Descriptive Epidemiology of Game-Related Youth Flag Football Injuries.

CONTEXT: Flag football is promoted as a safer alternative to tackle football. This may be 1 reason why participation rates have risen by 39% over the past 3 years. Despite rising participation, epidemiologic research on sport-specific injuries and associated relative risk is lacking. OBJECTIVE: To prospectively document the epidemiology of injuries in youth flag football. DESIGN: Descriptive epidemiology study. SETTING: Regional and national youth flag football tournaments. PATIENTS OR OTHER PARTICIPANTS: Athletes (N = 1939; 1744 boys and 195 girls), ages 6 to 12 years. An athletic trainer prospectively monitored the athletes for sport-related injury and exposures. MAIN OUTCOME MEASURE(S): Athlete risks of injury and injury rates were calculated overall and by sex. Injury characteristics were reported for the total population and by sex. RESULTS: Forty-seven injuries to unique individuals were recorded in 1939 athletes with a total of 9228 athlete-exposures (AEs). The overall risk of injury was 2.4% (95% CI = 1.79%, 3.21%), with an overall injury rate of 5.1 per 1000 AEs (95% CI = 3.75, 6.77). Of the 47 injuries, 36 occurred in boys (8365 AEs), and 11 occurred in girls (863 AEs). A higher risk in girls was evidenced by both the injury risk ratio (2.73; 95% CI = 1.41, 5.30) and injury rate ratio of 2.96 (95% CI = 1.51, 5.82). The most common injury sites were the head/face/neck (n = 15, 31.9%), followed by the ankle/foot (n = 9, 19.1%). The most frequent types of injury were contusion (55.3%), sprain/subluxation (14.9%), and general trauma (10.6%); 74.5% of all injuries resulted from direct impact. CONCLUSIONS: Although the competition injury rate for youth flag football was lower than the values from studies reporting comparable tackle football data, the frequencies by body part, type, and mechanism were similar. Given that most injuries were related to some form of impact and predominantly contusions, adopting minimal protective equipment or padding may reduce the numbers of these injuries.

The Reliability and Validity of Gluteal Endurance Measures (GEMs).

BACKGROUND: The gluteals have unique morphology related to muscle endurance, including moderate fiber sizes and a majority of Type I endurance fibers. Evidence suggests gluteal endurance is related to low back pain, running kinematics, balance, posture, and more. However, reliable and valid measures specific to gluteal endurance are lacking in the literature. HYPOTHESIS/PURPOSE: The purpose of this study was to examine the intra- and inter-rater reliability of two gluteal endurance measures (GEMs) for clinical use. It also aimed to examine validity for the two measures by using electromyography (EMG), recording reasons for task failure, and analyzing differences between demographic groups. STUDY DESIGN: Cross-Sectional. METHODS: Sixty-eight males and females with and without recurrent low back pain aged 18-35 years were recruited from a university population. Electromyography electrodes were placed on subjects' gluteus maximus and gluteus medius, and each subject performed three trials of GEM-A (abduction endurance) and GEM-B (bridging endurance). Hold times, EMG median frequency (MF) data, and subjective reasons for task failure were analyzed. RESULTS: Both GEMs demonstrated high intra-rater reliability (ICC = 0.87-0.94) and inter-rater reliability (ICC = 0.99). Mean hold times were 104.83 ± 34.11 seconds for GEM-A (abduction endurance) and 81.03 ± 24.79 seconds for GEM-B (bridging endurance). No statistically significant difference was found between subjects with and without recurrent LBP. Median frequency data validated the onset of gluteal fatigue during both measures. Posterolateral hip (gluteal) fatigue was reported as the primary reason for task failure in 93% and 86% of subjects for GEM-A and GEM-B, respectively. CONCLUSION: This seminal study of GEM-A (abduction endurance) and GEM-B (bridging endurance) found both measures to be reliable and valid measures of gluteal endurance. Further examination of the GEMs in samples with different types of LBP or hip pain is recommended. LEVEL OF EVIDENCE: 3.

Impact of Preceding Workload on Team Performance in Collegiate Men's Ice Hockey.

ABSTRACT: Neeld, KL, Peterson, BJ, Dietz, CC, Cappaert, TA, and Alvar, BA. Impact of preceding workload on team performance in collegiate men's ice hockey. J Strength Cond Res 35(8): 2272-2278, 2021-Although the workload-injury relationship has received ample research attention, the relationship between prior workload and performance in team sport remains poorly understood. The purpose of this study was to determine if preceding workloads influence competition performance in men's ice hockey. On-ice workload data were collected from all players on a NCAA Division I men's ice hockey team for 2 consecutive seasons. Training and match workloads were characterized using 7 variables (player load, skating load, explosive efforts, high force strides, player load·min-1, skating load·min-1, and average stride force·lb-1). Team performance was calculated as the difference between the subject and opposing teams' shots on goal. Nine separate ANCOVAs were performed to assess the effect of workload across quartiles of 5 different time spans (1,3,5,7 and 28 days), and low, typical, and high zones of 4 time ratios (1/28, 3/28, 5/28, and 7/28) days) on team shot differential, accounting for season quarter and rank differential between the subject and opposing team. Alpha was set a priori to 0.05. Of all workload measures included in each analysis, only 7-day high force strides (p < 0.01, eta2 = 0.72), and 7-day player load·min-1 (p < 0.05, eta2 = 0.50) had a significant effect on shot differential. Measures of skating intensity in the week preceding competition have the largest impact on team performance. These results can be used by performance coaches to examine tests of speed, power, strength, and conditioning to identify potential limiting factors to high-intensity skating, design training programs with specific need-based emphases, and make recommendations for weekly management of high-intensity skating loads.

Self-Reflection as a Support to Evidence-Based Practice: A Grounded Theory Exploration.

The purpose of this study was to explore how reflective practice is experienced by occupational therapists. Thirty participants were purposefully sampled to explore reflective practice experiences using a critical reflection inquiry model as a theoretical framework. Grounded theory using a constant comparative analysis method was used to analyze interview data. Three categories emerged: triggers to reflection, depth of reflection, and actions taken. The frequency of statements compared across survey groups showed that participants with high reflection behaviors made more critical reflections, used steps of the EBP cycle, and took actions to correct practice. Results inform practice in three ways: (1) practitioner experiences were analyzed through the complete reflective practice construct, (2) findings indicated that greater depth of reflective thinking promotes EBP use and actions taken to correct practice, and (3) narrative content analysis was found to be a credible method of assessing reflection within practice narratives, suggesting it as useful for education and promoting continuing competency.

Occupational Therapists' Implementation of Evidence-Based Practice: A Cross Sectional Survey.

Evidence-based practice (EBP) implementation has been associated with quality health care outcomes, yet only a small proportion of occupational therapists implement EBP. We conducted a cross-sectional survey measuring EBP implementation, skill and knowledge, self-reflection behavior, and practice demographics to clarify implementation of EBP and factors acting as supports. A random sample of occupational therapists practicing in the U.S. was invited to participate; 578 surveys were included in the final analysis. Participants implemented EBP less than 1 time over the previous 8 weeks; EBP use was highest in those with a doctorate (p = .002) and high self-reflection behavior (p = .001); EBP use was marginally higher in those with organizational support (p = .008; p = .009), time for EBP (p = .009), and access to full text articles (p = .006). Further investigation of how reflective practice and levels of doctoral education support EBP use are recommended.

Examining the Environmental Effects of Athletic Training: Perceptions of Waste and the Use of Green Techniques.

CONTEXT: Environmental sustainability is a critical concern in health care. Similar to other professions, the practice of athletic training necessitates the use of a large quantity of natural and manufactured resources. OBJECTIVE: To examine the perceptions of the waste produced by the practice of athletic training and the green practices currently used by athletic trainers (ATs) to combat this waste. DESIGN: Mixed-methods study. SETTING: Field setting. PATIENTS OR OTHER PARTICIPANTS: A total of 442 ATs completed the study. Sixteen individuals participated in the qualitative portion. MAIN OUTCOME MEASURE(S): Data from sections 2 and 3 of the Athletic Training Environmental Impact Survey were analyzed. Focus groups and individual interviews were used to determine participants' views of waste and the efforts used to combat waste. Descriptive statistics were used to examine types of waste. Independent t tests, χ2 tests, and 1-way analyses of variance were calculated to identify any differences between the knowledge and use of green techniques. Interviews and focus groups were transcribed verbatim and analyzed inductively. RESULTS: Participants reported moderate knowledge of green techniques (3.18 ± 0.53 on a 5-point Likert scale). Fifty-eight percent (n = 260) of survey participants perceived that a substantial amount of waste was produced by the practice of athletic training. Ninety-two percent (n = 408) admitted they thought about the waste produced in their daily practice. The types of waste reported most frequently were plastics (n = 111, 29%), water (n = 88, 23%), and paper for administrative use (n = 81, 21%). Fifty-two percent (n = 234) agreed this waste directly affected the environment. The qualitative aspect of the study reinforced recognition of the large amount of waste produced by the practice of athletic training. Types of conservation practices used by ATs were also explored. CONCLUSIONS: Participants reported concern regarding the waste produced by athletic training. The amount of waste varies depending on practice size and setting. Future researchers should use direct measures to determine the amount of waste created by the practice of athletic training.

Athletic Trainers' Attitudes and Perceptions of Environmental Sustainability.

CONTEXT: Environmental sustainability efforts are becoming a critical concern in health care. However, little is known regarding how athletic trainers feel about the environment or what can be done to reduce the environmental impact of the practice of athletic training. OBJECTIVE: To examine athletic trainers' attitudes toward and perceptions of factors related to environmental sustainability. DESIGN: Sequential, mixed methods using a survey, focus groups, and personal interviews. SETTING: Field study. PATIENTS OR OTHER PARTICIPANTS: Four hundred forty-two individuals completed the survey. Sixteen participated in the qualitative portion. MAIN OUTCOME MEASURE(S): Quantitative results from the Athletic Training Environmental Impact Survey included data from a 5-point Likert scale (1 = lowest rating and 5 = highest rating). Descriptive statistics and 1-way analyses of variance were used to describe perceptions and determine differences in mean opinion, National Athletic Trainers' Association district, and use of green techniques. Qualitative data were transcribed verbatim and analyzed inductively. RESULTS: The mean score for opinion of the environment was 3.30 ± 0.52. A difference was found between opinion and National Athletic Trainers' Association district ( F9, 429 = 2.43, P = .01). A Bonferroni post hoc analysis identified this difference ( P = .03) between members of District 2 (Delaware, New Jersey, New York, Pennsylvania) and District 9 (Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, Tennessee). An inductive analysis resulted in 3 emergent themes: (1) barriers to using green techniques, (2) motivators for using green techniques, and (3) solutions to overcoming the barriers. The information gleaned from participants in the qualitative portion of the study can be useful for clinicians wishing to implement basic conservation efforts in their practice settings and may guide future sustainability projects. CONCLUSIONS: Overall, participants reported a positive opinion of environmental sustainability topics related to athletic training. However, many barriers to practicing green techniques were identified.

Eccentric Exercise Versus Eccentric Exercise and Soft Tissue Treatment (Astym) in the Management of Insertional Achilles Tendinopathy.

BACKGROUND: Eccentric exercise is commonly used in the management of Achilles tendinopathy (AT) but its effectiveness for insertional AT has been questioned. Soft tissue treatment (Astym) combined with eccentric exercise could result in better outcomes than eccentric exercise alone. HYPOTHESIS: Soft tissue treatment (Astym) plus eccentric exercise will be more effective than eccentric exercise alone for subjects with insertional AT. STUDY DESIGN: Prospective randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: Sixteen subjects were randomly assigned to either a soft tissue treatment (Astym) and eccentric exercise group or an eccentric exercise-only group. Intervention was completed over a 12-week period, with outcomes assessed at baseline, 4, 8, 12, 26, and 52 weeks. Outcomes included the Victorian Institute of Sport Assessment Achilles-Specific Questionnaire (VISA-A), the numeric pain rating scale (NPRS), and the global rating of change (GROC). RESULTS: Significantly greater improvements on the VISA-A were noted in the soft tissue treatment (Astym) group over the 12-week intervention period, and these differences were maintained at the 26- and 52-week follow-ups. Both groups experienced a similar statistically significant improvement in pain over the short and long term. A significantly greater number of subjects in the soft tissue treatment (Astym) group achieved a successful outcome at 12 weeks. CONCLUSION: Soft tissue treatment (Astym) plus eccentric exercise was more effective than eccentric exercise only at improving function during both short- and long-term follow-up periods. CLINICAL RELEVANCE: Soft tissue treatment (Astym) plus eccentric exercise appears to be a beneficial treatment program that clinicians should consider incorporating into the management of their patients with insertional AT.

Athletic Trainers' Beliefs About and Implementation of Evidence-Based Practice.

CONTEXT: Understanding the beliefs about and use of evidence-based practice (EBP) among athletic trainers (ATs) will help to determine appropriate strategies to improve implementation. OBJECTIVE: To examine the ATs' beliefs about and use of EBP. DESIGN: Cross-sectional study. SETTING: Online survey instrument. PATIENTS OR OTHER PARTICIPANTS: A total of 467 ATs responded to the survey request, a response rate of 11.67%. A total of 385 (9.6%) completed the EBP Beliefs Scale and 342 (8.5%) completed the EBP Implementation Scale. MAIN OUTCOME MEASURE(S): The EBP Beliefs Scale and EBP Implementation Scale were administered. The surveys collected demographic information in addition to information about participants' beliefs regarding EBP and implementation of EBP in clinical practice. RESULTS: The ATs demonstrated a level of neither agree nor disagree (56.00 ± 7.86) on the EBP Beliefs Scale. Belief scores were higher among those ATs required to document for third-party reimbursement (P = .001), those with access to current research through professional journals other than the Journal of Athletic Training (P = .02), and those with a doctoral degree (P = .01). A low level of implementation (9.00 ± 11.38), representing the implementation of EBP approximately 0 times in the previous 8 weeks, was found on the EBP Implementation Scale. Implementation scores were higher among preceptors (P = .01), those required to document for third-party reimbursement (P < .001), those with access to current research through professional journals (P = .002), and those with a doctoral degree (P = .01). CONCLUSIONS: Participants had a positive attitude toward EBP; however, they were not implementing EBP concepts when providing patient care. This suggests that additional information and EBP resources are needed so ATs can better implement EBP in practice. To provide the best patient care and to promote EBP within the profession, clinicians should make EBP a priority and advocate for EBP implementation.

Prevalence and characteristics of general and football-specific emergency medical service activations by high school and collegiate certified athletic trainers: a national study.

OBJECTIVE: To describe frequency and characteristics of emergency medical services (EMS) activations by certified athletic trainers (ATs) and effects of pre-season planning meetings on interactions between ATs and EMS both generally and specifically during football head/neck emergencies. DESIGN: Retrospective cross-sectional survey. SETTING: 2009 Web-based survey. PARTICIPANTS: Athletic trainers (n = 1884; participation rate, 28%) in high school and collegiate settings. INDEPENDENT VARIABLES: Athletic trainer work setting, AT demographics, history of pre-season planning meetings. MAIN OUTCOME MEASURES: Proportions and 95% confidence intervals (CIs) estimated the prevalence of EMS activation, planning meetings, and characteristics of AT-EMS interactions (eg, episodes of AT-perceived inappropriate care and on-field disagreements). Chi square tests tested differences (P < 0.05) in proportions. Associations (odds ratio = OR and 95% CI) between work setting, demographics, preseason meetings and fall 2008 1) episodes of AT-perceived inappropriate care, and 2) on-field disagreements were assessed using multivariate logistic regression. RESULTS: High school ATs activated EMS more frequently than collegiate ATs (eg, fall 2008 EMS activation for football injury, 59.9% vs 27.5%; P < 0.01) and reported fewer pre-season planning meetings (eg, met with EMS to practice, 38.1% vs 55.8%; P < 0.01). During the Fall 2008 football season, high school ATs perceived more episodes of inappropriate care (10.4% vs 3.9%; P < 0.01) and on-field disagreements (5.4 vs 2.2%; P < 0.01) than collegiate ATs. High school work setting was independently associated with episodes of AT-perceived inappropriate care (adjusted OR = 2.76; 95% CI, 1.65-4.62) and on-field disagreements (adjusted OR = 2.33; 95% CI, 1.17-4.64). CONCLUSIONS: Athletic trainer-EMS interactions are common and sometimes involve AT-perceived episodes of inappropriate care and on-field disagreements between emergency care providers.

National Athletic Trainers' Association position statement: environmental cold injuries.

OBJECTIVE: To present recommendations for the prevention, recognition, and treatment of environmental cold injuries. BACKGROUND: Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk. RECOMMENDATIONS: These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.

The influence of various factors on high school football helmet face mask removal: a retrospective, cross-sectional analysis.

CONTEXT: Most research on face mask removal has been performed on unused equipment. OBJECTIVE: To identify and compare factors that influence the condition of helmet components and their relationship to face mask removal. DESIGN: A cross-sectional, retrospective study. SETTING: Five athletic equipment reconditioning/recertification facilities. PARTICIPANTS: 2584 helmets from 46 high school football teams representing 5 geographic regions. INTERVENTION(S): Helmet characteristics (brand, model, hardware components) were recorded. Helmets were mounted and face mask removal was attempted using a cordless screwdriver. The 2004 season profiles and weather histories were obtained for each high school. MAIN OUTCOME MEASURE(S): Success and failure (including reason) for removal of 4 screws from the face mask were noted. Failure rates among regions, teams, reconditioning year, and screw color (type) were compared. Weather histories were compared. We conducted a discriminant analysis to determine if weather variables, region, helmet brand and model, reconditioning year, and screw color could predict successful face mask removal. Metallurgic analysis of screw samples was performed. RESULTS: All screws were successfully removed from 2165 (84%) helmets. At least 1 screw could not be removed from 419 (16%) helmets. Significant differences were found for mean screw failure per helmet among the 5 regions, with the Midwest having the lowest failure rate (0.08 +/- 0.38) and the Southern (0.33 +/- 0.72), the highest. Differences were found in screw failure rates among the 46 teams (F(1,45) = 9.4, P < .01). Helmets with the longest interval since last reconditioning (3 years) had the highest failure rate, 0.47 +/- 0.93. Differences in success rates were found among 4 screw types (chi(2) (1,4) = 647, P < .01), with silver screws having the lowest percentage of failures (3.4%). A discriminant analysis (Lambda = .932, chi(2) (14,n=2584) = 175.34, P < .001) revealed screw type to be the strongest predictor of successful removal. CONCLUSIONS: Helmets with stainless steel or nickel-plated carbon steel screws reconditioned in the previous year had the most favorable combination of factors for successful screw removal. T-nut spinning at the side screw locations was the most common reason and location for failure.