Differential screen and treatment of vestibular dysfunction in an elderly patient: A case report.

BACKGROUND/PURPOSE: Concussion sequelae in the elderly is under recognized and negatively impacts quality of life. Labyrinthine concussion (LC) is an uncommon diagnosis, as is multiple canal (MC) benign paroxysmal positional vertigo (BPPV). This case report highlights physical therapist (PT) evaluation and treatment of an elderly male misdiagnosed with LC and successfully treated for MC BPPV. CASE DESCRIPTION: A 72 year old male presented to his PT 23 days after falling off a ladder, resulting in a mild traumatic brain injury (mTBI). Diagnosed with LC, he was referred to PT due to ongoing symptoms of "falling backwards," poor gait, and diminished mobility. PT examination revealed an atypical BPPV. Thus, the patient was treated in two PT visits, which included canalith repositioning techniques and neuromuscular reeducation. OUTCOMES: The PT diagnosis was MC BPPV, including the right lateral and left posterior semicircular canals. Initial positive findings of Head Impulse Test, Bow and Lean Test, Dix-Hallpike, and Roll Test were negative on the last visit. Patient-Specific Functional Scale improved from 0 to 9.9 (10 being no limitations). The patient progressed from minimum assistance to independence in bed mobility, transfers, gait, and previous activities. DISCUSSION: The patient's presentation was atypical in signs and symptoms with a diagnosis of LC. PT examination and intervention successfully resolved the patient's signs and symptoms within two visits. Further research is needed regarding identification and treatment of elderly individuals with head injuries, such as MC BPPV, as well as the efficacy of a PT seeing patients shortly after mTBI.

Differential screen and treatment of sternocleidomastoid syndrome versus eagle syndrome: a case report.

BACKGROUND/PURPOSE: Differential screening is a complex process in chronic pain conditions. There is significant uncertainty that surrounds the pathophysiology of many chronic pain syndromes that may lead to misdiagnosis and treatment failures. Such differential screening is even more challenging where there is regional overlapping from surrounding tissues. This case report chronicles the differential screening and treatment of a patient with sternocleidomastoid syndrome (SCMS) originally diagnosed as Eagle's syndrome (ES). CASE DESCRIPTION: A 55-year-old woman, referred to a physical therapist (PT) by an ear, nose and throat (ENT) physician with the diagnosis of ES. The patient complained of yearlong left-sided otalgia, blurred vision, excessive lacrimation, dysphagia, hyperesthesia on the left side of the face, unilateral temporal headaches, and both left mandibular and anterior neck pain. OUTCOMES: The PT examination revealed the patient did not exhibit hallmark findings for clinical confirmation of ES and instead demonstrated multiple signs consistent with SCMS. DISCUSSION: Manual therapy techniques and therapeutic exercises resolved the patient's year-long chronic symptoms within 6 sessions.

Retrospective Chart Review Examining Differences and Timelines in Recommended and Delivered Wheelchair Equipment in a Midwestern Dedicated Seating Department.

OBJECTIVE: To compare recommended wheeled mobility equipment with delivered equipment, excluding custom seats and backs, considering demographic factors, such as sex, age, and funding source, as well as the timeline of the procurement process. DESIGN: Retrospective chart review. SETTING: Dedicated wheelchair seating department within a Midwestern rehabilitation hospital and associated complex rehabilitation technology durable medical equipment suppliers. PARTICIPANTS: Wheelchair recommendations (N=546) made between January 1, 2017, and December 31, 2017, to physician-referred wheelchair users of all ages and diagnoses. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Recommended and delivered wheelchair equipment type and length of time between recommendation and delivery. RESULTS: Differences were found between the recommended and delivered equipment in manual wheelchairs, power mobility devices, seat backs, cushions, and power option equipment groups (P≤.001). Delivered manual wheelchairs were 7% more likely to be different than the recommendation for each year decrease in age (P≤.001), although the model lacked sufficient predictive accuracy for clinical application. The average length of time from equipment recommendation to delivery was about 6 months (mean, 176d). Standard and complex power mobility devices were associated with longer timelines (median, 137d and 173d, respectively; P=.001), although only complex power mobility device timelines were significantly associated with public funding sources (P=.02). CONCLUSIONS: Wheelchair bases, positioning accessories, and power options may be delivered differently than originally recommended, and the process for procuring complex power mobility devices with public funding sources should be studied further. Health care professionals should consistently follow up on delivered equipment to ensure that expectations and needs of the wheelchair user are met. Reducing systemic barriers to interdisciplinary communication postrecommendation may improve patient outcomes.

Systematic review of the effectiveness of caregiver training with functional mobility tasks for informal caregivers assisting patients with neurological diagnoses.

PURPOSE: To complete a systematic review to identify evidence of the effectiveness of informal caregiver training with functional mobility tasks for patients with neurological diagnoses routinely completed by physical therapists (PTs). METHODS: Databases searched: PubMed, PEDro, CINAHL, Web of Science, Proquest Health and Medical, and Scopus. Authors included studies with adult patients requiring assistance with functional mobility due to a neurological diagnosis, with the care provided by informal caregivers. Authors excluded studies with paid caregivers, or patient diagnoses of human immunodeficiency virus, dementia, or cancer. Data extracted included type of study, methodological quality review (using Downs and Black scale), number of subjects, outcome measures, interventions, and main results. RESULTS: Of 2372 total articles screened, 36 full-text articles were analyzed, with seven articles identified for inclusion in the review. All studies showed variability in number of subjects, methods, interventions, outcome measures, and results. Four of the studies showed positive results from the training of informal caregivers. CONCLUSIONS: While there is initial evidence that training informal caregivers in physical mobility tasks may help to lessen caregiver burden, further investigation is warranted. The topics typically addressed by PTs with informal caregiver training, such as transfers and ambulation, have not been extensively studied in the literature.Implications for rehabilitationPhysical therapists routinely complete training for caregivers on functional mobility tasks, with some initial evidence of the effectiveness of this training.Training for informal caregivers assisting individuals with neurological conditions has the potential to reduce injuries and decrease caregiver burden.Rehabilitation professionals should implement effective training methods for caregivers, resulting in a safer home environment for individuals with neurological diagnoses.

Hydration to Maximize Performance and Recovery: Knowledge, Attitudes, and Behaviors Among Collegiate Track and Field Throwers.

Hydration plays an important role in performance, injury prevention, and recovery for athletes engaged in competitive sports. Therefore, it is important that strength and conditioning coaches understand an athlete's hydration needs to prevent illness and enhance performance. The purpose of this study was to identify hydration knowledge, attitudes, and behaviors of collegiate track and field throwers, as well as identify barriers to hydration and sources of nutritional information. The Rehydration and Refueling in Collegiate Track and Field Throwers Survey was sent to 271 track and field thrower coaches with a request to forward the email to current track and field throwers. Pearson correlation coefficients were calculated regarding knowledge, attitude, and behavior scores among the participants in this sample. Differences among response patterns were assessed via Chi-square analysis. Alpha level was set at p = .05. Results demonstrated that 97.3% (n = 287) of respondents knew that dehydration would decrease performance, but 50.5% (n = 149) erroneously believed thirst was the best indicator of dehydration. Chi-square analysis demonstrated a significant difference in reported values between participants who intended to eat a performance-enhancing diet and those who consumed less fluid than recomended values (207 - 295 m)l in the 2-3 hours prior to competition (χ2 = 10.87, p < .05). Pearson correlation coefficients demonstrated a large association between knowledge and behavior (r = .70, p < .05), a medium association between knowledge and attitude (r = .41, p < .05), and a small association between attitude and behavior (r = .21, p < .05). This suggests that strength and conditioning coaches and health staff need to educate and monitor hydration behaviors among collegiate track and field throwers to optimize performance.

Efficacy Sources that Predict Leadership Behaviors in Coaches of Athletes with Disabilities.

Researchers suggest that sport participation among athletes with disabilities promotes healthier lifestyles, increases self-esteem, and enhances peer acceptance. Ideally, coaches should be confident in teaching skills, tactics, and sportsmanship, while exhibiting appropriate leadership behaviors in order to positively impact the psychosocial development of any athlete. Thus, the present research examined sources of coaching efficacy that predict leadership behaviors in coaches who work with athletes who have physical disabilities. Seventy international Paralympic coaches of female and male sport teams completed a modified version of the Coaching Success Questionnaire-2, the Coaching Efficacy Scale and the Leadership Scale for Sports. Regression models indicated that total coaching efficacy was a significant predictor of instructional and positive feedback leadership behaviors, with prior success also being a significant predictor of instructional behavior.

Validity of the 6-Minute Walk Test and YMCA Submaximal Cycle Test During Midpregnancy.

ABSTRACT: Tinius, RA, Blankenship, M, Maples, JM, Pitts, BC, Furgal, K, Norris, ES, Hoover, DL, Olenick, A, Lambert, J, and Cade, WT. Validity of the 6-minute walk test and Young Men's Christian Association (YMCA) submaximal cycle test during midpregnancy. J Strength Cond Res 35(11): 3236-3242, 2021-Submaximal exercise testing can be a feasible alternative to maximal testing within special populations to safely predict fitness levels; however, submaximal exercise testing has not been well-validated for use during pregnancy. The purpose of this study was to determine the concurrent validity of the 6-minute walk test (6MWT) and the YMCA submaximal cycle test (YMCAT) to predict V̇o2max in physically active women during midpregnancy. Thirty-seven (n = 37) pregnant women (22.1 ± 1.4 weeks' gestation) and 10 (n = 10) nonpregnant women participated in the study. Subjects completed a graded maximal treadmill test at 1 visit to measure maximal oxygen consumption (V̇o2max), and then subjects completed the 6MWT and YMCAT in randomized order during a separate visit. The predicted V̇o2max from each submaximal test were compared with the measured V̇o2max from the treadmill test to assess the validity of these tests during pregnancy. Among pregnant women, predicted V̇o2max from the YMCAT was not correlated to the measured V̇o2max (r = 0.14, p = 0.42), and the predicted V̇o2max from the 6MWT was only moderately correlated (r = 0.40, p = 0.016) to the measured V̇o2max. Among nonpregnant women, the predicted V̇o2max values from both the YMCAT and the 6MWT had strong correlations with the measured V̇o2max values (YMCAT: r = 0.71, p = 0.02; 6MWT: r = 0.80, p = 0.006). Neither test demonstrated concurrent validity among the pregnant sample. The main finding is that the YMCAT is not a valid method to estimate V̇o2max during midpregnancy (likely due to physiological changes in heart rate [HR] during pregnancy). The 6MWT has potential to be used clinically for estimating fitness as actual and predicted values did positively correlate, and it is not dependent on HR responses to exercise. However, if a precise measure of fitness is needed, then neither test appears to have strong validity for use during midpregnancy.

Predictive Validity of a Functional Movement Screen in Professional Basketball Players.

Background and objectives: Striking a balance between maximizing performance and preventing injury remains elusive in many professional sports. The purpose of this study was to assess the relative risk of non-contact injuries in professional basketball players based on predictive cut scores on the Functional Movement Screen™ (FMS). Materials and Methods: Thirty-two professional basketball players from the National Basketball Association (NBA) and Women's National Basketball Association (WNBA) participated in this study. This observational pilot cohort study assessed and scored each participant using the FMS during training camp. Each athlete was then tracked throughout the season while recording the number, type, and time lost due to injuries. Possible exposures, actual exposures, and exposures missed due to non-contact injury (NCI) for each athlete were calculated and then used to determine the crude and specific incident rates for exposures missed due to NCI per 1000 exposures. Results: Linear regression models were used to evaluate the predictive ability of the FMS score for total missed exposures, NCI, and CI missed exposures. In all models, the FMS total score failed to attain significance as a predictor (p > 0.05). FMS scores ranged from 5 to 18. The recommended cut score of 14 showed a sensitivity of 0.474 and a specificity of 0.750. The cut score of 15 showed the best combination, exhibiting a sensitivity of 0.579 and specificity of 0.625. A total of 5784 exposures to NCI were possible for the men and women combined, and 681 possible exposures were missed. Of these, 23.5% were due to NCI, 16.5% were due to contact injuries (CI), and 60% were due to illnesses and personal reasons. Conclusions: The FMS proved to be a measure that was not associated with any injury measure in this sample of professional basketball players, suggesting the instrument lacks predictive validity in this population.

A Fraction of Recommended Practices: Implementation of the FIFA 11+ in NCAA Soccer Programs.

Background and Objectives: National Collegiate Athletic Association (NCAA) soccer coaches implement numerous warm-up and flexibility strategies to prepare athletes for training and competition. The Fédération Internationale de Football Association (FIFA) developed the 11+ injury prevention program to reduce non-contact injuries. This study aimed to analyze the level of familiarity with and implementation of the evidence-based FIFA 11+ amongst NCAA Division I (DI) and Division III (DIII) men's and women's soccer coaches. Materials and Methods: NCAA soccer coaches in the United States received an Institutional Review Board-approved survey hyperlink. A total of 240 coaches completed the survey. The respondents represented 47.5% men's and 52.5% women's teams distributed within DI and DIII programs. Descriptive statistics are reported as frequency counts and mean ± standard deviation where applicable. Pearson's chi-square tests were performed to assess potential differences with a significance level set at α < 0.05. Results: The results indicated that approximately 62% of the respondents reported being familiar with the FIFA 11+ program. Of those coaches familiar with the program, 15.0% reported full implementation, 57.5% reported partial implementation, and 27.5% reported no implementation. Chi-square analyses revealed significant differences in FIFA 11+ implementation based upon division level (χ2 = 4.56, p = 0.033) and coaching certification levels (χ2 = 13.11, p = 0.011). Conclusions: This study indicates that there is a gap between FIFA 11+ knowledge and actual implementation. To reduce the risk of non-contact injury, there is a need to educate coaches and athletic trainers on the purpose of the FIFA 11+ program and how to perform the exercises correctly.

Pre- and Post-Activity Stretching Practices of Collegiate Soccer Coaches in the United State.

Current pre- and post-activity stretching guidelines are designed to optimize performance and reduce injury risk. However, it is unclear whether soccer coaches adhere to these recommendations. The purpose of this study was to determine if collegiate soccer coaches' perceptions and practices align with current scientific recommendations. A total of 781 questionnaires were electronically distributed to soccer coaches from NCAA Division I and III universities. The questionnaire obtained demographic, professional, and educational information, as well as stretching practices. Statistical analysis consisted of computing frequency counts and means where applicable. Pearson's Chi-square tests were performed to assess the potential differences in stretching perceptions and practices among the cohort of soccer coaches. Results suggest that soccer coaches are choosing some forms of stretching more frequently than other coaches (χ2 = 342.7, p < 0.001). Further analysis failed to determine significant associations between stretching type and coaching certification, level, sex, years of experience, and age. Of the 209 respondents, 84.9% believed pre-activity stretching to be of greater than average importance on a seven-point Likert scale. Dynamic stretching (68.7%) or a combination of static and ballistic stretching (18.0%) prior to athletic events was the most typical stretching prescribed. Current post-activity practices demonstrate that most coaches (95.4%) are using some form of a general cool-down following practice or competition. This study is an important assessment of the extent to which collegiate coaches administer appropriate stretching techniques. Most coaches adhere to current recommendations; however, they should continue to evaluate their practices against ongoing research and the practices of their peers.

Metabolic flexibility is impaired in women who are pregnant and overweight/obese and related to insulin resistance and inflammation.

CONTEXT: Maternal obesity is a significant public health concern that contributes to unfavorable outcomes such as inflammation and insulin resistance. Women with obesity may have impaired metabolic flexibility (i.e. an inability to adjust substrate metabolism according to fuel availability). Impaired metabolic flexibility during pregnancy may mediate poor pregnancy outcomes in women with obesity. PURPOSE: The purposes of this study were to: 1) compare metabolic flexibility between overweight/obese and lean women; and 2) determine the relationships between metabolic flexibility, inflammation following a high-fat meal, and maternal metabolic health outcomes (i.e. gestational weight gain and insulin resistance). PROCEDURES: This interventional physiology study assessed lipid oxidation rates via indirect calorimetry before and after consumption of a high-fat meal. The percent change in lipid metabolism was calculated to determine 'metabolic flexibility.' Maternal inflammatory profiles (CRP, IL-6, IL-8, IL-10, IL-12, TNF-α) and insulin resistance (HOMA-IR) were determined via plasma analyses. MAIN FINDINGS: 64 women who were pregnant (lean = 35, overweight/obese = 29) participated between 32 and 38 weeks gestation. Lean women had significantly higher metabolic flexibility compared to overweight/obese women (lean 48.0 ±â€¯34.1% vs overweight/obese 29.3 ±â€¯34.3%, p = .035). Even when controlling for pre-pregnancy BMI, there was a negative relationship between metabolic flexibility and percent change in CRP among the overweight/obese group (r = -0.526, p = .017). Metabolic flexibility (per kg fat free mass) was negatively correlated with postprandial HOMA-IR (2 h: r = -0.325, p = .016; 4 h: r = -0.319, p = .019). CONCLUSIONS: Overweight and obese women who are pregnant are less 'metabolically flexible' than lean women, and this is related to postprandial inflammation and insulin resistance.

Practices, Perceived Benefits, and Barriers to Resistance Training Among Women Enrolled in College.

The American College of Sports Medicine (ACSM) has recommended that resistance training be performed at least twice per week, with 8-12 repetitions of 8-10 exercises targeting all major muscle groups (1). However, Kruger, Carlson, and Kohl (18) reported that women were participating less than the U.S. population on the whole, as only 20% of women were engaging in resistance training two or more times per week. In order to better understand why only 1 in 5 women participate regularly in this form of physical activity, this study investigated current resistance training practices, perceived benefits, and barriers to resistance training among college women. One-hundred and sixteen women college students from a large, public, Midwestern university participated in this study. Correlation and hierarchical multiple regression analyses were used to identify the strongest predictors of resistance training behaviors. The predictors in the regression model included demographic characteristics in block one, perceived barriers to resistance training in block two, and perceived benefits of resistance training in block three. Results indicated that the level of perceived "time/effort" barriers significantly predicted resistance training behavior. Findings in this area may help researchers, university recreation programmers, personal trainers, and other health and fitness professionals better understand the attitudes and actions of college women regarding resistance training, toward the goal of promoting fitness center environments that college women find more inviting.

Management of a patient's gait abnormality using smartphone technology in-clinic for improved qualitative analysis: A case report.

BACKGROUND AND PURPOSE: Qualitative analysis has its limitations as the speed of human movement often occurs more quickly than can be comprehended. Digital video allows for frame-by-frame analysis, and therefore likely more effective interventions for gait dysfunction. Although the use of digital video outside laboratory settings, just a decade ago, was challenging due to cost and time constraints, rapid use of smartphones and software applications has made this technology much more practical for clinical usage. CASE DESCRIPTION: A 35-year-old man presented for evaluation with the chief complaint of knee pain 24 months status-post triple arthrodesis following a work-related crush injury. In-clinic qualitative gait analysis revealed gait dysfunction, which was augmented by using a standard IPhone® 3GS camera. After video capture, an IPhone® application (Speed Up TV®, https://itunes.apple.com/us/app/speeduptv/id386986953?mt=8 ) allowed for frame-by-frame analysis. Corrective techniques were employed using in-clinic equipment to develop and apply a temporary heel-to-toe rocker sole (HTRS) to the patient's shoe. OUTCOMES: Post-intervention video revealed significantly improved gait efficiency with a decrease in pain. The patient was promptly fitted with a permanent HTRS orthosis. This intervention enabled the patient to successfully complete a work conditioning program and progress to job retraining. DISCUSSION: Video allows for multiple views, which can be further enhanced by using applications for frame-by-frame analysis and zoom capabilities. This is especially useful for less experienced observers of human motion, as well as for establishing comparative signs prior to implementation of training and/or permanent devices.

Assessment of endpoint criteria and perceived barriers during maximal cardiorespiratory fitness testing among pregnant women.

BACKGROUND: A plateau in volume of oxygen consumption (VO2) is the primary indicator for determining if an individual has reached their maximal aerobic capacity. However, secondary criteria can also be used to identify maximal effort (i.e. lactate level, rating of perceived exertion [RPE], percent of age-predicted maximal heart rate [HR] and respiratory exchange ratio [RER]). Age and gender-specific secondary criteria have been developed for the general population, but no secondary criteria have been established for pregnant women. The primary purpose of this study was to analyze secondary endpoint criteria during VO2max testing among pregnant women. A secondary purpose was to identify emotional and physical barriers pregnant women have that may prevent them from reaching maximal effort. METHODS: Twenty-five pregnant women (age= 30.0±3.6 years; gestation age= 22.1±1.4 weeks, pre-pregnancy BMI= 23.68±4.04 kg/m2) participated. Each participant completed a Bruce protocol treadmill test and maximal HR, RER, lactate, and RPE were assessed and compared to standards. Barriers were assessed immediately postexercise via open-ended questions. RESULTS: The mean VO2max was 32.9±8.8 mL/kg/min. Mean RPEmax was 17.6±1.8 versus the standard of RPE≥17 (P=0.12). Percent of age-predicted HRmax was 88.0±6.8% versus the standard of ≥95% (P<0.001). Immediate postexercise lactate was 6.8±2.4mM versus the standard of ≥8 mM (P=0.03). Maximal RER was 1.2±0.2 versus the standard of RERmax ≥1.1 (P=0.08). CONCLUSIONS: Our data provide preliminary evidence that secondary criteria may need to be adjusted for pregnant women. Additionally, physical and emotional barriers may be enhanced by pregnancy (e.g. pain, discomfort, anxiety, health concerns), and may limit the performance of pregnant women during maximal exercise.

LOWER EXTREMITY KINEMATICS OF ACL-REPAIRED AND NON-INJURED FEMALES WHEN USING KNEE SAVERS®.

BACKGROUND: Knee Savers® (KS) are an ergonomic aid purported to lessen the risk of injuries linked to deep squats. While widely used in sports such as baseball and softball, KS have not been tested to determine their effect upon lower extremity kinematics in any population. PURPOSE: The purpose of the study was to determine if KS influenced the lower extremity kinematics when females with previous anterior cruciate ligament (ACL)-reconstruction and healthy participants completed an end-range squat. STUDY DESIGN: A repeated measures, counter-balanced laboratory study design was used. METHODS: Twenty female participants (mean (SD) - age: 21.65 (2.06) yrs, height: 175.26 (9.29) cm, weight: 64.66 (7.72) kg) with a history of ACL-repair (n=10) or non-injury (n=10) completed this study. Participants completed a standardized trial of three deep squats with and without KS. Movement was analyzed using 2D video analysis methods increasingly available in clinical environments. RESULTS: During the ascending phases of a squatting motion, there was significantly greater medial (p = .009) and lateral (p = .005) motion of the patella in the frontal plane for non-injured participants, when compared to the ACL-repaired group. No significant differences were found in sagittal plane lower extremity kinematics when squatting with and without KS. Ascending angular velocity was slower in ACL-repaired than non-injured females (p = .008) and slower with the KS than without KS for non-injured females (p = .007). CONCLUSIONS: When squatting with and without KS, the non-injured group experienced more frontal plane motion at the knee, compared to the ACL-repaired group. However, while KS are purported to influence lower extremity joint positions during the bottom phase of a deep squat, the data from the current study did not support this claim. Additionally, KS appear to slow ascending velocity for those without a history of ACL-repair. These findings may have clinically meaningful implications for athletes who use KS during sport activities. LEVEL OF EVIDENCE: Level 2.

Mood and Performance Anxiety in High School Basketball Players: A Pilot Study.

Participation in competitive sport may impact psychological measures, such as mood and performance anxiety, which in turn may impact enjoyment, adherence, continued participation, and so on. This study assessed the feasibility - in terms of process, resources, management, and potential scientific value- of measuring the effect of varying competitive challenges upon the mood and performance anxiety measures of high school athletes. The participants (n=12) consisted of the boys' varsity basketball team at a high school in a rural Midwestern community. Participants completed the Profile of Mood States (POMS) to assess mood and the Sport Anxiety Scale-2 (SAS-2) to assess performance anxiety, respectively. Survey administration occurred at baseline and prior to games designated as non-conference, conference, and state tournament. A-priori feasibility measures were achieved in this prospective design. Significant correlations on the subscale measures were found on the POMS and SAS-2 administered before the four conditions in this study; Chronbach's alpha ranged from 0.54-0.94 across conditions for POMS subscales, and Chronbach's alpha ranged from 0.73-0.97 across all conditions for SAS-2 subscales, respectively. Significant differences were found across conditions in the POMS subscale confusion [F(3,33) = 5.71, p = 0.01] and in the SAS-2 subscale worry [F(3,33) = 6.13, p=0.01]. These preliminary findings suggest that the competitive conditions in this study significantly affected some measures of mood and performance anxiety in high school basketball players. These findings warrant further investigation, as well as suggest coaches could gather such information from their players, ultimately aiding in player development and team performance.

Pre- and Post-Activity Stretching Practices of Collegiate Athletic Trainers in the United States.

Popp, JK, Bellar, DM, Hoover, DL, Craig, BW, Leitzelar, BN, Wanless, EA, and Judge, LW. Pre- and post-activity stretching practices of collegiate athletic trainers in the United States. J Strength Cond Res 31(9): 2347-2354, 2017-The aim of the study was to investigate the knowledge and practices of collegiate-certified athletic trainers (ATs) in the United States. Participants (n = 521) were provided an overview of the study and a hyperlink to a web-based survey. The "pre- and post-activity practices in athletic training questionnaire" consisted of demographic items and elements to measure knowledge and practices related to pre- and post-activity stretching routines. In previous studies, the survey demonstrated construct validity, α = 0.722. Pearson chi-square test was used to evaluate goodness of fit, and kappa was calculated to measure agreement between items. Only 32.2% of ATs recommended dynamic stretching (DS) to be performed pre-activity, whereas a larger percentage (42.2%) recommended a combination of static stretching (SS) and DS. Athletic trainers reported that only 28.0% of athletes are performing DS before activity. Conversely, 60.6% of collegiate ATs recommended SS postexercise, and 61.0% of athletes agree and perform after workout SS (κ = 0.761, p < 0.001). Collegiate ATs seem to underuse the current research evidence, which indicates that DS is more beneficial than SS when used pre-activity, and ATs continue to regularly incorporate SS in their pre-activity routines. However, there is evidence that collegiate ATs in the United States emphasize SS postactivity in a manner consistent with current research.

Effects of Environmental Context on Physiological Response During Team Handball Small Sided Games.

This study examined the distance covered and physiological effects of altering the number of players during small-sided games (SSG) in team handball. Twelve professional female handball players [24.6±3.7 years, 172±6.2 cm, 68.2 ± 9.9kg, 22.7 ± 2 kg/m2] participated in this study. The SSG were played, first with five on each side (SSG 5), then four (SSG 4), then three (SSG 3). Each game was four minutes long, followed by three minutes of rest. The distance covered and time spent in four speed zones (based on player movement speed) were selected for analysis: Zone 1 (0-1.4 m/s), Zone 2 (1.5-3.4 m/s), Zone 3 (3.5-5.2 m/s), and Zone 4 (>5.2 m/s). Statistically significant differences were found in Zone 2, between conditions SSG 3 and SSG 4 (p=.049,ω2= .32). The highest average heart rate (HR) occurred during SSG 3. Average HR between SSG 3 (89.7 % HRmax) and SSG 5 (87.8 % HRmax) (p= .04, ω2= .26) were also significantly different. Participant HR response between the speed zones was not statistically significant. HR response was negatively correlated with the number of players within the SSG condition. Statistically significant results were found for RPE between SSG 3 and the other two SSG conditions (SSG 4, p = .01, and SSG 5, p = .00). These results indicate that changing the number of SSG players can be used to manipulate the physiological response during handball training.

Physical therapist screening and differential diagnosis for traumatic-onset elbow pain: A case report.

BACKGROUND AND PURPOSE: Elbow pain can originate from many sources yet have similar signs and symptoms, thereby presenting differential diagnostic challenges. The elbow is commonly injured, thus requiring all clinicians to possess excellent diagnostic skills. CASE DESCRIPTION: A 24-year-old woman slipped and fell on her outstretched left hand, experiencing immediate elbow pain. The same day radiographs were deemed negative by her orthopedist, who referred her to physical therapy with the diagnoses of elbow sprain and contusion. Immediately after examining the patient, the physical therapist consulted with the referring orthopedist. The decision to consult was based on: the mechanism of injury, pain severity out of proportion to the referred diagnoses, significantly limited ROM, abnormal joint end feels, exquisite pain with tactile and tuning fork bony palpation, and positive elbow extension test. OUTCOMES: The treating physical therapist shared the above-noted findings with the orthopedist, who overruled and recommended continuing the original prescription of non-steroidal anti-inflammatory medication and physical therapist treatment for four weeks. The physical therapist's updated plan of care at four weeks noted the patient's continued reports of pain, functional limitations, and disability. A magnetic resonance image (MRI) was then ordered, revealing a radial head fracture. DISCUSSION: A thorough history and examination by the physical therapist led to clustering of signs and symptoms, allowing for the development of a differential diagnosis list which included occult radial head fracture. All clinicians should be prepared to screen for complex conditions. Timely diagnosis and improved outcomes for clinically complex patients are increasingly necessary in contemporary healthcare reimbursement models.

Effects of acute androstenedione supplementation on testosterone levels in older men.

The purpose of the study was to examine the effects of acute androstenedione supplementation on hormone levels in older men at rest and during exercise. Men (n = 11) between the ages of 58 and 69 were divided into an experimental (n = 6; 62.33 ± 2.57 y) and control (n = 5; 60.2 ± 1.02 y) groups. Each participant received an oral 300 mg dose of either androstenedione (experimental) or a cellulose placebo (control) for 7 d. Pre- and post-supplementation participants completed two separate, 20-min strength tasks consisting of leg extension and leg curls at different percentages of their 10-RM. Researchers collected blood samples pre-, during, and post-exercise. Blood samples were analyzed for testosterone, androstenedione, and estradiol levels. The researchers found a significant difference between pre- (4.36 ± 56 ng/mL) and post- (5.51 ± 0.35 ng/mL) testosterone levels, as well as pre- (0.88 ± 0.20) and post- (7.46 ± 1.25) androstenedione levels, but no significant differences between pre- and post-estradiol levels for either group. It appears that short-term androstenedione supplementation augmented acute testosterone responses to resistance exercise in older men. However, further study of this supplement is needed to determine any potential it may have in mitigating andropause.