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The article emphasizes the need for athletic trainers (ATs) in secondary schools in the U.S. It relates the growth in the number of ATs serving in secondary school athletic programs. It presents statistics on the prevalence of sports injuries in secondary school settings. The challenges facing ATs working in secondary school settings are outlined, including the need to provide a high volume of care without the help of additional ATs. It emphasizes the need to develop a national agenda to expand the role of the AT within the U.S. health care system.

Background: Sport specialization is a strategy to acquire superior sport performance in 1 sport but is associated with increased injury risk. Currently, the degree of high school specialization among Division I athletes is unknown.Hypothesis: College athletes will display increased rates of specialization as they progress through their high school careers.Study Design: Descriptive epidemiological study.Level Of Evidence: Level 4.Methods: Three hundred forty-three athletes (115 female) representing 9 sports from a Midwest Division I University completed a previously utilized sport specialization questionnaire regarding sport participation patterns for each grade of high school. McNemar and chi-square tests were used to investigate associations of grade, sport, and sex with prevalence of sport specialization category (low, moderate, high) (a priori P ≤ 0.05).Results: Specialization increased throughout high school, with 16.9% (n = 58) and 41.1% (n = 141) of athletes highly specialized in 9th and 12th grades, respectively. Football athletes were less likely to be highly specialized than nonfootball athletes for each year of high school ( P < 0.001). There was no difference in degree of specialization between sexes at any grade level ( P > 0.23).Conclusion: The majority of Division I athletes were not classified as highly specialized throughout high school, but the prevalence of high specialization increased as athletes progressed through high school. Nonfootball athletes were more likely to be highly specialized than football athletes at each grade level.Clinical Relevance: Most athletes who are recruited to participate in collegiate athletics will eventually specialize in their sport, but it does not appear that early specialization is necessary to become a Division I athlete. Athletes should be counseled regarding safe participation in sport during high school to minimize injury and maximize performance. [ABSTRACT FROM AUTHOR]

Objective: To examine the role of proprioceptive training programmes in the primary prevention of ankle sprains in athletes. Data sources: Electronic data bases MEDLINE, CINAHL, Current Contents, PreMedline, and SPORTDiscus were searched for papers published between 1966 and June 2003 using the subject terms: "proprioceptive training AND ankle sprain prevention in athletes." Additional references found in the bibliographies of sports medicine textbooks and in the papers retrieved from the database searches were also reviewed. Study selection: Studies that focused on diagnosis, treatment, or rehabilitation of ankle sprains, and those that addressed prevention of ankle sprains by alternative methods to proprioceptive training techniques were excluded. Thus studies included in this review had to utilise a proprioceptive training programme that included one or more of the following elements: static balance training; hopping drills; ankle disk training; or training in safe side-to-side, take-off, and landing techniques. Data extraction: Five studies were identified that met the inclusion criteria, and only the data relevant to the results of proprioceptive training as the primary intervention were analysed in this review. Data synthesis: All five studies found that proprioceptive training was effective for significantly reducing the incidence of sprains in those ankles that had sustained prior injuries. However, in three of the five studies, there were other confounding variables, so that the effect of the proprioceptive training could not be clearly identified. There were no studies that examined its efficacy as the primary intervention for prevention of ankle sprains in athletes with healthy ankles. Conclusions: The use of proprioceptive training reduces the incidence of ankle sprains in athletes who have sustained prior injuries to the same level as subjects without any history of ankle sprains. However, its efficacy as a single primary preventive measure has not been confirmed by current studies, nor has its role been determined for athletes without prior ankle injuries. [ABSTRACT FROM AUTHOR]

In athletic training, research seems to be focused on laboratory studies rather than injury trials with athletes in actual sport settings. Practicing athletic trainers need to collaborate with traditional laboratory researchers and methods experts to make such studies a reality. [ABSTRACT FROM AUTHOR]

Purpose: To determine if the rate of sport-related concussion (SRC) is lower following state interscholastic athletic association mandated rule change (effective starting with 2014 season) that limited amount and duration of full contact activities during high school football practice sessions. The new rule prohibited full contact during week 1, and limited full contact to 75 min/wk during week 2 and to 60 min/wk week 3 and beyond. Full contact was defined as drills or game situations that occur at game speed when full tackles are made at a competitive pace and players are taken to the ground. Methods: Prospective cohort study of US high school football players (grades 9-12). Prior to rule change - 2012 (36 schools), 2013 (18 schools) seasons, 2081 players (age = 15.9+1.2 yrs). After rule change - 2014 season (26 schools), 945 players (age = 15.9 + 1.1 yrs). Players provided previous concussion and demographic information by self-report. Licensed Athletic Trainers recorded incidence and severity (median, IQR days lost) for each SRC. Chi-square tests were used to compare incidence of SRC in pre-rule 2012/2013 seasons with incidence in post-rule 2014 season. Wilcoxon Rank Sum tests were used to determine differences in severity (days lost) of SRC. Results: Total of 67 players (7.1%) sustained 70 SRC in 2014 compared to 206 players (9.0%) who sustained 211 SRC in 2012/2013 combined. Overall rate of SRC per 1000 Athletic Exposures (AE) was 1.28 in 2014 compared to 1.57 in 2012/2013 (p=0.155). Tackling was primary mechanism of injury for 46% of all SRC. The rate of SRC sustained overall in practice was significantly lower (p=.003) post-rule in 2014 (15 SRCs, 0.33/1000AE) compared to pre-rule 2012/2013 (86 SRCs, 0.76/1000AE). For 2014 season,12/15 SRCs were sustained during full contact practices, compared to 82/86 SRCs in 2012/2013 seasons. The rate of SRC in full contact practice was 0.57/1000AE in 2014 compared to 0.87/1000AE in 2012/2013 (p=0.216). There was no difference (p = 0.999) in the rate of SRC sustained in games pre (5.81/1000AE) and post rule (5.74/1000AE) change. There was no difference (p = 0.967) in severity of SRC pre (13 days lost [10-18 IQR]) and post rule (14 days lost [10.25-16 IQR]). Years of football playing experience did not affect incidence of SRC in 2014 season (p=0.941). Conclusions: The majority of SRC sustained in high school football practice occurred during full contact activities. The rate of SRC sustained in high school football practice was more than twice as high in the two seasons prior to a rule change limiting the amount and duration of full contact activities. Significance of Findings: Limitations on contact during high school football practice may be one effective measure to reduce the incidence of SRC. [ABSTRACT FROM AUTHOR]

Context: The COVID-19 pandemic has affected almost every aspect of life including youth sports. Little data exists on COVID-19 incidences and risk mitigation strategies in youth club sports., Objective: To determine the reported incidence of COVID-19 cases among youth club sport athletes and the information sources used to develop COVID-19 risk mitigation procedures., Design: Cross-sectional study., Setting: Online surveys., Patients: Soccer and volleyball youth club directors., Intervention: A survey was completed by directors of youth volleyball and soccer clubs across the country in October 2020. Surveys included self-reported date of re-initiation, number of players, player COVID-19 cases, sources of infection, COVID-19 mitigation strategies, and information sources for the development of COVID-19 mitigation strategies., Main Outcome Measures: Total number of cases reported, number of players, and days since club re-initiation were used to calculate an incidence rate of cases per 100,000 player-days. To compare reported incidence rates between soccer and volleyball, a negative binomial model was developed to predict player cases with sport and state incidence as covariates and log(player-days) as an offset. Estimates were exponentiated to yield a reported incidence rate ratio (IRR) with Wald confidence intervals., Results: A total of 205,136 athletes (soccer=165,580; volleyball=39,556) were represented by 437 clubs (soccer=159; volleyball=278). Club organizers reported 673 COVID-19 cases (soccer=322; volleyball=351), for a reported incidence rate of 2.8 cases per 100,000 player-days (soccer=1.7, volleyball=7.9). Volleyball had a significantly higher reported COVID-19 incidence rate compared to soccer (reported IRR = 3.06 [2.0-4.6], p<0.001). Out of 11 possible mitigation strategies, the median number of strategies used by all clubs was 7 with an interquartile range of 2., Conclusions: The incidence of self-reported cases of COVID-19 was lower in soccer clubs than volleyball clubs. Most clubs report using many COVID-19 mitigation strategies to reduce the risk of COVID-19.

Context: Girls high school volleyball is very popular across the United States. There is limited prospective data regarding the incidence and risk factors of time loss (TL) and non-time loss (NTL) injuries sustained in this population., Objectives: To estimate the incidence and describe the characteristics of injuries (TL and NTL) sustained in a girls' high school volleyball season., Design: Descriptive epidemiology study., Setting: Convenience sample of 78 high school interscholastic volleyball programs., Patients or Other Participants: High school volleyball players participating during the 2018 interscholastic season., Main Outcome Measures: TL and NTL injury rates, proportions, rate ratios, and with 95%CI., Results: A total of 2,072 girls enrolled in the study with 468 subjects (22.5%) sustaining 549 injuries (NTL=28.4%, TL=71.6%) for an overall injury rate of 5.31 [4.89, 5.79] per 1000 AEs. The competition injury rate was greater than the practice injury rate for all injuries (IRR: 1.19, [1.00, 1.41]) and TL injuries (IRR: 1.31, [1.07, 1.60]). Players with a previous musculoskeletal injury had a higher rate of TL than NTL injuries (IRR; 1.36 [1.12, 1.65]). Ankle injuries accounted for the greatest proportion of TL injuries (n=110, 28%), while the greatest proportion of NTL injuries occurred in the hand/fingers (n=34, 22%). Moreover, ligament sprains accounted for 40% of TL injuries (n=156), whereas muscle/tendon strains (n=79, 51%) accounted for over half of all NTL injuries., Conclusions: While the majority of injuries sustained by adolescent girls' volleyball athletes were TL in nature, nearly a third of all injuries were NTL injuries. Injury characteristics differed widely between TL and NTL injuries. Understanding the most common types and characteristics of injury among high school volleyball players is critical for the development of effective injury prevention programs., (© by the National Athletic Trainers' Association, Inc.)

Objectives: To describe the socioeconomic status, measured by household income and educational attainment, of parents with children participating on youth club sport teams., Design: Cross-sectional survey., Setting: Local sport events., Participants: 949 parents (571 female) of youth athletes between 10 and 18 years old were recruited at club team events and practices to complete an anonymous questionnaire., Main Outcome Measures: SES variables included total household income (THI) and educational attainment. Sport specialization was classified as low, moderate, or high using a previously utilized 3-point specialization scale. Chi-square tests were used to compare frequencies SES categories with child specialization., Results: Parents reported spending a median of 1500 [500-3000] USD per year on their children's club sports activities. Most parents reported a THI greater than 100,000 USD per year and a bachelor's degree or higher level of education. Parents in the higher THI categories were more likely to have a child that is highly specialized in one sport., Conclusion: The current youth sports system in the United States, which emphasizes year-round participation on club teams, may be limiting the participation of families without the resources to participate in this system., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Sport specialization is associated with an increased risk of musculoskeletal lower extremity injuries (LEIs) in adolescent athletes presenting in clinical settings. However, sport specialization and the incidence of LEIs have not been investigated prospectively in a large population of adolescent athletes., Purpose: To determine if sport specialization was associated with an increased risk of LEIs in high school athletes., Study Design: Cohort study; Level of evidence, 2., Methods: Participants (interscholastic athletes in grades 9-12) were recruited from 29 Wisconsin high schools during the 2015-2016 school year. Participants completed a questionnaire identifying their sport participation and history of LEIs. Sport specialization of low, moderate, or high was determined using a previously published 3-point scale. Athletic trainers reported all LEIs that occurred during the school year. Analyses included group proportions, odds ratios (ORs) and 95% CIs, and days lost due to injury (median and interquartile range [IQR]). Multivariate Cox proportional hazard ratios (HRs) with 95% CIs were calculated to investigate the association between the incidence of LEIs and sport specialization level., Results: A total of 1544 participants (50.5% female; mean age, 16.1 ± 1.1 years) enrolled in the study, competed in 2843 athletic seasons, and participated in 167,349 athlete-exposures. Sport specialization was classified as low (59.5%), moderate (27.1%), or high (13.4%). Two hundred thirty-five participants (15.2%) sustained a total of 276 LEIs that caused them to miss a median of 7.0 days (IQR, 2.0-22.8). Injuries occurred most often to the ankle (34.4%), knee (25.0%), and upper leg (12.7%) and included ligament sprains (40.9%), muscle/tendon strains (25.4%), and tendinitis/tenosynovitis (19.6%). The incidence of LEIs for moderate participants was higher than for low participants (HR, 1.51 [95% CI, 1.04-2.20]; P = .03). The incidence of LEIs for high participants was higher than for low participants (HR, 1.85 [95% CI, 1.12-3.06]; P = .02)., Conclusion: Athletes with moderate or high sport specialization were more likely to sustain an LEI than athletes with low specialization. Sports medicine providers need to educate coaches, parents, and interscholastic athletes regarding the increased risk of LEIs for athletes who specialize in a single sport.

Background: The prevalence of sport specialization in high school athletes is unknown. This information is needed to determine the scope of this issue in an active population., Purpose: To determine the prevalence of sport specialization in high school athletes and to determine if specialization is influenced by classification method, year in school, sex, and school size. A secondary purpose was to determine if highly specialized athletes would be more likely to report a history of lower extremity injuries., Study Design: Cross-sectional study; Level of evidence, 3., Methods: High school athletes between the ages of 13 and 18 years from 2 local high schools completed both a sport specialization survey and an injury history survey. Athletes were classified into low, moderate, or high specialization groups using a recently developed 3-point system and were also classified using a self-classification method., Results: A total of 302 athletes completed the surveys and were classified as low specialization (n = 105, 34.8%), moderate specialization (n = 87, 28.8%), or high specialization (n = 110, 36.4%). Athletes from the small school were more likely to be classified in the low specialization group (low, 43%; moderate, 32%; high, 25%) compared with those from the large school (low, 26%; moderate, 26%; high, 48%) (P < .001). Athletes in the high specialization group were more likely to report a history of overuse knee injuries (n = 18) compared with moderate (n = 8) or low specialization (n = 7) athletes (P = .048). Athletes who trained in one sport for more than 8 months out of the year were more likely to report a history of knee injuries (odds ratio [OR], 2.32; 95% CI, 1.22-4.44; P = .009), overuse knee injuries (OR, 2.93; 95% CI, 1.16-7.36; P = .018), and hip injuries (OR, 2.74; 95% CI, 1.09-6.86; P = .026). Using the self-classification method, more participants self-classified as multisport (n = 213, 70.5%) than single sport (n = 89, 29.5%). Athletes from the small school were more likely to classify themselves as multisport (n = 128, 86%) (P < .001) than those from the large school (n = 85, 56%). There were no differences in the history of hip, knee, or ankle injuries between athletes who self-classified as single sport (hip: n = 10, 3%; knee: n = 19, 6%; ankle: n = 35, 12%) versus those who self-classified as multisport (hip: n = 45, 8%; knee: n = 23, 15%; ankle: n = 98, 33%) (P > .370)., Conclusion: Classification method and school size influenced the prevalence of specialization in high school athletes. Highly specialized athletes were more likely to report a history of overuse knee or hip injuries. Participating in a single sport for more than 8 months per year appeared to be an important factor in the increased injury risk observed in highly specialized athletes., (© 2016 The Author(s).)

Background: Creatine is a nutritional supplement used to enhance athletic performance in collegiate and professional athletes. There is increasing evidence that high school athletes are using creatine as well. The objective of this study was to describe patterns of creatine supplementation as well as the behaviors and beliefs associated with creatine use in high school athletes., Methods: 4011 high school student-athletes from 37 public high schools in Wisconsin took part in a cross-sectional, multi-site, anonymous, descriptive survey. Measurements included self-reported patterns of creatine use., Results: 16.7% of the athletes (25.3% males, 3.9% females) reported using creatine. Creatine use was lowest in the 9th grade (8.4%) and highest in the 12th grade (24.6%). The percentage of participants in each sport who used creatine varied considerably from 1.3% (female cross country) to 30.1% (football). Increased strength was the most likely perceived benefit of creatine supplementation, while dehydration was cited most often as a perceived risk of creatine use. Users were encouraged to take creatine most often by their friends while their parents discouraged its use., Conclusion: Despite the lack of research regarding the efficacy or safety of creatine supplementation in high school athletes, creatine was used by 25% of males and 4% of female high school athletes in Wisconsin. High school athletes who use creatine may not be aware of the risks and benefits associated with creatine supplementation. Primary care providers and sports medicine professionals need to educate athletes, coaches and parents about the creatine use as a performance enhancing supplement.