Collegiate Athletic Association Division IA Research Articles

Nonoperative Management of High Ankle Sprains: A Case Series With ≥18-Year Follow-up

Background: High ankle sprains are common athletic injuries and can be associated with long-term sequelae. Regardless of operative or nonoperative treatment, there is a paucity of data in the literature about the long-term outcomes of high ankle sprains. Hypothesis: Nonoperative treatment of high ankle sprains utilizing a standardized protocol will result in good long-term outcomes. Study Design: Case series; Level of evidence, 4. Methods: Patients who experienced a high ankle sprain without radiographic diastasis of the syndesmosis were identified from a previous study database and contacted for long-term follow-up. All patients were high school or National Collegiate Athletic Association Division IA athletes at initial injury and were treated nonoperatively with the same standardized protocol. Patients completed a questionnaire that included documentation of any interim ankle injuries, 2 different patient-reported outcome scores, and ankle radiographs to conduct Kellgren-Lawrence scoring for ankle osteoarthritis. Results: In total, 76 cases in 74 patients were identified in the database. A total of 40 patients were successfully contacted, and 31 patients (24 collegiate and 7 high school athletes) with 33 high ankle sprains completed the survey (31/40; 77.5%). The mean age at follow-up was 45 years (range, 34-50 years), with a mean time from injury to follow-up of 25 years. Overall, 93.5% (n = 29) of the respondents were male, and 42% (n = 13) of the respondents reported an ipsilateral ankle injury since their initial injury, with 16% (n = 5) having ankle or Achilles surgery. The mean Patient-Reported Outcomes Measurement Information System-10 score was 53.4 (SD, 8.3; range, 37.4-67.7), PROMIS median (IQR), 54.1 (39.9, 68.3), and the mean Self-reported Foot and Ankle Score score was 42.7 (SD, 5.86). Follow-up ankle radiographs were obtained in 11 (35%) of the respondents; 27% had Kellgren-Lawrence grade >2 osteoarthritis, and 36% had signs of heterotopic ossification on imaging. The mean tibiofibular clear space was 4.5 mm, and the mean tibiofibular overlap was 7.15 mm, with 27% of patients demonstrating some tibiotalar narrowing. Conclusion: At long-term follow-up, nonoperative management of high ankle sprains without diastasis on imaging was associated with acceptable patient-reported functional outcomes and low rates of subsequent ankle injuries. There was a high incidence of arthritis, but most cases were not clinically significant. This case series shows the natural history of nonoperatively treated high ankle sprains and may serve as a comparison for different management techniques in the future.

A comparison of the Functional Movement ScreenTM and the Landing Error Scoring System: A cohort study.

Background:The Functional Movement Screen (FMSTM) is a nonspecific movement pattern assessment while the Landing Error Scoring System (LESS) is a screen for movement patterns associated with lower extremity injury. The purpose of this study was to determine if the LESS and FMSTM are correlated or if they can be used as complementary assessments of preseason injury risk for anterior cruciate ligament injury.Methods:FMSTM and LESS were used to conduct a cohort study of 126 male National Collegiate Athletic Association Division IA football players. One hundred and eleven players met the criteria for inclusion during data review. At risk and not at risk LESS scores of players and FMSTM exercise score status were compared using Welch’s t-test. Associations between FMSTM composites and LESS scores were evaluated using linear regression.Results:The average LESS score was 5.51±1.34, and the average composite FMSTM score was 11.77±2.13 (max=15). A poor FMSTM squat score (≤1 or asymmetry present) was associated with a higher LESS score (P<0.001). No other FMSTM individual exercise score was associated with an at-risk LESS score (P>0.05). Composite FMSTM score was loosely associated with the LESS score (R-squared=0.0677, P=0.006). Prior history of an ACL injury and player position were not associated with LESS score on multivariate regression (P>0.05).Conclusions:The LESS and FMSTM are not well correlated and may serve as complementary assessments for preseason injury risk.Level of Evidence:Level III.

Efficacy of the National Football League-225 Test to Track Changes in One Repetition Maximum Bench Press After Training in National Collegiate Athletic Association Division IA Football Players.

Numerous investigations have attested to the efficacy of the National Football League (NFL)-225 test to estimate one repetition maximum (1RM) bench press. However, no studies have assessed the efficacy of the test to track changes in strength across a training program. The purpose of this study was to determine the accuracy of the NFL-225 test for determining the change in 1RM bench press in National Collegiate Athletic Association Division IA college football players after training. Over a 4-year period, players (n = 203) were assessed before and after a 6-week off-season resistance program for 1RM bench press and repetitions completed with 102.3 kg (225 lbs). Test sessions typically occurred within 1 week of each other. Players significantly increased 1RM by 4.2 ± 8.6 kg and NFL-225 repetitions by 0.9 ± 2.3, although the effect size (ES) for each was trivial (ES = 0.03 and 0.07, respectively). National Football League 225 prediction equations had higher correlations with 1RM before training (intraclass correlation coefficient [ICC] = 0.95) than after training (ICC = 0.75). The correlation between the change in NFL-225 repetitions and change in 1RM was low and negative (r = -0.22, p < 0.02). Short-term heavy resistance training may alter the association between muscular strength and muscular endurance in college football players and render the NFL-225 test less effective in predicting the change in 1RM bench press strength after short-term training.

Test-Retest and Interrater Reliability of the Functional Movement Screen

The Functional Movement Screen (FMS) is a popular test to evaluate the degree of painful, dysfunctional, and asymmetric movement patterns. Despite great interest in the FMS, test-retest reliability data have not been published. To assess the test-retest and interrater reliability of the FMS and to compare the scoring by 1 rater during a live session and the same session on video. Cross-sectional study. Human performance laboratory in the sports medicine center. A total of 21 female (age = 19.6 ± 1.5 years, height = 1.7 ± 0.1 m, mass = 64.4 ± 5.1 kg) and 18 male (age = 19.7 ± 1.0 years, height = 1.9 ± 0.1 m, mass = 80.1 ± 9.9 kg) National Collegiate Athletic Association Division IA varsity athletes volunteered. Each athlete was tested and retested 1 week later by the same rater who also scored the athlete's first session from a video recording. Five other raters scored the video from the first session. The Krippendorff α (K α) was used to assess the interrater reliability, whereas intraclass correlation coefficients (ICCs) were used to assess the test-retest reliability and reliability of live-versus-video scoring. Good reliability was found for the test-retest (ICC = 0.6), and excellent reliability was found for the live-versus-video sessions (ICC = 0.92). Poor reliability was found for the interrater reliability (K α = .38). The good test-retest and high live-versus-video session reliability show that the FMS is a usable tool within 1 rater. However, the low interrater K α values suggest that the FMS within the limits of generalization should not be used indiscriminately to detect deficiencies that place the athlete at greater risk for injury. The FMS interrater reliability may be improved with better training for the rater.

Occlusion Training Increases Muscular Strength in Division IA Football Players

The purpose of this study was to investigate the effectiveness of 4 weeks of low-intensity resistance training with blood-flow occlusion on upper and lower body muscular hypertrophy and muscular strength in National Collegiate Athletic Association Division IA football players. There were 32 subjects (average age 19.2 ± 1.8 years) who were randomized to an occlusion group or control group. The athletes performed 4 sets of bench press and squat in the following manner with or without occlusion: 30 repetitions of 20% predetermined 1 repetition maximum (1RM), followed by 3 sets of 20 repetitions at 20% 1RM. Each set was separated by 45 seconds. The training duration was 3 times per week, after the completion of regular off-season strength training. Data collected included health history, resting blood pressure, pretraining and posttraining bench press and squat 1RM, upper and lower chest girths, upper and lower arm girths, thigh girth, height, and body mass. The increases in bench press and squat 1RM (7.0 and 8.0%, respectively), upper and lower chest girths (3 and 3%, respectively), and left upper arm girth were significantly greater in the experiment group (p < 0.05). Occlusion training could provide additional benefits to traditional strength training to improve muscular hypertrophy and muscular strength in collegiate athletes.

Predicting Football Players' Dual-Energy X-Ray Absorptiometry Body Composition Using Standard Anthropometric Measures

The recent increase in athlete size, particularly in football athletes of all levels, coupled with the increased health risk associated with obesity warrants continued monitoring of body composition from a health perspective in this population. Equations developed to predict percentage of body fat (%Fat) have been shown to be population specific and might not be accurate for football athletes. To develop multiple regression equations using standard anthropometric measurements to estimate dual-energy x-ray absorptiometry %Fat (DEXA%Fat) in collegiate football players. Controlled laboratory study. One hundred fifty-seven National Collegiate Athletic Association Division IA football athletes (age = 20 ± 1 years, height = 185.6 ± 6.5 cm, mass = 103.1 ± 20.4 kg, DEXA%Fat = 19.5 ± 9.1%) participated. Participants had the following measures: (1) body composition testing with dual-energy x-ray absorptiometry; (2) skinfold measurements in millimeters, including chest, triceps, subscapular, midaxillary, suprailiac, abdominal (SFAB), and thigh; and (3) standard circumference measurements in centimeters, including ankle, calf, thigh, hip (AHIP), waist, umbilical (AUMB), chest, wrist, forearm, arm, and neck. Regression analysis and fit statistics were used to determine the relationship between DEXA%Fat and each skinfold thickness, sum of all skinfold measures (SFSUM), and individual circumference measures. Statistical analysis resulted in the development of 3 equations to predict DEXA%Fat: model 1, (0.178 · AHIP) + (0.097 · AUMB) + (0.089 · SFSUM) - 19.641; model 2, (0.193 · AHIP) + (0.133 · AUMB) + (0.371 · SFAB) - 23.0523; and model 3, (0.132 · SFSUM) + 3.530. The R(2) values were 0.94 for model 1, 0.93 for model 2, and 0.91 for model 3 (for all, P < .001). The equations developed provide an accurate way to assess DEXA%Fat in collegiate football players using standard anthropometric measures so athletic trainers and coaches can monitor these athletes at increased health risk due to increased size.

Longitudinal Effects of a Collegiate Strength and Conditioning Program in American Football

The purpose of this study was to examine the longitudinal effects of a strength and conditioning program on selected body composition and performance data over 4 consecutive years of training. Body mass, percent body fat, lean body mass, proagility (18.3 m shuttle), 36.6-m (40-yd) sprint, bench press, chin-ups, vertical jump, and power index data for 84 National Collegiate Athletic Association division IA collegiate football players were examined. In addition to examining data on all athletes, data were analyzed on specific groups categorized by position. Groups were categorized as (a) skill (wide receivers, defensive backs, and running backs), (b) big skill (linebackers, kickers, tight ends, quarterbacks, and specialists), and (c) line (offensive and defensive linemen). Data on each individual performance criteria were analyzed using pairwise t-tests to indicate changes from year to year. Results for all participants showed that the greatest number of significant improvements among test parameters occurred during the first year of training. Years 2-4 of training demonstrated inconsistent improvement among the test parameters. Bench press performance significantly improved throughout 4 years of training among all participants. Data analysis from specific position groups also revealed the greatest number of significant improvements occurred during the first year of training. Overall, the results of this study clearly demonstrate that the greatest rate of improvement in the selected performance parameters occurred during the initial year of the strength and conditioning program. This study provides valuable information for coaches to establish appropriate progression and program variation guidelines for athletes over consecutive years of training.

A Comparison of Whole-Body Vibration and Resistance Training on Total Work in the Rotator Cuff

Whole-body vibration machines are a relatively new technology being implemented in the athletic setting. Numerous authors have examined the proposed physiologic mechanisms of vibration therapy and performance outcomes. Changes have mainly been observed in the lower extremity after individual exercises, with minimal attention to the upper extremity and resistance training programs. To examine the effects of a novel vibration intervention directed at the upper extremity as a precursor to a supervised, multijoint dynamic resistance training program. Randomized controlled trial. National Collegiate Athletic Association Division IA institution. Thirteen female student-athletes were divided into the following 2 treatment groups: (1) whole-body vibration and resistance training or (2) resistance training only. Participants in the vibration and resistance training group used an experimental vibration protocol of 2 x 60 seconds at 4 mm and 50 Hz, in a modified push-up position, 3 times per week for 10 weeks, just before their supervised resistance training session. Isokinetic total work measurements of the rotator cuff were collected at baseline and at week 5 and week 10. No differences were found between the treatment groups (P > .05). However, rotator cuff output across time increased in both groups (P < .05). Although findings did not differ between the groups, the use of whole-body vibration as a precursor to multijoint exercises warrants further investigation because of the current lack of literature on the topic. Our results indicate that indirectly strengthening the rotator cuff using a multijoint dynamic resistance training program is possible.

Coronary Heart Disease: Risk Profiles of College Football Players

In brief: Before their preseason training, 95 National Collegiate Athletic Association division IA football players were evaluated for several coronary heart disease (CHD) risk factors: blood pressure, serum total cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, percent body fat, family history, cigarette smoking, and aerobic capacity. Offensive linemen had significantly higher mean values for triglycerides, systolic blood pressure, and percent body fat, and lower aerobic capacity. Food records showed that intakes of fat, sugar, cholesterol, and sodium were higher than recommended levels. The data suggest that the large, overfat college football player may have an increased risk of CHD.