Smartphone virtual reality to increase clinical balance assessment responsiveness.

OBJECTIVE: To determine if a low cost smartphone based, clinically applicable virtual reality (VR) modification to the standard Balance Error Scoring System (BESS) can challenge postural stability beyond the traditional BESS. DESIGN: Cross-sectional study. SETTING: University research laboratory. PARTICIPANTS: 28 adults (mean age 23.36 ±â€¯2.38 years, mean height 1.74 m ±â€¯0.13, mean weight 77.95 kg ±â€¯16.63). MAIN OUTCOME MEASURES: BESS postural control errors and center of pressure (CoP) velocity were recorded during the BESS test and a VR modified BESS (VR-BESS). The VR-BESS used a headset and phone to display a rollercoaster ride to induce a visual and vestibular challenge to postural stability. RESULTS: The VR-BESS significantly increased total errors (20.93 vs. 11.42, p < 0.05) and CoP velocity summed across all stances and surfaces (52.96 cm/s vs. 37.73 cm/s, p < 0.05) beyond the traditional BESS. CONCLUSION: The VR-BESS provides a standardized, and effective way to increase postural stability challenge in the clinical setting. The VR-BESS can use any smartphone technology to induce postural stability deficits that may otherwise normalize with traditional testing. Thus, providing a unique relatively inexpensive and simple to operate clinical assessment tool and∖or training stimulus.

The Epidemiology of Overuse Conditions in Youth Football and High School Football Players.

CONTEXT: High-intensity sport training at the youth level has led to increased concern for overuse conditions. Few researchers have examined overuse conditions in youth sports. OBJECTIVE: To examine the rates, risks, and distributions of overuse conditions between youth and high school football players. DESIGN: Descriptive epidemiologic study. SETTING: Youth and high school football teams. PATIENTS OR OTHER PARTICIPANTS: The Youth Football Safety Study (YFSS) investigated youth football athletes from age 5 to 14 years. The National Athletic Treatment, Injury and Outcomes Network (NATION) focused on high school football athletes 14 to 18 years old. The YFSS data consisted of 210 team-seasons, and the NATION data consisted of 138 team-seasons. MAIN OUTCOME MEASURE(S): Athletic trainers collected football injury and exposure data during the 2012 and 2013 seasons. Injury rates, risks, and distributions were calculated, with injury rate ratios, risk ratios, and injury proportion ratios with 95% confidence intervals (CIs) comparing youth and high school football players. RESULTS: The YFSS reported 1488 injuries, of which 53 (3.6%) were overuse conditions. The NATION reported 12 013 injuries, of which 339 (2.8%) were overuse conditions. The overuse condition rate did not differ between high school and youth football (3.93 versus 3.72/10 000 athlete-exposures; injury rate ratio = 1.06; 95% CI = 0.79, 1.41). However, the 1-season risk of overuse condition was higher in high school than in youth football players (2.66% versus 1.05%; risk ratio = 2.53; 95% CI = 1.84, 3.47). Compared with high school football players, youth football players had greater proportions of overuse conditions that were nontime loss (ie, <24 hours participation-restriction time; 83.0% versus 67.0%; injury proportion ratio = 1.24; 95% CI = 1.07, 1.43) and affecting the lower extremity (92.5% versus 62.5%; injury proportion ratio = 1.48; 95% CI = 1.32, 1.65). CONCLUSIONS: Overuse conditions may not present a primary concern in youth and high school football players. However, differences existed between the 2 levels of competition. Although additional research on the incidence of overuse conditions across all youth and high school sports is needed, these findings may highlight the need for programming that is specific to competition level.

Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries.

UNLABELLED: The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool. OBJECTIVE: To evaluate the measures of diagnostic accuracy of the OARs in the acute setting. METHODS: The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. RESULTS: The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18). CONCLUSION: When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the AT's decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

Epidemiology of Hip Injuries in the National Basketball Association: A 24-Year Overview.

BACKGROUND: Professional athletes are subject to various injuries that are often dictated by the nature of their sport. Professional basketball players previously have been shown to sustain injuries throughout the musculoskeletal system, most commonly to the ankle and knee. PURPOSE: The purpose of this study was to report the epidemiology of injuries specific to the pelvis, hip, and thigh and their effect on games missed in professional basketball players. STUDY DESIGN: Descriptive epidemiological. METHODS: Records were recalled from the National Basketball Association epidemiological database for athletic-related pelvis, hip, or thigh injuries that occurred from the 1988-1989 through the 2011-2012 seasons. The primary information collected included anatomic location where the injury occurred, when in the course of the season injury occurred, specific pathology, date, activity at the time of injury, injury mechanism, number of practices and games missed, and whether surgery was required. The number of practices and games missed were summed to yield the number of days missed per episode. RESULTS: There were 2852 cases (14.6% of all athletic-related injuries) involving 967 individual players. In 1746 (61.2%) cases, injuries occurred during game competition. Across the course of this study, clinical incidence of injury to the pelvis, hip, or thigh was 1.50 per 100 players. The mean (±standard deviation) number of days missed per case was 6.3 ± 10.2. The quadriceps group was the most commonly injured structure (contusions and strains) and had a significantly higher game-related injury rate than other structures (0.96 per 100 athletic exposures, 95% confidence interval [CI] = 0.87-1.04). Players had the greatest risk (relative risk = 1.38, 95% CI = 1.26-1.52) of sustaining a strain than any other type of injury, with a game-related injury rate of 1.79 (95% CI = 1.67-1.90). The hamstring muscle group was the most frequently strained. Strains were more likely to occur in the preseason. CONCLUSION: Pelvis, hip, and thigh injuries in professional basketball players are commonly extra-articular strains and contusions and represent a significant burden of injury. The actual amount of intra-articular hip disorders may be underestimated, as the awareness of these disorders has increased only in the past decade. With the awareness of the types of injuries that occur in this region, focused injury prevention strategies may be beneficial to players and teams at all levels of competition, not only professional athletes.

Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.

BACKGROUND: The current incidence and outcomes of meniscal injury have not been quantified in professional athletes. PURPOSE: To describe the incidence, risk, amount of time lost, and effect on performance for isolated meniscal injury in athletes from the National Basketball Association (NBA). Demographic factors predicting the risk of meniscal tears and the effect of injury in return to play were also investigated. STUDY DESIGN: Descriptive epidemiology study. METHODS: A centralized database was queried to identify meniscal injuries occurring in the NBA over 21 seasons. The frequency of injury, time lost, game exposures, and incidence, rate, and risk were calculated. The preinjury and postinjury player efficiency rating (PER) was used to identify changes in player performance. RESULTS: We identified 129 isolated meniscal tears in NBA athletes during a 21-season span. From this number, 77 (59.7%) involved the lateral meniscus and 52 (40.3%) the medial meniscus. Injuries occurred more frequently in games. The lateral meniscus had a statistically significant higher injury rate. Both left and right knees were equally affected. The number of days missed for lateral meniscal tears and medial meniscal tears was 43.8 ± 35.7 days and 40.9 ± 29.7 days, respectively, and was not statistically different. There was a significant inverse relationship between age and rate of lateral meniscal tears, with lateral meniscal tears more likely to occur up to age 30 years; beyond that medial meniscal tears were more common. Players with a body mass index (BMI) greater than 25 had a significantly increased risk of meniscal tears compared with players with a BMI less than 25, specifically with an increased risk of lateral meniscal tears. Twenty-five players (19.4%) did not return to play. For those who did, upon returning to competition, there was no statistical change in PER from their preinjury status, and the mean number of seasons completed was 4.1 ± 3.7 seasons. CONCLUSION: The lateral meniscus is more frequently torn than the medial meniscus, but there was no difference in the amount of playing time lost. Both right and left knees were equally affected. There was an inverse relationship between age and the rate of lateral meniscal tears. Risk of tears was increased in players having a BMI greater than 25. Injury did not negatively affect playing performance.

Gastrointestinal temperature increases and hypohydration exists after collegiate men's ice hockey participation.

The cold environments in which ice hockey players participate are counterintuitive to the predisposing factors of heat- and hypohydration-related illnesses. This population has received little consideration in hypohydration-related illness risk assessments. Protective equipment, multiple clothing layers, and performance intensity may predispose these athletes to significant decreases in hydration and increases in core temperature. The purpose of this study was to measure hydration status and gastrointestinal temperature (T(GI)) in male ice hockey players during practice sessions that focused on pre-season skill development and cardiovascular conditioning. The study used a repeated measures design. Data were collected in a collegiate ice hockey rink (ambient temperature = 6.03 +/- 1.65 degrees C; relative humidity = 40.4 +/- 11.89%). Seventeen ice hockey players (age = 20.6 +/- 1.1, height = 180 +/- 5 cm, mass = 85.04 +/- 7.9 kg) volunteered for this study. Urine-specific gravity (USG) and body weight were measured before and after two 110-minute practice sessions. Urine reagent strips measured USG. Calibrated CorTemp (HQ, Inc., Palmetto, FL, USA) radiofrequency telemetered thermometers collected T(GI) before, during, and after two 110-minute practice sessions. Individual participant sweat rates were calculated. Data from both sessions were pooled. T(GI) (p < 0.0001), and USG (p < 0.0001) increased over the 110-minute session. Post-exercise body weight (83.9 +/- 7.6 kg) was statistically lower (p < 0.001) than the pre-exercise weight (85.0 +/- 7.9 kg). Sweat rates were calculated to be 0.83 +/- 0.50 L.h(-1). These male ice hockey players become hypohydrated during participation potentially predisposing them to dehydration-related illnesses. This change in hydration status resulted in a gastrointestinal temperature increase and significant weight loss during activity. Prevention and rehydration strategies such as those developed by the American College of Sports Medicine and National Athletic Trainers' Association should be implemented to reduce the possibility of heat-related illness for this population.

Prevalence of community-associated methicillin-resistant Staphylococcus aureus in high school wrestling environments.

Methicillin-resistant Staphylococcus Aureus (MRSA) was predominantly a hospital-acquired organism; recently, however, community-associated MRSA (CA-MRSA) has been causing outbreaks in otherwise healthy individuals involved in athletics. As such, CA-MRSA is of emerging concern to sanitarians and public health officials. Secondary school athletic trainers and student athletes may be at elevated risk of spreading or contracting MRSA. The absence of proper hygiene protocols or equipment may further increase this risk. In the study discussed in this article, environmental samples were obtained to identify the prevalence of MRSA on surfaces in high school athletic training and wrestling facilities mats in nine rural Ohio high schools. Frequencies and descriptive statistics were prepared. All nine (100%) of the sites tested had at least one positive sample for the presence of MRSA. The need for heightened sanitation, hygiene education of affected persons about skin and soft tissue infections like MRSA, and intervention opportunities for public health professionals are discussed.

Assessment of athletic health care facility surfaces for MRSA in the secondary school setting.

Methicillin-resistant Staphylococcus aureus (MRSA) was once largely a hospital-acquired infection, but increasingly, community-associated MRSA (CA-MRSA) is causing outbreaks among otherwise healthy people in athletic settings. Secondary school athletic trainers, student athletes, and the general student population may be at elevated risk of MRSA infection. To identify the prevalence of MRSA on surfaces in high school athletic training settings, 10 rural high school athletic training facilities and locker rooms were sampled for MRSA. Results showed 90% of facilities had two or more positive MRSA surfaces, while one school had no recoverable MRSA colonies. Of all surfaces tested (N=90), 46.7% produced a positive result. From this limited sample, it is evident that significant exposure opportunities to MRSA exist in athletic training clinics and adjacent facilities for both the patient and the clinician. Furthermore, the findings point to the need for community hygiene education about skin and soft tissue infections like MRSA.

Injury in the national basketball association: a 17-year overview.

BACKGROUND: Injury patterns in elite athletes over long periods continue to evolve. The goal of this study was to review of the injuries and medical conditions afflicting athletes competing in the National Basketball Association (NBA) over a 17-year period. DESIGN: Descriptive epidemiological study. METHODS: Injuries and player demographic information were reported by each team's athletic trainer. Criteria for reportable injuries were those that resulted in (1) physician referral, (2) a practice or game being missed, or (3) emergency care. The demographics, frequency of injury, time lost, and game exposures were tabulated, and game-related injury rates and 95% confidence intervals were calculated. RESULTS: A total of 1094 players appeared in the database 3843 times (3.3 ± 2.6 seasons). Lateral ankle sprains were the most frequent orthopaedic injury (n, 1658; 13.2%), followed by patellofemoral inflammation (n, 1493; 11.9%), lumbar strains (n, 999; 7.9%), and hamstring strains (n, 413; 3.3%). The most games missed were related to patellofemoral inflammation (n, 10 370; 17.5%), lateral ankle sprains (n, 5223; 8.8%), knee sprains (n, 4369; 7.4%), and lumbar strains (n, 3933; 6.6%). No correlations were found between injury rate and player demographics, including age, height, weight, and NBA experience. CONCLUSION: Professional athletes in the NBA experience a high rate of game-related injuries. Patellofemoral inflammation is the most significant problem in terms of days lost in competition, whereas ankle sprains are the most common injury. True ligamentous injuries of the knee were surprisingly rare. Importantly, player demographics were not correlated with injury rates. Further investigation is necessary regarding the consequences and sport-specific treatment of various injuries in NBA players. CLINICAL RELEVANCE: Knowledge of these injury patterns can help to guide treatments and provide more accurate guidelines for an athlete to return to play.

Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association.

PURPOSE: The purpose of this study was to determine the rate of return to play and to quantify the effect on the basketball player's performance after surgical reconstruction of the anterior cruciate ligament (ACL). METHODS: Surgical injuries involving the ACL were queried for a 10-year period (1993-1994 season through 2004-2005 season) from the database maintained by the National Basketball Association (NBA). Standard statistical categories and player efficiency rating (PER), a measure that accounts for positive and negative playing statistics, were calculated to determine the impact of the injury on player performance relative to a matched comparison group. Over the study period, 31 NBA players had 32 ACL reconstructions. Two patients were excluded because of multiple ACL injuries, one was excluded because he never participated in league play, and another was the result of nonathletic activity. RESULTS: Of the 27 players in the study group, 6 (22%) did not return to NBA competition. Of the 21 players (78%) who did return to play, 4 (15%) had an increase in the preinjury PER, 5 (19%) remained within 1 point of the preinjury PER, and the PER decreased by more than 1 point after return to play in 12 (44%). Although decreases occurred in most of the statistical categories for players returning from ACL surgery, the number of games played, field goal percentage, and number of turnovers per game were the only categories with a statistically significant decrease. Players in the comparison group had a statistically significant increase in the PER over their careers, whereas the study group had a marked, though not statistically significant, increase in the PER in the season after reconstruction. CONCLUSIONS: After ACL reconstruction in 27 basketball players, 22% did not return to a sanctioned NBA game. For those returning to play, performance decreased by more than 1 PER point in 44% of the patients, although the changes were not statistically significant relative to the comparison group. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Injury risk in professional basketball players: a comparison of Women's National Basketball Association and National Basketball Association athletes.

BACKGROUND: Gender-based differences in injury rates have been reported in scholastic and collegiate basketball. The purpose of this study was to retrospectively compare injury rates in women's and men's professional basketball. HYPOTHESIS: Female professional basketball players are injured at a higher rate than are men. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: Women's National Basketball Association and National Basketball Association injury data were retrospectively reviewed for 6 full seasons. The frequency of all injuries and the rate of game-related injuries were calculated. RESULTS: Complete player profiles were obtained on 702 National Basketball Association athletes and 443 Women's National Basketball Association athletes who competed in their respective leagues during the data collection period. Total game exposures totaled 70,420 (National Basketball Association) and 22,980 (Women's National Basketball Association). Women's National Basketball Association athletes had a higher overall game-related injury rate (24.9 per 1000 athlete exposures; 95% confidence interval, 22.9-26.9; P < .05) when compared with National Basketball Association athletes (19.3 per 1000 athlete exposures; 95% confidence interval, 18.3-20.4) and sustained a higher rate of lower extremity injuries (14.6 per 1000 athlete exposures; 95% confidence interval, 13.1-16.2; P < .05) than seen in the National Basketball Association (11.6 per 1000 athlete exposures; 95% confidence interval, 10.8-12.4). The lower extremity was the most commonly injured body area (65%), and lateral ankle sprain (13.7%) was the most common diagnosis in both leagues. The incidence of game-related knee injury was higher in Women's National Basketball Association players. The incidence of anterior cruciate ligament injury in the National Basketball Association (n = 22, 0.8%) and Women's National Basketball Association (n = 14, 0.9%) accounted for 0.8% of the 4446 injuries reported. CONCLUSION: The lower extremity is the most frequently injured body area in both leagues, and Women's National Basketball Association athletes are more susceptible than are National Basketball Association athletes. There were, however, few statistical differences in the actual injuries occurring between the 2 leagues.

Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-year prospective study.

BACKGROUND: The value of femoral notch size and the notch width index in predicting anterior cruciate ligament injury has been debated. This study examined the relationship between the notch width index and anterior cruciate ligament injury in professional basketball players. HYPOTHESIS: No significant difference exists between the notch width index of anterior cruciate ligament-injured and noninjured professional basketball players. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Using a notch view radiograph, the authors prospectively measured the femoral notch and the condylar widths and then calculated the notch width index of 615 male athletes who participated in the National Basketball Association's combine workouts between 1992 and 1999. Players who participated in at least 1 professional game were included. After an 11-year follow-up period, the National Basketball Association's leaguewide injury database was reviewed to identify injured players. The players were then categorized into anterior cruciate ligament-injured or noninjured groups. Notch width, condylar width, and notch width index were compared between the 2 groups. RESULTS: A total of 305 players were followed for a period of up to 11 years. Anterior cruciate ligament trauma was suffered by 14 (4.6%) of the subjects. The average notch width index was 0.235 +/- 0.031 for anterior cruciate ligament-injured players and 0.242 +/- 0.041 for noninjured players (t305=-0.623, P=.534). This difference was not significantly different. Two (3.9%) of the subjects with critical notch stenosis (notch width index 0.20) had noncontact anterior cruciate ligament injuries. CONCLUSIONS: The notch width index did not predict the rate of anterior cruciate ligament injury. A level of critical notch stenosis was not detected. Anterior cruciate ligament injury could not be predicted by the absolute measurement of the femoral inter-condylar notch. Use of a preparticipation notch view radiograph in male professional basketball players as a predictor of anterior cruciate ligament injury is not recommended.

Scholarly Productivity of Athletic Training Faculty Members.

OBJECTIVE: To compare the scholarly productivity index (SPI) among the levels of academic appointment, degree type, and percentage of academic appointment of athletic training faculty members. DESIGN AND SETTING: We used a 5 x 6 x 4 factorial design for this study. A survey instrument was used to determine the number of publications and the number of years in their current appointment. SUBJECTS: Subjects were faculty members in Commission on Accreditation of Allied Health Education Programs-accredited athletic training education programs. MEASUREMENTS: The SPI was calculated by dividing the total number of publications (peer-reviewed and non-peer-reviewed journal articles, peer-reviewed abstracts, books written or edited, book chapters, platform presentations, published book reviews, and external funding) by the number of years in the productivity period. RESULTS: The SPIs were different for the levels of academic rank. Full professors had a higher SPI than all other groups (Tukey honestly significant difference, P