Adam M. Kushner

The back squat: A proposed assessment of functional deficits and technical factors that limit performance

ABSTRACT FUNDAMENTAL MOVEMENT COMPETENCY IS ESSENTIAL FOR PHYSICAL ACTIVITY PARTICIPATION AND FOR REDUCING INJURY RISK, WHICH ARE BOTH KEY ELEMENTS OF HEALTH PROMOTION. THE SQUAT MOVEMENT PATTERN IS ARGUABLY ONE OF THE MOST CRITICAL FUNDAMENTAL MOVEMENTS NECESSARY TO IMPROVE SPORT PERFORMANCE, TO REDUCE INJURY RISK, AND TO SUPPORT LIFELONG PHYSICAL ACTIVITY. BASED ON CURRENT EVIDENCE, THIS FIRST (1 OF 2) REPORT DECONSTRUCTS THE TECHNICAL PERFORMANCE OF THE BACK SQUAT AND PRESENTS A NOVEL DYNAMIC SCREENING TOOL THAT INCORPORATES IDENTIFICATION TECHNIQUES FOR KNOWN FUNCTIONAL DEFICITS. THE FOLLOW-UP REPORT WILL OUTLINE TARGETED CORRECTIVE METHODOLOGY FOR EACH OF THESE FUNCTIONAL DEFICITS.

Training the developing brain, part I: cognitive developmental considerations for training youth.

Based on the fundamental principles of pediatric exercise science and developmental physiology, childhood provides a critical window to develop the physical readiness of youth through age-related training programs that are designed purposely to teach and reinforce fundamental movement skills to enhance preparedness for physical activity and sport. Successful implementation of developmental programs requires age-related instruction by qualified professionals who understand the physical and psychosocial uniqueness of children and adolescents. An understanding of the interaction of physical and cognitive development is needed to design and implement training strategies that optimize training outcomes. Regular training with structured and integrative modalities throughout the developmental years as part of physical education, recreation, and sports practice can improve athletic performance while reducing common sports-related injuries and can facilitate the adoption of healthy lifestyles throughout adulthood. In this commentary, we outline cognitive developmental considerations in youth that may influence the design and implementation of training programs aimed at optimizing motor skill development in youth.

Rates of Concussion Are Lower in National Football League Games Played at Higher Altitudes

STUDY DESIGN Retrospective epidemiologic investigation. OBJECTIVE To investigate the relationship between altitude and concussion rate in the National Football League (NFL). Because of the physiologic responses that occur during acclimatization to altitude, it was hypothesized that games played on fields at a higher altitude would have reduced concussion rates compared to games played on fields at a lower altitude. BACKGROUND Recent research indicates that the elevation above sea level at which football games are played may be associated with the likelihood of a concussion in high school football athletes. METHODS Data on incident concussions and athlete exposures for the first 16 weeks of the NFL 2012 and 2013 regular seasons were obtained from publicly available web-based sources and used to calculate competition concussion rates for each NFL stadium. Concussion rates were analyzed in relation to game elevation. RESULTS During the first 16 weeks of the 2012 and 2013 NFL regular seasons, 300 concussions, involving 284 players, were reported (64.3 primary cases per 10,000 game exposures). The odds of a concussion were 30% lower when playing at a higher elevation (equal to or greater than 644 ft [196.3 m] above sea level) compared to a lower elevation (odds ratio = 0.70; 95% confidence interval: 0.53, 0.94). A multivariable generalized linear model controlling for season, week, and clustering of team at home and away confirmed these results, showing that the odds of at least 1 concussion were reduced by 32% in games played at higher elevation. CONCLUSION The results of this epidemiological investigation indicate that increased altitude was associated with a reduction in the odds of a sport-related concussion in NFL athletes. The reported relationship of concussion incidence and field elevation should be further investigated, and, if verified, further work will be needed to understand why that relationship exists. LEVEL OF EVIDENCE Prognosis, level 2c.

Training the Developing Brain Part II: Cognitive Considerations for Youth Instruction and Feedback

Growing numbers of youth participating in competitive, organized physical activity have led to a concern for the risk of sports-related injuries during important periods of human development. Recent studies have demonstrated the ability of integrative neuromuscular training (INT) to enhance athletic performance and reduce the risk of sports-related injuries in youth. Successful implementation of INT necessitates instruction from knowledgeable and qualified instructors who understand the unique physical, cognitive, and psychosocial characteristics of the youth to provide appropriate training instruction and feedback. Principles of a classical theory of cognitive development provide a useful context for discussion of developmentally appropriate methods and strategies for INT instruction of youth. INT programs that consider these developmentally appropriate approaches will provide a controlled efficacious environment for youth to improve athletic performance and reduce risk of sports-related injury, thus promoting a healthy active lifestyle beyond an individual’s formative years.

The Back Squat: Targeted Training Techniques to Correct Functional Deficits and Technical Factors That Limit Performance

ABSTRACT THE BACK SQUAT IS A WELL-RESEARCHED AND WIDELY USED EXERCISE TO ENHANCE FUNDAMENTAL MOVEMENT COMPETENCY THAT CREATES A FOUNDATION FOR OPTIMAL MECHANICAL STRATEGIES DURING A BROAD RANGE OF ACTIVITIES. THE PRIMARY COMMENTARY INTRODUCED THE BACK SQUAT ASSESSMENT (BSA): A CRITERION-BASED ASSESSMENT OF THE BACK SQUAT THAT DELINEATES 30 POTENTIALLY OBSERVABLE FUNCTIONAL DEFICITS. THIS FOLLOW-UP COMMENTARY PROVIDES A TARGETED SYSTEM OF TRAINING CUES AND EXERCISES TO SUPPLEMENT THE BSA TO GUIDE CORRECTIVE INTERVENTION. WE PROPOSE A CRITERION-DRIVEN APPROACH TO CORRECTIVE EXERCISE THAT CAN SUPPORT PRACTITIONERS IN THEIR GOAL TO HELP INDIVIDUALS ACHIEVE MOVEMENT COMPETENCY IN THE BACK SQUAT.

Epidemiology of injuries in men's lacrosse: injury prevention implications for competition level, type of play, and player position.

ABSTRACT Objective: The growth in participation in men’s lacrosse has increased the likelihood of sport-specific injuries, yet there continues to be a need for specific epidemiological data concerning lacrosse injuries. The purpose of this literature review is to aggregate available published data on injuries that occur in the sport of men’s lacrosse at the youth, high school, collegiate, and professional levels. Methods: A comprehensive literature search was performed in PubMed, High Wire Press, SPORTDiscus, Google Scholar, and Ovid, using the keywords Lacrosse Injuries, Epidemiology Lacrosse Injuries, Lacrosse Injury, Lacrosse AND Injury and limited to 1990–2016. All bibliographies were cross-referenced to identify any additional publications. Sources were categorized based on data provided and were aggregated into groups based on reported overall injury rates, rates by setting (competition vs. practice), nature of injury, location, type, severity, and player position. Results: The game and practice injury rates in college are greater than the rates in high school, similarly rates greater for high school players than in youth leagues. Rates of injury varied from 0.095–12.98 per 1000 athlete exposures. Game injury rates were higher across all studies. Injuries in men’s lacrosse occur most often from player-to-player contact, which result in immediate injuries, such as concussions, contusions, and lacerations. Overall concussion incidence was reported to range from 0.11–0.84 per 1000 AE. The most common types of injuries were sprain, strain, concussion, and contusions and the most common area of injury was hand (23%), with a significant proportion of these (59.4%) being to the thumb. Limited evidence of different injuries among the player positions suggests there might be a pattern that midfield players had the most injuries, followed by offensive players and then defensive players. Conclusions: The potential for sports-related injury is of relative concern; especially considering rising participation and total number of injuries. Further development and proper enforcement of safety rules on player contact and protective equipment are recommended to decrease the rate of lacrosse-related injury. Additional longitudinal research is needed to better classify and to ultimately predict lacrosse injury factors and mechanisms across all levels of play.

Epidemiology of Injuries in Womenʼs Lacrosse: Implications for Sport-, Level-, and Sex-Specific Injury Prevention Strategies

Objective: By the end of 2013, the United States had an estimated 278 000 female lacrosse players, with half of those participating at the youth level. The effects of the sports rapid growth on injury rates have yet to be determined. The purpose of this clinical review is to synthesize the available published data on injuries that have occurred in the sport of womens lacrosse. Of particular interest was the risk of injury based on the level of play and position. Data Sources: A comprehensive literature search was performed in PubMed, High Wire Press, SPORTDiscus, Google Scholar, and Ovid using the keywords “Lacrosse Injuries,” “Epidemiology Lacrosse Injuries,” “Lacrosse Injury,” “Lacrosse,” and “Injury.” Study Selection: The electronic search included material published during or after 1950. In addition, all bibliographies of electronically found sources were cross-referenced to identify any additional publications that were not produced in the electronic searches. Data Extraction: All articles with data on womens injury rates were categorized by overall injury rates, rates by session (competition vs practice), nature of injury, location, type, severity, and player position. Data Synthesis: Injury rates increase with age: from youth leagues to high school and finally to the collegiate level. Rates of injury varied from 0.03 to 3.9 injuries/100 athletes. Womens game injury rates are consistently higher than practice injury rates (ranging from 0.2 to 7.1 vs 0.01 to 3.3). Injuries occur most frequently from stick-to-player or player-to-ball contact, rather than player-to-player contact. Women sustain a higher percentage of head and facial injuries relative to male lacrosse players. The most common types of injuries for women are concussions, sprains, contusions, and lacerations. More than half of all injuries are in the mild category resulting in players missing practice and games for 1 to 7 days. Offensive players had the most injuries, followed by defensive players and then midfielders, with goalies having the fewest number of injuries. Conclusions: In womens lacrosse, the rules and equipment used are substantially different than for the mens game. Face and hand injuries are more prevalent for women when compared with men, and ankle injuries are most prevalent in female youth. Medical professionals who treat lacrosse players can benefit from an improved understanding of the types and rates of the injuries they are likely to encounter. Improved awareness of lacrosse-specific injuries can assist these professionals to be more prepared to treat these athletes, which may lead to improved care and outcomes.