Michelle A. Sandrey

National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries.

OBJECTIVE To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6-18 years). BACKGROUND Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches. RECOMMENDATIONS Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization.

Effects of shoe sole thickness on joint position sense

The objective of this study was to determine the effects of shoe sole thickness on joint position sense in the sagittal and frontal plane by determining the estimate angle error. Joint position sense was measured by manipulating angle and direction of a slope surface board (30 cm x 30 cm x 1.5 cm) to perform the movements of dorsiflexion, plantar flexion, inversion and eversion. Sandwiching wooden wedges with pre-determined angles between 0 and 25 degrees between the slope surface boards made the slope surface angles. Twenty healthy college male students were asked to estimate the angle and direction of movements under each of the shod conditions while standing on the slope surface board. Estimate angle error was calculated for each movement under all shod conditions. For all shod conditions, estimate angle error was the greatest for plantar flexion and inversion compared to dorsiflexion and eversion. Independent of shod condition, subjects had the most difficulty estimating plantar flexion and inversion movements.

Special physical examination tests for superior labrum anterior-posterior shoulder tears: an examination of clinical usefulness.

REFERENCE/CITATION Calvert E, Chambers GK, Regan W, Hawkins RH, Leith JM. Special physical examination tests for superior labrum anterior-posterior shoulder injuries are clinically limited and invalid: a diagnostic systematic review. J Clin Epidemiol. 2009;62(5):558-563. CLINICAL QUESTION The systematic review focused on diagnostic accuracy studies to determine if evidence was sufficient to support the use of superior labrum anterior-posterior (SLAP) physical examination tests as valid and reliable. The primary question was whether there was sufficient evidence in the published literature to support the use of SLAP physical examination tests as valid and reliable diagnostic test procedures. DATA SOURCES Studies published in English were identified through database searches on MEDLINE, EMBASE, and the Cochrane database (1970-2004) using the search term SLAP lesions. The medical subject headings of arthroscopy, shoulder joint, and athletic injuries were combined with test or testing, physical examination, and sensitivity and specificity to locate additional sources. Other sources were identified by rereviewing the reference lists of included studies and review articles. STUDY SELECTION Studies were eligible based on the following criteria: (1) published in English, (2) focused on the physical examination of SLAP lesions, and (3) presented original data. A study was excluded if the article was limited to a clinical description of 1 or more special tests without any research focus to provide clinical accuracy data or if it did not focus on the topic. DATA EXTRACTION The abstracts that were located through the search strategies were reviewed, and potentially relevant abstracts were selected. Strict epidemiologic methods were used to obtain and collate all relevant studies; the authors developed a study questionnaire to record study name, year of publication, study design, sample size, and statistics. Validity of the diagnostic test study was determined by applying the 5 criteria proposed by Calvert et al. If the study met the inclusion and validity criteria, 95% confidence intervals were calculated for each sensitivity, specificity, and positive and negative likelihood ratio reported. No specific information was provided about the procedure if the reviewers disagreed on how the evaluation criteria were applied. MAIN RESULTS The specific search criteria led to the identification of 29 full-text articles. The studies were reviewed, and inclusion and exclusion criteria were applied. This resulted in 14 excluded studies and 15 eligible studies for analysis. Of the 15 eligible studies, 1 evaluated only a single physical examination test for a SLAP lesion or biceps tendon injury, and 10 studies evaluated 2 to 6 physical examination tests for a SLAP lesion or biceps tendon injury. Nine studies reported sensitivities and specificities greater than 75%, 4 had sensitivities less than 75%, 3 had specificities less than 75%, 1 did not report sensitivity, and 2 did not report specificities. When validity was assessed for those 15 papers, only 1 study that evaluated the biceps tendon met the 5 critical appraisal criteria of Calvert et al and calculated 95% confidence intervals. When the Speed and Yergason tests were each compared with the gold standard (arthroscopy), the confidence intervals for the positive and negative likelihood ratios spanned 1. This indicated that the test result is unlikely to change the odds of having or not having the condition, respectively. CONCLUSIONS The literature currently used as a reference for teaching in medical schools and continuing education lacks the necessary validity to help rule in or out a SLAP lesion or biceps tendon involvement. Based on the results from the systematic review conducted by Calvert et al, no tests clinically diagnose a SLAP lesion. This is a cause for concern as magnetic resonance imaging or magnetic resonance arthrography, which are frequently used to assess a possible SLAP lesion, may also have diagnostic flaws and may be cost prohibitive. Performing arthroscopy on every patient to rule the condition in or out is unethical, especially if a SLAP lesion is not present. More rigorous validity studies should be conducted for SLAP lesion physical examination tests using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool or Standards for Reporting Diagnostic Accuracy (STARD) criteria.

Effect of Prophylactic Ankle-Brace Use During a High School Competitive Basketball Season on Dynamic Postural Control.

CONTEXT Few studies have evaluated the long-term effects of prophylactic ankle-brace use during a sport season. OBJECTIVE To determine the effects of prophylactic ankle-brace use during a high school basketball season on dynamic postural control and functional tests. DESIGN Prospective repeated-measures design. SETTING High school athletic facility. PARTICIPANTS 21 healthy high school basketball athletes (13 girls, 8 boys). INTERVENTIONS The order of testing was randomized using the Star Excursion Balance Test (SEBT) for posteromedial (PM), medial (M), and anteromedial (AM) directions and 3 functional tests (FT) consisting of the single-leg crossover hop, single-leg vertical jump, and the single-leg 6-m hop for time at pre-, mid-, and postseason. After pretesting, the ankle brace was worn on both limbs during the entire 16-wk competitive basketball season. MAIN OUTCOME MEASURES SEBT for PM, M, and AM and 3 single-leg FTs. RESULTS Dynamic postural control using the SEBT and the 3 FTs improved over time, notably from pretest to posttest. The left limb was different from the right limb during the single-leg vertical jump. Effect sizes were large for pretest to posttest for the 3 SEBT directions and 2 of the 3 FTs. CONCLUSIONS The 16-wk basketball prophylactic ankle-brace intervention significantly improved dynamic postural control and single-limb FTs over time.

Two 4-Week Balance-Training Programs for Chronic Ankle Instability

CONTEXT   Traditional single-limb balance (SLB) and progressive dynamic balance-training programs for those with chronic ankle instability (CAI) have been evaluated in the literature. However, which training program may be more beneficial is not known. OBJECTIVE   To investigate the effects of a progressive hop-to-stabilization balance (PHSB) program compared with an SLB program on self-reported function, dynamic postural control, and joint position sense (JPS) where angle and direction were self-reported by participants with CAI. DESIGN   Randomized controlled clinical trial. SETTING   A single testing location in a mid-Atlantic state. PATIENTS OR OTHER PARTICIPANTS   A total of 18 participants (age = 18.38 ± 1.81 years; height = 175.26 ± 6.64 cm; mass = 75.79 ± 12.1 kg) with CAI. INTERVENTION(S)   Participants were randomly assigned to the PHSB or SLB program. The PHSB and SLB groups pursued their 4-week programs 3 times a week. The PHSB group performed a battery of single-limb hop-to-stabilization exercises, while the SLB group performed a series of SLB exercises. Exercises were advanced throughout the 4 weeks for both groups. MAIN OUTCOMES MEASURE(S)   Pretest and posttest measurements were the Foot and Ankle Ability Measure (FAAM)-Activities of Daily Living subscale; FAAM-Sports subscale; Star Excursion Balance Test in the anterior, posteromedial, and posterolateral directions; and weight-bearing JPS blocks (dorsiflexion, plantar flexion, inversion, eversion). RESULTS   A significant main effect of time was present for the FAAM-Activities of Daily Living, FAAM-Sports, Star Excursion Balance Test (anterior, posteromedial, and posterolateral directions), and JPS (dorsiflexion, plantar flexion, inversion), as posttest results improved for the PHSB and SLB groups. The main effect of group was significant only for the FAAM-Sports, with the SLB group improving more than the PHSB group. CONCLUSIONS   Either a 4-week PHSB or SLB can be used in athletes with CAI, as both programs resulted in similar gains.

The Effects of Eversion Fatigue on Frontal Plane Joint Position Sense in the Ankle: 2401

CONTEXT There is limited information on fatigue of the evertors on frontal plane joint position sense (JPS). OBJECTIVE To examine the effects of isokinetic concentric-eccentric fatigue of the evertors on frontal plane JPS of the ankle. DESIGN A2 x 4 factorial design. SETTING Research Laboratory. PATIENTS OR OTHER PARTICIPANTS 40 male and female healthy subjects. INTERVENTIONS JPS was tested at 10 degrees and 20 degrees of inversion and 5 degrees and 10 degrees of eversion in a nonfatigued/fatigued condition. After fatigue of evertors was determined on an isokinetic device, post fatigue testing of JPS occurred. MAIN OUTCOME MEASURES JPS absolute error (AE) for inversion and eversion. RESULTS Main effect for condition and angle were significant with pre/post fatigue. There were overestimation of angles postfatigue with AE greater at 20 degrees of inversion (P = .003), followed by 10 degrees of inversion (P < .001), 10 degrees of eversion (P = .005), and 5 degrees of eversion (P = .005). CONCLUSION When the ankle evertors were fatigued, the AE for JPS was significantly higher at all test angles.