The association between lower extremity strength ratios and the history of injury in collegiate athletes.

CONTEXT: Strength ratios are important because imbalances in opposing muscle groups can cause articular instability and subsequently increase the risk of musculoskeletal injury (MSKI). Therefore, the purpose of this study was to evaluate the association between lower extremity (LE) musculoskeletal isometric strength ratios and the history of LE MSKI. PARTICIPANTS: One hundred eighty-two NCAA Division 1 soccer, football, volleyball, and basketball athletes. INTERVENTIONS: All isometric strength assessments were measured bilaterally using a handheld dynamometer. Strength assessments included: ankle inversion/eversion, ankle dorsiflexion/plantarflexion, knee flexion/extension, hip abduction/adduction, and hip external/internal rotation. LE MSKI history was collected through self-report; a report of the LE MSKI sustained in the one year prior to testing were collected. RESULTS: The hip external/internal rotation ratio was statistically significant for side to side differences in the non-injured (NINJ) group (p = 0.001). The dominant leg of the NINJ group had a mean external/internal rotation ratio of 1.109 ± 0.221, and the non-dominant leg had a mean ratio of 1.177 ± 0.208. CONCLUSIONS: There were no statistically significant differences between the injured (INJ) and NINJ groups. This could indicate that injury history does not play a role in current strength ratios and could suggest that the athletes in the INJ group are performing successful rehabilitation for their injuries.

Atlantic Coast Conference Mandatory College Football Medical Observer. A Necessary Addition to the Preexisting Medical Team?

Background: Some NCAA conferences now require a press box-based Medical Observer for all football games to identify injuries missed by on-field providers. The objective of this study was to determine whether a Medical Observer identified injuries missed by the on-field medical personnel. Methods: This was a comparative observational study of injury identification methods which was done at nine NCAA football games. The athletes on a single institution's varsity football team participated. Eight games and one bowl game were studied. Observers were sports medicine Fellows (Orthopaedic, Primary Care). Injury logs were kept by the Medical Observer to document game day injuries. The athletic training staff collected injury reports in the days following games. These were compared with game day injury logs to identify any injuries that were not reported to the medical staff during competition. Results: A total of 41 game injuries were identified (4.56 injuries/ game). 29 injuries (29/41; 71%) were identified by both the sideline medical providers and the Observer, 12 (12/41; 29%) were identified by only the sideline medical providers and no injuries were identified by only the Observer. A total of 95 game-related injuries were evaluated in the training room on the day after each game. 27 injuries (27/95; 28%) had been identified during the game (9 [33%] by the sideline medical team and 18 [67%] by both the sideline medical team and the Observer). Fourteen game injuries were not severe enough to require care the following day. There were 68 (68/95; 72%) delayed self-reported injuries treated by the training room staff the next day. Conclusions: A press box-based Medical Observer did not identify any injuries missed by the on-field medical staff. This study did, however, identify a large number of unreported game-day injuries that were treated the following day.Level of Evidence: II.

Upper Extremity Musculoskeletal Characteristics and the Kerlan-Jobe Orthopaedic Clinic Questionnaire Score in Collegiate Baseball Athletes.

CONTEXT: Upper extremity (UE) musculoskeletal injuries are common in baseball athletes due to the increased demand placed on the UE. The link between risk factors for UE musculoskeletal injuries and baseball athletes' perceived UE function and pain, as measured by the Kerlan-Jobe Orthopaedic Clinic (KJOC) questionnaire, is unclear. OBJECTIVE: To (1) describe the musculoskeletal characteristics of the UE (posture, range of motion, flexibility, and isometric strength) in a population of baseball athletes and (2) determine the predictive capability of UE musculoskeletal characteristics for the KJOC score in these athletes. DESIGN: Cohort study. SETTING: Athletic training room. PATIENTS OR OTHER PARTICIPANTS: A total of 37 male National Collegiate Athletic Association Division I baseball athletes (age = 20.10 ± 1.27 years, height = 186.96 ± 7.64 cm, mass = 90.60 ± 10.69 kg). INTERVENTION(S): Athletes self-reported all shoulder musculoskeletal injuries and completed the KJOC questionnaire. Postural assessment consisted of forward head and shoulder posture. Flexibility tests characterized glenohumeral internal and external rotation, posterior shoulder tightness, and pectoralis minor length. Strength tests involved the lower and middle trapezius, rhomboid, glenohumeral internal and external rotation, pectoralis major, serratus anterior, supraspinatus, and upper trapezius. MAIN OUTCOME MEASURE(S): All 10 KJOC questions were summed for an overall score out of 100. Questions 1 through 5 were summed for a pain score; questions 6 through 10 were summed for a function score. All data were assessed for normality. A stepwise multiple regression model was fit to determine if the predictor variables assessed could predict the KJOC score. We set the α level a priori at .05. RESULTS: For the KJOC total score, a 1-year history of shoulder injury accounted for 7.80% of the variance in the KJOC total score (P = .07). For KJOC questions 1 through 5, a history of UE injury in the year before testing and posterior shoulder tightness accounted for 14.40% of the variance in the KJOC total score (P = .047). CONCLUSIONS: The link between a history of UE musculoskeletal injuries and the KJOC score highlights the need for continued focus on self-perceived pain and function after UE musculoskeletal injury.

Playing hurt: hand and wrist injuries and protected return to sport.

When treating hand and wrist injuries, there is often an opportunity to allow an athlete to return to play before complete healing of the injury and/or surgery. Protective devices can make this possible. The risks of returning to play in this manner depend on many factors including the injury itself, position played, hand dominance, etc. Communication between treating health care professional, athlete, trainer, and coaches is critical in this decision process. Protective options include taping, custom-made splints, commercially available braces, soft casts, and hard casts. Ability to use these devices during competition is governed by the rules of each individual sport and often dependent on final approval by referee or game official.

Spinal injuries in contact sports.

Contact and collision sports such as American football expose the athlete to a wide array of potential injuries. Knee injuries garner much of the attention, but spinal injuries are potentially catastrophic and all levels of medical coverage of football must be knowledgeable and prepared to attend to an athlete with a neck injury. Of the other possible spinal conditions, some resolve on their own, others might require conservative therapy, and still others might require surgical intervention. The spectrum of potential injury is wide, yet the medical team must practice and prepare to treat the possible catastrophic neck injury.