US Army Reserve Officers' Training Corps Cadets' Knowledge of Exercise-related Musculoskeletal Injuries.

Musculoskeletal injuries, especially resulting from physical training, are a significant threat to military readiness. Due to costs related to treating injuries and the high probability of chronic, recurrent injuries, prevention should be a primary focus to maximize human performance and military success. However, in the US Army, many personnel are uninformed on injury prevention topics, and no research has identified injury prevention knowledge gaps in military leaders. This study examined the current knowledge of US Army ROTC cadets on injury prevention topics. This cross-sectional study was conducted at two university ROTC programs in the US. Cadets completed a questionnaire to identify participants' knowledge of injury risk factors and effective prevention strategies. Participants' perceptions of their leadership and their desires for future injury prevention education were also assessed. The survey was completed by 114 cadets. Except for dehydration and prior injury, participants had a greater than 10% incorrect response rate for questions regarding the impact of various factors on injury risk. Overall, participants displayed a positive view of their leadership's interest in injury prevention. The majority (74%) of participants reported a preference to receive injury prevention educational materials via electronic delivery. To develop implementation strategies and educational materials for injury prevention, identifying current injury prevention knowledge of military personnel should be a priority for researchers and military leaders. The initial military training of future officers is a critical time for further research and education efforts to improve the effectiveness and adoption of injury prevention strategies.

Collegiate Football Players' Ankle Range of Motion and Dynamic Balance in Braced and Self-Adherent-Taped Conditions.

CONTEXT: Ankle sprains are one of the most common injuries in the physically active population. Previous researchers have shown that supporting the ankle with taping or bracing is effective in preventing ankle sprains. However, no authors have compared the effects of self-adherent tape and lace-up ankle braces on ankle range of motion (ROM) and dynamic balance in collegiate football players. OBJECTIVE: To examine the effectiveness of self-adherent tape and lace-up ankle braces in reducing ankle ROM and improving dynamic balance before and after a typical collegiate football practice. DESIGN: Crossover study. SETTING: Collegiate athletic training room. PATIENTS OR OTHER PARTICIPANTS: Twenty-nine National Collegiate Athletic Association Division I football athletes (age = 19.2 ± 1.14 years, height = 187.52 ± 20.54 cm, mass = 106.44 ± 20.54 kg). INTERVENTION(S): Each participant wore each prophylactic ankle support during a single practice, self-adherent tape on 1 leg and lace-up ankle brace on the other. Range of motion and dynamic balance were assessed 3 times for each leg throughout the testing session (baseline, prepractice, postpractice). MAIN OUTCOME MEASURE(S): Ankle ROM for inversion, eversion, dorsiflexion, and plantar flexion were measured at baseline, immediately after donning the brace or tape, and immediately after a collegiate practice. The Y-Balance Test was used to assess dynamic balance at these same time points. RESULTS: Both interventions were effective in reducing ROM in all directions compared with baseline; however, dynamic balance did not differ between the tape and brace conditions. CONCLUSIONS: Both the self-adherent tape and lace-up ankle brace provided equal ROM restriction before and after exercise, with no change in dynamic balance.

Correlation of Shoulder and Elbow Kinetics With Ball Velocity in Collegiate Baseball Pitchers.

CONTEXT: Throwing a baseball is a dynamic and violent act that places large magnitudes of stress on the shoulder and elbow. Specific injuries at the elbow and glenohumeral joints have been linked to several kinetic variables throughout the throwing motion. However, very little research has directly examined the relationship between these kinetic variables and ball velocity. OBJECTIVE: To examine the correlation of peak ball velocity with elbow-valgus torque, shoulder external-rotation torque, and shoulder-distraction force in a group of collegiate baseball pitchers. DESIGN: Cross-sectional study. SETTING: Motion-analysis laboratory. PATIENTS OR OTHER PARTICIPANTS: Sixty-seven asymptomatic National Collegiate Athletic Association Division I baseball pitchers (age = 19.5 ± 1.2 years, height = 186.2 ± 5.7 cm, mass = 86.7 ± 7.0 kg; 48 right handed, 19 left handed). MAIN OUTCOME MEASURE(S): We measured peak ball velocity using a radar gun and shoulder and elbow kinetics of the throwing arm using 8 electronically synchronized, high-speed digital cameras. We placed 26 reflective markers on anatomical landmarks of each participant to track 3-dimensional coordinate data. The average data from the 3 highest-velocity fastballs thrown for strikes were used for data analysis. We calculated a Pearson correlation coefficient to determine the associations between ball velocity and peak elbow-valgus torque, shoulder-distraction force, and shoulder external-rotation torque (P < .05). RESULTS: A weak positive correlation was found between ball velocity and shoulder-distraction force (r = 0.257; 95% confidence interval [CI] = 0.02, 0.47; r(2) = 0.066; P = .018). However, no significant correlations were noted between ball velocity and elbow-valgus torque (r = 0.199; 95% CI = -0.043, 0.419; r(2) = 0.040; P = .053) or shoulder external-rotation torque (r = 0.097; 95% CI = -0.147, 0.329; r(2) = 0.009; P = .217). CONCLUSIONS: Although a weak positive correlation was present between ball velocity and shoulder-distraction force, no significant association was seen between ball velocity and elbow-valgus torque or shoulder external-rotation torque. Therefore, other factors, such as improper pitching mechanics, may contribute more to increases in joint kinetics than peak ball velocity.

Acute effects of instrument assisted soft tissue mobilization for improving posterior shoulder range of motion in collegiate baseball players.

BACKGROUND: Due to the repetitive rotational and distractive forces exerted onto the posterior shoulder during the deceleration phase of the overhead throwing motion, limited glenohumeral (GH) range of motion (ROM) is a common trait found among baseball players, making them prone to a wide variety of shoulder injuries. Although utilization of instrument-assisted soft tissue mobilization (IASTM), such as the Graston® Technique, has proven effective for various injuries and disorders, there is currently no empirical data regarding the effectiveness of this treatment on posterior shoulder tightness. PURPOSE: To determine the effectiveness of IASTM in improving acute passive GH horizontal adduction and internal rotation ROM in collegiate baseball players. METHODS: Thirty-five asymptomatic collegiate baseball players were randomly assigned to one of two groups. Seventeen participants received one application of IASTM to the posterior shoulder in between pretest and posttest measurements of passive GH horizontal adduction and internal rotation ROM. The remaining 18 participants did not receive a treatment intervention between tests, serving as the controls. Data were analyzed using separate 2× 2 mixed-model analysis of variance, with treatment group as the between-subjects variable and time as the within-subjects variable. RESULTS: A significant group-by-time interaction was present for GH horizontal adduction ROM with the IASTM group showing greater improvements in ROM (11.1°) compared to the control group (-0.12°) (p <0.001). A significant group-by-time interaction was also present for GH internal rotation ROM with the IASTM group having greater improvements (4.8°) compared to the control group (-0.14°) (p < 0.001). CONCLUSIONS: The results of this study indicate that an application of IASTM to the posterior shoulder provides acute improvements in both GH horizontal adduction ROM and internal rotation ROM among baseball players. LEVEL OF EVIDENCE: 2b.

Acute lower extremity running kinematics after a hamstring stretch.

CONTEXT: Limited passive hamstring flexibility might affect kinematics, performance, and injury risk during running. Preactivity static straight-leg raise stretching often is used to gain passive hamstring flexibility. OBJECTIVE: To investigate the acute effects of a single session of passive hamstring stretching on pelvic, hip, and knee kinematics during the swing phase of running. DESIGN: Randomized controlled clinical trial. SETTING: Biomechanics research laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty-four male (age = 21.2 ± 1.4 years) and female (age = 21.3 ± 2.0 years) recreational athletes. INTERVENTION(S): Participants performed treadmill running pretests and posttests at 70% of their age-predicted maximum heart rate. Pelvis, hip, and knee joint angles during the swing phase of 5 consecutive gait cycles were collected using a motion analysis system. Right and left hamstrings of the intervention group participants were passively stretched 3 times for 30 seconds in random order immediately after the pretest. Control group participants performed no stretching or movement between running sessions. MAIN OUTCOME MEASURE(S): Six 2-way analyses of variance to determine joint angle differences between groups at maximum hip flexion and maximum knee extension with an α level of .008. RESULTS: Flexibility increased between pretest and posttest in all participants (F(1,30) = 80.61, P < .001). Anterior pelvic tilt (F(1,30) = 0.73, P = .40), hip flexion (F(1,30) = 2.44, P = .13), and knee extension (F(1,30) = 0.06, P = .80) at maximum hip flexion were similar between groups throughout testing. Anterior pelvic tilt (F(1,30) = 0.69, P = .41), hip flexion (F(1,30) = 0.23, P = .64), and knee extension (F(1,30) = 3.38, P = .62) at maximum knee extension were similar between groups throughout testing. Men demonstrated greater anterior pelvic tilt than women at maximum knee extension (F(1,30) = 13.62, P = .001). CONCLUSIONS: A single session of 3 straight-leg raise hamstring stretches did not change pelvis, hip, or knee running kinematics.

Hip- and trunk-muscle activation patterns during perturbed gait.

CONTEXT: Selected muscles in the kinetic chain may help explain the body's ability to avert injury during unexpected perturbation. OBJECTIVE: To determine the activation of the ipsilateral rectus femoris (RF), gluteus maximus (MA), gluteus medius (ME), and contralateral external obliques (EO) during normal and perturbed gait. DESIGN: Single-factor, repeated measures. SETTING: University research laboratory. PARTICIPANTS: 32 physically active, college-age subjects. INTERVENTION: Subjects walked a total of 20 trials the length of a 6.1-m custom runway capable of releasing either side into 30° of unexpected inversion. During 5 trials, the platform released into inversion. MAIN OUTCOME MEASURES: Average, peak, and time to peak EMG were analyzed across the 4 muscles, and comparisons were made between the walking trials and perturbed trials. RESULTS: Significantly higher average and peak muscle activity were noted for the perturbed condition for RF, MA, and EO. Time to peak muscle activity was faster during the perturbed condition for the EO. CONCLUSION: Rapid contractions of selected postural muscles in the kinetic chain help explain the body's reaction to unexpected perturbation.

The immediate effects of muscle energy technique on posterior shoulder tightness: a randomized controlled trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To compare a muscle energy technique (MET) for the glenohumeral joint (GHJ) horizontal abductors and an MET for the GHJ external rotators to improve GHJ range of motion (ROM) in baseball players. BACKGROUND: Overhead athletes often exhibit loss of GHJ ROM in internal rotation, which has been associated with shoulder pathology. Current stretching protocols aimed at improving flexibility of the posterior shoulder have resulted in inconsistent outcomes. Although utilization of MET has been hypothesized to lengthen tissue, there are limited empirical data describing the effectiveness of such stretches for treating posterior shoulder tightness. METHODS: Sixty-one Division I baseball players were randomly assigned to 1 of 3 groups: MET for the GHJ horizontal abductors (n = 19), MET for the GHJ external rotators (n = 22), and control (n = 20). We measured preintervention and postintervention GHJ horizontal adduction and internal rotation ROM, and conducted analyses of covariance, followed by Tukey honestly significant difference post hoc analysis for significant group-by-time interactions (P<.05). RESULTS: The group treated with the MET for the horizontal abductors had a significantly greater increase in GHJ horizontal adduction ROM postintervention (mean ± SD, 6.8° ± 10.5°) compared to the control group (-1.1° ± 6.8°) (P = .011) and a greater increase in internal rotation ROM postintervention (4.2° ± 5.3°) compared to the group treated with the MET for the external rotators (0.2° ± 6.3°) (P = .020) and the control group (-0.2° ± 4.0°) (P = .029). No significant differences among groups were found for any other variables (P>.05). CONCLUSION: A single application of an MET for the GHJ horizontal abductors provides immediate improvements in both GHJ horizontal adduction and internal rotation ROM in asymptomatic collegiate baseball players. Application of MET for the horizontal abductors may be useful to gain ROM in overhead athletes. LEVEL OF EVIDENCE: Therapy, level 2b-.

The role of shoe design in ankle sprain rates among collegiate basketball players.

CONTEXT: Much of the recent focus in shoe design and engineering has been on improving athletic performance. Currently, this improvement has been in the form of "cushioned column systems," which are spring-like in design and located under the heel of the shoe in place of a conventional heel counter. Concerns have been raised about whether this design alteration has increased the incidence of ankle sprains. OBJECTIVE: To examine the incidence of lateral ankle sprains in collegiate basketball players with regard to shoe design. DESIGN: Prospective cohort study. SETTING: Certified athletic trainers at 1014 National Collegiate Athletic Association (NCAA)-affiliated schools sponsoring basketball during the 2005-2006 regular season were notified of an online questionnaire. Athletic trainers at 22 of the 1014 schools participated. PATIENTS OR OTHER PARTICIPANTS: A total of 230 basketball players (141 males, 89 females; age = 20.2 +/- 1.5 years) from NCAA Division I-III basketball programs sustained lateral ankle sprains. MAIN OUTCOME MEASURE(S): Ankle sprain information and type of shoe worn (cushioned column or noncushioned column) were collected via online survey. The incidence of lateral ankle sprains and type of shoes worn were compared using a chi-square analysis. RESULTS: No difference was noted in ankle sprain incidence between groups (chi(2) = 2.44, P = .20, relative risk = 1.47, 95% confidence interval [CI] = 0.32, 6.86). The incidence of ankle sprains was 1.33 per 1000 exposures in the cushioned column group (95% CI = 0.62, 3.51) and 1.96 per 1000 exposures in the noncushioned column group (95% CI = 0.51, 4.22). CONCLUSIONS: No increased incidence of ankle sprains was associated with shoe design.

Low-Level Laser Therapy Facilitates Superficial Wound Healing in Humans: A Triple-Blind, Sham-Controlled Study.

OBJECTIVE: Low-level laser therapy (LLLT) has been promoted for its beneficial effects on tissue healing and pain relief. However, according to the results of in vivo studies, the effectiveness of this modality varies. Our purpose was to assess the putative effects of LLLT on healing using an experimental wound model. DESIGN AND SETTING: We used a randomized, triple-blind, placebo-controlled design with 2 within-subjects factors (wound and time) and 1 between-subjects factor (group). Data were collected in the laboratory setting. SUBJECTS: Twenty-two healthy subjects (age = 21 +/- 1 years, height = 175.6 +/- 9.8 cm, mass = 76.2 +/- 14.2 kg). MEASUREMENTS: Two standardized 1.27-cm(2) abrasions were induced on the anterior forearm. After wound cleaning, standardized digital photos were recorded. Each subject then received LLLT (8 J/cm(2); treatment time = 2 minutes, 5 seconds; pulse rate = 700 Hz) to 1 of the 2 randomly chosen wounds from either a laser or a sham 46-diode cluster head. Subjects reported back to the laboratory on days 2 to 10 to be photographed and receive LLLT and on day 20 to be photographed. Data were analyzed for wound contraction (area), color changes (chromatic red), and luminance. RESULTS: A group x wound x time interaction was detected for area measurements. At days 6, 8, and 10, follow-up testing revealed that the laser group had smaller wounds than the sham group for both the treated and the untreated wounds (P < .05). No group x wound x time differences were detected for chromatic red or luminance. CONCLUSIONS: The LLLT resulted in enhanced healing as measured by wound contraction. The untreated wounds in subjects treated with LLLT contracted more than the wounds in the sham group, so LLLT may produce an indirect healing effect on surrounding tissues. These data indicate that LLLT is an effective modality to facilitate wound contraction of partial-thickness wounds.

National Athletic Trainers' Association Position Statement: Emergency Planning in Athletics.

OBJECTIVES: To educate athletic trainers and others about the need for emergency planning, to provide guidelines in the development of emergency plans, and to advocate documentation of emergency planning. BACKGROUND: Most injuries sustained during athletics or other physical activity are relatively minor. However, potentially limb-threatening or life-threatening emergencies in athletics and physical activity are unpredictable and occur without warning. Proper management of these injuries is critical and should be carried out by trained health services personnel to minimize risk to the injured participant. The organization or institution and its personnel can be placed at risk by the lack of an emergency plan, which may be the foundation of a legal claim. RECOMMENDATIONS: The National Athletic Trainers' Association recommends that each organization or institution that sponsors athletic activities or events develop and implement a written emergency plan. Emergency plans should be developed by organizational or institutional personnel in consultation with the local emergency medical services. Components of the emergency plan include identification of the personnel involved, specification of the equipment needed to respond to the emergency, and establishment of a communication system to summon emergency care. Additional components of the emergency plan are identification of the mode of emergency transport, specification of the venue or activity location, and incorporation of emergency service personnel into the development and implementation process. Emergency plans should be reviewed and rehearsed annually, with written documentation of any modifications. The plan should identify responsibility for documentation of actions taken during the emergency, evaluation of the emergency response, institutional personnel training, and equipment maintenance. Further, training of the involved personnel should include automatic external defibrillation, cardiopulmonary resuscitation, first aid, and prevention of disease transmission.