Experiences of Athletic Trainers in Tactical Athlete Settings When Managing Patients With Mental Health Conditions

CONTEXT

Researchers have demonstrated that job demands impair tactical athletes' mental health. Mental health stigmas in this population and limited resources may prevent individuals from receiving care. Athletic trainers (ATs) are often the first, and sometimes the only, contact for mental health concerns. Previous literature indicated that ATs desired more psychosocial training and experience.

OBJECTIVE

To investigate ATs' preparedness and experiences managing patients with mental health conditions in the tactical athlete setting.

DESIGN

Consensual qualitative research study.

SETTING

One-on-one, semistructured interviews.

PATIENTS OR OTHER PARTICIPANTS

Fifteen ATs (men = 7, women = 8; age = 36 ± 10 years; experience in tactical athlete setting = 4 years [range, 6 months-20 years]; military = 12, law enforcement = 2; fire service = 1).

MAIN OUTCOME MEASURE(S)

Interviews followed a 9-question protocol focused on job setting preparation, mental health training, and perceived role managing patients with mental health concerns. Interviews were audio recorded and transcribed verbatim. A 3-person coding team convened for data analysis following the consensual qualitative research tradition. Credibility and trustworthiness were established using a stability check, member checking, and multianalyst triangulation.

RESULTS

Four domains emerged surrounding ATs' mental health management experiences with tactical athletes: (1) population norms, (2) provider preparation, (3) provider context, and (4) structure of job responsibilities. Most ATs felt their educational experiences lacked comprehensive mental health training. Some participants described formal employer resources that were optional or mandatory for their job, whereas others engaged in self-education to feel prepared for this setting. Participants shared that unfamiliar experiences, such as divorce and deployment, influenced their context as providers. Most ATs had no policy related to mental health care and referral, indicating it was outside their responsibilities or they were unsure of role delineation.

CONCLUSIONS

For ATs working with tactical athletes, our respondents suggested that additional mental health education and training are necessary. They also indicated that improvement is needed in job structure regarding role delineation and the establishment of policies regarding behavioral health.

Bilateral Strength Asymmetries and Unilateral Strength Imbalance: Predicting Ankle Injury When Considered With Higher Body Mass in US Special Forcesa

CONTEXT

Ankle injury is one of the most common conditions in athletics and military activities. Strength asymmetry (SA) and imbalance may represent a risk factor for injury, but past investigations have produced ambiguous conclusions. Perhaps one explanation for this ambiguity is the fact that these authors used univariate models to predict injury.

OBJECTIVE

To evaluate the predictive utility of SA and imbalance calculations for ankle injury in univariate and multivariate prediction models.

DESIGN

Prospective cohort study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 140 male US Air Force Special Forces.

MAIN OUTCOME MEASURE(S)

Baseline testing consisted of body composition, isometric strength, and aerobic and anaerobic capacity. A clinician conducted medical chart reviews 365 days posttesting to document the incidence of ankle injury. Strength asymmetries were calculated based on the equations most prevalent in the literature along with known physiological predictors of injury in the military: age, height, weight, body composition, and aerobic capacity. Simple logistic regression was conducted using each predictor, and backward stepwise logistic regression was conducted with each equation method and the physiological predictors entered initially into the model.

RESULTS

Strength asymmetry or imbalance or both, as a univariate predictor, was not able to predict ankle injury 365 days posttesting. Body mass (P = .01) and body mass index (P = .01) significantly predicted ankle injury. Strength asymmetry or imbalance or both significantly predicted ankle injury when considered with body mass (P = .002-.008).

CONCLUSIONS

As a univariate predictor, SA did not predict ankle injury. However, SA contributed significantly to predicting ankle injury in a multivariate model using body mass. Interpreting SA and imbalance in the presence of other physiological variables can help elucidate the risk of ankle injury.

Physical and Performance Characteristics Related to Unintentional Musculoskeletal Injury in Special Forces Operators: A Prospective Analysis

CONTEXT

  Seventy-seven percent of musculoskeletal injuries sustained by United States Army Special Forces Operators are preventable. Identification of predictive characteristics will promote the development of screening methods to augment injury-prevention programs.

OBJECTIVE

  To determine physical and performance characteristics that predict musculoskeletal injuries.

SETTING

  Clinical laboratory.

PATIENTS OR OTHER PARTICIPANTS

  A total of 95 Operators (age = 32.7 ± 5.1 years, height = 179.8 ± 6.9 cm, mass = 89.9 ± 12.7 kg).

MAIN OUTCOME MEASURE(S)

  Laboratory testing consisted of body composition, aerobic and anaerobic capacity, upper and lower body strength and flexibility, balance, and biomechanical evaluation. Injury data were captured for 12 months after laboratory testing. Injury frequencies, cross-tabulations, and relative risks (RRs) were calculated to evaluate the relationships between physical characteristics and injury proportions. Between-groups differences (injured versus uninjured) were assessed using appropriate t tests or Mann-Whitney U tests.

RESULTS

  Less shoulder-retraction strength (RR = 1.741 [95% confidence interval = 1.003, 3.021]), knee-extension strength (RR = 2.029 [95% confidence interval = 1.011, 4.075]), and a smaller trunk extension : flexion ratio (RR = 0.533 [95% confidence interval = 0.341, 0.831]) were significant risk factors for injury. Group comparisons showed less trunk strength (extension: P = .036, flexion: P = .048) and smaller right vertical ground reaction forces during landing ( P = .025) in injured Operators. Knee strength, aerobic capacity, and body mass index were less in the subgroup of spine-injured versus uninjured Operators ( P values = .013-.036).

CONCLUSIONS

  Knee-extension and shoulder-retraction strength were risk factors for musculoskeletal injury in Operators. Less trunk-flexion and -extension strength, higher body mass index, lower aerobic capacity, and increased ground reaction forces during landing were characteristics that may also contribute to musculoskeletal injury. Having 2 or more risk factors resulted in a greater injury proportion (χ² = 13.512, P = .015); however, more research is needed. Athletic trainers working in the military or similar high-demand settings can use these data to augment screening and injury-prevention protocols.

Landing Kinematics and Kinetics at the Knee During Different Landing Tasks

CONTEXT

  Several tasks have been used to examine landing biomechanics for evaluation and rehabilitation, especially as related to anterior cruciate ligament injuries. However, comparing results among studies in which different tasks were used can be difficult, and it is unclear which task may be most appropriate.

OBJECTIVE

  To compare lower extremity biomechanics across 5 commonly used landing tasks.

DESIGN

  Descriptive laboratory study.

SETTING

  University-operated US Air Force Special Operations Forces human performance research laboratory.

PATIENTS OR OTHER PARTICIPANTS

  A total of 65 US Air Force Special Tactics Operators (age = 27.7 ± 5.0 years, height = 176.5 ± 5.7 cm, mass = 83.1 ± 9.1 kg).

INTERVENTION(S)

  Kinematic and kinetic analysis of double- and single-legged drop landing, double- and single-legged stop jump, and forward jump to single-legged landing.

MAIN OUTCOME MEASURE(S)

  Hip-, knee-, and ankle-joint kinematics; knee-joint forces and moments; and ground reaction forces (GRFs) were the dependent measures. We used repeated-measures analyses of variance or Friedman tests, as appropriate, to assess within-subject differences across tasks.

RESULTS

  Peak vertical GRF and peak knee-flexion angle were different among all tasks ( P < .001). Single-legged landings generated higher vertical GRF (χ² = 244.68, P < .001) and lower peak knee-flexion values ( F_4,64 = 209.33, P < .001) except for forward jump to single-legged landing, which had the second highest peak vertical GRF and the lowest peak knee-flexion value. The single-legged drop landing generated the highest vertical (χ² = 244.68, P < .001) and posterior (χ² = 164.46, P < .001) GRFs. Peak knee-valgus moment was higher during the double-legged drop landing (χ² = 239.63, P < .001) but similar for all others.

CONCLUSIONS

  Different landing tasks elicited different biomechanical responses; no single task was best for assessing a wide range of biomechanical variables related to anterior cruciate ligament injuries. Therefore, depending on the goals of the study, using multiple assessment tasks should be considered.