S-153 S-56 Acromion fatigue, S-50 osteoarthritis, S-185 nonunion

fibular reposition taping, S-53 outcome measures, S-132 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 collegiate football player, S-196 force sense, S-137, S-154 psychosocial experiences, S-180 Activation, muscle function, S-58 quadriceps performance, S-132 superimposed burst, S-54 gait initiation profiles, S-48 quadriceps strength, S-146 Activity levels gait kinematics, S-49 Anterior talofibular ligament morphology glenohumeral joint instability Hoffmann reflex, S-37 ankle sprain, S-57 health-related quality of life, S-27 Identification of Functional Ankle Approved Clinical Instructors Adolescent athletes Instability, S-33 clinical decision making baseball joint mobilization, S-58 accessibility, S-66 olecranon stress fracture, S-87 jump landings, S-50, S-139 barriers, S-66 concussions landing kinetics, S-51 Arteriovenous malformation, leg health-related quality of life, S-30 lower extremity energy dissipation, S-56 cross-country runner, S-64 school accommodations, S-30 measures, S-134 Assessment Sport Concussion Assessment Tool-2, neuromuscular alterations, S-38 concussion S-12 plantar pressure distribution, S-50 adolescent athletes, S-12 health-related quality of life postural control, S-139 attention-deficit hyperactivity disorder, fatigue, S-29 questionnaire, S-33 S-12, S-68 sex differences, S-29 range of motion, S-58 ImPACT, S-11 hip range of motion reactive joint stiffness, S-154 Sport Concussion Assessment Tool-2, lower extremity alignment, S-124 shank-rearfoot coupling, S-51, S-119 S-12 landing mechanics, S-126 subjective characteristics, S-139 Standardized Assessment of Concussion, lower extremity alignment, S-126 walking gait, S-48 S-13, S-14 overhead squat test wobble board rehabilitation, S-115 stimulant medications, S-68 lower extremity alignment, S-40 laxity functional volleyball dynamic postural stability, S-32 balance changes after exercise, S-41 reflex sympathetic dystrophy, S-86 self-reported function, S-32 knee conditions, S-40 Adolescents movement Athletes lower extremity injury rates, S-100 patellofemoral pain, S-68 adolescents African American athletes stair descent, S-68 concussions, S-12, S-30 dietary, exercise behaviors, S-22 muscle stabilizers health-related quality of life, S-29 Age 5-toed socks, S-138 hip range of motion, S-124 neuromuscular training reflex excitability, S-138 landing mechanics, S-126 anterior cruciate ligament injury, S-117 osteoarthritis lower extremity alignment, S-40, S-124, Age differences, postconcussion stair ascent, descent, S-184 S-126 neurocognitive performance, S-111 range of motion overhead squat test, S-40 postural stability, S-111 taping, S-70 African American symptoms, S-111 self-reported function dietary, exercise behaviors, S-22 Alcohol consumption postural stability, S-31 collegiate hydration, S-17 sprains dietary behaviors, S-22 Alignment, lower extremity anterior talofibular ligament morphology, exercise behaviors, S-22 adolescent athletes, S-124 S-57 Functional Movement Screen, S-43 Anaerobic exercise balance, S-118 tibial stress fracture, S-63 mouthguards, S-107 bracing, S-70 female Ankle chronic regional pain syndrome, S-189 Functional Movement Screen, S-43 anterior talofibular ligament morphology disability, S-34 high school ankle sprain, S-57 dorsiflexion, S-34 concussions, S-11 bracing posterior talar glide, S-155 knee ligament injury jump landing, S-50 textured insoles, S-118 KOOS, S-185 plantar pressure distribution, S-50 Ankle Instability Instrument, S-134 WOMAC, S-185 cryotherapy Anterior cruciate ligament male Hoffmann reflex, S-37 injury tibial stress fracture, S-63 dislocation hip muscle stiffness, S-83 nonoverhead high school football player, S-188 lower extremity biomechanics, S-18 upward scapular rotation, S-96 displacement postural control, S-151 overhead patellofemoral pain, S-152 injury prevention upward scapular rotation, S-96 dorsiflexion range of motion, S-155 female athletes, S-117

S-214 Volume 47 • Number 3 (Supplement) May 2012 scapular upward rotation fatigue, S-104 Bone bruises athletic participation, S-157 hyperthermia, S-104 descriptive analysis, S-57 track and field throwers hypohydration, S-104 Bracing, ankle tibial stress fracture, S-63 Ballet dancers ankle instability, S-50 Athletic trainers ground reaction forces, S-53 flexion angle, S-71 Athletic Training Career Intent Survey, S-122 postural stability, S-53 jump landing, S-50 burnout, S-121 Baseball players plantar pressure, S-50 clinical education adolescent sprain, S-70 preparation for practice, S-172 olecranon stress fracture, S-87 Brain concussion assessment, S-176 collegiate cavernous malformation concussion management, S-176 shoulder stiffness, S-97 professional baseball player, S-206 continuing education high school Bruises, bone acquisition, retention, S-171 humeral retrotorsion, S-133 descriptive analysis, S-57 electronic medical records, S-166 strengthening program, S-160 Bull riders, professional

postprofessional graduates professional postural sway, S-167 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 clinical satisfaction levels, S-172 cavernous malformation, S-206 Burnout, athletic trainers', S-121 Athletic training forearm rotation, S-95 Burst superimposition technique hierarchical linear model, S-166 Baseline testing optimal stimulation settings, S-38 Athletic Training Career Intent Survey Standardized Assessment of Concussion, reliability, validity, S-122 S-14 C Athletic training education Basketball players California Critical Thinking Disposition clinical decision making collegiate Inventory Approved Clinical Instructors, S-66 abnormal heart rhythm, S-194 Board of Certification examination, S-174 clinical education, S-60 balance, S-156 Capitate fracture Clinical Outcomes Research Education for neuromuscular control, S-156 collegiate female lacrosse player, S-199 Athletic, S-65 os acromiale, S-197 Cardiac conditions evidence-based practice intervention, S-132 female Wolff-Parkinson-White syndrome students' commitment to program, S-173 abnormal heart rhythm, S-194 female collegiate volleyball player, S-74 students' frustrations, S-171 balance, S-156 Cardiopulmonary resuscitation Athletic training education programs fibular avulsion fracture, S-204 education employers' confidence neuromuscular control, S-156 learning outcomes, retention, S-120 employers' knowledge, S-122 high school Cartilage postprofessional injury prevention, S-159 serum oligomeric matrix protein preceptors' perspectives, S-59 recreational exercise intensity, S-187 Athletic training services posterior tibial tendon dysfunction, S-203 Cavernous malformation South Carolina high schools, S-100 Behaviors professional baseball player, S-206 Athletic training students dietary, exercise Center of gravity clinical education, S-60 African American collegiate athletes, S-22 bull riders commitment to education program, S-173 foundational handedness, S-167 female athletic training students, S-59 Central activation ratio, quadriceps motherhood perceptions, S-121 Biceps brachii muscle cryotherapy, S-115 foundational behaviors, S-59 activation rehabilitation exercises, S-115 musculoskeletal anatomy instruction, S-119 glenohumeral joint, S-81 Ceramide deficiency perceptions light therapy recreational intramural athlete, S-205 standardized patients, S-119 strength, S-93 Cervical spine, nerve root avulsion program frustrations, S-171 Biochemical markers collegiate football player, S-200 Attention disturbance iron deficiency Children concussion, S-175 collegiate runners, S-23 lower extremity injury rates, S-100 Attention-deficit hyperactivity disorder Biomechanics Chondrosarcoma stimulants game penalties, S-54 collegiate volleyball player, S-208 concussion assessment, S-12 head impacts Clinical education Avascular necrosis, sesamoid collegiate football players, S-54 athletic trainers' high school football player, S-190 jump landings preparation for practice, S-172 B gluteal strength, S-20 satisfaction levels landings postprofessional graduates, S-172 Balance adolescent athletes, S-126 Clinical Outcomes Research Education for ankle instability youth soccer athletes, S-83 Athletic, S-65 joint mobilization, S-58 lower extremities Clinical reasoning skills EFX, S-126 anterior cruciate ligament injury, S-18 Board of Certification examination, S-173 neuromuscular control lower extremity energy absorption CNS Vital Signs collegiate female basketball players, S-156 landings, S-82 concussion, S-112 patellofemoral pain syndrome meniscal injury Coaches taping, S-148 biomechanics, S-147 secondary school football postexercise changes predictors sudden death perspective, S-25 functional assessment, S-41 anterior tibial shear force, S-82 youth soccer textured insoles Board of Certification examination anterior cruciate ligament injury ankle sprain history, S-118 California Critical Thinking Disposition prevention, S-179 Balance Error Scoring System Inventory, S-174 Cold-water immersion baseline values clinical reasoning skills, S-173 blood lactate response high school athletes, S-102 Health Science Reasoning Test, S-174 professional ice hockey players, S-163

Journal of Athletic Training S-215 College student, female soccer physical activity fibromyalgia, S-195 complex regional pain syndrome, S-206 functional outcomes, S-177 Collegiate athletes hamstring strains, S-182 postural control, S-112 baseball hip strength ratios, S-44 Stability Evaluation Test, S-113 shoulder stiffness, S-97 lower extremity injury, S-44 postural stability basketball medial collateral ligament tear, S-198 age, sex, S-111 abnormal heart rhythm, S-194 sex differences, S-182 reporting prevalence balance, S-156 tibial plateau fracture, S-198 high school athletes, S-177 neuromuscular control, S-156 tracking distance, S-169 sex differences, S-177 os acromiale, S-197 softball return to play distance running scaphoid cyst, S-195 high school athletes, S-11 compartment syndrome, S-204 track and field throwing school accommodations female tibial stress fracture, S-63 adolescents, S-30 abnormal heart rhythm, S-194 volleyball Standardized Assessment of Concussion

balance, S-156 chondrosarcoma, S-208 baseline values, S-14 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 capitate fracture, S-199 shoulder kinematics, S-124 Rasch calibration, S-15 complex regional pain syndrome, S-206 wrestling symptoms compression fractures, S-209 knee infection, S-62 age, sex, S-111 Functional Movement Screen, S-43, S-125 Compartment pressures Theory of Unpleasant Symptoms, S-128 giardiasis, S-202 lower extremity Continuing education medial collateral ligament tear, S-198 skiers, S-153 athletic trainers neuromuscular control, S-156 Compartment syndrome acquisition, S-171 Standardized Assessment of Concussion, collegiate distance runner, S-204 retention, S-171 S-13 forearm Core stability training Star Excursion Balance Test, S-125 collegiate rower, S-62 core muscular endurance, S-108 tibial plateau fracture, S-198 Complex regional pain syndrome postural control, S-108 field hockey collegiate female soccer player, S-206 Corticospinal excitability giardiasis, S-202 Compliance, exercise quadriceps football superior labrum lesions, S-79 knee flexion angle, S-36 1st rib fracture, S-191 Compression knee joint effusion, S-36 acromial nonunion, S-196 femoral artery blood flow, S-162 muscle activation, S-36 cervical nerve root avulsion, S-200 tissue temperature, S-162 stair descent, S-36 functinoal performance, S-42 Concussions Counterirritants game penalites, S-54 adolescent athletes hamstring flexibility, S-92 head impacts, S-54 health-related quality of life, S-30 pressure sensation, S-92 impetigo, S-77 assessment surface temperature, S-92 medial patellofemoral ligament rupture, adolescent athletes, S-12 Coupling media S-199 athletic trainers, S-176 phonophoresis, S-93 patellar stress fracture, S-207 attention-deficit hyperactivity disorder, Cramps, muscle preseason creatine kinase levels, S-144 S-68 sweat rate, S-144 sodium replacement, S-23 ImPACT, S-11 sweat-electrolyte concentration, S-144 Star Excursion Balance Test, S-44 Sport Concussion Assessment Tool-2, Creatine kinase gymnastics S-12 collegiate football players common variable immune deficiency, Standardized Assessment of Concussion, preseason, S-144 S-192 S-14 Cross-country runners compression fractures, S-209 stimulant medications, S-68 arteriovenous malformation health-related quality of life attentional disturbance leg, S-64 knee injuries, S-28 high school athletes, S-175 Cryotherapy lacrosse dual-task gait performance, S-111 application duration capitate fracture, S-199 fatigue muscle, ligament temperature, S-90 male health-related quality of life, S-178 delayed-onset muscle soreness, S-163 Standardized Assessment of Concussion, health-related quality of life, S-30 effectiveness, S-90 S-14 hypertension femoral artery blood flow, S-162 tibial stress fracture, S-63 high school football player, S-190 Hoffmann reflex power ImPACT ankle instability, S-37 warm-ups, S-157 EFX, S-141 intramuscular cooling rower symptom responders, S-129 sex differences, S-134 forearm compartment syndrome, S-62 management intramuscular temperature, S-89 rugby athletic trainers, S-176 microvascular perfusion, S-162 gastroparesis, S-208 Division I, S-175 quadriceps injuries, S-183 MAPS scores, S-192 exercise, S-89 sex differences in injuries, S-183 multiple quadriceps central activation ratio, S-115 running postural control, S-113 tissue temperature, S-162 iron deficiency, S-23 neurocognition, S-112 Cumberland Ankle Instability Tool, S-33, S-134 restrictive lung disease, S-201 age, sex, S-111 Cysts, ganglion scoliosis, S-201 NeuroCom tibiofibular joint, S-87 sex differences symptom responders, S-129 Cytokines Landing Error Scoring System, S-103 neuropsychological disturbance transforming growth factor beta skiing high school athletes, S-175 eccentric muscle injury, S-136 lower leg compartment pressures, S-153

S-216 Volume 47 • Number 3 (Supplement) May 2012 D Elite athletes F triathlete Dancers performance, S-26 Face-mask removal ballet, S-53 Elite triathletes football players, S-106 ground reaction forces, S-53 hydration, S-26 Fatigue postural stability, S-53 Endurance Balance Error Scoring System, S-104 Decision making core muscular concussions clinical, teaching core stability training, S-108 health-related quality of life, S-178 Approved Clincal Instructors, S-66 muscular functional protocol Dehydration baseball-specific strengthening, S-160 joint position sense, S-95 strength/power tests patellofemoral pain syndrome health-related quality of life resistance-trained men, S-16 taping, S-67 adolescent athletes, S-29 Delayed-onset muscle soreness Energenetic capabilities sex differences, S-29 cryotherapy, S-163 lower extremity mood, S-143 Diet behaviors plantar pressure distribution

lean mass, S-146 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 African American collegiate athletes, S-22 Energy absorption ankle instability, S-50 Disability lower extremities jump landing, S-50 ankle sprain landings, S-82 reaction time, S-143 dorsiflexion, S-34 Environmental conditions Feedback Dislocations Heat Observation Technology System jump landings, S-84 ankle validity, S-25 Landing Error Scoring System, S-149 high school football player, S-188 Equipment, protective Female athletes sternoclavicular joint football helmets anterior knee pain professional rescue diver, S-196 hardware removal, S-55 functional outcomes, S-34 Disorders Ethyl chloride vapocoolant basketball attention-deficit hyperactivity cold perception, S-92 abnormal heart rhythm, S-194 concussion assessment, S-68 intramuscular temperature, S-92 balance, S-156 Diver, professional rescue subcutaneous temperature, S-92 fibular avulsion fracture, S-204 sternoclavicular joint dislocation, S-196 surface temperature, S-92 neuromuscular control, S-156 Dorsiflexion Evaluation measures collegiate ankle sprain disability, S-34 sleeper stretches, S-78 abnormal heart rhythm, S-194 Drop-jump task Evidence-based practice balance, S-156 muscle activation Clinical Outcomes Research Education for capitate fracture, S-199 sex differences, S-150 Athletic, S-65 complex regional pain syndrome, S-206 Dynamic Postural Stability Index educational intervention, S-132 compression fractures, S-209 ankle laxity, S-32 Exercises Functional Movement Screen, S-43, S-125 Dyskinesis, scapular anaerobic performance giardiasis, S-202 glenohumeral joint pathology, S-80 mouthguards, S-107 medial collateral ligament tear, S-198 behaviors neuromuscular control, S-156 E African American collegiate athletes, S-22 Standardized Assessment of Concussion, Eccentric exercises compliance S-13 muscle damage superior labrum lesions, S-79 Star Excursion Balance Test, S-125 soft tissue mobilization, S-142 cryotherapy tibial plateau fracture, S-198 strength interface temperature, S-89 volleyball, S-74 light therapy, S-93 intramuscular temperature, S-89 field hockey Education hamstring stiffness giardiasis, S-202 athletic training low back pain, S-110 high school clinical decision making, S-66 intensity Balance Error Scoring System, S-102 clinical education, S-60 serum cartilage oligomeric matrix protein, lacrosse postprofessional, S-59 S-187 capitate fracture, S-199 cardiopulmonary resuscitation on ice neuromuscular training learning outcomes, S-120 test-retest reliability, S-168 anterior cruciate ligament injury, S-117 retention, S-120 range of motion hip abductor strength, S-109 EFX underwrap, S-71 soccer balance, S-126 rehabiltiation complex regional pain syndrome, S-206 ImPACT, S-141 quadriceps central activation ratio, S-115 hip kinematics, S-147 isokinetic strength, S-141 short foot knee kinematics, S-147 Elbow posterior tibial tendon dysfunction, S-203 medial collateral ligament tear, S-198 olecranon stress fracture shoulder tibial plateau fracture, S-198 adolescent baseball player, S-87 scapular muscle activation, S-78 volleyball Electrolytes single-leg squat Wolff-Parkinson-White syndrome, S-74 balance surface angle, S-158 Females collegiate football players, S-23 single-leg stepdowns low back pain professional football players, S-22 hip kinematics, S-159 hamstring stiffness, S-110 imbalance knee kinematics, S-159 Femoral artery blood flow high school football player, S-188 straight-leg raises compression, S-162 sweat muscle activation, S-108 cryotherapy, S-162 cramping, S-144 Experimental design Ferritin Electronic medical records hierarchical linear model, S-166 iron deficiency athletic trainers, S-166 collegiate runners, S-23

Journal of Athletic Training S-217 Fibromyalgia Forces Gastroparesis female college student, S-195 anterior tibial shear collegiate rugby player, S-208 Fibula biomechanical predictors, S-82 Giardiasis avulsion fracture Forearm collegiate female field hockey player, S-202 female basketball player, S-204 compartment syndrome Glenohumeral joint distal and pilon fracture collegiate rower, S-62 instability collegiate softball player, S-202 rotation activity levels, S-27 Maisonneuve fracture baseball players, S-95 health-related quality of life, S-27 high school football player, S-188 Forefoot inversion objective measures, S-27 reposition taping ankle instability, S-48 patient-based measures, S-27 ankle instability, S-53 Fractures stiffness, S-27 Field hockey player 1st rib muscle activation collegiate female collegiate football player, S-191 biceps brachii, S-81 giardiasis, S-202 acromial nonunion pathology

Flexibility collegiate football player, S-196 scapular muscle activation, S-80 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 counterirritants, S-92 capitate scapular muscle strength, S-80 hamstrings collegiate female lacrosse player, S-199 range of motion foam rolling, S-46 distal fibula and pilon Kinesiotape, S-137 stretching collegiate softball player, S-202 Glenoid labrum tear high school athletes, S-47 fibular avulsion nonsurgical management, S-197 Fluids female basketball player, S-204 overhead athletes, S-197 consumption Maisonnueve rehabilitation, S-197 sodium replacement, S-22 high school football player, S-188 Global positioning systems Foam rolling olecranon stress tracking distance hamstring stretching, S-46 adolescent baseball player, S-87 collegiate men's soccer, S-169 Foot and Ankle Disability Index, S-33 patellar stress Gluteal muscles Foot and Ankle Disability Index-Sport, S-33 collegiate football player, S-207 activity Foot Posture Index spinal compression hip strength, S-20 reliability, S-102 collegiate female gymnast, S-209 lower extremity kinematics, S-20 Football stress strength helmets tibial, S-63 jump landings, S-20 hardware removal, S-55 tibial plateau Ground reaction forces secondary school coaches collegiate female soccer player, S-198 ballet dancers, S-53 sudden death perspective, S-25 Function Grounded theory studies Football players ankle laxity athletic trainers' foundational behaviors, S-59 collegiate dynamic postural stability, S-32 Gymnast, collegiate 1st rib fracture, S-191 Functional assessment common variable immune deficiency, S-192 acromial nonunion, S-196 balance changes after exercise, S-41 Gymnasts cervical nerve root avulsion, S-200 knee conditions, S-40 collegiate female functional performance, S-42 Functional Movement Screen compression fractures, S-209 game penalties, S-54 ankle, knee injury predictor head impacts, S-54 female collegiate athletes, S-43 H impetigo, S-77 female collegiate athletes, S-125 Hamstrings muscles medial patellofemoral ligament rupture, male youth lacrosse players, S-42 :quadriceps ratio S-199 Functional outcome low back pain, S-109 patellar stress fracture, S-207 concussion flexibility preseason creatine kinase levels, S-144 physical activity, S-177 counterirritants, S-92 sodium replacement, S-23 Functional performance foam rolling, S-46 Star Excursion Balance Test, S-44 ankle brace, S-70 stiffness face-mask removal ankle instability low back pain, S-110 helmet removal, S-106 joint mobilization, S-58 strains Heat Observation Technology System ankle taping, S-70 collegiate soccer players, S-182 validity, S-25 football players, S-42 sex differences, S-182 helmet removal G Handedness air-bladder deflation, S-106 bull riders high school Gait postural sway, S-167 ankle dislocation, S-188 dual-task performance Head impacts concussion, S-190 concussions, S-111 collegiate football players, S-54 electrolyte imbalance, S-188 initiation profiles game penalties, S-54 hypertension, S-190 ankle instability, S-48 Health Science Reasoning Test Maisonneuve fracture, S-188 kinematics Board of Certification examination, S-174 sesamoid avascular necrosis, S-190 ankle instability, S-49 Health-related quality of life youth walking adolescent athletes osteochondritis dissecans, S-85 ankle instability, S-48 concussion symptoms, S-30 Force production Game penalties concussions, S-30 transforming growth factor beta football fatigue eccentric muscle injury, S-136 head impacts, S-54 adolescent athletes, S-29 Force sense Ganglion cysts concussions, S-178 ankle instability, S-154 tibiofibular joint sex differences, S-29 Kinesiotape, S-137 youth soccer player, S-87 glenohumeral joint instability, S-27

S-218 Volume 47 • Number 3 (Supplement) May 2012 knee injury history kinematics Immune system collegiate athletes, S-28 female soccer players, S-147 common variable immune deficiency lower extremity injury history, S-130 single-leg stepdowns, S-159 collegiate gymnast, S-192 Heart movement ImPACT abnormal rhythm patellofemoral pain, S-68 alternate forms equivalence, S-11 collegiate female basketball player, S-194 stair descent, S-68 EFX, S-141 Wolff-Parkinson-White syndrome muscle stiffness symptom responders, S-129 female collegiate volleyball player, S-74 anterior cruciate ligament injury, S-83 Impacts, head Heat Observation Technology System patellofemoral pain syndrome collegiate football players, S-54 validity, S-25 hip kinematics, S-18 game penalites, S-54 Helmets, football hip kinetics, S-18 Impetigo hardware removal, S-55 knee kinematics, S-18 collegiate football players, S-77 removal, S-106 knee kinetics, S-18 Infections Hematocrit range of motion giardiasis

iron deficiency lower extremity alignment, S-124 collegiate female field hockey player, Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 collegiate runners, S-23 medial knee displacement, S-150 S-202 Hematologic conditions strength knee idiopathic thrombocytopenic purpura gluteal muscle activity, S-20 collegiate wrestler, S-62 recreational runner, S-75 lower extremity kinematics, S-20 Injuries Hematomas medial knee displacement, S-150 eccentric muscle abdominal wall strength ratios transforming growth factor beta, S-136 motorcyclist, S-193 collegiate soccer players, S-44 knee Hemoglobin lower extremity injury, S-44 health-related quality of life, S-28 iron deficiency History lower extremity collegiate runners, S-23 knee injury military cadets, S-180, S-202 Hierarchical linear model health-related quality of life, S-28 mental toughness training, S-165 athletic training, S-166 Hoffmann reflex orthopaedic High school athletes cryotherapy pediatric hospital, S-99 Balance Error Scoring System ankle instability, S-37 ovulation status, S-169 baseline values, S-102 Humerus prediction baseball retrotorsion Functional Movement Screen, S-43 humeral retrotorsion, S-133 high school baseball players, S-133 Star Excursion Balance Test, S-44 strengthening program, S-160 Hydration shoulder basketball alcohol consumption, S-17 muscle activation, S-79 injury prevention, S-159 elite triathletes, S-26 Injury epidemiology concussion reporting fluid consumption collegiate rugby players sex differences, S-177 professional football players, S-22 sex differences, S-183 concussions hypohydration lower extremity attentional disturbance, S-175 Balance Error Scoring System, S-104 adolescents, S-100 neuropsychological disturbance, S-175 mood, S-143 children, S-100 football reaction time, S-143 orthopaedic trauma ankle dislocation, S-188 measurements pediatric hospital, S-99 concussion, S-190 freezing, S-16 stock car racing, S-181 electrolyte imbalance, S-188 refrigeration, S-16 summer sports camp, S-99 hypertension, S-190 refractometers Injury prevention Maisonneuve fracture, S-188 validity, S-143 anterior cruciate ligament pectoralis major absence, S-85 sodium replacement youth soccer coaches, S-179 sesamoid avascular necrosis, S-190 collegiate football players, S-23 head and neck hip range of motion Hyperactivity Disorders stock car racing, S-181 medial knee displacement, S-150 concussion assessment, S-68 high school basketball players, S-159 hip strength Hypertension Insoles, textured medial knee displacement, S-150 concussion ankle sprain history, S-118 lacrosse high school football player, S-190 balance, S-118 Kawasaki syndrome, S-76 Hyperthermia Instability, ankle male Balance Error Scoring System, S-104 5-toed socks, S-139 lacrosse, S-76 mood, S-143 abdominal training, S-116 postconcussion return to play, S-11 reaction time, S-143 college-aged population, S-179 stretching Cumberland Ankle Instability Tool, S-33 flexibility, S-47 I dorsiflexion, S-153 performance, S-47 Identification of Functional Ankle Instability, dynamic balance, S-58 soreness, S-47 S-33, S-134 dynamic postural stability, S-31 strength, S-47 Idiopathic thrombocytopenic purpura dynamic stability, S-153 High schools, South Carolina recreational runner, S-75 fatigue, S-50 athletic training services, S-100 Iliotibial band tightness fibular reposition taping, S-53 Hip soft tissue mobilization, S-128 Foot and Ankle Disability Index, S-33 abductor strength Illness Foot and Ankle Disability Index-Sport, S-33 female athletes, S-109 mental toughness training, S-165 force sense, S-137, S-154 neuromuscular training, S-109 Illness epidemiology function, S-58 internal rotation summer sports camp, S-99 gait initiation profiles, S-48 patellofemoral pain syndrome, S-152 gait kinematics, S-49

Journal of Athletic Training S-219 Identification of Functional Ankle Instability, knee flexion moment S-33 patellofemoral pain syndrome, S-18 anterior cruciate ligament reconstruction, joint mobilization, S-58 playing surface, S-147 S-146 jump landing, S-139 single-leg stepdowns, S-159 functional assessment, S-40 jump landings, S-50 lower extremity functional outcomes landing kinetics, S-51 gluteal muscle activity, S-20 anterior knee pain, S-34 lower extremity energy dissipation, S-56 hip strength, S-20 infection measures, S-134 jump landings, S-84 collegiate wrestler, S-62 neuromuscular alterations, S-38 patellofemoral pain syndrome, S-19 injuries plantar pressure, S-50 real-time feedback, S-84 Star Excursion Balance Test, S-44 postural control, S-139 overhead squat test injury history questionnaires, S-33 adolescent athletes, S-40 health-related quality of life, S-28 range of motion, S-58 lower extremity alignment, S-40 jump landings, S-104 reactive joint stiffness, S-154 shoulder injury predictor

shank-rearfoot coupling, S-51, S-119 collegiate volleyball players, S-124 Functional Movement Screen, S-43 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 subjective characteristics, S-139 trunk internal rotation walking gait, S-48 patellofemoral pain syndrome, S-19 patellofemoral pain syndrome, S-152 wobble board rehabilitation, S-115 Kinesiotape joint effusion Iron deficiency force sense quadriceps activation, S-36 biochemical markers ankle instability, S-137 quadriceps corticospinal excitability, S-36 collegiate runners, S-23 glenohumeral range of motion, S-137 kinematics Isokinetic strength lower leg female soccer players, S-147 EFX, S-141 loading rate, S-140 single-leg stepdowns, S-159 Isometric exercises shoulder proprioception, S-140 ligament injury hamstrings:quadriceps ratio shoulder strength, S-140 KOOS, S-185 low back pain, S-109 Kinetics WOMAC, S-185 hip medial collateral ligament tear J patellofemoral pain syndrome, S-18 collegiate female soccer player, S-198 Joint mobilization knee medial displacement ankle instability patellofemoral pain syndrome, S-18 hip range of motion, S-150 dynamic balance, S-58 landings hip strength, S-150 function, S-58 ankle instability, S-51 medial patellofemoral ligament rupture range of motion, S-58 stair ascent collegiate football player, S-199 Joint position sense ankle osteoarthritis, S-184 meniscal injury upper extremity stair descent biomechanics, S-147 functional fatigue protocol, S-95 ankle osteoarthritis, S-184 patellofemoral pain syndrome, S-67 softball players, S-95 Knee hip kinematics, S-18 Jump landings anterior cruciate ligament hip kinetics, S-18 ankle bracing injury prevention, S-117, S-179 knee kinematics, S-18 plantar pressure, S-50 injury risk factors, S-156 knee kinetics, S-18 ankle instability anterior cruciate ligament injury lower extremity kinematics, S-19 5-toed socks, S-139 hip muscle stiffness, S-83 pain, S-67 fatigue, S-50 lower extremity biomechanics, S-18 risk factors, S-68 plantar pressure, S-50 postural control, S-151 stair descent, S-68, S-152 postural control, S-139 risk factors, S-68 strength, S-67 subjective characteristics, S-139 anterior cruciate ligament reconstruction taping, S-67, S-148 anterior cruciate ligament reconstruction, jump landings, S-149 trunk kinematics, S-19 S-149 knee flexion angle, S-146 reconstruction biomechanics knee flexion movement, S-146 psychosocial experiences, S-180 gluteal strength, S-20 landings, S-146 surgery kinematics lower extremity neuromuscular function, lower extremity functional outcomes, real-time feedback, S-84 S-56 S-130 knee injury history, S-104 osteoarthritis, S-185 tibial plateau fracture Landing Error Scoring System outcome measures, S-132 collegiate female soccer player, S-198 feedback, S-149 psychosocial experiences, S-180 KOOS quadriceps performance, S-132 knee ligament injury, S-185 K quadriceps strength, S-146 anterior pain L Kawasaki syndrome young athletic females, S-34 male high school lacrosse athlete, S-76 Lacrosse players bone bruises Kinematics collegiate female descriptive analysis, S-57 anterior cruciate ligament injury capitate fracture, S-199 effusion hip muscle stiffness, S-83 high school male flexion angle, S-36 gait Kawasaki syndrome, S-76 quadriceps corticospinal excitability, S-36 ankle instability, S-49 male stair descent, S-36 hip Functional Movement Screen, S-42 flexion angle patellofemoral pain syndrome, S-18 youth anterior cruciate ligament reconstruction, playing surface, S-147 Functional Movement Screen, S-42 S-146 single-leg stepdowns, S-159

S-220 Volume 47 • Number 3 (Supplement) May 2012 Lactate hip strength Measures cold-water immersion gluteal muscle activity, S-20 ankle instability professional ice hockey players, S-163 injuries Ankle Instability Instrument, S-134 Landing Error Scoring System collegiate soccer players, S-44 Cumberland Ankle Instability Tool, S-134 jump landings hip strength ratios, S-44 Identification of Functional Ankle feedback, S-149 military cadets, S-180, S-202 Instability, S-134 sex differences injury rates Foot Posture Index collegiate athletes, S-103 adolescents, S-100 reliability, S-102 Landings children, S-100 glenohumeral joint instability anterior cruciate ligament reconstruction, injury severity objective, S-27 S-146 health-related quality of life, S-130 patient based, S-27 jump kinematics outcomes ankle bracing, S-50 hip strength, S-20 anterior cruciate ligament reconstruction, ankle instability, S-50 jump landings, S-84 S-132

fatigue, S-50 patellofemoral pain syndrome, S-19 Medications Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 gluteal strength, S-20 real-time feedback, S-84 osteoarthritis, S-186 kinematics, S-84 loading rate phonophoresis, S-93 knee injury history, S-104 Kinesiotape, S-140 stimulant plantar pressure, S-50 neuromuscular control concussion assessment, S-12, S-68 kinetics collegiate female basketball players, S-156 Meniscal injury ankle instability, S-51 neuromuscular funtion biomechanics, S-147 lower extremity anterior cruciate ligament reconstruction, Mental, Emotional and Bodily Toughness energy absorption, S-82 S-56 Inventory lower extremity alignment static alignment construct validity, S-165 adolescent athletes, S-126 anterior cruciate ligament injury, S-68 Mental toughness training sex differences patellofemoral pain syndrome, S-68 illness, injury, S-165 youth soccer athletes, S-83 strength Microvascular perfusion Ligaments anterior cruciate ligament injury, S-68 cryotherapy, S-162 anterior cruciate injury patellofemoral pain syndrome, S-68 Military athletes lower extremity biomechanics, S-18 Lower extremity lower extremity injuries lower extremity static alignment, S-68 alignment risk factors, S-180, S-202 lower extremity strength, S-68 landing mechanics, S-126 Modalities anterior cruciate reconstruction Lungs massage, S-46 lower extremity neuromuscular function, restrictive disease Modalities, therapeutic S-56 collegiate runner, S-201 compression anterior talofibular ligament morphology femoral artery blood flow, S-162 ankle sprain, S-57 M tissue temperature, S-162 medial collateral tear Maisonneuve fracture cryotherapy collegiate female soccer player, S-198 high school football player, S-188 application duration, S-90 medial patellofemoral rupture Male athletes delayed-onset muscle soreness, S-163 collegiate football player, S-199 collegiate effectiveness, S-90 Light therapy Standardized Assessment of Concussion, exercise, S-89 near infrared S-14 femoral artery blood flow, S-162 strength, S-93 tibial stress fracture, S-63 Hoffmann reflex, S-37 Low back pain high school intramuscular temperature, S-89 hamstrings stiffness Balance Error Scoring System, S-102 microvascular perfusion, S-162 females, S-110 Kawasaki syndrome, S-76 quadriceps central activation ratio, S-115 hamstrings:quadriceps torque ratio, S-109 lacrosse tissue temperature, S-162 straight-leg raises Functional Movement Screen, S-42 ethyl chloride vapocoolant muscle activation, S-108 Kawasaki syndrome, S-76 cold perception, S-92 Lower extremities track and field throwers intramuscular temperature, S-92 alignment tibial stress fracture, S-63 subcutaneous temperature, S-92 adolescent athletes, S-40, S-124 youth surface temperature, S-92 hip range of motion, S-124 Functional Movement Screen, S-42 Pain Ease joint kinematics, S-40 Malignancies cold perception, S-91 overhead squat test, S-40 chondrosarcoma intramuscular temperature, S-91 anterior tibial shear force collegiate volleyball player, S-208 subcutaneous temperature, S-91 biomechanical predictors, S-82 Manual therapy surface temperature, S-91 biomechanics soft tissue mobilization phonophoresis anterior cruciate ligament injury, S-18 muscle damage, S-142 coupling media, S-93 compartment pressures Massage medications, S-93 skiers, S-153 cell survival soft tissue mobilization energenetic capabilities autophagy, S-46 iliotibial band tightness, S-128 lean mass, S-146 Measurements muscle damage, S-142 energy absorption Dynamic Postural Stability Index Mood landings, S-82 ankle laxity, S-32 fatigue, S-143 energy dissipation hydration hyperthermia, S-143 ankle instability, S-56 freezing, S-16 hypohydration, S-143 functional outcomes refrigeration, S-16 Morphology knee surgery, S-130 sleeper stretches, S-78 anterior talofibular ligament ankle sprain, S-57 Journal of Athletic Training S-221 Motoneuron pool excitability N lower extremity functional ankle instability, S-53 knee surgery, S-130 Motor excitability Nerve palsy, common peroneal patient reported ankle instability, S-38 youth soccer player, S-87 time context, S-29 Motorcyclist Neurocognitive performance Overhead athletes abdominal wall hematoma, S-193 postconcussion acromiohumeral interval Mouthguards age, sex, S-111 scapulohumeral rhythm, S-97 anaerobic exercise performance, S-107 NeuroCom labral tear Movement symptom responders, S-129 nonsurgical managment, S-197 ankle, hip Neuromuscular control rehabilitation, S-197 stair descent, S-68 lower extremity Overhead squat test Movement and Activity in Physical Space Score collegiate female basketball players, S-156 kinematics concussion, S-192 Neuromuscular function adolescent athletes, S-40 Muscle activation lower extremities lower extremity alignment, S-40 anterior cruciate ligament reconstruction,

glenohumeral joint Ovulation status Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 biceps brachii, S-81 S-56 time of injury, S-169 quadriceps, S-117 Neuromuscular responses optimal stimulation settings, S-38 patellofemoral pain syndrome P scapula taping, S-148 Pain shoulder exercises, S-78 Neuromuscular system chronic regional syndrome sex differences ankle instability, S-38 ankle sprain, S-189 drop-jump task, S-150 Neuromuscular training complex regional syndrome shoulder anterior cruciate ligament injury collegiate female soccer player, S-206 previous injury, S-79 age, S-117 patellofemoral, S-67 Muscles female athletes, S-117 taping, S-67, S-72, S-148 activation risk factors, S-156 Pain Ease abdominal training, S-116 hip abductor strength cold perception, S-91 straight-leg raises, S-108 female athletes, S-109 intramuscular temperature, S-91 superimposed burst, S-54 Neuropathy, cervical subcutaneous temperature, S-91 ankle stabilizers collegiate football player, S-200 surface temperature, S-91 5-toed socks, S-138 Neuropsychological disturbance Patella reflex excitability, S-138 concussion patellofemoral pain syndrome biceps brachii high school athletes, S-175 taping, S-72 light therapy, S-93 Neuropsychological tests stress fracture cooling CNS Vital Signs, S-112 collegiate football player, S-207 sex differences, S-134 ImPACT Patellofemoral pain syndrome cramps symptom responders, S-129 balance, S-148 sweat rate, S-144 NeuroCom hip kinematics, S-18 sweat-electrolyte concentration, S-144 symptom responders, S-129 hip kinetics, S-18 damage Nonathletes knee kinematics, S-18 soft tissue mobilization, S-142 scapular upward rotation, S-96 knee kinetics, S-18 eccentric injury Numbers-needed-to-treat analysis lower extremity kinematics, S-19 transforming growth factor beta, S-136 anterior cruciate ligament reconstruction neuromuscular response, S-148 endurance osteoarthritis, S-185 pain, S-148 baseball-specific strengthening, S-160 O risk factors gluteal lower extremity static alignment, S-68 activity, S-20 Orthopaedic trauma lower extremity strength, S-68 hamstrings pediatric hospital, S-99 stair descent stiffness, S-110 Os acriomiale ankle displacement, S-152 hamstrings:quadriceps ratio collegiate basketball player, S-197 ankle movement, S-68 low back pain, S-109 Osteoarthritis hip internal rotation, S-152 hip ankle hip movement, S-68 stiffness, S-83 stair ascent, S-184 knee internal rotation, S-152 hip abductor strength stair descent, S-184 strength female athletes, S-109 anterior cruciate ligament reconstruction pain, S-67 neuromuscular training, S-109 numbers needed to treat, S-185 taping, S-148 intramuscular temperature medications, S-186 endurance, S-67 cryotherapy, S-89 physical activity intensity, S-184 pain, S-67 ethyl chloride vapocoolant, S-92 supplements, S-186 strength, S-67 pectoralis major Osteochondritis dissecans trunk kinematics, S-19 congenital absence, S-85 middle school football player, S-85 Patient-reported measures quadriceps Outcomes outcomes superimposed burst, S-54 anterior cruciate ligament reconstruction, S- time context, S-29 scapular 132 Pectoralis major muscle activation, S-80 concussion congenital absence strength, S-80 physical activity, S-177 high school athlete, S-85 functional knee Perceptions anterior knee pain, S-34 cold learning ethyl chloride vapocoolant, S-92 cardiopulmonary resuscitation, S-120 Pain Ease, S-91

S-222 Volume 47 • Number 3 (Supplement) May 2012 motherhood Power athletes Questionnaires, ankle female athletic training students, S-121 collegiate Cumberland Ankle Instability Tool, S-33 students' warm-ups, S-157 Foot and Ankle Disability Index, S-33 standardized patients, S-119 Power tests Foot and Ankle Disability Index-Sport, S-33 Performance dehydration, S-16 postural stability, S-31 dual-task gait rehydration, S-16 concussions, S-111 Preceptors R elite triathletes clinical education perspectives, S-59 Range of motion hydration, S-26 Predictors ankle brace, S-70 sprint times biomechanical ankle instability warm-ups, S-157 anterior tibial shear force, S-82 joint mobilization, S-58 Star Excursion Balance Test, S-52 Pressure sensation ankle taping, S-70 stretching counterirritants, S-92 dorsiflexion high school athletes, S-47 Professional athletes ankle sprain, S-155

Peroneal nerve palsy baseball glenohumeral joint Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 youth soccer player, S-87 cavernous malformation, S-206 Kinesiotape, S-137 Perspectives forearm rotation, S-95 hip preceptors' rescue diving lower extremity alignment, S-124 clinical education, S-59 sternoclavicular joint dislocation, S-196 medial knee displacement, S-150 secondary school coaches' Professional practice Rasch calibration sudden death, S-25 foundational behaviors, S-59 Standardized Assessment of Concussion, Phonophoresis Proprioception, shoulder S-15 coupling media, S-93 Kinesiotape, S-140 Reaction time medications, S-93 Protective devices fatigue, S-143 Physical activity ankle brace hyperthermia, S-143 functional outcome measure flexion angle, S-71 hyphohydration, S-143 concussion, S-177 Protective equipment Recreational athletes intensity football basketball osteoarthritis, S-184 face-mask removal, S-106 posterior tibial tendon dysfunction, S-203 Pitching, baseball hardware removal, S-55 intramural humeral retrotorsion, S-133 helmet removal, S-106 ceramide deficiency, S-205 Plantar pressure stock car racing, S-181 Reflex excitability ankle bracing, S-50 Psychology ankle stabilizing muscles ankle instability, S-50 mental toughness training 5-toed socks, S-138 jump landing, S-50 illness, injury, S-165 Reflex sympathetic dystrophy ankle instability, S-50 rehabiliation adolescent volleyball player, S-86 fatigue, S-50 anterior cruciate ligament reconstruction, collegiate female soccer player, S-206 Playing surface S-180 Refractometers hip kinematics Q validity female soccer players, S-147 hydration status, S-143 knee kinematics Quadriceps muscles Rehabilitation female soccer players, S-147 :hamstrings torque ratio exercises Posterior tibial tendon dysfunction low back pain, S-109 quadriceps central activation ratio, S-115 short foot exercises, S-203 activation labral tear Postprofessional athletic training education optimal stimulation settings, S-38 overhead athletes, S-197 preceptors' perspectives, S-59 superimposed burst, S-54 psychosocial experiences Postural control therapeutic modalities, S-117 anterior cruciate ligament reconstruction, ankle instability central activation ratio S-180 5-toed socks, S-139 cryotherapy, S-115 short foot exercises jump landings, S-139 rehabilitation exercises, S-115 posterior tibial tendon dysfunction, S-203 anterior cruciate ligament injury, S-151 corticospinal excitability wobble board concussion, S-112 knee flexion angle, S-36 ankle instability, S-115 Stability Evaluation Test, S-113 knee joint effusion, S-36 Rehydration core stability training muscle activation, S-36 strength/power tests core muscular endurance, S-108 stair descent, S-36 resistance-trained men, S-16 multiple concussions, S-113 cryotherapy Reliability Postural stability exercise, S-89 Athletic Training Career Intent Survey, S-122 ankle instability interface temperature, S-89 Foot Posture Index, S-102 ankle questionnaires, S-31 intramuscular temperature, S-89 gait initiation profiles ankle laxity, S-32 performance ankle instability, S-48 ballet dancers, S-53 anterior cruciate ligament reconstruction, test-retest postconcussion S-132 on-ice exercises, S-168 age, S-111 strength Resistance training sex, S-111 anterior cruciate ligament reconstruction, dehydration, S-16 self-reported ankle function, S-31 S-146 rehydration, S-16 visual distraction, S-160 Questionnaires Responses, perceptual Postural sway Identification of Functional Ankle Instability, dehydration, S-16 bull riders S-33 rehydration, S-16 handedness, S-167

Journal of Athletic Training S-223 Return to play health-related quality of life Soccer players postconcussion fatigue, S-29 collegiate high school athletes, S-11 intramuscular cooling, S-134 complex regional pain syndrome, S-206 Ribs landings hamstring strains, S-182 fracture, 1st youth soccer athletes, S-83 hip strength ratios, S-44 collegiate football player, S-191 muscle activation lower extremity injury, S-44 Risk factors drop-jump task, S-150 medial collateral ligament tear, S-198 anterior cruciate ligament injury postconcussion sex differences, S-182 lower extremity strength, S-68 neurocognitive performance, S-111 tibial plateau fracture, S-198 neuromuscular training, S-156 postural stability, S-111 tracking distance, S-169 static alignment, S-68 symptoms, S-111 female lower extremity injuries Shank-rearfoot coupling complex regional pain syndrome, S-206 military cadets, S-180, S-202 variability analysis hip kinematics, S-147 patellofemoral pain syndrome ankle instability, S-51, S-119 knee kinematics, S-147

lower extremity strength, S-68 Shoulder medial collateral ligament tear, S-198 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 static alignment, S-68 acromial nonunion tibial plateau fracture, S-198 Rower, collegiate collegiate football player, S-196 youth forearm compartment syndrome, S-62 acromiohumeral interval common peroneal nerve palsy, S-87 Rugby players, collegiate overhead athletes, S-97 landing biomechanics, S-83 gastroparesis, S-208 glenohumeral joint tibiofibular ganglion cyst, S-87 injuries, S-183 scapular muscle activation, S-80 Socks, 5 toed sex differences in injuries, S-183 scapular muscle strength, S-80 ankle stabilizing muscles Runners glenohumeral joint instability reflex excitability, S-138 collegiate activity levels, S-27 postural control compartment syndrome, S-204 health-related quality of life, S-27 ankle instability, S-139 iron deficiency, S-23 objective measures, S-27 jump landings, S-139 restrictive lung disease, S-201 patient-based measures, S-27 Sodium replacement scoliosis, S-201 stiffness, S-27 collegiate football players, S-23 cross-country glenohumeral joint muscle activation professional football players, S-22 arteriovenous malformation, S-64 biceps brachii, S-81 Soft tissue mobilization distance glenohumeral joint range of motion foam rolling compartment syndrome, S-204 Kinesiotape, S-137 hamstring flexibility, S-46 recreational kinematics iliotibial band tightness, S-128 idiopathic thrombocytopenic purpura, collegiate volleyball players, S-124 massage S-75 labral tear autophagy, S-46 nonsurgical management, S-197 muscle damage S overhead athletes, S-197 eccentric exercise, S-142 Scaphoid cyst rehabilitation, S-197 Softball players collegiate softball players, S-195 muscle activation collegiate Scapula previous injury, S-79 scaphoid cyst, S-195 dyskinesis os acromiale joint position sense muscle activation, S-80 collegiate basketball player, S-197 functional fatigue protocol, S-95 muscle strength, S-80 proprioception Soleus glenohumeral joint pathology Kinesiotape, S-140 alpha motoneuron pool excitability muscle activation, S-80 scapula ankle instability, S-53 muscle strength, S-80 muscle activation, S-80 Soreness muscle activation muscle strength, S-80 stretching, S-47 shoulder exercises, S-78 scapular muscle activation, S-78 Spine scapulohumeral rhythm scapular upward rotation compression fractures overhead athletes, S-97 athletes, S-157 female collegiate gymnast, S-209 upward rotation nonathletes, S-96 low back pain athletic participation, S-157 nonoverhead athletes, S-96 hamstring stiffness, S-110 nonathletes, S-96 overhead athletes, S-96 hamstrings:quadriceps torque ratio, S-109 nonoverhead athletes, S-96 scapulohumeral rhythm straight-leg raises, S-108 overhead athletes, S-96 overhead athletes, S-97 scoliosis Scoliosis stiffness collegiate runner, S-201 collegiate runner, S-201 collegiate baseball players, S-97 Sport Concussion Assessment Tool-2 Serum cartilage oligomeric matrix protein strength adolescent athletes, S-12 exercise intensity, S-187 Kinesiotape, S-140 Sprains, ankle Sesamoids superior labral lesions anterior talofibular ligament morphology, avascular necrosis exercise protocol compliance, S-79 S-57 high school football player, S-190 Skiers, collegiate balance, S-118 Sex differences lower leg compartment pressures, S-153 bracing, S-70 collegiate athletes Skin conditions chronic regional pain syndrome, S-189 Landing Error Scoring System, S-103 ceramide deficiency disability, S-34 collegiate rugby injuries, S-183 recreational intramural athlete, S-205 dorsiflexion, S-34 concussion reporting Sleeper stretches dorsiflexion range of motion, S-155 high school athletes, S-177 evaluative measure, S-78 posterior talar glide, S-155 hamstring strains Soccer coaches textured insoles, S-118 collegiate soccer players, S-182 anterior cruciate ligament injury prevention, Squat exercise, single leg S-179 surface angle, S-158 S-224 Volume 47 • Number 3 (Supplement) May 2012 Stability, dynamic Kinesiotape, S-140 T ankle instability, S-153 stretching Stairs high school athletes, S-47 Talus, posterior glide ascent tests ankle sprain, S-155 ankle osteoarthritis, S-184 dehydration, S-16 Taping descent rehydration, S-16 ankle instability, S-53 ankle osteoarthritis, S-184 Stress fractures ankle range of motion patellofemoral pain syndrome, S-68, S- olecranon functional performance, S-70 152 adolescent baseball player, S-87 fibular reposition, S-53 Standardized Assessment of Concussion patellar ankle instability, S-53 baseline values, S-14 collegiate football player, S-207 Kinesiotape female collegiate athletes, S-13 tibia lower leg loading, S-140 male collegiate athletes, S-14 male collegiate athlete, S-63 shoulder proprioception, S-140 Rasch calibration, S-15 track and field thrower, S-63 shoulder strength, S-140 patellar Standardized patients Stretches, sleeper Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 athletic training students' perceptions, S-119 evaluative measure, S-78 pain scores, S-72 Star Excursion Balance Test Stretching patellofemoral pain ankle, knee injury predictor flexibility endurance, S-67 collegiate football players, S-44 high school athletes, S-47 pain, S-67 female collegiate athletes, S-125 performance strength, S-67 performance variables, S-52 high school athletes, S-47 patellofemoral pain syndrome Stationary cycling blood lactate soreness balance, S-148 professional ice hockey players, S-163 high school athletes, S-47 neuromuscular response, S-148 Stepdowns, single leg strength pain, S-148 hip kinematics high school athletes, S-47 underwrap knee kinematics, S-159 Students, athletic training range of motion, S-71 Sternoclavicular joint dislocation clinical education, S-60 Tasks, drop jump professional rescue diver, S-196 foundational behaviors, S-59 muscle activation, S-150 Stiffness Studies, grounded theory Teaching glenohumeral joint athletic trainers' foundational behaviors, S-59 musculoskeletal anatomy instruction activity levels, S-27 Sudden death in sports athletic training students, S-119 health-related quality of life, S-27 coaches' perspective Temperature hamstrings secondary school football, S-25 intramuscular low back pain, S-110 Superimposed burst technique cryotherapy, S-89 hip muscles quadriceps activation ethyl chloride vapocoolant, S-92 anterior cruciate ligament injury, S-83 superimposed burst, S-54 Pain Ease, S-91 reactive joint Superior labrum lesions intramuscular cooling ankle instability, S-154 exercise protocol compliance, S-79 sex differences, S-134 shoulder Supplements ligament collegiate baseball players, S-97 osteoarthritis, S-186 cryotherapy, S-90 Stimulant medications Sweat rate muscle concussion assessment cramping, S-144 cryotherapy, S-90 attention deficit hyperactivity disorder, Symptoms, concussion quadriceps interface S-12 age, S-111 exercise, S-89 Stock car racing ImPACT, S-129 quadriceps intramuscular head and neck injury prevention, S-181 NeuroCom, S-129 exercise, S-89 injuries, S-181 sex, S-111 subcutaneous Strength Theory of Unpleasant Symptoms, S-128 ethyl chloride vapocoolant, S-92 baseball-specific program Syndromes Pain Ease, S-91 muscular endurance, S-160 chronic regional pain surface gluteal ankle sprain, S-189 counterirritants, S-92 jump landings, S-20 compartment ethyl chloride vapocoolant, S-92 hip collegiate rower, S-62 Pain Ease, S-91 gluteal muscle activity, S-20 Kawasaki tissue lower extremity kinematics, S-20 male high school lacrosse athlete, S-76 compression, S-162 medial knee displacement, S-150 patellofemoral pain cryotherapy, S-162 hip abductor hip kinematics, S-18 Tendon, posterior tibial female athletes, S-109 hip kinetics, S-18 dysfunction, S-203 neuromuscular training, S-109 knee kinematics, S-18 Tests hip ratios knee kinetics, S-18 Athletic Training Career Intent Survey collegiate soccer players, S-44 lower extremity kinematics, S-19 reliability, S-122 lower extremity injury, S-44 pain, S-67 validity, S-122 isokinetic risk factors, S-68 Balance Error Scoring System EFX, S-141 stair descent, S-68 baseline values, S-102 light therapy, S-93 strength, S-67 fatigue, S-104 patellofemoral pain syndrome, S-67 taping, S-67, S-72 high school athletes, S-102 taping, S-67 trunk kinematics, S-19 hyperthermia, S-104 quadriceps muscles Wolff-Parkinson-White hypohydration, S-104 anterior cruciate ligament reconstruction, female collegiate volleyball player, S-74 California Critical Thinking Disposition S-146 Inventory shoulder Board of Certification examination, S-174 Journal of Athletic Training S-225 concussion assessment stress fracture physical activity postconcussion attention-deficit hyperactivity disorder, male collegiate athlete, S-63 functional outcome measure, S-177 S-68 track and field thrower, S-63 refractometers stimulant medications, S-68 Tibiofibular joint, ganglion cyst hydration status, S-143 female collegiate athletes, S-13 youth soccer player, S-87 Vascular system Functional Movement Screen, S-42 Tightness, iliotibial band arteriovenous malformation female collegiate athletes, S-125 soft tissue mobilization, S-128 cross-country runner, S-64 Health Science Reasoning Time context Vector coding variability analysis Board of Certification examination, S-174 patient-reported outcomes, S-29 shank-rearfoot coupling ImPACT Topical vapocoolants ankle instability, S-51, S-119 alternate forms, S-11 ethyl chloride Visual distraction EFX, S-141 cold perception, S-92 postural stability, S-160 symptom responders, S-129 intramuscular temperature, S-92 Volleyball players injuries subcutaneous temperature, S-92 adolescent

Star Excursion Balance Test, S-44 surface temperature, S-92 reflex sympathetic dystrophy, S-86 Downloaded from http://meridian.allenpress.com/jat/article-pdf/47/3 Supplement/S-1/1454373/1062-6050-47_3_s1.pdf by guest on 25 September 2021 KOOS Pain Ease collegiate knee ligament injury, S-185 cold perception, S-91 chondrosarcoma, S-208 male youth lacrosse players, S-42 intramuscular temperature, S-91 shoulder kinematics, S-124 Mental, Emotional and Bodily Toughness subcutaneous temperature, S-91 Wolff-Parkinson-White syndrome, S-74 Inventory surface temperature, S-91 female construct validity, S-165 Torque collegiate, S-74 NeuroCom hamstrings:quadriceps ratio Volumetry symptom responders, S-129 low back pain, S-109 modified, S-167 overhead squat Track and field athletes traditional, S-167 adolescent athletes, S-40 tibial stress fracture, S-63 kinematics, S-40 Training W lower extremity alignment, S-40 abdominal Walking Sport Concussion Assessment Tool-2, S-12 ankle instability, S-116 forefoot inversion Stability Evaluation core stability ankle instability, S-48 concussions, S-113 core muscular endurance, S-108 Warm-ups Standardized Assessment of Concussion, postural control, S-108 sprint time performance S-14 mental toughness collegiate power athletes, S-157 baseline values, S-14 illness, S-165 Wobble board rehabilitation Rasch calibration, S-15 injury, S-165 ankle instability, S-115 Star Excursion Balance neuromuscular WOMAC female collegiate athletes, S-125 anterior cruciate ligament injury, knee ligament injury, S-185 performance variables, S-52 S-117, S-156 Wrestlers, collegiate strength/power hip abductor strength, S-109 knee infection, S-62 dehydration, S-16 resistance Wrist rehydration, S-16 dehydration, S-16 capitate fracture WOMAC rehydration, S-16 collegiate female lacrosse player, S-199 knee ligament injury, S-185 Transforming growth factor beta scaphoid cyst Theory of Unpleasant Symptoms eccentric muscle injury, S-136 collegiate softball players, S-195 concussions, S-128 Traumatic injuries Therapeutic modalities orthopaedic Y cryotherapy pediatric hospital, S-99 Youth athletes application duration, S-90 Triathletes, elite female delayed-onset muscle soreness, S-163 performance, S-26 anterior knee pain, S-34 effectiveness, S-90 Triathletes., elite football exercise, S-89 hydration, S-26 osteochondritis dissecans, S-85 Hoffmann reflex, S-37 Trunk kinematics male lacrosse intramuscular temperature, S-89 patellofemoral pain syndrome, S-19 Functional Movement Screen, S-42 microvascular perfusion, S-162 soccer quadriceps central activation ratio, S-115 U common peroneal nerve palsy, S-87 massage, S-46 Underwrap landing biomechanics, S-83 Pain Ease range of motion, S-71 tibiofibular ganglion cyst, S-87 cold perception, S-91 Upper extremity intramuscular temperature, S-91 joint position sense subcutaneous temperature, S-91 functional fatigue protocol, S-95 surface temperature, S-91 softball players, S-95 phonophoresis coupling media, S-93 V medications, S-93 Validity quadriceps activation, S-117 Athletic Training Career Intent Survey, soft tissue mobilization S-122 iliotibial band tightness, S-128 construct muscle damage, S-142 Mental, Emotional and Bodily Tibia Toughness Inventory, S-165 anterior shear force Heat Observation Technology System, biomechanical predictors, S-82 S-25

S-226 Volume 47 • Number 3 (Supplement) May 2012