Physical demands and physiological strain of American football referees while officiating.

OBJECTIVES: Certain occupations are associated with greater risk of triggering a sudden cardiac event because of high levels of physical exertion and extreme thermal environments in which they occur. The extent to which sports officials--particularly high school (HS) American football referees--experience these conditions is unknown. Forty-six male HS officials (72% White/Caucasian; age = 48 ± 12 years, body mass index = 31.7 ± 6.6 kg·m-2) were studied to quantify the physiological strain and physical demands of officiating. METHODS: Referee demographics (e.g., experience, habitual exercise), pre-game urine specific gravity (USG), thermal (peak core temperature [Tcore]) and cardiovascular (average heart rate [HR]) strain, kinematic activity (e.g., total distance, speed, mechanical intensity), and environmental conditions were measured during 10 regular season varsity HS football games (≈2.5 h each) in the Southeastern United States (average wet bulb globe temperature and relative humidity: 18.9 ± 6.0 °C and 78.2% ± 12.1%). Analyses included descriptive statistics, bivariate correlations, and linear regression. RESULTS: Referees covered 5.2 ± 1.2 km per game, eliciting average HR and peak Tcore of 71.5% ± 8.0% HRmax and 38.3 ± 0.5 °C, respectively; 38% began games dehydrated (USG = 1.026 ± 0.004). Multiple regression analyses revealed that obesity (ß = 0.34), not participating in regular exercise (ß = -0.36), and officiating at lower mechanical intensity (ß = -0.33) predicted greater cardiovascular strain (all p ≤ 0.03). White/Caucasian race/ethnicity (ß = 0.59), younger age (ß = -0.46), and obesity (ß = 0.28) predicted greater thermal strain (all p ≤ 0.01). CONCLUSION: HS football referees experienced elevated levels of physiological strain while officiating, with individual factors modulating the magnitude of strain. Strategies aimed at reducing obesity, increasing exercise participation, and improving cardiovascular health should be emphasized to mitigate strain and prevent cardiac events.

Nonsurgical Management of Heterotopic Ossification in a Runner.

A 51-year-old man was referred to physical therapy with right calf and anterior lateral lower-leg pain that had begun 3 weeks prior. Radiographs ordered by his physician identified calcific changes within the mid-posterior lower leg. Computed tomography was ordered to further characterize the lesion and identified heterotopic ossification in the right soleus. The patient refrained from running for 3 weeks and had complete resolution of pain. Following 5 weeks of physical therapy, the patient was able to increase his distance and remain pain free. J Orthop Sports Phys Ther 2019;49(9):676. doi:10.2519/jospt.2019.8491.

Midterm Follow-up of Divergent Peg Glenoid Components in Total Shoulder Arthroplasty.

Glenoid component aseptic loosening is the most common source of total shoulder arthroplasty (TSA) revision. Divergent pegged glenoids may improve fixation. Thirty-four patients underwent divergent peg TSA. Data were reviewed for component loosening. Failure was defined as the need for revision after loosening. The last postoperative radiographs were graded on a Lazarus glenoid lucency scale. Mean follow-up was 5.6 years ± 2.44 (range, 2-10 years). Radiolucency around one or fewer pegs was noted in 14/20 patients. Six glenoids had complete radiolucency around two pegs; one shoulder had gross loosening. No secondary surgery was performed. Improvements were seen in active elevation and internal rotation. The mean Shoulder Pain and Disability Index (SPADI) score decreased by 48.1 points (p = .039). Shoulder elevation, internal rotation, and SPADI scores significantly improved at final follow-up. No patients underwent revision for glenoid loosening. There were, however, a significant number of patients with radiolucency around two pegs. (Journal of Surgical Orthopaedic Advances 27(1):6-9, 2018).

Vision testing is additive to the sideline assessment of sports-related concussion.

We examined the King-Devick (K-D) test, a vision-based test of rapid number naming, as a complement to components of the Sport Concussion Assessment Tool, 3rd edition (SCAT3) for diagnosis of concussion. Baseline and postconcussion data for the University of Florida men's football, women's soccer, and women's lacrosse teams were collected, including the K-D test, Standardized Assessment of Concussion (SAC), and Balance Error Scoring System (BESS). Among 30 athletes with first concussion during their athletic season (n = 217 total), differences from baseline to postinjury showed worsening of K-D time scores in 79%, while SAC showed a ≥2-point worsening in 52%. Combining K-D and SAC captured abnormalities in 89%; adding the BESS identified 100% of concussions. Adding a vision-based test may enhance the detection of athletes with concussion.