Injury Incidence in Youth, High School, and NCAA Men's Lacrosse.

BACKGROUND: We compared injury incidence and mechanisms among youth, high school (HS), and National Collegiate Athletic Association (NCAA) boys' and men's lacrosse athletes for the 2014-2015 to 2016-2017 lacrosse seasons. METHODS: Multiple injury surveillance systems were used to capture 21 youth boys', 22 HS boys', and 20 NCAA men's lacrosse team-seasons of data during the 2014-2015 to 2016-2017 seasons. Athletic trainers reported game and practice injuries and athlete exposures (AEs). Injuries included those occurring during a game and/or practice and requiring evaluation from an athletic trainer and/or physician. Injury counts, rates per 1000 AEs, and injury rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. RESULTS: The injury rate in youth was higher than those reported in HS (10.3 vs 5.3 per 1000 AEs; IRR = 2.0; 95% CI: 1.6-2.4) and the NCAA (10.3 vs 4.7 per 1000 AEs; IRR = 2.2; 95% CI: 1.9-2.5). When considering time loss injuries only (restricted participation of ≥24 hours), the injury rate in youth was lower than those reported in HS (2.0 vs 2.9 per 1000 AEs; IRR = 0.7; 95% CI: 0.5-0.95) and the NCAA (2.0 vs 3.3 per 1000 AEs; IRR = 0.6; 95% CI: 0.4-0.8). The concussion rate in youth was higher than those in HS (0.7 vs 0.3 per 1000 AEs; IRR = 2.4, 95% CI: 1.1-5.2) and the NCAA (0.7 vs 0.3 per 1000 AEs; IRR = 2.1, 95% CI: 1.2-3.7). Injuries at the youth, HS, and NCAA levels were most commonly associated with stick contact, inflammatory conditions (including bursitis, tendonitis, and other unspecified inflammation), and noncontact mechanisms, respectively. CONCLUSIONS: Although the time loss injury rate was lowest in youth boys' lacrosse, the concussion rate was the highest. Injury prevention approaches should be specific to the mechanisms associated with each level of play (eg, equipment skill development in youth).

Epidemiology of Youth Boys' and Girls' Lacrosse Injuries in the 2015 to 2016 Seasons.

PURPOSE: Examinations of injury among younger populations of lacrosse players that are beginning their development is limited. This study describes the epidemiology of youth boys' and girls' lacrosse injuries during the 2015 to 2016 seasons. METHODS: Surveillance data originated from a convenience sample of 10 leagues in five states with 1090 boy lacrosse players and 408 girl lacrosse players from the U9-U15 divisions. Athletic trainers reported injury and exposure data at games and practices. Time loss (TL) injuries were defined as resulting in ≥24 h of participation restriction time. Injury counts and rates per 1000 athlete games/practices were calculated. Injury rate ratios (IRR) with 95% confidence intervals (CI) compared rates by sex and age division. RESULTS: Overall, 241 and 59 injuries were reported in boys' and girls' youth lacrosse, respectively, of which 17.0% and 18.6% were TL. Compared with girls, boys had a higher overall injury rate (12.7 vs 8.7/1000 athlete games/practices; IRR, 1.5; 95% CI, 1.1-1.9). U13/U15 boys had a higher TL injury rate than U9/U11 boys (2.6 vs 1.0/1000 athlete game/practices; IRR, 2.6; 95% CI, 1.1-6.1). Most injuries were diagnosed as contusions (boys, 53.7%; girls, 47.2%) and resulted from stick contact (boys, 34.1%; girls, 30.6%) and ball contact (boys, 17.1%; girls, 25.0%). Among girls, ball contact contributed to 75.0% (n = 9) of all head/face injuries. Among the 14 concussions reported in boys, player contact was the most common injury mechanism (50.0%, n = 7), followed by stick contact (35.7%, n = 5). CONCLUSIONS: Boys' lacrosse has a higher injury incidence than girls' lacrosse, reflecting the contact nature of the boys' game. The high incidence of stick- and ball-related injuries suggests the need for youth-specific rules to better protect youth players.

Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football.

BACKGROUND: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards. PURPOSE: To compare injury rates between youth tackle football players in the AO and AW playing standard conditions. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non-time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only. RESULTS: Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]). CONCLUSION: For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.

Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football.

BACKGROUND: Research evaluating the effect of comprehensive coach education and practice contact restriction in youth football injury rates is sparse. In 2012, USA Football released their Heads Up Football coaching education program (HUF), and Pop Warner Football (PW) instituted guidelines to restrict contact during practice. PURPOSE: To compare injury rates among youth football players aged 5 to 15 years by whether their leagues implemented HUF and/or were PW-affiliated. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2014 youth football season. Players were drawn from 10 leagues across 4 states. The non-Heads Up Football (NHUF) group consisted of 704 players (none of whom were PW-affiliated) from 29 teams within 4 leagues. The HUF+PW group consisted of 741 players from 27 teams within 2 leagues. The HUF-only group consisted of 663 players from 44 teams within 4 leagues. Injury rates and injury rate ratios (IRRs) were reported with 95% CIs. RESULTS: A total of 370 injuries were reported during 71,262 athlete-exposures (AEs) (rate, 5.19/1000 AEs). Compared with the NHUF group (7.32/1000 AEs), the practice injury rates were lower for the HUF+PW group (0.97/1000 AEs; IRR, 0.13; 95% CI, 0.08-0.21) and the HUF-only group (2.73/1000 AEs; IRR, 0.37; 95% CI, 0.26-0.53). Compared with the NHUF group (13.42/1000 AEs), the game injury rate was lower for the HUF+PW group (3.42/1000 AEs; IRR, 0.25; 95% CI, 0.15-0.44) but not for the HUF-only group (13.76/1000 AEs; IRR, 1.02; 95% CI, 0.73-1.43). Also, the HUF+PW game injury rate was lower than that of HUF-only (IRR, 0.20; 95% CI, 0.12-0.36). Higher injury rates were typically found in those aged 11 to 15 years compared with those aged 5 to 10 years. However, stronger effects related to HUF implementation and PW affiliation were seen among 11- to 15-year-olds. When restricted to concussions only, the sole difference was found between the practice concussion rates among 11- to 15-year-olds in the HUF+PW (0.14/1000 AEs) and NHUF groups (0.79/1000 AEs) (IRR, 0.18; 95% CI, 0.04-0.85). CONCLUSION: These findings support comprehensive coach education and practice contact restrictions as effective methods of injury mitigation. Future research should continue evaluating similar programming within other levels of competition and sports.

Impact attenuation properties of new and used lacrosse helmets.

The National Operating Committee on Standards for Athletic Equipment (NOCSAE) has developed impact attenuation thresholds that protective helmets worn in sport must meet to be commercially available in an attempt to prevent injury. It remains unknown how normal helmet use in athletic activity alters the force attenuation ability of lacrosse helmets. We tested 3 new and 3 randomly selected used helmets from 2 popular lacrosse models (Cascade Pro7, Cascade CPXR). All used helmets had been worn for 3 collegiate seasons prior to testing and had never been refurbished. Helmets were drop-tested using 3 prescribed impact velocities at 6 locations according to the NOCSAE lacrosse helmet standard, and we compared the Gadd Severity Index (GSI) scores between new and used helmets using a repeated measure ANOVA with location as the repeated variable and data separated by impact velocity. All 12 helmets passed the NOCSAE GSI threshold for all testing conditions; however 1 used helmet shell cracked resulting in a failed test. We found a significant main effect for helmet age at the low (F5,50=2.98, P=.02), medium (F5,50=3.71, P=.006), and high (F5,50=2.70, P=.03) velocities. We suspect that helmet use can degrade materials under some conditions, but improve performance in others due to changes in helmet composition from use. The clinical implications of the differences in GSI scores noted remain unclear. Because one helmet shell cracked resulting in a failed test, used helmets should be regularly inspected for cracks or other signs of mechanical fatigue that may weaken helmet integrity.

Student-Retention and Career-Placement Rates Between Bachelor's and Master's Degree Professional Athletic Training Programs.

CONTEXT: The debate over what the entry-level degree should be for athletic training has heightened. A comparison of retention and career-placement rates between bachelor's and master's degree professional athletic training programs may inform the debate. OBJECTIVE: To compare the retention rates and career-placement rates of students in bachelor's and master's degree professional programs. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 192 program directors (PDs) from bachelor's degree (n = 177) and master's degree (n = 15) professional programs. INTERVENTION(S): The PDs completed a Web-based survey. MAIN OUTCOME MEASURE(S): We instructed the PDs to provide a retention rate and career-placement rate for the students in the programs they lead for each of the past 5 years. We also asked the PDs if they thought retention of students was a problem currently facing athletic training education. We used independent t tests to compare the responses between bachelor's and master's degree professional programs. RESULTS: We found a higher retention rate for professional master's degree students (88.70% ± 9.02%, 95% confidence interval [CI] = 83.71, 93.69) than bachelor's degree students (80.98% ± 17.86%, 95% CI = 78.30, 83.66) (t25 = -2.86, P = .008, d = 0.55). Similarly, PDs from professional master's degree programs reported higher career-placement percentages (88.50% ± 10.68%, 95% CI = 82.33, 94.67) than bachelor's degree professional PDs (71.32% ± 18.47%, 95% CI = 68.54, 74.10) (t20 = -5.40, P < .001, d = 1.14). Finally, we observed no difference between groups regarding whether retention is a problem facing athletic training (χ(2)1 = 0.720, P = .40, Φ = .061). CONCLUSIONS: Professional master's degree education appears to facilitate higher retention rates and greater career-placement rates in athletic training than bachelor's degree education. Professional socialization, program selectivity, and student commitment and motivation levels may help to explain the differences noted.

Program directors' perceptions of undergraduate athletic training student retention.

CONTEXT: The average retention rate for students enrolled in undergraduate athletic training programs (ATPs) nationwide has been reported to be 81%, and slightly more than half of program directors (PDs) have indicated that retention of athletic training students (ATSs) is a problem. However, why PDs do or do not believe ATS retention is problematic is unknown. OBJECTIVE: To determine why PDs do or do not believe ATS retention is problematic. DESIGN: Qualitative study. SETTING: Undergraduate ATPs. PATIENTS OR OTHER PARTICIPANTS: We obtained responses from 177 of the 343 PDs (51.6%). Using data saturation as a guide, we randomly selected 16 PDs from the survey responses to participate in follow-up telephone interviews; 8 believed retention was a problem and 8 did not. DATA COLLECTION AND ANALYSIS: During audio-recorded telephone interviews, we asked PDs why they thought retention was or was not a problem for athletic training education. Following verbatim transcription, we used grounded theory to analyze the interview data and maintained trustworthiness by using intercoder agreement, member checks, and peer review. RESULTS: Program directors believed that retaining ATSs was a problem because students lack information regarding athletic training and the rigor of the ATP. Program directors were consistent in their perception that ATPs do not have a retention challenge because of the use of a secondary admissions process. This finding was likely based on personal use of a secondary admissions process in the ATPs these PDs lead. CONCLUSIONS: Program directors who lead ATPs that struggle to retain ATSs should consider using a secondary admissions process. During the preprofessional phase of the ATP, faculty and staff should work to socialize students to the demands of the ATP and the professional lives of athletic trainers.

The professional socialization of the athletic trainer serving as a preceptor.

CONTEXT: The role of the preceptor requires the athletic trainer to be versed in effective instructional techniques, supervisory skills, and communication skills beyond his or her competence as an athletic trainer, but many have not received formal training in educational techniques. OBJECTIVE: To gain a better understanding about the professional socialization process for the athletic trainer assuming the role of the preceptor. DESIGN: Qualitative study. SETTING: Athletic training education programs. PATIENTS OR OTHER PARTICIPANTS: Twenty-four preceptors (11 men, 13 women; age = 32 ± 7 years, clinical experience = 9 ± 6 years, preceptor experience = 5 ± 3 years) employed in the collegiate (n = 12) or secondary school (n = 12) setting. DATA COLLECTION AND ANALYSIS: We gathered data using asynchronous, in-depth interviewing via QuestionPro. We analyzed data using a general inductive approach to uncover the dominant themes. Credibility was secured by using consistency and stakeholder checks and a peer review. RESULTS: We identified 2 main themes by which preceptors develop in their roles as clinical instructors: formal processes and informal processes. The participants used observations, previous experiences or interactions with role models, and self-reflection and evaluation as informal socialization processes. Formal socialization processes included preceptor training/workshops, professional development, and formal teacher certification. CONCLUSIONS: Athletic trainers who serve as preceptors learned their roles by a combination of informal and formal processes. Preceptor training sessions appeared to be effective in initially helping preceptors learn their responsibilities, whereby more informal processes seemed to help them refine their skills. Furthermore, one socialization strategy did not appear to dominate role learning; rather, a combination of several processes fostered an understanding.

Clinical integration and how it affects student retention in undergraduate athletic training programs.

CONTEXT: A better understanding of why students leave an undergraduate athletic training education program (ATEP), as well as why they persist, is critical in determining the future membership of our profession. OBJECTIVE: To better understand how clinical experiences affect student retention in undergraduate ATEPs. DESIGN: Survey-based research using a quantitative and qualitative mixed-methods approach. SETTING: Three-year undergraduate ATEPs across District 4 of the National Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: Seventy-one persistent students and 23 students who left the ATEP prematurely. DATA COLLECTION AND ANALYSIS: Data were collected using a modified version of the Athletic Training Education Program Student Retention Questionnaire. Multivariate analysis of variance was performed on the quantitative data, followed by a univariate analysis of variance on any significant findings. The qualitative data were analyzed through inductive content analysis. RESULTS: A difference was identified between the persister and dropout groups (Pillai trace = 0.42, F(1,92) = 12.95, P = .01). The follow-up analysis of variance revealed that the persister and dropout groups differed on the anticipatory factors (F(1,92) = 4.29, P = .04), clinical integration (F(1,92) = 6.99, P = .01), and motivation (F(1,92) = 43.12, P = .01) scales. Several themes emerged in the qualitative data, including networks of support, authentic experiential learning, role identity, time commitment, and major or career change. CONCLUSIONS: A perceived difference exists in how athletic training students are integrated into their clinical experiences between those students who leave an ATEP and those who stay. Educators may improve retention by emphasizing authentic experiential learning opportunities rather than hours worked, by allowing students to take on more responsibility, and by facilitating networks of support within clinical education experiences.

Frustrations among graduates of athletic training education programs.

CONTEXT: Although previous researchers have begun to identify sources of athletic training student stress, the specific reasons for student frustrations are not yet fully understood. It is important for athletic training administrators to understand sources of student frustration to provide a supportive learning environment. OBJECTIVE: To determine the factors that lead to feelings of frustration while completing a professional athletic training education program (ATEP). DESIGN: Qualitative study. SETTING: National Athletic Trainers' Association (NATA) accredited postprofessional education program. PATIENTS OR OTHER PARTICIPANTS: Fourteen successful graduates (12 women, 2 men) of accredited professional undergraduate ATEPs enrolled in an NATA-accredited postprofessional education program. DATA COLLECTION AND ANALYSIS: We conducted semistructured interviews and analyzed data with a grounded theory approach using open, axial, and selective coding procedures. We negotiated over the coding scheme and performed peer debriefings and member checks to ensure trustworthiness of the results. RESULTS: Four themes emerged from the data: (1) Athletic training student frustrations appear to stem from the amount of stress involved in completing an ATEP, leading to anxiety and feelings of being overwhelmed. (2) The interactions students have with classmates, faculty, and preceptors can also be a source of frustration for athletic training students. (3) Monotonous clinical experiences often left students feeling disengaged. (4) Students questioned entering the athletic training profession because of the fear of work-life balance problems and low compensation. CONCLUSIONS: In order to reduce frustration, athletic training education programs should validate students' decisions to pursue athletic training and validate their contributions to the ATEP; provide clinical education experiences with graded autonomy; encourage positive personal interactions between students, faculty, and preceptors; and successfully model the benefits of a career in athletic training.

National Athletic Trainers' Association-accredited postprofessional athletic training education: attractors and career intentions.

CONTEXT: Anecdotally, we know that students select graduate programs based on location, finances, and future career goals. Empirically, however, we lack information on what attracts a student to these programs. OBJECTIVE: To gain an appreciation for the selection process of graduate study. DESIGN: Qualitative study. SETTING: Postprofessional programs in athletic training (PPATs) accredited by the National Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: A total of 19 first-year PPAT students participated, representing 13 of the 16 accredited PPAT programs. DATA COLLECTION AND ANALYSIS: All interviews were conducted via phone and transcribed verbatim. Analysis of the interview data followed the procedures as outlined by a grounded theory approach. Trustworthiness was secured by (1) participant checks, (2) participant verification, and (3) multiple analyst triangulations. RESULTS: Athletic training students select PPAT programs for 4 major reasons: reputation of the program or faculty (or both), career intentions, professional socialization, and mentorship from undergraduate faculty or clinical instructors (or both). Participants discussed long-term professional goals as the driving force behind wanting an advanced degree in athletic training. Faculty and clinical instructor recommendations and the program's prestige helped guide the decisions. Participants also expressed the need to gain more experience, which promoted autonomy, and support while gaining that work experience. Final selection of the PPAT program was based on academic offerings, the assistantship offered (including financial support), advanced knowledge of athletic training concepts and principles, and apprenticeship opportunities. CONCLUSIONS: Students who attend PPAT programs are attracted to advancing their entry-level knowledge, are committed to their professional development as athletic trainers, and view the profession of athletic training as a life-long career. The combination of balanced academics, clinical experiences, and additional professional socialization and mentorship from the PPAT program experience will help them to secure their desired career positions.

Factors of persistence among graduates of athletic training education programs.

CONTEXT: Previous researchers have indicated that athletic training education programs (ATEPs) appear to retain students who are motivated and well integrated into their education programs. However, no researchers have examined the factors leading to successful persistence to graduation of recent graduates from ATEPs. OBJECTIVE: To determine the factors that led students enrolled in a postprofessional education program accredited by the National Athletic Trainers' Association (NATA) to persist to graduation from accredited undergraduate ATEPs. DESIGN: Qualitative study. SETTING: Postprofessional education program accredited by the NATA. PATIENTS OR OTHER PARTICIPANTS: Fourteen graduates (12 women, 2 men) of accredited undergraduate entry-level ATEPs who were enrolled in an NATA-accredited postprofessional education program volunteered to participate. DATA COLLECTION AND ANALYSIS: We conducted semistructured interviews and analyzed data through a grounded theory approach. We used open, axial, and selective coding procedures. To ensure trustworthiness, 2 independent coders analyzed the data. The researchers then negotiated over the coding categories until they reached 100% agreement. We also performed member checks and peer debriefing. RESULTS: Four themes emerged from the data. Decisions to persist to graduation from ATEPs appeared to be influenced by students' positive interactions with faculty, clinical instructors, and peers. The environment of the ATEPs also affected their persistence. Participants thought they learned much in both the clinic and the classroom, and this learning motivated them to persist. Finally, participants could see themselves practicing athletic training as a career, and this greatly influenced their eventual persistence. CONCLUSIONS: Our study gives athletic training educators insight into the reasons students persist to graduation from ATEPs. Specifically, athletic training programs should strive to develop close-knit learning communities that stress positive interactions between students and instructors. Athletic training educators also must work to present the athletic training field as exciting and dynamic.

Student retention in athletic training education programs.

CONTEXT: The success of any academic program, including athletic training, depends upon attracting and keeping quality students. The nature of persistent students versus students who prematurely leave the athletic training major is not known. Understanding the profiles of athletic training students who persist or leave is important. OBJECTIVE: To (1) explore the relationships among the following variables: anticipatory factors, academic integration, clinical integration, social integration, and motivation; (2) determine which of the aforementioned variables discriminate between senior athletic training students and major changers; and (3) identify which variable is the strongest predictor of persistence in athletic training education programs. DESIGN: Descriptive study using a qualitative and quantitative mixed-methods approach. SETTING: Thirteen athletic training education programs located in District 3 of the National Athletic Trainers' Association. PATIENTS OR OTHER PARTICIPANTS: Ninety-four senior-level athletic training students and 31 college students who changed majors from athletic training to another degree option. DATA COLLECTION: Data were collected with the Athletic Training Education Program Student Retention Questionnaire (ATEPSRQ). ANALYSIS: Data from the ATEPSRQ were analyzed via Pearson correlations, multivariate analysis of variance, univariate analysis of variance, and a stepwise discriminant analysis. Open-ended questions were transcribed and analyzed using open, axial, and selective coding procedures. Member checks and peer debriefing techniques ensured trustworthiness of the study. RESULTS: Pearson correlations identified moderate relationships among motivation and clinical integration (r = 0.515, P < .01) and motivation and academic integration (r = 0.509, P < .01). Univariate analyses of variance showed that academic integration (F(1,122) = 8.483, P < .004), clinical integration (F(1,119) = 30.214, P < .001), and motivation (F(1,121) = 68.887, P < .001) discriminated between seniors and major changers. Discriminant analysis indicated that motivation was the strongest predictor of persistence in athletic training education, accounting for 37.2% of the variance between groups. The theoretic model accurately classified 95.7% of the seniors and 53.8% of the major changers. A common theme emerging from the qualitative data was the presence of a strong peer-support group that surrounded many of the senior-level students. CONCLUSIONS: Understanding student retention in athletic training is important for our profession. Results from this study suggest 3 key factors associated with student persistence in athletic training education programs: (1) student motivation, (2) clinical and academic integration, and (3) the presence of a peer-support system. Educators and program directors must create comprehensive recruitment and retention strategies that address factors influencing students' decisions to stay in the athletic training profession.