Infrared Thermography-A Novel Tool for Monitoring Fracture Healing: A Critically Appraised Topic With Evidence-Based Recommendations for Clinical Practice.

CLINICAL SCENARIO: Stress fractures are one of the most common injuries in athletes. Unfortunately, they are hard to diagnose, require multiple radiology exams and follow-up which leads to more exposure to radiation and an increase in cost. Stress fractures that are mismanaged can lead to serious complications and poorer outcomes for the athlete. During the rehabilitation process, it would be beneficial to be able to monitor the healing of fractures to know when it is safe to gradually allow a patient to a return to sport because the return to activity is not usually objective and based on pain level. CLINICAL QUESTION: Can infrared thermography (IRT) be a useful tool to measure the pathophysiological state of the fracture healing? The aim of this critically appraised topic is to analyze the current evidence of IRT for measuring the temperature change in fractures to provide recommendations for medical practitioners. SUMMARY OF KEY FINDINGS: For this critically appraised topic, we examined 3 articles that compared medical imaging and IRT over multiple time points during the follow-up. The 3 articles concluded that a 1 °C asymmetry in temperature followed by a return to normal (less than 0.3 °C) temperature during the healing process of fractures can be monitored using IRT. CLINICAL BOTTOM LINE: Once the patient has been diagnosed with a fracture, IRT can safely be used to monitor the evolution of a fracture. When the thermogram progresses from a hot thermogram to a cold thermogram, the healing is considered good enough to return to sport. STRENGTH OF RECOMMENDATION: Grade 2 evidence exists to support IRT being used by clinicians to monitor fracture healing. Due to the limited research and novelty of the technology, the current recommendations are for following the treatment of the fracture once the initial diagnosis is made.

Warming Up With a Dynamic Moment of Inertia Bat Can Increase Bat Swing Speed in Competitive Baseball Players.

INTRODUCTION: While most baseball players' warm-up with a weighted bat/donut, there is evidence to suggest the swing speed decreases after the warm-up even though the bat feels lighter. Warming up with a dynamic moment of inertia bat may not decrease the swing speed and therefore improve the performance of baseball players. The hypothesis is that a dynamic moment of inertia bat will negate the effect of the kinesthetic illusion observed with a weighted bat. OBJECTIVE: To measure the difference in bat swing speed between warming up with the dynamic moment of inertia bat compared with a weighted bat. METHODS: Thirty-nine competitive baseball players participated in the study. All players were randomly assigned a warm-up tool that could be either a dynamic moment of inertia bat or a weighted bat. After the players' warm-up, they swung their normal bat, and the bat swing speed was measured using a high-speed camera. We used motion analysis software to calculate the swing speed which measured the linear displacement during the last 15 frames before ball contact. The process was then repeated so that each player had the chance to try both warm-up bats. RESULTS: The post warm-up swing speeds using the dynamic moment of inertia bat were significantly faster compared with a weighted bat warm-up. There was a 0.56 (0.78) m/s (1.26 [1.74] mph) increase in swing speed when using the dynamic moment of inertia bat (P = .0001), which is an average increase of 2.10% compared with a weighted bat warm-up. CONCLUSIONS: Our findings suggest that using a dynamic moment of inertia bat before an at-bat can increase swing speed compared with a weighted warm-up. Future studies are needed to determine if using a dynamic moment of inertia bat as part of rehabilitation can facilitate returning to competition after injury by focusing on swing speed.

Psychological Interventions Can Reduce Injury Risk in Athletes: A Critically Appraised Topic.

Clinical Scenario: Injury prevention programs are becoming standard practice for reducing sports-related injuries, but most programs focus on musculoskeletal elements. Psychological factors can be strong predictors of sports-related injuries and there is recent evidence that suggests psychological interventions can be effective at reducing injury risk. It is unclear if injury prevention programs that focus on psychological factors are an important inclusion for athletic trainers/therapists. Athletes can be exposed to different psychological factors based on sport type including team or individual sports, which can increase their risk of injury. While psychological interventions can reduce injuries by addressing psychological symptoms, it is unclear if the interventions are effective for at-risk athletes in addition to athletes who are not suffering from any psychological factors. Currently, there are no guidelines or recommendations for athletic trainers/therapists to address psychological factors with the purpose of injury prevention. Clinical Question: Are psychological intervention programs effective in reducing sports-related injury risk and are they clinically relevant to athletic trainers/therapists for implementation in all settings? Summary of Findings: The authors searched the literature for studies investigating the use of psychological intervention programs to reduce sports-related injuries in an athletic population. The search returned 6 possible papers (2 systematic reviews without meta-analysis, 1 systematic review with a meta-analysis, 2 meta-analyses, and 1 randomized control trial not included in the systematic reviews). The authors narrowed our appraisal to one systematic review and one randomized controlled trial. The review contained all the studies from the previous review papers including 3 studies which performed screening procedures. The collection of evidence demonstrates positive effects associated with implementing psychological intervention techniques to reduce sports injury rates in all athletes; at-risk athletes, not at-risk athletes, and individual and team-sport athletes. Bottom Line: There is sufficient evidence supporting the use of a psychological-based intervention by athletic trainers/therapists to effectively reduce the number of injury occurrences in the athletic population. Direct comparisons of effectiveness between team and individual sports was not conducted in the research, but a substantial representation of both sport types existed. The current evidence includes a variety of athletic populations, at-risk and not at-risk, different sport types, and competition levels. Athletic trainers/therapists should consider the integration of psychological disciplines in current injury prevention practices to address the psychological concerns which put athletes at additional risk for injury. Strength of Recommendation: Grade B evidence exists to support the use of psychological intervention strategies in a well-developed injury prevention plan. Sports medicine practitioners can help athletes reduce stress, increase mindfulness, and be more aware of mental health practices which helps reduce injury risk.

The Influence of Chronic Pain and Catastrophizing on Patient Outcomes in an Athletic Therapy Setting.

CONTEXT: Chronic pain is a challenge for Athletic Trainers and Athletic Therapists working in a clinical or university setting. The fear avoidance model, including catastrophizing, is well established in other health professions but is not established in Athletic Training and Athletic Therapy and may affect rehabilitation outcomes. OBJECTIVE: To measure the influence of catastrophizing on rehabilitation outcomes of patients being treated in an Athletic Therapy setting. DESIGN: Prospective single group pre-post design. SETTING: Student Athletic Therapy clinic. PATIENTS: A total of 92 patients were evaluated at initial assessment, and 49 were evaluated at follow-up. INTERVENTION: All participants completed self-reported function questionnaires to assess level of injury and then received individualized treatments for a variety of musculoskeletal injuries. All measures were completed at initial assessment and at follow-up approximately 6 weeks later. MAIN OUTCOME MEASURES: The authors measured function using a variety of patient self-reported functional questionnaires: the Disability of the Arm, Shoulder, and Hand; Lower Extremity Functional Scale; the Neck Disability Index; and the Oswestry Disability Index depending on injury site. Catastrophizing was measured using the Pain Catastrophizing Scale. RESULTS: Function significantly improved from the initial assessment to the follow-up (P > .001). Patients with acute pain experienced a significantly greater improvement in function between the initial assessment and follow-up compared with participants with chronic pain (P = .050). Those with high catastrophizing presented with lower levels of function at initial assessment (66.8%) and follow-up (72.1%) compared with those with low catastrophizing (80.8% and 87.0%, respectively). CONCLUSION: Similar to other studies in other professions, the function of patients with chronic pain does not improve as much compared with patients recovering from acute pain in an Athletic Therapy setting. It is important to measure patient-reported outcomes to evaluate patient rehabilitation progress. Rehabilitating patients with chronic pain is a challenge, and pain catastrophizing should be evaluated at the initial assessment since catastrophizing is associated with worse function.