Headgear safety attitudes: a national survey of collegiate women's lacrosse stakeholders

Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.

Effects of Nontraditional Division III Lacrosse Participation on Movement Pattern Quality and Dynamic Postural Control

Background/Purpose

No studies have observed the effects of a collegiate lacrosse season on movement pattern quality, dynamic postural control, or the accuracy of athletes' perceived movement pattern quality. The purpose was to examine the effects of a nontraditional fall season on movement pattern quality, perceived movement pattern quality, and dynamic postural control in collegiate lacrosse athletes.

Design

Cross-sectional laboratory study.

Methods

Fifty men's (age=19.38±1.24 years, height=182.63±6.16 cm, mass=82.37±8.46 kg) and 22 women's (age=19.68±1.17 years, height=165.10±6.88 cm, mass=64.09±8.72 kg) lacrosse players were recruited. Outcome measures included individual Functional Movement Screen™ (FMS™) scores, self-reported perceived movement pattern quality scores, lower and upper extremity Y-Balance Test (YBT) measurements, and active dorsiflexion range of motion (ROM) before the start and again at the end of the fall lacrosse season. Pre- and post-season measurements were assessed using paired t-tests and chi-squared analyses.

Results

FMS™ composite scores did not significantly change from preseason to postseason for males (p=0.74) or females (p=0.07). Male perceived movement pattern quality was significantly higher than measured for 10 of 12 movements (p<0.05). Female perceived movement pattern quality was significantly higher than measured for four of 12 movements (p<0.05). Asymmetry frequency significantly increased in males in the hurdle step from two individuals to nine (χ 2 1=25.52, p<0.01), inline lunge from 10 to 20 (χ 2 1=12.50, p<0.01), and shoulder mobility from 4 to 21 (χ 2 1=78.53, p<0.01). Asymmetries in male athletes significantly decreased in the active straight leg raise from 26 to 8 (χ 2 1=25.96, p<0.01). YBT composite scores increased in males for the right leg (p=0.001) and left leg (p<0.03). Right dorsiflexion ROM (p<0.001) and left dorsiflexion ROM (p<0.001) significantly decreased in males from preseason to postseason. YBT scores for the right leg significantly increased in females from preseason to postseason (p=0.01). YBT scores for females for the right arm significantly increased from preseason to postseason (p=0.045).

Conclusions

A 5-week season may not change overall movement pattern quality of men's or women's lacrosse players, but some individual movement scores diminished. Athletes may overestimate self-reported movement pattern quality and are therefore unlikely to individually address movement deficits. Male dynamic postural control may change throughout a season, resulting in a potential increased risk of injury later in the season due to compensatory patterns or changes in mobility, proprioception, or balance.

Level of Evidence

3b.

Academic adjustments and concussion recoveries in NCAA student-athletes: a LIMBIC MATARS investigation

OBJECTIVE

The aim of this study was to investigate the association between academic adjustments and recovery from sport-related concussions (SRCs) in collegiate athletes.

MATERIALS AND METHODS

A retrospective medical chart review was performed between the 2015-2016 and 2019-2020 sport seasons at 11 Long-term Impact of Military-relevant Brain Injury Consortium Military and Tactical Athlete Research Study (LIMBIC MATARS) sites. Days between injury and symptom resolution, and injury and return to sport (dependent variables) for collegiate athletes who did or did not receive academic adjustments (independent variable) were analyzed using Mann-Whitney U tests.

RESULTS

The number of days between date of injury and symptom-resolution between those who did (median = 9 [interquartile range = 5,16]) and did not have (7[3,12]) academic adjustments were statistically different (z=-2.76, p < 0.01, r=-0.17). However, no differences were observed between days to return to sport among those who did (14[10,22]) and did not (13[8,20]) receive assigned academic adjustments (z= -1.66, p = 0.10, r= -.10).

CONCLUSIONS

Recovery trajectories were similar between athletes diagnosed with a SRC who did or did not receive academic adjustments.. Our findings suggest academic adjustments supported recovery for those who needed academic adjustments. Clinicians and healthcare professionals should assist and support collegiate athletes after SRCs on an individual basis, including academic adjustments when appropriate based on patient presentation.

Secondary School Athletic Trainers' Experiences Managing Workplace Organizational- Professional Conflict

CONTEXT

Athletic trainers (ATs) face organizational-professional conflict (OPC), often surrounding return-to-sport decisions. To prioritize patient safety and establish a healthy work environment, OPC must be mitigated, yet little research has determined how ATs manage conflicts with stakeholders.

OBJECTIVE

To explore ATs' experiences with OPC in the secondary school setting.

DESIGN

Qualitative study.

SETTING

Telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

16 ATs (9 females, 7 males; age = 43±11 years; years certified = 17±9; years in their current positions = 9±6).

DATA COLLECTION AND ANALYSIS

We digitally recorded telephone interviews and had them professionally transcribed. Data saturation guided recruitment efforts, and was met. To ensure rigor and trustworthiness of the data, we completed basic member checks along with multiple analyst triangulation. We analyzed the qualitative data using an interpretive phenomenological approach.

RESULTS

Four themes emerged: effective communication, professional relationships, stakeholder education and professional experience. Participants used effective communication described as frequent, open, and direct, during interactions with stakeholders to manage OPC. OPC was reduced when ATs built professional relationships with stakeholders centered on trust and respect. Participants used stakeholder education as a primary strategy for managing OPC by educating stakeholders about prognosis and return-to-sport timelines post-injury and providing rationale for decisions made. Additionally, years of experience served as a mitigating factor of conflict, in that as ATs gained experience and confidence, they perceived less OPC.

CONCLUSIONS

Participants suggested various interpersonal relationship development strategies that can be implemented to manage OPC, especially when starting a new position or building rapport with stakeholders. Specifically, educating various stakeholders on reasons for clinical decisions via effective communication and developing strong professional relationships built on mutual respect assisted in avoiding OPC. Since professional experience appears to alleviate conflict, OPC management strategies should be taught during professional preparation and used early during transition to autonomous practice.

Exploring the relationship between contraceptive medication use and concussion recovery in female collegiate athletes: a LIMBIC MATARS consortium investigation

OBJECTIVE

While recovery from concussion is variable, women are more likely to report symptoms, experience worse outcomes, and have longer recovery trajectories following concussion than men. Preliminary data suggest that hormonal fluctuations, specifically progesterone, may be associated with this variability. This study aimed to understand the effect of contraceptive medication on concussion recovery.

METHODS

A retrospective chart review using consensus-based common data elements was conducted at 11 NCAA institutions as part of the LIMBIC MATARS consortium. Participants included female collegiate athletes diagnosed with a concussion who did (n = 117) or did not report (n = 339) contraceptive medication use. Number of days between diagnosis and symptom resolution were compared using Mann-Whitney U tests. Self-reported diagnosis of attention deficit hyperactivity disorder, concussion history, anxiety, and depression was compared using Chi-squared tests.

RESULTS

The proportions of participants who did or did not take contraceptive medication were similar across covariates. Female athletes regardless of contraceptive medication use recovered similarly following a concussion.

CONCLUSIONS

Our findings suggest that contraceptive medication use did not significantly impact concussion recovery. Future prospective investigations should examine documentation practices and operationalize terminology for hormonal contraceptive medication to better understand their role on recovery from sport-related concussion in female collegiate athletes.

Concussion diagnosis and recovery in relation to collegiate athletic department classification: a LIMBIC MATARS consortium investigation

PURPOSE

We investigated time to reach concussion diagnosis and recovery milestones in collegiate athletes relative to their schools' National Collegiate Athletic Association (NCAA) classification.

METHODS

We retrospectively examined 849 (43.1% female) concussion cases from 11 NCAA institutions (Division I Power 5 [n = 4], Division I Non-Power 5 [n = 4], and Division II/III [n = 3]) from the 2015-16 to 2019-20 athletic seasons. Our primary outcome measures were days to reach specific clinical milestones following concussion.

RESULTS

Median (IQR) time from injury to diagnosis was significantly longer at Division II/III institutions (1 [0-4] days) compared to Division I Power 5 (0 [0-1] days) and Division I Non-Power 5 (0 [0-1] days) institutions (p < 0.001). Likewise, Division II/III athletes (15 [11-22] days) took significantly longer to return to sport after concussion than Division I Power 5 (10 [7-16] days) and Division I Non-Power 5 (11 [7-18.5] days) athletes (p < 0.001).

CONCLUSION

Division II/III athletes had delayed concussion diagnoses and return to sport timelines compared to Division I athletes. Our results suggest that differences in sports medicine resources across NCAA divisions may influence injury recognition and recovery in collegiate athletes with concussion.

Physical activity and recovery following concussion in collegiate athletes: a LIMBIC MATARS Consortium Investigation

OBJECTIVE

To investigate whether routine daily activities (RDA), non-prescribed exercise (Non-ERx), or prescribed exercise (ERx) were associated with recovery from sport-related concussion (SRC) in collegiate athletes.

MATERIALS AND METHODS

Data for this cross-sectional, retrospective chart review of collegiate athletes diagnosed with SRC (n = 285[39.6% female], age = 19.5 ± 1.4 years) were collected during the 2015-16 to 2019-20 athletic seasons. The independent variable was group (RDA, Non-ERx, ERx). Dependent variables included days from date of diagnosis to symptom resolution (Dx-SR) and SR to return to sport (SR-RTS).

RESULTS

Those in the Non-ERx group took nearly 1.3 times longer to achieve SR (IRR = 1.28, 95% CI: 1.11, 1.46) and, 1.8 times longer for RTS (IRR = 1.82, 95% CI: 1.11, 2.71) when compared to those in the RDA group. No other comparisons were significant.

CONCLUSION

Collegiate athletes in the Non-ERx group took approximately 1 week longer to achieve SR as compared to the RDA and ERx groups. Our findings suggest that if exercise is recommended following SRC, it must be clearly and specifically prescribed. If exercise parameters cannot be prescribed, or monitored, RDA appear to be similarly beneficial during recovery for collegiate athletes with concussion.

Access to athletic trainers and sex as modifiers of time to reach clinical milestones after sport-related concussion in collegiate athletes

OBJECTIVE

Investigate whether an athlete's biological sex and exposure to a dedicated athletic trainer (AT) were related to clinical milestones after a sports-related concussion (SRC).

DESIGN

Retrospective chart review.

METHODS

Medical charts of collegiate athletes (n = 196 [70.9% female]) diagnosed with SRC were reviewed to extract: biological sex, dedicated AT exposure for their sport (yes/no), and time (days) to reaching clinical milestones (diagnosis, symptom resolution, unrestricted return to sport [RTS]). Mann-Whitney U tests were used to determine whether time to clinical milestones differed by sex, AT exposure, or their interaction. Proportions of same-day diagnoses and times to diagnosis, symptom resolution, and unrestricted RTS were evaluated with chi-squared and spearman's rank correlations, respectively.

RESULTS

There were no significant differences in times to reaching any clinical milestone by sex, AT exposure, or their interaction (ps > 0.05). Forty-three percent of participants were diagnosed on the day of their SRC. This did not differ by sex or AT exposure (ps > 0.29). Longer times to SRC diagnosis were associated with more days to symptom resolution (ρ = 0.236, p = 0.001) and unrestricted RTS (ρ = 0.223, p < 0.001).

CONCLUSIONS

Athlete sex and AT exposure were not associated with times to reach any clinical milestone; however, delayed diagnosis was associated with longer times to reach clinical recovery.

Sport Type and Risk of Subsequent Injury in Collegiate Athletes Following Concussion: a LIMBIC MATARS Consortium Investigation

OBJECTIVE

To investigate the association between sport type (collision, contact, non-contact) and subsequent injury risk following concussion in collegiate athletes.

MATERIALS AND METHODS

This retrospective chart review of 248 collegiate athletes with diagnosed concussions (age: 20.0 ± 1.4 years; height: 179.6 ± 10.9 cm; mass: 79.0 ± 13.6 kg, 63% male) from NCAA athletic programs (n = 11) occurred between the 2015-2020 athletic seasons. Acute injuries that occurred within six months following concussion were evaluated. Subsequent injuries were grouped by lower extremity, upper extremity, trunk, or concussion. The independent variable was sport type: collision, contact, non-contact. A Cox proportional hazard model was used to assess the risk of subsequent injury between sport types.

RESULTS

Approximately 28% (70/248) of athletes sustained a subsequent acute injury within six months post-concussion. Collision sport athletes had a significantly higher risk of sustaining any injury (HR: 0.41, p < 0.001, 95% CI: 0.28, 0.62), lower extremity (HR: 0.55, p = 0.04, 95% CI: 0.32, 0.97), and upper extremity (HR: 0.41, p = 0.01, 95% CI: 0.20, 0.81) injuries following concussion. No differences between sport types were observed for other injuries.

CONCLUSION

Collision sport athletes had a higher rate of any subsequent injury, lower, and upper extremity injuries following concussion. Future research should focus on sport-specific secondary injury prevention efforts.

Mechanical characterization of athletic helmet shells

Our purpose was to compare the mechanical properties of the protective outer shells of various athletic helmets in their final, fully manufactured form. Sections were taken from 3 different helmet shells (Bauer RE-AKT hockey helmet, Cascade R lacrosse helmet, and Riddell Speedflex football helmet) at 4 different locations (front, side, top, and rear) for a total of 12 test specimens. The 4 specimens from each helmet shell were potted together in epoxy resin moulds and mechanically polished. The hardness, elastic modulus and phase angle were measured using dynamic nanoindentation performed at 100 Hz with an oscillation amplitude of 1 nm (rms). Repeated ANOVA analysis was used to compare each of the dependent variables for each of the 3 helmets across the 4 different locations. The interaction between helmet type and location was significant for hardness (F6,63 = 2.84, P = 0.032, Pη2 = 0.21), elastic modulus (F6,63 = 6.412, P < 0.001, Pη2 = 0.38), and phase angle (F6,63 = 7.65, P < 0.001, Pη2 = 0.42). Polycarbonate has a higher ability to dissipate mechanical energy making it the recommended superior choice for helmet shells. In addition, the results lead us to speculate that manufacturing causes changes in the molecular weight or the distribution of fillers across locations for polyethylene but not for polycarbonate since mechanical properties are fairly uniform over the surface of football helmets, at least within a given helmet.

Multistakeholder Perceptions of Young Professionals' Integration During Role Transition

CONTEXT

The transition to autonomous clinical practice for early professionals (EPs) has been found to be a stressful time, but no studies with multiple stakeholder groups have been completed.

OBJECTIVE

To examine the perceptions of EPs' integration during role transition from multiple stakeholder groups.

DESIGN

Qualitative study.

SETTING

Online interviews.

PATIENTS OR OTHER PARTICIPANTS

Seventeen EPs in the first 2 years of their first job postcertification (9 women, 8 men, age = 26 ± 5 years, experience = 9.5 ± 5 months), 16 supervisors and mentors of EPs (6 women, 10 men, age = 52 ± 11 years), and 10 faculty members and 8 preceptors (11 women, 7 men, age = 43 ± 10 years).

DATA COLLECTION AND ANALYSIS

Semistructured interviews using a validated interview guide based on the current literature were conducted. We analyzed data using consensual qualitative research principles. Multiple-analyst triangulation (n = 3), member checking, and peer review served as trustworthiness strategies.

RESULTS

We identified 4 themes that defined the integration of EPs during role transition. The integration of EPs was facilitated through role inductance and mentoring. Early professionals struggle finding balance to avoid burnout as they are new to the profession and feel obligated to exceed expectations from a coverage standpoint rather than focusing on the quality of care delivered. Finally, stakeholders suggested a timeline by which EPs become fully integrated into autonomous professional practice and understand all aspects of their role that typically takes anywhere from 1 to 3 years.

CONCLUSIONS

Early professionals benefited from appropriate graded autonomy during clinical education to develop their clinical reasoning skills, confidence, and mentoring network with past preceptors. Ongoing personal and professional support are needed during the initial few years to ease EPs' role inductance while they gain more experience and establish their clinician identity. Expectations for EPs should be reasonable to allow for the provision of quality care, adequate work-life balance, and integration into the profession without guilt.

Clinical outcomes for various benign paroxysmal positional vertigo (BPPV) diagnoses in adolescents and young adults with recent concussions

OBJECTIVE

Determine how positive BPPV findings in adolescents and young adults following concussion impacted the total number of treatments required and time until discharge.

SETTING

Outpatient physical therapy clinic.

PARTICIPANTS

167 individuals who were diagnosed with concussion or brain injury.

DESIGN

Retrospective chart review.

MAIN MEASURES

Total number of treatments and days until discharge were compared for various BPPV diagnoses (anterior canal, posterior canal, horizontal canal, and combination) and for individuals with and without BPPV.

RESULTS

Fifty-one out of 167 cases (30.54%) were diagnosed with BPPV. The total number of treatments provided was statistically different across BPPV diagnoses (P = .004). However, days until discharge were not statistically different between BPPV diagnoses (P = .28). There was no significant difference between time to discharge between those with BPPV (median = 21 days, range = 7-126) and those without (median = 28 days, range = 7-84 days; P = .23, r = 0.09).

CONCLUSION

To optimize outcomes, including symptom resolution and return to sport and/or work, early identification of BPPV and subsequent intervention should be prioritized for individuals who have concussion symptoms that suggest vestibular dysfunction.

Transition to Practice Among Diverse Early Professional Athletic Trainers

CONTEXT

Early professional (EP) Athletic Trainers (ATs) may encounter adjustments and develop individual identities to master a new role, which can be difficult while transitioning from student to autonomous professional. Previous literature lacks content about the transition to practice of credentialed ATs who identify as Black, Indigenous, or People of Color (BIPOC).

OBJECTIVE

Identify challenges during professional education and transition to practice of EP ATs identifying as BIPOC.

DESIGN

Qualitative study.

SETTING

Virtual interview.

PATIENTS OR OTHER PARTICIPANTS

15 recently credentialed athletic trainers (13 female, 2 male, age=26.73±1.41 years, experience=13.80±4.03 months) who self-identified as BIPOC.

DATA COLLECTION AND ANALYSIS

We used an interview guide, validated by peer (n=1) and expert (n=3) review, to structure data collection sessions. Data saturation guided recruitment and we obtained theoretical redundancy after the final interview. We analyzed data with a phenomenological approach and used multianalyst triangulation (n=2) and peer review (n=2) as credibility strategies.

RESULTS

Every participant mentioned they were victims of microaggressions during either their professional preparation and/or work environment because of their race. Those who chose to report the incidents felt a lack of support from work supervisors, faculty, peers, and preceptors. Participants noted a preference for racially concordant mentoring to facilitate talking to someone who could better understand BIPOC EPs' experiences. Participants also relied on outside support from friends and family as coping mechanisms. Finally, participants experienced perceived incompetency from supervisors due to their limited work experience as early professionals and felt their professional preparation was stunted by the COVID-19 pandemic.

CONCLUSIONS

Participants perceived that their transition to practice was stressful due to microaggressions encountered, a lack of support, and a lack of racially concordant mentoring. Diversity, equity, and inclusion training should be included in athletic training education and workspaces to assist in providing more welcoming environments for BIPOC EP ATs and students.

Racial identity and concussion diagnosis and recovery trajectories in collegiate athletes: a LIMBIC MATARS investigation

OBJECTIVE

To determine if there were concussion diagnosis and recovery disparities between collegiate athletes with Black and White racial identities.

DESIGN

Retrospective cohort study.

METHODS

Concussion information was extracted from NCAA athlete medical files at LIMBIC MATARS member institutions from the 2015-16' to 2019-20' academic years. A total of 410 concussions from 9 institutions were included that provided all independent (i.e. racial identity of Black or White) and dependent variable information (i.e. dates of injury, diagnosis, symptom resolution, and return to sport) that were analyzed using Mann-Whitney U tests. The sample consisted of 114 (27.8%) concussions sustained by Black athletes and 296 (72.1%) sustained by White athletes.

RESULTS

The overall sample had a median of 0 days between injury occurrence to diagnosis, 7 days to symptom resolution, and 12 days to return to sport. No significant timing differences were observed for concussion diagnosis (p = .14), symptom resolution (p = .39), or return to sport (p = 0.58) between collegiate athletes with Black versus White racial identities.

CONCLUSIONS

These findings may reflect equitable access to onsite sports medicine healthcare resources that facilitate concussion management in the collegiate sport setting. Future work should explore these associations with a larger and more diverse sample of collegiate athletes.

Are Metabolic Power Distribution and Accelerometer-Based Global Positioning System Variables Associated With Odds Ratios of Noncontact Injuries in Professional Soccer Players?

ABSTRACT

Nobari, H, Alves, AR, Abbasi, H, Khezri, D, Zamorano, AD, and Bowman, TG. Are metabolic power distribution and accelerometer-based GPS variables associated with odds ratios of noncontact injuries in professional soccer players? J Strength Cond Res 37(9): 1809-1814, 2023-The present study was intended to i) investigate the relationship between metabolic power average (MPA), acceleration (AcZ) and deceleration (DcZ) zones, and their differences (Δ) on 3 load levels with noncontact injuries in professional players throughout a full soccer season and ii) to analyze the injury risk associated between high-load versus low-load levels for each of the aforementioned parameters with odds ratios (OR) and relative risk (RR), respectively. Twenty-one professional soccer players (age = 28.3 ± 3.9 years) were monitored during a full season (48 weeks) through global positioning system (GPS). A relationship between MPA and accelerometer-based GPS, mainly in explosive actions (i.e., AcZs and DcZs), was found. A higher incidence of injuries in the high-load weeks compared with the low-load weeks were reported (mainly in MPA, AcZ1, AcZ2, and DcZ3 variables). Moreover, significant means of OR (mean = 4.3) and RR (mean = 2.6) of noncontact injuries were established in intense periods with higher metabolic load (i.e., power accelerations, AcZ1, x2 = 0.022). Our results may be useful for coaches, sports scientists, and researchers regarding the optimization of the athletes' performance, as well as providing insights about the impact of intense exercise.

Secondary School Athletic Trainers' Experiences With Organizational Conflict: A Comparison Across Employment Models

CONTEXT

Athletic training is a multifaceted profession characterized by interpersonal relationships and a team approach to care. Collaborative relationships, by nature, open the door to conflict, which has been reported frequently in the collegiate athletic setting. However, secondary school athletic trainers' (ATs') experiences with conflict and pressure in their role are not readily understood.

OBJECTIVE

To measure the extent and sources of stress, pressure, and conflict within the secondary school athletic training setting and determine if differences exist across employment characteristics.

DESIGN

Cross-sectional study.

SETTING

Secondary school athletics.

PATIENTS OR OTHER PARTICIPANTS

Secondary school ATs (n = 725, age = 39.8 ± 10.5 years, years certified = 16.7 ± 9.7, years in current role = 10.6 ± 7.8).

MAIN OUTCOME MEASURES

Participants were asked to reply to an online questionnaire with quantitative measures pertaining to organizational conflict and workplace dynamic. Employment type (school district employee, school district teacher, medical or university facility, independent contractor) and status (full time, part time) served as independent variables. Likert-scale scores (1 = strongly agree to 5 = strongly disagree; 1 = always to 5 = never) and perceived sources of stress, pressure, and conflict were the dependent variables. Analyses consisted of Kruskal-Wallis tests with Mann-Whitney U post hoc tests and odds ratios to assess associations between variables of interest.

RESULTS

We obtained a 15.3% response rate (725/4745). Although the ATs reported experiencing conflict and pressure, these experiences were relatively infrequent and not universal. Compared with part-time ATs, full-time ATs described higher ratings of strong relationships with coaches (P = .003) and principals (P = .002). The most frequently identified sources of conflict were parents (59%) and coaches (53.9%), followed by athletes (32.6%). Full-time ATs were 1.6 times more likely to report experiencing conflict with a coach than part-time ATs (odds ratio = 1.550, 95% CI = 1.037, 2.317; P = .040).

CONCLUSIONS

Secondary school ATs' experiences regarding organizational conflict were relatively positive. Instances of pressure and conflict were noted, though relatively infrequently, and these experiences were largely uninfluenced by employment type.

Lessons Learned and Potential Long-Term Effects on Athletic Trainers and Clinical Practice After a Global Pandemic

CONTEXT

Perceived stress and burnout are significant concerns among athletic trainers (ATs) due to growing professional demands. The global COVID-19 pandemic brought additional stressors, especially for health care providers, including the need to learn and integrate new skill sets in order to continue providing safe and effective patient care.

OBJECTIVE

To explore the influence of COVID-19 stressors on ATs engaged in patient care.

DESIGN

Cross-sectional study.

SETTING

Internet survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 429 ATs (age = 33 ± 9 years; experience = 11 ± 9 years; 74 men, 355 women) currently providing patient care.

MAIN OUTCOME MEASURE(S)

We recruited participants from social media sites to complete a questionnaire with the Coronavirus Anxiety Scale (CAS), Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS MP), and qualitative questions related to the effects of COVID-19. We calculated correlations between CAS and MBI-HSS MP composite scores (emotional exhaustion, personal accomplishment, and depersonalization) and used regression analysis to explore if CAS scores could be predicted by vaccination status (vaccinated or unvaccinated), sex, and MBI-HSS MP composite scores. We analyzed the qualitative data using a phenomenological, inductive approach with multianalyst triangulation and peer review as trustworthiness strategies.

RESULTS

Significant correlations existed between CAS and MBI-HSS MP composite scores (P < .001). Emotional exhaustion (P < .001) and depersonalization (P = .008) explained 28% of the variance in CAS scores (F2,405 = 81.29, P < .001). Three major areas of focus emerged: effects on wellness, emphasis on the value of athletic training, and the lessons learned and future innovation to inform potential long-term changes in the athletic training profession.

CONCLUSIONS

Key factors of emotional exhaustion and depersonalization during the pandemic may have exacerbated the potential for burnout among ATs. The pandemic affected ATs' wellness, changed perceptions of ATs, and altered operating procedures. Healthy coping strategies and organizational support are suggested for those who are struggling.

Headgear safety attitudes among women's lacrosse stakeholders: Qualitative results

OBJECTIVE

To explore diverse stakeholders' perceptions of headgear use in collegiate women's lacrosse.

PARTICIPANTS

189 collegiate women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32).

METHODS

Participants completed online open-ended qualitative questions surrounding headgear use in the sport. Responses were coded by the research team via inductive reasoning.

RESULTS

Stakeholders felt that incorporating headgear use into women's lacrosse would increase aggression and change the nature of the sport. Some felt that headgear was important for injury risk mitigation and invoked a need for research and development. Stakeholders raised the need for coaching and officiating improvement as primary injury prevention measures. Players were concerned about esthetics and performance limitations. Finally, many felt that it should be left to player choice to wear headgear or not.

CONCLUSION

Most stakeholders invoke concerns of risk compensation and changing the nature of the sport of women's lacrosse, and are in favor of headgear remaining optional.

Exploring the Effects of a Neck Strengthening Program on Purposeful Soccer Heading Biomechanics and Neurocognition

Background

Cervical (neck) strengthening has been proposed as an important factor in concussion prevention. The purpose of the study was to determine if a six-week cervical strengthening program affected neurocognition and purposeful soccer heading biomechanics. The hypothesis was that the neck strengthening program would improve strength, maintain neurocognition, and alter purposeful soccer heading biomechanics.

Study Design

Randomized controlled trial.

Methods

Twenty collegiate soccer athletes (8 males, 12 females, age=20.15±1.35 years, height=171.67±9.01 cm, mass=70.56±11.03 kg) volunteered to participate. Time (pre, post) and group (experimental, control) served as the independent variables. Four composite scores from the CNS Vital Signs computer based neurocognitive test (CNSVS; verbal memory, visual memory, executive function, reaction time) and aspects of heading biomechanics from inertial measurement units (xPatch; peak linear acceleration, peak rotational acceleration, duration, Gadd Severity Index [GSI]) served as the dependent variables. Each athlete completed a baseline measure of neck strength (anterior neck flexors, bilateral anterolateral neck flexors, bilateral cervical rotators) and CNSVS after heading 10 soccer balls at two speeds (11.18 and 17.88 m/s) while wearing the xPatch. The experimental group completed specific cervical neck strengthening exercises twice a week for six weeks using a Shingo Imara™ cervical neck resistance apparatus while the control group did not. After six weeks, the participants completed the same heading protocol followed by measurement of the same outcome variables. The alpha value was set to p<0.05 a priori.

Results

The interaction between time and group was significant for visual memory (F1,17=5.16, p=0.04, η2=0.23). Interestingly, post hoc results revealed visual memory decreased for the control group from pretest (46.90±4.46) compared to posttest (43.00±4.03; mean difference=3.90, 95% CI=0.77-7.03, p=0.02). Interactions for all other dependent variables were not statistically significant (p>0.05).

Conclusions

The cervical neck strengthening protocol allowed maintenance of visual memory scores but did not alter other neurocognitive measures or heading biomechanics. The link between cervical neck strengthening and concussion predisposition should continue to be explored.

Level of Evidence

Level 1b.

Workload is associated with the occurrence of non-contact injuries in professional male soccer players: A pilot study

Injuries in professional soccer are a significant concern for teams, and they are caused amongst others by high training load. This cohort study describes the relationship between workload parameters and the occurrence of non-contact injuries, during weeks with high and low workload in professional soccer players throughout the season. Twenty-one professional soccer players aged 28.3 ± 3.9 yrs. who competed in the Iranian Persian Gulf Pro League participated in this 48-week study. The external load was monitored using global positioning system (GPS, GPSPORTS Systems Pty Ltd) and the type of injury was documented daily by the team's medical staff. Odds ratio (OR) and relative risk (RR) were calculated for non-contact injuries for high- and low-load weeks according to acute (AW), chronic (CW), acute to chronic workload ratio (ACWR), and AW variation (Δ-Acute) values. By using Poisson distribution, the interval between previous and new injuries were estimated. Overall, 12 non-contact injuries occurred during high load and 9 during low load weeks. Based on the variables ACWR and Δ-AW, there was a significantly increased risk of sustaining non-contact injuries (p &lt; 0.05) during high-load weeks for ACWR (OR: 4.67), and Δ-AW (OR: 4.07). Finally, the expected time between injuries was significantly shorter in high load weeks for ACWR [1.25 vs. 3.33, rate ratio time (RRT)] and Δ-AW (1.33 vs. 3.45, RRT) respectively, compared to low load weeks. The risk of sustaining injuries was significantly larger during high workload weeks for ACWR, and Δ-AW compared with low workload weeks. The observed high OR in high load weeks indicate that there is a significant relationship between workload and occurrence of non-contact injuries. The predicted time to new injuries is shorter in high load weeks compared to low load weeks. Therefore, the frequency of injuries is higher during high load weeks for ACWR and Δ-AW. ACWR and Δ-AW appear to be good indicators for estimating the injury risk, and the time interval between injuries.

Sprint Variables Are Associated with the Odds Ratios of Non-Contact Injuries in Professional Soccer Players

Significant evidence has emerged that a high volume of sprinting during training is associated with an increased risk of non-contact injuries in professional soccer players. Training load has been reported as a modifiable risk factor for successive injury in soccer. Sprint workload measures and non-contact injuries were recorded weekly in twenty-one professional soccer players over a one season period. Odds ratio (OR) and relative risk (RR) were calculated based on the weeks of high and low load of total distance (TD), high-speed distance (HSD), sprint distance (SPD). and repeated sprints (RS). The Poisson distribution estimated the interval time between the last injury and the new injury. The weeks with high-load levels increased the risk of non-contact injury associated with TD (OR: 4.1; RR: 2.4), HSD (OR: 4.6; RR: 2.6), SPD (OR: 6.9; RR: 3.7), and RS (OR: 4.3; RR: 2.7). The time between injuries was significantly longer in weeks of low-load in TD (rate ratio time (RRT) 1.5 vs. 4.2), HSD (RRT: 1.6 vs. 4.6), and SPD (RRT: 1.7 vs. 7.7) compared to weeks of high-load. The findings highlight an increased risk of non-contact injuries during high weekly sprint workloads. Possibly, TD, HSD, and SPD measured via a wearable inertial measurement unit could be modeled to track training and to reduce non-contact injuries. Finally, the interval time between the last injury and the new injury at the high-load is shorter than the low-load.

The Impact of Environmental Conditions on Player Loads During Preseason Training Sessions in Women's Soccer Athletes

ABSTRACT

Austin, AB, Collins, SM, Huggins, RA, Smith, BA, and Bowman, TG. The impact of environmental conditions on player loads during preseason training sessions in women's soccer athletes. J Strength Cond Res 35(10): 2775-2782, 2021-Our objective was to determine the impact of environmental conditions on player loads during preseason training sessions in women's soccer athletes. Eleven women's NCAA Division III soccer players (age = 20 ± 1 year, height = 167.28 ± 8.65 cm, body mass = 60.18 ± 5.42 kg, V̇o2max = 43.70 ± 3.95 ml·kg-1·min-1) volunteered to wear Global Positioning System (GPS) devices (Sports Performance Tracking, Melbourne, Australia) that provided measures of training session external intensity throughout all preseason practices (n = 15). We recorded wet-bulb globe temperature (WBGT), session Rating of Perceived Exertion-Training Load (sRPE-TL), and ΔBM during each preseason training session and set α ≤ 0.05. The combination of WBGT, sRPE-TL, and ΔBM explained 34% of the variance in GPS-based intensity score (proprietary measure) (F3,153 = 26.25, p < 0.001). Wet-bulb globe temperature (t156 = -2.58, p = 0.01), sRPE (t156 = 8.24, p < 0.001), and ΔBM (t156 = 2.39, p = 0.02) were significantly associated with intensity. The ΔBM from prepractice (60.00 ± 5.21 kg) to postpractice (59.61 ± 5.10 kg) was statistically significant (p < 0.001); however, ΔBM from the beginning of preseason (59.87 ± 5.31 kg) to the end of preseason (59.91 ± 5.58 kg) was not significant (p = 0.89). Despite relatively low to moderate environmental conditions, increases in WBGT were associated with reductions in GPS intensity and elevated internal load via sRPE-TL. Our findings support the association between exercise intensity and WBGT, internal load, and hydration status; thus, coaches and exercise scientists should take these factors into account when monitoring or interpreting intensity metrics. Furthermore, these findings support the continued use of environmental monitoring and hydration best-practice policies to limit exercise intensity in the heat so as to mitigate excessive heat stress.

A Theoretical Model of Transition to Practice for Athletic Trainers

CONTEXT

The transition to practice of newly credentialed athletic trainers (ATs) has become an area of focus in the athletic training literature. However, no theoretical model has been developed to describe the phenomenon and drive investigation.

OBJECTIVE

To better understand the lived experience of the transition to practice and develop a theoretical model of transition to practice for ATs.

DESIGN

Qualitative study.

SETTING

Telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Fourteen professional master's athletic training students (7 men, 7 women, age = 25.6 ± 3.7 years, from 9 higher education institutions) in the first year of clinical practice as newly credentialed ATs.

DATA COLLECTION AND ANALYSIS

Participants completed semistructured phone interviews at 3 timepoints over 12 to 15 months. The first interview was conducted just before graduation, the second 4 to 6 months later, and the third at 10 to 12 months. The interviews were transcribed and analyzed using a grounded theory approach.

RESULTS

We developed a theoretical model to explain the causal conditions that triggered transition, how the causal conditions were experienced, the coping strategies used to persist through the first year of practice, and the consequences of those strategies.

CONCLUSIONS

The model provides a framework for new athletic training clinicians, educators, and employers to better understand the transition process in order to help new clinicians respond by accepting or adapting to their environment or their behaviors.

The Effects of Soft Tissue Flossing on Hamstring Range of Motion and Lower Extremity Power

BACKGROUND

Flossing includes wrapping a specialized latex band around a muscle group providing compression, partially occluding blood flow, followed by performing exercises. This is hypothesized to improve flexibility by dissipating myofascial adhesions; however, research is lacking.

OBJECTIVE

To determine the effect of the application of a floss band to the thigh on hamstring flexibility and lower extremity power.

DESIGN

Crossover Study.

SETTING

Exercise Physiology Laboratory.

PARTICIPANTS

Twenty-one recreationally active individuals (8 male, 13 female; age = 22.62±2.99 years; height = 171.52±9.08 cm; mass = 73.57±11.37 kg).

METHODS

Three counterbalanced interventions were studied during body weight squats, lunges, and hamstring curls (without resistance): floss, sham, and control. The floss treatment included wrapping the Rogue Wide Voodoo Floss Band™ from the proximal knee to the gluteal fold at a pressure of 140 to 200 mmHg. The sham treatment included wrapping the same band in the same location with less pressure (10 to 40 mmHg) while the control treatment did not include floss band application. Hip flexion range of motion, via the straight leg raise, and power (single-leg vertical jump) were compared from pre-test to post-test using a 3x2 repeated measures ANOVA.

RESULTS

There was a significant interaction between time and session for hamstring flexibility (F(2,40)=17.54, p<0.001, η2=0.47). Post hoc tests showed significant differences between pre- (86.14±8.06 degrees) and post-test (90.81±7.69 degrees) for the floss session (p<0.001, Mean Difference=4.67, CI95=3.35-5.98) and between pre- (87.67±7.51 degrees) and post-test (89.86±7.88 degrees) for the sham session (p=0.001, Mean Difference=2.19, CI95=0.98-3.40). There were no significant interactions for jump power (F(2,40)=1.82, P=0.18, η2=0.08, 1-β=0.36).

CONCLUSIONS

Flossing treatment increased hamstring flexibility more than the sham session without affecting lower body power. Flossing could be beneficial when treatment or performance preparation goals are increased flexibility without decreased power. Future studies should continue to examine the clinical effectiveness of flossing on an injured population.

Immunoglobulin A Autoreactivity toward Brain Enriched and Apoptosis-Regulating Proteins in Saliva of Athletes after Acute Concussion and Subconcussive Impacts

The diagnosis and management of concussion is hindered by its diverse clinical presentation and assessment tools reliant on subjectively experienced symptoms. The biomechanical threshold of concussion is also not well understood, and asymptomatic concussion or "subconcussive impacts" of variable magnitudes are common in contact sports. Concerns have risen because athletes returning to activity too soon have an increased risk of prolonged recovery or long-term adverse health consequences. To date, little is understood on a molecular level regarding concussion and subconcussive impacts. Recent research suggests that neuroinflammatory mechanisms may serve an important role subsequent to concussion and possibly to subconcussive impacts. These studies suggest that autoantibodies may be a valuable tool for detection of acute concussion and monitoring for changes caused by cumulative exposure to subconcussive impacts. Hence, we aimed to profile the immunoglobulin (Ig)A autoantibody repertoire in saliva by screening a unique sport-related head trauma biobank. Saliva samples (n = 167) were donated by male and female participants enrolled in either the concussion (24-48 h post-injury) or subconcussion (non-concussed participants having moderate or high cumulative subconcussive impact exposure) cohorts. Study design included discovery and verification phases. Discovery aimed to identify new candidate autoimmune targets of IgA. Verification tested whether concussion and subconcussion cohorts increased IgA reactivity and whether cohorts showed similarities. The results show a significant increase in the prevalence of IgA toward protein fragments representing 5-hydroxytryptamine receptor 1A (HTR1A), serine/arginine repetitive matrix 4 (SRRM4) and FAS (tumor necrosis factor receptor superfamily member 6) after concussion and subconcussion. These results may suggest that concussion and subconcussion induce similar physiological effects, especially in terms of immune response. Our study demonstrates that saliva is a potential biofluid for autoantibody detection in concussion and subconcussion. After rigorous confirmation in much larger independent study sets, a validated salivary autoantibody assay could provide a non-subjective quantitative means of assessing concussive and subconcussive events.

The Effect Of Mild Exercise Induced Dehydration On Sport Concussion Assessment Tool 3 (SCAT3) Scores: A within-subjects design

BACKGROUND

Sports-related concussions are prevalent in the United States. Various diagnostic tools are utilized in order to monitor deviations from baseline in memory, reaction time, symptoms, and balance. Evidence indicates that dehydration may also alter the results of diagnostic tests.

PURPOSE

The purpose was to determine the effect of exercise-induced dehydration on performance related to concussion examination tools.

STUDY DESIGN

Repeated measures design.

METHODS

Seventeen recreationally competitive, non-concussed participants (age: 23.1±3.1 years, height:168.93±10.71 cm, mass: 66.16 ± 6.91 kg) performed three thermoneutral, counterbalanced sessions (rested control, euhydrated, dehydrated). Participants were either restricted (0.0 L/hr) or provided fluids (1.0 L/hr) while treadmill running for 60 min at an intensity equal to 65-70% age-predicted maximum heart rate (APMHR). The Sport Concussion Assessment Tool 3 (SCAT3) was utilized to assess symptoms, memory, balance, and coordination.

RESULTS

Statistically significant differences were seen among sessions for symptom severity and symptom total. The rested control session had significantly lower values when compared to the dehydrated session. Additionally, the symptom total in the rested control was significantly lower than the euhydrated condition as well. No statistically significant differences were seen for the BESS or memory scores.

CONCLUSIONS

Mild exercise-induced dehydration results in increased self-reported symptoms associated with concussions. Clinicians tasked with monitoring and accurately diagnosing head trauma should take factors such as hydration status into account when assessing patients for concussion with the SCAT3. Clinicians should proceed with caution and not assume concussion as primary cause for symptom change.

LEVEL OF EVIDENCE

Level 3.

The Effect of Lacrosse Protective Equipment on Cardiopulmonary Resuscitation and Automated External Defibrillator Shock

CONTEXT

In the event of an acute cardiac event, on-field equipment removal is suggested, although it remains unknown how lacrosse equipment removal may alter time to first chest compression and time to first AED shock.

OBJECTIVE

To determine time to first chest compression and first AED shock in 2 chest exposure procedures with 2 different pad types.

DESIGN

Crossover study Setting: Simulation laboratory Participants: Thirty-six athletic trainers (21 females, 15 males; age=30.58±7.81) Main Outcome Measures: Participants worked in pairs to provide 2 rescuer CPR intervention on a simulation manikin (QCPR manikin, Laerdal Medical, Wappingers Falls, NY) outfitted with lacrosse pads and helmet. Participants completed a total of 8 trials per pair (2 chest exposure procedures X 2 pad types X 2 participant roles). The dependent variables were time to first compression (s) and time to first AED shock (s). The independent variables were chest exposure procedure with 2 levels (procedure 1: removal of helmet while initiating CPR over the pads followed by pad retraction and AED application; procedure 2: removal of helmet and removal of pads followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector).

RESULTS

We found a statistically significant interaction between chest exposure procedure and pad type for time to first compression (F1,35=4.66, P=0.04, ω2p=0.10) with significantly faster times during procedure 1 for both the Nemesis pads (16.1±3.4 s) and the Hitman pads (16.1±4.5 s) compared to procedure 2 (Nemesis pads: 49.6±12.9 s, P<0.0001; Hitman pads: 53.8±14.5 s, P<0.0001).

CONCLUSIONS

Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens time to first chest compression without diminishing CPR quality which may improve patient outcomes. Time to first AED shock was not different between equipment procedure or pad type.

Sex differences in mechanisms of head impacts in collegiate soccer athletes

BACKGROUND

There has been growing interest in head impacts related to sports participation due to potential long- and short-term consequences of head injuries. Our purpose was to compare head impact magnitude and frequency between men's and women's intercollegiate soccer players based on head impact mechanism.

METHODS

28 collegiate soccer players (16 women: age = 19.94 (1.06) years, height = 163.75 (5.15) cm, mass = 61.21 (5.09) kg; 12 men: age = 20.25 (1.14) years, height = 180.34 (6.03) cm, mass = 74.09 (9.32) kg) wore xPatch (X2 Biosystems, Seattle, WA) head impact sensors. Each practice and game was video recorded in order to confirm head impacts. The independent variable was impact mechanism (head to head, head to body (other than head), head to ground, ball to head, goal to head, and combination). Sensors collected linear and rotational accelerations and frequency of head impacts per 1000 athlete exposures.

FINDINGS

Men were more likely to sustain head impacts than women (IRR = 1.74, CI₉₅ = 1.59-1.92). The highest head impact incidence rate for men was head to body (IR = 611.68, CI₉₅ = 553.11-670.25) while the highest impact incidence rate for women was ball to head (IR = 302.29, CI₉₅ = 270.93-333.64). The interaction between sex and mechanism was significant for rotational accelerations (F_{4, 1720} = 3.757, P = .005, ω² = 0.013) but not for linear accelerations (F_4,1720 = 0.680, P = .606, ω² < 0.001, 1 - β = 0.223).

INTERPRETATION

To reduce the frequency of head impacts in men, perhaps rules governing player to player contact should be more strictly enforced as these data confirm frequent player-to-head contact during soccer practices and games. Prevention efforts for women should be focused on limiting the amount of purposeful heading (planned contact between the head and ball) occurring during play especially since these impacts had higher magnitudes compared to men.

Collegiate Athletic Trainers' Experiences With External Pressures Faced During Decision Making

CONTEXT

Conflict is prevalent between sports medicine professionals and coaching staffs regarding return-to-play decisions for athletes after injury in the National Collegiate Athletic Association (NCAA) Division I setting. The firsthand experiences of athletic trainers (ATs) regarding such conflict have not been fully investigated.

OBJECTIVE

To better understand the outside pressures ATs face when making medical decisions regarding patient care and return to play after injury in the NCAA Division I Football Bowl Subdivision (FBS) setting.

DESIGN

Qualitative study.

SETTING

Semistructured one-on-one telephone interviews.

PATIENTS OR OTHER PARTICIPANTS

Nine ATs (4 men, 5 women; age = 31 ± 8 years [range = 24-48 years]; years certified = 9 ± 8).

DATA COLLECTION AND ANALYSIS

Interviews were audio recorded and later transcribed. Thematic analysis was completed phenomenologically. Researcher triangulation, peer review, and member checks were used to establish trustworthiness.

RESULTS

Two major themes emerged from the qualitative analysis: (1) pressure is an expected component of the Division I FBS AT role, and (2) strategies can be implemented to mitigate the negative effects of pressure. Three subthemes supported the second major theme: (1) ensuring ongoing and frequent communication with stakeholders about an injured athlete's status and anticipated timeline for return to play, (2) providing a rationale to coaches or administrations to foster an understanding of why specific medical decisions are being made, and (3) establishing positive relationships with coaches, athletes, and administrations.

CONCLUSIONS

External pressure regarding medical decisions was an anticipated occurrence for our sample. Such pressure was described as a natural part of the position, not negative but rather a product of the culture and environment of the Division I FBS setting. Athletic trainers who frequently face pressure from coaches and administration should use the aforementioned strategies to improve the workplace dynamic and foster an environment that focuses on patient-centered care.

Impact Mitigation Properties of Women's Lacrosse Headgear

Recently, protective headgear has been released for women's lacrosse despite the fact that contact to the head is illegal. The purposes of this study were to (1) compare the linear and rotational impact attenuation properties of 2 brands of lacrosse headgear at 4 different locations during laboratory pendulum impacts and (2) determine impact dissipation of new and used lacrosse headgear. We measured peak rotational acceleration (PRA; rad/s²) and linear acceleration (PLA; g) at 4 impact locations (side, rear boss non-centric (NC), front boss, and front) in two headgear brands (Cascade LX, Hummingbird). Two headgear service lives (new headgear, used headgear) were included for the second analysis. During the slower speed, there was a significant interaction between impact location and helmet brand (p = 0.002) for PLA. No other findings were significant. While the Hummingbird headgear reduced linear and rotational accelerations of the headform better than the Cascade headgear during slow velocity impacts to the front and front boss locations, it did so due to extreme motion of the helmet upon impact that we believe may compromise protection of the head and face from lacerations and other injuries.

Challenges Faced by Collegiate Athletic Trainers, Part I: Organizational Conflict and Clinical Decision Making

CONTEXT

Organizational conflict, particularly between coaches and medical professionals, has been reported in collegiate athletics. Different values create room for conflict between coaches and athletic trainers (ATs); however, ATs' experiences when making medical decisions are not fully understood.

OBJECTIVE

To investigate the presence of organizational conflict regarding medical decision making and determine if differences exist across athletic affiliations.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics (National Collegiate Athletic Association [NCAA], National Association of Intercollegiate Athletics [NAIA], National Junior College Athletic Association [NJCAA]).

PATIENTS OR OTHER PARTICIPANTS

A total of 434 ATs responded (age = 27.7 ± 3.2 years, years certified = 5.2 ± 2.7), representing the NCAA Division I (DI; n = 199), Division II (DII; n = 67), Division III (DIII; n = 108); NAIA (n = 37); and NJCAA (n = 23) settings.

MAIN OUTCOME MEASURE(S)

The survey instrument contained quantitative measures and open-ended questions, with affiliation as our primary independent variable. Responses to Likert-scale questions (1 = strongly agree, 5 = strongly disagree) regarding organizational pressures within athletics served as the dependent variables. Kruskal-Wallis analysis-of-variance and Mann-Whitney U post hoc tests assessed differences in organizational conflict across affiliations. Open-ended questions were analyzed inductively.

RESULTS

We obtained a 14.47% (434 of 3000) response rate. National Collegiate Athletic Association DI ATs disagreed less than NCAA DII and DIII and NJCAA ATs that they would worry about job security if turnover in the head coaching position occurred (P < .05). Regarding the influence of coaches on job performance, differences were found between NCAA DI and DIII and between DI and NJCAA ATs (P < .01). Visibility of the injury and situational factors influenced the level of perceived pressure.

CONCLUSIONS

Athletic trainers perceived pressure from coaches regarding medical decision making. Division I ATs placed greater emphasis on the role that coaches played in their job performance and job security. Athletic departments should consider transitioning to patient-centered models of care to better align values and reduce the external pressures placed on ATs.

Challenges Faced by Collegiate Athletic Trainers, Part II: Treating Concussed Student-Athletes

CONTEXT

Conflict between athletic trainers (ATs) and other stakeholders can occur because of competing interests over medical decisions regarding concussion. However, we are unaware of any studies specifically exploring these situations across various collegiate athletic affiliations.

OBJECTIVE

To investigate the challenges faced by ATs when treating concussed student-athletes.

DESIGN

Qualitative study.

SETTING

Online questionnaire.

PATIENTS OR OTHER PARTICIPANTS

A total of 434 ATs (267 women, 166 men, 1 missing data; age = 27.73 ± 3.24 years, experience = 5.17 ± 2.67 years) completed the questionnaire (response rate = 14.47%). Our participants represented multiple employment settings within intercollegiate athletics.

DATA COLLECTION AND ANALYSIS

We sent an online questionnaire to 3000 ATs working in the collegiate and university setting across the United States. A survey expert verified face, content, and construct validity of the questionnaire in 2 rounds of review, and 3 ATs completed a content-validity tool before we finalized the survey. We analyzed the qualitative data using a general inductive approach and ensured trustworthiness through multiple-analyst triangulation and peer review.

RESULTS

When we examined the responses from our participants regarding their work with student-athletes who had sustained concussions, we found 2 major themes, each with subthemes. First, educational efforts appeared to be only modestly effective because of a lack of honesty, noncompliant actions, and coach interference. Second, return to learn was challenging because of a lack of communication among stakeholders, athletes being anxious about needing accommodations, and difficulty convincing faculty to provide reasonable accommodations.

CONCLUSIONS

Based on our findings, we recommend continued efforts to improve the culture surrounding concussion in collegiate athletes. Athletic trainers should include key stakeholders such as coaches, student-athletes, parents, faculty, and other educational administrators in their educational efforts to improve the policies and culture surrounding concussion treatment.

The effects of socioeconomic status on baseline neurocognitive testing scores

Baseline neurocognitive testing has been recommended to provide a more accurate representation of the pre-concussion cognitive status of individual athletes. Socioeconomic status is not typically controlled for when obtaining baseline scores, which may lead to inaccurate findings if post-injury scores are compared to normative data. Understanding the role of socioeconomic status in baseline testing is important for the accurate analysis of test scores and proper evaluation of patients if individualized baseline data are not available. Our purpose was to investigate the effects of socioeconomic status, as determined by eligibility for free or reduced cost lunch on baseline neurocognitive test scores in secondary school athletes. 1,788 secondary school athletes (females = 778, males = 1,010, age = 14.96 ± 1.11 years, height = 171.25 ± 17.83 cm, mass = 66.82 ± 21.63 kg) completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) upon starting scholastic athletics. ImPACT components (symptom severity scores and composite scores of verbal memory, visual memory, visual motor speed, and reaction time) served as the dependent variables. School administration coded free or reduced cost lunch eligibility (N = 1255 not eligible, N = 563 eligible) for each participant (group), which served as the independent variable. Free or reduced cost lunch eligibility significantly altered the combined dependent variables (multivariate F_5,1780=14.41, p < .001, ɳ² = .04) when sex and age were controlled. Follow up ANOVAs showed that participants eligible for free or reduced cost lunch scored significantly worse on verbal memory (F_1,1784 = 24.81, p < .001, ɳ² = .01), visual memory (F_1,1784 = 24.90, p < .001, ɳ² = .01), and visual motor speed (F_1,1784 = 50.54, p < .001, ɳ² = .03). In addition, slower reaction times (F_1,1784 = 35.10, p < .001, ɳ² = .02) and higher symptom severity scores (F_1,1784 = 10.37, p < .01, ɳ² = .01) were observed in those eligible for free or reduced cost lunch. If normative data are used instead of individual baselines, potential modifiers such as socioeconomic status should be taken into account when analyzing concussion scores to provide accurate diagnoses.

Junior Athletic Training Faculty Members' Perceptions of Doctoral Education on Their Role Transition

AIMS

Faculty members in healthcare professions have an important role in developing future clinicians, and preparation for their responsibilities is important. The purpose of this study was to examine junior athletic training faculty members' perceptions of doctoral preparation using a qualitative, phenomenological design.

METHODS

We included 20 athletic training faculty members (14 women, 6 men) who were 32±3 yrs of age and averaged 2±2 yrs as full-time faculty members in accredited athletic training programs. We audio-recorded and transcribed verbatim semi-structured telephone interviews designed to gain participants' perspectives on their doctoral education and transition to their faculty role. Two investigators analyzed data using a phenomenological approach, and saturation was obtained. Trustworthiness was established with the use of member checking, multiple analyst triangulation, and peer review.

RESULTS

Perceptions of doctoral preparation emerged into three themes: 1) doctoral preparation emphasizes research preparation, 2) teaching experience is important, and 3) faculty desire more preparation for faculty life and administrative responsibilities. Generally, participants felt highly prepared to do research, somewhat prepared to teach, and inadequately prepared for faculty life and administrative duties.

CONCLUSIONS

Doctoral program advisors and administrators should consider diversifying doctoral education to more holistically prepare faculty members.

Differences in the Mechanism of Head Impacts Measured Between Men's and Women's Intercollegiate Lacrosse Athletes

Background

Lacrosse is a rapidly growing sport in the United States. Comparing the magnitude and frequency of head impact mechanisms between sexes will provide data for injury prevention techniques and risk reduction of head injuries.

Purpose

To compare sex-specific differences in the magnitude and frequency of head impact mechanisms in National Collegiate Athletic Association (NCAA) Division III intercollegiate lacrosse athletes.

Study Design

Cohort study; Level of evidence, 2.

Methods

A total of 31 NCAA Division III intercollegiate lacrosse athletes (16 men [mean age, 21 ± 1 years; mean height, 179.70 ± 5.82 cm; mean weight, 80.71 ± 6.33 kg] and 15 women [mean age, 20 ± 1 years; mean height, 165.43 ± 5.25 cm; mean weight, 64.08 ± 7.59 kg]) voluntarily participated in this study. Participants wore xPatch sensors at every event during the 2015 spring season. Sensors recorded the magnitude, frequency, and location of head impacts over 10g. Linear (g) and rotational (deg/s²) acceleration determined impact magnitudes. We calculated incidence rates (IRs; per 1000 athlete-exposures [AEs]) and incidence rate ratios (IRRs) with 95% CIs to determine frequency differences. Film footage from each event was synchronized with the time of each head impact for verification and mechanism coding. Sex and impact mechanism served as the independent variables.

Results

A significant interaction was found between impact mechanism and sex (P < .001) and main effects for impact mechanism (P < .001) and sex (P < .001). The most common mechanism in men's lacrosse was head to body (IR, 970.55/1000 AEs [95% CI, 266.14-331.98]), and in women's lacrosse, stick to head (IR, 289.87/1000 AEs [95% CI, 124.32-184.55]) was most common. Only 9 of 419 impermissible head impacts in men's lacrosse games were classed as penalties (2%); 7 of 25 impermissible head impacts in women's lacrosse games were called as penalties (28%).

Conclusion

The impact mechanisms of head to body in men's lacrosse and stick to head in women's lacrosse are penalties but occur frequently, suggesting that a focus on stressing rule enforcement is warranted. Because mechanism and sex affect the magnitude of head impacts, proper offensive and defensive techniques against opponents should be encouraged to reduce head impacts.

TEST-RETEST RELIABILITY OF THE LIMITS OF STABILITY TEST PERFORMED BY YOUNG ADULTS USING NEUROCOM® VSR SPORT

BACKGROUND

A reliable measure of dynamic postural control is needed for inclusion in the sports-related concussion assessment battery. Currently, there is not a clinical gold standard. The Limits of Stability (LOS) test has potential to be a useful tool to collect objective data on important dynamic postural stability variables. Psychometric properties of the LOS test with healthy young adults are yet to be established.

HYPOTHESIS/PURPOSE

The purpose of this study was to examine the intra-session and test-retest reliability for the LOS on the NeuroCom® VSR Sport when performed by young adults.

STUDY DESIGN

Reliability study.

METHODS

Twenty-seven healthy university students completed four trials of the LOS in each of two testing sessions one week apart. Relative reliability was measured within each session with an intraclass correlation coefficient (ICC[3,k]) for Session 1 and Session 2, respectively, on each of the five dependent variables (movement velocity [MVL], directional control [DCL], maximum excursion [MXE], endpoint excursion [EPE], and reaction time [RT]) provided by the Neurocom. Test-retest reliability was assessed using a repeated-measures analysis of variance along with an ICC (3,k) for relative reliability. An ICC value of 0.90 or higher was defined as having a high reliability, moderate reliability for ICC values between 0.80-0.89, and below 0.80 as questionable.

RESULTS

The reliability within each session for LOS composite scores for MVL, DCL, and MXE was moderate to high (ICC[3,k]=0.89-0.95). These same three variables also had high levels of test-retest reliability (ICC[3,k]=0.95-0.96). EPE and RT had moderate reliability over time (ICC[3,k]=0.88) but differences for within session reliability.

CONCLUSIONS

LOS provides a reliable measure of dynamic postural control for young adults. Two trials are recommended at baseline with the first being an adaptation trial to ensure accuracy of findings. Care needs to be taken when interpreting EPE and DCL scores on post-injury tests due to a learning effect for those variables.

LEVEL OF EVIDENCE

2c.

Airway Management in Athletes Wearing Lacrosse Equipment

CONTEXT

  Patient ventilation volume and rate have been found to be compromised due to the inability to seal a pocket mask over the chinstrap of football helmets. The effects of supraglottic airway devices such as the King LT and of lacrosse helmets on these measures have not been studied.

OBJECTIVE

  To assess the effects of different airway management devices and helmet conditions on producing quality ventilations while performing cardiopulmonary resuscitation on simulation manikins.

DESIGN

  Crossover study.

SETTING

  Simulation laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Thirty-six athletic trainers (12 men, 24 women) completed this study.

INTERVENTION(S)

  Airway-management device (pocket mask, oral pharyngeal airway, King LT airway [KA]) and helmet condition (no helmet, Cascade helmet, Schutt helmet, Warrior helmet) served as the independent variables. Participant pairs performed 2 minutes of 2-rescuer cardiopulmonary resuscitation under 12 trial conditions.

MAIN OUTCOME MEASURE(S)

  Ventilation volume (mL), ventilation rate (ventilations/min), rating of perceived difficulty (RPD), and percentage of quality ventilations were the dependent variables.

RESULTS

  A significant interaction was found between type of airway-management device and helmet condition on ventilation volume and rate ( F_12,408 = 2.902, P < .0001). In addition, a significant interaction was noted between airway-management device and helmet condition on RPD scores ( F_6,204 = 3.366, P = .003). The no-helmet condition produced a higher percentage of quality ventilations compared with the helmet conditions ( P ≤ .003). Also, the percentage of quality ventilations differed, and the KA outperformed each of the other devices ( P ≤ .029).

CONCLUSIONS

  The helmet chinstrap inhibited quality ventilation (rate and volume) in airway procedures that required the mask to be sealed on the face. However, the KA allowed quality ventilation in patients wearing a helmet with the chinstrap fastened. If a KA is not available, the helmet may need to be removed to provide quality ventilations.

The Ability to Provide Quality Chest Compressions Over Lacrosse Shoulder Pads

CONTEXT

  Performance of quality cardiopulmonary resuscitation is essential for improving patient outcomes. Performing compressions over football equipment inhibits compression depth and rate, but lacrosse equipment has not yet been studied.

OBJECTIVE

  To assess the effect of lacrosse shoulder pads on the ability to provide quality chest compressions on simulation manikins.

DESIGN

  Crossover study.

SETTING

  Simulation laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Thirty-six athletic trainers (12 men: age = 33.3 ± 9.7 years; 24 women: age = 33.4 ± 9.8 years).

MAIN OUTCOME MEASURE(S)

  No shoulder pads (NSP), Warrior Burn Hitman shoulder pads (WSP), and STX Cell II shoulder pads (SSP) were investigated. Outcomes were chest-compression depth (millimeters), rate (compressions per minute), rating of perceived exertion (0-10), hand-placement accuracy (%), and chest recoil (%).

RESULTS

  We observed a difference in mean compression depth among shoulder-pad conditions ( F_2,213 = 3.73, P = .03, ω² = 0.03), with a shallower depth during the WSP (54.1 ± 5.8 mm) than the NSP (56.8 ± 5.7 mm; P = .02) trials. However, no differences were found in mean compression rate ( F_2,213 = 0.87, P = .42, ω² = 0.001, 1-β = .20). We noted a difference in rating of perceived exertion scores ( F_2,213 = 16.41, P < .001, ω² = 0.12). Compressions were more difficult during the SSP condition (4.1 ± 1.3) than during the NSP (2.9 ± 1.2; P < .001) and WSP (3.3 ± 1.1; P = .002) conditions. A difference was present in hand-placement accuracy among the 3 shoulder-pad conditions (χ²₂ = 11.14, P = .004). Hand-placement accuracy was better in the NSP than the SSP condition ( P = .002) and the SSP than the WSP condition ( P = .001).

CONCLUSIONS

  Lacrosse shoulder pads did not inhibit the ability to administer chest compressions with adequate rate and depth. With appropriate training to improve hand placement, the pads may be left in place while cardiopulmonary resuscitation is initiated during sudden cardiac arrest.

The Doctor of Philosophy Experience of Athletic Trainers: Facilitators and Barriers to Anticipatory Faculty Socialization

CONTEXT

  It is important to understand the process whereby athletic trainers learn about their future roles, particularly when the roles can be complex and demanding. Little is known about the experiences of athletic training doctoral students, including facilitators and barriers to socialization as aspiring faculty members.

OBJECTIVE

  To investigate factors influencing the anticipatory socialization of athletic training doctoral students into future faculty roles.

DESIGN

  Qualitative study.

SETTING

  Universities with athletic training doctoral students.

PATIENTS OR OTHER PARTICIPANTS

  We recruited 28 students (19 women, 9 men, age = 28 ± 3 years) with a minimum of 1 year of doctoral coursework completed and participating in an assistantship at the time of the study to reach data saturation. Participants were certified for 6 ± 3 years and represented 5 National Athletic Trainers' Association districts and 9 institutions.

DATA COLLECTION AND ANALYSIS

  We completed semistructured, 1-on-1 telephone interviews with participants. We transcribed each interview verbatim and analyzed the data using an inductive approach. Peer review, multiple-analyst triangulation, and member checks ensured trustworthiness.

RESULTS

  We uncovered 4 themes from our analysis related to facilitators and barriers to professional socialization. Participants described comprehensive autonomous experiences in research that allowed them to feel confident they could sustain a scholarly agenda. Independent experiences and lack of pedagogy training yielded mixed preparedness relative to teaching responsibilities. Limited formal experience led to incomplete role understanding related to the service component of the professoriate. Finally, with regard to the administrative duties associated with athletic training faculty positions, participants noted a lack of direct exposure to common responsibilities.

CONCLUSIONS

  Role occupation in various aspects of the professoriate helped doctoral students prepare as future faculty members, although full role understanding was limited. Intentional exposure to research, teaching, service, and administrative expectations during doctoral experiences may facilitate the socialization of future athletic training faculty into academic roles.

The Ability of an Aftermarket Helmet Add-On Device to Reduce Impact-Force Accelerations During Drop Tests

CONTEXT

  The Guardian Cap provides a soft covering intended to mitigate energy transfer to the head during football contact. Yet how well it attenuates impacts remains unknown.

OBJECTIVE

  To evaluate the changes in the Gadd Severity Index (GSI) and linear acceleration during drop tests on helmeted headforms with or without Guardian Caps.

DESIGN

  Crossover study.

SETTING

  Laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Nine new football helmets sent directly from the manufacturer.

INTERVENTION(S)

  We dropped the helmets at 3 velocities on 6 helmet locations (front, side, right front boss, top, rear right boss, and rear) as prescribed by the National Operating Committee on Standards for Athletic Equipment. Helmets were tested with facemasks in place but no Guardian Cap and then retested with the facemasks in place and the Guardian Cap affixed.

MAIN OUTCOME MEASURE(S)

  The GSI scores and linear accelerations measured in g forces.

RESULTS

  For the GSI, we found a significant interaction among drop location, Guardian Cap presence, and helmet brand at the high velocity (F_10,50 = 3.01, P = .005) but not at the low (F_3.23,16.15 = 0.84, P = .50) or medium (F_10,50 = 1.29, P = .26) velocities. Similarly for linear accelerations, we found a significant interaction among drop location, Guardian Cap presence, and helmet brand at the high velocity (F_10,50 = 3.01, P = .002, ω² = 0.05) but not at the low (F_10,50 = 0.49, P = .89, ω² < 0.01, 1-β = 0.16) or medium (F_5.20,26.01 = 2.43, P = .06, ω² < 0.01, 1-β = 0.68) velocities.

CONCLUSIONS

  The Guardian Cap failed to significantly improve the helmets' ability to mitigate impact forces at most locations. Limited evidence indicates how a reduction in GSI would provide clinically relevant benefits beyond reducing the risk of skull fracture or a similar catastrophic event.

Comparison of head impact location during games and practices in Division III men's lacrosse players

BACKGROUND

Head impacts have been studied extensively in football, but little similar research has been conducted in men's lacrosse. It is important to understand the location and magnitude of head impacts during men's lacrosse to recognize the risk of head injury.

METHODS

Descriptive epidemiology study set on collegiate lacrosse fields. Eleven men's lacrosse players (age=20.9±1.13years, mass=83.91±9.04kg, height=179.88±5.99cm) volunteered to participate. We applied X2 sensors behind the right ear of participants for games and practices. Sensors recorded data on linear and rotational accelerations and the location of head impacts. We calculated incidence rates per 1000 exposures with 95% confidence intervals for impact locations and compared the effect of impact location on linear and rotational accelerations with Kruskal-Wallis tests.

FINDINGS

We verified 167 head impacts (games=112; practices=55). During games, the incidence rate was 651.16 (95% confidence interval=530.57-771.76). The high and low incidence rates for head impact locations during games were: side=410.7 (95% confidence interval=292.02-529.41) and top=26.79 (95% confidence interval=3.53-57.10). For games and practices combined, the impact locations did not significantly affect linear (χ²₃=6.69, P=0.08) or rotational acceleration (χ²₃=6.34, P=0.10).

INTERPRETATION

We suggest further research into the location of head impacts during games and practices. We also suggest player and coach education on head impacts as well as behavior modification in men's lacrosse athletes to reduce the incidence of impacts to the side of the head in an effort to reduce potential injury.

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.

Multistakeholder Perspectives on the Transition to a Graduate-Level Athletic Training Educational Model

CONTEXT

The decision has been made to move away from the traditional bachelor's degree professional program to a master's degree professional program. Little is known about the perceptions about this transition from those involved with education.

OBJECTIVE

To examine multiple stakeholders' perspectives within athletic training education on the effect that a change to graduate-level education could have on the profession and the educational and professional development of the athletic trainer.

DESIGN

Qualitative study.

SETTING

Web-based survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 18 athletic training students (6 men, 12 women; age = 24 ± 5 years), 17 athletic training faculty (6 men, 9 women, 2 unspecified; 7 program directors, 5 faculty members, 3 clinical coordinators, 2 unidentified; age = 45 ± 8 years), and 15 preceptors (7 men, 7 women, 1 unspecified; age = 34 ± 7 years) completed the study.

DATA COLLECTION AND ANALYSIS

Participants completed a structured Web-based questionnaire. Each cohort responded to questions matching their roles within an athletic training program. Data were analyzed following a general inductive process. Member checks, multiple-analyst triangulation, and peer review established credibility.

RESULTS

Thirty-one (62%) participants supported the transition, 14 (28%) were opposed, and 5 (10%) were neutral or undecided. Advantages of and support for transitioning and disadvantages of and against transitioning emerged. The first higher-order theme, advantages, revealed 4 benefits: (1) alignment of athletic training with other health care professions, (2) advanced coursework and curriculum delivery, (3) improved student and professional retention, and (4) student maturity. The second higher-order theme, disadvantages, was defined by 3 factors: (1) limited time for autonomous practice, (2) financial concerns, and (3) lack of evidence for the transition.

CONCLUSIONS

Athletic training students, faculty, and preceptors demonstrated moderate support for a transition to the graduate-level model. Factors supporting the move were comparable with those detailed in a recent document on professional education in athletic training presented to the National Athletic Trainers' Association Board of Directors. The concerns about and reasons against a move have been discussed by those in the profession.