Brady L. Tripp

Glenohumeral Rotational Range of Motion in Collegiate Overhead-Throwing Athletes During an Athletic Season

CONTEXT Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the throwers shoulder. OBJECTIVE To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD. DESIGN Observational, repeated-measures study. SETTING Collegiate athletic training room. PATIENTS OR OTHER PARTICIPANTS Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age = 19 + or - 1 years, height = 174 + or - 14 cm, mass = 77.8 + or - 18.1 kg; 19 softball, 29 baseball players). MAIN OUTCOME MEASURE(S) We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc. RESULTS In the dominant shoulder, ER increased during the season (F(2,96) = 17.433, P < .001), but IR remained the same (F(2,96) = 1.839, P = .17). The total arc in the dominant shoulder increased between time intervals (F(2,96) = 14.030, P < .001); the mean difference between prefall and postspring measurements was 9.694 degrees (P < .001), and the mean difference between prefall and postspring measurements was 10.990 degrees (P < .001). In the nondominant shoulder, ER increased over the season (F(2,96) = 23.395, P < .001), but IR did not change over the season (F(2,96) = 0.087, P = .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F(2,96) = 18.552, P < .001). No changes were noted in GIRD over time. However, more athletes with GIRD were identified with the GIRD (IR difference) calculation in prefall (n = 6) than in prespring (n = 1) and postspring (n = 4) (Cochran Q = 5.2, P = .07). In addition, more athletes with GIRD were identified with the GIRD (% total arc) calculation in postspring (n = 6) than in prefall (n = 5) or prespring (n = 4) (Cochran Q = 2.6, P = .27). CONCLUSIONS Healthy NCAA Division I and Division II athletes did not display changes in glenohumeral IR over an athletic season. However, they gained in ER and total arc during the season in both shoulders. Future researchers should investigate changes over multiple seasons. The 2 methods of calculating GIRD identified different athletes as having GIRD, indicating that additional investigation is warranted to determine the clinical benefits of each method.

Concussion knowledge in high school football players

CONTEXT Participating in sports while experiencing symptoms of a concussion can be dangerous. An athletes lack of knowledge may be one factor influencing his or her decision to report symptoms. In an effort to enhance concussion education among high school athletes, legislation in Florida has attempted to address the issue through parental consent forms. OBJECTIVE To survey high school varsity football players to determine their level of knowledge about concussions after the initiation of new concussion-education legislation. DESIGN Cross-sectional study. SETTING Descriptive survey administered in person during a team meeting. PATIENTS OR OTHER PARTICIPANTS A total of 334 varsity football players from 11 high schools in Florida. MAIN OUTCOME MEASURE(S) Participants completed a survey and identified the symptoms and consequences of a concussion among distractors. They also indicated whether they had received education about concussions from a parent, formal education, neither, or both. RESULTS The most correctly identified symptoms were headache (97%), dizziness (93%), and confusion (90%), and the most correctly identified consequence was persistent headache (93%). Participants reported receiving education from their parents (54%) or from a formal source (60%). Twenty-five percent reported never receiving any education regarding concussions. No correlations were found between the method of education and the knowledge of symptoms or consequences of concussion. CONCLUSIONS The high school football players we surveyed did not have appropriate knowledge of the symptoms and consequences of concussions. Nausea or vomiting, neck pain, grogginess, difficulty concentrating, and personality or behavioral changes were often missed by participants, and only a small proportion correctly identified brain hemorrhage, coma, and death as possible consequences of inappropriate care after a concussion. Even with parents or guardians signing a consent form indicating they discussed concussion awareness with their child, 46% of athletes suggested they had not.

Elbow Joint Position Sense After Neuromuscular Training With Handheld Vibration

CONTEXT Clinicians use neuromuscular control exercises to enhance joint position sense (JPS); however, because standardizing such exercises is difficult, validations of their use are limited. OBJECTIVE To evaluate the acute effects of a neuromuscular training exercise with a handheld vibrating dumbbell on elbow JPS acuity. DESIGN Crossover study. SETTING University athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS Thirty-one healthy, college-aged volunteers (16 men, 15 women, age = 23 + or - 3 years, height = 173 + or - 8 cm, mass = 76 + or - 14 kg). INTERVENTION(S) We measured and trained elbow JPS using an electromagnetic tracking device that provided auditory and visual biofeedback. For JPS testing, participants held a dumbbell and actively identified the target elbow flexion angle (90 degrees ) using the software-generated biofeedback, followed by 3 repositioning trials without feedback. Each neuromuscular training protocol included 3 exercises during which participants held a 2.55-kg dumbbell vibrating at 15, 5, or 0 Hz and used software-generated biofeedback to locate and maintain the target elbow flexion angle for 15 seconds. MAIN OUTCOME MEASURE(S) We calculated absolute (accuracy) and variable (variability) errors using the differences between target and reproduced angles. RESULTS Training protocols using 15-Hz vibration enhanced accuracy and decreased variability of elbow JPS (P < or = .005), whereas 5-Hz vibration did not affect accuracy (F(1,61) = 2.625, P = .100) but did decrease variability (F(1,61) = 7.250, P = .009). The control condition and 0-Hz training protocol had no effect on accuracy or variability (P > or = .200). CONCLUSIONS Our results suggest these neuromuscular control exercises, which included low-magnitude, low-frequency handheld vibration, may enhance elbow JPS. Future researchers should examine vibration of various durations and frequencies, should include injured participants and functional multijoint and multiplanar measures, and should examine long-term effects of training protocols on JPS and injury.

Exertional Heat Illnesses and Environmental Conditions During High School Football Practices

Background: Guidelines for preventing exertional heat illnesses (EHIs) during extreme heat stress should be specific to regional environments, age, and sport and should be based on evidence of reducing the risk. Each year in the United States, over 1 million high school football players practice in the August heat; however, no published data describe the incidence of EHIs in these athletes. Purpose: To describe the environmental conditions and incidence of EHIs during high school football practices over a 3-month period. Study Design: Descriptive epidemiology study. Methods: For a 3-month period (August-October), athletic trainers at 12 high schools in North Central Florida recorded the practice time and length, environmental conditions (wet-bulb globe temperature), and incidences of EHIs in varsity football athletes. Results: Athletes suffered 57 total EHIs during 29,759 athlete-exposures (AEs) for the 3-month data collection period (rate = 1.92/1000 AEs). August accounted for the majority of all EHIs, with 82.5% (47/57) and the highest rate (4.35/1000 AEs). Of total heat illnesses, heat cramps accounted for 70.2% (40/57), heat exhaustion 22.8% (13/57), and heat syncope 7.0% (4/57). The odds ratio indicated that athletes in August practices that lasted longer than the recommended 3 hours were 9.84 times more likely to suffer a heat illness than those in practices lasting ≤3 hours. Conclusion: The highest rate of EHIs was during August. Practices in August that exceeded the recommended 3 hours were associated with a greater risk of heat illnesses. The overall rate of EHIs was lower for the high school football athletes observed in the study compared with that reported for collegiate football athletes in the region. The low rates of EHIs recorded suggest that the prevention guidelines employed by sports medicine teams are appropriate for the region and population. Clinical Relevance: Team physicians and athletic trainers should employ evidence-based, region- and population-specific EHI prevention guidelines. Sports medicine teams, coaches, and athletes should be aware of the increased risk of EHIs during August practices and the risk of prolonged practices during August.

Handheld vibration effects shoulder motion.

We explored effects of handheld vibration on glenohumeral motion in competitive overhead-throwing athletes. We used a randomized, blinded pre-test post-test cross-over design. Each arm of each subject experienced 2 conditions (1-control, 1-experimental), each with pre-test and post-test measures; the order of which was randomized. Participants included Division-I baseball and softball players (n=35: age=20+/-2 yr, height=178+/-9 cm, mass=84+/-12 kg, years of sport participation=13+/-4 yrs). During the experimental condition, participants held a vibrating (2.2 mm, 15 Hz, 20 s), 2.55 kg (5.62 lbs) Mini-VibraFlex dumbbell (Orthometric, New York, NY) in neutral glenohumeral rotation. During the control condition, participants held the still dumbbell (0 mm, 0 Hz, 20 s). Participants rested one min after each trial (3). We used a digital protractor to assess range of motion bilaterally, employing a standard technique for measuring maximal internal (IR) and external rotation (ER). Repeated-measures analyses of variance indicated that range of dominant IR increased 6.8% ( P=0.001, ES=0.16) after handheld vibration. Handheld vibration did not affect range of dominant ER ( P>0.05, 1-beta=0.20), non-dominant IR ( P>0.05, 1-beta=0.41), or non-dominant ER ( P>0.05, 1-beta=0.05). Short bouts of handheld vibration increased dominant IR in collegiate baseball and softball athletes. These results suggest that handheld vibration may help maintain glenohumeral IR that is vital to the healthy and competitive throwing shoulder.

Unaccounted Workload Factor: Game-Day Pitch Counts in High School Baseball Pitchers—An Observational Study:

Background: Throwing injuries are common in high school baseball. Known risk factors include excessive pitch counts, year-round pitching, and pitching with arm pain and fatigue. Despite the evidence, the prevalence of pitching injuries among high school players has not decreased. One possibility to explain this pattern is that players accumulate unaccounted pitch volume during warm-up and bullpen activity, but this has not yet been examined. Hypotheses: Our primary hypothesis was that approximately 30% to 40% of pitches thrown off a mound by high school pitchers during a game-day outing are unaccounted for in current data but will be revealed when bullpen sessions and warm-up pitches are included. Our secondary hypothesis was that there is wide variability among players in the number of bullpen pitches thrown per outing. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Researchers counted all pitches thrown off a mound during varsity high school baseball games played by 34 high schools in North Central Florida during the 2017 season. Results: We recorded 13,769 total pitches during 115 varsity high school baseball starting pitcher outings. The mean ± SD pitch numbers per game were calculated for bullpen activity (27.2 ± 9.4), warm-up (23.6 ±8.0), live games (68.9 ±19.7), and total pitches per game (119.7 ± 27.8). Thus, 42.4% of the pitches performed were not accounted for in the pitch count monitoring of these players. The number of bullpen pitches thrown varied widely among players, with 25% of participants in our data set throwing fewer than 22 pitches and 25% throwing more than 33 pitches per outing. Conclusion: In high school baseball players, pitch count monitoring does not account for the substantial volume of pitching that occurs during warm-up and bullpen activity during the playing season. These extra pitches should be closely monitored to help mitigate the risk of overuse injury.

The Effect of Concussion on Subsequent Musculoskeletal Risk in High School Athletes: 90 Board #4 May 30 9

95%CI: 1.12, 2.45). Of the seven concussions sustained by goalies, 42.9% were due to contact with the puck; in comparison, no concussions among all other competition positions had concussions reported to be due to contact with the puck. CONCLUSION: Concussions in high school boys’ ice hockey occur mainly in competition and result from player contact. These concussions appear to be position dependent with the highest incidence occurring to wings. Examination of adaptations to the checking rule or teaching the checking technique may lead to a reduction in concussive events.

Exercise intervention for unilateral amputees with low back pain: study protocol for a randomised, controlled trial

BackgroundAtraumatic lower limb amputation is a life-changing event for approximately 185,000 persons in the United States each year. A unilateral amputation is associated with rapid changes to the musculoskeletal system including leg and back muscle atrophy, strength loss, gait asymmetries, differential mechanical joint loading and leg length discrepancies. Even with high-quality medical care and prostheses, amputees still develop secondary musculoskeletal conditions such as chronic low back pain (LBP). Resistance training interventions that focus on core stabilization, lumbar strength and dynamic stability during loading have strong potential to reduce LBP and address amputation-related changes to the musculoskeletal system. Home-based resistance exercise programs may be attractive to patients to minimize travel and financial burdens.Methods/designThis study will be a single-assessor-blinded, pre-post-test randomised controlled trial involving 40 men and women aged 18–60 years with traumatic, unilateral transtibial amputation. Participants will be randomised to a home-based, resistance exercise group (HBRX) or a wait-list control group (CON). The HBRX will consist of 12 weeks of elastic resistance band and bodyweight training to improve core and lumbopelvic strength. Participants will be monitored via Skype or Facetime on a weekly basis. The primary outcome will be pain severity (11-point Numerical Pain Rating Scale; NRSpain). Secondary outcomes will include pain impact on quality of life (Medical Outcomes Short Form 36, Oswestry Disability Index and Roland Morris Disability Questionnaire), kinematics and kinetics of walking gait on an instrumented treadmill, muscle morphology (muscle thickness of multifidus, transversus abdominis, internal oblique), maximal muscle strength of key lumbar and core muscles, and daily step count.DiscussionThe study findings will determine whether a HBRX program can decrease pain severity and positively impact several physiological and mechanical factors that contribute to back pain in unilateral transtibial amputees with chronic LBP. We will determine the relative contribution of the exercise-induced changes in these factors on pain responsiveness in this population.Trial registrationClinicalTrials.gov, ID: NCT03300375. Registered on 2 October 2017.