Leamor Kahanov

The Effect of Kinesio Taping on Lower Trunk Range of Motions

The purpose of the study was to determine the effects of kinesio taping (KT) on trunk flexion, extension, and lateral flexion. Thirty healthy subjects with no history of lower trunk or back issues participated in the study. Subjects performed two experimental measurements of range of motion (with and without the application of KT) in trunk flexion, extension, and right lateral flexion. A dependent t test was used to compare the range of motion measurements before and after the application of KT. Through evaluation of the sum of all scores, KT in flexion produced a gain of 17.8 cm compared with the non-kinesiotape group (t (29) = 2.51, p < 0.05). No significant difference was identified for extension (−2.9 cm; t (29) = −0.55, p > 0.05) or lateral flexion (3 cm; t (29) = −1.25, p > 0.05). Based on the findings, we determined that KT applied over the lower trunk may increase active lower trunk flexion range of motion. Further investigation on the effects of KT is warranted.

Reliability of Biodex Balance System Measures

This study examined the reliability of measures of dynamic balance obtained using the Biodex Balance System (BBS). Twenty male (n = 10) and female (n = 10) active adults engaged in weight-bearing sports volunteered for this study. Dynamic balance was assessed using measures obtained from the BBS at a spring resistance level of 2. Spring resistance levels range from 1 (least stable) to 8 (most stable). The BBS uses a circular platform that is free to move in the anterior-posterior and medial-lateral axes simultaneously, which permits three measures to be obtained: an overall stability index (OSI), an anterior-posterior stability index (APSI), and a medial-lateral stability index (MLSI). Measures were obtained from 20-sec trials during which participants were asked to maintain an upright standing position on their dominant limb on the unstable surface of the BBS. An examination of measures obtained across 8 trials indicated that the BBS produced reliable measures as indicated by R = .94 (OSI), R = .95 (APSI), and R = .93 (MLSI). Based on findings in this study, the testing protocol recommended providing 2 practice trials (Trial 1 and Trial 2) followed by 2 test trials (Trial 3 and Trial 4). Reliability estimates for Trials 3 and 4 were R = .90 (OSI), R = .86 (APSI), and R = .76 (MLSI). Replication of this protocol with a separate group of 27 collegiate athletes resulted in reliability estimates of R = .92 (OSI), R = .89 (APSI), R = .93 (MLSI).

Understanding of athletes' nutritional needs among athletes, coaches, and athletic trainers.

Media sources, as well as educational programs and the medical community, have delivered the consistent and easily understood message that good nutrition is an important aspect ofa healthy lifestyle. While poor nutrition can be the source ofa number ofhealth problems that develop over time (e.g., lowered resistance to infection, high cholesterol level), the effect among athletes training in a highly competitive environment may be both immediate and severe (e.g.,~~ performance, heat exhaustion). Hydration, for example, is of particular importance to athletes (Clark, 1995). A fewofthe dangers ofdehydration include impaired thermoregulation, reduced work capacity, a proportional rise in perceived exertion, and iso-osmotic hypovolemia, which reduces sweating and increases core temperature (Gisolfi, 1996). Increased demands on the body accompany training and competition, making it essential to match dietary intake with energy expenditure. It is, therefore, important to examine the extent to which those involved in athletics understand dietary needs and principles to avoid potential problems. Typically, those who do not participate in athletics consider athletes, coaches, and athletic trainers to be knowledgeable about nutrition (Presidents Council on Physical Fitness and Sports Research Digest, 1998). However, studies conducted to assess the nutritional knowledge of those involved with the athletic commu-

Longitudinal Assessment of Noncontact Anterior Cruciate Ligament Injury Risk Factors During Maturation in a Female Athlete: A Case Report

OBJECTIVE To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. BACKGROUND In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. DIFFERENTIAL DIAGNOSIS Partial or complete tear of the ACL. MEASUREMENTS The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. FINDINGS The injury occurred in the year after the third assessment during the athletes club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. CONCLUSIONS During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.

Self-Reported Headgear Use and Concussions Among Collegiate Men’s Rugby Union Players

The perceived effectiveness of rugby union headgear in reducing concussions in American male collegiate rugby union athletes was assessed. Data collection was conducted by survey method distributed using electronic mail. One hundred and thirty-one men’s club rugby union participants from eight university teams in the United States were surveyed. Demographic data were assessed using frequencies, means, and standard deviations. An ANOVA was used to assess differences in the frequencies of responses between players with concussions and their perception of headgear, with an increase in positive perception of headgear with increased concussions. Player position and years of experience played a role in the number of concussions and use of protective headgear. Seventy-six different athletes reported a concussion while playing, with the majority (51%) not wearing headgear. Athletes who wore headgear experienced 24% of the concussions, compared to 76% of those who did not wear headgear. The incidence of concussions and severity of concussions were perceived as less severe among the group wearing headgear. The general perception of those individuals polled as to the effectiveness of headgear in reducing head injuries was positive.

Exertional Rhabdomyolysis in a Collegiate American Football Player After Preventive Cold-Water Immersion: A Case Report

OBJECTIVE To describe a case of exertional rhabdomyolysis in a collegiate American football player after preventive coldwater immersion. BACKGROUND A healthy man (19 years old) participated in full-contact football practice followed by conditioning (2.5 hours). After practice, he entered a coach-mandated postpractice cold-water immersion and had no signs of heat illness before developing leg cramps, for which he presented to the athletic training staff. After 10 minutes of repeated stretching, massage, and replacement of electrolyte-filled fluids, he was transported to the emergency room. Laboratory tests indicated a creatine kinase (CK) level of 2545 IU/L (normal range, 45-260 IU/L), CK-myoglobin fraction of 8.5 ng/mL (normal < 6.7 ng/mL), and CK-myoglobin relative index of 30% (normal range, 25%-30%). Myoglobin was measured at 499 ng/mL (normal = 80 ng/mL). The attending physician treated the athlete with intravenous fluids. DIFFERENTIAL DIAGNOSIS Exercise-associated muscle cramps, dehydration, exertional rhabdomyolysis. TREATMENT The patient was treated with rest and rehydration. One week after the incident, he began biking and swimming. Eighteen days later, the patient continued to demonstrate elevated CK levels (527 IU/L) but described no other symptoms and was allowed to return to football practice as tolerated. Two months after the incident, his CK level remained high (1900 IU/L). UNIQUENESS The athlete demonstrated no signs of heat illness upon entering the cold-water immersion but experienced severe leg cramping after immersion, resulting in a diagnosis of exertional rhabdomyolysis. Previously described cases have not linked cold-water immersion with the pathogenesis of rhabdomyolysis. CONCLUSIONS In this football player, CK levels appeared to be a poor indicator of rhabdomyolysis. Our patient demonstrated no other signs of the illness weeks after the incident, yet his elevated CK levels persisted. Cold-water immersion immediately after exercise should be monitored by the athletic training staff and may not be appropriate to prevent muscle damage, given the lack of supporting evidence.

Bilateral pulmonary emboli in a collegiate gymnast: a case report.

OBJECTIVE To characterize the diagnosis of pulmonary embolism in collegiate student-athletes and to raise awareness among sports medicine providers of the possibility of this potentially fatal disease in the student-athlete population. BACKGROUND An 18-year-old, previously healthy National Collegiate Athletic Association Division I female gymnast complained of intense pain, bilaterally, deep in her chest. The athlete was referred to her team physician, who identified normal vital signs but referred her to the emergency room because of significant pain. The student-athlete was diagnosed with bilateral pulmonary emboli in the emergency room. DIFFERENTIAL DIAGNOSIS Pneumonia, renal calculi, upper urinary tract infection, intercostal muscle strain or rib fracture, pancreatitis, gall bladder disease, gastritis, ulceration, esophagitis, infection, tumor, pulmonary embolism. TREATMENT The student-athlete was immediately placed on anticoagulants for 6 months. During that time, she was unable to participate in gymnastics and was limited to light conditioning. UNIQUENESS Documented cases of female student-athletes developing a pulmonary embolism are lacking in the literature. Two cases of pulmonary embolism in male high school student-athletes have been documented, in addition to many cases in elderly and sedentary populations. CONCLUSIONS All health care providers, including sports medicine professionals, should be aware that this condition may be present among student-athletes. During the initial evaluation, prescreening should include questions about any previous or family history of pulmonary embolism or other blood clots. Athletes who answer positively to these questions may have a higher likelihood of pulmonary embolism and should be referred for testing.

Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in and around therapeutic whirlpools in college athletic training rooms.

CONTEXT Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a leading cause of skin and soft tissue infection in the nonhospitalized community. Care of the athletes in athletic training rooms is specifically designed with equipment tailored to the health care needs of the athletes, yet recent studies indicate that CA-MRSA is still prevalent in athletic facilities and that cleaning methods may not be optimal. OBJECTIVE To investigate the prevalence of Staphylococcus aureus and CA-MRSA in and around whirlpools in the athletic training room. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I university. PATIENTS OR OTHER PARTICIPANTS Student-athletes (n = 109) consisting of 46 men (42%) and 63 women (58%) representing 6 sports. MAIN OUTCOME MEASURE(S) Presence of MRSA and Staphylococcus aureus in and around the whirlpool structures relative to sport and number of athletes using the whirlpools. RESULTS We identified Staphylococcus aureus in 22% (n = 52/240) of the samples and MRSA in 0.8% (n = 2/240). A statistically significant difference existed between the number of athletes using the whirlpool and the presence of Staphylococcus aureus in and around the whirlpools (F(2,238) = 2.445, P = .007). However, Staphylococcus aureus was identified regardless of whether multiple athletes used a whirlpool or no athletes used a whirlpool. We did not identify a relationship between the number of athletes who used a whirlpool and Staphylococcus aureus or MRSA density (P = .134). CONCLUSIONS Staphylococcus aureus and MRSA were identified in and around the whirlpools. Transmission of the bacteria can be reduced by following the cleaning and disinfecting protocols recommended by the Centers for Disease Control and Prevention. Athletic trainers should use disinfectants registered by the Environmental Protection Agency to sanitize all whirlpools between uses.

CA-MRSA Infection Incidence and Care in High School and Intercollegiate Athletics.

PURPOSE Position papers offer solutions to manage community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), yet few studies establish the infection rate, management protocols, and referral practices among student-athletes. Over the 2012-2013 and 2013-2014 school years, we assessed the annual CA-MRSA infection incidence, sport risk, referral practices, and management steps among high school and intercollegiate athletics. METHODS This study targeted high school and intercollegiate athletic programs in the Northeastern United States. For the 2012-2013 study, 156 athletic trainers completed a one-time questionnaire. In the 2013-2014 study, 87 athletic trainers reported data bimonthly during the academic year. Each questionnaire targeted demographic information, physician-confirmed CA-MRSA infection occurrence, and management of CA-MRSA infections and bacterial skin lesions. RESULTS The CA-MRSA infection incidence was 15.5 per 10,000 athletes (95% confidence interval [CI], 13-19) in 2012-2013 and 16.3 per 10,000 athletes (95% CI, 13-21) in 2013-2014. The CA-MRSA infection incidence was higher in wrestling and football compared to the general student-athlete population. During the 2012-2013 study, the wrestling incidence rate was 90.2 per 10,000 (95% CI, 62-132); the football incidence rate was 42.3 per 10,000 (95% CI, 31-59). In the 2013-2014 study, the wrestling incidence rate was 89.0 per 10,000 (95% CI, 50-158); the football incidence rate was 61.4 per 10,000 (95% CI, 42-90). In both studies, primary care and general physicians received over 60% (2012-2013: 60.5%, n = 133; 2013-2014: 66.5%, n = 125) of referrals. In the 2012-2013 study, respondents indicated that student-athlete isolation and setting decontamination were common management steps used (58.1%, n = 306). CONCLUSIONS The incidence of CA-MRSA infections among student-athletes remains high. Therefore, it is critical that sports medicine providers continually reassess management protocols and best practices.

Trends in Doctoral Education Among Healthcare Professions: An Integrative Research Review

Context: Evidence suggests widespread adoption of the entry-level doctorate among health professions, although little is known about how these changes have impacted associated professions and influenced education, collaborative practice, professional advancement, or professional salaries. Objective: Threefold: (1) What doctoral education models are currently utilized among health care professional education programs in the United States? (2) How do entry-level clinical doctorates in health care professions impact research training and productivity? (3) How do clinical doctorates among health professions influence practice opportunities and salary? Design: Data were extracted from various sources including professional organizations, accrediting body Web sites, and the US Department of Labor database. Full-text articles published in English between the years 2001–2011 were extracted from a search of 38 databases in the University of Washington libraries. The remaining article abstracts were reviewed for co...