Infrared Thermography-A Novel Tool for Monitoring Fracture Healing: A Critically Appraised Topic With Evidence-Based Recommendations for Clinical Practice.

CLINICAL SCENARIO: Stress fractures are one of the most common injuries in athletes. Unfortunately, they are hard to diagnose, require multiple radiology exams and follow-up which leads to more exposure to radiation and an increase in cost. Stress fractures that are mismanaged can lead to serious complications and poorer outcomes for the athlete. During the rehabilitation process, it would be beneficial to be able to monitor the healing of fractures to know when it is safe to gradually allow a patient to a return to sport because the return to activity is not usually objective and based on pain level. CLINICAL QUESTION: Can infrared thermography (IRT) be a useful tool to measure the pathophysiological state of the fracture healing? The aim of this critically appraised topic is to analyze the current evidence of IRT for measuring the temperature change in fractures to provide recommendations for medical practitioners. SUMMARY OF KEY FINDINGS: For this critically appraised topic, we examined 3 articles that compared medical imaging and IRT over multiple time points during the follow-up. The 3 articles concluded that a 1 °C asymmetry in temperature followed by a return to normal (less than 0.3 °C) temperature during the healing process of fractures can be monitored using IRT. CLINICAL BOTTOM LINE: Once the patient has been diagnosed with a fracture, IRT can safely be used to monitor the evolution of a fracture. When the thermogram progresses from a hot thermogram to a cold thermogram, the healing is considered good enough to return to sport. STRENGTH OF RECOMMENDATION: Grade 2 evidence exists to support IRT being used by clinicians to monitor fracture healing. Due to the limited research and novelty of the technology, the current recommendations are for following the treatment of the fracture once the initial diagnosis is made.

Warming Up With a Dynamic Moment of Inertia Bat Can Increase Bat Swing Speed in Competitive Baseball Players.

INTRODUCTION: While most baseball players' warm-up with a weighted bat/donut, there is evidence to suggest the swing speed decreases after the warm-up even though the bat feels lighter. Warming up with a dynamic moment of inertia bat may not decrease the swing speed and therefore improve the performance of baseball players. The hypothesis is that a dynamic moment of inertia bat will negate the effect of the kinesthetic illusion observed with a weighted bat. OBJECTIVE: To measure the difference in bat swing speed between warming up with the dynamic moment of inertia bat compared with a weighted bat. METHODS: Thirty-nine competitive baseball players participated in the study. All players were randomly assigned a warm-up tool that could be either a dynamic moment of inertia bat or a weighted bat. After the players' warm-up, they swung their normal bat, and the bat swing speed was measured using a high-speed camera. We used motion analysis software to calculate the swing speed which measured the linear displacement during the last 15 frames before ball contact. The process was then repeated so that each player had the chance to try both warm-up bats. RESULTS: The post warm-up swing speeds using the dynamic moment of inertia bat were significantly faster compared with a weighted bat warm-up. There was a 0.56 (0.78) m/s (1.26 [1.74] mph) increase in swing speed when using the dynamic moment of inertia bat (P = .0001), which is an average increase of 2.10% compared with a weighted bat warm-up. CONCLUSIONS: Our findings suggest that using a dynamic moment of inertia bat before an at-bat can increase swing speed compared with a weighted warm-up. Future studies are needed to determine if using a dynamic moment of inertia bat as part of rehabilitation can facilitate returning to competition after injury by focusing on swing speed.

Athlete Fear Avoidance, Depression, and Anxiety Are Associated with Acute Concussion Symptoms in Athletes.

Background: Assessing sport-related concussions in athletes presents challenges due to symptom variability. This study aimed to explore the relationship between acute concussion symptoms and athlete fear avoidance, pain catastrophizing, depression, and anxiety. Anxiety and depression have previously been associated with the number of symptoms after a concussion, but no prior research has examined the possible link between athlete fear avoidance and acute concussion symptoms. Methods: Thirty-four collegiate athletes (mean age = 20.9 ± 1.8 years) were assessed within 48 h of a concussion using the Sport Concussion Assessment Tool 5, Athlete Fear Avoidance Questionnaire (AFAQ), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. Results: Results showed a significant association between the athlete fear avoidance and the number of concussion symptoms (r = 0.493, p = 0.003), as well as depression and anxiety measured by HADS (r = 0.686, p < 0.001). Athlete fear avoidance and HADS scores were predictors of symptom severity, explaining 41% of the variance (p = 0.001). Athletes with higher fear avoidance tended to report more symptoms post concussion. Conclusions: This study underscores the link between athlete fear avoidance, anxiety, depression, and the severity of concussion symptoms. Administering the AFAQ to assess athlete fear avoidance at the initial assessment of a concussion may be helpful in interpreting the symptoms of an acute concussion.

Longitudinal Validation of a Specific Measure of Fear Avoidance in Athletes: Predicting Time from Injury to Return to Sports Competition.

Purpose: We developed the Athlete Fear Avoidance Questionnaire (AFAQ) to measure fear avoidance in athletes. Previous fear avoidance scales were developed for the general population and have demonstrated significant predictive capabilities regarding rehabilitation. No research to date has examined the association between athlete fear avoidance as measured by the AFAQ and the rehabilitation time in athletes. Patients and Methods: Fifty-nine athletes who were injured during sport season participated in the study (40 males and 19 females). At injury onset, all participants completed self-report functional questionnaires. In addition, we measured multiple aspects of fear avoidance including athlete fear avoidance (AFAQ), kinesiophobia (TSK), and pain catastrophizing (PCS). Finally, we assessed pain severity and interference, as well as depression. Once the athletes were able to return to competition all participants answered the questionnaires again. Pearson correlations and a regression analysis were used to identify relationships between function, psychological variables, pain, and return to competition time. Results: The AFAQ yielded the strongest correlation with return to competition time (r=0.544, p<0.001). In addition, function at initial injury time and pain interference were also significantly correlated with return to competition time (r=0.442, p<0.001 and r=0.356, p=0.006 respectively). Athlete fear-avoidance combined with function at the time of injury explained 34% of the variance of return to competition time in the multivariate regression model (p<0.001). Conclusion: Athlete fear-avoidance as measured by the AFAQ is associated with rehabilitation time and returning to competition in injured athletes. Psychosocial factors including athlete fear avoidance may explain why some athletes take longer to rehabilitate than others and should be evaluated in athletes who are taking longer than anticipated to complete their rehabilitation. Reducing athlete fear avoidance may facilitate rehabilitation in future studies.