Gary B. Wilkerson

Prediction of Core and Lower Extremity Strains and Sprains in Collegiate Football Players: A Preliminary Study

CONTEXT Poor core stability is believed to increase vulnerability to uncontrolled joint displacements throughout the kinetic chain between the foot and the lumbar spine. OBJECTIVE To assess the value of preparticipation measurements as predictors of core or lower extremity strains or sprains in collegiate football players. DESIGN Cohort study. SETTING National Collegiate Athletic Association Division I Football Championship Subdivision football program. PATIENTS OR OTHER PARTICIPANTS All team members who were present for a mandatory physical examination on the day before preseason practice sessions began (n = 83). MAIN OUTCOME MEASURE(S) Preparticipation administration of surveys to assess low back, knee, and ankle function; documentation of knee and ankle injury history; determination of body mass index; 4 different assessments of core muscle endurance; and measurement of step-test recovery heart rate. All injuries were documented throughout the preseason practice period and 11-game season. Receiver operating characteristic analysis and logistic regression analysis were used to identify dichotomized predictive factors that best discriminated injured from uninjured status. The 75th and 50th percentiles were evaluated as alternative cutpoints for dichotomization of injury predictors. RESULTS Players with ≥2 of 3 potentially modifiable risk factors related to core function had 2 times greater risk for injury than those with <2 factors (95% confidence interval = 1.27, 4.22), and adding a high level of exposure to game conditions increased the injury risk to 3 times greater (95% confidence interval = 1.95, 4.98). Prediction models that used the 75th and 50th percentile cutpoints yielded results that were very similar to those for the model that used receiver operating characteristic-derived cutpoints. CONCLUSIONS Low back dysfunction and suboptimal endurance of the core musculature appear to be important modifiable football injury risk factors that can be identified on preparticipation screening. These predictors need to be assessed in a prospective manner with a larger sample of collegiate football players.

Identification of Cardiometabolic Risk Among Collegiate Football Players

CONTEXT Excessive fat mass clearly has adverse effects on metabolic processes that can ultimately lead to the development of chronic disease. Early identification of high-risk status may facilitate referral for definitive diagnostic tests and implementation of interventions to reduce cardiometabolic risk. OBJECTIVE To document the prevalence of metabolic syndrome among collegiate football players and to develop a clinical prediction rule that does not require blood analysis to identify players who may possess a high level of cardiometabolic risk. DESIGN Cross-sectional cohort study. SETTING University athletic training research laboratory. PATIENTS OR OTHER PARTICIPANTS Sixty-two National Collegiate Athletic Association Division I Football Championship Subdivision football players (age = 19.9 +/- 1.2 years, height = 182.6 +/- 6.1 cm, mass = 97.4 +/- 18.3 kg). MAIN OUTCOME MEASURE(S) Anthropometric characteristics associated with body fat, isokinetic quadriceps strength, and biometric indicators associated with metabolic syndrome were measured. Participants were classified as high risk or low risk for future development of type 2 diabetes and cardiovascular disease. RESULTS The prevalence of metabolic syndrome in the cohort was 19% (12 of 62), and 79% (49 of 62) of the players exceeded the threshold for 1 or more of its 5 components. A 4-factor clinical prediction rule that classified individuals on the basis of waist circumference, blood pressure, quadriceps strength, and ethnic category had 92% sensitivity (95% confidence interval = 65%, 99%) and 76% specificity (95% confidence interval = 63%, 86%) for discrimination of high-risk or low-risk status. CONCLUSIONS The risk for developing type 2 diabetes and cardiovascular disease appears to be exceptionally high among collegiate football players. A lack of race-specific criteria for the diagnosis of metabolic syndrome almost certainly contributes to an underestimation of the true level of cardiometabolic risk for African American collegiate football players.

A Refined Prediction Model for Core and Lower Extremity Sprains and Strains Among Collegiate Football Players.

CONTEXT Researchers have identified high exposure to game conditions, low back dysfunction, and poor endurance of the core musculature as strong predictors for the occurrence of sprains and strains among collegiate football players. OBJECTIVE To refine a previously developed injury-prediction model through analysis of 3 consecutive seasons of data. DESIGN Cohort study. SETTING National Collegiate Athletic Association Division I Football Championship Subdivision football program. PATIENTS OR OTHER PARTICIPANTS For 3 consecutive years, all 152 team members (age = 19.7 ± 1.5 years, height = 1.84 ± 0.08 m, mass = 101.08 ± 19.28 kg) presented for a mandatory physical examination on the day before initiation of preseason practice sessions. MAIN OUTCOME MEASURE(S) Associations between preseason measurements and the subsequent occurrence of a core or lower extremity sprain or strain were established for 256 player-seasons of data. We used receiver operating characteristic analysis to identify optimal cut points for dichotomous categorizations of cases as high risk or low risk. Both logistic regression and Cox regression analyses were used to identify a multivariable injury-prediction model with optimal discriminatory power. RESULTS Exceptionally good discrimination between injured and uninjured cases was found for a 3-factor prediction model that included equal to or greater than 1 game as a starter, Oswestry Disability Index score equal to or greater than 4, and poor wall-sit-hold performance. The existence of at least 2 of the 3 risk factors demonstrated 56% sensitivity, 80% specificity, an odds ratio of 5.28 (90% confidence interval = 3.31, 8.44), and a hazard ratio of 2.97 (90% confidence interval = 2.14, 4.12). CONCLUSIONS High exposure to game conditions was the dominant injury risk factor for collegiate football players, but a surprisingly mild degree of low back dysfunction and poor core-muscle endurance appeared to be important modifiable risk factors that should be identified and addressed before participation.

Effects of the subtalar sling ankle taping technique on combined talocrural-subtalar joint motions.

Background: The findings of research on the effectiveness of ankle taping for protection against ligament injury have been inconsistent, and the topic remains controversial. The precise orientation of the force vectors created by tension within the various tape strip components of an ankle taping procedure may be a critical factor influencing the degree of motion restraint that is provided. We hypothesized that the addition of the subtalar sling component to the widely recognized standard (Gibney) ankle taping procedure would enhance restraint of ankle motion. This was a controlled laboratory study, with fully repeated measures (subjects served as their own controls). Methods: An ankle arthrometer was used to quantify anteroposterior (AP) translation and frontal plane inversion-eversion (I-E) tilt of the talocrural-subtalar joints under untaped and taped conditions in normal subjects. A 15-minute exercise session was conducted to loosen the tape before measurement of its effect on motion restraint. Results: The ankle taping procedure that incorporated the subtalar sling provided significantly greater restriction of postexercise AP translation (p < 0.001, η2 = 0.63) and postexercise I-E tilt (p < 0.001, η2 = 0.66). Conclusions: The subtalar sling ankle taping procedure provides greater restriction of motions associated with ankle instability than the more widely used Gibney procedure.

Health-related factors associated with the healthcare costs of office workers.

Objective: The purpose of this study was to assess the relative importance of factors associated with total health care costs (THC) among office workers. Methods: Biometric and anthropometric values, health-related survey responses, and THC for 214 employees were analyzed. Factors that had a statistically significant (P < 0.05) bivariate correlation with logarithmically transformed THC data were entered into multiple regression analysis. Results: Age, gender, and SF-36 physical component summary score were identified as THC predictors (F3210 = 20.78, P < 0.001, Radj2 = 0.218). With physical component summary score excluded, age, gender, and exercise level collectively accounted for an almost identical amount of variance (F3210 = 19.64, P < 0.001, Radj2 = 0.212). Factorial ANOVA identified a significant interaction between age category and exercise level (F3198 = 3.04, P = 0.030). Conclusions: Inactivity was the only modifiable factor found to be predictive of THC, which appears to have an increasing effect with advancing age.

Utilization of Practice Session Average Inertial Load to Quantify College Football Injury Risk

Abstract Wilkerson, GB, Gupta, A, Allen, JR, Keith, CM, and Colston, MA. Utilization of practice session average inertial load to quantify college football injury risk. J Strength Cond Res 30(9): 2369–2374, 2016—Relatively few studies have investigated the potential injury prevention value of data derived from recently developed wearable technology for measurement of body mass accelerations during the performance of sport-related activities. The available evidence has been derived from studies focused on avoidance of overtraining syndrome, which is believed to induce a chronically fatigued state that can be identified through monitoring of inertial load accumulation. Reduced variability in movement patterns is also believed to be an important injury risk factor, but no evidence currently exists to guide interpretation of data derived from inertial measurement units (IMUs) in this regard. We retrospectively analyzed archived data for a cohort of 45 National Collegiate Athletic Association Division 1-football bowl subdivision football players who wore IMUs on the upper back during practice sessions to quantify any associations between average inertial load measured during practice sessions and occurrence of musculoskeletal sprains and strains. Both the coefficient of variation for average inertial load and frequent exposure to game conditions were found to be strongly associated with injury occurrence. Having either or both of the 2 risk factors provided strong discrimination between injured and noninjured players (&khgr; 2 = 9.048; p = 0.004; odds ratio = 8.04; 90% CI: 2.39, 27.03). Our findings may facilitate identification of individual football players who are likely to derive the greatest benefit from training activities designed to reduce injury risk through improved adaptability to rapidly changing environmental demands.

Cohort Study Design: An Underutilized Approach for Advancement of Evidence-Based and Patient-Centered Practice in Athletic Training

OBJECTIVE Providing patient-centered care requires consideration of numerous factors when making decisions that will influence a patients health status. BACKGROUND Clinical decisions should be informed by relevant research evidence, but the literature often lacks pertinent information for problems encountered in routine clinical practice. Although a randomized clinical trial provides the best research design to ensure the internal validity of study findings, ethical considerations and the competitive culture of sport often preclude random assignment of patients or participants to a control condition. CLINICAL ADVANTAGES A cohort study design and Bayesian approach to data analysis can provide valuable evidence to support clinical decisions. Dichotomous classification of both an outcome and 1 or more predictive factors permits quantification of the likelihood of occurrence of a specified outcome. CONCLUSIONS Multifactorial prediction models can reduce uncertainty in clinical decision making and facilitate the individualization of treatment, thereby supporting delivery of clinical services that are both evidence based and patient centered.

Mitigating Sports Injury Risks Using Internet of Things and Analytics Approaches: Mitigating Sports Injury Risks Using IoT

Sport injuries restrict participation, impose a substantial economic burden, and can have persisting adverse effects on health-related quality of life. The effective use of Internet of Things (IoT), when combined with analytics approaches, can improve player safety through identification of injury risk factors that can be addressed by targeted risk reduction training activities. Use of IoT devices can facilitate highly efficient quantification of relevant functional capabilities prior to sport participation, which could substantially advance the prevailing sport injury management paradigm. This study introduces a framework for using sensor-derived IoT data to supplement other data for objective estimation of each individual college football players level of injury risk, which is an approach to injury prevention that has not been previously reported. A cohort of 45 NCAA Division I-FCS college players provided data in the form of self-ratings of persisting effects of previous injuries and single-leg postural stability test. Instantaneous change in body mass acceleration (jerk) during the test was quantified by a smartphone accelerometer, with data wirelessly transmitted to a secure cloud server. Injuries sustained from the beginning of practice sessions until the end of the 13-game season were documented, along with the number of games played by each athlete over the course of a 13-game season. Results demonstrate a strong prediction model. Our approach may have strong relevance to the estimation of injury risk for other physically demanding activities. Clearly, there is great potential for improvement of injury prevention initiatives through identification of individual athletes who possess elevated injury risk and targeted interventions.

A Sport Fitness Index for Assessment of Sport-related Injury Risk

Objective:To develop and validate a concise survey that will identify athletes who possess elevated injury risk. Design:Cohort study. Setting:National Collegiate Athletic Association Division I athletic program. Participants:Cohorts of 188 and 146 college athletes who participated during successive academic years. Assessment of Risk Factors:The first cohort provided responses to 4 joint-specific outcome surveys that were related to subsequent time-loss injury occurrence. Receiver operating characteristic analysis identified survey items that provided best discrimination, which were combined with a negative life event stress item to create a new 10-item survey. The second cohort provided responses to the new survey, which were converted to a 0 to 100 score. Main Outcome Measures:Construct validity was assessed through documentation of time-loss injuries sustained during the preceding 12 months and predictive validity was assessed through prospective documentation of sport-related sprains and strains. Cronbach alpha was calculated to assess internal consistency. Results:Each of the outcome survey items used to develop the new survey demonstrated much greater specificity than sensitivity. Both the retrospective and prospective receiver operating characteristic (ROC) analyses identified scores of 96 and 88 as cut-points that provided good discrimination between injured and noninjured cases. The area under the curve was 0.69 (P < 0.001) for the retrospective analysis and 0.62 (P = 0.016) for the prospective analysis. Cronbach alpha was 0.89 (90% CI, 0.86-0.91). Conclusions:Self-reported effects of previous injury may be one method to efficiently identify athletes who possess elevated injury risk, and subsequently deliver preventive interventions, thereby providing an alternative method to time-intensive functional testing.

The Need for Accountability and Transparency in Intercollegiate Athletic Medicine

Over the years, intercollegiate athletics has exertedinfluences that have sometimes had adverse effects on thehealth and welfare of student–athletes. Even individualswho routinely uphold high ethical standards are notimmune to intense situational pressures for compromise.Conflicts of interest generally arise from a sense of duty toan organization or concern that one’s employment is injeopardy. Team physicians and athletic trainers share inthe challenges associated with the efforts to achieve teamand organizational success, but their first priority is toprovide optimal health care for each student–athlete. TheAmerican Medical Association Opinion 3.06–SportsMedicine,