Thomas G. Bowman

The purpose of this study was to examine walking and running biomechanics with and without the addition of a cognitive task in athletes recently diagnosed with concussions. We sought to determine if deficits remained after athletes were asymptomatic, had returned to baseline in all common clinical tests, and had been cleared for full return to sport participation. Seven collegiate athletes with recent concussions (recently concussed) and seven healthy matched controls (controls) completed testing sessions 1–3 days after unrestricted clearance (S1) and 1-week postclearance (S2). Participants completed four gait conditions: (1) walking alone (single task), (2) walking while completing simple mental tasks (dual task), (3) running single task, and (4) running dual task. Participants completed a total of eight walking trials, followed by a total of eight running trials counterbalanced between single- and dual-task conditions. Runscribe™ wearable shoe sensors (Scribe Labs, Inc.) were utilized to assess walking and running gait biomechanics. No significant interaction was found between group (recently concussed, control) and session (S1, S2) for speed (m/s), stride length (m), or step rate (steps/min) during the four gait conditions (p ≥ .34). However, several moderate to large effect sizes were observed for pairwise comparisons (−0.09 ≤ d ≤ 1.72), suggesting clinically meaningful decreased performance in the recently concussed group that would benefit from further study with larger samples.

Lacrosse has experienced significant growth in popularity worldwide and will return to the Summer Olympic Games in 2028. While there are published consensus recommendations for prehospital care of athletes with suspected spine injuries, there are currently no recommendations specific to lacrosse athletes with and without circulation, airway, or breathing (CAB) compromise. The document aims to determine evidence- and consensus-based best practices and provide implementation recommendations to guide healthcare professionals in the prehospital care of suspected spine-injured lacrosse athletes. We comprised a consensus group of 15 individuals with diverse clinical, research, and administrative experiences to ensure broad representation across lacrosse competition levels. Peer-reviewed scientific and medical research literature was systematically searched for articles on spine injury in lacrosse participants to derive evidence-based recommendations. Following a modified Delphi approach with three rounds of voting, the author panel developed ten consensus-based best practices and implementation recommendations related to the care of potentially spine-injured lacrosse athletes with and without CAB compromise. In addition, recommendations are provided to guide the implementation of key preparations before lacrosse participation, such as developing and distributing an emergency action plan, lacrosse-specific policies and procedures, and cardiopulmonary resuscitation and automated external defibrillator requirements. All recommendations obtained acceptable levels of agreeability, feasibility, and clarity from at least 80% of the panel. The recommendations provide prehospital care guidance for healthcare professionals and event organisers aimed at improving patient outcomes following suspected spine injury.

National Collegiate Athletics Association (NCAA) Division III athletes have restrictive rules on preseason practice timelines leading to questions about how performances are affected by environmental conditions during preseason practices. Purpose: The purpose was to determine how heat, humidity, core body temperature, hydration status, and reported sleep affected the performances of women’s Division III soccer players during preseason training. Methods: Ten female collegiate soccer players (age=19.5±1.43 years, mass=62.14±5.01 kg, height=167.78±7.65 cm) were recruited. Core temperature was collected every 10 minutes during practice via an ingestable thermistor. Before each training session, participants recorded the previous night's sleep quantity and quality via the Karolinska Sleep Diary (KSD). Internal and external loads were monitored via heart rate, training load session rate of perceived exertion (TL-sRPE), and Global Position System (GPS) metrics. WetBulb Globe Temperature (WBGT) was continuously recorded throughout each training session as well as participant total fluid consumption. Results: TL-RPE, Δbody mass (ΔBM), ΔWBGT and maximum HR (maxHR) explained approximately 53% of the variance in intensity (r=0.73, F4,82=23.506, P<.001). Whereas sleep metrics, session duration, and average heart rate had no significant (p>0.05) impact on intensity. Conclusion: The changes in exercise intensity observed were most associated with the perceived training load, body mass loss, heat indices, and maximum heart rate. These variables should be controlled to elicit the desired training outcome while keeping player safety at the forefront during preseason soccer.

Lacrosse is an open-field, invasion sport with limited knowledge of the physiological demands of gameplay at the Division III level. This study aimed to investigate the external loads of Division III men’s lacrosse players during NCAA season games. Comparisons were made between the external loads placed on the athletes in high competition versus those placed on the athletes in low competition matches. High competition matches were defined as matches against teams that qualified for the NCAA tournament whereas low competition matches included teams that did not meet high competition requirements. The dependent variables measured included total distance, work rate, intensity, 2D load, and 3D load. Defensive players were found to have significantly higher external load values for total distance (m; p=0.003, d=1.43), work rate (m/min; p=0.006, d=1.34), 2D load (AU; p=0.039, d=1.03), and 3D load (AU; p=0.022, d=1.15), while there were no significant differences (p>0.05) for other positions between competition level. Competition level exerts a higher external load for defensive players, but not attack, midfield, or specialists (goalie, face-off). This may indicate the need for specialized conditioning or active load management to deal with potential fatigue based on position and playing time.

Context: There is strong evidence that racial and ethnic disparities exist in multiple arenas of health and wellness. The causes of racial and ethnic differences in health care are multidimensional; one factor that may affect injury/illness communication, interactions, and outcomes is patient-provider racial and ethnic concordance. At present, it is unclear what role patient-provider racial and ethnic concordance and discordance plays in facilitating concussion care for collegiate athletes. Objective: To investigate the presence of athlete–athletic trainer (AT) racial and ethnic concordance and discordance among diagnosed concussion cases and examine if racial and ethnic concordance and discordance influences time (in days) until diagnosis, symptom resolution, or return-to-sport clinical milestones in collegiate athletes. Design: Retrospective cohort study. Setting: Collegiate athletics. Patients or Other Participants: A total of 694 concussion cases (38.6% [n = 268] sustained by women, 61.4% [n = 426] sustained by men) that occurred within the 2015–2016 through 2019–2020 sport seasons at 9 institutions. Main Outcome Measure(s): The number of days from the date of injury to diagnosis, symptom resolution, and return to sport and from the date of diagnosis to symptom resolution and return to sport. Results: Overall, 68.4% (n = 475) of concussion cases had patient-provider racial and ethnic concordance, and 31.6% (n = 219) were discordant. All concordant pairs included a White athlete and White AT. Time to diagnosis differed between the concordant and discordant groups (median [interquartile range] = 1 [0–2] versus 0 [0–1], respectively) only in the model adjusted for sex, sport type, and availability of an AT (odds ratio [95% CI] = 1.46 [1.07–1.85]). There were no other group differences. Conclusions: One-third of concussion cases had athlete-AT racial and ethnic discordance. Although this group was diagnosed with a concussion 1 day sooner than the concordant group, no differences were observed for any concussion recovery milestones. These findings suggest that patient-provider racial and ethnic concordance may play a minor role in concussion recognition or reporting but not necessarily in the management and recovery thereafter.

The athletic training and nursing professions have similar characteristics regarding workplace environment and challenges with interdependence. Professionals in both fields often face conflict with stakeholders while fulfilling their job responsibilities. Although sources and antecedents of conflict differ somewhat between the professions, the consequences of conflict are nearly identical. Job-related stress, depression and burnout, and interpersonal conflict can take a toll on clinicians’ mental and physical health. Greater efforts must be made to better prepare clinicians to diffuse and resolve conflict. Compared with athletic training, nursing has placed a greater emphasis on developing students’ conflict resolution skills in the professional curriculum. Therefore, athletic training educators and preceptors can learn from nursing education and adopt similar educational experiences for athletic training students. Providing students with tools early on can give them confidence to address conflict promptly and constructively, which may mitigate negative impacts of the conflict on patient care.

ObjectiveThe present study aimed to assess the potential influence of a diagnosis of ADHD on concussion recovery among collegiate athletes.DesignRetrospective and cross-sectional.MethodsData were extracted retrospectively from medical records across LIMBIC MATARS member institutions (n = 11), representing 1,044 concussion cases among collegiate athletes. After exclusions, 406 concussions were included in our analysis (ADHD: n = 38, age = 20.2 +/- 1.67 years, 18.4% female; No ADHD: n = 368, age = 19.8 +/- 1.39 years, 40.1% female). Mann-Whitney U tests were used to compare days from injury to diagnosis, symptom resolution, and return to sport among athletes with and without ADHD.ResultsNo differences were observed for days from concussion until diagnosis (z = -0.33, p = 0.74), until days to symptom resolution (z = -1.30, p = 0.19), or days until return to sport (z = -0.68, p = 0.49); among concussion cases with or without a previously reported diagnosis of ADHD.ConclusionOur findings further expand the literature that suggests ADHD is not strongly associated with recovery trajectory following sport concussion in collegiate athletes. Future research should extend these findings to be inclusive of additional preexisting health conditions and moderating effects related to medication usage among diverse athlete levels.

ObjectiveThe purpose of this study was to characterize the associations of international student status and native language on time (in days) with the date of injury to (i) diagnosis, (ii) symptom resolution, and (iii) return to sport.MethodsUtilizing data from a cross-sectional cohort of 1,044 concussion cases from LIMBIC MATARS member institutions (n = 11) in the US, we conducted two, matched case-control designs. Cases were divided into two groups: (i) international (n = 32) or domestic students (n = 32) and (ii) English as an Additional Language (EAL) speakers (n = 18) or Native English language speakers (n = 18). Both groups were individually matched to their respective controls based on gender, age, sport, and preexisting health conditions.ResultsThere were no significant differences in days from injury to diagnosis (p = 0.94), symptom resolution (p = 0.64), or return to sport (p = 0.15) between international and domestic athletes. EAL speakers experienced symptom resolution approximately 7.5 days sooner (Md = 4.50; IQR = 4.00, 8.00) than Native English language speakers (Md = 12.00; IQR = 7.00, 21.00, p = 0.01).ConclusionsOur findings suggest that native language is associated with symptom resolution in collegiate athletes. Healthcare professionals should consider barriers related to native language that may impact symptom reporting and the overall injury experience of diverse collegiate athletes.

Objective: The aim of this study was to investigate the association between academic adjustments and recovery from sport-related concussions (SRCs) in collegiate athletes. Materials and Methods: A retrospective medical chart review was performed between the 2015-2016 and 2019-2020 sport seasons at 11 Long-term Impact of Military-relevant Brain Injury Consortium Military and Tactical Athlete Research Study (LIMBIC MATARS) sites. Days between injury and symptom resolution, and injury and return to sport (dependent variables) for collegiate athletes who did or did not receive academic adjustments (independent variable) were analyzed using Mann-Whitney U tests. Results: The number of days between date of injury and symptom-resolution between those who did (median = 9 [interquartile range = 5,16]) and did not have (7[3,12]) academic adjustments were statistically different (z=-2.76, p < 0.01, r=-0.17). However, no differences were observed between days to return to sport among those who did (14[10,22]) and did not (13[8,20]) receive assigned academic adjustments (z= -1.66, p = 0.10, r= -.10). Conclusions: Recovery trajectories were similar between athletes diagnosed with a SRC who did or did not receive academic adjustments.. Our findings suggest academic adjustments supported recovery for those who needed academic adjustments. Clinicians and healthcare professionals should assist and support collegiate athletes after SRCs on an individual basis, including academic adjustments when appropriate based on patient presentation.

We investigated time to reach concussion diagnosis and recovery milestones in collegiate athletes relative to their schools' National Collegiate Athletic Association (NCAA) classification. We retrospectively examined 849 (43.1% female) concussion cases from 11 NCAA institutions (Division I Power 5 [n = 4], Division I Non-Power 5 [n = 4], and Division II/III [n = 3]) from the 2015-16 to 2019-20 athletic seasons. Our primary outcome measures were days to reach specific clinical milestones following concussion. Median (IQR) time from injury to diagnosis was significantly longer at Division II/III institutions (1 [0-4] days) compared to Division I Power 5 (0 [0-1] days) and Division I Non-Power 5 (0 [0-1] days) institutions (p < 0.001). Likewise, Division II/III athletes (15 [11-22] days) took significantly longer to return to sport after concussion than Division I Power 5 (10 [7-16] days) and Division I Non-Power 5 (11 [7-18.5] days) athletes (p < 0.001). Division II/III athletes had delayed concussion diagnoses and return to sport timelines compared to Division I athletes. Our results suggest that differences in sports medicine resources across NCAA divisions may influence injury recognition and recovery in collegiate athletes with concussion.