James M. Mensch

Comprehensive Coach Education and Practice Contact Restriction Guidelines Result in Lower Injury Rates in Youth American Football

Background: Research evaluating the effect of comprehensive coach education and practice contact restriction in youth football injury rates is sparse. In 2012, USA Football released their Heads Up Football coaching education program (HUF), and Pop Warner Football (PW) instituted guidelines to restrict contact during practice. Purpose: To compare injury rates among youth football players aged 5 to 15 years by whether their leagues implemented HUF and/or were PW-affiliated. Study Design: Cohort study; Level of evidence, 2. Methods: Athletic trainers (ATs) evaluated and tracked injuries at each practice and game during the 2014 youth football season. Players were drawn from 10 leagues across 4 states. The non–Heads Up Football (NHUF) group consisted of 704 players (none of whom were PW-affiliated) from 29 teams within 4 leagues. The HUF+PW group consisted of 741 players from 27 teams within 2 leagues. The HUF-only group consisted of 663 players from 44 teams within 4 leagues. Injury rates and injury rate ratios (IRRs) were reported with 95% CIs. Results: A total of 370 injuries were reported during 71,262 athlete-exposures (AEs) (rate, 5.19/1000 AEs). Compared with the NHUF group (7.32/1000 AEs), the practice injury rates were lower for the HUF+PW group (0.97/1000 AEs; IRR, 0.13; 95% CI, 0.08-0.21) and the HUF-only group (2.73/1000 AEs; IRR, 0.37; 95% CI, 0.26-0.53). Compared with the NHUF group (13.42/1000 AEs), the game injury rate was lower for the HUF+PW group (3.42/1000 AEs; IRR, 0.25; 95% CI, 0.15-0.44) but not for the HUF-only group (13.76/1000 AEs; IRR, 1.02; 95% CI, 0.73-1.43). Also, the HUF+PW game injury rate was lower than that of HUF-only (IRR, 0.20; 95% CI, 0.12-0.36). Higher injury rates were typically found in those aged 11 to 15 years compared with those aged 5 to 10 years. However, stronger effects related to HUF implementation and PW affiliation were seen among 11- to 15-year-olds. When restricted to concussions only, the sole difference was found between the practice concussion rates among 11- to 15-year-olds in the HUF+PW (0.14/1000 AEs) and NHUF groups (0.79/1000 AEs) (IRR, 0.18; 95% CI, 0.04-0.85). Conclusion: These findings support comprehensive coach education and practice contact restrictions as effective methods of injury mitigation. Future research should continue evaluating similar programming within other levels of competition and sports.

Key Factors for Providing Appropriate Medical Care in Secondary School Athletics: Athletic Training Services and Budget

CONTEXT Research suggests that appropriate medical care for interscholastic athletes is frequently lacking. However, few investigators have examined factors related to care. OBJECTIVE To examine medical care provided by interscholastic athletics programs and to identify factors associated with variations in provision of care. DESIGN Cross-sectional study. SETTING Mailed and e-mailed survey. PATIENTS OR OTHER PARTICIPANTS One hundred sixty-six South Carolina high schools. INTERVENTION(S) The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot tested. It included 119 items assessing medical care based on the Appropriate Medical Care for Secondary School-Age Athletes (AMCSSAA) Consensus Statement and Monograph (test-retest reliability: r = 0.89). Also included were items assessing potential influences on medical care. Presence, source, and number of athletic trainers; school size; distance to nearest medical center; public or private status; sports medicine supply budget; and varsity football regional championships served as explanatory variables, whereas the school setting, region of state, and rate of free or reduced lunch qualifiers served as control variables. MAIN OUTCOME MEASURE(S) The Appropriate Care Index (ACI) score from the AMCAT provided a quantitative measure of medical care and served as the response variable. The ACI score was determined based on a schools response to items relating to AMCSSAA guidelines. RESULTS Regression analysis revealed associations with ACI score for athletic training services and sports medicine supply budget (both P < .001) when controlling for the setting, region, and rate of free or reduced lunch qualifiers. These 2 variables accounted for 30% of the variance in ACI score (R(2) = 0.302). Post hoc analysis showed differences between ACI score based on the source of the athletic trainer and the size of the sports medicine supply budget. CONCLUSIONS The AMCAT offers an evaluation of medical care provided by interscholastic athletics programs. In South Carolina schools, athletic training services and the sports medicine supply budget were associated with higher levels of medical care. These results offer guidance for improving the medical care provided for interscholastic athletes.

Keeping Your Head in the Game: Sport-Specific Imagery and Anxiety Among Injured Athletes

CONTEXT The use of sport-specific imagery during rehabilitation is sparse. Athletes who used imagery (either facilitative or debilitative) during injury rehabilitation were compared with injured athletes who did not use imagery. Return-to-practice anxiety in the groups was investigated also. OBJECTIVE To (1) explore debilitative images used during rehabilitation, (2) examine athlete and injury characteristics in relation to variations in imagery content and return-to-practice anxiety, (3) compare the frequency of imagery use early in injury rehabilitation with that just before return to practice, and (4) examine the relationship between image use and return-to-practice anxiety. DESIGN Observational design. SETTING Athletic training facilities. PATIENTS OR OTHER PARTICIPANTS Thirty-six injured National Collegiate Athletic Association Division I collegiate athletes sustaining at least an 8-day practice suspension due to injury. MAIN OUTCOME MEASURE(S) Sport Imagery Questionnaire, Sport Anxiety Scale. RESULTS Athletes used both facilitative and debilitative images during different phases of rehabilitation. Men used more sport skill, strategy, and excitement imagery content than did women, who reported higher scores for worry and concentration disruption than did men. Athletes used fewer images related to their sport skills and strategies early in rehabilitation than just before they returned to practice. Additionally, athletes who used more arousal and less strategic imagery experienced more somatic anxiety. CONCLUSIONS Similar to research findings on healthy athletes, sport-specific image content in injured athletes is related to return-to-practice anxiety during rehabilitation, and some of the images were perceived as debilitative. Practitioners should advise injured athletes to use sport-specific imagery, especially that related to sport skills and strategies, but they should caution athletes against using arousal imagery, because it may elevate somatic anxiety before return to practice. Image content recommendations should encompass the cognitive and motivational functions of imagery, and the practitioner should assess if any image used by the athlete is debilitative.

An assessment of burnout in graduate assistant certified athletic trainers.

CONTEXT Graduate assistant athletic trainers (GAATs) must balance the demands of clinical care and the academic load of graduate-level students. OBJECTIVE To examine burnout among GAATs with clinical assistantships at National Collegiate Athletic Association (NCAA) Division I institutions and to identify the personal and situational variables that are related to burnout. DESIGN Cross-sectional study. SETTING Division I universities offering graduate assistantship programs. PATIENTS OR OTHER PARTICIPANTS Two hundred one GAATs enrolled at NCAA Division I universities with graduate assistantship positions. MAIN OUTCOME MEASURES(S) The Athletic Training Burnout Inventory, which assesses stress and burnout among ATs through 4 constructs: emotional exhaustion and depersonalization, administrative responsibility, time commitment, and organizational support. The 6-point Likert scale is anchored by 1 (never true) and 6 (always true). RESULTS The GAATs who traveled with athletic teams (4.051 ± 0.895) and those who provided classroom instruction (4.333 ± 1.16) reported higher levels of stress due to time commitment than those who did not travel (3.713 ± 1.22) or teach (3.923 ± 0.929). We also found a difference in administrative responsibility across clinical settings (F(6,194) = 3.507, P = .003). The results showed that GAATs in NCAA Division I clinical settings (44.55 ± 13.17 hours) worked more hours than those in NCAA Division III clinical settings (33.69 ± 12.07 hours) and those in high school settings (30.51 ± 9.934 hours). CONCLUSIONS Graduate assistant ATs are at risk for burnout because of the time necessary to complete their clinical and academic responsibilities and their additional administrative responsibilities. Graduate assistants who work in the Division I clinical setting are at greater risk for burnout than those in the secondary school setting because of the large number of hours required.

Injury Rates in Age-Only Versus Age-and-Weight Playing Standard Conditions in American Youth Football.

Background: American youth football leagues are typically structured using either age-only (AO) or age-and-weight (AW) playing standard conditions. These playing standard conditions group players by age in the former condition and by a combination of age and weight in the latter condition. However, no study has systematically compared injury risk between these 2 playing standards. Purpose: To compare injury rates between youth tackle football players in the AO and AW playing standard conditions. Study Design: Cohort study; Level of evidence, 2. Methods: Athletic trainers evaluated and recorded injuries at each practice and game during the 2012 and 2013 football seasons. Players (age, 5-14 years) were drawn from 13 recreational leagues across 6 states. The sample included 4092 athlete-seasons (AW, 2065; AO, 2027) from 210 teams (AW, 106; O, 104). Injury rate ratios (RRs) with 95% CIs were used to compare the playing standard conditions. Multivariate Poisson regression was used to estimate RRs adjusted for residual effects of age and clustering by team and league. There were 4 endpoints of interest: (1) any injury, (2) non–time loss (NTL) injuries only, (3) time loss (TL) injuries only, and (4) concussions only. Results: Over 2 seasons, the cohort accumulated 1475 injuries and 142,536 athlete-exposures (AEs). The most common injuries were contusions (34.4%), ligament sprains (16.3%), concussions (9.6%), and muscle strains (7.8%). The overall injury rate for both playing standard conditions combined was 10.3 per 1000 AEs (95% CI, 9.8-10.9). The TL injury, NTL injury, and concussion rates in both playing standard conditions combined were 3.1, 7.2, and 1.0 per 1000 AEs, respectively. In multivariate Poisson regression models controlling for age, team, and league, no differences were found between playing standard conditions in the overall injury rate (RRoverall, 1.1; 95% CI, 0.4-2.6). Rates for the other 3 endpoints were also similar (RRNTL, 1.1 [95% CI, 0.4-3.0]; RRTL, 0.9 [95% CI, 0.4-1.9]; RRconcussion, 0.6 [95% CI, 0.3-1.4]). Conclusion: For the injury endpoints examined in this study, the injury rates were similar in the AO and AW playing standards. Future research should examine other policies, rules, and behavioral factors that may affect injury risk within youth football.

Tackling community-acquired methicillin-resistant Staphylococcus aureus in collegiate football players following implementation of an anti-MRSA programme

Competitive football players’ safety has become an important concern at the high school, collegiate and professional level and warrants attention.1–4 From 2003 to 2008, five players at our institution developed clinically significant community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections requiring hospitalisation and intravenous antibiotics. In 2008, the University of South Carolina team instituted anti-MRSA precautions based on recommendations made by the Centers for Disease Prevention and Control (CDC) (box 1). In an attempt to understand if guidelines recommended by the CDC resulted in low MRSA colonisation rates, we randomly selected players on a Division I collegiate football programme to evaluate colonisation for MRSA obtained from nares, helmets and shoulder pads. Inclusion criteria were age 18 or older and current team member. Exclusion criteria were presence of skin infection, receiving antibiotics or hospitalisation in the prior month. The study received IRB approval and informed consent was obtained from study participants. A research assistant or team physician obtained specimens from the nares, helmet and shoulder pads with a cotton-tipped swab from …

Environmental Conditions and Seasonal Variables in American Youth Football Leagues

Our study describes youth football (YFB) environmental conditions and the associated heat index (HI) risk category. An observational research design was utilized. Independent variables included month, time, event, and geographic location. Main outcome variables were frequency of events, average HI, and corresponding risk categorization. The HI was recorded with the day and time for each YFB event across 2 YFB seasons. Nearly half (49.8%) of events were in a high HI risk category and 20.0% should have been cancelled. The hottest HI values were recorded in July and August (83.2 ± 9.4°F to 87.2 ± 10.9°F; 24.0% of YFB events). The 7 to 10 am time frame was cooler (67.7 ± 14.5°F; 6.3% of YFB events) than other time frames (P < .001). Hotter HI values were recorded in practices versus games (75.9 ± 14.1°F vs 70.6 ± 14.6°F; t = −6.426, P < .001). Starting the YFB season in September and holding weekend events in the early morning hours can decrease exposure to environmental heat stress.