Jeff G. Konin

Development of a Distance-Based Interval Throwing Program for Little League-Aged Athletes

We developed a distance-based interval throwing pro gram for Little League-aged athletes (9 to 12 years) to be used in training and rehabilitation. The timing and repetition parameters were developed from data col lected during 400 innings of organized baseball during a single season, and short toss distance from Little League rules for field dimensions. There were 1022 boys from organized baseball teams in the four stud ies. Maximal distance and speed measurements were recorded for 853 boys. We developed a mathematical model from these data to predict maximal throwing distance from maximal throwing speed. This model was then tested on a second sample of 114 players. We compared the predicted distance with the actual maximal throwing distance; the correlation coefficient was 0.92. Forty players aged 9 to 12 participated in a study to assess degradation of speed and distance. The average variability of the speed was small (<5 mph), but the variability in distance was large (22.4 feet). Fifteen boys then threw the entire throwing pro gram as designed. These results show that healthy young athletes can be expected to be able to throw the predicted value of this practical progressive interval throwing program for Little League-aged athletes. The appropriate program can be assigned from age and known preinjury pitch speed.

Diagnostic ultrasound in sports medicine: current concepts and advances.

Diagnostic ultrasound is a valuable imaging tool that is slowly gaining in popularity among sports medicine clinicians. Commonly referred to as “musculoskeletal ultrasound,” its valuable role in assisting with sports medicine diagnoses has been to date underused for a variety of reasons. Effective clinical usage for sports medicine diagnoses includes commonly seen conditions such as rotator cuff disease, ulnar collateral ligament of the elbow injury, and internal derangement of the knee, among many others. Limitation of clinical usage has been deterred by the cost of the unit, perception of time associated with assessment procedures, and the lack of formal training associated with diagnostic implementation. However, when properly used, musculoskeletal ultrasound can increase the accuracy of diagnosis and treatment, improve time to treatment intervention, and improve patient satisfaction. The purpose of this paper is to review the fundamentals of musculoskeletal ultrasound and present its specific diagnostic uses.

Controlled warm-up intensity enhances hip range of motion.

&NA; Wenos, D.L., and J.G. Konin. Controlled warm‐up intensity enhances hip range of motion. J. Strength Cond. Res. 18(3):529–533. 2004.—Acute effects of active and passive warmup, proprioceptive neuromuscular facilitation (PNF), and ratings of perceived exertion (RPE) were compared during hip‐joint range of motion (ROM). Two active warm‐up treatments included (a) achieving a respiratory exchange ratio (RER) of 1.00 and (b) achieving 60% of heart rate reserve (HRR). Hydrocollator pads (HP) served as the passive warm‐up treatment. These treatments and a control were randomly assigned to increase hamstring muscle temperature of the dominant leg. Warm‐up treatments were administered to 12 men (mean 25.3 years) with a minimum of 24 hours interspersed between each treatment. A timed PNF (slow‐reversal‐hold) technique was conducted after each warm‐up treatment. Tukey tests (p < 0.05) showed ROM for RER (107.4°) was greater than all other treatments. ROM for HRR (102.8°) and HP (103.4°) did not differ from each other but were greater than the control (98.8°). Ratings of perceived exertion were lowest for RER (4.0) and highest for control (8.5). Ratings of perceived exertion for HRR (6.0) and HP (6.5) were similar. In conclusion, an active warm‐up before PNF stretching appears to be the most effective treatment to increase hip ROM. Results of RPE reinforce that active warm‐up reduces the resistance to stretch. In a field setting, it is estimated that a warmup of 70% of HRR would duplicate the muscle readiness equivalent to an RER of 1.00 before PNF stretching.

Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I Institutions

Background Sudden cardiac arrest is the leading cause of death in competitive athletes during sport, and screening strategies for the prevention of sudden cardiac death are debated. The purpose of this study was to assess the incorporation of routine non-invasive cardiovascular screening (NICS), such as ECG or echocardiography, in Division I collegiate preparticipation examinations. Methods Cross-sectional survey of current screening practices sent to the head athletic trainer of all National Collegiate Athletic Association (NCAA) Division I football programmes listed in the National Athletic Trainers’ Association directory. Results Seventy-four of 116 (64%) programmes responded. Thirty-five of 74 (47%) of responding schools have incorporated routine NICS testing. ECG is the primary modality for NICS in 31 (42%) of schools, and 17 (49%) also utilise echocardiography. Sixty-four per cent of the programmes that do NICS routinely screen their athletes only once as incoming freshmen. Of institutions that do not conduct NICS, American Heart Association guidelines against routine NICS and cost were the most common reasons reported. Conclusions While substantial debate exists regarding protocols for cardiovascular screening in athletes, nearly half of NCAA Division I football programmes in this study already incorporate NICS into their preparticipation screening programme. Additional research is needed to understand the impact of NICS in collegiate programmes.

Protective athletic equipment slows initiation of CPR in simulated cardiac arrest

OBJECTIVE Standard protective athletic equipment used in collision sports such as American football poses a unique challenge to rescuers because they block access to both the airway and chest. The main objective of this investigation was to determine the effect of athletic equipment on the initiation of CPR. The feasibility of performing compressions over the chest protector as a potential time-saving step was also evaluated. METHODS Thirty-four certified athletic trainers performed CPR on a manikin wearing protective equipment during a simulated episode of cardiac arrest. For one trial the protective equipment was removed or unfastened prior to initiating CPR, and for another, chest compressions were initiated over the protective equipment. The following were recorded for comparison purposes: time until first breath and first compression; percentage of compressions delivered to the recommended depth; compression rate; accuracy of hand placement; percentage of compressions without full chest recoil. RESULTS Although chest compressions began sooner when compressions were delivered over the chest protector, this improvement was not statistically significant. A more notable positive outcome resulting from keeping the chest protector on was an increase in the number of compressions that were delivered to the recommended depth. Unfortunately, one of the significant negative outcomes of performing chest compression over the chest pad was the increased percentage of compressions that did not obtain full chest recoil. CONCLUSIONS Although removal of the chest protector delays the initiation of chest compressions, keeping the chest protector on during CPR does not appear to be a feasible option.

Office-based Ultrasound in Sports Medicine Practice

Increasing knowledge, interest, and visibility in the field of sports medicine has equipped clinicians in the field with a novel array of diagnostic and therapeutic options but has also provided a higher level of complexity in patient care. True understanding of the vast spectrum of radiographic technology available to the sports clinician has become more critical than ever. Advances particularly in the areas of magnetic resonance imaging, diagnostic office ultrasound, and 3-dimensional reconstruction computed tomography, as well as nuclear medicine, offer the clinician a myriad of diagnostic options in patient evaluation. As these advances accumulate, the challenge to optimize care, contain cost, and interpret the extensive data generated becomes even more difficult to manage. Improving technology, education, and application of office ultrasound offers an interesting new tool for the bedside evaluation in real time of dynamic motion and pathology of sports-related injuries. As studies continue to validate ultrasounds effectiveness in diagnosing injuries to the upper and lower extremities compared with more costly magnetic resonance imaging and more invasive exploratory surgery, its promise as a cost-effective diagnostic tool is growing. A particularly promising development in the care of sports injuries is the expansion of injection therapies, and in-office ultrasound provides assurance that prolotherapy, platelet-rich plasma, dry needling, corticosteroid, and viscosupplementation are delivered accurately and safely. Communication with patients continues to increase in complexity because a greater understanding of the presence of radiographic abnormalities irrelevant to the current complaint is gained. All the accumulated data must then be interpreted and communicated to the patient with a firm understanding of not only the patient history and physical examination but also the availability, indications, contraindications, sensitivity, specificity, and even the cost implications of the spectrum of diagnostic options.

Introduction to Rehabilitation

Rehabilitation plays an integral role when it comes to managing sports injuries in a safe and timely manner. Doing so competently allows for a greater chance of quick recovery and ultimate success on and off the field. Understanding the goals of rehabilitation and how to enhance communication between all providers who are involved with athlete care is critical to the process. The purpose of this article is to thoroughly explain the steps and critical components of a rehabilitation process designed specifically for each athletes needs.

Developing an injury tracking software system specific for volleyball: a case example

Background Injury tracking systems are becoming increasingly popular in the realm of sports medicine. Identifying the prevalence and types of injuries can contribute to the identification of risk factors associated with sport specific injuries, as well as lead to the development of injury prevention programs, educational material, rule changes, and improved protective equipment. Objective To describe the process of creating an injury tracking system for volleyball in an effort to track variables associated with injury patterns. Design A software program containing over 1000variables was developed by certified athletic trainers and public health experts. Variables included demographic information, environmental factors, and sport specific movements. Standardized definitions (ie, ‘injury’) were established and pilot tested for reliability and validity purposes using internally developed case studies. Setting Data was collected via a web-based software program through the university academic program. Participants Participants included female volleyball players between 14–18 years of age. Results Analysis of the results identified common injuries associated with volleyball and their associated mechanisms. These findings directly led to the implementation of educational programs designed to prevent such injuries from occurring in the future. Furthermore, internal assessments of the program development noted the requirement of frequent variable modifications, standardized training necessities, and ongoing discussion to assure accurate data input. Conclusions The development of an injury tracking system specific to volleyball requires time, funding, ongoing re-evaluation, standardized terms, training for data collectors, and plans for implementing the findings into practical information for coaches, players, parents, and health care providers. When developed successfully, the information collected can prove to be valuable.

Analysis of Florida high school athlete's sports injury data for 2008–2009

Purpose To analyze the Florida high school athletes sports injury data for the 2008–2009 academic year and to provide recommendations for further research and practice. The data collected for this study were part of the initiatives of the SMART Institute of the University of South Florida. The surveillance tool is unique in that no other instrument captures the incidence, prevalence, risk factor and exposure information of all sports played by Florida high school athletes. Methods Certified Athletic Trainers (ATCs) hired by SMART and placed in 10 public high schools in west-central Florida collected the athletes injury and treatment data utilizing the Simtrak software template. Data were collected on football, baseball, volleyball, swimming, track, cross-country, flag football, soccer, basketball, golf, wresting, softball, tennis and cheerleading. Results Six-hundred injuries were reported by the ATCs. The leading rate of sports-related injury per 1000 athlete-exposures for practices was for football at 3.58, followed by flag football at 2.67 and wrestling at 2.52. For competitions, the leading rate was for football at 19.20, followed by womens soccer at 7.53 and wrestling at 6.59. Flag football emerged as great risk for injury rates in practice and baseball injuries ranked third in frequency. Sprains and strains were the leading physiologic injuries and the leading body sites injured were the ankles, knees and head. Conclusions These results allow for the development of targeted injury interventions for these athletes leading to reductions in injuries.