How traditional undergraduate college students define and perceive wellness: A qualitative phenomenological study.

OBJECTIVE: To understand college students' perceptions and understanding of wellness. PARTICIPANTS: A convenience sample of 20 undergraduate students (age 20.6 ± 2.2 years) at a private liberal arts university in Southern California who recently completed a general education health and wellness course. METHOD: Five focus group sessions were conducted to explore perceptions of wellness among undergraduate college students. Data was analyzed, themed, and coded. RESULTS: A thematic analysis of the descriptions of wellness revealed 2 higher-ordered themes as whole-person and wellbeing, and 3 lower-ordered themes of balance, interconnectedness, and personalized in relation to participants' understanding of wellness. CONCLUSIONS: The importance of balance between wellness dimensions and the acknowledgment of the interconnectedness of wellness dimensions are related to quality of life and life satisfaction. A deeper insight is needed to better understand the perceptions of wellness in this population to provide more effective interventions. This can be achieved through the development of enhanced pedagogy, which may improve student health.

Motivation and Behaviors Related to Sport Specialization in College Baseball Players.

CONTEXT: Early sport specialization is a growing concern among youth sports athletes, particularly in baseball. Motivation to participate in sports is an important factor in determining which sports youth athletes participate in and why. OBJECTIVE: The purpose of this study was to qualitatively investigate youth sport participation behaviors and motivations of college baseball players. DESIGN: Qualitative Study. SETTING: Online Teleconference. PATIENTS OR OTHER PARTICIPANTS: We conducted 25 semi-structured interviews with college baseball athletes who were classified as either high-level (n=8), moderate-level (n=9), or low-level specialists (n=8) prior to college. DATA COLLECTION AND ANALYSIS: Participants completed an individual semi-structured interview to develop an understanding of the participants' youth and high school sports experiences and associated motivations to participate in those experiences. A framework analysis approach was used to analyze transcript data to identify themes among the three specialization groups. RESULTS: From our interview analysis, six overall themes emerged among the groups: (1) Motivation, (2) Stress, (3) Quitting, (4) Barriers, (5) Facilitators of Success, and (6) Future Directions. Moderate and high-level specialists described higher levels of passion, participating in deliberate practice, higher levels of performance-related stress, and a desire to quit sports more than low-level specialists. None of the groups described parents as an overbearing external motivator to participate in sports at an early age. CONCLUSIONS: Participants who were classified as low-, moderate-, and high-level specialists described different experiences related to their motivation, stress levels, desire to quit, barriers to participating in baseball, facilitators of success, and their overall future career goals after completing baseball. This information may be useful for parents, coaches, and health care professionals to better communicate the benefits and risks associated with sport specialization to youth athletes. Future research is needed to determine if differences in motivation levels exist in younger populations.

Early Sport Specialization and Long-term Throwing Arm Health in College Baseball Players.

BACKGROUND: Early sport specialization is associated with increased risk of overuse injuries in several sports, including baseball. However, limited evidence exists evaluating how early sport specialization affects patient-reported outcome measures as they age. The purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Scores among collegiate baseball players based on the grade when a participant first reported high specialization behaviors. HYPOTHESIS: Baseball players who were highly specialized at a younger age will have worse throwing arm health while participating in college. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 752 college baseball players was contacted through their institution's athletic trainer. We measured baseball specialization and KJOC scores using the validated Baseball and Sport Experience survey. Data were summarized using means and SDs, medians and interquartile ranges (IQRs), and frequencies and percentages. A Kruskal-Wallis test was used to determine differences in mean KJOC scale scores based on the earliest time the participant reported high-level specialization. RESULTS: A total of 294 baseball players completed the survey (response rate: 39.1%). Of the 294 participants, 280 completed the KJOC scale questions to generate a total KJOC score (median: 90.5; IQR: 76.6-97.2). No significant differences in KJOC total scores (P = 0.78) existed based on the grade period in which the athlete was first highly specialized. CONCLUSION: Early baseball specialization as a youth baseball player may not impact throwing arm health in college baseball athletes. CLINICAL RELEVANCE: Early specialization has been linked to increased risk for overuse injuries in certain sports, but may not lead to poorer throwing arm health in college baseball players. Sports medicine clinicians and researchers may use this information to educate various stakeholders about the benefits and risks associated with early sport specialization.

Faculty Use and Perceptions of Service-Learning in Radiologic Science Education.

PURPOSE: To investigate faculty integration of service-learning into radiologic science curricula and its effects on faculty and students. METHODS: An online survey was distributed to radiologic science faculty to assess the status of service-learning in radiologic science education. Invitations were sent to 2351 faculty in diagnostic medical sonography, nuclear medicine technology, radiation therapy, and radiography programs. Quantitative analysis using descriptive statistics was performed on the raw data, and mind maps were created from responses to open-ended questions for qualitative analysis. RESULTS: A total of 444 surveys were returned, for a 19% response rate. Faculty who incorporated service-learning into their courses reported outcomes of increased professionalism, leadership, career skills, empathy, and community awareness. Primary deterrents for integrating service-learning into curricula were lack of faculty and student time and logistical challenges. DISCUSSION: The most profound professional benefits of service-learning reported were increased community awareness and relationships among faculty, community, and students. Faculty also indicated that service-learning improved professional effectiveness in terms of knowledge and application. Survey results indicated that service-learning provides students with experiences relevant to the environment they will encounter after graduation. Faculty who use service-learning reported additional benefits for themselves and their students, including having a richer understanding of the community and its members, which ultimately improves critical soft-skills of practice. CONCLUSION: Faculty who use service-learning in their courses and those who plan to use it in the future reported that logistical management and institutional support in the form of release time (ie, counting course development time toward teaching load requirements) are of paramount importance. This type of support would help engage faculty in developing and maintaining service-learning coursework.

Community-associated Methicillin-Resistant Staphylococcus aureus Infection Rates and Management among Student-Athletes.

PURPOSE: Although community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have reduced among inpatient populations, the incidence in athletics continues to range greatly dependent on the sport. Over the 2015 to 2016 and 2016 to 2017 school years, we assessed the annual CA-MRSA incidence, sport risk, referral practices, and management protocols or interventions among high school and intercollegiate athletics. METHODS: This study targeted high school and intercollegiate athletic programs across the United States. For the 2015 to 2016 study, 269 athletic trainers completed a one-time questionnaire. In the 2016 to 2017 study, 217 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions. RESULTS: The CA-MRSA infection incidence was 26.8 per 10,000 athletes (95% confidence interval [CI], 24-30) in 2015-2016 and 20.3 per 10,000 athletes (95% CI, 18-23) in 2016-2017. The CA-MRSA infection incidence was high in wrestling and football compared to the general student-athlete population. During the 2015 to 2016 study, the wrestling incidence rate was 248.3 per 10,000 (95% CI, 204-302); the football incidence rate was 71.0 per 10,000 (95% CI, 60-85). In the 2016 to 2017 study, the wrestling incidence rate was 100.0 per 10,000 (95% CI, 66-151); the football incidence rate was 81.8 per 10,000 (95% CI, 68-99). At least 23% of respondents denoted at least one physician-confirmed CA-MRSA infection within their populations (2015-2016, 39%, n = 105; 2016-2017, 23.5%, n = 51). In the 2015 to 2016 survey, respondents indicated that athlete education and environmental decontamination were the most used management steps (51.8%, n = 582). CONCLUSIONS: Despite increased awareness of CA-MRSA, more educational efforts focusing on best practices and education are needed, especially with athletes and the medical community involved in their care.

CA-MRSA Infection Incidence and Care in High School and Intercollegiate Athletics.

PURPOSE: Position papers offer solutions to manage community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), yet few studies establish the infection rate, management protocols, and referral practices among student-athletes. Over the 2012-2013 and 2013-2014 school years, we assessed the annual CA-MRSA infection incidence, sport risk, referral practices, and management steps among high school and intercollegiate athletics. METHODS: This study targeted high school and intercollegiate athletic programs in the Northeastern United States. For the 2012-2013 study, 156 athletic trainers completed a one-time questionnaire. In the 2013-2014 study, 87 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions. RESULTS: The CA-MRSA infection incidence was 15.5 per 10,000 athletes (95% confidence interval [CI], 13-19) in 2012-2013 and 16.3 per 10,000 athletes (95% CI, 13-21) in 2013-2014. The CA-MRSA infection incidence was higher in wrestling and football compared to the general student-athlete population. During the 2012-2013 study, the wrestling incidence rate was 90.2 per 10,000 (95% CI, 62-132); the football incidence rate was 42.3 per 10,000 (95% CI, 31-59). In the 2013-2014 study, the wrestling incidence rate was 89.0 per 10,000 (95% CI, 50-158); the football incidence rate was 61.4 per 10,000 (95% CI, 42-90). In both studies, primary care and general physicians received over 60% (2012-2013: 60.5%, n = 133; 2013-2014: 66.5%, n = 125) of referrals. In the 2012-2013 study, respondents indicated that student-athlete isolation and setting decontamination were common management steps used (58.1%, n = 306). CONCLUSIONS: The incidence of CA-MRSA infections among student-athletes remains high. Therefore, it is critical that sports medicine providers continually reassess management protocols and best practices.

Diagnosis, treatment, and rehabilitation of stress fractures in the lower extremity in runners.

Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence.

Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in and around therapeutic whirlpools in college athletic training rooms.

CONTEXT: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a leading cause of skin and soft tissue infection in the nonhospitalized community. Care of the athletes in athletic training rooms is specifically designed with equipment tailored to the health care needs of the athletes, yet recent studies indicate that CA-MRSA is still prevalent in athletic facilities and that cleaning methods may not be optimal. OBJECTIVE: To investigate the prevalence of Staphylococcus aureus and CA-MRSA in and around whirlpools in the athletic training room. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletic Association Division I university. PATIENTS OR OTHER PARTICIPANTS: Student-athletes (n = 109) consisting of 46 men (42%) and 63 women (58%) representing 6 sports. MAIN OUTCOME MEASURE(S): Presence of MRSA and Staphylococcus aureus in and around the whirlpool structures relative to sport and number of athletes using the whirlpools. RESULTS: We identified Staphylococcus aureus in 22% (n = 52/240) of the samples and MRSA in 0.8% (n = 2/240). A statistically significant difference existed between the number of athletes using the whirlpool and the presence of Staphylococcus aureus in and around the whirlpools (F(2,238) = 2.445, P = .007). However, Staphylococcus aureus was identified regardless of whether multiple athletes used a whirlpool or no athletes used a whirlpool. We did not identify a relationship between the number of athletes who used a whirlpool and Staphylococcus aureus or MRSA density (P = .134). CONCLUSIONS: Staphylococcus aureus and MRSA were identified in and around the whirlpools. Transmission of the bacteria can be reduced by following the cleaning and disinfecting protocols recommended by the Centers for Disease Control and Prevention. Athletic trainers should use disinfectants registered by the Environmental Protection Agency to sanitize all whirlpools between uses.

Suprascapular neuropathy in collegiate baseball player.

BACKGROUND: Suprascapular neuropathy (SSN) is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release. CASE PRESENTATION: A 20 year-old male baseball pitcher with right shoulder pain reported for athletic training evaluation, was treated conservatively, and due to lack of resolution was referred for further imaging and evaluation by an orthopedist. Following inconclusive magnetic resonance imaging findings the patient underwent electrodiagnostic testing which showed decreased nerve conduction velocity of the right suprascapular nerve. The patient elected for surgical intervention. Post-operative rehabilitation followed and the patient was able to pitch in 22 weeks. The patient provided positive subjective feedback and was able to return to unrestricted pitching without pain, loss of velocity, or loss in pitch control. CONCLUSION: This study demonstrates a need for further investigation into the most appropriate treatment and rehabilitation of suprascapular nerve injury.

Athletic trainer perceptions of life-work balance and parenting concerns.

CONTEXT: Life-work balance may be one reason for retention concerns among athletic trainers (ATs), yet evidence does not exist to support the supposition. OBJECTIVE: To assess the perceptions of ATs regarding life-work balance, specifically on parenting issues. DESIGN: Survey. SETTING: Online survey at www.surveymonkey.com . PATIENTS OR OTHER PARTICIPANTS: A random sample of National Athletic Trainers' Association members (N = 9516) received the survey; 20.6% (n = 1962; male = 954, female = 816; age = 37 ± 10 years, experience = 13 ± 9 years) completed any portion of the survey. Most respondents worked in the college/university (34.5%, n = 657 of 1908) and secondary school settings (25.9%, n = 476 of 1908). A majority of participants (50.7%, n = 898 of 1770) were parents. INTERVENTION(S): We calculated frequencies and percentages and used Mann-Whitney U tests and Kruskal-Wallis tests to identify the differences between sexes and among job settings on life-work balance measures among parents. MAIN OUTCOME MEASURES: The questionnaire included 8 life-work balance items, 7 parenting challenge items, and 3 nonparent items. RESULTS: The results indicate that sex and setting significantly affected perceptions about parenting. Males articulated a stronger sense of difficulty in finding balance as a working parent (P < .001; 1.95 ± 1.98). Females felt more strongly than males that managing work and family was stressful (P = .04; 3.86 ± 1.13) and caused burnout (P = .004; 3.50 ± 1.24), and that their energy tended to fall short of their needs (P < .001; 3.74 ± 1.15). The decision not to have children was strongly affected by the work setting (P = .014; 3.37 ± 1.42). Both college/university (4.14 ± 0.85) and secondary school (4.03 ± 0.90) ATs would prefer to spend more time at home, as compared with ATs in other settings (P < .001). College/university ATs (P = .025; 3.17 ± 1.23) felt most strongly that their families were neglected because of work. In none of the settings did ATs feel that their employment settings were particularly tolerant of their parenting responsibilities (P = .027; 1.72 ± 1.97). CONCLUSIONS: Male and female employees had similar perceptions of life-work balance, but occupational setting may affect these perceptions.

Exertional rhabdomyolysis in a collegiate american football player after preventive cold-water immersion: a case report.

OBJECTIVE: To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion. BACKGROUND: A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%-30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/mL). The attending physician treated the athlete with intravenous fluids. DIFFERENTIAL DIAGNOSIS: Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis. TREATMENT: The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). UNIQUENESS: The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. CONCLUSIONS: In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence.

Sacral stress fracture in a distance runner.

Sacral stress fractures are uncommon injuries that are associated with repetitive load-bearing activities. The authors describe a 23-year-old male cross-country runner who presented with low back and buttocks pain. Radiographic findings were unremarkable, but a hop test identified a sacral stress fracture. The patient was instructed to stop running and to take calcium and vitamin D supplements. Four months later, his symptoms completely resolved and he began running again. The authors also present a review of the literature, which revealed that patients with sacral stress fractures are likely to have normal neurologic examinations and full active range of motions. However, they will likely describe discomfort with passive hip flexion. The authors recommend the hop test for patients with this type of history and these physical examination findings. If a sacral stress fracture is found, treatment regimens should consist of 4 to 6 weeks of rest with gradual return to activity.

Age, sex, and setting factors and labor force in athletic training.

CONTEXT: Occupation or occupational setting shifts might be occurring in the athletic training profession, and differences between sexes might exist; however, little evidence exists to confirm this supposition. OBJECTIVE: To evaluate trends in male and female athletic training employment patterns in terms of age and occupational setting. DESIGN: Cross-sectional study. SETTING: We requested demographic data from the National Athletic Trainers' Association (October 27, 2009) and obtained frequency totals of members by sex across the occupational life span by occupational setting. PATIENTS OR OTHER PARTICIPANTS: Our sample included 18 571 athletic trainers employed in the 3 largest classifications of occupational settings within the profession: college or university, clinical, and secondary school. MAIN OUTCOME MEASURE(S): We calculated frequencies and percentages to determine demographic and descriptive data. We analyzed the data using an analysis of variance to identify the differences between sexes across age and setting. RESULTS: We observed trends in occupational setting and sex across ages 22 to 67 years. We identified differences between sexes across the ages 22 to 67 years (F(1,18569) = 110818.080, P < .001, η(2) = .068) and across occupational settings (F(1,18569) = 61.908, P < .001, η(2) = .003), noting a marked decline in female athletic trainers in the workforce beginning around age 28 years and an increase in male athletic trainers in the secondary school setting beginning around their middle to late 40s. We observed differences at the intercept between setting and sex (F(1,18569) = 63529.344, P < .001, η(2) = .845), which were greater when observed across the ages (F(1,18569) = 23566787.642, P < .001, η(2) = .939). CONCLUSIONS: We identified differences between sexes across settings and ages in addition to an overall decrease in the workforce among all professionals. A marked decline in female athletic trainers occurred at age 28 years, yet the male population increased at the secondary school level, suggesting a setting shift. Burnout, fatigue, pay scale, and a misunderstanding of professional culture and job duties might influence the exodus or shift in athletic training.

Certified athletic trainers' knowledge of methicillin-resistant Staphylococcus aureus and common disinfectants.

CONTEXT: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in athletic settings. The MRSA knowledge and infection-control practices of certified athletic trainers (ATs) and the cleanliness of the athletic training room are important factors in preventing MRSA infections. OBJECTIVE: To assess knowledge of MRSA and the use of common disinfectants among ATs and to explore their infection-control practices. DESIGN: Cross-sectional study. SETTING: High school and collegiate athletic training rooms. PATIENTS OR OTHER PARTICIPANTS: A total of 163 ATs from National Collegiate Athletic Association Divisions I, II, and III and high schools, representing all 10 National Athletic Trainers' Association districts. MAIN OUTCOME MEASURE(S): Frequencies, analyses of variance, and χ(2) tests were used to assess current practices and opinions and relationships between factors. RESULTS: Methicillin-resistant Staphylococcus aureus was perceived as a national problem by 92% of respondents; 57% perceived MRSA as a problem in their practice setting. Most respondents had treated general infections (88%), staphylococcal infections (75%), and MRSA infections (57%). Male sex was associated with treating all 3 types of infections (χ(2) test, P < .05). Noncurriculum education was associated with a lack of recognition of environmental issues as risk factors and with the use of isopropyl alcohol for disinfection (χ(2) test, P < .05). For example, 10% of respondents did not recognize that contaminated whirlpools can be a source of MRSA infection. Respondents also incorrectly identified effective cleaning solutions. Thirty percent of respondents cleaned their hands frequently or sometimes before treating each athlete and 35% cleaned their hands sometimes, occasionally, or never after seeing each athlete. CONCLUSIONS: The majority of ATs were informed about MRSA and made correct disinfection choices. However, improvements are still needed, and not all ATs were using proper disinfection practices.

Perspectives on parenthood and working of female athletic trainers in the secondary school and collegiate settings.

CONTEXT: Female athletic trainers (ATs) are currently underrepresented in the collegiate setting. Parenting and family obligations may play a role in this underrepresentation. OBJECTIVE: To examine female ATs' perspectives on parenting and working in the secondary school and collegiate employment settings. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1000 nonstudent, female certified ATs who were currently members of the National Athletic Trainers' Association. MAIN OUTCOME MEASURE(S): An original survey was developed to assess perceptions related to motherhood and work responsibilities. Descriptive statistics were used to assess age, years of experience as a certified AT, employment position, and parent or nonparent status. A correlation matrix was conducted to determine factors among parent and nonparent status, perceptions of motherhood, and employment-setting decisions. RESULTS: Of the 1000 surveys sent via e-mail, 411 (41.1%) female ATs responded. Responses indicated that a majority of the female ATs worked in the secondary school setting. Sixty-one percent of the respondents did not have children. Past female ATs' experiences indicated a perception that motherhood created more challenges or struggles (or both) in the work and family settings. Whether parents considered children a factor in employment-setting changes produced conflicting results: no significant correlations or differences were found among responses. CONCLUSIONS: Parenting considerations had influences on both the home and employment settings. Although parents and nonparents had different views on the implications of parenting in the workplace, both groups agreed that parenting could affect the work environment and the choice to change employment settings and careers. Administrative decisions need to be considered in relation to parenting concerns. Mentoring that includes employment-setting choices relative to life goals should be provided to ATs, regardless of sex.

Adherence to drug-dispensation and drug-administration laws and guidelines in collegiate athletic training rooms: a 5-year review.

CONTEXT: To both ensure athletes' safety and avoid legal penalties, athletic trainers' (ATs') handling of medications in the athletic training room should conform with federal and state statutes. OBJECTIVE: To revisit drug dispensation and administration in collegiate athletic training rooms 5 years after the initial study. DESIGN: Survey study. SETTING: College and university athletic training rooms. PATIENTS OR OTHER PARTICIPANTS: All 4627 certified ATs employed in National Collegiate Athletic Association Divisions I, II, and III and National Association of Intercollegiate Athletics institutions, as listed by the National Athletic Trainers' Association, were surveyed. DATA COLLECTION AND ANALYSIS: The survey was created for the 2001 study based on federal laws. We used analyses of variance to study compliance by division (I, II, or III) and sex and by sex and employment status (head or assistant AT). RESULTS: A total of 2330 ATs (N = 4627, 50%) provided 1535 usable responses. For comparison with the 2001 data, only head ATs' responses were included (n = 670). In general, drug distribution compliance scores among head ATs were low (mean = 6.37 +/- 0.15, range = 0-25 points). The ATs were less compliant when handling over-the-counter (OTC) medications. Only 55.5% of ATs stored medications in a locked cabinet, compared with 67.1% in 2001. A large number of ATs administered OTC drugs in any amount necessary (n = 689, 44%), and 3.6% (n = 55) allowed athletes access without any consultation, compared with 53.8% and 4.9%, respectively, in 2001. However, prescription medication practices improved since the first study. Also, we noted a main effect of employment status (F(1,934) = 5.57, P < .05): head ATs were less compliant than assistant ATs. CONCLUSIONS: Compared with 5 years ago, ATs appear to be more compliant with federal statutes regarding prescription drug regulation. A thorough understanding of appropriate OTC medication administration practices still appears to be lacking.

Bilateral pulmonary emboli in a collegiate gymnast: a case report.

OBJECTIVE: To characterize the diagnosis of pulmonary embolism in collegiate student-athletes and to raise awareness among sports medicine providers of the possibility of this potentially fatal disease in the student-athlete population. BACKGROUND: An 18-year-old, previously healthy National Collegiate Athletic Association Division I female gymnast complained of intense pain, bilaterally, deep in her chest. The athlete was referred to her team physician, who identified normal vital signs but referred her to the emergency room because of significant pain. The student-athlete was diagnosed with bilateral pulmonary emboli in the emergency room. DIFFERENTIAL DIAGNOSIS: Pneumonia, renal calculi, upper urinary tract infection, intercostal muscle strain or rib fracture, pancreatitis, gall bladder disease, gastritis, ulceration, esophagitis, infection, tumor, pulmonary embolism. TREATMENT: The student-athlete was immediately placed on anticoagulants for 6 months. During that time, she was unable to participate in gymnastics and was limited to light conditioning. UNIQUENESS: Documented cases of female student-athletes developing a pulmonary embolism are lacking in the literature. Two cases of pulmonary embolism in male high school student-athletes have been documented, in addition to many cases in elderly and sedentary populations. CONCLUSIONS: All health care providers, including sports medicine professionals, should be aware that this condition may be present among student-athletes. During the initial evaluation, prescreening should include questions about any previous or family history of pulmonary embolism or other blood clots. Athletes who answer positively to these questions may have a higher likelihood of pulmonary embolism and should be referred for testing.

Longitudinal evaluation of Journal of Athletic Training author credentials: implications for future research engagement in athletic training.

PURPOSE: To employ retrospective trend analysis in an attempt to provide a layered description of the relative contribution (per credential) of clinical athletic trainers (those without terminal degrees) to authoring scientific literature in the Journal of Athletic Training (JAT). From these data, our secondary purpose was to evaluate trends relative to changes in journal policy and increased educational rigor or professional limitations over the past decade, discussing how they may affect the potential for clinical athletic trainers to contribute to JAT. DESIGN: Exploratory study design with trend analysis. PARTICIPANTS: Data collection and analysis included a trend evaluation of the credentials of clinical athletic trainer authors in JAT and the teams (by credential) of authorship to determine the credentials of authors who published in JAT. MEASUREMENTS: Longitudinal tabulation of JAT author credentials from 1995 through 2007. RESULTS: We noted increases in the absolute number of research articles per volume and the number of authors per article and a decrease in the relative percentage of authors who were athletic trainers. The results also suggested that the bachelor of science degree (BS-ATC, representative of clinical athletic trainers without advanced degrees) and Doctor of Medicine (MD) credential may be underrepresented in JAT authorship. CONCLUSIONS: Postgraduate research training may facilitate scientific article contribution by athletic trainers. Continued evolution in the athletic training evidence-based medicine movement should foster research-based mentorship during education. Cultivating collaborations between clinical athletic trainers and research teams may also promote outcomes assessment trials, which will benefit athletic training practices.

Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete: a case report.

OBJECTIVE: To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. BACKGROUND: In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. DIFFERENTIAL DIAGNOSIS: Partial or complete tear of the ACL. MEASUREMENTS: The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. FINDINGS: The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. CONCLUSIONS: During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.

The effect of kinesio taping on lower trunk range of motions.

The purpose of the study was to determine the effects of kinesio taping (KT) on trunk flexion, extension, and lateral flexion. Thirty healthy subjects with no history of lower trunk or back issues participated in the study. Subjects performed two experimental measurements of range of motion (with and without the application of KT) in trunk flexion, extension, and right lateral flexion. A dependent t test was used to compare the range of motion measurements before and after the application of KT. Through evaluation of the sum of all scores, KT in flexion produced a gain of 17.8 cm compared with the non-kinesiotape group (t(29)=2.51, p<0.05). No significant difference was identified for extension (-2.9 cm; t(29)=-0.55, p>0.05) or lateral flexion (3 cm; t(29)=-1.25, p>0.05). Based on the findings, we determined that KT applied over the lower trunk may increase active lower trunk flexion range of motion. Further investigation on the effects of KT is warranted.