Author: Mokhtar

Masculinity, optimism, and perceived stakeholder pressure influence concussion prevention intentions and behaviors in college students and athletes.

Weber Rawlins ML, Welch Bacon CE, Tomporowski P, Gay JL, Bierema L, Schmidt JD. J Am Coll Health. 2022 Sep 9:1-7. doi: 10.1080/07448481.2022.2115300. E-publishing prior to printing.

https://pubmed.ncbi.nlm.nih.gov/36084227/

Take home message

Student-athletes with a pessimistic view of concussion risk have higher intentions to report symptoms or a concussion.

Background

Doctors rely on student-athletes to report a possible concussion to ensure proper diagnosis and treatment. We can optimize education efforts to improve concussion reporting with a better understanding of the barriers to concussion reporting. Three emerging areas that may influence messaging are masculinity (qualities traditionally associated with men), optimism (thinking that bad things are less likely to happen to the person than others), and perceived pressure from stakeholders (e.g., coaches, teammates).

Study aim

Weber Rawlins and colleagues completed a survey study to determine how masculinity, optimism, and perceived pressure from others were related to reporting intentions and behavior.

Methods

Student-athletes from three universities in the southeastern US used online survey software to complete five tools that assessed key factors:

1. masculinity (winning, emotional control, risk taking, violence, power over women, playboy, self-reliance, primacy of sports and heterosexual self-presentation)
2. optimism bias
3. perceived pressure (from coaches, teammates, parents/guardians, sports medicine professionals, athlete administrators, and sports fans)
4. concussion and symptom reporting intentions (summarized as reporter or non-reporter)
5. concussion and symptom reporting behavior (summarized as reporter or non-reporter)

Results

A total of 313 respondents completed all parts of the survey, and 369 respondents completed at least one part of the survey. A student-athlete was less likely to report symptoms or a concussion if he was not a pessimist (neutral or optimist). Furthermore, they were less likely to report symptoms if they reported higher levels of masculinity in two domains: “playboy” and “heterosexual self-preservation.” In terms of intent to report concussions, someone with higher scores for “primacy of the sport” and “pressure from athletic administration” was less likely to report it.

Viewpoints

Interestingly, the most consistent result was that someone who was neutral or less likely to experience bad events than someone else was less likely to report symptoms or a concussion. Based on this finding, the authors suggest that “educational efforts should emphasize the realistic risk that student-athletes have for sustaining a concussion in sport or developing long-term health consequences as a result of that concussion.” The authors also reported predictors of reporting behavior during the previous year. These analyzes led to different results than what we reported above. One explanation is that reporting intentions and actual behavior do not match. However, it is difficult to compare these results because only 10-20% of participants had symptoms or a concussion to report (or not report) in the previous year. Therefore, the different results could be a fluke, or this subset of people may be unique to the remaining 80-90% of participants without concussions or symptoms in the previous year. It will be interesting to see if future studies with a larger group of people with symptoms or concussions in the previous year yield similar results.

Clinical implications

Clinicians should encourage timely reporting of concussions and provide realistic estimates of a student-athlete’s risk for concussion and the consequences of a concussion.

Questions for discussion

What strategies have you used to educate stakeholders about the dangers of not reporting concussions? Have you found these efforts to be successful? Why or why not?

Written by: Kyle Harris
Review by: Jeffrey Driban

related posts

Better posture can improve concussion reporting habits
Concussion knowledge is getting better, but is reporting getting worse?
Knowledge of concussions does not translate into healthy reporting habits
Differences in symptom reporting between male and female athletes before and after concussion

New research from Edith Cowan University (ECU) has shown that one type of muscle contraction is most effective at increasing muscle strength and size – and instead of lifting weights, the focus should be on lowering them.

The team, which also included researchers from Niigata University and Nishi Kyushu University in Japan and Londrina State University in Brazil, had groups of people perform three different types of dumbbell curl exercises and measured the results.

It turned out that those who only lowered a weight saw the same improvements as those who increased and decreased their weight – despite only performing half the number of repetitions.

Professor Ken Nosaka from ECU said the results reinforce previous research showing that a focus on “eccentric” muscle contractions – where activated muscles are lengthened – is more important for increasing the strength and size of muscles, rather than volume.

“We already know that just one eccentric muscle contraction per day can increase muscle strength if performed five days a week – even if it only lasts three seconds per day – but concentric (lifting a weight) or isometric muscle contraction (holding a weight) does not produce such an effect,” said Professor Nosaka.

“This latest study shows that we can be much more efficient in the time we spend training and still see significant results by focusing on eccentric muscle contractions.

“In the case of a dumbbell curl, many people may believe that the lifting action provides the most benefit, or at least some benefit, but we found that concentric muscle contractions contributed little to the training effects.”

Crunching the numbers

The study consisted of three groups that performed dumbbell curls twice a week for five weeks, plus a control group that did nothing.

Of the training groups, one group performed exclusively eccentric muscle contractions (lowering weight), another performed exclusively concentric muscle contractions (lifting weight), and another performed both concentric and eccentric muscle contractions (alternating lifting and lowering weight).

All three saw improvements in concentric strength, but this was the only improvement for the concentric-only group.

The eccentric-only and concentric-eccentric groups also saw significant improvements in isometric (static) strength and eccentric strength.

Most interestingly, despite the eccentric-only group doing half as many reps as those who lifted and lowered weights, the gains in strength were very similar and the eccentric-only group also saw greater improvement in muscle thickness , an indicator of muscle hypertrophy: 7.2 percent compared to the 5.4 percent of the concentric-eccentric group.

“Understanding the benefits of eccentric training can allow people to spend their time exercising more efficiently,” said Professor Nosaka.

“With the small amount of daily exercise needed to see results, people don’t necessarily need to go to the gym — they can incorporate eccentric exercises into their daily routine.”

Putting it into practice

So how can we use this knowledge in the gym?

When using a barbell, Professor Nosaka recommends using two hands to assist with the concentric phase (lifting weight), before using one arm for the eccentric phase (lowering weight), when performing:

• Biceps curls
• Overhead extension
• Front elevation
• Shoulder press

Using leg weight machines, Professor Nosaka recommends using the same concentric/eccentric technique when performing:

• Knee extensions
• Leg curls
• Calf goes up

Taking care of bodies in the home

Luckily, Professor Nosaka says you don’t need gym weights to apply the same principles to a workout and has come up with some simple exercises you can do at home.

During the exercises, feel the contracting muscles being gradually stretched from the beginning to the end of the range of motion.

After each eccentric muscle contraction, minimize the effort to return to the starting position (i.e. concentric muscle contraction).

Repeat 10 times for each exercise.

Chair sitting: From a semi-squat position, slowly sit down on a chair for three seconds (narrower and wider positions will create different effects). If this becomes easy, try sitting with one leg.

Chair recline: Sit on the front of a chair to create space between your back and the backrest and slowly lean back for three seconds (arms can be crossed on the chest or held at the back of the head).

Uneven squat: Stand behind a chair, lean to one side to put more weight on one leg, then squat down for three seconds.

Heel down: Still behind a chair, lean forward and lift your heels. Then lift one leg off the ground and lower the heel of the other leg for three seconds.

Wall kiss: Lean against a wall with both arms fully extended. Slowly bend the elbow joint for three seconds until your face comes close to the wall.

Forward lunge: Place one leg in front of the other and bend the knees deeper for three seconds.

‘Comparison between concentric only, eccentric only and concentric-eccentric resistance training of the elbow flexors for their effects on muscle strength and hypertrophy’ was published in the European Journal of Applied Physiology.

Early psychological symptoms predict concussion recovery time in middle and high school athletes.

[ PMC gratis artikel ][ PubMed ]Wilmoth K, Tan A, Tarkenton T, Rossetti HC, Hynan LS, Didehbani N, Miller SM, Bell KR, Cullum CM. J Clin Exp Neuropsychol. 2022 May;44(4):251-257. doi: 10.1080/13803395.2022.2118676. Epub 8 Sep 2022. PMID:36073744.

Full text not freely available

Take home message

Middle and high school athletes who reported more concussion symptoms and sleep problems, as well as post-traumatic memory loss, were more likely to have long-term recovery than peers without these concerns. Additionally, depressive symptoms can help identify men at risk for a prolonged recovery.

Background

Recovery from a concussion is quite variable. Therefore, determining risk factors for long-term recovery is essential to provide appropriate patient care to reduce this risk. Several risk factors for prolonged post-injury recovery have been identified (e.g., emotional symptoms, sleep disturbances). However, these factors have not been well established in college athletes.

Study aim

The authors analyzed clinical data from middle and high school athletes to investigate whether post-concussion psychological factors and sleep symptoms predict long-term recovery.

Methods

The authors recruited 393 high school students (~15 years old; 45% female) to complete 3 surveys within 14 days of injury (~6 days of injury), which is part of a larger study through Con Tex. completed the 3 questionnaires during their clinical evaluation: 1. 7-item Generalized Anxiety Disorder Scale (GAD-7), which screened for anxiety; 2. The eight-item patient questionnaire (PHQ-8) to assess whether depression is present; and 3. The Pittsburg Sleep Quality Index (PSQI) to evaluate sleep quality. The authors located the provider’s documented date of symptom resolution through a medical record review.

Results

A total of 17% (n=66) needed more than 30 days to recover. The authors found that post-traumatic memory loss, worse concussion scores, and poorer sleep quality predicted longer concussion recovery. In women, only more severe concussion symptoms predicted longer recovery. In men, on the other hand, greater depression and post-traumatic memory loss are related to long-term recovery.

Viewpoints

Someone with more severe symptoms or poor sleep quality within the first two weeks after a concussion may have a greater chance of long-term recovery from the concussion. However, the authors found that there were different predictors when they looked at sex. Women with greater symptom severity were more likely to have a long recovery. At the same time, men were more likely to have a long recovery if they had worse depression symptoms or post-traumatic memory loss. It is worth noting that although sleep, anxiety and depressive symptoms were predictive factors, the overall scores were low, indicating that they were unlikely to experience high levels of anxiety, depression or sleep disturbance.

Clinical implications

Medical professionals should screen patients after a concussion for signs of anxiety, depression, or sleep disturbance, because even subtle signs can increase the likelihood of long-term recovery. These assessments can help identify problems early and lead to a more targeted concussion plan.

Questions for discussion

Have you noticed any specific predictors associated with your athlete’s recovery? How do you incorporate concussion risk into your concussion education/management/basic protocol?

related posts

1. Wake-up call for collegiate athletes’ sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness
2. A few more hours of sleep, my baseline for your athletes
3. Typical versus prolonged recovery time and predictors after concussion in high school and college athletes
4. In patients who report persistent symptoms after a concussion, groups of symptoms occur together

Written by: Jane McDevitt
Review by: Jeffrey Driban

Although the popularity of professional women’s football has increased in many countries, highlighted by England’s recent victory at the 2022 UEFA European Women’s Football Championships, the technology and equipment are still largely designed for men’s football. Strikingly, a recent study found only 32 published scientific articles on technology in women’s football.

Kat Okholm Kryger and colleagues – including England women’s national football team captain Leah Williamson – asked ten questions to highlight the minimal progress that has been made in elite women’s football technology, and the barriers that still exist to tailor-made making equipment available to female players. The authors discuss why tailor-made technology for female footballers is necessary and highlight that although women have different physical needs than men, equipment such as football boots and balls are still designed for men rather than women. These issues can both increase the risk of injury from ill-fitting shoes, and reduce performance due to the proportionately greater effort required to kick the ball compared to men.

Additionally, the authors report that many female soccer players feel uncomfortable wearing soccer shorts (which are typically white) due to concerns about possible menstrual leaks. Professional female footballers are also often required to wear specific sports bras provided by kit sponsors, rather than the optimal sports bra for their body type. This can also reduce performance and lead to discomfort while running and turning.

The authors note that manufacturers are recognizing the lack of development in women’s football technology and that there is a positive shift towards women-specific products. However, progress is limited by the lack of existing research, and concerted efforts are needed to address key gaps in understanding the needs of female footballers.

The influence of therapeutic exercises after an ankle sprain on the occurrence of subsequent knee, hip and lumbar spine injuries

Foster KS, Greenlee TA, Fraser JJ, Young JL, Rhon DI. Medicine and science in sport and exercise. August 2022. doi: 10.1249/MSS.0000000000003035.
https://pubmed.ncbi.nlm.nih.gov/36084225/

Take home message

Performing therapeutic exercises after an ankle sprain reduces the chance of a knee, hip, or lumbar spine injury in the following year.

Background

Ankle sprains are the most common injury, especially among active individuals. However, not everyone receives care, which can contribute to chronic ankle instability and limitations in lower extremity movement, including instability and reduced sensorimotor function. These limitations can increase a person’s risk for later injury to other joints in the lower extremities. However, we have little evidence to support or refute this hypothesis.

Study aim

The authors evaluated the rate of secondary injuries after an ankle sprain and whether therapeutic exercises after an ankle sprain reduced the risk of future injuries to the knee, hip and lumbar spine.

Methods

The authors conducted a retrospective cohort study within the military health care system. They used diagnostic and billing codes to identify individuals who sought care for an ankle sprain between 2010 and 2011, regardless of whether or not they received therapeutic exercise within 90 days of the injury and whether or not they subsequently suffered an injury to the knee, hip, or suffered a knee injury. lumbar spine within one year of the ankle injury.

Results

Twenty percent of the subjects (6,848) were diagnosed with a proximal joint injury. Most of these were knee and lumbar spine injuries. Only 28% of all individuals received therapeutic exercises for their initial ankle sprain. Individuals who received therapeutic exercise were ~13%, ~18%, and ~32% less likely than their peers without exercise to sustain a knee, lumbar spine, or hip injury at any time during the year after an ankle sprain.

Viewpoints

Individuals may suffer a secondary injury after an initial ankle sprain due to decreased mobility, strength and muscle activation. Only 8% of total costs for ankle sprains go toward physical therapy, but those who do not seek care are more likely to report decreased function and develop chronic ankle instability. Ankle sprains are often thought of as minor injuries, which may explain the lack of care or referral for therapeutic exercises. However, physical rehabilitation after an injury can improve ankle range of motion, pain, gait, balance and stability. It is therefore obvious that this would have a positive influence on the risk of future injuries. It would have been helpful to know who made the initial diagnosis and how their background/training influenced referral to therapeutic exercise.

Clinical implications

We need to be more proactive in educating healthcare professionals about the need to refer people to physical rehabilitation after an ankle sprain. They need to recognize that this is not a minor injury and that one in five people will suffer an injury to the knee, hip or lumbar spine within a year of an initial ankle sprain, which is already the most common sports injury.

Questions for discussion

Have you encountered the perception among patients that ankle sprains are minor, and if so, how have you explained the problem to them? Conversely, how would you change the way you explain ankle sprains to patients, even if they seem minor?

related posts

1. Nothing to fear except the fear of themselves in people with chronic ankle instability
2. Ankle sprains are over-treated and under-rehabilitated
3. Chronic ankle instability starts earlier than we thought

Written by Jennifer Xu
Reviewed by Jeffrey Driban