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PubMed2002

Overview of Athletic Training Education Research Publications.

OBJECTIVE: To provide an overview of the limited amount of peer-reviewed literature on athletic training education that has been published in athletic training journals. Publications that related specifically to the development of evaluation tools or specific addenda to the required athletic training curriculum were not included. BACKGROUND: As education reform continues to unfold in athletic training, it is important for all certified athletic trainers to understand the research that undergirds the educational practices in athletic training. Many of the profession's educational practices have been taken from standards and methods developed by the discipline of education, with very little validation for applicability to the discipline of athletic training. A very limited number of comprehensive scientific investigations of the educational standards and practices in athletic training education have been carried out; however, for more research to be conducted, it is essential that the currently available research be reviewed. DESCRIPTION: The summaries of athletic training educational research in this article include the topics of learning styles, facilitation of learning and professional development, instructional methods, clinical instruction and supervision, predictors of success on the National Athletic Trainers' Association Board of Certification certification examination, program administration, and continuing education. The amount of research in athletic training education is limited when compared with the amount and quality of educational research available in other professions, such as medicine, nursing, dentistry, physical therapy, and occupational therapy. In this article, I attempt to describe the existing literature and identify what is needed to expand the breadth and depth of research in athletic training education. CLINICAL ADVANTAGES: This article is intended to help educators identify areas within athletic training education that require further validation and to provide both educators and clinicians with insight into the current validated educational practices that may be appropriate to incorporate into educational settings or practice.

Journal Article↗
PubMed1993

Injured athletes' attitudes and judgments toward rehabilitation adherence.

In a follow-up study to certified athletic trainers' (ATCs') attitudes and judgments toward injury rehabilitation adherence, previously injured and rehabilitated athletes (n=36) were administered the Athletic Injury Rehabilitation Adherence Questionnaire. The purpose of the study was to compare the results collected from athletes with those collected previously from ATCs. The questionnaire consisted of 60 statements, categorized into seven scales: athletic trainers' influence, environmental influences, athlete's personality, pain tolerance, self-motivation, goals and incentives, and significant others. Four additional open-ended questions dealing with successful and unsuccessful rehabilitation strategies also were completed. Athletes' responses were generally similar to those of ATCs. Factors deemed significant to rehabilitation adherence were: (a) good rapport and communication between athletic trainers and injured athletes, (b) support from athletic trainers and coaches, (c) self-motivation on the part of athletes, and (d) convenience, accessibility, and flexibility of the rehabilitation facility and staff. The greatest deviations between athletes' and ATCs' responses were in the areas of self-motivation, pain tolerance, education about injury and rehabilitation exercises, and degree of realistic feedback. Analyses of open-ended question responses reinforced the aforementioned results. The strongest findings derived from these questions were the importance of rapport, communication, and support to rehabilitation adherence. Also, athletes' distastes for threats and scare tactics were quite evident.

Journal Article↗
PubMed1998

An analysis of selected factors that affect the work lives of athletic trainers employed in accredited educational programs.

OBJECTIVE: To gain insight into selected factors that affect certified athletic trainers who work in accredited athletic train- ing educational programs. Specifically, the demands and ex- pectations placed upon certified athletic trainers relative to workloads, elements of compensation such as salary and benefits, and performance evaluation criteria were studied. DESIGN AND SETTING: We designed the Survey of Athletic Trainer Workloads, Criteria for Retention and Promotion, and Salary Levels. Three copies were sent to all undergraduate curriculum directors for accredited athletic training education programs (n = 88). One hundred fifty-three usable surveys were returned (58%). SUBJECTS: The subjects were 153 certified athletic trainers who were employed in accredited athletic training education programs. MEASUREMENTS: Simple descriptive data including frequency distributions and measures of central tendency were used to compile most of the results and findings. A 2-way analysis of variance was performed relating to salary, years of experience, and sex. RESULTS: Most certified athletic trainers (78%) worked on staffs of at least 3 certified athletic trainers. Almost universally, responsibilities included some combination of teaching, athletic service, and student supervision. Certified athletic trainers reported being certified an average of 12.5 years and typically worked more than 50 hours per week. The greatest percentage of those responding (56%) earned between $25,000 and $39,999 annually. Salaries were significantly lower for females than for their male counterparts of equal experience (P < .05). Chairperson evaluations and student evaluations on teaching were rated as the most important performance evaluation criteria for athletic trainers regarding merit and promotion. CONCLUSIONS: Although there was a wide range of responses for most categories surveyed, the data revealed clear trends. With more information of this nature, realistic assessments and comparisons can be made among certified athletic trainers working in accredited curriculum programs.

Journal Article↗
PubMed1998

Student athletic trainer perceptions of clinical supervisor behaviors: a critical incident study.

OBJECTIVE: To identify and describe critical helpful and hindering clinical teaching behaviors of supervising athletic trainers, as perceived by student athletic trainers, and to provide a better understanding of the student athletic training experience. DESIGN AND SETTING: The critical incident technique was used to identify critical behaviors of supervising athletic trainers as perceived by student athletic trainers. SUBJECTS: Sixty-four student athletic trainers from 4 undergraduate NATA-approved or CAAHEP-accredited programs volunteered to participate. MEASUREMENTS: The data from the critical incident forms were reviewed for acceptability, inductively analyzed, and categorized. Results are reported in raw numbers and percentages. Examples are provided to illustrate each category. RESULTS: Helpful and hindering supervisor behaviors were identified in 4 major categories and 24 subcategories. Students reported more helpful than hindering behaviors. Students reported mentoring behaviors most often, followed by accep- tance, nurturing, and modeling behaviors. Student athletic trainers wanted to be respected as professionals regarding ability and knowledge. They also desired mentoring through explanation, demonstration, and constructive feedback and nurturing through confidence building and other supportive supervisor behaviors. Students most often identified incidents of humiliating behaviors and lack of availability by the supervisors as hindering the clinical experience. CONCLUSIONS: Supervising athletic trainer behaviors had a profound effect on the professional development of student athletic trainers. Interaction between supervisors and students positively or negatively affected student athletic trainers' growth and development. Selection of supervising athletic trainers, matching of supervisors with students, and training for supervising athletic trainers are important issues that need further investigation. Student athletic trainers can provide insightful information that can be used to better understand and enhance the clinical experience.

Journal Article↗
PubMed2000

Asthma medications: basic pharmacology and use in the athlete.

OBJECTIVE: Asthma is a chronic disease that affects athletes at all levels of sport. Several categories of drugs, including relatively new agents, are available to treat the asthmatic patient. By understanding the appropriate uses and effects of these drugs, the athletic trainer can assist the asthmatic athlete in improving therapeutic outcomes from the asthma therapy. The appropriate use of these medications includes not only the use of the appropriate drug(s), but also appropriate technique for administration, compliance with the prescribed dosing intervals, and sufficient care to avoid side effects. DATA SOURCES: I searched MEDLINE and CINAHL from 1982 to 1999 and International Pharmaceutical Abstracts from 1990 to 1999. Terms searched were "asthma," "athlete,""athletic," "exercise-induced," "exercise," "performance," "therapy," and "treatment." DATA SYNTHESIS: Bronchodilators include beta2 agonists, anticholinergics, and methylxanthines. Of these, the beta2 agonists used by inhalation are the drugs of choice to treat an acute asthma attack or to prevent an anticipated attack (such as before exercise). Anti-inflammatory agents include corticosteroids mast cell-stabilizing agents, and antileukotrienes. Corticosteroids by inhalation are the drugs of choice for long-term treatment to curb the inflammatory process in the lung. Each of these drug categories has a unique mechanism of action. The athletic trainer who understands the appropriate use of these medications can help the athlete to obtain optimal results from drug therapy. Encouraging the athlete to comply with appropriate therapy, monitoring the effectiveness of the therapy, and recognizing the stimuli that initiate asthmatic attacks can improve the patient's therapeutic outcomes. CONCLUSIONS/RECOMMENDATIONS: The athletic trainer has an opportunity to play a key role in ensuring that the asthmatic athlete achieves the desired outcomes from treatment. The athletic trainer can help to minimize the effect of asthma on athletic performance by ensuring that the athlete uses inhaler devices properly, is compliant with the prescribed drug therapy, monitors pulmonary function appropriately, uses medications properly before exercise, and is aware of the factors that initiate asthma symptoms.

Journal Article↗
PubMed1978

Age at menarche and selected menstrual characteristics in athletes at different competitive levels and in different sports.

Ages at menarche in 110 non-athletes, 59 high school atjletes, 53 college athletes, and 18 olympic volleyball candidates were determined through interview. The athletes attained menarche significantly later than the non-athletes (p less than .001), and the olympic athletes attained menarche significantly later than the high school and college athletes (p less than .001). The high school and college athletes did not differ significantly in the mean age at menarche. When menarche in college athletes was analyzed by specific sports, the small samples of participants in golf (n = 4), volleyball (n = 7), swimming (n = 7), basketball (n = 16), and gymnastics and track (n = 6) did not differ significantly from each other in the mean age at menarche. The olympic volleyball aspirants attained menarche significantly later than all sport-specific groups (p less than .05 to p less than .001) except the gymnastics-track and tennis (n = 13) athletes. Smaller samples of non-athletes (n = 27) and college athletes (n = 21 from volleyball and basketball), plus the olympic athletes were also interviewed regarding selected menstrual characteristics. Although the athletes reported a greater incidence of dysmenorrhea and menstrual irregularity, none of the chi square values comparing the three groups was significant.

Adolescent↗
PubMed1996

Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles.

OBJECTIVE: To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly. DESIGN: Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data. PARTICIPANTS AND SETTING: A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed. MAIN OUTCOME MEASURES--Characteristics and probable cause of death. RESULTS: Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P = .01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%). CONCLUSIONS: Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.

Adolescent↗
PubMed1996

[Prevalence of hypertensive response to exercise in a group of healthy young male athletes. Relationship with left ventricular mass and prospective clinical implications].

AIM: We examined the prevalence of hypertensive response to exercise in a group of healthy young male athletes and evaluate the relationship between this exaggerated blood pressure response to exercise and left ventricular mass. METHODS: We studied 37 healthy male athletes (18 soccer players, 12 mountain climbers and 7 canoeists) at a similar level of physical conditioning at the time of the study. The age ranged from 16 to 37 (mean +/- SD: 25.9 +/- 6 yrs.). They underwent basal measurements of heart rate and blood pressure, maximum cycle ergometry in the erect position (increasing 50 W each 3 minutes until exhaustion) and basal echocardiography-Doppler. The statistical analysis was performed using a non-paired Student-t-test. RESULTS: A hypertensive response to exercise was observed in 8 of the 37 athletes (21.6%). In these 8 athletes the mean left ventricular mass index was 204.88 +/- 63.22 g/m2 estimated by echocardiography, whereas the mean in athletes without exaggerated blood pressure response to exercise was 143.29 +/- 27.51 g/m2 (p < 0.0001). All the athletes with hypertensive response to exercise showed left ventricular hypertrophy, being severe in 75% of them. Of the athletes without hypertensive response to exercise, 44.9% did not exhibit left ventricular hypertrophy. A left ventricular mass index of > or = 190 g/m2 was observed in 50% of athletes with exaggerated blood pressure response to exercise, versus only 6.8% of athletes without it. CONCLUSIONS: A fairly high prevalence of hypertensive response to exercise was observed in our series of healthy young male athletes. The athletes with exaggerated blood pressure response to exercise exhibited a significantly greater left ventricular mass than athletes without it. According to current general knowledge, this group of healthy athletes with hypertensive response to exercise could be prone to develop future chronic high blood pressure at rest and non-physiologic left ventricular hypertrophy. Thus, ergometry may be a useful test to prospectively identify a group of individuals at increased risk for developing essential arterial hypertension, potentially allowing early intervention before hypertension may contribute to cardiovascular risk.

Adolescent↗
PubMed2005

A prospective randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint in young athletes.

PURPOSE: The purpose of this study was to compare the outcomes of mosaic-type osteochondral autologous transplantation (OAT) and microfracture (MF) procedures for the treatment of the articular cartilage defects of the knee joint in young active athletes. TYPE OF STUDY: Prospective randomized clinical study. METHODS: Between 1998 and 2002, a total of 60 athletes with a mean age of 24.3 years (range, 15 to 40 years) and with a symptomatic lesion of the articular cartilage in the knee were randomized to undergo either an OAT or an MF procedure. Only those athletes playing in competitive sports at regional or national levels were included in the study. Fifty-seven athletes (95%) were available for a follow-up. There were 28 athletes in the OAT group and 29 athletes in the MF group. The mean duration of symptoms was 21.32 +/- 5.57 months and the mean follow-up was 37.1 months (range, 36 to 38 months), and none of the athletes had prior surgical interventions to the affected knee. Patients were evaluated using modified Hospital for Special Surgery (HSS) and International Cartilage Repair Society (ICRS) scores, radiograph, magnetic resonance imaging (MRI), and clinical assessment. An independent observer performed a follow-up examination after 6, 12, 24, and 36 months. At 12.4 months postoperatively, arthroscopy with biopsy for histologic evaluation was carried out. A radiologist and a pathologist, both of whom were blinded to each patient's treatment, did the radiologic and histologic evaluations. RESULTS: After 37.1 months, both groups had significant clinical improvement (P < .05). According to the modified HSS and ICRS scores, functional and objective assessment showed that 96% had excellent or good results after OAT compared with 52% for the MF procedure (P < .001). At 12, 24, and 36 months after surgery, the HSS and ICRS showed statistically significantly better results in the OAT group (P = .03; P = .006; P = .006). Younger athletes did better in both groups. No serious complications were reported. There was 1 failure in the OAT group and 9 in the MF group. The ICRS Cartilage Repair Assessment for macroscopic evaluation during arthroscopy at 12.4 months showed excellent or good repairs in 84% after OAT and in 57% after MF. Biopsy specimens were obtained from 58% of the patients and histologic evaluation of repair showed better scores (according to ICRS) for the OAT group (P < .05). MRI evaluation showed excellent or good repairs in 94% after OAT compared with 49% after MF. Twenty-six (93%) OAT patients and 15 (52%) MF patients returned to sports activities at the preinjury level at an average of 6.5 months (range, 4 to 8 months). Others showed a decline in sports activity level. CONCLUSIONS: At an average of 37.1 months (range, 36 to 38 months) follow-up, our prospective, randomized, clinical study in young active athletes under the age of 40 has shown significant superiority of OAT over MF for the repair of articular cartilage defects in the knee. We found that only 52% of MF athletes could return to sports at the preinjury level. Limitations of our study included a small number of athletes and a relatively short (3-year) follow-up. A long-term follow-up is needed to assess the durability of articular cartilage repair using these methods in young active athletes. LEVEL OF EVIDENCE: Level I, Therapeutic study, randomized controlled trial, significant difference (a).

Adolescent↗
PubMed2003

Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes.

OBJECTIVE: To evaluate symptoms and neurocognitive recovery patterns after sports-related concussion in high school and college athletes. STUDY DESIGN: College athletes (n = 371) and high school athletes (n = 183) underwent baseline neuropsychological evaluation between 1997 and 2000. Individuals who received a concussion during athletic competition (n = 54) underwent serial neuropsychologic evaluation after injury and were compared with a noninjured within-sample control group (n = 38). Main outcome measures included structured interview, four memory measures, and Concussion Symptom Scale ratings. Baseline to postinjury change scores and multiple analyses of variance were used to compare recovery curves within and between groups. RESULTS: High school athletes with concussion had prolonged memory dysfunction compared with college athletes with concussion. High school athletes performed significantly worse than age-matched control subjects at 7 days after injury (F = 2.90; P <.005). College athletes, despite having more severe in-season concussions, displayed commensurate performance with matched control subjects by day 3 after concussion. Self-report of postconcussion symptoms by student athletes was not predictive of poor performance on neuropsychologic testing. CONCLUSIONS: Caution and systematic evaluation should be undertaken before returning athletes with concussion to competition. Sole reliance on the self-report of the athlete may be inadequate. Preliminary data may suggest a more protracted recovery from concussion in high school athletes.

Adolescent↗
PubMed1999

The outcome of lumbar discectomy in elite athletes.

STUDY DESIGN: An outcomes assessment of 14 elite college athletes who had undergone lumbar disc surgery was performed using the SF-36, a validated questionnaire that assesses quality of life. OBJECTIVES: To determine the outcomes and results of lumbar disc surgery in an elite group of athletes and compare the results with those in the general population and in age-matched control subjects. SUMMARY OF BACKGROUND DATA: Lumbar disc surgery is reported to be a highly successful procedure with excellent results. The outcome in elite athletes has not been assessed and compared with population norms and age-matched control subjects. METHODS: Fourteen athletes from schools in the National Collegiate Athletic Association with a mean age of 20.7, underwent lumbar discectomy for radiculopathy refractory to conservative treatment. Ten had a single-level microdiscectomy, three a two-level microdiscectomy, and one a percutaneous discectomy. Patients were evaluated at a mean follow-up of 3.1 years, underwent a detailed clinical evaluation, and filled out the SF-36 questionnaire. RESULTS: All 14 patients had improvement of pain with elimination of the radicular component, took less medication than before surgery, and returned to recreational sports. Nine patients, all with a single level microdiscectomy, returned to varsity sports. Five athletes prematurely retired from competitive sports because of continued symptoms. Three of the athletes who retired underwent two-level procedures, and one had a percutaneous discectomy. SF-36 scores for bodily pain, physical role, and social and mental health roles were significantly lower in those athletes who retired. Patient scores were also compared with those in a group of noninjured age-and sport-matched college athletes. There were no differences between injured and noninjured athletes, but both groups had scores significantly lower than normal values in an age-matched group for bodily pain, physical role, general health, and social function. CONCLUSIONS: All patients were satisfied with their surgeries, were greatly improved, and were pain free in activities of daily living. For a single-level microdiscectomy, the success rate in elite athletes is excellent, with 90% of athletes able to return to a high level of competition. Two-level disease may be associated with a less favorable outcome.

Activities of Daily Living↗
PubMedDate not supplied

Lower-limb function among former elite male athletes.

To determine the relationship between previous lower-limb loading and current self-reported hip and knee disability, we sent a questionnaire to 1321 former elite male athletes who had represented Finland between 1920 and 1965 in international competitions and to 814 control subjects who had been classified as healthy at the age of 20. After adjustment for age, body mass index, and occupational group, the odds ratios of hip disability in the athletes compared with control subjects were 0.35 in endurance athletes (95% confidence interval, 0.14 to 0.85, P = 0.02), 0.56 in team sport athletes (0.28 to 1.10, P = 0.09), 0.30 in track and field athletes (0.12 to 0.73, P < 0.01), 0.84 in power sport athletes (0.51 to 1.39, P = 0.49), 0.30 in shooters (0.07 to 1.32, P = 0.11), and 0.54 (0.36 to 0.82, P < 0.01) in all athletes combined. Compared with control subjects, only team sport athletes had a higher risk of knee disability (odds ratio, 1.76; 95% confidence interval, 1.03 to 3.02; P = 0.04). Even though athletes have been reported to be at an increased risk for lower-limb osteoarthritis, our data show that former elite male endurance and track and field athletes and all athletes combined reported less hip disability than the control subjects. The effect of vigorous athletic activity on the function of knee joints is more controversial, because sports that involve a high risk of knee injury are likely to lead to pain, disability, and osteoarthritis.

Aged↗
PubMed2005

Prolonged effects of concussion in high school athletes.

OBJECTIVE: To identify enduring prolonged neuropsychological effects of cerebral concussion in high school youth athletes. METHODS: High school athletes (n = 223) underwent baseline neuropsychological evaluation between 1999 and 2000, assigned to independent groups on the basis of concussion history: athletes with no concussion history or present medical and/or neuropsychological complaints (n = 82), symptom-free athletes who experienced one (n = 56) or two or more (n = 45) concussions (not in the prior 6 mo), and those who experienced a concussion 1 week before testing (n = 40). Main outcome measures included a structured clinical interview, demographic form, symptom checklist, the Repeatable Battery for the Assessment of Neuropsychological Status, and the Trail Making Tests A and B. Analyses of variance were used to determine between-group differences. RESULTS: Athletes with recent concussions performed significantly worse on measures of attention and concentration than youth athletes with no concussion history. Symptom-free athletes with a history of two or more concussions performed similar on testing to youth athletes who had just experienced a recent concussion. Similarly, cumulative academic grade point averages were significantly lower not only for youth athletes with two or more previous concussion groups, but for youth athletes who experienced recent concussions, suggesting that athletes with lower grade point averages may be more prone to concussion. CONCLUSION: There seem to be subtle yet significant prolonged neuropsychological effects in youth athletes with a history of two or more previous concussions.

Adolescent↗
PubMed1994

Achilles tendon injuries in athletes.

Two-thirds of Achilles tendon injuries in competitive athletes are paratenonitis and one-fifth are insertional complaints (bursitis and insertion tendinitis). The remaining afflictions consist of pain syndromes of the myotendineal junction and tendinopathies. The majority of Achilles tendon injuries from sport occur in males, mainly because of their higher rates of participation in sport, but also with tendinopathies a gender difference is probably indicated. Athletes in running sports have a high incidence of Achilles tendon overuse injuries. About 75% of total and the majority of partial tendon ruptures are related to sports activities usually involving abrupt repetitive jumping and sprinting movements. Mechanical factors and a sedentary lifestyle play a role in the pathology of these injuries. Achilles tendon overuse injuries occur at a higher rate in older athletes than most other typical overuse injuries. Recreational athletes with a complete Achilles tendon rupture are about 15 years younger than those with other spontaneous tendon ruptures. Following surgery, about 70 to 90% of athletes have a successful comeback after Achilles tendon injury. Surgery is required in about 25% of athletes with Achilles tendon overuse injuries and the frequency of surgery increases with patient age and duration of symptoms as well as occurrence of tendinopathic changes. However, about 20% of injured athletes require a re-operation for Achilles tendon overuse injuries, and about 3 to 5% are compelled to abandon their sports career because of these injuries. Myotendineal junction pain should be treated conservatively. Partial Achilles tendon ruptures are primarily treated conservatively, although the best treatment method of chronic partial rupture seems to be surgery. Complete Achilles tendon ruptures of athletes are treated surgically, because this increases the likelihood of athletes reaching preinjury activity levels and minimises the risk of re-ruptures. Marked forefoot varus is found in athletes with Achilles tendon overuse injuries, reflecting the predisposing role of ankle joint overpronation. Athletes with the major stress in lower extremities have often a limited range of motion in the passive dorsiflexion of the ankle joint and total subtalar joint mobility, which seems to be predisposing factor for these injuries. Various predisposing transient factors are found in about one-third of athletes with Achilles tendon overuse injuries; of these, traumatic factors (mostly minor injuries) predominate. The typical histological features of chronically inflamed paratendineal tissue of the Achilles tendon are profound proliferation of loose, immature connective tissue and marked obliterative and degenerative alterations in the blood vessels. These changes cause continuing leakage of plasma proteins, which may have an important role in the pathophysiology of these injuries. The chronically inflamed paratendineal tissues of the Achilles tendon do not seem to have enough capacity to form mature connective tissue.

Achilles Tendon↗
PubMed2006

Sudden cardiac arrest in intercollegiate athletes: detailed analysis and outcomes of resuscitation in nine cases.

BACKGROUND: Public access defibrillation programs have demonstrated a survival benefit in persons with out-of-hospital cardiac arrest. However, little is known about the effectiveness of early defibrillation in young competitive athletes with sudden cardiac arrest (SCA). OBJECTIVES: The purpose of this study was to investigate the details and outcomes of resuscitation in a cohort of intercollegiate athletes with SCA. METHODS: Nine cases of SCA in intercollegiate athletes occurring between 1999 and 2005 were identified through prior research and public media. A detailed questionnaire was completed by the certified athletic trainer involved in the resuscitation, and direct phone follow-up was achieved in every case. RESULTS: Nine intercollegiate athletes with SCA (4 basketball, 2 football, 2 lacrosse, and 1 swimming) had an average age of 21 years (range 18-30 years). All 9 athletes had a witnessed collapse, 7 occurred during practice, 1 during competition, and 1 during organized weight training. Cardiopulmonary resuscitation (CPR) was initiated within 30 seconds after cardiac arrest in 6 cases and by 1 minute in 2 additional cases. An automated external defibrillator (AED) was provided by an athletic trainer in 5 cases and by arriving emergency medical services (EMS) in 4 cases. The initial cardiac rhythm was confirmed or suspected ventricular fibrillation in 7 athletes, pulseless idioventricular rhythm in 1 case, and unknown in 1 case. In 7 cases a shock was deployed, with an average time from cardiac arrest to defibrillation of 3.1 minutes (range 1-7.5 minutes). The average time from arrest to defibrillation decreased significantly if an AED was provided by an athletic trainer as compared with the responding EMS (1.6 vs 5.2 minutes; P = .046). Eight of the 9 athletes died. The underlying cause of sudden cardiac death was hypertrophic cardiomyopathy in 5, commotio cordis in 2, and myocardial infarction in 1. Diagnostic studies in the survivor demonstrated no structural heart disease or precise cause of SCA. CONCLUSION: Despite witnessed collapse, immediate CPR, and prompt AED use in most cases, early defibrillation showed limited success, and survival was less than expected in this small cohort of intercollegiate athletes. More research is needed to determine the effectiveness of early defibrillation and factors that affect survival in young athletes with SCA.

Adolescent↗
PubMed2006

Snuff use and smoking in Finnish olympic athletes.

This study aimed to assess the prevalence of smoking and snuff use in Finnish elite athletes. Of all the athletes (n = 494) financially supported by the National Olympic Committee, 446 completed a structured questionnaire (response rate 90.3 %) in 2002. A control group (n = 1504, response rate 80.2 %) comprised an age-matched sample from the population-based sample collected by the National Public Health Institute. Any smoking was reported by 11.4 % of the athletes (3.6 % daily and 7.8 % occasionally) and by 38.3 % of the controls (28.1 % and 10.2 %). After adjusting for age, sex, and education, OR (95 % CI) for any smoking was highest 0.42 (0.23 - 0.77) for athletes in skill-based events and lowest 0.06 (0.02 - 0.17) for endurance athletes as compared with controls. Snuff use was reported by 24.6 % of the athletes (9.6 % daily and 15.0 % occasionally) and by 3.7 % of the controls (1.8 % and 1.9 %). The adjusted OR (95 % CI) for any snuff use was highest 15.6 (9.55 - 25.6) for team-sport athletes and lowest 3.33 (1.54 - 7.21) for endurance athletes as compared with controls. Although snuff use in the general female population is rare, also female athletes did use snuff. Though prevalence of daily smoking among athletes was one-seventh of the respective figure for the general population, prevalence of daily snuff use was five-fold that of controls. Tobacco free elite athletes are valuable in health counselling because athletes are considered role models influencing their peers and the sport. Sport associations are challenged to ban all forms of tobacco.

Adult↗
PubMed1996

Ventricular arrhythmias and athlete's heart. Role of signal-averaged electrocardiography.

The aim of this study was to assess the prevalence and the prognostic value of ventricular late potentials in apparently healthy top-level athletes with ventricular arrhythmias, and the effect of physiological myocardial hypertrophy (athlete's heart) on the electrogenesis of the signal-averaged electrocardiogram (ECG). Two groups of asymptomatic athletes without underlying heart disease were studied: group A consisted of 35 athletes without arrhythmias and group B of 25 athletes with frequent and complex ventricular arrhythmias (ventricular ectopic beats > 5000.24 h-1 and ventricular couplets > 15.24 h-1). Late potentials were present if athletes had significantly prolonged filtered QRS and low amplitude signal duration and low root mean square voltages at both 25-250 Hz and 40-250 Hz filters. While late potentials were absent in all normal athletes of group A, they were present in seven of 25 (28%) athletes with arrhythmias of group B (P < 0.003). Ten of 25 athletes (five with and five without late potentials) of group B underwent programmed ventricular stimulation using a protocol comprising up to three extrastimuli. No episode of sustained ventricular tachycardia was induced. In four of five athletes with late potentials and in one of five without them, unsustained ventricular responses were induced. Echocardiographically determined left ventricular mass found in both groups of athletes did not influence the pathological result of the signal-averaged ECG parameters. This study shows the applicability of the signal-averaged ECG in identifying ventricular late potentials in a selected population of top-level athletes with frequent and complex ventricular arrhythmias and without overt heart disease; it also shows that the presence of late potentials is not influenced by left ventricular mass, even if extreme ( > 350 g), and it is correlated to a non-sustained ventricular response during an electrophysiological study.

Action Potentials↗
PubMed2001

Prevalence of stress and urge urinary incontinence in elite athletes and controls.

PURPOSE: The purposes of the present study were to examine the prevalence of stress and urge incontinence in female elite athletes and controls, assess a possible association between urge and stress incontinence and eating disorders, and assess a possible association between stress and urge incontinence and menstrual irregularity. METHODS: This was a two-stage study including a screening part by questionnaire and a clinical interview. Questions included in the questionnaire were related to training history, menstrual history, eating behavior, and stress and urge incontinence. DSM-IV criteria were used in the clinical part of the study to diagnose eating disorders in those classified as being at risk. The total population of female elite athletes, defined as one representing the national team for junior or senior (N = 660), and age-matched nonathlete controls (N = 765) aged 15-39 were asked to answer the questionnaire. The response rate was 87% and 75% for athletes and controls, respectively. RESULTS: Four percent of the athletes and 33% of the controls had delivered (P < 0.05). There was no significant difference in prevalence of stress urinary incontinence (SUI) in the athletes and controls, 41% and 39%, respectively. No significant difference was observed between sport groups. No difference in the frequency of urge incontinence was found when athletes (16%) and controls (19%) were compared. Twenty percent of the elite athletes and 9% of the controls met the DSM-IV criteria for eating disorder. The prevalence of SUI (49.5%) and urge incontinence (20%) in eating disordered athletes was significantly higher than in healthy athletes, 38.8% (P = 0.003) and 15% (P = 0.048). No difference in prevalence was observed when eating disordered nonathletes (39%) and healthy nonathletes (39%) were compared (P = 0.426). CONCLUSION: There is a high prevalence of stress and urge incontinence in female elite athletes. The frequency of SUI and urge incontinence was significantly higher in eating disordered athletes compared with healthy athletes.

Adolescent↗