Sports Medicine Research: In the Lab & In the Field (Sports Med Res)
Monday, June 26, 2017

Sleeper Stretch: Proven Remedy for GIRD in Overhead Athletes

Effectiveness of a Posterior Shoulder Stretching Program on University-Level Overhead Athletes: Randomized Controlled Trial

Chepeha, J; Magee, D; Bouliane, M; Sheps, D; Beaupre, L. Clinical Journal of Sports Medicine. 2017 April, e-pub ahead of print.

Take Home Message: Performing the sleeper stretch increases internal rotation in overhead athletes with an internal rotation deficit. Effectively managing posterior shoulder tightness could be important in reducing the incidence of shoulder pathology in overhead athletes.

In overhead athletes, the intense demands placed on the glenohumeral joint lead to anatomical adaptations that result in altered range of motions; such as, reduced internal rotation and increased external rotation.  Posterior shoulder tightness due to changes in the posterior capsule and posterior rotator cuff contribute to these rotational alterations.  Stretching programs that address posterior shoulder tightness, such as the “cross-body stretch” and “sleeper stretch”, are effective in baseball players.  However, few studies have investigated the benefits of the stretch in other overhead athlete populations.  Additionally, the optimal dosage parameters, expected rates of change, and the effect on pain and function of the sleeper stretch are poorly defined.  Therefore, the authors of this study had two goals: 1) to determine if an 8-week posterior shoulder stretching program increased range of motion (ROM) in a variety of overhead university-level athletes with deficits in internal rotation and 2) to investigate the rate of change in internal rotation and horizontal adduction ROM over time and to determine whether pain and/or function changes with stretching.
Wednesday, June 21, 2017

Retired Athletes May Be Set Up for Unhealthy Lifestyles

The Impact of Previous Athletic Experience on Current Physical Fitness in Former Collegiate Athletes and Noncollegiate Athletes

Simon JE, & Docherty CL. Sports Health. 2017; Published online ahead of print

Take Home Message: Former collegiate athletes were less physically fit and healthy than adults who were physically active in college about 30 years after participation.  This highlights a need for early identification, prevention, and education to help these at-risk individuals. 

Participation in sports and vigorous physical activity is typically a positive and healthy part of a young person’s life.  However, a physically active individual is at greater risk of injury, which could negatively affect their long-term wellness.  The authors of this study compared the physical activity health of former NCAA Division I athletes and compared their performance to non-athletes 20 to 40 years after college.
Monday, June 19, 2017

Injury Prevention Programs May Work if Your Athletes Use Them Regularly

Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomized control trial

Hipslop MD, Stokes KA, Williams S, McKay CD, England ME, Kemp SPT, Trewartha G . B J Sport Med. 2017; ahead of print

Take Home Message: Completing a sport-specific movement control exercise program 3 times per week reduced musculoskeletal and concussion injuries in school-age rugby athletes.

Injury prevention warm-up programs decrease the risk of injury in sports such as basketball and soccer. However, little is known about whether these programs prevent injuries in rugby, which is a sport with a lot of player contact and a high risk of concussion and musculoskeletal injuries. Therefore, the authors conducted a cluster-randomized trial to determine if a movement control exercise program could prevent musculoskeletal injuries and concussions among school-age rugby players. They also sought to assess the effect of different doses (via compliance/adherence) on injury risk.<--more--> All of the invited schools had onsite nurses and physiotherapists who would treat rugby-related injuries. The authors randomized 40 independent schools (participating in either under-15, 16, or 18 rugby teams) to either a movement control program or a basic exercise program. Both programs were comprised of 4 progressive phases, which would be performed during the first 20 minutes of each pitch-based training session and match warm-up. The coaches attended a 1-hour pre-study workshop on how and when to implement the programs. Seventeen schools completed the movement control program (44 teams, 1,325 players), which integrated balance/perturbation training, resistance training, plyometric training, and controlled rehearsal of sports-specific landing and cutting maneuvers with verbal feedback and reinforcement of technique from the coach. Fourteen schools (39 teams, 1,127 players) completed the basic exercise program, which consisted of running-based warm up, dynamic stretching, controlled wrestling, mobility and speed of direction drills (without coach feedback). The authors counted an injury if it resulted in a time loss of > 24 hours. The school medical staff recorded each injury location and diagnosis. Coaches reported the length of each training session, number of players attending each session, information about the matches played, and the number and level of each program phase the athletes completed each week. Overall, there were no differences between interventions; however, a closer look shows that athletes who performed the movement control program may be 28 to 34% less at risk for head/neck, upper extremity, or concussion injuries compared with the athletes in the control program. Additionally, the authors found that athletes who performed the movement control program at least 3 times per week suffered 72% fewer injuries and 59% fewer concussions compared with those who performed the basic exercise program more than 3 times a week.

The authors demonstrated that a movement control, sport-specific excise protocol that is implemented at least 3 times per week may alter the amount of injuries high school rugby athletes sustain. It is important to note that there was likely a dose effect, which highlights that a good injury prevention program will only be effective if the coaches and athletes commit to performing the program as prescribed. Only 12 out of 63 teams performed the programs 3 or more times/week on average. One issue may be the duration of the program. The recently released Consensus Opinion for Best Practice Features of Injury Prevention Programs advocated that programs should only take 10 to 15 minutes to promote compliance. The 20-minute warm-up program may be too long, which led to a low compliance rate. These findings also support the consensus opinion’s recommendation that injury prevention programs should be performed at least 2 to 3 times/week. This study offers strong evidence that an injury prevention program can reduce the risk of injury in rugby but there is a need to find approaches to promote compliance. Currently, medical professionals should be aware of these prevention programs. They should also try to implement a shorter version of this program or ensure compliance with the current program to help reduce the risk of injury among rugby players.  

Question for Discussion: Are you currently using any preventative warm up protocols? If not, would you consider implementing them? If so, which sports in particular would you focus on?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Wednesday, June 14, 2017

Who Benefits from Early or Delayed ACL Reconstruction?

Delaying ACL reconstruction and treating with exercise therapy alone may alter prognostic factors for 5-year outcome: an exploratory analysis of the KANON trial.

Filbay SR, Roos EW, Frobell RB, Roemer, Ranstam J, Lohmander LS. Br J Sports Med. 2017. [Epub ahead of print].

Take Home Message: Patients who are active and present with both an anterior cruciate ligament (ACL) rupture and meniscal injury or more severe knee pain/symptoms should consider starting exercise therapy before an ACL reconstruction. 

After an ACL injury, many patients fail to return to the same level of activity, develop early-onset osteoarthritis, or have a fear of reinjury – all of which could contribute to a decreased quality of life years after an injury. If clinicians knew which factors predicted long-term outcomes then they could develop best practices for selecting an optimal treatment strategy for certain patients. Therefore, Filbay and colleagues completed an exploratory analysis of data from the KANON randomized controlled trial to identify factors that may predict 5-year outcomes among 118 people with an acute ACL injury who were treated with 1) an early reconstruction (59 people), 1) supervised exercise therapy with a delayed ACL reconstruction (30 people), or 3) exercise therapy alone (29 people).
Wednesday, June 7, 2017

Medical Professionals Could Measure the Athlete’s Change of Heart Following A Concussion

Heart rate variability of athletes across concussion recovery milestones: A preliminary study

Senthinathan A, Mainwaring L, Hutchison M. Clin J Sport Med. 2017; 27(3):288-295

Take Home Message: Athletes that sustained a concussion displayed altered heart rate variability measures compared with controls, and those with a history of concussion had more disturbances in heat rate variability measures.

Concussions can affect numerous physiological processes including those in the cardiovascular system (via the autonomic nervous system). Medical professionals can measure heart rate variability as a noninvasive, objective measure to assess the influence of concussions on the heart and to assist with return-to-play decisions. However, heart rate variability, which has been explored for severe brain injury, has been understudied with respect to sport concussion. Therefore, the authors evaluated heart rate variability among 11 athletes that sustained a concussion and 11 healthy sex- and sport-matched controls. They tested the athletes at 3 phases during an athlete’s concussion recovery: (1) within 1-week after injury (the symptomatic phase), (2) after resolution of symptoms (progressing to exercise in return-to-play progression), and (3) 1-week after medical clearance to return to play.
Friday, June 2, 2017

ACR Appropriateness Criteria® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

ACR Appropriateness Criteria® Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae

Expert Panel on Musculoskeletal Imaging:, Bencardino JT, Stone TJ, Roberts CC, Appel M, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS9, Gyftopoulos S0, Hochman MG, Jacobson JA, Mintz DN, Mlady GW, Newman JS, Rosenberg ZS, Shah NA, Small KM, Weissman BN. J Am Coll Radiol. 2017 May;14(5S):S293-S306. doi: 10.1016/j.jacr.2017.02.035.
Full Text Not Freely Available (but see resources below)
The American College of Radiology has released new Appropriateness Criteria® (evidence-based guidelines) for stress fractures. Several of the clinical scenarios are relevant to patients participating in sports or physical activity.

Helpful Resources:

Wednesday, May 31, 2017

Self-Reported Concussion Details Takes a Hit with High School Athletes

Relationship between concussion history and concussion knowledge, attitudes, and disclosure behavior in high school athletes

Register-Mihalik JK, Valovich McLeod TC, Linnan LA, Guskiewicz KM, Marshal SW. Clin J Sport Med. 2017; 27(3):321-324

Take Home Message: More targeted concussion education for high school athletes with a history of concussion is needed. Athletes with more prior concussions, especially negative experiences, are less likely to disclose symptoms, more likely to play with symptoms, and have poorer attitudes regarding concussion reporting.

Honest disclosures of concussions and associated attitudes is an issue among high school athletes, especially when an athlete had a previous negative experience. Healthcare professionals rely on athletes to be truthful when self-reporting symptoms so that an athlete can be evaluated or held from competition or practice until symptom resolution. Unfortunately, an athlete with a prior diagnosed concussion who experienced no negative impact to themselves, may not appreciate the value of concussion self-reporting in future incidents; however, there is little research to confirm if this is occurring. Hence, the researchers expanded on their prior investigation to assess the connection between self-reported concussion history and disclosure, knowledge, and attitudes of high school athletes.