Biomedical subjects

Craig R. Denegar

Publications and source records attributed to Craig R. Denegar.

6 recordsLinked to original sources

PubMed2004

Does Cryotherapy Hasten Return to Participation? A Systematic Review.

OBJECTIVE: To search the English-language literature for original research addressing the effect of cryotherapy on return to participation after injury. DATA SOURCES: We searched MEDLINE, the Physiotherapy Evidence Database, SPORT Discus, the Cochrane Reviews database, and CINAHL from 1976 to 2003 to identify randomized clinical trials of cryotherapy. Key words used were cryotherapy, return to participation, cold treatment, ice, injury, sport, edema, and pain. DATA SYNTHESIS: Original research, including outcomes-assessment measures of return to participation of injured subjects, was reviewed using the Physiotherapy Evidence Database (PEDro) Scale. Four studies were identified and reviewed by a panel of certified athletic trainers. The 4 articles' scores ranged from 2 to 4 on the PEDro scale, which has a maximum of 10 points. Two of the articles suggested that cryotherapy speeds return to participation after ankle sprains. However, these authors failed to provide in-depth statistical analysis of their results. A confounding factor of compression as part of the treatment prevented interpretation of the effects of cryotherapy in 1 article. CONCLUSIONS: After critically reviewing the literature for the effect of cryotherapy on return-to-participation measures, we conclude that cryotherapy may have a positive effect. Despite the extensive use of cryotherapy in the management of acute injury, few authors have actually examined the effect of cryotherapy alone on return-to-participation measures. The relatively poor quality of the studies reviewed is of concern. Randomized, controlled clinical studies of the effect of cryotherapy on acute injury and return to participation are needed to better elucidate the treatment responses.

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PubMed2004

Prophylactic Ankle Taping and Bracing: A Numbers-Needed-to-Treat and Cost-Benefit Analysis.

OBJECTIVE: Taping and bracing are thought to decrease the incidence of ankle sprains; however, few investigators have addressed the effect of preventive measures on the rate of ankle sprains. Our purpose was to examine the effectiveness of ankle taping and bracing in reducing ankle sprains by applying a numbers-needed-to-treat (NNT) analysis to previously published studies. DATA SOURCES: We searched PubMed, CINAHL, SPORT Discus, and PEDro for original research from 1966 to 2002 with key words ankle taping, ankle sprains, injury incidence, prevention, ankle bracing, ankle prophylaxis, andnumbers needed to treat. We eliminated articles that did not address the effects of ankle taping or bracing on ankle injury rates using an experimental design. DATA SYNTHESIS: The search produced 8 articles, of which 3 permitted calculation of NNT, which addresses the clinical usefulness of an intervention by providing estimates of the number of treatments needed to prevent 1 injury occurrence. In a study of collegiate intramural basketball players, the prevention of 1 ankle sprain required the taping of 26 athletes with a history of ankle sprain and 143 without a prior history. In a military academy intramural basketball program, prevention of 1 sprain required bracing of 18 athletes with a history of ankle sprain and 39 athletes with no history. A study of ankle bracing in competitive soccer players produced an NNT of 5 athletes with a history of previous sprain and 57 without a prior injury. A cost- benefit analysis of ankle taping versus bracing revealed taping to be approximately 3 times more expensive than bracing. CONCLUSIONS/RECOMMENDATIONS: Greater benefit is achieved in applying prophylactic ankle taping or bracing to athletes with a history of ankle sprain, compared with those without previous sprains. The generalizability of these results to other physically active populations is unknown.

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PubMed2003

Cryotherapy, Sensation, and Isometric-Force Variability.

OBJECTIVE: To determine the changes in sensation of pressure, 2-point discrimination, and submaximal isometric-force production variability due to cryotherapy. DESIGN AND SETTING: Sensation was assessed using a 2 x 2 x 2 x 3 repeated-measures factorial design, with treatment (ice immersion or control), limb (right or left), digit (finger or thumb), and sensation test time (baseline, posttreatment, or postisometric-force trials) as independent variables. Dependent variables were changes in sensation of pressure and 2-point discrimination. Isometric-force variability was tested with a 2 x 2 x 3 repeated-measures factorial design. Treatment condition (ice immersion or control), limb (right or left), and percentage (10, 25, or 40) of maximal voluntary isometric contraction (MVIC) were the independent variables. The dependent variables were the precision or variability (the standard deviation of mean isometric force) and the accuracy or targeting error (the root mean square error) of the isometric force for each percentage of MVIC. SUBJECTS: Fifteen volunteer college students (8 men, 7 women; age = 22 +/- 3 years; mass = 72 +/- 21.9 kg; height = 183.4 +/- 11.6 cm). MEASUREMENTS: We measured sensation in the distal palmar aspect of the index finger and thumb. Sensation of pressure and 2-point discrimination were measured before treatment (baseline), after treatment (15 minutes of ice immersion or control), and at the completion of isometric testing (final). Variability (standard deviation of mean isometric force) of the submaximal isometric finger forces was measured by having the subjects exert a pinching force with the thumb and index finger for 30 seconds. Subjects performed the pinching task at the 3 submaximal levels of MVIC (10%, 25%, and 40%), with the order of trials assigned randomly. The subjects were given a target representing the submaximal percentage of MVIC and visual feedback of the force produced as they pinched the testing device. The force exerted was measured using strain gauges mounted on an apparatus built to measure finger forces. RESULTS: Sensation of pressure was less (ie, it took greater pressure to elicit a response) after ice immersion, thumbs were more affected than index fingers, and the decrease was greater in the right limb than the left. Two-point discrimination was not affected by cryotherapy but was higher in the finger than in the thumb under all conditions. Isometric-force variability (standard deviation of mean isometric force) was greater as percentage of force increased from 10% to 40% of MVIC. Targeting accuracy (root mean square error) was decreased at 40% of MVIC. Accuracy and force variability were not affected by cryotherapy. CONCLUSIONS: The application of cryotherapy and reduced sensation of pressure appear to have little effect on motor control of the digits. These results support the hypothesis that the use of cold is not contraindicated for use as an analgesic before submaximal rehabilitative exercise focusing on restoring neuromuscular control to injured tissues.

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PubMed2003

Volume Decreases After Elevation and Intermittent Compression of Postacute Ankle Sprains Are Negated by Gravity-Dependent Positioning.

OBJECTIVE: Elevation and intermittent compression are routinely prescribed after soft tissue injury. Individuals must, however, resume activity in an upright position. The effect of gravity-dependent positioning after elevation and intermittent compression has not been extensively examined. Our purpose was to examine the effects of gravity-dependent positioning after elevation and intermittent compression on the volume of injured ankles. DESIGN AND SETTING: Ankle-injured subjects were randomly assigned to 1 of 2 treatment groups: elevation or elevation and intermittent compression. Each treatment lasted 30 minutes. SUBJECTS: Twelve college students with inversion ankle sprains 2 to 4 days earlier participated. MEASUREMENTS: Measurements of ankle volume were performed before treatment and at 5, 10, 15, 20, 25, 30, 45, and 60 minutes after treatment. RESULTS: Regardless of treatment, ankle volume decreased (by 17.25 +/- 4.05 mL) between the pretreatment measurement and the immediate posttreatment measurement (P <.05). The effects of both treatments, however, lasted less than 5 minutes after the limb was returned to a gravity-dependent position. CONCLUSIONS: These results suggest that elevation or elevation and intermittent compression do not effectively decrease ankle volume for a prolonged period of time in patients with postacute ankle sprains.

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PubMed2001

Serial Testing of Postural Control After Acute Lateral Ankle Sprain.

OBJECTIVE: To identify subjects' changes in postural control during single-leg stance in the 4 weeks after acute lateral ankle sprain. DESIGN AND SETTING: We used a 2 x 2 x 3 (side-by-plane-by-session) within-subjects design with repeated measures on all 3 factors. All tests were performed in a university laboratory. SUBJECTS: Seventeen young adults (9 men, 8 women; age, 21.8 +/- 5.9 years; mass, 74.9 +/- 10.5 kg; height, 176.9 +/- 7.1 cm) who had sustained unilateral acute mild or moderate lateral ankle sprains. MEASUREMENTS: Measures of center-of-pressure excursion length, root mean square velocity of center-of-pressure excursions (VEL), and range of center-of-pressure excursions (RANGE) were calculated separately in the frontal and sagittal planes during 5-second trials of static single-leg stance. RESULTS: We noted significant side-by-plane-by-session interactions for magnitude of center-of-pressure excursions in a given trial (PSL) (P =.004), VEL (P =.011), and RANGE (P =.009). Both PSL and VEL in the frontal plane were greater in the injured limbs compared with the uninjured limbs on day 1 and during week 2 but not during week 4, whereas sagittal-plane differences existed during all 3 testing sessions. Injured-limb, frontal-plane RANGE scores were greater than uninjured values at day 1 but not during weeks 2 or 4. No significant differences in sagittal-plane RANGE scores were seen. CONCLUSIONS: Postural control was significantly impaired in the injured limbs at day 1 and during week 2 after lateral ankle sprain but not during week 4. Consistent improvement in postural control measures on both injured and uninjured limbs was seen throughout the 4 weeks after ankle sprain.

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PubMed2001

Educational History, Employment Characteristics, and Desired Competencies of Doctoral-Educated Athletic Trainers.

OBJECTIVE: The study had 3 objectives: (1) to assess the educational history of doctoral-educated certified athletic trainers (ATCs) who work at academic institutions, (2) to determine the current employment characteristics of doctoral-educated ATCs who work at academic institutions, and (3) to identify which competencies doctoral-educated ATCs feel are important for new doctoral graduates to possess upon graduation. DESIGN AND SETTING: Multiple sources were used to identify doctoral-educated ATCs who work at academic institutions. These individuals were surveyed to assess their educational histories, current employment characteristics, and opinions on desired competencies for new doctoral graduates. Data were analyzed using descriptive and inferential statistics. SUBJECTS: Surveys were sent to 130 individuals, and the response rate was 89.2% (n = 116). MEASUREMENTS: Subjects answered questions regarding their educational history and employment characteristics. A 5-point Likert scale was used to assess the importance of 22 competencies for new doctoral graduates to possess upon graduation. Comparisons were made between program directors and non-program directors, respondents employed at doctoral-granting institutions and non-doctoral-granting institutions, and doctoral student advisors and non-advisors. RESULTS: Subjects reported several different educational backgrounds, job titles, and job responsibilities. Significant differences in job responsibilities and assessment of desired competencies were found between program directors and non-program directors, employees of doctoral-granting institutions and non-doctoral-granting institutions, and doctoral student advisors and non-advisors. CONCLUSIONS: As new doctoral programs are established in athletic training, students should receive training as classroom instructors and program administrators, in addition to learning the skills necessary to perform independent research in athletic training.

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