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Athletic Training Student Research

2015 National Athletic Trainers' Association Annual Meeting Poster Abstracts

Shadle IB, Jacko AD, Rahman EK, Cacolice PA: Duquesne University, Pittsburgh, PA

Objective: Questions concerning the ability to prevent hamstring injuries and the potential effectiveness of prevention programs are frequently raised. The purpose of this project was to perform a critical appraisal of literature to address the question: What is the effect of eccentric exercises on hamstring strain prevention in adult male soccer players? Design and Setting: Using the PICO question as our framework the following search parameters were utilized: Population: male AND professional OR amateur AND adult AND soccer; Intervention: eccentric exercises OR strengthening AND prevention; Comparison: no intervention AND control; Outcomes: hamstring strain OR hamstring injury. The database resources searched included Pubmed, Medline, Sport Discus, ProQuest Health Management, PEDro Database, and additional resources obtained via review of reference lists and hand searches. The search enabled us to evaluate studies that looked at male soccer players and intervention programs designed to prevent hamstring strain injuries. Subjects: The selected studies investigated eccentric strengthening, exercises, or prevention programs designed for hamstring strains. Level 2 evidence or higher articles limited to English language, utilizing humans, soccer athletes, and adult males were the inclusion criteria. Any articles looking at mixed subject pool (male vs. female, adults and adolescent) and hamstring biomechanics compared to strengthening were excluded. Measurements: A review of the data found in articles that met the inclusion requirements were examined to determine if eccentric exercise reduced hamstring strain frequencies. Results: Four relevant studies were located meeting the specific criteria. After a review of the four articles, a Strength of Recommendation level of A exists that supports using eccentric strengthening to prevent hamstring strains. One article noted strength gains using eccentric hamstring training while the other three articles found a significant decrease in hamstring strains with eccentric training. Conclusion: There is robust supportive evidence that eccentric hamstring exercises can prevent a hamstring injury to an adult, male soccer player. Therefore, it is recommended that athletic trainers evaluate current practices as it relates to hamstring injury prevention and consider implementing eccentric exercise based prevention programs.

*Presented at the 2014 Pennsylvania Athletic Trainers' Society Annual Meeting (June 2014)

O'Brien D, Klein K, Wozniak N, Cacolice PA: Duquesne University, Pittsburgh, PA

Objective: As our awareness of traumatic brain injuries (TBI) in athletics has evolved, we are also beginning to develop a greater appreciation of TBI in military personnel. While the role of sleep in the management of TBI in athletics has received attention, less is understood about how TBI impacts sleep patterns in military personnel. Therefore, we elected to evaluate the question, "What effect do TBIs have upon sleep in military personnel?" The aim of our critical appraisal was to understand the effect of traumatic brain injuries (TBIs) on irregular sleep in military personnel. Design and Settings: We conducted a PICO-based search using the following parameters: Population: military, Intervention: TBIs OR concussions OR head trauma, Comparison: military AND civilian, Outcome(s): sleep OR sleep disturbance. For our search we utilized the following databases: PubMed, SportsDiscus, Google Scholar, CINAHL, ProQuest, PEDro and Cochrane Library. The resulting articles were classified according to the Level of Evidence. Subjects: Active duty military personnel and military contractors. Measurements: Inclusion factors included articles with a level of evidence 1 or 2, which primarily addressed insomnia, sleep disorders, and TBI's. Exclusion factors included non-military populations, and articles published earlier than 2011. Results: In all four of our sources, individuals with TBIs reported significantly poorer sleep quality. In fact, approximately four times as many patients with a single TBI and 10 times as many patients with multiple TBIs exceeded the threshold for clinical insomnia. Insomnia, PTSD, and pain co-occurred in 51.8% of military veterans in the studies. Conclusions: Evidence shows that TBIs continue to be prevalent in the military personnel. Furthermore, the impact of TBI on sleep worsens as individuals experience multiple TBI. Without adequate sleep following TBI, military personnel will struggle to make full recoveries. Future research efforts will need to address TBI-related sleep deficiencies in this population and how to improve their recovery.

* Presented at the 2014 Pennsylvania Athletic Trainers' Society Annual Meeting (June 2014)
^ Presented at the 2015 Eastern Athletic Trainers Association Annual Meeting (January 2015)

Powell MD, Spicher AW, Woodring SC, Cacolice PA: Duquesne University, Pittsburgh, PA

Objective: In an effort to return baseball players to full active participation following injury, restoration of throwing velocity must be considered in the rehabilitation progression. The aim of this critical appraisal topic was to evaluate the literature and its ability to address the question "what is the effect of using plyometric training to increase throwing velocity in adolescent and young adult baseball players?" Design and Study: The design of the study was a critical appraisal topic. We conducted a search of the literature using our PICO question to guide the search. The PICO-based search defined the following parameters: Population: baseball Intervention: plyometric OR ballistic resistance AND shoulder Comparison: plyometric training protocol AND control Outcomes: baseball-throwing velocity OR (baseball AND velocity). The literature was searched for articles with a level of evidence of 3 or higher. The databases searched were PubMed, Google Scholar, PEDro database, Sport Discus, and ProQuest. Additional articles were hand searched using the reference lists in previously obtained articles. Inclusion criteria for articles were English language articles within the last ten years (2004-2014), utilizing human subjects. Intervention programs using resistance band training were accepted. Exclusion criteria was any population older than college age, a mixed gender or age pool, articles utilizing weight training unless compared to plyometric training, and examination of other throwing sports besides baseball. Subjects: A total of 126 male baseball players were utilized throughout the three articles that were found. All players were within an age range of 11-21. Measurements: Pre and post testing measures of throwing velocity served as the outcome variable or dependent variable. Additionally, questionnaires speaking to overall satisfaction with the program were considered during the analysis. A plyometric or ballistic resistance training program that utilized the stretch shortening cycle was a component in each study. Results: Two high quality randomized controlled trials and one non-randomized controlled trial were identified. All three studies showed a statistically significant increase in throwing velocity after the intervention. Between the three studies, there was an increase in throwing velocity of 1.5-2.2 mph with the implementation of a plyometric training program. For the questionnaires, of all participants across the studies, only one of the subjects expressed displeasure with the training program. Conclusion: A plyometric training protocol can significantly increase throwing velocity in a baseball player. Indeed, even a simple six week training program can increase throwing velocity, which allows for practical implementation into a rehabilitation program.

* Presented at the 2014 Pennsylvania Athletic Trainers' Society Annual Meeting (June 2014) 
^ Presented at the 2015 Eastern Athletic Trainers Association Annual Meeting (January 2015)

2015 Pennsylvania Athletic Trainers' Society Annual Meeting Poster Abstracts

Alimenti AN, Fisher ET, Cacolice PA: Duquesne University, Pittsburgh, PA

Objective: To determine the effect of Blood Flow Restricted (BFR) exercises to increase strength and hypertrophy in collegiate male collision sport athletes compared to unrestricted exercises. Design and Settings: We utilized a Critically Appraised Topic design with PICO question as our framework. The following search parameters were used: Population: college AND athlete; Intervention: vascular occlusion OR blood flow restricted training; Comparison: no intervention OR control; Outcomes: increased muscle strength OR hypertrophy. The resources searched included Pubmed, Medline, PEDro Database, CINAHL, Sport Discus, and additional resources obtained via hand search. Inclusion criteria included English-only articles with level 3 evidence or higher, utilizing human, male collegiate collision sport athletes. Subjects: American collegiate football and semi-professional rugby athletes. Measurements: The use of cuffs or wraps that prevented venous return in the upper and lower extremities during resistance training programs. The outcomes consisted of changes found in strength or hypertrophy in collegiate athletes. Results: All five studies that met inclusion criteria showed an increase in maximal resistance lifted with BFR mechanisms. Three studies achieved these results using BFR training at considerably reduced training intensities. Conclusions: There is robust supportive evidence that the use of BFR training increases muscle strength and hypertrophy. Therefore, it is recommended that clinicians may implement this style of training into their athletes' workout programs.

2014 Pennsylvania Athletic Trainers' Society Annual Meeting Poster Abstracts

Greenawalt TJ, Kidder AJ, Seiner EB, Cacolice PA: Duquesne University, Pittsburgh, PA

Objective: The utilization of cold water immersion (CWI) is often debated among athletic trainers as a modality to treat delayed onset muscle soreness (DOMS). The aim of this investigation then was to conduct a critical appraisal to determine the effectiveness of CWI on reducing DOMS in an athletic population. Design and Settings: Using our PICO question as our framework, we conducted a search using these search parameters: Population: Athlete, Intervention: Cold AND (immersion OR Bath), Comparison: CWI and No treatment, Outcome: DOMS OR Muscle soreness. We utilized these terms in each of the following research databases: PubMed, PEDro database, SportDiscus, Cochrane Library, and ProQuest. Our independent variable was CWI, while the dependent variable was the level of DOMS. Inclusion criteria were English language articles with a Level of Evidence 2 or higher, adult human subjects and articles limited to the last 7 years (2007 and newer). Articles were excluded if they utilized a mixed-age pool of subjects or if the article was a Systematic Review. Subjects: Athletes and the athletic population 18 or older were studied in all selected articles. Three articles used only males, while the fourth article used a mixed sex pool of predominantly females. Measurements: All levels of DOMS were measured before exercise and at various times post-exercise. To measure the DOMS, soreness self-ratings were performed, as well as blood tests. Results: The articles we used had PEDro ratings of 4, 4, 5, and 8. All of the articles had Levels of Evidence 1b. The three articles that examined the effect of DOMS on males showed that there was a significant decrease in the level of DOMS between athletes who used CWIs and those who did not. The mixed sex investigation, which had a higher PEDro score was inconclusive as to the effect of CWI on DOMS. Conclusions: The evidence supports the use of CWI to prevent DOMS in the adult male athletic population. Additional research would be needed to conclusively assure the reduction of DOMS in female adult athletes. For that reason, the sports medicine clinician should exercise judgment on the use of CWI for female athletes.

Feild CE, Burke CA, Fields HJ, Cacolice PA: Duquesne University, Pittsburgh, PA

Objective: The effectiveness of cross education training has been debated by researchers for the last half century. The purpose of this critical appraisal (CAT) was to evaluate the clinical literature regarding cross education (CE) training and to assess its effectiveness as a treatment on immobilized limbs. Our critical appraisal addressed the question, "Does cross-education increase strength in a contralateral immobilized limb." Design & Settings: A database search was constructed using our PICO question and the following search terms. (Immobil* OR unilateral) AND (Cross education OR Cross transfer OR central facilitation) AND (strength). We conducted our search using Pubmed, CINAHL, Cochrane Library, PEDro Database, SportDiscus, and MedLine databases. English language studies on humans published in the last 15 years (1999-2014) relevant to the PICO question were included in this CAT. Studies that focused on the brain and cortex outcomes rather than neuromuscular strength measurement were excluded. Subjects: One of the four studies selected looked at 50 year old women, two additional studies looked at young adult women and the final study looked at young adult men. Two studies compared a program with electrical muscle stimulation to volitional contractions, one study measured the differences in strength transfer between dominant and non-dominant limbs, and one study only viewed the effects of a volitional training program versus no training. Measurements: The measurements that were used in the studies reviewed included peak muscle force, peak torque, muscle thickness, EMG activity, isokinetic strength, and maximal grip strength. Results: The four articles showed unanimous, statistically significant results in favor of CE as an effective treatment for patients with unilateral immobilization. Across all studies, gains were seen in either strength or torque. Positive results were also found in the studies that looked at muscle thickness and EMG activity. Conclusion: Clinicians should consider integrating CE as part of the rehabilitation process when managing patients. CE should be initiated as early as when a limb is first immobilized. The use of electrical stimulation (Russian) on the dominant side showed the strongest results. If the clinician does not have access to electrical stimulation, or if the patient is injured on their dominant side, CE has still been shown to increase strength in the affected limb. Future research on the specific neurological facilitation involved with CE would benefit the strength of recommendation of CE as a treatment strategy.