Prophylactic Ankle Bracing in Military Settings: A Review of the Literature.

BACKGROUND: Within athletics and the military, ankle sprains are one of the most common injuries with the potential for long-term functional deficits. Incidence rates for ankle sprains within the military are one of the leading causes of limited duty days, especially during basic combat training, parachute training exercises, and in cadet populations. In 2008, the Department of Defense U.S. Army Center for Health Promotion and Preventative Medicine report recommended that military personnel should wear semirigid ankle braces during parachuting, basketball, soccer, and other similar high-risk activities to reduce ankle sprain injuries. This recommendation was developed using a majority of athletic references with limited data stemming from military works. Of these included military studies, none presented data on ankle braces and their effects on performance, especially in military-specific environments. The purpose of this review was to provide an up-to-date account on the use of ankle braces in military populations and effects on performance measures. METHODS: A comprehensive online systematic review of the literature was conducted to delineate the current use of ankle braces in the military and how they specifically affect functional performance measures. The scope of this study eliminated military studies that were not prospective in nature or did not incorporate subjects wearing military equipment (i.e., combat boots). FINDINGS: It was determined that little progress has been made in validating the use of semirigid ankle braces in military populations other than in instances such as parachuting and only in reducing the number ankle injuries. To date, only one study has looked specifically at the use of ankle braces and its effects on performance measures in a military sample. DISCUSSION: With the high incidence rate and increased risk for subsequent reinjury, ankle sprains are an economic and force readiness burden to the U.S. Armed Forces. This study was conducted to determine whether additional literature was available for the use of ankle braces on performance measures in the military. It was determined that there is a scarcity of information currently available on the use of ankle braces in military populations, outside of parachuting activities. The Department of Defense recommendation of using semirigid ankle braces may ultimately be beneficial to a multitude of high-risk military activities, but further research must be conducted to determine possible detrimental performance effects.

Injury and illness epidemiology at a summer sport-camp program, 2008 through 2011.

CONTEXT: University-sponsored summer sport camps often employ athletic trainers; however, there is a dearth of epidemiologic studies describing the injury and illness experience of sport-camp participants to guide clinicians. OBJECTIVE: To describe the injury and illness experience of youth participants at a university-sponsored summer sport-camp program during a 4-year period. DESIGN: Descriptive epidemiology study. SETTING: A National Collegiate Athletic Association Division I university that sponsored 76 to 81 camps for 28 sports each summer. PATIENTS OR OTHER PARTICIPANTS: A total of 44, 499 camp participants enrolled during the 4 years. Male and female participants ranged in age from 10 to 17 years and in athletic skill from novice to elite. MAIN OUTCOME MEASURE(S): Data from handwritten injury and illness log books, maintained by sports health care personnel, were accessed retrospectively, entered into an electronic spreadsheet, and coded. Data were applied to the National Athletic Injury/Illness Reporting System. Participant-personnel contacts, defined as any instance when a participant sought health care services from personnel, were calculated per 100 participants. Injury and illness rates were calculated per 10 ,000 exposures, measured in participant-days. The distribution of injury and illness conditions and affected body regions were calculated. RESULTS: There were 11 ,735 contacts, for an overall rate of 26 per 100 participants, and 4949 injuries and illnesses, for a rate of 1 per 10, 000 participant-days. Participants at single-sex camps were less likely to sustain injuries and illnesses than participants at coeducational camps (rate ratio [RR] = 0.49; 95% confidence interval = 0.45, 0. 35; P < .001, and RR = 0.47; 95% confidence interval = 0.43, 0.51; P < .001, respectively). The lower extremity was injured most frequently (27.9%). Most injury and illness conditions were dermatologic (37.1%). CONCLUSIONS: The contact and injury and illness differences observed among sports and between sexes demonstrated potential differences in the sports health care needs of camp participants. These data can be used to make evidence-based clinical decisions, such as determining injury-prevention strategies and sports health care staffing needs.

Factors associated with anterior cruciate ligament injury: history in female athletes.

AIM: Little is known about the association of lower extremity structural malalignments, flexibility patterns, generalized laxity, postural control, previous ankle sprain history and the increased risk of anterior cruciate ligament (ACL) injuries in females. We hypothesized that females with a history of ACL injury would be more likely to have a history of prior ankle sprain and different structural alignments than females without a history of ACL injury. METHODS: It is a case control study: 33 young adult females with a history of an ACL injury and 33 controls with no history of knee injury provided their knee and ankle injury history and had 16 lower extremity measures taken. RESULTS: The factors most associated with ACL injury history were greater generalized laxity (r(2) change: 0.073), greater genu recurvatum (r(2) change: 0.069), and decreased iliotibial band (ITB) flexibility (r(2) change: 0.069). There was also a significant association between ACL injury history and previous ankle sprain injury history (chi squared=5.27; P=0.02). Those with a history of ACL injury were more likely to have had a prior ipsilateral ankle sprain. CONCLUSION: Increased generalized laxity, greater genu recurvatum, and decreased ITB flexibility discriminated between females with and without history of ACL injury. A relationship linking previous ankle injury and ACL injury risk was found. Taking a thorough medical history and screening for generalized laxity, genu recurvatum, and a tight ITB in those with a history of LAS, may help identify those at risk for an ACL injury and who may benefit most from preventive measures.

Static innominate asymmetry and leg length discrepancy in asymptomatic collegiate athletes.

The objectives of the study were to assess: (1) static innominate asymmetry in the sagittal plane, (2) leg length discrepancy (LLD), and (3) the relationship between static innominate rotation and LLD in asymptomatic collegiate athletes. The study was an observational study by design which took place in a University athletic training research laboratory. The participants were twenty-four male and 20 female asymptomatic intercollegiate athletes who volunteered to take part in the study. Static innominate asymmetry was assessed with a caliper/inclinometer tool and LLD was measured with a tape measure using standard clinical methods. Results showed that forty-two subjects (95%) demonstrated some degree of static innominate asymmetry. In 32 subjects (73%), the right innominate was more anteriorly rotated than the left. Nearly all subjects were determined to have unequal leg lengths with a majority, 30 subjects (68%), showing a slightly longer left leg. Weak correlations (r=0.33 - 0.44) were identified between static innominate asymmetry and LLD. In Conclusion static innominate asymmetry and LLD are common among asymptomatic collegiate athletes. This information provides clinicians with normative data of common clinical measures in a physically active population.

Effect of rearfoot orthotics on postural sway after lateral ankle sprain.

OBJECTIVE: To investigate the effects of different rearfoot orthotics on postural sway during unilateral stance after lateral ankle sprain. DESIGN: Repeated-measures 3-factor analysis of variance on postural sway length and velocity in the frontal and sagittal planes with factors being stance leg (injured, uninjured), session (within 3 d, 2 wk, 4 wk postinjury), and condition (6 orthotic conditions). SETTING: University biomechanics laboratory. PATIENTS: Fifteen collegiate athletes with acute, unilateral first- or second-degree lateral ankle sprain. INTERVENTIONS: Balance testing was performed under 6 conditions: (1) shoe only, (2) molded Aquaplast orthotic, (3) lateral heel wedge, (4) 7 degrees medially posted orthotic, (5) 4 degrees laterally posted orthotic, and (6) neutral orthotic. MAIN OUTCOME MEASURES: Postural sway length and postural sway velocity in the frontal and sagittal planes. RESULTS: Significant main effects were found for side and session, but not orthotic condition, for all 4 dependent variables. Postural sway length and velocity were greater on the injured limbs as compared with the uninjured limbs during the first 2 sessions but not during the third session. None of the orthotics significantly reduced postural sway compared with the shoe-only condition after lateral ankle sprain. CONCLUSIONS: Rearfoot orthotics, irrespective of design or posting, were ineffective at improving postural sway after lateral ankle sprain.

Serial Testing of Postural Control After Acute Lateral Ankle Sprain.

OBJECTIVE: To identify subjects' changes in postural control during single-leg stance in the 4 weeks after acute lateral ankle sprain. DESIGN AND SETTING: We used a 2 x 2 x 3 (side-by-plane-by-session) within-subjects design with repeated measures on all 3 factors. All tests were performed in a university laboratory. SUBJECTS: Seventeen young adults (9 men, 8 women; age, 21.8 +/- 5.9 years; mass, 74.9 +/- 10.5 kg; height, 176.9 +/- 7.1 cm) who had sustained unilateral acute mild or moderate lateral ankle sprains. MEASUREMENTS: Measures of center-of-pressure excursion length, root mean square velocity of center-of-pressure excursions (VEL), and range of center-of-pressure excursions (RANGE) were calculated separately in the frontal and sagittal planes during 5-second trials of static single-leg stance. RESULTS: We noted significant side-by-plane-by-session interactions for magnitude of center-of-pressure excursions in a given trial (PSL) (P =.004), VEL (P =.011), and RANGE (P =.009). Both PSL and VEL in the frontal plane were greater in the injured limbs compared with the uninjured limbs on day 1 and during week 2 but not during week 4, whereas sagittal-plane differences existed during all 3 testing sessions. Injured-limb, frontal-plane RANGE scores were greater than uninjured values at day 1 but not during weeks 2 or 4. No significant differences in sagittal-plane RANGE scores were seen. CONCLUSIONS: Postural control was significantly impaired in the injured limbs at day 1 and during week 2 after lateral ankle sprain but not during week 4. Consistent improvement in postural control measures on both injured and uninjured limbs was seen throughout the 4 weeks after ankle sprain.

Educational History, Employment Characteristics, and Desired Competencies of Doctoral-Educated Athletic Trainers.

OBJECTIVE: The study had 3 objectives: (1) to assess the educational history of doctoral-educated certified athletic trainers (ATCs) who work at academic institutions, (2) to determine the current employment characteristics of doctoral-educated ATCs who work at academic institutions, and (3) to identify which competencies doctoral-educated ATCs feel are important for new doctoral graduates to possess upon graduation. DESIGN AND SETTING: Multiple sources were used to identify doctoral-educated ATCs who work at academic institutions. These individuals were surveyed to assess their educational histories, current employment characteristics, and opinions on desired competencies for new doctoral graduates. Data were analyzed using descriptive and inferential statistics. SUBJECTS: Surveys were sent to 130 individuals, and the response rate was 89.2% (n = 116). MEASUREMENTS: Subjects answered questions regarding their educational history and employment characteristics. A 5-point Likert scale was used to assess the importance of 22 competencies for new doctoral graduates to possess upon graduation. Comparisons were made between program directors and non-program directors, respondents employed at doctoral-granting institutions and non-doctoral-granting institutions, and doctoral student advisors and non-advisors. RESULTS: Subjects reported several different educational backgrounds, job titles, and job responsibilities. Significant differences in job responsibilities and assessment of desired competencies were found between program directors and non-program directors, employees of doctoral-granting institutions and non-doctoral-granting institutions, and doctoral student advisors and non-advisors. CONCLUSIONS: As new doctoral programs are established in athletic training, students should receive training as classroom instructors and program administrators, in addition to learning the skills necessary to perform independent research in athletic training.

Desire for weight gain and potential risks of adolescent males using anabolic steroids.

This study examined the perceptions of adolescent males regarding their physical strength, health status, and desire to gain weight and their perceptions of anabolic steroid use. Subjects were 12th-grade boys (N = 3403), drawn from a pool of 150 high schools nationwide, who completed a health questionnaire. Analysis indicated 47.0% (n = 1475) who wanted to gain weight, perceived themselves as of less than average strength and having good health, and were sports participants. Also, among those who desired weight gain, about 24% (n = 345) were not sure about the most dangerous health risks associated with anabolic steroid use, and 16% (n = 221) did not want to see the use of anabolic steroids in sports stopped. The findings indicate that adolescent boys, who desired weight gain and currently abstained from anabolic steroid use, might be at risk for becoming users.

An in vitro biomechanical study of the static stabilizing effect of lateral prophylactic knee bracing on medial stability.

We attempted to determine if the selected lateral prophylactic knee braces (ie, Anderson Knee Stabler-101W, Don Joy-PKG and McDavid Knee Guard) were effective at stabilizing the medial collateral ligament against valgus loading to the knee joint. We tested 23 volunteer subjects under each of three braced conditions, plus a nonbraced condition. Applying stress to the lower leg of the subjects, we measured and recorded the linear displacement of the tibia in abduction and/or adduction. We analyzed the data, using a repeated measures ANOVA. There were no differences between the bracing conditions. We concluded that the three knee braces were not effective at stabilizing the knee joint from a static valgus force.

The injury experience of the competitive athlete with a disability: prevention implications.

The purpose of this project was to describe the injury experiences of athletes with disabilities. A cross-disability instrument was developed to measure variables of interest. A retrospective survey was administered to 426 athletes who participated at the 1989 national competition of the National Wheelchair Athletic Association (NWAA), United States Association for Blind Athletes (USABA), and the United States Cerebral Palsy Athletic Association (USCPAA). The definition of injury was any trauma to the participant that occurred during any practice, training, or competition session that caused the athlete to stop, limit, or modify participation for 1 d or more. Thirty-two percent (N = 137) of the total respondents reported at least one time-loss injury. By organization, 26% of the total injuries were from the NWAA and 37% were from the USABA and USCPAA, respectively. The shoulder and arm/elbow accounted for 57% of the total NWAA injuries. Fifty-three percent of the injuries to the USABA athlete were to the lower extremity. Injuries to the USCPAA athlete were distributed among four body locations, knee (21%), shoulder (16%), forearm/wrist (16%), and leg/ankle (15%). The athlete with a disability demonstrated approximately the same percentage of injury as the athlete without a disability in similar sport activities. Biomechanical considerations of locomotion and specific sport skills should be analyzed by experts to reduce the percentage of injuries.

The injury experience and training history of the competitive skier with a disability.

The purpose of this investigation was to describe the training history and injury experience of the competitive skier with a disability. A retrospective survey was administered to 68 athletes who participated in the National Handicapped Sports and the United States Association for Blind Athletes Winter National Games held in March 1989. The frequency, length, and specific components of the practice session were obtained. The definition of injury was any trauma to the participant that occurred during any practice, training, or competitive session that resulted in the cessation, limitation, or modification of the athlete's participation for at least 24 hours. The athletes practiced aerobic, anaerobic, and strength training activities two times a week or less. Upper extremities were injured 1.4 times more often than the lower extremities. The number of chronic injuries was greater than the number of acute injuries for both the upper and lower extremity. The thigh and knee were involved in 30% of the acute injuries, followed by the shoulder (25%), and neck and spine (15%). For chronic injuries, the shoulder, thigh/knee complex, and arm and elbow accounted for 73.3% of the total injuries reported. The skier with a disability incurred approximately the same proportion of injuries as the skier without a disability. Conditioning programs should be developed to emphasize both the aerobic and anaerobic energy systems to reduce the number of injuries.

The Wentworth Center for Clinical Engineering: a collaborative and interactive venture.

A program has been developed in Boston to bring together hospital and industrial biomedical engineers, BMETs, CEs, nurses, physicians, the Massachusetts Medical Devices Society, academic engineering technologists, and students. This program is headquartered at the Center for Clinical Engineering at the Wentworth Institute of Technology, and is designed to serve and support the interests of the participants for educational, professional, networking and interdisciplinary activities. Because of the availability of engineering technology programs at Wentworth, and the willingness of local professionals to participate, a comprehensive and unique program has been developed to train BMETs and CEs. This program emphasizes hands-on electronic technology, biomedical lectures and laboratories, management lectures and in-hospital preceptorships under the supervision of BMETs, CEs, biomedical directors and nurses.

Estimated prevalence of anabolic steroid use among male high school seniors.

The use of anabolic-androgenic steroids (AS) is perceived by the media, by segments of the sports medicine and athletic communities, and by the public to have grown to epidemic proportions. Unfortunately, the incidence and prevalence of AS use among elite, amateur, and recreational athletes is poorly documented. This study was designed to help identify AS use patterns among the male portion of the general adolescent population. The overall participation rate on a schoolwide basis was 68.7% and on an individual basis reached 50.3%. Participants in this investigation were 12th-grade male students (N = 3403) in 46 private and public high schools across the nation who completed a questionnaire that established current or previous use of AS as well as user and nonuser characteristics. Results indicate that 6.6% of 12th grade male students use or have used AS and that over two thirds of the user group initiated use when they were 16 years of age or younger. Approximately 21% of users reported that a health professional was their primary source. The evidence indicates that educational intervention strategies should begin as early as junior high school; the intervention should not be directed only toward those individuals who participate in school-based athletics.

Concussions in college football. A multivariate analysis.

The purpose of this investigation was to examine risk patterns of concussion in college football. Multivariate models were used to interpret the data. Specifically, log-linear modeling and analysis techniques were incorporated into the investigation. An average of 49 college teams were studied over the 8 year period 1975 to 1982. This represented over 36,000 athlete-seasons and 395 team-seasons. The data selected were limited to 1,005 game-related concussions. The general hypotheses tested were the null hypothesis that the variables of team (offense and defense), player position, situation (rushing and passing), and activity (block and tackle) had no effect on the occurrence of these game-related concussions. It was found that concussions were a persistent and regular but relatively infrequent type of injury in college football. Concussions accounted for 75% of the total number of injuries on or about the head. The injuries were examined relative to player position, situation, and activity using a log-linear modeling technique, with interactions among the variables also established. The contribution of each variable was not always equal or completely interactive. Generally, the highest risk of concussion was associated with offensive and defensive players involved in a block on a rushing play. Specifically, running backs demonstrated the highest risk of concussion, regardless of activity. The lowest risk was for offensive linemen and quarterbacks while blocking on any type of play. On defense, the secondary exhibited the highest risk of concussion while being blocked on a running play. Similarly, linemen experienced their greatest risk while being blocked on plays run inside the tackle.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-Reported Use of Anabolic-Androgenic Steroids by Elite Power Lifters.

In brief: Sixty-one athletes competed in the 1987 National Championship of the US Powerlifting Federation; all were surveyed to obtain information on anabolic-androgenic steroids regarding attitudes, patterns of use, and health effects. Of the 45 who responded to the survey, 15 admitted having used steroids. In a follow-up telephone interview of 20 of the competitors, 11 reported previous steroid use. The reason given most often for using steroids was improved athletic performance; the most common side effects reported were heightened libido, acne, and increased body hair. The small number of admitted users suggests that underreporting took place; this level of use probably represents the lower bound of steroid use among power lifters.

Problems in ground integrity testing.

This paper discusses the present Standards requirements and techniques for the testing of ground circuitry. The authors have found problems in the accepted standards and offer observations and testing protocols substantiating their claims. An alternate testing procedure is suggested for determining the integrity of grounding circuits.