Interscholastic Athletes Research Articles

Impact of Early Sport Specialization on Interscholastic Athletes and Programs

Early sport specialization (ESS) is a popular pathway for athletic development with implications for enhanced skill acquisition but also adverse mental and physical outcomes (LaPrade et al., 2016). As such, adolescent athletes may face a dilemma regarding whether to play multiple sports or immediately narrow the focus to one. Coaches are positioned to influence motivational climates and sport-specific skill development (Amorose & Anderson-Butcher, 2007), making it important to understand their perceptions of ESS. Interviews were conducted with thirteen coaches of girls’ volleyball and basketball teams to gain an understanding of ESS as it pertains to athletes and programs at the interscholastic level. Participants identified influences and impacts of ESS, specifically how it can affect participation and competitiveness of interscholastic sports.

Adolescent Athletes’ Perspectives on the Social Implications of Sport-Related Concussion

Purpose: Sport-related concussion can affect many domains of a patient’s health status. Social functioning is an important consideration, especially for adolescent athletes. Our purpose was to explore adolescent athletes’ social perspectives regarding sport and concussion. Methods: Using a qualitative study design we interviewed 12 interscholastic athletes who had sustained a sport-related concussion. The interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified using the consensual qualitative research process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted. Results: Following concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included: friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion. Conclusions: Participation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents/guardians, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Providing a supportive environment in which patients can recover from concussion while engaging with peers and teammates is important. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management and should be known to all stakeholders.

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

Sport Participation in Patients with Implantable Cardioverter-Defibrillators.

Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf. The ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other physical activity or rest, there were no failures to defibrillate and no injuries related to arrhythmia or shock during sports. Recent subanalyses as described below have focused on how best to program the ICD, and on the younger subgroup including interscholastic athletes. Based on these data, the most recent consensus statement from the AHA/ACC on athletic eligibility now describes sports participation with an ICD as a IIB recommendation, "may be considered".

Parents and interscholastic sport: a mixed-method approach to identify salient issues

ABSTRACTParents are generally considered one of the strongest influences on interscholastic athletes. Unfortunately, empirical research identifying the most salient administrative issues associated with parents is scarce, leaving administrators to use anecdotal or dated information that is uninformed by empirical research. The current study bridged a gap in the literature by using a mixed-method design to identify which parent issues throughout the United States are most prominent to administrators. A national sample of interscholastic administrators (N = 170) from eight geographic regions revealed ten issues that are currently and predicted to be impactful five years into the future. The top three issues were Educating Parents, Keeping Athletics in Perspective, and Treatment of Coaches. Qualitative semi-structured interviews were then conducted with seasoned administrators to provide clarity on how these issues manifest themselves within interscholastic sport. Ultimately, this study offers a foundation from which further research and interscholastic policy can be influenced.

Update on Sports Participation for Athletes with Implantable Cardioverter Defibrillators

Abstract Prior statements have recommended restriction from competitive sports participation for all athletes with ICDs. Recent data, however, suggests that many athletes can participate in sports without adverse events. In the ICD Sports Registry, 440 athletes, aged 8-60 years, 77 of which were high-level interscholastic athletes, who had continued to practice sports, were prospectively followed for 4 years, with no deaths or failures to defibrillate during practice, and no injuries related to arrhythmia or shock during sports. Shocks did occur, [...]

Lived Experiences of Adolescent Athletes Following Sport-Related Concussion.

Background:Previous studies have identified the effect of sport-related concussion on health-related quality of life through the use of patient-reported outcome measures. However, there has been little research exploring the underlying mechanisms that influence these perceptions of health-related quality of life among adolescent athletes who have sustained a sport-related concussion.Purpose:To explore the psychosocial aspects of concussion among adolescent athletes.Study Design:Case series; Level of evidence, 4.Methods:A total of 12 interscholastic athletes (4 girls, 8 boys; mean ± SD age, 15.7 ± 1.7 years; grade level, 10.2 ± 1.4) were interviewed via a semistructured interview protocol between 15 and 30 days postinjury. Data analysis was guided by the consensual qualitative research tradition. Themes and categories emerged through consensus by a 3-person research team, and bias was minimized through the use of multiple-analyst triangulation.Results:Participants identified numerous postconcussion symptoms that resulted in increasing difficulty with emotions (eg, irritable, easily frustrated), roles at school (eg, concentration difficulties, fatigue), and roles in their social environment (eg, letting the team down, not being able to contribute to sport). As a result, participants expressed how they tried to minimize or mask symptoms to decrease the potential of being viewed differently by their peers.Conclusion:Adolescent athletes perceived a significant effect of sport-related concussion on numerous areas of psychosocial and emotional health and well-being. Anticipatory guidance—with education regarding the possible signs and symptoms, risk factors, and recovery expectations following a concussion—is important to include in postinjury management. A better understanding of sport-related concussion and expected recovery could help to improve perceptions of this injury among interscholastic athletes. Additionally, best practices should be identified to assist health care professionals and school personnel in the development of temporary adjustments or formal academic adjustment policies in the secondary school setting, therefore ensuring that the patients receive the support that they need to maintain their roles as students.

The Long-Term Effects of Sport-related Concussions on Cognition in Interscholastic and Collegiate Athletes: A Meta-analysis of Cross-Sectional Studies

Over the past twenty years researchers have conducted cross sectional and longitudinal studies to examine how concussions could impact cognitive functions. Previous meta-analysis exploring the effect of a sport-related concussion on cognition lacked matched control groups and only assessed short-term effects ranging 7-14 days.

A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

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.

The Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Objectives:Sport specialization has been shown to be associated with increased risk of musculoskeletal lower extremity injuries (LEI) in adolescent athletes presenting in clinical settings. However, the association of sport specialization and incidence of LEI has not been studied prospectively in a large population of adolescent athletes. The objective of this study was to compare the incidence of LEI in high school athletes identified as having low (LOW), moderate (MOD) or high (HIGH) levels of sport specialization.Methods:Subjects (male and female, interscholastic athletes, grades 9 - 12) were recruited from a diverse sample of 29 Wisconsin high schools during the 2015/16 school year to participate in the study. Subjects d a questionnaire identifying all of the interscholastic and club sports they participated in during the previous and current school years, history of previous LEI, their primary sport and the number of primary sport competitions in which they participated in within the previous 12 months. Sport specialization status was determined using a previously published 3 item specialization scale (total score: 0 - 1 = LOW, 2 = MOD, 3 = HIGH). Athletic trainers at each school reported all athletic exposures and LEI that occurred for each subject during each interscholastic sport season they participated in during the school year. Analyses included group proportions, Odds Ratios (OR, [95%CI]) and median days lost due to injury (Med [IQR 25th,75th]. Multivariate Cox Proportional Hazards Ratios (HR, [95%CI]) were calculated to investigate the association between the incidence of LEI and sport specialization level while controlling for gender, grade, history of previous LEI, primary sport and the number of primary sport competitions.Results:A total of N =1,544 subjects (Female = 50%, Age =16.1+1.1 yrs.) enrolled in the study, competed in 2,843 athletic seasons and participated in 167,349 athletic exposures during the school year. Subjects were classified as being LOW (60%), MOD (27%) or HIGH (13%) specialization. Females were more likely to be classified as HIGH than males (OR = 2.07 [1.53 - 2.81, p < 0.001]. The sports with the greatest percentage of HIGH participants were soccer (22%), baseball/softball (19%), volleyball (17%), and basketball (13%). Two hundred thirty five subjects (15%) sustained a total of n = 276 LEI that caused them to miss a median of 7.0 [2.0, 22.8] days. Injuries occurred most often to the ankle (34%), knee (25%), upper leg (13%) and lower leg (12%). LEI were acute (66%) or gradual / recurrent (34%) onset. Common injuries included ligament sprains (41%), muscle / tendon strains (25%) and tendonitis / tenosynovitis (20%). Surgical treatment was required for n = 23 (8%) of the LEI. The incidence of LEI for MOD subjects was higher than LOW subjects (HR = 1.51 [1.04 - 2.20], p = 0.029). The incidence of LEI for HIGH subjects was higher than LOW subjects (HR = 1.85 [1.12 - 3.06], p = 0.017).Conclusion:Interscholastic athletes with MOD or HIGH sport specialization were more likely to sustain a LEI than athletes with LOW specialization. Sports medicine providers need to educate officials of sport governing bodies, school coaches, parents and interscholastic athletes regarding the increased risk of LEI for athletes who specialize in a single sport.

Adolescent athletes’ social perspectives following a sport-related concussion

ObjectiveTo explore adolescent athletes’ social perspectives regarding sport and concussion.DesignQualitative inquiry.SettingIndividual in-person interviews.Participants12 interscholastic athletes (4 females, 8 males; age=15.7±1.7 years; grade level=10.2±1.4; sports=football, soccer, volleyball, basketball, and wrestling) were interviewed.Outcome measuresA semi-structured interview protocol was used. Interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified based on the consensus process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted.ResultsFollowing concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included: uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion.ConclusionsParticipation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management.Competing interestsFunded from a grant from the National Operating Committee on Standards for Athletic Equipment.

Validity of Single-Item Patient-Rated Outcomes in Adolescent Football Athletes With Concussion

ObjectiveTo determine the longitudinal and concurrent validity of single-item patient-rated outcomes (PROs) in adolescent football athletes with concussion. DesignLongitudinal. SettingAthletic training facilities. ParticipantsConvenience sample of male adolescent interscholastic athletes (n=94; mean age, 15.7±1.1y; mean grade, 10.1±1.1) from a larger investigation who suffered a sport-related concussion during football and had at least 3 follow-up assessments at 3, 10, and 30 days postinjury (N=249). InterventionsNot applicable. Main Outcome MeasuresParticipants were administered 3 global rating questions (1 generic, 1 for daily activities, and 1 for athletic activities) along with the Pediatric Quality of Life Inventory (PedsQL), Multidimensional Fatigue Scale (MFS), and Headache Impact Test-6 (HIT-6) at 3, 10, and 30 days postconcussion. Longitudinal validity was determined through a mixed linear model with random effects for subjects, with pairwise differences assessed using Bonferroni correction (P<.05). Concurrent validity was determined by examining Spearman ρ correlations between the single-item PROs and multi-item PROs. ResultsAll 3 single-item PROs improved over time, demonstrating longitudinal validity (P<.001), except day 10 versus day 30 for global change (P=.072). Fair to moderate correlations were identified between the single-item PROs and the PedsQL, MFS, and HIT-6. ConclusionsThe improvement of single-item PRO scores over a postinjury time period of 30 days suggests that these PROs respond as expected to patient recovery. The correlations identified between the single-item PROs and common multi-item PROs used in athletes with concussion demonstrate concurrent validity. Therefore, single-item PROs appear to measure patient progress in adolescent football athletes postconcussion.

Injury-Related Fear in Acutely Injured Interscholastic and Intercollegiate Athletes

Unrecognized and unaddressed injury-related fears may hinder the rehabilitation process in injured athletes. Currently, 3 scales have been reported to measure injury-related fears in general orthopedic patient populations: the Tampa Scale of Kinesiophobia-11 (TSK-11), the Fear-Avoidance Beliefs Questionnaire (FABQ), and the Re-Injury Anxiety Inventory (RIAI). However, these instruments have not been studied extensively in athletes with musculoskeletal injuries. The purpose of this case series was to describe changes in injury-related fear in intercollegiate and interscholastic athletes with acute musculoskeletal injuries. Twenty-six athletes completed the 3 questionnaires at 48 hours, 1 week, and 3 weeks postinjury. Responses to all 3 questionnaires and their subscales, except for the RIAIRehab subscale, changed signifi cantly over the course of the study. In addition, signifi cant correlations were found among most measures, as each appears to be measuring diff erent constructs of the same phenomena. Following acute musculoskeletal injury, injury-related fear scores decreased as the athletes’ condition improved. [Athletic Training & Sports Health Care. 2013;x(x):xxx-xxx.]

Changes through the lens? US photographic newspaper coverage of female high school athletes

The social constructs of race and gender are often diluted in their importance to the processes of human reality. However, understanding how each is shaped by social institutions, such as sports media, is necessary in order to explain individual perceptions of each. Using framing theory, and informed by feminist thought and critical race theory, this study critically examines the visual US newspaper coverage of interscholastic female athletes, thereby addressing the need for further research regarding the intersections of race and gender in sports media. Specifically, it thematically analyses the photographs and accompanying text of interscholastic female basketball players. Affirming prior research, this study found that newspapers upheld hegemonic masculinity through their under-representation of photographic images of high school female athletes. However, contrary to female collegiate and professional coverage, the instances of occurrences of female high school athletes and their accompanying texts did not serve to reduce, trivialize, or underestimate their athletic accomplishments. Rather, they seemed to affirm female athletics.

Postconcussion Deficits Measured by the Sport Concussion Assessment Tool 2 Among Interscholastic Athletes

Postconcussion Deficits Measured by the Sport Concussion Assessment Tool 2 Among Interscholastic Athletes

Health-related quality of life following sport-related concussion in interscholastic athletes

ObjectiveTo determine the impact of concussion on general, fatigue-specific, and headache-specific Health-related quality of life (HRQOL).DesignRepeated measures.SettingHigh school athletic facilities.PatientsTwo hundred and fifty-nine adolescent athletes who sustained a concussion diagnosed...

A Unique Patient Population? Health-Related Quality of Life in Adolescent Athletes Versus General, Healthy Adolescent Individuals

Normative scores for patient-rated outcome (PRO) instruments are important for providing patient-centered, whole-person care and making informed clinical decisions. Although normative values for the Pediatric Quality of Life Generic Core Scale (PedsQL) have been established in the general, healthy adolescent population, whether adolescent athletes demonstrate similar values is unclear. To compare PedsQL scores between adolescent athletes and general, healthy adolescent individuals. Cross-sectional study. Secondary schools. A convenience sample of 2659 interscholastic athletes (males = 2059, females = 600, age = 15.7 ± 1.1 years) represented the athlete group (ATH), and a previously published normative dataset represented the general, healthy adolescent group (GEN). All participants completed the PedsQL during 1 testing session. The PedsQL consists of 2 summary scores (total, psychosocial) and 4 subscale scores (physical, emotional, social, school), with higher scores indicating better health-related quality of life (HRQOL). Groups were stratified by age (14, 15, or 16 years old). Independent-samples t tests were conducted to compare between-groups and sex differences. The ATH group scored higher than the GEN group across all ages for total and psychosocial summary scores and for emotional and social functioning subscale scores (P ≤ .005). For physical functioning, scores of the 15-year-old ATH were higher than for their GEN counterparts (P = .001). Both 14- and 15-year-old ATH scored higher than their GEN counterparts for the school functioning subscale (P ≤ .013), but differences between 16-year olds were not significant (P = .228). Male adolescent athletes reported higher scores than female adolescent athletes across all scores (P ≤ .001) except for social functioning (P = .229). Adolescent athletes reported better HRQOL than GEN, particularly in emotional functioning. These findings further support the notion that ATH constitutes a unique population that requires its own set of normative values for self-reported, patient-rated outcome instruments.

Representative Baseline Values on the Sport Concussion Assessment Tool 2 (SCAT2) in Adolescent Athletes Vary by Gender, Grade, and Concussion History

Background: To improve and standardize the sideline evaluation of sports-related concussion, the Sport Concussion Assessment Tool 2 (SCAT2) was developed. This tool assesses concussion-related signs and symptoms, cognition, balance, and coordination. This newly published assessment tool has not established representative baseline data on adolescent athletes. Hypothesis: Representative baseline SCAT2 scores in adolescent athletes will differ by gender, grade in school, and self-reported concussion history. Study Design: Descriptive epidemiology study. Methods: Interscholastic athletes were administered the SCAT2 during a preseason concussion baseline testing session. The SCAT2 total score ranges from 0 to 100 points, with lower scores indicating poorer performance. Overall, representative values were calculated using descriptive statistics. Separate independent-samples t tests, with gender and concussion history as the independent variables, and a 1-way analysis of variance, with grade as the independent variable, were conducted to assess differences in SCAT2 total score (P < .05). Results: There were 1134 high school athletes (872 male and 262 female) who participated. The SCAT2 total score across all participants was 88.3 ± 6.8 (range, 58-100); skewness was −0.86 ± 0.07, and kurtosis was 0.73 ± 0.14. Male athletes scored significantly lower on the SCAT2 total score (P = .03; 87.7 ± 6.8 vs 88.7 ± 6.8), and 9th graders (86.9 ± 6.8) scored significantly lower than 11th (88.7 ± 7.0) and 12th (89.0 ± 6.6) graders (P < .001). Athletes with a self-reported concussion history scored significantly lower on the SCAT2 total score than those with no concussion history (P < .001; 87.0 ± 6.8 vs 88.7 ± 6.5). Conclusion: These data provide representative scores on the SCAT2 in adolescent athletes and show that male athletes, 9th graders, and those with a self-reported concussion history scored significantly lower than their female, upperclassmen, or nonconcussed peers. Clinical Relevance: These results suggest that healthy adolescent athletes display variability on the SCAT2 at baseline. Therefore, clinicians should administer baseline assessments of the SCAT2 because assuming a perfect baseline score of 100 points is not appropriate in an adolescent athlete population.

Are ADs and Coaches Working as a Team?

In the past 37 years the number of interscholastic athletes has risen from 3,455,219 in 1969-1970 to 7,342,910 in 2006-2007. This tremendous increase has resulted in an overwhelming demand for sports coaches. As schools struggle to find coaches to meet this demand, the emphasis on qualified coaches has been replaced with the need to have a person to fill the position regardless of qualifications.

Concussion In High School Football: A Biomechanical Assessment

Concussion represents a major medical concern in the United States with up to 3.8 million injuries annually resulting from physical activity. Identifying concussed athletes is particularly difficult as many individuals do not report the injury to medical personnel and there are often no outwardly visible signs or symptoms. To address this concern some have suggested that biomechanical variables may be used as a diagnostic tool for concussive injuries. PURPOSE: We sought to develop injury diagnostic criteria using the biomechanical properties of concussive impacts in interscholastic athletes. METHODS: High school football athletes (N=78, 16.7 years) were equipped with the Head Impact Telemetry System (HITS) from 2005 through 2008. The HITS allows for the measurement of the magnitude and location of all impacts to the head occurring during practice and game sessions. A classification and regression tree (CART) was used to analyze concussive blows as a means of establishing concussion threshold. RESULTS: During the study period 54,247 impacts were recorded and 13 concussive episodes captured for analysis. CART analysis indicated that rotational acceleration (>5582.3 rad/s2), linear acceleration (>96.1g), and impact location (front, top, back) yielded a high predictive chance of concussion (13.4%). CONCLUSIONS: The threshold values for linear acceleration, rotational acceleration, and impact location align with those reported in biomechanical assessments of collegiate and professional athlete concussions. This similarity may make it possible for comparable injury diagnostic criteria to be used in interscholastic, collegiate and professional athletes.