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PURPOSE: Prediction of athlete wellness is difficult-or, many sports-medicine practitioners and scientists would argue, impossible. Instead, one settles for correlational relationships of variables gathered at fixed moments in time. The issue may be an inherent mismatch between usual methods of data collection and analysis and the complex nature of the variables governing athlete wellness. Variables such as external load, stress, muscle soreness, and sleep quality may affect each other and wellness in a dynamic, nonlinear, way over time. In such an environment, traditional data-collection methods and statistics will fail to capture causal effects. If we are to move this area of sport science forward, a different approach is required. METHODS: We analyzed data from 2 different soccer teams that showed no significance between player load and wellness or among individual measures of wellness. Our analysis used methods of attractor reconstruction to examine possible causal relationships between GPS/accelerometer-measured external training load and wellness variables. RESULTS: Our analysis showed that player self-rated stress, a component of wellness, seems a fundamental driving variable. The influence of stress is so great that stress can predict other components of athlete wellness, and, in turn, self-rated stress can be predicted by observing a player's load data. CONCLUSION: We demonstrate the ability of nonlinear methods to identify interactions between and among variables to predict future athlete stress. These relationships are indicative of the causal relationships playing out in athlete wellness over the course of a soccer season.
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OBJECTIVE: The primary aim was to compare differences in live game pitch counts (LGPCs) with all pitch counts (APCs) over the course of a youth baseball season. DESIGN: Prospective longitudinal study. SETTING: Midwest youth travel baseball. PARTICIPANTS: Ten male baseball players part of a youth baseball travel team. VARIABLES: Demographic data, pitch counts (practice, game, warm-up, and bullpen), innings pitched, and recommended rest days. MAIN OUTCOME MEASURES: Live pitch counts compared with APCs and the relationship to recommended rest days. RESULTS: During the season, 7866 pitches were recorded among 9 pitchers. By using the LGPC method alone, 42.5% of the pitches were unaccounted for. When considering age-specific rest days suggested by Pitch Smart Guidelines (PSGs), there were 104 rest days unaccounted for by using the live game pitch method. CONCLUSION: There is a high number of unaccounted for pitches and an underestimation of rest days per outing when using live game methods. Revisions to the PSGs that include all pitches should be considered to accurately reflect pitching volume, which may be associated with the rising rate of injuries among these athletes.
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OBJECTIVE: The physical therapist labor market has recently noted higher rates of turnover and job vacancies. An understudied factor contributing to these trends in the profession is job satisfaction. The profession continues to experience relatively low wages compared with other health professions, and graduates of Doctor of Physical Therapy programs face increasingly high student debt. This study used the labor-search model as a conceptual framework to understand associations between job satisfaction, income, and educational debt. The purpose of this study is to observe the financial and workplace factors that are associated with higher levels of physical therapist job satisfaction. METHODS: Data from 4764 physical therapists in 1 state were captured retrospectively through the state's licensure renewal process from 2014 to 2020. A random effects panel analysis, with job satisfaction as the dependent variable, was used to evaluate the relationships between job satisfaction and income, educational debt, and a variety of work-related factors. RESULTS: Job satisfaction was negatively correlated with educational debt, number of hours worked per week, and some practice settings. Conversely, job satisfaction was positively correlated with the expected age of retirement. The percentage of time spent in research and administration was also positively correlated with job satisfaction, though additional research in this area is needed to draw meaningful conclusions on this association. CONCLUSION: The results support the conceptual framework, which suggests that early career physical therapists, motivated by high amounts of educational debt, may choose more financially advantageous practice settings and increased working hours to the detriment of job satisfaction. IMPACT: High levels of job satisfaction among physical therapists are correlated with low levels of educational debt, working 45 hours or less per week, a longer time horizon until retirement, and practice settings other than home health and skilled nursing facilities.
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Fisioterapeutas , Humanos , Satisfação no Emprego , Estudos Retrospectivos , Local de Trabalho , Renda , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Newly graduated physical therapists have high amounts of educational debt. Educational debt may negatively affect job satisfaction, aspirations for professional development, and choice of workplace setting. Research has not shown this association directly, yet it is conceptually supported by the Labor-Search Model. The purpose of this study was to understand the role that educational debt has on additional factors related to job choice in the Labor-Search Model. METHODS: Retrospective data were captured through the Virginia Longitudinal Data System (VLDS) for 12,594 licensed physical therapists within the Commonwealth of Virginia from 2014 to 2020. A fixed effects panel analysis, with inflation-adjusted educational debt as the variable of interest, was conducted to assess whether patterns of professional certifications, volume of work, workplace setting, and job satisfaction were related to educational debt. RESULTS: Educational debt was positively correlated with higher professional degrees (p = 0.009), the number of hours worked per week (p = 0.049), and expected number of years until retirement (p = 0.013). Job satisfaction was statistically significant (p = 0.042) and negatively correlated with educational debt. CONCLUSIONS: Those with higher educational debt appear to have the habit of working more hours per week and have a longer time horizon until retirement. Newly licensed physical therapists with higher amounts of educational debt are more likely to experience this trend. Income and job satisfaction demonstrated an interaction effect on educational debt, such that those with lower levels of income had a stronger, negative relationship between their debt and job satisfaction, as compared to those with higher income.
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Fisioterapeutas , Humanos , Estudos Retrospectivos , Emprego , Escolaridade , Renda , Satisfação no EmpregoRESUMO
Stress fractures likely have a 1-2% incidence in athletes in general. In runners, a more vulnerable population, incidence rates likely range between 3.2 and 21% with female runners having greater susceptibility. The incidence of femoral shaft stress fractures is less well known. New basic and translational science research may impact the way clinicians diagnose and treat femoral stress fractures. By using a fictitious case study, this paper applies bone science to suggest new approaches to evaluating and treating femoral shaft stress fractures in the running population.
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Fraturas do Fêmur , Fraturas de Estresse , Humanos , Feminino , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/terapia , Osso e Ossos , Fêmur , AtletasRESUMO
SYNOPSIS: Current injury-specific return-to-performance rehabilitation programs are not comprehensive, lack intensity, and need better tailoring to the demands of sport. The vast number of rehabilitation and return to sport protocols also reflects a lack of consensus about what the best program looks like, which hinders beginning practitioners from implementing best practices across the spectrum of injuries and sports. Backward design, which has underpinnings in educational research, can facilitate implementation by encouraging practitioners to begin with the end in mind before logically and intentionally working backwards to design transferable and context-specific rehabilitation plans that improve sports injury rehabilitation practices. We discuss and illustrate using case examples how clinicians can apply backward design in best practice sports injury rehabilitation. J Orthop Sports Phys Ther 2022;52(12):770-776. Epub: 7 October 2022. doi:10.2519/jospt.2022.11440.
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Traumatismos em Atletas , Esportes , Humanos , ConsensoRESUMO
Rehabilitation professionals prescribe exercise regularly with the goals of decreasing pain, increasing function, and returning athletes to competition. To maximize the effect of an exercise intervention, the program must be individualized and in context for the athlete considering biopsychosocial aspects of care. Current models of exercise prescription may not be ideal considering that less than 50% of injured athletes return to their pre-injury level. Advice on exercise prescription has been offered in the past, but the paradigms are either not user friendly or user friendly but linear, based on phases of recovery. As such, there is a need for a more flexible exercise prescription paradigm that should improve the individuality of exercise prescription. In this Current Opinion, we offer a user-friendly construct-oriented paradigm designed to facilitate the creation of individualized exercise programs for athletes.
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Traumatismos em Atletas , Terapia por Exercício , Traumatismos em Atletas/reabilitação , Humanos , Modelos Teóricos , PrescriçõesRESUMO
ABSTRACT: Devine, NF, Hegedus, EJ, Nguyen, A-D, Ford, KR, and Taylor, JB. External match load in women's collegiate lacrosse. J Strength Cond Res 36(2): 503-507, 2022-Quantifying external loads during athletic activities, particularly game-level competition, can provide objective data for the management of athlete performance, late-stage rehabilitation, and return-to-play decisions after lower extremity injury; yet, no studies have quantified these data in collegiate women's lacrosse athletes. The purpose of this study was to report external load values for collegiate women's lacrosse players and identify positional differences in activity demands during game competition. Load data were collected on 18 collegiate women's lacrosse players using a wearable global positioning system unit during a 19-game season. Descriptive statistics of distance, speed, and frequency (sprints, high-intensity sprints, high-intensity accelerations, high-intensity decelerations) measures were computed. Linear mixed models were used to identify differences between positions and phases of the season (α = 0.05). On average, players travelled 4,733 ± 2,294 m per game (range, 1,259-7,811 m), of which 656 ± 446 m (range 60-1,633 m) occurred at high-intensity speeds and reached a maximum speed of 24.1 ± 2.6 km·h-1 (range, 19.2-27.7 km·h-1). In each game, subjects averaged 124 ± 68 sprints, 6.1 ± 4.1 high-intensity sprints, 51 ± 34 high-intensity accelerations, and 38 ± 25 high-intensity decelerations. Positional differences were identified for total (p = 0.04) and relative (p = 0.01) distance travelled at high-intensity speeds, and frequency of sprints (p = 0.01) and high-intensity decelerations (p = 0.03). During game competition, collegiate women's lacrosse demands significant external load, much of which occurs at high intensities. These data provide sport- and position-specific values for reference during late-stage rehabilitation and return-to-play testing, allowing clinicians to quantitatively progress load tolerance throughout rehabilitation and guide safe return to play.
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Desempenho Atlético , Esportes com Raquete , Aceleração , Atletas , Feminino , Humanos , UniversidadesRESUMO
Running injuries are very common, and there are well-established protocols for clinicians to manage specific musculoskeletal conditions in runners. However, competitive and elite runners may experience different injuries than the average recreational runner, due to differences in training load, biomechanics, and running experience. Additionally, injury-specific rehabilitation protocols do not consider the broader goal of return to competitive running, including the unique psychosocial and cardiorespiratory fitness needs of elite athletes. This review aims to suggest a guideline for running-specific progression as part of a comprehensive rehabilitation program for injured competitive runners. Tools to evaluate an athlete's psychosocial preparedness to return to competition are presented. Recommendations are also provided for monitoring cardiorespiratory fitness of injured runners, including the nuances of interpreting these data. Finally, a six-phase training paradigm is proposed to guide clinicians as they help competitive runners transition from the early stages of injury through a full return to competition.
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Corrida , Atletas , Fenômenos Biomecânicos , Humanos , Corrida/lesõesRESUMO
OBJECTIVE: To analyze the effectiveness of shoulder injury prevention programs in overhead athletes. DESIGN: Systematic Review. METHODS: CINAHL, Embase, PubMed, and SPORTDiscus electronic databases were searched from database inception through December 2020 for randomized controlled or prospective cohort studies that implemented shoulder injury prevention programs in overhead athletes and reported shoulder injury incidence rates. RESULTS: Seven studies fulfilled the inclusion criteria. Two studies reported on odds ratios (OR) that resulted in a reduction of shoulder injuries in overhead athletes following shoulder strengthening and flexibility exercises (OR, 0.72; 95% CI; 0.52, 0.98; OR, 0.22; 95% CI; 0.06, 0.75). One study reported on hazard ratio (HR) that resulted in a reduction of shoulder injuries following stretching of the posterior capsule (HR, 0.36; 95% CI; 0.13, 0.95). CONCLUSION: There is limited research surrounding the effectiveness of shoulder injury prevention programs in overhead athletes specific to injury reduction. Only three studies reported a favorable effect in terms of injury prevention, with only one study at low risk of bias. At present, no conclusions can be made regarding the effectiveness of shoulder injury prevention programs in the overhead athlete.
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Traumatismos em Atletas , Lesões do Ombro , Esportes , Atletas , Traumatismos em Atletas/prevenção & controle , Humanos , Estudos Prospectivos , Ombro , Lesões do Ombro/prevenção & controleRESUMO
The sports medicine literature is filled with associations between injury and causal factors. However, those results have been inconsistent. We're left wondering which of our athletes might need more attention and where our efforts might be best spent. Resistance to injury is the result of interaction between many variables. These variables are interdependent with dynamic relationships which can be sometimes correlated, at times anti-correlated and from time to time show no relationship with injury risk. Relationships we may have seen yesterday do not necessarily hold true for today and we should not use those to infer what will happen. This perspective piece builds on prior works and describes how the complex interaction between injury determinants presents in other systems, why determinants are not stable and instead vary over time due to internal and external forcing and why our prediction ability remains limited even when determinants are identified. Patterns built from frequent time series data in conjunction with nonlinear dynamical methods can offer us a new approach to thinking about injury prediction.
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Traumatismos em Atletas/etiologia , Relesões/etiologia , Humanos , Controle Interno-Externo , Dinâmica não Linear , Fatores de RiscoRESUMO
Knee injuries such as ACL tears commonly occur and there is a high re-injury rate after primary ACL reconstruction with figures estimated at 25%-33%. Clinicians often use hip strengthening as a key component of knee rehabilitation. Evidence suggests that adopting a "regional" or "proximal" approach to rehabilitation can increase hip strength, but motor control often remains unchanged, particularly during more complex tasks such as running and jumping. It has been previously suggested that the current approach to "regional/proximal" rehabilitation is too basic and is constrained by a reductionist philosophy. This clinical commentary provides the clinician a framework for optimizing knee rehabilitation, underpinned by a more global approach. Although this approach remains hip-focused, it can be easily adapted to modify exercise complexity and key loading variables (speed, direction, flight), which will help the clinician to better replicate the sport specific demands on the knee. LEVEL OF EVIDENCE: 5.
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OBJECTIVE: The purpose of this study was to perform a systematic review and meta-analysis of the current literature surrounding risk factors associated with shoulder and elbow injuries among adolescent baseball pitchers. METHODS: Relevant studies were assessed for inclusion and retained from PubMed, EMBASE, SportDiscus, and CINAHL databases. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis. RESULTS: The search resulted in 1238 studies identified with 10 ultimately retained for systematic review. Five studies including one case-control, two prospective cohort, and two cross-sectional studies met inclusion criteria for meta-analysis. This meta-analysis revealed that playing with arm fatigue was a significant risk factor (pooled odds ratio = 13.32, 95% confidence interval: 3.22-55.09). The other three risk factors (long competitive season, pitching for more than one team or league, and playing catcher as a secondary position) were not statistically significant. CONCLUSION: Pitching with arm fatigue is a significant risk factor for shoulder and elbow injuries among adolescent baseball pitchers. Future efforts in assessment and mitigation of pitching with arm fatigue among this population may help to reduce the risk of arm injuries. Furthermore, investigations of additional risk factors in a more homogeneous population of adolescent pitchers may be warranted.
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Beisebol/lesões , Lesões no Cotovelo , Medição de Risco/métodos , Lesões do Ombro/etiologia , Adolescente , Estudos Transversais , Humanos , Estudos Prospectivos , Fatores de RiscoRESUMO
Shoulder instability has varying mechanisms of injury, direction, and severity. Classification systems based on clustering signs and symptoms have been developed to define subgroups of shoulder instability. Despite this attempt at homogeneity, multidirectional instability (MDI) suffers from the same lack of diagnostic clarity as low back pain. In this Viewpoint, the authors outline 3 key areas to address when diagnosing MDI: patient interview, medical comorbidities, and specific shoulder tests and measures. J Orthop Sports Phys Ther 2020;50(2):52-54. doi:10.2519/jospt.2020.0602.
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Transtornos Traumáticos Cumulativos/diagnóstico , Instabilidade Articular/diagnóstico , Lesões do Ombro , Voleibol/lesões , Adolescente , Transtornos Traumáticos Cumulativos/classificação , Transtornos Traumáticos Cumulativos/fisiopatologia , Feminino , Humanos , Instabilidade Articular/classificação , Instabilidade Articular/fisiopatologia , Anamnese , Exame Físico , Articulação do Ombro/fisiopatologiaRESUMO
The risk of knee injury in sport may be related to deviations in lower-limb alignment. An example of biomechanical deviation is dynamic knee valgus, considered by many to be one of the most important predictors of serious knee injury; however, the predictive validity of commonly used screening tests for dynamic knee valgus has recently been questioned. In this Viewpoint, the authors argue that assessing the risk of knee injury is complex and endeavor to present pelvic pronation and system tension as a 3-D construct to consider during physical assessments and exercise design, and to recognize dynamic knee valgus as a normal and necessary response to ground reaction forces. J Orthop Sports Phys Ther 2019;49(4):216-218. doi:10.2519/jospt.2019.0606.