Search

Female high school athletes are an at-risk population for the Female Athlete Triad--a syndrome including low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. School nurses can play an important role in reducing the health burden of this syndrome, by educating coaches and athletes, and by referring symptomatic student-athletes to appropriate community resources for evaluation and treatment. This study assessed knowledge, attitudes, communication, and referral behaviors of U.S. high school nurses about the Female Athlete Triad. Participants were a random sample of 370 U.S. high school nurses. The results indicated that only 19% of the nurses were able to identify the three components of the Triad and only 25% reported that they work proactively with coaches to help prevent health issues among their female athletes. Over 95% expressed interest in learning more about the Triad. Implications for educational program design are discussed.

The prevalence of childhood obesity is almost 20%and affects 14.7million youth. It is not amatter of if but when and how often sports medicine clinicians will care for patients with obesity. Considering the social, emotional, medical, and physical impact of obesity, we need a nuanced approach to communicate with patients and develop effective treatment plans to maintain or encourage physical activity. Neuromusculoskeletal impairments, physical complications, pain, biomechanical differences, and physical deconditioning act as potential barriers to treatment. This article introduces ways to pivot the conversation frommusculoskeletal pain to a productive, well-received conversation about a holistic approach to weight management that also promotes physical activity and overall wellness in youth with obesity. Special attention is given to equipping clinicians with recommendations that incorporate the use of inclusive language, health behavior theories, and tenets of motivational interviewing to deliver equitable treatment regardless of body habitus. [ABSTRACT FROM AUTHOR]

Background and Purpose Half of adolescent athletes report low back pain (LBP) and there is a significant risk of vertebral injury in this population. The current model of care for adolescent athletes with LBP is to first confirm a medical diagnosis of spondylolysis which frequently requires advanced imaging. However, routine use of advanced imaging increases cost, delays treatment, and can expose the athlete to radiation. Purpose The purpose of this pilot study was to assess the viability of a physical therapist guided functional progression program to manage low back pain (LBP) in adolescent athletes. Study Design Non-randomized, controlled clinical trial. Methods Sixteen adolescents (15 ± 1.8 years, 50% female) with extension-based LBP were assigned to the biomedical model or physical therapy first model. The biomedical model sought to determine a spondylolysis diagnosis to guide treatment. In the physical therapy first model, patients began early therapeutic exercise and their ability to functionally progress determined the course of care. Dependent variables were change in Micheli Function Score, use of imagining, days out of sport, and ability to return to sport. Adverse events were monitored in order to assess safety. Descriptive statistics were completed to assess the viability of the alternative model. Results Both models had similar improvements in pain and function. The physical therapy first model reduced use of advanced imaging by 88% compared to the biomedical model. Patients in the biomedical model who did not sustain a vertebral injury returned to sport sooner than the physical therapy first model (3.4 days versus 51 days), while those with a vertebral injury took longer in the current model (131 days versus 71 days). All of the patients in the physical therapy first model and 88% of patients in the current model made a full return to sport. Two adverse events occurred in the biomedical model, and none were noted in the physical therapy first model. Conclusion This pilot study demonstrated that the physical therapist guided functional progression program may be a viable method for treating young athletes with LBP and further research is warranted. Level of Evidence 3b [ABSTRACT FROM AUTHOR]

We examined the effect of a noncontact, subsymptom exacerbation early exercise recommendation on recovery from sports-related concussion. Retrospective analysis of adolescents, 10-17 years old, with symptomatic concussion, within 30 days of injury was performed. Time to recovery was measured between the early exercise group and a comparison group. A total of 187 patients studied—112 in the exercise group and 75 in the comparison group; 55% were male (n = 103). The exercise group had a significantly longer duration of concussion symptoms (18.5 days vs 14, P =.002), although both groups recovered within the expected time to recovery for concussion. When analyzed separately, males experienced longer time to recovery from injury (19 days vs 14, P =.003), than females, respectively (18 days vs 14.5, P =.18). Recommendation of early exercise resulted in significantly longer recovery from concussion in male adolescents but had no significant effect in female adolescents; both groups recovered within the expected time frame. [ABSTRACT FROM AUTHOR]

Objective: To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP). Design: Retrospective case series. Setting: Hospital-based sports medicine clinic. Patients: The medical charts of 1025 adolescent athletes with LBP (age 15 +/- 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis. Assessment of Risk: Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females. Main Outcome Measure: Relative risk of diagnosis of spondylolysis injury. Results: The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis. Conclusions: The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating. [ABSTRACT FROM AUTHOR]

Objectives: The purposes of this study were (1) to determine whether the duration of rest before referral to physical therapy (PT) affects the time to make a full return to activity for patients with an acute spondylolysis, (2) to assess the safety of an early referral to PT in patients with an acute spondylolysis. Study Design: Retrospective chart review. Setting: Hospital-based sports medicine clinic. Patients: The medical charts of 196 adolescent athletes (mean age = 14.3 6 1.8 years) with an acute spondylolytic injury met the inclusion criteria and were reviewed. Independent Variable: Patients were subgrouped based on physician referral to PT. Patterns: An aggressive referral group (<10 weeks) and a conservative referral group (> 10 weeks). Main Outcome Measures: Duration of rest before clearance to a full return to activity and the frequency of adverse reactions during the course of treatment. Safety was assessed by calculating the risk of experiencing an adverse reaction in each group. Results: Median days to a full return to activity for aggressive referral group (115.5 days, interquartile range 98-150 days) and conservative referral group (140.0 days, interquartile range 114.5-168 days) were significantly different (P = 0.002). Eleven patients had adverse reactions during the course of treatment. The risk of adverse reaction was not statistically significant between groups (P = 0.509). Conclusions: Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups. [ABSTRACT FROM AUTHOR]

Background/objective: Conventional neuroimaging is not recommended for the routine diagnosis of concussion, but some patients with concussion undergo computed tomography (CT) or magnetic resonance imaging (MRI). The objective of this study was to explore the clinical factors that predict neuroimaging utilization in concussion. Methods: Concussion-related CT and MRI data were analysed from 1953 patients, aged 10–19 years, who presented to a sports concussion clinic within 30 days of injury. Results: The majority of CT scans (n= 193) were obtained during the acute concussion period (mean = 2.7 days post-concussion), whereas MRI scans (n= 134) were ordered later during recovery (mean = 39.4 days post-concussion). Predictors of CT utilization included loss of consciousness, amnesia and vomiting (allp< 0.001). Prior concussion (p= 0.002) and continued participation in activity after injury (p= 0.03) predicted greater MRI utilization. Neuroimaging with either CT (p= 0.024, hazard ratio = 1.2) or MRI (p< 0.001, hazard ratio = 2.75) was associated with prolonged symptoms. Only 3.1% of CTs and 1.5% of MRIs demonstrated signs of traumatic brain injury. Conclusion: Several clinical factors predict neuroimaging utilization in patients with concussion. CT is generally used acutely, while MRI is used in the sub-acute and chronic post-concussion periods. In a sports concussion clinic, delayed neuroimaging has limited clinical yield. [ABSTRACT FROM AUTHOR]

STUDY DESIGN: Retrospective review with telephone follow-up. BACKGROUND: Acute spondylolytic injuries have a dramatic impact on the young athlete. Excellent short-term clinical outcomes have been observed, but not enough is known about long-term clinical outcomes. OBJECTIVES: (1) To report long-term clinical outcomes for patients diagnosed with acute spondylolysis, and (2) to assess the prognostic ability of retrospective variables for long-term outcomes. METHODS: Patients from 2010 through 2013 were retrospectively reviewed to identify patients and to obtain demographic, baseline, and short-term outcomes. Long-term follow-up data were collected by telephone from patients diagnosed with acute spondylolysis to assess recurrence rate of low back pain, perceived outcome, pain, and functional ability. Patients were categorized as having a good or poor long-term outcome based on these measures. Logistic regression analysis was performed to assess the prognostic ability of the retrospective variables for long-term outcomes 3.4 years (range, 1.5-5.6 years) after treatment. RESULTS: One hundred twenty-one (71.6%) patients completed the follow-up questionnaire (48 female; mean age at baseline, 14.4 years). At follow-up, 81 (66.9%) patients were able to maintain their same or a higher level of sport. Recurrence of significant symptoms was reported by 55 (45.5%) patients, with 41 (33.9%) requiring medical treatment. The final logistic regression model revealed that female sex, adverse reaction during care, and multilevel injury were significant predictors of poor long-term outcome (R² = 0.22). CONCLUSION: Although excellent short-term outcomes were noted, 42% of patients reported a poor outcome at long-term follow-up. Female sex, multilevel injury, and experiencing an adverse reaction during care were significant predictors of poor long-term clinical outcome for patients diagnosed with acute spondylolysis. LEVEL OF EVIDENCE: Prognosis, level 4. Registered January 15, 2015 at www.clinicaltrials.gov [ABSTRACT FROM AUTHOR]

The article offers information on the syndrome of menstrual dysfunction, relative energy deficiency, and low bone mineral density in women athletes. Topics discussed include an increased risk of musculoskeletal injuries in teenagers with menstrual dysfunction (MD), risk factors for amenorrhea, eating disorders, or osteoporosis, and physical examination for sports for MD screening among female high school and middle school athletes.

Objective: To explore head-upright tilt table (HUT) signs of autonomic dysfunction in a cohort of youth with persistent postconcussion symptoms (PCSs) that include light-headedness and to correlate repeat tilt table results with symptom improvements for those patients found to have postural tachycardia syndrome (POTS) on initial testing. Design: Prospective cohort design. Setting: Nationwide Children's Hospital, Neurology Clinic. Participants: Thirty-four patients (13-18 years of age) with persistent PCSs. Main Outcome Measures: All patients underwent at least 1 tilt table test. The PCS Interview (PCS-I) and patient ratings of light-headedness and vertigo were used to measure symptom burden. Patients found to have POTS were asked to repeat tilt table testing when PCSs improved or 3 to 6 months after the initial test if symptoms persisted. Results: Twenty-four of the 34 (70.6%) patients had abnormal tilt table results with patients categorized as normal (n = 10), isolated syncope (n = 10), and POTS (n = 14). Patients with POTS had higher PCS-I scores than normal patients (P < 0.001) and higher ratings of light-headedness than both normal patients (P = 0.015) and syncope patients (P = 0.04). Twelve POTS patients underwent repeat tilt table testing, and 9 of 12 (75%) no longer met POTS diagnostic criteria. All patients with resolution of POTS had corresponding improvements in PCSs, including light-headedness and vertigo. Conclusions: Our study demonstrates a high rate of tilt table abnormalities among youth with persistent PCSs. Several patients with POTS had normalization of tilt table testing when PCSs improved. These findings warrant further research of autonomic dysfunction related to concussion. Clinical Relevance: Our study is the first to prospectively characterize autonomic dysfunction in patients with persistent PCSs using HUT testing and to show that the tilt test abnormalities normalize in some patients as PCSs improve. [ABSTRACT FROM AUTHOR]

Background: Concussion guidelines recommend physical and cognitive rest until all postconcussion symptoms resolve, in part because of potential health risks, including catastrophic injury related to a second impact. However, when postconcussion symptoms persist for weeks or months, these risks are poorly characterized.Hypothesis: Physicians' perceived health risks and management strategies for patients with persistent postconcussion symptoms will vary.Study Design: Cross-sectional study.Level Of Evidence: Level 3.Methods: A survey of the physician members of the American College of Sports Medicine assessed the perceived health risks related to advancing activity, the indications for neuroimaging, and the referral patterns for patients with persistent postconcussion symptoms.Results: A total of 572 physicians completed the survey (response rate, 27.2%). The majority of physicians recommended physical rest (97.4%) and cognitive rest (93.8%) within the first week of injury. Perceived health risks related to advancing activity in the symptomatic patient differed at 2 weeks versus 3 months after injury (P < 0.001 for all comparisons). Respondents from the United States were more likely to list second impact syndrome as a potential health risk at 2 weeks compared with respondents from other countries (P = 0.04). The majority (56%) responded that the risk of second impact syndrome remains until all symptoms resolve. When postconcussion symptoms persist beyond 1 month, 61.9% of physicians responded that neuroimaging is indicated. Approximately 60% of respondents had access to a multidisciplinary concussion clinic within 60 miles of their practice.Conclusion: When postconcussion symptoms persist, the perceived health risks, management practices, and access to multidisciplinary care vary among physicians. [ABSTRACT FROM AUTHOR]

Background/aim: A standard definition of Post-concussion Syndrome (PCS) does not exist. The objective was to determine consensus regarding the definition of PCS among physician members of the American College of Sports Medicine (ACSM). Methods: Physician members of the ACSM were sent an electronic survey to determine opinions regarding the PCS diagnosis. Results: Five hundred and ninety-seven physicians completed the survey. When asked the minimum duration of symptoms required to diagnose PCS, respondents answered: <2 weeks (26.6%), 2 weeks to 1 month (20.4%), 1-3 months (33%) and >3 months (11.1%). Physicians who see ≥10% concussion patients in their practise, as well as physicians whose concussion population consists of >50% paediatric patients, were more likely to require >1 month of symptoms ( p < 0.001). When asked the minimum number of symptoms required to diagnose PCS, responses varied: one symptom (55.9%), two symptoms (17.6%), three symptoms (14.6%) and four or more symptoms (3.2%). Respondents from the US were more likely than non-US respondents to require only one symptom for the PCS diagnosis ( p = 0.01). Conclusions: There is a lack of consensus regarding the definition of PCS among physician members of the ACSM. A standard definition would improve consistency in concussion research and in clinical practise. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine rates of menstrual dysfunction among female athletes using the Ohio High School Athletic Association Preparticipation Physical Evaluation (PPE). PPE forms from 207 female athletes were analyzed. Age, sport, body mass index (BMI), age of menarche, number of periods in the previous year, fracture history, and 4 questions geared toward eating attitude were recorded. The athlete's average age of men-arche and number of periods per year was 11.94 ± 1.15 years and 11.51 ± 1.57, respectively. Seven percent reported menstrua dysfunction. No differences in BMI, stress fracture, or fracture history were found between eumenorrheic and dysmenorrheic groups (P = .48, P = 57, P = 57, respectively). Dysmenorrheic athletes were significantly older at menarche (12.5 versus 11.9 years; P = .04). The rates of menstrual dysfunction recorded from the Ohio PPE are significantly lower than previously reported values. [Athletic Training & Sports Health Care. 2014;6(6):261-266.] [ABSTRACT FROM AUTHOR]

The article provides information on the significance of potassium and sodium for normal body function. It presents a study which reveals that inadequate potassium and excess sodium are both associated to the potential for subsequent cardiovascular disease and high blood pressure. Recommendations to address the underconsumption of potassium and overconsumption of sodium in the American diet are discussed.

accounting for as much as 40% of all low back pain in this population. Currently, there is no evidence to guide physicians on when to make a safe referral to physical therapy [PT] for these patients. There were two primary objectives of this study: (1) to determine if the amount of time prior to referral to PT affects the time to make a full return to activity for patients with an acute spondylolysis (2) To assess the safety of an early referral to PT compared with a longer rest period prior to PT in patients with an acute spondylolysis. Methods: This was a retrospective study which consisted of the review of each patient's medical chart and lumbar imaging. Participants: One hundred and ninety-six patients with an acute spondylolysis injury met the inclusion criteria during the pre-selected review period. Patients were sub-grouped into 2 groups by physician referral patterns: an aggressive referral to PT group (< 10 weeks) and a conservative referral to PT group (> 10 weeks). Safety was assessed by calculating the number of adverse reactions experienced in each group during the course of treatment. Data Analysis: Mann-Whitney U tests were used to analyze the first study objective. Relative risk of an adverse reaction was calculated to assess the second study objective. Results: Median days to a full return to sport for aggressive PT referral group (115.5 days IQR 50.5) and conservative PT referral (140.0 days IQR 40.3) was significantly different (p = 0.003). A total of 11 patients had documented adverse reactions during the course of treatment for acute spondylolysis. Although there was a higher percentage of patients who experienced an adverse reaction in the conservative referral to PT group, this difference was not statistically significant (p = 0.509). Conclusions: The results of this retrospective study show that patients of physicians who referred to physical therapy sooner returned to sport more quickly without an increased risk of adverse reaction. [ABSTRACT FROM AUTHOR]

Objective: The term "post-traumatic migraine" (PTM) has been used to describe post-traumatic headaches (PTHs) that have associated migraine features, but studies of this relationship are lacking. The objective of the present study was to determine whether PTH correlates strongly with migraine symptoms among youth with concussion.Methods: Twenty-three symptoms were analyzed from a retrospective cohort of 1953 pediatric patients with concussion. A principal component analysis (PCA) with oblique Promax rotation was conducted to explore underlying symptom relationships in the full cohort and in subcohorts stratified by the presence (n = 414) or absence (n = 1526) of premorbid headache.Results: The mean patient age was 14.1 years; 63% were male. Headache was the most common postconcussion symptom, acknowledged by 69.4% of patients. When considering the full cohort, the PCA demonstrated clustering of headache with photophobia, phonophobia, nausea, dizziness, and neck pain. Similar clustering was present among patients without premorbid headaches. Repeating the analysis in the patients with preconcussion headaches led to elimination of neck pain from the cluster.Conclusions: PTH correlates strongly with other migraine symptoms among youth with concussion, regardless of premorbid headaches. This clustering of migraine symptoms supports the existence of PTM as a distinct clinical entity in some patients. [ABSTRACT FROM AUTHOR]