Descriptive Analysis of Forces Applied by Trained Clinicians During Two-Handed Instrument-Assisted Soft Tissue Mobilization

Instrument-assisted soft tissue mobilization (IASTM) is a common intervention among clinicians. Despite the popularity, little is known about the forces applied by the clinician with the instruments during treatment. The purpose of this investigation was to examine the forces applied by trained clinicians using IASTM instruments during a simulated treatment. Eleven IASTM trained (Graston Technique, Técnica Gavilán, or RockBlades) clinicians (Physical Therapist = 2, Chiropractor = 2, Athletic Trainer = 7) participated in the study. Each clinician performed 75 two-handed strokes distributed evenly across five different IASTM instruments on a skin simulant attached to a force plate. IASTM stroke application was analyzed for peak normal forces (Fpeak) and mean normal forces (Fmean) by stroke. We observed an average Fpeak of 8.9N and Fmean of 6.0N across all clinicians and instruments. Clinicians and researchers may use the descriptive values as a reference for application of IASTM in practice and research.

Emergency Action Planning in School-Based Athletics: A Systematic Review

Introduction. A significant number of preventable catastrophic injuries occur in secondary school athletics. Compliance to Emergency Action Plan (EAP) recommendations is not well documented. The purpose of this systematic review was to identify compliance to EAP recommendations, access to an athletic trainer (AT) and automated external defibrillator (AED), and current legislative mandates in school-based athletics. Methods. Electronic databases were searched to identify articles that met criteria for inclusion. Studies in English that focused on adoption, implementation, or compliance with EAPs or other national guidelines pertaining to athlete health were eligible for inclusion. Quality and validity were examined in each article and data were grouped based on outcome measures. Results. Of 12,906 studies, 21 met the criteria for inclusion and full text review. Nine studies demonstrated EAP adoption rates ranging from 55% - 100%. Five studies found that EAPs were rehearsed and reviewed annually in 18.2% - 91.6% of schools that have an EAP. At total of 9.9% of schools were compliant with all 12 National Athletic Trainers Association (NATA) EAP guidelines. A total of 2.5% - 27.5% of schools followed NATA exertional heat illness guidelines and 50% - 81% of schools had access to an Athletic Trainer. In addition, 61% - 94.4% of schools had an AED available at their athletic venues. Four of 51 state high school athletic association member schools were required to meet best practice standards for EAP implementation, 7 of 51 for AED access, 8 of 51 for heat acclimation, and 3 of 51 for concussion management. Conclusions. There was a wide range of EAP adoption and a low rate of compliance to EAP guidelines in U.S. schools. Barriers to EAP adoption and compliance were not well documented and additional research should aim to identify impeding and facilitating factors.

Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA

ObjectiveMinority student-athletes have a lower survival rate from sudden cardiac arrest (SCA) than non-minority student-athletes. This study examined the relationship between high school indicators of socioeconomic status (SES) and survival in student-athletes with exercise-related SCA.MethodsHigh school student-athletes in the USA with exercise-related SCA on school campuses were prospectively identified from 1 July 2014 to 30 June 2018 by the National Center for Catastrophic Sports Injury Research. High school indicators of SES included the following: median household and family income, proportion of students on free/reduced lunch and percent minority students. Resuscitation details included witnessed arrest, presence of an athletic trainer, bystander cardiopulmonary resuscitation and use of an on-site automated external defibrillator (AED). The primary outcome was survival to hospital discharge. Differences in survival were analysed using risk ratios (RR) and univariate general log-binomial regression models.ResultsOf 111 cases identified (mean age 15.8 years, 88% male, 49% white non-Hispanic), 75 (68%) survived. Minority student-athletes had a lower survival rate compared with white non-Hispanic student-athletes (51.1% vs 75.9%; RR 0.67, 95% CI 0.49 to 0.92). A non-significant monotonic increase in survival was observed with increasing median household or family income and with decreasing percent minority students or proportion on free/reduced lunch. The survival rate was 83% if an athletic trainer was on-site at the time of SCA and 85% if an on-site AED was used.ConclusionsMinority student-athletes with exercise-related SCA on high school campuses have lower survival rates than white non-Hispanic athletes, but this difference is not fully explained by SES markers of the school.

Healthcare Navigation of Black and White Adolescents Following Sport-Related Concussion: A Path Towards Achieving Health Equity

Context: Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. These differences may not only stem from health inequities but can further perpetuate disparities in care for SRCs. Objective: To determine whether racial differences exist in the care pathway from injury to SRC clinic within adolescent athletes. Design: Retrospective cohort Setting: Regional SRC center Participants: Of 582 total athletes, 486 (83.5%) White and 96 (16.5%) Black adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic. Main Outcome Measures: Race was the defined exposure, dichotomized as Black or White. The four primary outcomes included: 1)location of first health system contact, 2)time from injury to first health system contact 3) time to in-person SRC clinic visit, and 4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or lost to follow-up. Results: Black and White athletes mostly presented directly to SRC clinic (61.5% vs 62.3%) at a median[interquartile range] of 3[1,5] vs 4[1,8] days respectively (p=0.821). Similar proportions of Black and White athletes also first presented to the ED (30.2% vs 27.2%) at a median of 0[0,1] vs 0[0,1] days (p=0.941). Black athletes more frequently had care transferred to their athletic trainer (39.6% vs 29.6%) and less frequently established care (56.3% vs 64.0%), however these differences were not statistically significant (p=0.138). Lost to follow-up was uncommon among Black and White athletes alike (4.2% vs 6.4%). Conclusions: This study demonstrated that within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed and/or ultimately presented to SRC clinic despite racial differences in school type and insurance coverage. SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.

Diagnosis, Management and Return to Sport of a 16-year-old Patient with a Chiari I Malformation: A Case Report and Literature Review.

This CASE report presents a 16-year-old female volleyball, basketball and track & field athlete who was diagnosed with a Chiari I Malformation following a concussion. Surgical decompression was recommended and performed 3 months following her initial diagnosis. This patient presented unique challenges due to her age, desire to return-to-sport, and the lack of access to medical care due to living in a rural area. There are few evidence-based best-practice recommendations for the management and return-to-sport of Chiari I Malformation patients, particularly for post-surgical Chiari I Malformation cases. This case study discusses the treatment and return-to-sport process for the patient, and also provides a comprehensive review of the published literature on patients attempting to return-to-sport following Chiari I Malformation diagnosis. Additionally, this case report suggests and explores the utilization of an athletic trainer to reconcile various barriers in management and return-to-sport evident in this case and the reviewed literature.

Evaluating Concussion Nondisclosure in College Athletes using a Health Disparities Framework and Appreciation for Social Determinants of Health

Context: There is limited research concerning the relationship between social determinants of health, including race, healthcare access, socioeconomic status (SES), and physical environment; and, concussion nondisclosure in college-athletes. However, in high school athletes, disparities have been noted, with Black athletes attending under-resourced schools and lacking access to an athletic trainer (AT) disclosing fewer concussions. Objective: To investigate whether concussion nondisclosure disparities exist by 1) race, 2) SES, and 3) AT healthcare access prior to college; and to understand the differential reasons for concussion nondisclosure between Black and White college-athletes. Design: Cross-sectional Setting: College athletics Participants: 735 college-athletes (84.6% White, 15.4% Black) Main Outcome Measures: Participants completed a questionnaire that directly assessed concussion nondisclosure, including reasons for not reporting a suspected concussion. With the premise of investigating social determinants of health, race was the primary exposure of interest. The outcome of interest, nondisclosure, was assessed with a binary (yes/no) question, “Have you ever sustained a concussion that you did not report to your coach, athletic trainer, parent, teammate, or anyone else?” Results: Overall, among White and Black athletes 15.6% and 17.7% respectively reported a history of concussion nondisclosure. No significant differences were found by race for distributions of history of concussion nondisclosure (p=0.57). Race was not associated with concussion nondisclosure when evaluated as an effect modification measure or confounder; and, no significant associations were noted by SES or high school AT access. Differences by race for reported reasons for nondisclosure were found for: “At the time I did not think it was a concussion” (p=0.045) and “I thought my teammates would think I am weak” (p=0.03) with Black athletes reporting these more frequently than White athletes. Conclusions: These data help to contextualize race and its intersection with other social determinants of health that could influence concussion nondisclosure outcomes in college-athletes.

Athletic therapist's management of persistent musculoskeletal pain: Time to embrace a biopsychosocial lens.

Chronic musculoskeletal pain continues to be a rising cost and burden on individuals and society on a global level, thus driving the demand for improved management strategies. Despite the fact that the biopsychosocial model has long been a recommended approach to help manage chronic pain with its' consideration of the person and their experiences, psychosocial context and societal considerations, the biomedical model continues to be the basis of athletic therapy/training education programs and therefore clinical practice. For over 30 years, psychosocial factors have been identified in the literature to be predictors of outcomes relating to chronic pain, including (but not limited to) catastrophizing, fear-avoidance, and self-efficacy. Physical assessment strategies including use of validated outcome measures can be used by the Athletic Therapist and Athletic Trainer to determine the presence and/or severity of non-biogenic pain. Knowledge of these predictors and strategies will allow the Athletic Therapist and Athletic Trainer to frame use of exercise (e.g. graded exposure), manual therapy and/or therapeutic modalities in the appropriate way to improve clinic outcomes. Through change in educational curricula content, such as that recommended by the International Association for the Study of Pain (IASP), Athletic Therapists and Athletic Trainers can develop profession-specific knowledge and skills that will enhance clinical practice to better assist those living with chronic musculoskeletal pain conditions.

Athletic Trainers' Use of Support Systems for Balancing Roles as an Athletic Trainer and Parent

Context: Work-life balance is a topic of interest in the athletic training profession. Particularly for parents, managing work and home roles can be challenging. Social support has been identified as resource to improve athletic trainers' balance and quality of life and warrants further investigation. Objective: The purpose of this study was to explore the sources and perceptions of social support among athletic trainers with children. Design: Qualitative study. Setting: Collegiate and secondary school settings. Participants: 32 athletic trainers working in the collegiate (12) and secondary school (20) settings participated in our study. All participants (19 female, 13 male) were parents and ranged from 25 to 72 years of age with 2–52 years of experience as an athletic trainer. Data Collection and Analysis: Participants were recruited from a larger cross-sectional survey. A semi-structured interview was developed by the research team and reviewed by a peer expert in the field. Participants completed the interview protocol which included questions from numerous areas related to work-life balance. Data analyses were guided by research questions related to social support and used a phenomenological approach. The researchers immersed themselves in the data and engaged in a coding process. Researcher triangulation and peer review were used to establish credibility. Results: Analyses revealed that our participants found social support in their work and home lives. Support was described by source (e.g., supervisors, coworkers, spouses, family, friends) and type (e.g., emotional, tangible, network). Participants perceived that support stemmed from understanding, flexibility, sharing responsibilities, and shared life experiences which aided in balancing their roles. Conclusions: Athletic trainers valued social support and utilized different types of support to help create work-life balance. Support in the workplace, at home, and from the profession is necessary for athletic trainers who are parents as it provides a means to help balance roles and responsibilities.

Structural constants of the internal logic of tennis

This article discusses the factors that determine the structure of the sport of tennis based on the theories of motor action. It outlines a framework of tennis by reviewing the major theoretical contributions published and by identifying the most unique and specific elements of the game that every coach or athletic trainer needs to know when teaching the tennis concepts or planning and optimizing its training.