Male High School Football Players Research Articles

Arthroscopic Shoulder Stabilization in High School Football Players.

Destabilizing shoulder injuries are common in high school American football players; however, the rate of recurrent glenohumeral instability and return to play after arthroscopic labral stabilization surgery remains unknown. The purpose of this study was to determine the rate of recurrent instability on return to competitive high school football after arthroscopic shoulder labral stabilization and capsulorrhaphy procedures. It was hypothesized that the instability rate would be greater in players with more years of eligibility remaining (YER) to play at the high school level. Case series; Level of evidence, 4. Consecutive male high school football players with at least 1 YER who sustained at least 1 anterior traumatic inseason shoulder instability episode and underwent arthroscopic stabilization between 2012 and 2017 were identified. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistical analysis was conducted using chi-square tests to compare recurrent shoulder instability with return to play and YER. A total of 45 football players aged 14 to 17 years were included, with a mean follow-up of 4.1 years. Most patients (60%) chose not to return to competitive football, due mainly to fear of recurrent injury. Overall, the recurrent instability rate was 15.6% (7/45). The instability rate in players who returned to football was 16.7%, with 66.7% requiring revision surgery. The instability rate in patients who did not return to football was 14.8%, with no revision procedures required. In players who returned to football, the instability rate in YER group 4 was significantly higher than that in YER groups 1 to 3 (42% vs 10.5%, respectively, P = .03), with each year of play conferring an additional 10% risk of reinjury. There was a significant difference in the type of recurrent instability in players who returned to any sport versus those who did not (P = .029). High school football players who returned to competitive play after arthroscopic shoulder stabilization surgery experienced a higher rate of recurrent instability that was dependent on their YER. Over half of the players chose not to return to football, with fear of reinjury being the most common reason.

Football Practices in Hot Environments Impact Subsequent Days' Hydration.

Ashley, CD, Lopez, RM, and Tritsch, AJ. Football practices in hot environments impact subsequent days' hydration. J Strength Cond Res XX(X): 000-000, 2023-The impact of proper hydration to prevent exertional heat illness in American football has not been evaluated during high school preseason football practices in a hot environment (wet-bulb globe temperature = 31.3 ± 1.8° C). The purposes of this study were to examine the accuracy of urinary hydration measures to assess body mass (BM) changes and to examine carryover effects of consecutive practices by comparing postpractice with the next prepractice values. Before and after each of 7 outdoor practices, 31 male high school football players (age = 16 ± 1 years, height = 181.2 ± 12.0 cm, BM = 85.7 ± 19.1 kg, body mass index = 20.8 ± 1.8) provided a urine sample and were weighed to assess hydration. Sensitivity and specificity of urine color (Ucol) and urine-specific gravity (USG) to determine BM changes were determined using receiver operating characteristic (ROC) analysis. Paired samples t-tests assessed carryover effects between practices. Repeated-measures analysis of variance assessed carryover effects across practices. Significance was set at p < 0.05. Sensitivity and specificity for using Ucol or USG to determine BM changes was not significant. For Ucol, there was a carryover effect from practice numbers 2 to 3, 6 to 7 am, 7 am to 7 pm (p < 0.001 for all), and 10 to 11 (p = 0.004); most with less than 24 hours between practices. The %BM loss (%BML) was significantly greater (p = 0.001 to 0.024) after 2-a-day practices. Effects of previous days' exercise in the heat, as evidenced by higher Ucol and %BL, are greater after 2-a-day practices, which occurred on later practice days. Athletes must replenish fluids during and between practices to remain euhydrated.

Longitudinal, prospective study of head impacts in male high school football players.

Repetitive, subconcussive events may adversely affect the brain and cognition during sensitive periods of development. Prevention of neurocognitive consequences of concussion in high school football is therefore an important public health priority. We aimed to identify the player positions and demographic, behavioral, cognitive, and impact characteristics that predict the frequency and acceleration of head impacts in high school football players. In this prospective study, three cohorts of adolescent male athletes (N = 53, 28.3% Hispanic) were recruited over three successive seasons in a high school American football program. Demographic and cognitive functioning were assessed at baseline prior to participating in football. Helmet sensors recorded impact frequency and acceleration. Each head impact was captured on film from five different angles. Research staff verified and characterized on-field impacts. Player-level Poisson regressions and year-level and impact-level linear mixed-effect models were used to determine demographic, behavioral, cognitive, and impact characteristics as predictors of impact frequency and acceleration. 4,678 valid impacts were recorded. Impact frequency positively associated with baseline symptoms of hyperactivity-impulsivity [β(SE) = 1.05 impacts per year per unit of symptom severity (1.00), p = 0.01] and inattentiveness [β(SE) = 1.003 impacts per year per T-score unit (1.001), p = 0.01]. Compared to quarterbacks, the highest acceleration impacts were sustained by kickers/punters [β(SE) = 21.5 g's higher (7.1), p = 0.002], kick/punt returners [β(SE) = 9.3 g's higher (4.4), p = 0.03], and defensive backs [β(SE) = 4.9 g's higher (2.5), p = 0.05]. Impacts were more frequent in the second [β(SE) = 33.4 impacts (14.2), p = 0.02)] and third [β(SE) = 50.9 impacts (20.1), p = 0.01] year of play. Acceleration was highest in top-of-the-head impacts [β(SE) = 4.4 g's higher (0.8), p<0.001]. Including screening questions for Attention-Deficit/Hyperactivity Disorder in pre-participation evaluations can help identify a subset of prospective football players who may be at risk for increased head impacts. Position-specific strategies to modify kickoffs and correct tackling and blocking may also reduce impact burden.

Longitudinal Associations of Clinical and Biochemical Head Injury Biomarkers With Head Impact Exposure in Adolescent Football Players

Consequences of subconcussive head impacts have been recognized, yet most studies to date have included small samples from a single site, used a unimodal approach, and lacked repeated testing. To examine time-course changes in clinical (near point of convergence [NPC]) and brain-injury blood biomarkers (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1], and neurofilament light [NF-L]) in adolescent football players and to test whether changes in the outcomes were associated with playing position, impact kinematics, and/or brain tissue strain. This multisite, prospective cohort study included male high school football players aged 13 to 18 years at 4 high schools in the Midwest during the 2021 high school football season (preseason [July] and August 2 to November 19). A single football season. The main outcomes were NPC (a clinical oculomotor test) and serum levels of GFAP, UCH-L1, and NF-L. Participants' head impact exposure (frequency and peak linear and rotational accelerations) was tracked using instrumented mouthguards, and maximum principal strain was computed to reflect brain tissue strain. Players' neurological function was assessed at 5 time points (preseason, post-training camp, 2 in season, and postseason). Ninety-nine male players contributed to the time-course analysis (mean [SD] age, 15.8 [1.1] years), but data from 6 players (6.1%) were excluded from the association analysis due to issues related to mouthguards. Thus, 93 players yielded 9498 head impacts in a season (mean [SD], 102 [113] impacts per player). There were time-course elevations in NPC and GFAP, UCH-L1, and NF-L levels. Compared with baseline, the NPC exhibited a significant elevation over time and peaked at postseason (2.21 cm; 95% CI, 1.80-2.63 cm; P < .001). Levels of GFAP and UCH-L1 increased by 25.6 pg/mL (95% CI, 17.6-33.6 pg/mL; P < .001) and 188.5 pg/mL (95% CI, 145.6-231.4 pg/mL; P < .001), respectively, later in the season. Levels of NF-L were elevated after the training camp (0.78 pg/mL; 95% CI, 0.14-1.41 pg/mL; P = .011) and midseason (0.55 pg/mL; 95% CI, 0.13-0.99 pg/mL; P = .006) but normalized by the end of the season. Changes in UCH-L1 levels were associated with maximum principal strain later in the season (0.052 pg/mL; 95% CI, 0.015-0.088 pg/mL; P = .007) and postseason (0.069 pg/mL; 95% CI, 0.031-0.106 pg/mL; P < .001). The study data suggest that adolescent football players exhibited impairments in oculomotor function and elevations in blood biomarker levels associated with astrocyte activation and neuronal injury throughout a season. Several years of follow-up are needed to examine the long-term effects of subconcussive head impacts in adolescent football players.

Changes in resting state networks in high school football athletes across a single season.

The aim of this pilot cohort study was to examine changes in the organization of resting-state brain networks in high school football athletes and its relationship to exposure to on-field head impacts over the course of a single season. Seventeen male high school football players underwent functional magnetic resonance imaging and computerized neurocognitive testing (CNS Vital Signs) before the start of contact practices and again after the conclusion of the season. The players were equipped with helmet accelerometer systems (Head Impact Telemetry System) to record head impacts in practices and games. Graph theory analysis was applied to study intranetwork local efficiency and strength of connectivity within six anatomically defined brain networks. We observed a significant decrease in the local efficiency (-24.9 ± 51.4%, r = 0.7, p < 0.01) and strength (-14.5 ± 26.8%, r = 0.5, p < 0.01) of functional connectivity within the frontal lobe resting-state network and strength within the parietal lobe resting-state network (-7.5 ± 17.3%, r = 0.1, p < 0.01), as well as a concomitant increase in the local efficiency (+55.0 +/- 59.8%, r = 0.5, p < 0.01) and strength (+47.4 +/- 47.3%, r = 0.5, p < 0.01) within the mediotemporal networks. These alterations in network organization were associated with changes in performance on verbal memory (p < 0.05) and executive function (p < 0.05). We did not observe a significant relationship between the frequency or cumulative magnitude of impacts sustained during the season and neurocognitive or imaging outcomes (p > 0.05). Our findings suggest the efficiency and strength of resting-state networks are altered across a season of high school football, but the association of exposure levels to subconcussive impacts is unclear. The efficiency of resting-state networks is dynamic in high school football athletes; such changes may be related to impacts sustained during the season, though further study is needed.

Correlation between Repeated Sprint Ability (RSA) and Hoff Test of High School Soccer Plyers

PURPOSE: This study aimed to investigate the correlation between repeated sprint ability (RSA) and Hoff test performance in high school soccer players.METHODS: Fourteen male high school football players participated in this study. After measuring body composition, the Bangsbo Sprint Test for RSA and Hoff test were performed. The tests were conducted in the field to create an experimental environment similar to that during actual training and competition.RESULTS: A significant correlation was observed between the fatigue index (FI) in the RSA and running distance in the Hoff test (&lt;i&gt;p&lt;/i&gt;&lt;.05). A high level of correlation between the performance distance and body fat percentage and muscle mass in the Hoff test was observed (&lt;i&gt;p&lt;/i&gt;&lt;.001). There was no significant relationship between the best and average RSA records using the Hoff test.CONCLUSIONS: It was confirmed that the running distance in the Hoff test developed for event specificity affects the FI in RSA. In subsequent studies, it will be necessary to examine the variables affecting the best and average RSA records.

Participating in Two Video Concussion Education Programs Sequentially Improves Concussion-Reporting Intention

Undiagnosed concussions increase the risk of additional concussion and persistent symptoms from concussion. Because there are no reliable objective markers of concussion, self-reporting of subjective and non-visible symptoms are critical to ensuring proper concussion management. For this reason, educational interventions target concussion reporting, but the majority of studies have examined the efficacy of single educational interventions or compared interventions to one another. This randomized crossover study sought to identify whether there was benefit to administering multiple concussion education programs in tandem, back to back. The study randomized 313 male high school football players to first receive CrashCourse concussion education (CC) or Centers for Disease Control and Prevention video concussion education (CDC) followed by crossover with the other education. Athlete concussion-reporting intention, attitudes, subjective norms, perceived behavioral control, and enjoyment of education were assessed at baseline and after each intervention. There were statistically significant improvements across all measures, both after single intervention and crossover (all p < 0.001). Secondary analyses examining differences between education found that athletes reported higher enjoyment of concussion education immediately after participating in CC, as compared to CDC (p < 0.001). These findings demonstrate an additive benefit to implementing CC and CDC education in tandem, without decrement in enjoyment of concussion education after experiencing dual educations; in fact, enjoyment of concussion education improved after receiving education programs back to back. These educational programs appear to complement one another, and the results support the use of multi-modal concussion education to differentially target and maximize concussion reporting.

Athlete Enjoyment of Prior Education Moderates change in Concussion-Reporting Intention after Interactive Education.

Undiagnosed concussions increase risk of additional injuries and can prolong recovery. Because of the difficulties recognizing concussive symptoms, concussion education must specifically target improving athlete concussion reporting. Many concussion education programs are designed without significant input from athletes, resulting in a less enjoyable athlete experience, with potential implications on program efficacy. Athlete enjoyment of previous concussion education programs moderates the improvement in concussion-reporting intention after experiencing the research version of CrashCourse (CC) concussion education. Prospective cohort study. Level of evidence: Level IV. Quantitative assessment utilizing ANOVA with moderation analysis of 173 male high school football players, aged 13 to 17, who completed baseline assessments of concussion knowledge, concussion reporting, and attitudes about prior educational interventions. Athletes were subsequently shown CC, before a follow-up assessment was administered assessing the same domains. At baseline, only 58.5% of athletes reported that they enjoyed their previous concussion education. After CC, athletes were significantly more likely to endorse that they would report a suspected concussion (from 69.3% of athletes to 85.6%; P < .01). Enjoyment of previous concussion education moderated concussion-reporting intention after CC (P = .02), with CC having a greater effect on concussion-reporting intention in athletes with low enjoyment of previous concussion education (b = 0.21, P = .02), than on individuals with high enjoyment of previous concussion education (P = .99). Enjoyment of CC did not have a moderating effect on concussion-reporting intention. Athletes who previously did not enjoy concussion education exhibited greater gains in concussion-reporting intention than athletes who enjoyed previous education. Given the potential risks associated with undiagnosed concussions, concussion education has sought to improve concussion reporting. Because most athletes participate in concussion education programs due to league or state mandates, improving concussion-reporting intention in these low-enjoyment athletes is of particular relevance to improving concussion-reporting intention broadly.

The cost of a single concussion in American high school football: a retrospective cohort study.

Aim:The potential financial burden of American football-related concussions (FRC) is unknown. Our objective was to describe the healthcare costs associated with an FRC and determine factors associated with increased costs.Methodology/results:A retrospective cohort study of concussed high school football players presenting between November 2017 and March 2020 was undertaken; 144 male high school football players were included. Total costs were about $115,000, for an average direct healthcare cost of $800.10/concussion. Visiting the emergency department (β = 502.29, 95% CI: 105.79–898.61; p = 0.01), the initial post-concussion symptom scale score (β = 0.39, 95% CI: 0.11–0.66; p = 0.01) and a post-concussion syndrome diagnosis (β = 670.37, 95% CI: 98.96–1241.79; p = 0.02) were each independently associated with total costs.Conclusion:A granular understanding of cost-driving factors associated with FRC is the first step in understanding the cost–effectiveness of prevention and treatment methods.

Food Security Status and Disordered Eating of Male High School Football Players in Rural, Appalachian Mississippi Participating in a Food Education Program

Food Security Status and Disordered Eating of Male High School Football Players in Rural, Appalachian Mississippi Participating in a Food Education Program

Body Mass And Urinary Hydration Measures During Preseason High School Football Practices In The Heat

Hydration assessment is an important measure to help reduce the risk of exertional heat illness. Maintaining adequate hydration can be problematic for football players practicing in the heat on consecutive days. PURPOSE: To examine day to day differences and the relationships between urinary markers of urine color (Ucol) and urine specific gravity (USG), and percent body mass loss (%BML) during football practices in the heat. METHODS: Thirty-one male high school football players (16 ± 1 years; 181.2 ± 12.0 cm; 68.1 ± 5.4 kg; BMI: 20.8 ± 1.8 km/m2) volunteered to participate in this study. Before and after each practice, players were weighed (in shorts) and provided a urine sample. Urine was assessed for Ucol and USG and was assessed by the same person. Correlations assessed relationships, while t-tests assessed differences between both pre-post differences and subsequent days. P value was significant at P<.05. RESULTS: Mean wet-bulb globe temperature across 8 practices was 30.6 ± 2.5oC. There were significant correlations between pre-Ucol and pre-USG (r = 0.73, p=0.00, n = 209) and post-Ucol and post-USG (r = 0.66, p = 0.00, n = 209). Post-Ucol (5 ± 1) was significantly greater than pre-Ucol (4 ± 2; p = 0.00). Post-USG (1.022 ± 0.008) was significantly greater than pre-USG (1.020 ± 0.008; p = 0.00). Post body mass measures were significantly lower than pre-body mass resulting in 0.9 ± 1.1%BML. Post-practice body mass and USG were not significantly different from the next day’s pre-practice measures (p > 0.05); however, post-Ucol was significantly higher (5 ± 2) compared to the next day’s pre-practice Ucol (4 ± 1; p = 0.000). CONCLUSION: Although the football players’ body mass measures were similar on subsequent days, their Ucol was lighter before the next day’s practice. We also found a strong relationship between Ucol and USG, suggesting Ucol is an acceptable hydration measure where USG is not feasible in field settings. Due to individual variability in these hydration measures, clinicians should provide individualized recommendations to ensure adequate hydration during practices in the heat as well as from one day to the next. This study was fully funded by the National Athletic Trainers’ Association Research & Education Foundation.

A NECK STRENGTH TRAINING PROTOCOL IN HIGH SCHOOL FOOTBALL PLAYERS FOR CONCUSSION RISK REDUCTION

Background:Increased neck strength may be a protective factor for reducing concussions in youth athletes. However, little research exists regarding validated neck strength training methods among this demographic.Purpose:To determine whether a 7-week neck strength training period is sufficient to achieve significant gains in neck strength and size amongst high school football players. Additionally, to assess if increased neck strength influences concussion outcomes.Methods:This study enrolled 54 male high school football players, ages 14-17, in a 7-week strength training protocol in which neck exercises were incorporated into preseason strength and conditioning workouts (figure 1). Pre- and post-neck strength was assessed in four directions: forward flexion (FF), extension (EXT), right lateral flexion (RLF) and left lateral flexion (LLF). Strength was measured as maximal isometric head pressure applied into a pre-inflated sphygmomanometer cuff (figure 2). Concussion totals from the subsequent 2018 season were compared with totals from the 2017 and 2016 seasons per data obtained from the team’s athletic trainer.Results:Fifty athletes in total were analyzed; 4/54 athletes did not complete final testing due to scheduling conflicts. A two sample t-test of neck circumferences revealed a statistically significant increase of 0.37 cm from pre- to post-neck strength training (p=0.0025, figure 3). Single sample strength t-test analysis (corrected for cuff pre-inflation) demonstrated a statistically significant post-test strength increase of 19.8% (FF), 11.0% (EX), 18.8% (RLF), and 18.0% (LLF) (p<0.001, figure 3). The team suffered 4 concussions in the 2018 season, 2 of which were sustained by athletes who did not participate in preseason neck training, compared to 12 concussions in 2017 and 7 concussions in 2016 (figure 3).ConclusionThis study demonstrates that increases in neck size and strength can be achieved amongst high school athletes using easily implemented training methods during a 7-week preseason training period. The additional observation of reduced concussion outcomes is not conclusive, though these initial results are promising. Additional research is needed to investigate the potential of neck strengthening in modifying concussion risk. Funding provided by the Stanford Medical Scholars Fellowship Program Figure 1.Neck ExercisesFigure 2.Strength TestingFigure 3.Results

ARTHROSCOPIC SHOULDER STABILIZATION IN HIGH SCHOOL FOOTBALL PLAYERS: RECURRENT INSTABILITY WITH RETURN TO CONTACT SPORT

Background:The etiology of recurrent shoulder instability after arthroscopic surgery in the high school American football population remains unknown.Purpose/Hypothesis:To determine the risk of recurrent instability after shoulder arthroscopy upon return to competitive football. The hypothesis was that the rate of recurrence would be greater in high school players with more years of eligibility remaining (YER), suggesting greater likelihood of return to football after surgery.Methods:Consecutive male high school football players with at least one year of eligibility remaining who sustained traumatic in-season shoulder instability episode(s) and underwent arthroscopic labral stabilization by two Orthopaedic Sports surgeons at Rady Children’s Hospital San Diego between 2012 and 2017 were identified. 64 subjects aged 14-17 met inclusion criteria of which 45 were able to be contacted and included in analyses. Average follow up period was 4.06 years. Patients and/or families were contacted by phone to discuss (1) recurrent instability episodes and (2) return to competitive sport and/or recreational athletic activity. Statistics were conducted using chi square analysis to compare recurrence of instability with return to sport.Results:Surgery itself was career ending in 50% of cases due to reported fear of recurrent football-related injury. The hypothesis that career longevity in terms of years of eligibility remaining (YER) affects return to game play in this young active population remains unclear although preliminary results suggest positive exponential correlation. Comparative analysis demonstrates a statistically significant difference between rate of recurrence in high school football players that return to contact sports vs transition to non-contact activity after arthroscopic shoulder stabilization. Interestingly, football players who concurrently played baseball during high school demonstrated decreased risk of postoperative instability episodes.Conclusion:Risk of recurrent instability after shoulder arthroscopy is increased in high school football players who return to competitive contact sports whereas transition to non-contact and/or recreational activity likely confers protective effect. High school football players who play baseball may derive functional benefit from cross training.Figure.Proportion of recurrent shoulder instability after arthroscopic stabilization in high school football players stratified by years of eligibility remaining (YER) demonstrating positive exponential correlation relationship.

Alterations in knee sensorimotor brain functional connectivity contributes to ACL injury in male high-school football players: a prospective neuroimaging analysis

ObjectiveThis study’s purpose was to utilize a prospective dataset to examine differences in functional brain connectivity in male high school athletes who suffered an anterior cruciate ligament (ACL) injury relative to their non-injured peers. MethodsSixty-two male high school football players were evaluated using functional magnetic resonance imaging prior to their competitive season to evaluate resting-state functional brain connectivity. Three athletes later experienced an ACL injury and were matched to 12 teammates who did not go on to sustain an ACL injury (controls) based on school, age, height, weight, and year in school. Twenty-five knee-motor regions of interest (ROIs) were created to identify differences in connectivity between the two groups. Between-subject F and t tests were used to identify significant ROI differences using a false discovery rate correction for multiple comparisons. ResultsThere was significantly less connectivity between the left secondary somatosensory cortex and the left supplementary motor area (p = 0.025), right pre-motor cortex (p = 0.026), right supplementary motor area (p = 0.026), left primary somatosensory cortex (superior division; p = 0.026), left primary somatosensory cortex (inferior division; p = 0.026), and left primary motor cortex (p = 0.048) for the ACL-injured compared to the control subjects. No other ROI-to-ROI comparisons were significantly different between the groups (all p > 0.05). ConclusionOur preliminary data indicate a potential sensorimotor disruption for male football players who go on to experience an ACL injury. Future studies with larger sample sizes and complementary measures of neuromuscular control are needed to support these findings.

The Dangers of Spear Tackling: A Case Report of a NEXUS-negative High School Football Player

BackgroundAlthough “spear tackling” is known to be a risk factor for cervical spine injury due to axial loading of the neck, and although this technique was officially banned from American football in 1976, football-associated cervical spine injuries continue to be reported. This case highlights the importance of recognizing high-risk mechanisms for cervical spine injury, and specifically the danger of spear tackling among football players at all levels. Case ReportA 16-year-old male high school football player presented to the pediatric emergency department for a neck injury sustained after spear tackling during a football game. He had no neurologic symptoms and met the NEXUS criteria for omitting x-ray evaluation. However, the description of spear tackling as the mechanism of injury led to the ordering of cervical radiographs, which revealed a C5 fracture. The patient was ultimately taken to the operating room for internal fixation, with a final surgical diagnosis of a C5 teardrop fracture. On outpatient follow-up at 1 year, the patient has had no neurologic sequelae. Why Should an Emergency Physician Be Aware of This?This case serves as a reminder that all evaluations of trauma patients should begin with an attempt to determine, as precisely as possible, the mechanism that was in play at the time of injury. The reassurance provided by a normal physical examination may be misleading. Spear tackling is not an uncommonly encountered cause of injury in American football, despite the practice being prohibited since a rule change in 1976. Continued education and increased awareness of the association of axial load injury with spear tackling may make it possible to avoid missing a potentially devastating cervical spine injury.

Longitudinal Changes in Resting State Connectivity and White Matter Integrity in Adolescents With Sports-Related Concussion.

The aim of this study was to investigate alterations in functional connectivity, white matter integrity, and cognitive abilities due to sports-related concussion (SRC) in adolescents using a prospective longitudinal design. We assessed male high school football players (ages 14-18) with (n=16) and without (n=12) SRC using complementary resting state functional MRI (rs-fMRI) and diffusion tensor imaging (DTI) along with cognitive performance using the Immediate Post-Concussive Assessment and Cognitive Testing (ImPACT). We assessed both changes at the acute phase (<7 days post-SRC) and at 21 days later, as well as, differences between athletes with SRC and age- and team-matched control athletes. The results revealed rs-fMRI hyperconnectivity within posterior brain regions (e.g., precuneus and cerebellum), and hypoconnectivity in more anterior areas (e.g., inferior and middle frontal gyri) when comparing SRC group to control group acutely. Performance on the ImPACT (visual/verbal memory composites) was correlated with resting state network connectivity at both time points. DTI results revealed altered diffusion in the SRC group along a segment of the corticospinal tract and the superior longitudinal fasciculus in the acute phase of SRC. No differences between the SRC group and control group were seen at follow-up imaging. Acute effects of SRC are associated with both hyperconnectivity and hypoconnectivity, with disruption of white matter integrity. In addition, acute memory performance was most sensitive to these changes. After 21 days, adolescents with SRC returned to baseline performance, although chronic hyperconnectivity of these regions could place these adolescents at greater risk for secondary neuropathological changes, necessitating future follow-up. (JINS, 2018, 24, 781-792).

Global Positioning System Analysis of a High School Football Scrimmage.

Gleason, BH, Sams, M, Salley, JT, Pustina, A, and Stone, MH. Global positioning system analysis of a high school football scrimmage. J Strength Cond Res 31(8): 2183-2188, 2017-The purpose of this study was to examine the physical demands of a high school American football scrimmage. Male high school football players (N = 25) participated in a spring scrimmage. Global positioning system data and game film were recorded throughout the entirety of the scrimmage to determine the total distance covered, the distance covered in different velocity bands, the number of accelerations and decelerations performed, and the work-to-rest ratio of the scrimmage. The athletes were divided into 2 groups: linemen (L) (N = 7) vs. nonlinemen (NL) (N = 8) for statistical analysis, and independent T-tests with Holm's sequential Bonferroni adjustment were used to determine differences in movement characteristics between the L and NL groups. Average play duration was 5.7 ± 2.1 seconds, whereas the rest interval was 33.4 ± 13.6 seconds between plays, for an overall exercise-to-rest ratio of 1:5.9. Total distance, standing and walking distance, running distance, striding distance, sprinting distance, and total high-speed running distance covered by NL was greater than L (statistically significant at p ≤ 0.05). Distances traveled in each velocity band by position and by play are also included to provide context of our findings. Data from the present study add to the pool of support for the use of position-specific training in preparing high school football players for competition.

Concurrent intracranial and spinal subdural hematoma in a teenage athlete: a case report of this rare entity.

A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

Posttraumatic Migraine as a Predictor of Recovery and Cognitive Impairment After Sport-Related Concussion

Background: Although previous research has demonstrated that patients with posttraumatic migraine (PTM) after concussion report more symptoms and cognitive deficits after injury than do those without PTM, it is not known whether these effects persist beyond the first week of injury or whether PTM predicts recovery time. Purpose: To determine whether PTM during the first week after injury predicts (1) cognitive impairment and symptoms in the second week after injury and (2) overall recovery time. Study Design: Cohort study; Level of evidence, 2. Methods: Participants were 138 male high school football players with a mean age of 15.96 years (SD, 1.18 years; range, 13-19 years). They were classified into 3 groups: PTM (headache, nausea, and photosensitivity or phonosensitivity), headache (headache without the other PTM symptoms), or no headache (no headache or PTM symptoms). The Immediate Post-concussion Assessment and Cognitive Test (ImPACT) was used to assess cognitive performance and symptoms at baseline, postinjury days 1-7, and postinjury days 8-14. Recovery time data were collected from medical records. Results: The PTM group performed worse on verbal memory than did the headache group at 8-14 days after injury. The PTM group performed worse on visual memory, reaction time, and symptoms than did the other groups at 1-7 days and 8-14 days after injury. The PTM group was 7.3 times (95% confidence interval, 1.80-29.91) more likely to have protracted recovery (>20 days) than the no headache group and 2.6 times (95% confidence interval, 1.10-6.54) more likely than the headache group. Conclusion: Results suggest that PTM is associated with cognitive impairments and protracted recovery and that headache alone is not a good predictor of recovery.

Isolated Tear of the Pectoralis Minor Tendon in a High School Football Player

Multiple pectoralis major tendon tears have been reported in the literature; however, isolated rupture of the pectoralis minor tendon is rare and has been reported 3 times (4 patients).This article describes a case of an isolated pectoralis minor tendon tear in a male high school football player after a traumatic injury. The patient was injured while making a tackle and leading with his arm and chest. He presented with left anterior shoulder and chest wall pain with direct tenderness on palpation over the coracoid. Magnetic resonance imaging of the chest revealed an isolated tear of the pectoralis minor tendon with slight retraction and significant edema in the muscle belly. The patient returned to full activities after conservative management.Although rare, the diagnosis of pectoralis minor tendon rupture should be considered in patients who sustain a contact injury to the shoulder with tenderness on palpation over the coracoid. The mechanism of injury can be related to a direct anterior force to the shoulder, forced external rotation of the arm in slight abduction, or with the arm in extension and shoulder in flexion (eg, blocking in football). The diagnosis can be confirmed with magnetic resonance imaging when edema exists on the medial aspect of the coracoid and extends into the muscle belly. Physical therapy with scapular stabilization exercises and avoidance of abduction and active adduction can be successful in returning these patients to their previous activity levels.