Preseason Physical Examinations Research Articles

Low back pain or injury before collegiate athletics, a potential risk factor for non-contact athletic injuries.

Majority of research surrounding the predictive value of clinical measurements and assessments for future athletic injury does not differentiate between contact and non-contact injuries. We assessed the association between clinical measures and questionnaire data collected prior to sport participation and the incidence of non-contact lower extremity (LE) injuries among Division III collegiate athletes. Prospective cohort study. University setting, NCAA Division III. 488 Division III freshmen athletes were recruited to participate in the study during their preseason physical examinations. 10,983 public schools. Prospective incidence of non-contact Lower extremity Injury. Athletes completed questionnaires to collect demographics and musculoskeletal pain history. Clinical tests, performed by trained examiners, included hip provocative tests, visual appraisal of a single leg squat to identify dynamic knee valgus, and hip range of motion (ROM). Injury surveillance for each athlete's collegiate career was performed. The athletic training department documented each athlete-reported, new onset injury and documented the injury location, type, and outcome (days lost, surgery performed). Univariable Generalized Estimating Equations (GEE) models were used to analyze the relationship between each clinical measure and the first occurrence of non-contact LE injury. An exchangeable correlation structure was used to account for repeated measurements within athletes (right and left limbs). Of the 488 athletes, 369 athletes (75%) were included in the final analysis. 69 non-contact LE injuries were reported. Responding "Yes" to "Have you ever had pain or an injury to your low back" was associated with an increased risk of non-contact LE, odds ratio = 1.59 (95%CI 1.03- 2.45, p=.04). No other clinical measures were associated with increased injury risk. A history of prior low back pain or injury was associated with an increased risk of sustaining a non-contact LE injury while participating in NCAA Division III athletics.

Chronic Adaptation of the Coracohumeral Space and Subscapularis Tendon in Professional Baseball Pitchers.

Pitchers frequently experience anterior shoulder pain, possibly associated with coracohumeral impingement; however, whether the coracohumeral distance (CHD) and/or subscapularis tendon adapt chronically (bilateral difference) due to pitching, and whether clinical measures are associated with CHD and subscapularis tendon organization have not been evaluated in professional pitchers. The authors hypothesized that dominant arm CHD would be smaller than the nondominant arm, dominant subscapularis tendon would have increased spatial frequency (ie, be more disorganized), and humeral retroversion (HR) would predict CHD and subscapularis tendon organization. Level 4. Healthy professional baseball pitchers were recruited during their preseason physical examination. Bilateral diagnostic ultrasound measured CHD, HR, and posterior capsule thickness (PCT), and quantified subscapularis tendon organization. External rotation, neutral, and crossbody CHD was measured. Overall, 52 healthy professional baseball pitchers participated. The dominant arm of pitchers demonstrated a significantly narrower CHD in all 3 positions (P < 0.01), increased scapular protraction (163 vs 156 mm; P < 0.01), and increased spatial frequency of the subscapularis tendon (1.8 vs 1.6 peaks/mm; P < 0.01). HR was associated with CHD in 30° of external rotation (R2 = 0.12; P < 0.01), neutral rotation (R2 = 0.11; P < 0.01), and the crossbody position (R2 = 0.28; P < 0.01). PCT was associated with CHD in 30° of external rotation (R2 = 0.16; P = 0.05). HR and CHD in 30° of external rotation was associated most strongly with subscapularis tendon organization (R2 = 0.11; P = 0.03). The dominant shoulder of professional pitchers presents with a smaller CHD, more scapular protraction, and more subscapularis tendon disorganization than the nondominant shoulder. Professional pitchers demonstrate chronic CHD and subscapularis tendon adaptations, which may increase their risk for anterior shoulder pain and subscapularis tendon injury.

Injury Risk in Collegiate Football Players With Generalized Joint Hypermobility: A Prospective Cohort Study Over 2 Years.

Generalized joint hypermobility (GJH) has been identified as a risk factor for injury in various athletic patient populations. To evaluate GJH as a predisposing risk factor for injury in a population of National Collegiate Athletic Association (NCAA) Division I football players. Cohort study; Level of evidence, 2. The Beighton score was collected for 73 athletes during their preseason physical examinations in 2019. GJH was defined as a Beighton score ≥4. Athlete descriptive characteristics, including age, height, weight, and playing position, were recorded. The cohort was evaluated prospectively for 2 years, and the number of musculoskeletal issues, injuries, treatment episodes, days unavailable, and surgical procedures for each athlete during this period were recorded. These measures were compared between the GJH and no-GJH groups. The mean Beighton score was 1.4 ± 1.5 for the 73 players; 7 players (9.6%) had a Beighton score indicating GJH. During the 2-year evaluation, there were 438 musculoskeletal issues, including 289 injuries. The mean number of treatment episodes per athlete was 77 ± 71 (range, 0-340), and the mean number of days unavailable was 67 ± 92 days (range, 0-432 days). There were 23 athletes who required 25 operations, the most common procedure being arthroscopic shoulder stabilization (n = 6). The number of injuries per athlete was not significantly different between the GJH and no-GJH groups (3.0 ± 2.1 vs 4.1 ± 3.0; P = .13), nor were there any between-group differences in the number of treatments received (74.6 ± 81.9 vs 77.2 ± 71.5; P = .47), days unavailable (79.6 ± 124.5 vs 65.3 ± 89.3; P = .61), or rates of surgery (43% vs 30%; P = .67). A preseason diagnosis of GJH did not place NCAA football players at a greater risk for injury during the 2-year study period. Based on the findings of this study, no specific preparticipation risk counseling or intervention is warranted for football players who are diagnosed with GJH as defined by the Beighton score.

Comparison of Glenohumeral Range of Motion Deficits in Youth, Collegiate, and Professional Baseball Players.

BackgroundExamining range of motion deficits across levels of baseball competition can result in a better understanding of the extent of altered range of motion patterns and identify competition levels that may require preventative interventions that target the deficits.PurposeThe purpose of this study was to compare shoulder range of motion in baseball players across levels of competition and compare the prevalence of glenohumeral internal rotaton deficit (GIRD) and total arc of motion differences (TAMD) between competition levels in pitchers and position players.Study DesignProspective descriptive cohortMethodsPassive internal and external rotation range of motion was measured bilaterally. Individuals with current pain in the arm, shoulder, elbow or shoulder surgery within the prior two years were excluded. Measurements were taken during pre-season physical examinations. Players were divided into seven groups: 12u (11-12 years; n=30), 14u (13-14 years; n=30), High School 1 (HS 1; 15-16 year; n=42), High School 2 (HS 2; 17-18 years; n=25), College (n=22), Professional 1 (Pro1; 17-22 years; n=37) and Professional 2 (Pro2; 23 and older; n=37). Multiple one-way analyses of variance were performed to determine differences between groups. Tukey test for post-hoc analysis was employed to determine which competition levels were significantly different.ResultsTwo-hundred and twenty-three male baseball players ages 11-26 participated. The 12u (53.7°) and 14u (54.2°) groups had significantly less internal rotation than HS1 (65.2°), HS2 (63.9°), College (62.3°), Pro1 (64.9°), and Pro2 (64.5°) players (p<0.0001). The 12u, 14u, HS1, college, and Pro2 groups had greater than 50% of players with total arc of motion differences >5°. Conclusions: Range of motion alterations exist across ages and levels of competition with 12u and 14u players having less internal rotation than the older groups and youth pitchers having less total range of motion than HS1.Level of Evidence2

Preseason Dynamic Balance Performance in Healthy Elite Male Soccer Players.

Lower limb musculoskeletal injuries in sports are linked with balance abnormalities and altered postural control. Dynamic balance screening should be performed in order to identify athletes at risk. The purpose of the study was to evaluate the preseason dynamic balance performance and side-to-side asymmetry of healthy elite male soccer players, using modified Star Excursion Balance Test (mSEBT). Seventy-three elite soccer players (23.8 ± 5.4 years) were evaluated using the mSEBT. Normalized reach distances, side-to-side asymmetries, and composite scores were determined. The composite scores were 93.33% ± 8.99% for dominant leg and 93.36% ± 9.23% for nondominant leg. No significant differences were found between dominant and nondominant limb in any direction. The mSEBT is an easy-to-use tool to measure the dynamic balance performance in elite athletes. It can be applied successfully during preseason physical examinations. Future studies are needed to establish predictive cutoff points in order to increase mSEBT use in screening soccer players for dynamic balance abnormalities and identify those at risk for noncontact lower limb injuries.

Patient Reported Outcomes and Symptomatic Impingement in US Women’s Professional Soccer

Objectives:The purpose of this study was to determine: 1) normative data of multiple general health-, activity-, hip and groin-, and depression-specific patient-reported outcome (PRO) questionnaires; 2) if any PRO’s were able to predict a positive anterior impingement test, in female professional soccer player.Methods:An IRB-approved cross-sectional investigation of adult female US professional soccer players was performed at the team pre-season physical examination day. Adult (>18 years of age) female players without prior hip surgery were eligible. Hip impingement physical examination was performed (anterior, subspine, lateral, posterior) and recorded. Multiple questionnaires were administered to each player, including Short-Form-12 (Mental Component and Physical Component Scores [MCS, PCS]), Tegner activity score, Non-Arthritic Hip Score (NAHS), Hip and Groin Outcome Score (HAGOS), international Hip Outcome Tool-12 (iHOT-12), and Zung Depression Index. Descriptive statistics were calculated. Kolmogorov-Smirnov analysis was performed for data normality and Pearson’s (parametric) or Spearman’s (non-parametric) to assess correlation of ROM and radiographs. Binary logistic regression was performed to ascertain the effects of each PRO questionnaire score and prediction of a positive anterior impingement test.Results:Twenty-four players (48 hips) were analyzed (25.4+/-3.0 years of age; 2.8+/-2.2 years professional experience). Scores were collected: Tegner 9.9+/-0.3; SF-12 PCS 52.9+/-7.4; SF-12 MCS 54.3+/-7.0; iHOT-12 96.6+/-5.4%; NAHS Total 97.9+/-4.9; HAGOS symptoms 90.5+/-10.5, pain 97.8+/-3.4, activities of daily living 99.4+/-2.2, sports 97.1+/-4.2, physical activity 97.9+/-7.1, and quality of life 95.8+/-8.7; Zung 27.6+/-5.9. The iHOT-12 was able to correctly predict 71% of cases of positive anterior impingement test for the left hip and the logistic regression model was statistically significant, (5.2)1, p=0.02. For the right hip, the iHOT-12 was able to correctly predict 79% of cases of positive anterior impingement and the logistic regression model was statistically significant, χ 2 (9.1)1, p=0.003. SF-12 MCS and PCS scores were able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (11)2, p=0.005. The Zung score was able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (4.1)1, p=0.04.Conclusion:Multiple general health-, activity-, hip and groin-, and depression-specific patient reported outcome scores were collected and normative data established in a US women’s professional soccer club, showing that iHOT-12, SF-12 MCS and PCS, and Zung depression scores were able to correctly predict symptomatic impingement.

Magnetic Resonance Imaging Predictors of Failure in the Nonoperative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers

Background: A medial ulnar collateral ligament (UCL) injury of the elbow is an increasingly common injury in professional baseball pitchers. Predictors of success and failure are not well defined for the nonoperative management of these injuries. Purpose: To evaluate the efficacy of objective measures to predict failure of the nonoperative management of UCL injuries. Study Design: Case-control study; Level of evidence, 3. Methods: Thirty-two professional pitchers (82%) met inclusion criteria and underwent an initial trial of nonoperative treatment for UCL tears based on clinical and radiological findings. Age, preseason physical examination results, magnetic resonance imaging (MRI) characteristics, and performance metrics were analyzed for these pitchers. Successful nonoperative management was defined as a return to the same level of play or higher for >1 year. Failure was defined as recurrent pain or weakness requiring a surgical intervention after a minimum of 3 months’ rest when attempting a return to a throwing rehabilitation program. Results: Thirty-two pitchers (mean age, 22.3 years) who underwent initial nonoperative treatment of UCL injuries were evaluated. Thirty-four percent (11/32) failed and required subsequent ligament reconstruction. Sixty-six percent (21/32) successfully returned to the same level of play for 1 year without a surgical intervention. There was no significant difference seen in physical examination findings or performance metrics between these patients. When comparing MRI findings between the groups, 82% (9/11) (P < .001) who failed nonoperative management had distal tears, and 81% (17/21) who did not fail had proximal tears (P < .001). When adjusting for age, location, and evidence of chronic changes on MRI, the likelihood of failing nonoperative management was 12.40 times greater (P = .020) with a distal tear. No other variable alone or in combination reached significance. When combining the parameters of a high-grade tear and distal location, 88% (7/8) failed nonoperative management. Conclusion: In professional pitchers, distal UCL tears showed significantly higher odds of failure with nonoperative management compared with proximal tears. Thus, tear location should be considered when deciding between operative and nonoperative management.

Competition-Level Differences on the Lower Quarter Y-Balance Test in Baseball Players.

Decreased performance in dynamic balance has previously been associated with a history of ulnar collateral ligament injury in baseball players. Previous research on dynamic balance in soccer players has shown that test performance depends on competition level. However, dynamic balance has yet to be examined in baseball players. To understand normative values and determine differences in dynamic balance, as measured by the Lower Quarter Y-Balance Test, across competition levels in baseball players. Cross-sectional study. Preseason physical examinations. Dynamic balance was measured in 88 high school (HS), 78 collegiate (COL), and 90 professional (PRO) baseball players. All participants completed the Lower Quarter Y-Balance Test using the standard protocol. In unilateral stance, they reached with 1 foot in the anterior, posteromedial, and posterolateral directions. We calculated 1-way analyses of variance to compare performance, composite score, and reach asymmetry for each direction as well as the sum of the asymmetry values (P < .05). Composite score was calculated by averaging the maximum normalized reach scores. Reach asymmetry was determined by calculating bilateral differences in reach ability. In comparison with the HS and COL groups, the PRO players exhibited greater posteromedial (P < .01; effect size index [ESI]HS = 1.06, ESICOL = 0.95) and posterolateral reach (P < .01; ESIHS = 0.82, ESICOL = 0.84) as well as a greater composite score (P < .01; ESIHS = 0.60, ESICOL = 0.87). In contrast, HS baseball players exhibited increased anterior reach (P < .01; ESICOL = 0.60, ESIPRO = 0.39) compared with the COL and PRO cohorts. No significant differences in reach asymmetry were observed among groups. Lower extremity dynamic balance performance differed based on the baseball players' competition level. These baseline data may be helpful in identifying low-performing athletes who might benefit from neuromuscular interventions.

Reliability and Associated Risk Factors for Performance on the Vestibular/Ocular Motor Screening (VOMS) Tool in Healthy Collegiate Athletes

Background: The Vestibular/Ocular Motor Screening (VOMS) is a newly developed screening tool that evaluates vestibular and ocular motor symptom (eg, headache, dizziness, nausea, fogginess) provocation after a sport-related concussion. Baseline data on the VOMS are needed to extend the application of this measure to broad age groups and to document normal variations in performance. Purpose: The primary purpose of this study was to examine the internal consistency of the VOMS in a large sample of healthy, nonconcussed collegiate athletes. The secondary purpose was to investigate the effects of patient sex and history of motion sickness, migraines, and concussions on baseline VOMS scores. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 263 National Collegiate Athletic Association Division I athletes (mean ± SD age, 19.85 ± 1.35 years) completed self-reported demographic and medical history at preseason physical examinations and baseline screening. Internal consistency of the VOMS was assessed with Cronbach α. A series of univariate nonparametric tests (χ2 with odds ratios [ORs] and 95% CIs) were used to examine the associations among medical history risk factors and VOMS clinical cutoff scores (score of ≥2 for any individual VOMS symptom, near point of convergence [NPC] distance of ≥5 cm), with higher scores representing greater symptom provocation. Results: Internal consistency of the VOMS was high (Cronbach α = .97), and 89% of athletes scored below cutoff levels (ie, 11% false-positive rate). Female athletes (OR, 2.99 [95% CI, 1.34-6.70]; P = .006) and those with a personal history of motion sickness (OR, 7.73 [95% CI, 1.94-30.75]; P = .009) were more likely to have ≥1 VOMS scores above cutoff levels. No risk factors were associated with increased odds of an abnormal NPC distance. Conclusion: The VOMS possesses internal consistency and an acceptable false-positive rate among healthy Division I collegiate student-athletes. Female sex and a history of motion sickness were risk factors for VOMS scores above clinical cutoff levels among healthy collegiate student-athletes. Results support a comprehensive baseline evaluation approach that includes an assessment of premorbid vestibular and oculomotor symptoms.

Prevalence of Cam-Type Morphology in Elite Ice Hockey Players

Background: Femoroacetabular impingement (FAI) has been increasingly recognized as a cause of hip pain in athletes at all levels of competition, specifically ice hockey players. Purpose/Hypothesis: The purpose of this study was to define the prevalence of cam and pincer radiographic deformity in elite ice hockey players. The hypothesis was that elite hockey players will have a higher prevalence of radiographic hip abnormalities compared with the general population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Anteroposterior and frog-leg lateral radiographs on 137 elite ice hockey players were prospectively obtained during the 2014-2015 preseason entrance examinations. Study participants included National Hockey League roster players as well as the respective farm team members. Demographic data were collected, including age, position, shooting side, and any history of hip pain or hip surgery. Patients with a history of hip surgery were excluded from the analysis. A single sports medicine fellowship–trained orthopaedic surgeon used standard radiographic measurements to assess for the radiographic presence of cam or pincer deformity. Radiographs with an alpha angle ≥55° on a frog-leg lateral view were defined as cam-positive. Each participant underwent a preseason physical examination with an assessment of hip range of motion and impingement testing. Results: A total of 130 elite ice hockey players were included in the analysis; 180 (69.4%) hips met radiographic criteria for cam-type deformity. The prevalence in right and left hips was 89 (69.5%) and 91 (70.0%), respectively; 70 (60.8%) players demonstrated bilateral involvement. Hips with cam deformity had a mean alpha angle of 67.7° ± 8.3° on the right and 68.9° ± 9.0° on the left. Of the patients with alpha angles ≥55°, 5.6% (5/89) had a positive anterior impingement test of the right hip, while 11% (10/91) had positive anterior impingement test of the left. Players with radiologic cam deformity had a statistically significant deficit in external rotation of the right hip, as well as in both internal and external rotation of the left hip, compared with those with normal alpha angles. When assessing for crossover sign, 64 of 107 (59.8%) had a positive radiographic finding. Forty-one players (38.3%) had evidence of a crossover sign of the right hip and 42 (39.3%) of the left. When comparing position players, goalies had the highest prevalence of cam-type deformity (93.8%) and the least acetabular coverage. Conclusion: The study data suggest that elite ice hockey players have a significantly higher prevalence of radiographic cam deformity in comparison to what has been reported for the general population.

RISK OF SPORTS-RELATED MUSCULOSKELETAL INJURIES AMONG ELITE WOMEN BASKETBALL PLAYERS ACCORDING TO POSITION ON THE COURT AND SPORT RESULTS

Background. Basketball is a popular sport around the world, the number of players is growing, the probability to experience trauma is increasing, too. Studies have shown that women sustain 60% more injuries than men do. Pre- season physical examination helps to establish sports specific changes in the body of the athlete and to determine risk factors for training, competition, which cause injury to the players. Research aim was to analyse risk of non-contact musculoskeletal injuries in elite women basketball players according to the position on the court. Methods. The study involved 100 players in Lithuanian women basketball league who completed the questionnaire about the level of physical fatigue, performed Lower Quarter Y Balance Test™ and Functional Movement Screen ™ tests during pre-season physical examination in 2014. Data were analysed and compared according to player’s position on the court (guards and forwards). Results. The level of physical fatigue during pre-season period was low in both groups. Dynamic stability of the right leg was better in guards (composite score – 105.2 to 101.8 in forwards) while dynamic stability of the left leg remained the same in both groups. Guards had higher total scores in Functional Movement Screen™ tests pointing to the better quality of basic functional movement patterns. Conclusions. The guard’s playing efficiency during the season was higher than that of forwards and it was associated with better dynamic stability and higher level of physical fatigue at pre-season. Indirect indicators of non-contact musculoskeletal sport injuries showed that guards should have lower risk of non-contact sport-related injuries in women basketball.

The Relationship Between Glenohumeral Internal Rotational Deficits, Total Range of Motion, and Shoulder Strength in Professional Baseball Pitchers.

Although the lack of internal rotation (IR) and total range of motion (TRM) has been identified as a significant contributing factor of shoulder injuries, our goal was to determine whether a relationship exists between glenohumeral internal rotational deficits (GIRD), TRM, and shoulder strength in professional baseball pitchers. Our hypothesis was that GIRD with TRM differences within 5° will not lead to decreased shoulder strength; however, a shoulder with >5° of TRM difference with GIRD will lead to decreased shoulder strength. The study was conducted over a 4-year period and included 193 major and minor league pitchers. All measurements were taken prior to the pitcher's engaging in any baseball-related activities on the day of measurements. The entire measurement arc of passive range of motion (PROM), including external rotation (ER) and IR, was defined as the TRM. GIRD was defined as a loss of 25° or more of IR of the throwing shoulder compared with the nonthrowing shoulder. Shoulder strength measurements were obtained using a validated digital dynamometer with the arm in 90° of abduction and with the arm in 110° of flexion and 30° of abduction measured in pounds. The IR deficit was 5.89° (SD = 9.24°) in non-GIRD pitchers and 25.52° (SD = 4.35°) in GIRD pitchers (P > 0.001). The ER change was 124.08° (SD = 11.21°) in non-GIRD pitchers and 127.79° (SD = 9.15°) in GIRD pitchers. The total arc of motion was 179.54° (SD = 14.53°) in non-GIRD pitchers and 171.93° (SD = 12.34°) in GIRD pitchers (P > 0.001). The strength in the shoulder, measured with the arm in 90° of abduction, was 29.61 lb (SD = 4.76 lb) in non-GIRD pitchers versus 28.65 lb (SD = 4.81 lb) in GIRD pitchers. The strength with the arm in 110° of flexion and 30° of abduction was 29.43 lb (SD = 5.01 lb) in non-GIRD pitchers versus 28.13 lb (SD = 4.76 lb) in pitchers with GIRD (P = 0.043). Deficiencies in total arc of motion (P < 0.001) and shoulder strength (P < 0.043) were significantly associated with GIRD. In our evaluation of 193 pitchers examined during their preseason physical examinations, we identified a statistically significant association between decreased total arc of motion, decreased shoulder strength, and GIRD.

Preseason Perceived Physical Capability and Previous Injury.

Patient opinion about the ability to perform athletic maneuvers is important after injury; however, prospective assessment of self-perceived physical capability for athletes before the beginning of a season is lacking. To perform a descriptive analysis of knee, shoulder, and elbow self-perceived measures of physical capability specific to athletics and to compare the measures between athletes with and without a history of injury. Cross-sectional study. Preparticipation physical examinations. A total of 738 collegiate athletes (486 men, 251 women; age = 19 ± 1 years) were administered questionnaires after receiving medical clearance to participate in their sports. Of those athletes, 350 reported a history of injury. Athletes self-reported a history of knee, shoulder, or elbow injury. Perceived physical capability of the 3 joints was evaluated using the Knee Injury and Osteoarthritis Outcome Score Sport and Recreation Function and Knee-Related Quality of Life subscales and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score. We conducted nonparametric analysis to determine if scores differed between athletes with and without a history of injury. Median values for the Knee Injury and Osteoarthritis Outcome Score Sports and Recreation Function and Knee-Related Quality of Life subscales and the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score for all athletes were 100. Median values for perceived physical capability of athletes with a history of injury were 3 to 12 points lower for each questionnaire before the start of the season (P < .001). Our study provided descriptive values for individual perceived knee, shoulder, and elbow physical capability of collegiate athletes participating in 19 sports. Athletes who did not report previous injuries perceived their physical capabilities to be nearly perfect, which could set the goal for these athletes to return to participation after injury. Athletes reporting previous injuries perceived less physical capability before the competitive season. Self-assessment of joint-specific capability may supplement preseason physical examinations, identifying particular athletes needing further monitoring or care during a season.

Single leg balance test to identify risk of ankle sprains

Background: Ankle sprains are a common and potentially disabling injury. Successful prediction of susceptibility to ankle sprain injury with a simple test could allow ankle sprain prevention protocols to be...

Urine Specific Gravity and Osmolality Measurements in a College Football Team

NCAA regulations prohibit wrestlers from competing when urine specific gravity (U) is >1.020 g/dL. To date, no other sport has been evaluated for acceptable hydration levels using this same criterion. PURPOSE: to assess the level of hydration in a college football team prior to fall training and after 8 weeks of competition using Usg, osomolality (Uosm), and dipsticks. METHODS: NCAA Division II football players (n = 78) provided a urine sample during their pre-season physical examination in early August (n = 78) and again in late October (n = 50). Prior to each sample collection, fluids and diet were allowed ad libitum. Players self-reported average daily fluid consumption in the six weeks preceding measurement. Usg was measured using a refractometer (ICAL model 2020) and dipsticks (Urispec 11-way), and U was determined using freezing-point depression (Advanced Micro-Osmometer, model 3300). RESULTS: Reliability determined on randomly selected subgroups (n = 20 and 18) produced interclass correlation coefficients of 0.999 for both Usg and Uosmat each test session. Usg and Uosm were highly correlated at both test sessions (r = 0.95 and 0.97). Dipstick U measurements were significantly lower than the refractometer levels (t = 8.7), despite a correlation between the two. At pre-season testing, 89% of the players had Usg above 1.020 g/dL, (p<0.01) while at late-season testing, 64% were above that level (p<0.01). The change between pre-season and late-season was significant. At both pre-season and late-season testing, self-reported water intake was nonsignificantly correlated with Usg (r = −0.03 and 0.04) and Uosm(r = −0.04 and 0.17). There was no significant difference in Usg orUosm between players using nutritional supplements and those not using any supplementation at either pre-season or late-season season. CONCLUSIONS: A large percentage of college football players may not be well hydrated entering pre-season training but are likely to become significantly better hydrated over the course a football season due to readily available water supplies during and after practice. Despite improved hydration status, a substantial percent of football players might not attain recommended hydration level (1.020g/dL).

Elbow Range of Motion in Professional Baseball Pitchers

Background Physicians involved with the care of baseball players have noted elbow range of motion changes in pitchers. Objective data regarding the extent of these changes have rarely been documented. Hypothesis Dominant and nondominant elbow range of motion differences are common in baseball pitchers, and these differences are related to player age, amount and length of time professionally pitched, and history of surgical procedures on the dominant extremity. Study Design Cross-sectional study; Level of evidence, 4. Methods Thirty-three professional pitchers were evaluated for elbow range of motion during spring training preseason physical examination. Dominant and nondominant elbow range of motion including flexion, extension, supination, and pronation were measured with a goniometer. Range of motion measures from the dominant and nondominant sides were compared. Baseball records were reviewed for arm dominance, age, years of professional pitching, professional innings pitched, and history of elbow surgery. These factors were evaluated for their possible association with range of motion for each side and the difference between sides. Results Statistically significant differences between dominant and nondominant sides were noted for elbow extension (dominant decreased 7.9° ± 7.4°, P <. 0001), flexion (dominant decreased 5.5° ± 7.8°, P =. 0003), and total flexion-extension arc (dominant decreased 13.3° ± 13.7°, P <. 0001). No significant difference between sides was found for the supination or pronation measures. No correlation was noted for age, pitching history, surgery, or arm dominance and the motion differences. Conclusion Professional pitchers demonstrate elbow flexion and extension differences between dominant and nondominant elbows. No correlation was found between motion differences and age, pitching history, surgery, or arm dominance.

Magnetic Resonance Imaging of the Knee in Asymptomatic Professional Basketball Players

The purpose of this study was to evaluate the prevalence of articular cartilage lesions and meniscal tears on magnetic resonance imaging (MRI) scans in the knees of asymptomatic male professional basketball players. A retrospective review. Twenty players (40 knees) met the inclusion criteria of being signed by a National Basketball Association team and passing their preseason physical examination. All included athletes were assessed for the presence of articular cartilage lesions, meniscal pathology, and the presence of effusions. The overall prevalence of articular cartilage lesions on MRI was 47.5% in our study group. There were trochlear groove articular lesions in 25%. The lateral femoral condyle was involved in 2.5% of all knees. The medial femoral condyle was affected in 10% of all knees. The lateral tibial plateau showed articular cartilage lesions in 5%. The patella had articular cartilage lesions in 35%. The overall prevalence of various grade meniscal lesions was 20% on MRI. Medial intra-meniscal signals accounted for 87.5% and 12.5% on the lateral side. The results of our study show an equal to or higher prevalence of meniscal lesions in male professional basketball players than previously reported in the literature. We found a large number of patella-femoral articular cartilage lesions in our study population of male professional basketball players. These athletes perform at the highest demand level, which indicates that the presence of these lesions did not cause any symptoms. Level IV, case series.

High-sensitivity C-reactive protein levels in players on a major league baseball team

We performed a high-sensitivity C-reactive protein test in major league baseball players. This test was of limited usefulness on preseason physical examination of 50 major league baseball players. The test is more likely to be of greater value performed on those whose 10-year risk of coronary heart disease is in the 10% to 20% range.

Overview of injuries in the young athlete.

It is estimated that 30 million children in the US participate in organised sports programmes. As more and more children participate in sports and recreational activities, there has been an increase in acute and overuse injuries. Emergency department visits are highest among the school-age to young adult population. Over one-third of school-age children will sustain an injury severe enough to be treated by a doctor or nurse. The yearly costs have been estimated to be as high as 1.8 billion US dollars. There are physical and physiological differences between children and adults that may cause children to be more vulnerable to injury. Factors that contribute to this difference in vulnerability include: children have a larger surface area to mass ratio, children have larger heads proportionately, children may be too small for protective equipment, growing cartilage may be more vulnerable to stresses and children may not have the complex motor skills needed for certain sports until after puberty. The most commonly injured areas of the body include the ankle and knee followed by the hand, wrist, elbow, shin and calf, head, neck and clavicle. Contusions and strains are the most common injuries sustained by young athletes. In early adolescence, apophysitis or strains at the apophyses are common. The most common sites are at the knee (Osgood-Schlatter disease), at the heel (Sever's disease) and at the elbow (Little League Elbow). Non-traumatic knee pain is one of the most common complaints in the young athlete. Patellar Femoral Pain Syndrome (PFPS) has a constellation of causes that include overuse, poor tracking of the patellar, malalignment problems of the legs and foot problems, such as pes planus. In the child, hip pathology can present as knee pain so a careful hip exam is important in the child presenting with an insidious onset of knee pain. Other common injuries in young athletes discussed include anterior cruciate ligament injuries, ankle sprains and ankle fractures. Prevention of sports and recreation-related injuries is the ideal. There are six potential ways to prevent injuries in general: (i) the pre-season physical examination; (ii) medical coverage at sporting events; (iii) proper coaching; (iv) adequate hydration; (v) proper officiating; and (vi) proper equipment and field/surface playing conditions.

Preseason Physical Examinations: Assessing Flexibility

Preseason Physical Examinations: Assessing Flexibility