Vertical leg stiffness following ankle taping and bracing.

This study sought to determine if prophylactic ankle taping and bracing influenced vertical leg stiffness during hopping. Twenty healthy and physically active participants completed testing under three ankle stabilizer conditions, ankle tape, semi-rigid ankle brace or control (no stabilizer) during three separate sessions. Immediately following stabilizer application, participants completed an exercise bout prior to completing the hopping. Vertical ground reaction forces were collected during the hopping and were used to calculate vertical leg stiffness. No significant changes in vertical leg stiffness were revealed. These results are likely attributable to the exercise bout causing sufficient loosening of the stabilizers, concurrent proximal joint compensations and/or the possibility that the effect of ankle stabilizers on shock absorption during hopping is more subtle than the effects revealed during drop landings.

Effects of mild head injury on postural stability as measured through clinical balance testing.

OBJECTIVE: Although force-platform measures of postural stability provide objective information concerning mild head injury (MHI) resolution, their application has remained limited due to the high costs and impracticality for sideline use. Therefore, we investigated the efficacy of a clinical balance testing procedure for the detection of acute postural stability disruptions after MHI. DESIGN AND SETTING: We used a posttest control group design with repeated measures. Postural stability was tested at 3 postinjury time intervals (days 1, 3, and 5) using 2 procedures in a sports medicine laboratory: 1) a clinical balance battery consisting of 3 stances (double leg, single leg, and tandem) on 2 surfaces (firm and foam), and 2) the Sensory Organization Test using a sophisticated force-platform system. SUBJECTS: Sixteen MHI and 16 matched control subjects participated in this study. MEASUREMENTS: We measured performance with the Balance Error Scoring System for each of the clinical balance tests and the NeuroCom Smart Balance Master for Sensory Organization Testing. RESULTS: We found significantly higher postural instability in the MHI subjects revealed through the clinical test battery, with the 3 stances on the foam surface eliciting significant differences through day 3 postinjury. Results of the Sensory Organization Test revealed significant group differences on day 1 postinjury. CONCLUSIONS: Our results revealed that the Balance Error Scoring System may be a useful clinical procedure to assist clinicians in making return-to-play decisions in athletes with MHI in the absence of force-platform equipment.

A comparison of sideline versus clinical cognitive test performance in collegiate athletes.

OBJECTIVE: To test whether performance on 5 cognitive tests administered in a controlled clinical environment differed compared with administration in an uncontrolled sideline environment. Additionally, we investigated the effect of testing environment order on the learning effect for each cognitive test. DESIGN AND SETTING: Athletes were assessed on 2 test occasions (8 +/- 2 days apart), once in a sports medicine research laboratory and once on a lacrosse practice field site. SUBJECTS: A total of 59 Division I collegiate student-athletes participated in this study. MEASUREMENTS: Normative data were collected on 5 cognitive tests (Stroop Test, Trail-Making Test part A, Trail-Making Test part B, Wechsler Digit-Span Forward Test, and Digit-Span Backward Test). RESULTS: An independent-samples t test for environment difference on test day 1 revealed no significant differences between tests performed in the controlled environment and those performed in the uncontrolled environment. A repeated- measures analysis of variance test revealed a significant learning effect for all 5 tests, as subjects tended to improve approximately 11 points on the Stroop Test, 3 seconds on the Trail-Making A Test, 7 seconds on the Trail-Making B Test, and 1 point each on the Wechsler Digit Span Forward and Backward Tests. A paired-samples t test using delta scores (first test minus second test), sorted by order of testing environment, revealed a significant difference for the Stroop Test, but not for the remaining cognitive tests. CONCLUSIONS: There appears to be no difference in cognitive testing performance completed in a controlled clinical environment versus that performed in an uncontrolled sideline environment. This finding suggests that clinicians can administer cognitive tests to athletes with mild head injuries in uncontrolled sideline environments and expect valid results. Thus, clinicians can more thoroughly evaluate mildly head-injured athletes during the most crucial period after injury so that a safe return-to-play decision can be based on quantifiable, objective data.

Comparison of 3 methods of external support for management of acute lateral ankle sprains.

OBJECTIVE: To examine the efficacy of 3 different types of injury support systems (standard elastic wrap with horseshoe, Aircast Sport Stirrup, and Omni Multiphase orthosis) used in treating acute inversion ankle sprains. SUBJECTS: We recruited 30 physically active college-aged subjects who had sustained a grade 1 + or 2 lateral ankle sprain within the previous 24 hours for the study. DESIGN AND SETTING: Subjects were randomly placed into one of 3 groups, the first treated with standard elastic wrap with horseshoe, the second with an Aircast Sport Stirrup, and the third with an Omni Multiphase orthosis. Subjects reported to the athletic training room on days 1, 2, 3, 5, and 7 postinjury. MEASUREMENTS: We assessed subjects for ankle volume, functional performance, and self-perception of symptoms during the 5 postinjury assessments. RESULTS: We found no significant differences among the 3 groups on measures of volume, level of function, and self-perception of symptoms. CONCLUSIONS: Our results suggest that none of these methods is superior to the others for reducing swelling, restoring function, or relieving symptoms during the acute management of lateral ankle sprains.

Syncope and atypical chest pain in an intercollegiate wrestler: a case report.

OBJECTIVE: To present the case of a 20-year-old collegiate wrestler who suffered from atypical chest pains and syncope after rigorous exercise, dehydration, and ingestion of a metabolic stimulant. BACKGROUND: As a result of pressure to obtain a lower body weight for competition, wrestlers often pursue practices to lose a substantial amount of weight in a short period of time. These practices include rigorous exercise, starvation, dehydration, laxatives, diuretics, and over-the-counter stimulants. Our case involves an athlete who ingested a metabolic stimulant containing ma huang (ephedrine) and suffered from syncope and atypical chest pains during a bout of rigorous exercise and dehydration to lose weight for competition. DIFFERENTIAL DIAGNOSIS: Hypertrophic cardiomyopathy, electrolyte imbalance, drug overdose, traumatic head injury, myocardial infarction, syncope. TREATMENT: The emergency medical services transported the athlete to the emergency room, and he was hospitalized for 2 days. After discharge, the team physician counseled the athlete in the dangers of metabolic stimulants and excessive weight-loss techniques. UNIQUENESS: This case is unique because it presents an athlete who ingested an over-the-counter stimulant to lose weight and suffered from syncope and atypical chest pains during a bout of rigorous exercise and dehydration. CONCLUSIONS: Athletic trainers must understand not only the dangers of excessive weight loss, but also the dangers of using unregulated ephedrine-containing stimulants to aid in weight loss.

Alternative approaches to the assessment of mild head injury in athletes.

OBJECTIVES: Athletic trainers and team physicians are often faced with decisions concerning the severity and timing of an athletes return to play following mild head injury (MHI). These decisions can be the most difficult ones facing clinicians because of the limited amount of quantitative information indicating injury severity. Several authors have published guidelines for return to play following MHI, however these guidelines are based on limited scientific data. The purpose of this paper was to examine the effects of MHI on two objective measures, postural stability and cognitive function, to determine their usefulness in MHI assessment. The data gathered from these two measures has the potential to establish recovery curves based on objective data. METHODS: Eleven Division I collegiate athletes who sustained a MHI and eleven matched control subjects were assessed for postural stability and cognitive function at four intervals following injury. Postural stability was assessed using the Sensory Organization Test on the NeuroCom Smart Balance Master. Cognitive functioning was measured through the use of four neuropsychological tests: Stroop Test, Trail Making Test, Digits Span and Hopkins Verbal Learning Test. Separate mixed model repeated measures ANOVAs were calculated for the composite score and three ratio (vestibular, visual and somato-sensory) scores from the Sensory Organization Test and the scores from the neuropsychological test to reveal significant differences between groups and across days postinjury. RESULTS: A significant group by day interaction for overall postural stability (composite score) revealed that MHI athletes displayed increased postural instability for the first few days following MHI (p < .05). Analysis of the ratio scores revealed a significant interaction for the visual ratio. No significant group differences were revealed for any of the neuropsychological tests (p > .05), however significant day differences were revealed (p < .05). CONCLUSIONS: The results from this study indicate that athletes demonstrate decreased stability until 3 days postinjury. It appears this deficit is related to a sensory interaction problem, whereby the injured athlete fails to use their visual system effectively. These findings suggest that measures of postural stability may provide clinicians with a useful clinical tool for determining when an athlete may safely return to competition, although these findings need to be confirmed in larger groups of athletes.