Athletic Settings Research Articles

AAP Publications Reaffirmed or Retired

Policy Statement: Drinking water from private wells and risks to children. Pediatrics. 2009;123(6):1599–1605. Available at: http://pediatrics.aappublications.org/content/123/6/1599.full. Reaffirmed September 2019Technical Report: Drinking water from private wells and risks to children. Pediatrics. 2009;123(6):e1123–e1137. Available at: http://pediatrics.aappublications.org/content/123/6/e1123.full. Reaffirmed September 2019Clinical Report: Generic prescribing, generic substitution, and therapeutic substitution. Pediatrics. 1987;79(5):835. Available at: http://pediatrics.aappublications.org/content/79/5/835.full.pdf+html?sid=99b78e26-e4b0-43a7-9c93-c0d3a1b81966. Reaffirmed September 2019Clinical Report: Interferon-gamma release assays for diagnosis for tuberculosis infection. Pediatrics. 2014;134(6):e1763–e1773. Available at: https://pediatrics.aappublications.org/content/134/6/e1763. Reaffirmed July 2018Policy Statement: HIV and other blood-borne viral pathogens in the athletic setting. Pediatrics. 1999;104(6):1400–1403. Available at: https://pediatrics.aappublications.org/content/104/6/1400. Retired September 2019Policy Statement: Protective eyewear for young athletes. Pediatrics. 2004;113(3):619–622. Available at: https://pediatrics.aappublications.org/content/113/3/619. Retired September 2019Policy Statement: Immunization for Streptococcus pneumoniae infections in high-risk children. Pediatrics. 2014;134(6):1230–1233. Available at: https://pediatrics.aappublications.org/content/134/6/1230. Retired July 2018

Effects of Vibration Rolling with and without Dynamic Muscle Contraction on Ankle Range of Motion, Proprioception, Muscle Strength and Agility in Young Adults: A Crossover Study.

Vibration rolling (VR) has emerged as a self-myofascial release (SMR) tool to aid exercise performance when warming up. However, the benefits of VR on exercise performance when combined with dynamic muscle contraction are unclear. The purpose of this study was to investigate the immediate effects of the combination of VR with dynamic muscle contraction (DVR), VR, and static stretching (SS) during warm-up on range of motion (ROM), proprioception, muscle strength of the ankle, and agility in young adults. In this crossover design study, 20 recreationally active adults without musculoskeletal disorders completed three test sessions in a randomized order, with 48 h of rest between each session. Participants completed one warm-up intervention and its measurements on the same day; different warm-up interventions and measurements were performed on each of the three days. The measurements included ankle dorsiflexion and plantarflexion ROM, ankle joint proprioception, muscle strength, and agility. After DVR and VR intervention, ankle dorsiflexion ROM (both DVR and VR, p < 0.001), plantarflexion ROM (both DVR and VR, p < 0.001), plantar flexor muscle strength (DVR, p = 0.007; VR, p < 0.001), and agility (DVR, p = 0.016; VR, p = 0.007) significantly improved; after SS intervention, ankle dorsiflexion and plantar flexion ROM (dorsiflexion, p < 0.001; plantar flexion, p = 0.009) significantly improved, but muscle strength and agility were not enhanced. Compared with SS, DVR and VR significantly improved ankle plantar flexor muscle strength (p = 0.008 and p = 0.001, respectively). Furthermore, DVR significantly improved ankle dorsiflexion compared with VR (p < 0.001) and SS (p < 0.001). In conclusion, either DVR, VR, or SS increased ankle ROM, but only DVR and VR increased muscle strength and agility. In addition, DVR produced considerable increases in ankle dorsiflexion. These findings may have implications for warm-up prescription and implementation in both rehabilitative and athletic practice settings.

Improving Concussion Education: Consensus From the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge.

Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and MSA settings with a priori thresholds for retaining, discarding, and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and MSA cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes, and (5) organizational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioral health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.

Coaching Behaviors as Sources of Relation-Inferred Self-Efficacy (RISE) in American Male High School Athletes

Perceptions of relation-inferred self-efficacy (RISE) are developed from the interpretation of another’s verbal and nonverbal behaviors and have been shown to impact self-efficacy, which, in sport, can influence areas such as an individual’s choice to participate and level of enjoyment. This qualitative study identified specific coaching behaviors that high school male athletes use to inform their RISE beliefs. Forty-three high school male student-athletes participated in focus group interviews regarding their high school sport experiences, specifically related to how they perceive various coaching behaviors. Analysis revealed seven major themes: general encouragement, efficacy building statements, instruction, task-oriented statements, challenging opportunities, focused interpersonal attention, and expressiveness. A unique aspect compared to similar studies was the emergence of subthemes related to coaches caring about academic performance or providing opportunities to be a starter or leader on the team. Findings provided support for the tripartite model of efficacy beliefs in that high school athletes were aware and perceptive of different coaching behaviors they personally experienced. There was also a strong desire conveyed by the student-athletes for a personal relationship with their coaches outside of the athletic setting, indicating that coaches should do their best to communicate individually to each athlete.

Signature Pedagogies in Athletic Therapy Education

Context Developing an understanding of the signature pedagogies in athletic therapy education may help to promote greater pedagogical development opportunities and encourage meaningful reflection for educators. Objective To gain an understanding of the perceived level of pedagogical knowledge in Canadian athletic therapy educators and how they developed such knowledge. Design Sequential explanatory mixed-methods. Setting Seven undergraduate Canadian Athletic Therapists Association–accredited institutions Patients or Other Participants Twenty-one athletic therapy educators (16 women, 5 men) responded to the initial questionnaire; 15 athletic therapy educators (11 women, 4 men) participated in individual phone interviews. Main Outcome Measure(s) An initial questionnaire was designed to explore general pedagogical knowledge in athletic therapy educators and how familiar participants were with different teaching strategies. Emergent trends from these questionnaires were used to design a specific interview schedule. Phone interviews further explored the institutional, personal, student, and cultural factors that affected the selection of different pedagogical approaches. Findings from the questionnaires and interviews were combined to identify participants' pedagogical approaches to teaching in an athletic therapy setting. Results A pedagogical distinction was observed, dividing the sample into 2 groups. One group used a traditional, passive lecturing format, and the other, more innovative pedagogies. Educators who followed traditional teaching practices were less likely to know about different pedagogies or understand how these strategies could contribute to more effective instruction. The other group of educators appreciated the use of different pedagogies and explained how different teaching strategies could be incorporated to enhance learning in the athletic therapy curriculum. Conclusions On the basis of these findings, Canadian athletic therapy educators would benefit from more formalized pedagogical training and/or development. These formalized opportunities could familiarize educators with innovative pedagogical strategies while also preparing them with the necessary skills required to self-evaluate their own teaching approaches.

Private Universities and NCAA D-III Athletics as a General Recruiting Tool

Most economic research on university athletics programs examines National Collegiate Athletic Association Division I universities with some consideration of universities in Division II. Division III universities are very different than Division I, consequently that which holds for athletics might be different. In this paper the relationship between athletics and the number of applications received per existing student is examined using a balanced panel of private Division-III universities from 2003 to 2014. Controlling for numerous common recruiting variables, the results indicate that a larger share of athletes on campus is positively associated with more applications per existing full time equivalent undergraduate students. The presence of football, a large, almost exclusively male set of athletes, is neutral in its relationship with total applications, though positive for male and negative for female applicants. Among Division-III universities with football programs, winning football programs have a neutral effecton applications.

CrossTalk proposal: Exercise training intensity is more important than volume to promote increases in human skeletal muscle mitochondrial content.

CrossTalk proposal: Exercise training intensity is more important than volume to promote increases in human skeletal muscle mitochondrial content.

Age-Based Prediction of Maximal Heart Rate in Children and Adolescents: A Systematic Review and Meta-Analysis

ABSTRACTPurpose: Maximal heart rate (MHR) is an important physiologic tool for prescribing and monitoring exercise in both clinical and athletic settings. However, prediction equations developed in adults may have limited accuracy in youth. The purpose of this study was to systematically review and analyze the available evidence regarding the validity of commonly used age-based MHR prediction equations among children and adolescents. Methods: Included articles were peer-reviewed, published in English, and compared measured to predicted MHR in male and female participants <18 years old. The standardized mean difference effect size (ES) was used to quantify the accuracy of age-predicted MHR values and a priori moderators were examined to identify potential sources of variability. Results: The cumulative results of 20 effects obtained from seven articles revealed that prediction equations did not accurately estimate MHR (ES= 0.44, p < .05) by 6.3 bpm (bpm). Subgroup analyses indicated that the Fox equation (MHR = 220–age) overestimated MHR by 12.4 bpm (ES = 0.95, p < .05), whereas the Tanaka equation (MHR = 208–0.7*age) underestimated MHR by 2.7 bpm (ES = −0.34, p < .05). Conclusions: Age-based MHR equations derived from adult populations are not applicable to children. However, if the use of age-based equations cannot be avoided, we recommend using the Tanaka equation, keeping in mind the range of error reported in this study. Future research should control for potential pubertal influences on sympathetic modulation during exercise to facilitate the development of more age-appropriate methods for prescribing exercise intensity.

Examining social support, self-efficacy, stress, and performance, in U.S. Division I collegiate student-athletes’ academic and athletic lives

ABSTRACTStress can significantly harm ones physiological and psychological well-being. For student-athletes, the stress that accumulates across their dual roles as a student and an athlete is arguably unavoidable. The purpose of this study was to examine how social support is related to, if at all, the stress-coping process for collegiate student-athletes in their academic and athletic lives. This study included N = 459 Division I collegiate student-athletes from 18 different sports and institutions. Using a series of linear regressions, in both an academic and athletic setting, results revealed that stress negatively predicted self-efficacy; social support did not moderate the relationship between stress and self-efficacy; self-efficacy positively predicted performance; and self-efficacy partially mediated the relationship between stress and performance. It is suggested that institutional infrastructures consider targeting resources to emphasize all forms of social support to provide student-athletes with an overall sense of support.

Healthcare Satisfaction of Sexual Minority Athletes in the Athletic Training Setting

Healthcare Satisfaction of Sexual Minority Athletes in the Athletic Training Setting

Formal and Informal Work-Life Balance Practices of Athletic Trainers in Collegiate and University Settings.

Organizational policies for work-life balance exist, but little is known about athletic trainers' (ATs') awareness of and willingness to use them. To explore ATs' formal and informal work-life balance policies in the collegiate and university athletic training setting. Sequential mixed-methods study. Web-based survey. We sent 4673 e-mails to National Athletic Trainers' Association ATs (full-time employment for at least 1 year, nonacademic appointment); 1221 participants began our survey (access rate = 26.1%), and 783 completed the survey (64.1% completion rate). Demographics were as follows: men = 375 (48.0%) and women = 404 (51.7%); age = 36 ± 10 years; experience = 13 ± 9 years; years at current place of employment = 8 ± 8 years; and participants with children or minor dependents = 262 (33.5%). We created a 17-item instrument from an earlier qualitative study. A panel of experts (n = 3; employer, employee, and researcher) completed a content analysis. Variables of interest were confidence (scale = 1-4) and satisfaction (scale = 1-5) with policies. We used Pearson χ2 analyses to compare the effect of undergoing an orientation and the presence or absence of children on the main outcome measures. A majority of participants had experienced formal orientation through the human resources department (n = 522, 66.8%), the direct supervisor (n = 240, 30.7%), or a colleague (n = 114, 14.6%). However, many had received no orientation (n = 184, 23.6%). Those who had undergone orientation indicated greater confidence in knowing about (P < .001) and greater satisfaction with (P < .001) formal workplace policies and benefits. Those with children stated that they had greater confidence in knowing about (P < .001) and greater satisfaction with (P = .013) formal workplace policies and benefits. Those who had been oriented felt greater confidence in knowing about (P = .009) but no difference in satisfaction with (P = .060) informal workplace policies and benefits. We did not identify differences between those with and those without children regarding their confidence in knowing about (P = .653) or satisfaction with (P = .150) informal workplace policies and benefits. Athletic trainers in the collegiate and university setting were not confident in their knowledge of formal or informal work-life balance policies.

Can Off-Training Physical Behaviors Influence Recovery in Athletes? A Scoping Review.

Recently, the attention on recovery in sport increased enormously although there is lack of scientific evidence on the role of lifestyle in terms of movement [i.e., physical behaviors (PBs)], apart from sleep. Few studies assessed physical activity (PA) and sedentary behavior (SB) in athletes. The aims of this scoping review were to answer to the following scientific questions: (1) How active/inactive are competitive athletes out of training? (2) Do off-training PBs affect recovery, performance, and health? (3) What strategies can be implemented to improve recovery using off-training PBs, apart from sleep? From 1,116 potentially relevant articles, nine were eligible for inclusion in this review. The main issues identified were related to the heterogeneity concerning the types of sports, age category, gender, competitive level, sample size, and instruments/devices adopted, the paucity of studies investigating the effects of PBs while awake on recovery, and the lack of experimental designs manipulating PBs while awake to accelerate recovery. Furthermore, PA and SB domains were rarely investigated, while no research articles focused on the combined effect of 24-h PBs. Eight out of nine studies measured PA, seven SB, and two included sleep. Three studies included training practice into PA measurement by the means of accelerometry. Overall, almost the totality of the athletes achieved recommended PA levels although they sustained prolonged SB. In conclusion, more descriptive researches are needed in different athletic populations and settings. Furthermore, experimental designs aimed at investigating the effects of PBs manipulation on recovery and the putative mechanisms are encouraged.

Spinal injuries in airborne accidents: a demographic overview of 148 patients in a level-1 trauma center.

The purpose of this study was to investigate the type and severity of spinal injury in airborne sports, as well as patients demographics in this unique set of athletes. Paragliding is one of the most popular airborne sports in Switzerland, which thought to be no less dangerous with a high potential for spinal injury. Few studies on spinal column injuries have been performed in these high-risk athletes with only inconsistent findings. Patient charts were analyzed for all airborne sports injuries affecting the spine from 2010 to 2017 at a level-1 trauma center in Switzerland. To classify the injuries, we used the newest AOSpine classification, ASIA-grading and the injury severity score (ISS). In total, 235 patients were admitted to the emergency department due to an airborne injury. A total of 148 patients (148/235, 63.0%) which were predominantly male (125/235, 84.5%) at a mean age of 39.4years suffered 334 spinal fractures and 5 spinal contusions. The mean ISS was 17.3, and the L1 vertebra was most commonly affected (47.6% of cases, 68/148). A total of 78 patients (54.5% or 78/148) required spine surgery due to instability or neurological deficits (31/148 patients; 20.9%). Concomitant injuries were identified in 64.2% of cases (n = 95). Due to the increasing popularity of airborne sports, age of patients and severity of injuries (ISS) increased compared with the literature. The thoracolumbal spine is at especially high risk. To prevent further complications, the treatment procedure has to be sought carefully and algorithm should be introduced in clinics to avoid delay in diagnostics and surgery. III, retrospective comparative study. These slides can be retrieved under Electronic Supplementary Material.

3D Tibia Reconstruction Using 2D Computed Tomography Images.

Skeletal stress fracture of the lower limbs remains a significant problem for the military. The objective of this study was to develop a subject-specific 3D reconstruction of the tibia using only a few CT images for the prediction of peak stresses and locations. Full bilateral tibial CT scans were recorded for 63 healthy college male participants. A 3D finite element (FE) model of the tibia for each subject was generated from standard CT cross-section data (i.e., 4%, 14%, 38%, and 66% of the tibial length) via a transformation matrix. The final reconstructed FE models were used to calculate peak stress and location on the tibia due to a simulated walking load (3,700 N), and compared to the raw models. The density-weighted, spatially-normalized errors between the raw and reconstructed CT models were small. The mean percent difference between the raw and reconstructed models for peak stress (0.62%) and location (-0.88%) was negligible. Subject-specific tibia models can provide even great insights into the mechanisms of stress fracture injury, which are common in military and athletic settings. Rapid development of 3D tibia models allows for the future work of determining peak stress-related injury correlates to stress fracture outcomes.

Variations in Verbal Encouragement Modify Isokinetic Performance.

Rendos, NK, Harriell, K, Qazi, S, Regis, RC, Alipio, TC, and Signorile, JF. Variations in verbal encouragement modify isokinetic performance. J Strength Cond Res 33(3): 708-716, 2019-Verbal instruction and encouragement are common in exercise testing; however, the verbiage used during exercise testing is rarely controlled despite the likelihood it may affect the participant's performance. Although variations in verbal cuing based on rate and intensity have been examined during isometric contractions, they have not been examined during isokinetic testing, which is a standardized assessment of muscle performance in athletic, rehabilitation, and research settings. This study examined the effects of 4 variations in verbal encouragement during isokinetic knee flexion and extension exercises. Twenty-three healthy participants (aged 19-34 years) completed 4 isokinetic testing sessions on a Biodex isokinetic dynamometer. Each session consisted of 5, 10, and 15 repetitions at 1.05 rad·s (60°·s), 3.14 rad·s (180°·s), and 5.24 rad·s (300°·s), respectively, separated by 5-minute passive recoveries. The variations in verbal encouragement randomized during each testing session used the following statements: (a) "as fast as you can" (FAST); (b) "as hard as you can" (HARD); (c) "as hard and as fast as you can" (BOTH); and (d) no verbal encouragement (NO CUE). Repeated-measures analyses of variance with a Bonferroni post hoc analysis revealed that the FAST and BOTH verbal cues produced greater work, peak torque, and power at all 3 speeds of isokinetic testing. These findings indicate the verbal cues "as fast as you can" and "as hard and as fast as you can" should be used to maximize performance during isokinetic testing.

Perceptual and Contextual Sources of Athletic Training Confidence: The Transition to Professional Entry Level Master’s Programs

The shift of athletic training education from undergraduate degrees to professional master’s degrees and the prominence of computer-based credentialing may impact the hands-on experiences beneficial for developing confidence in athletic training competency domains. Health care provider confidence is critical for clinical skill development, performance and enhancing patient care. Purpose: To examine domain specific efficacy, its sources, learning contexts (i.e., classroom, laboratory, clinical settings) and clinical characteristics by program types. Method: Descriptive, cross-sectional design where 178 Athletic Trainers (AT; age 24.25 + 3.76, n = 72 male, n = 106 female) participated in the study (Master’s Program (MP) = 38; Undergraduate Program (UG) = 140). A questionnaire examining athletic training confidence was administered throughout multiple universities with accredited athletic training programs. Background characteristics, certification exam attempts, and programmatic characteristics were also ascertained. Results: Clinical settings were similar in both program types and there were few differences in domain-specific efficacy. Imaginal experiences, verbal persuasion and emotional states sources of efficacy differentiated master’s from undergraduate students. Conclusions: Sources of efficacy (e.g. vicarious experiences) occur naturally in athletic training educational settings; however, these sources need to be utilized. Educators should be informed about efficacy sources and devise strategies targeting each source for implementation across evolving learning contexts.

A COMPARISON OF EMERGENCY PREPAREDNESS AND MEDICAL COVERAGE BETWEEN HIGH SCHOOL AND CLUB SPORT COACHES

BACKGROUND: Recent studies have demonstrated that a large population of high-school aged athletes participate on club sport teams. Studies have documented emergency preparedness and medical coverage standards in the high school athletic setting. However, similar examinations do not exist for youth club sport teams. PURPOSE: To determine if differences in emergency preparedness and medical coverage exist between high school team coaches and high school-aged club team coaches. A secondary purpose was to compare emergency training characteristics between high school and club coaches. METHODS: A total of 769 coaches (female N=266, 34.6%, age: 41.0±11.5 years) completed an anonymous online questionnaire regarding their emergency preparedness and training. Coaches from 3 sports were surveyed (basketball N=290, volleyball N=256, soccer N=223). The questionnaire consisted of 1) demographics and information regarding the teams that the respondent coaches, 2) emergency preparedness factors such as automated external defibrillator (AED) availability, emergency action plan (EAP) awareness, and medical coverage, and 3) emergency care training requirements (CPR, AED, first aid). Chi-square tests were used to compare response frequencies to various emergency preparedness questions between high school and club coaches. RESULTS: Overall, 64.6% (N=497) respondents were coaches of a high school team, and 35.4% (N=272) were coaches of a club team with high school-aged athletes. High school coaches were more likely than club coaches to be aware of the EAP for their practice venue (83.9% vs. 54.4%, p&lt;.001), but most coaches in both categories had not practiced their EAP in the past 12 months (70.0% vs. 68.9%, p=.54). During competitions, high school coaches were more likely than club coaches to be aware of the EAP (47.5% vs. 37.1%, p=.02). However, the majority of coaches in each category reported that they were never aware of EAPs during competition. High school coaches were more likely than club coaches to 1) have an AED available at practice (87.9% vs. 58.8%, p&lt;.001), 2), to report that athletic trainers were responsible for medical care at practices (31.2% vs. 8.8%, p&lt;.001) and competitions (57.9% vs. 31.2%, p&lt;.001), and 3) to be required to have CPR, AED, or first aid training (p&lt;.001). Nearly all (98.8%) high school coaches were required to have CPR training, and overall, 58.6% of high school coaches were required to have training in all 3 categories (CPR, AED, first aid) compared to 23.9% of club coaches (p&lt;.001). CONCLUSIONS: High school sport coaches displayed greater levels of emergency preparedness and training compared to coaches of high school-aged club teams. Significant attention and effort is needed to improve emergency preparedness and medical coverage at the club sports level among basketball, soccer, and volleyball coaches.

The Effect of Olive Leaf Extract on Upper Respiratory Illness in High School Athletes: A Randomised Control Trial.

Upper respiratory illness (URI) has a major impact on both training and competition in an athletic setting. High school athletes are a sub-category who have reported higher illness rates than professional and sub-elite high school athletes of the same sport. Olive leaf extract (OLE) is an over-the-counter supplement that contains polyphenols, notably oleuropein and hydroxytyrosol, that have antiviral, antibacterial, anti-inflammatory and antioxidant properties that may reduce URI rates. Thirty-two high school students who play sport for the elite team at their school were recruited to a randomised controlled trial and allocated to a daily placebo or OLE (extent equivalent to 20 g of olive leaf, containing 100 mg oleuropein) supplementation for nine weeks during their competitive season. Twice weekly measures of wellbeing, training load and respiratory illness (sporting upper respiratory illness (SUPPRESS) questionnaire) were recorded at trainings, meetings or games. There was no significant difference in illness incidence (odds ratio (OR): 1.02 (95% confidence interval (CI) 0.21–4.44)), but there was a significant 28% reduction in sick days (OR: 0.72 (95% CI 0.56–0.93) p-value = 0.02) when supplemented with OLE. The dietary intakes of the athletes were sub-optimal with regard to immune support. OLE supplementation over a season did not significantly reduce URI incidence, but did decrease duration in high school athletes, potentially aiding return to play.

Activity modification in heat: critical assessment of guidelines across athletic, occupational, and military settings in the USA.

Exertional heat illness (EHI) risk is a serious concern among athletes, laborers, and warfighters. US Governing organizations have established various activity modification guidelines (AMGs) and other risk mitigation plans to help ensure the health and safety of their workers. The extent of metabolic heat production and heat gain that ensue from their work are the core reasons for EHI in the aforementioned population. Therefore, the major focus of AMGs in all settings is to modulate the work intensity and duration with additional modification in adjustable extrinsic risk factors (e.g., clothing, equipment) and intrinsic risk factors (e.g., heat acclimatization, fitness, hydration status). Future studies should continue to integrate more physiological (e.g., valid body fluid balance, internal body temperature) and biometeorological factors (e.g., cumulative heat stress) to the existing heat risk assessment models to reduce the assumptions and limitations in them. Future interagency collaboration to advance heat mitigation plans among physically active population is desired to maximize the existing resources and data to facilitate advancement in AMGs for environmental heat.

TREATMENT OF ROTATOR CUFF TENDINOPATHY AS A CONTRACTILE DYSFUNCTION. A CLINICAL COMMENTARY

Rotator cuff (RC) tendinopathy is a common disorder affecting many individuals, both in athletic and sedentary settings. Etiology of RC pathology or the most effective conservative treatment are not totally understood. The Mechanical Diagnosis and Treatment (MDT®) method is a widely known rehabilitative technique that allows therapists to diagnose and treat spinal, and peripheral mechanical disorders. Therefore, the purpose of this clinical commentary is to briefly describe RC tendinopathy, and its management using the MDT® method. RC tendinopathies are often named with several different terms, showing the difficulty related unambiguous terminology and the diagnostic process. Pathologies at the glenohumeral joint are mostly labeled according to anatomy or the impaired tissues rather than in a functional way. MDT® examination allows mechanical disorders of the shoulder to be classified into categories that show good outcomes when treated accordingly. The MDT® method may offer a practical, inexpensive, and effective solution to management of RC tendinopathies that present with a mechanical component. 5.