National Athletic Trainers' Association position statement: Preparticipation physical examinations and disqualifying conditions.

OBJECTIVE: To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions. BACKGROUND: Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties. RECOMMENDATIONS: Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.

Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I institutions.

BACKGROUND: Sudden cardiac arrest is the leading cause of death in competitive athletes during sport, and screening strategies for the prevention of sudden cardiac death are debated. The purpose of this study was to assess the incorporation of routine non-invasive cardiovascular screening (NICS), such as ECG or echocardiography, in Division I collegiate preparticipation examinations. METHODS: Cross-sectional survey of current screening practices sent to the head athletic trainer of all National Collegiate Athletic Association (NCAA) Division I football programmes listed in the National Athletic Trainers' Association directory. RESULTS: Seventy-four of 116 (64%) programmes responded. Thirty-five of 74 (47%) of responding schools have incorporated routine NICS testing. ECG is the primary modality for NICS in 31 (42%) of schools, and 17 (49%) also utilise echocardiography. Sixty-four per cent of the programmes that do NICS routinely screen their athletes only once as incoming freshmen. Of institutions that do not conduct NICS, American Heart Association guidelines against routine NICS and cost were the most common reasons reported. CONCLUSIONS: While substantial debate exists regarding protocols for cardiovascular screening in athletes, nearly half of NCAA Division I football programmes in this study already incorporate NICS into their preparticipation screening programme. Additional research is needed to understand the impact of NICS in collegiate programmes.

Protective athletic equipment slows initiation of CPR in simulated cardiac arrest.

OBJECTIVE: Standard protective athletic equipment used in collision sports such as American football poses a unique challenge to rescuers because they block access to both the airway and chest. The main objective of this investigation was to determine the effect of athletic equipment on the initiation of CPR. The feasibility of performing compressions over the chest protector as a potential time-saving step was also evaluated. METHODS: Thirty-four certified athletic trainers performed CPR on a manikin wearing protective equipment during a simulated episode of cardiac arrest. For one trial the protective equipment was removed or unfastened prior to initiating CPR, and for another, chest compressions were initiated over the protective equipment. The following were recorded for comparison purposes: time until first breath and first compression; percentage of compressions delivered to the recommended depth; compression rate; accuracy of hand placement; percentage of compressions without full chest recoil. RESULTS: Although chest compressions began sooner when compressions were delivered over the chest protector, this improvement was not statistically significant. A more notable positive outcome resulting from keeping the chest protector on was an increase in the number of compressions that were delivered to the recommended depth. Unfortunately, one of the significant negative outcomes of performing chest compression over the chest pad was the increased percentage of compressions that did not obtain full chest recoil. CONCLUSIONS: Although removal of the chest protector delays the initiation of chest compressions, keeping the chest protector on during CPR does not appear to be a feasible option.

Diagnosis of an ulnar collateral ligament tear using musculoskeletal ultrasound in a collegiate baseball pitcher: a case report.

OBJECTIVE: To demonstrate a comparative diagnostic approach between magnetic resonance imaging (MRI) and musculoskeletal ultrasound for detecting UCL trauma of the elbow in a collegiate baseball pitcher. BACKGROUND: A 19 year-old male baseball pitcher with no previous history of an elbow injury presented with left medial elbow pain after experiencing a popping sensation during a bull pen throwing session. Patient initially demonstrated palpable tenderness directly over the UCL and a positive milking maneuver. Minimal swelling and no observable discoloration were noted upon examination. Diagnostic ultrasound was utilized to assess the elbow anatomical structures. The differential diagnosis included medial epicondylitis, flexor pronator muscle strain, ulnar collateral ligament tear TREATMENT: Initial treatment was conservative while preparing for a ligament reconstruction. Goals included pain control, restoration of range of motion, and reduction of inflammation. UNIQUENESS: Accurate diagnosis of UCL disruption was made using dynamic diagnostic musculoskeletal ultrasound despite a negative MRI. The ability to accurately identify the injury contributed to the timeliness of the appropriate surgical intervention and the facilitation of a timely and successful rehabilitation program. CONCLUSIONS: Dynamic musculoskeletal ultrasound may offer an effective option for diagnosing UCL tears of the elbow. Diagnostic musculoskeletal ultrasound is an affordable, accessible, and portable option that provides a clinician with real-time information and accurate observations in the hands of a skilled operator. Diagnostic musculoskeletal ultrasound may play an increased role as a diagnostic tool in the sports medicine community.

Introduction to rehabilitation.

Rehabilitation plays an integral role when it comes to managing sports injuries in a safe and timely manner. Doing so competently allows for a greater chance of quick recovery and ultimate success on and off the field. Understanding the goals of rehabilitation and how to enhance communication between all providers who are involved with athlete care is critical to the process. The purpose of this article is to thoroughly explain the steps and critical components of a rehabilitation process designed specifically for each athlete's needs.

Diagnostic ultrasound in sports medicine: current concepts and advances.

Diagnostic ultrasound is a valuable imaging tool that is slowly gaining in popularity among sports medicine clinicians. Commonly referred to as "musculoskeletal ultrasound," its valuable role in assisting with sports medicine diagnoses has been to date underused for a variety of reasons. Effective clinical usage for sports medicine diagnoses includes commonly seen conditions such as rotator cuff disease, ulnar collateral ligament of the elbow injury, and internal derangement of the knee, among many others. Limitation of clinical usage has been deterred by the cost of the unit, perception of time associated with assessment procedures, and the lack of formal training associated with diagnostic implementation. However, when properly used, musculoskeletal ultrasound can increase the accuracy of diagnosis and treatment, improve time to treatment intervention, and improve patient satisfaction. The purpose of this paper is to review the fundamentals of musculoskeletal ultrasound and present its specific diagnostic uses.

Communication: the key to the game.

Being a team physician requires a whole new set of communications skills, depending on the organization one is affiliated with. There may be a single expected procedure to follow, or multiple procedures may be required. Regardless, it is imperative for the team physician to understand that his or her role is vital to those who seek accurate and timely information, thus potentially requiring physicians to adapt their current methods for communicating. Learning how to communicate as a team physician in a timely and accurate manner, understanding the appropriate chain of command, and avoiding common pitfalls associated with improper and sometimes adverse forms of communication will pave the way for an excellent long-term working relationship.

Controlled warm-up intensity enhances hip range of motion.

Acute effects of active and passive warm-up, proprioceptive neuromuscular facilitation (PNF), and ratings of perceived exertion (RPE) were compared during hip-joint range of motion (ROM). Two active warm-up treatments included (a) achieving a respiratory exchange ratio (RER) of 1.00 and (b) achieving 60% of heart rate reserve (HRR). Hydrocollator pads (HP) served as the passive warm-up treatment. These treatments and a control were randomly assigned to increase hamstring muscle temperature of the dominant leg. Warm-up treatments were administered to 12 men (mean 25.3 years) with a minimum of 24 hours interspersed between each treatment. A timed PNF (slow-reversal-hold) technique was conducted after each warm-up treatment. Tukey tests (p < 0.05) showed ROM for RER (107.4 degrees) was greater than all other treatments. ROM for HRR (102.8 degrees) and HP (103.4 degrees) did not differ from each other but were greater than the control (98.8 degrees). Ratings of perceived exertion were lowest for RER (4.0) and highest for control (8.5). Ratings of perceived exertion for HRR (6.0) and HP (6.5) were similar. In conclusion, an active warm-up before PNF stretching appears to be the most effective treatment to increase hip ROM. Results of RPE reinforce that active warm-up reduces the resistance to stretch. In a field setting, it is estimated that a warm-up of 70% of HRR would duplicate the muscle readiness equivalent to an RER of 1.00 before PNF stretching.

A Model for Learning Over Time: The Big Picture.

OBJECTIVE: To present a method of describing the concept of "learning over time" with respect to its implementation into an athletic training education program curriculum. BACKGROUND: The formal process of learning over time has recently been introduced as a required way for athletic training educational competencies and clinical proficiencies to be delivered and mastered. Learning over time incorporates the documented cognitive, psychomotor, and affective skills associated with the acquisition, progression, and reflection of information. This method of academic preparation represents a move away from a quantitative-based learning module toward a proficiency-based mastery of learning. Little research or documentation can be found demonstrating either the specificity of this concept or suggestions for its application. DESCRIPTION: We present a model for learning over time that encompasses multiple indicators for assessment in a successive format. Based on a continuum approach, cognitive, psychomotor, and affective characteristics are assessed at different levels in classroom and clinical environments. Clinical proficiencies are a common set of entry-level skills that need to be integrated into the athletic training educational domains. Objective documentation is presented, including the skill breakdown of a task and a matrix to identify a timeline of competency and proficiency delivery. CLINICAL ADVANTAGES: The advantages of learning over time pertain to the integration of cognitive knowledge into clinical skill acquisition. Given the fact that learning over time has been implemented as a required concept for athletic training education programs, this model may serve to assist those program faculty who have not yet developed, or are in the process of developing, a method of administering this approach to learning.