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1.  ASSOCIATIONS BETWEEN THE FEMALE ATHLETE TRIAD AND INJURY AMONG HIGH SCHOOL RUNNERS 
Purpose/Background:
During the 2013‐14 school year, over 763,000 female athletes participated in interscholastic running sports in the United States. Recent studies have indicated associations between the female athlete triad (Triad) and stress fracture or other musculoskeletal injuries in elite or collegiate female running populations. Little is known about these relationships in an adolescent interscholastic running population. The purpose of this study was to determine the associations between Triad and risk of lower extremity musculoskeletal injury among adolescent runners.
Methods:
Eighty‐nine female athletes competing in interscholastic cross‐country and track in southern California were followed, prospectively. The runners were monitored throughout their respective sport season for lower extremity musculoskeletal injuries. Data collected included daily injury reports, Eating Disorder Examination Questionnaire (EDE‐Q) that assessed disordered eating attitudes/behaviors, a questionnaire on menstrual history and demographic characteristics, a dual‐energy x‐ray absorptiometry scan that measured whole‐body bone mineral density (BMD) and body composition (lean tissue and fat mass), and anthropometric measurements.
Results:
Thirty‐eight runners (42.7%) incurred at least one lower extremity musculoskeletal injury. In the BMD Z‐score ≤ ‐1 standard deviation (SD) adjusted model, low BMD relative to age (BMD Z‐score of ≤ ‐1SD) was significantly associated (Odds Ratio [OR]=4.6, 95% confidence interval [CI]: 1.5‐13.3) with an increased occurrence of musculoskeletal injury during the interscholastic sport season. In the BMD Z‐score ≤ ‐2 SDs adjusted model, a history of oligo/amenorrhea was significantly associated (OR=4.1, 95% CI: 1.2‐13.5) with increased musculoskeletal injury occurrence.
Conclusion:
Oligo/amenorrhea and low BMD were associated with musculoskeletal injuries among the female interscholastic cross‐country and track runners.
Clinical Relevance:
Regular, close monitoring of adolescent female runners during seasonal and off‐season training may be warranted, so that potential problems can be recognized and addressed promptly in order to minimize the risk of running injury.
Level Of Evidence:
2
PMCID: PMC4275199  PMID: 25540710
Adolescent runners; bone mineral density; disordered eating; females; menstrual dysfunction; musculoskeletal injuries
2.  OFF‐SEASON TRAINING HABITS AND PRESEASON FUNCTIONAL TEST MEASURES OF DIVISION III COLLEGIATE ATHLETES: A DESCRIPTIVE REPORT 
Purpose/Background:
Division III (D III) collegiate coaches are challenged to assess athletic readiness and condition their athletes during the preseason. However, there are few reports on off‐season training habits and normative data of functional assessment tests among D III athletes. The purpose of this study was to examine off‐season training habits of D III athletes and their relationships to the standing long jump (SLJ) and single‐leg hop (SLH) tests.
Methods:
One‐hundred and ninety‐three athletes (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to the start of their sports seasons. Athletes reported their off‐season training habits (weightlifting, cardiovascular exercise, plyometric exercise, and scrimmage) during the six weeks prior to the preseason. Athletes also performed three maximal effort SLJs and three SLHs.
Results:
Male athletes reported training more hours per exercise category than their female counterparts. Mean SLJ distances (normalized to height) were 0.79 ± 0.10 for females and 0.94 ± 0.12 for males. Mean SLH distances for female athletes' right and left limbs were 0.66 (± 0.10) and 0.65 (± 0.10), respectively. Mean SLH distances for male athletes' right and left limbs were 0.75 (± 0.13) and 0.75 (± 0.12), respectively. Several significant differences between off‐season training habits and functional test measures were found for both sexes: males [SLJ and weightlifting (p = 0.04); SLH and weightlifting (p = 0.04), plyometrics (p = 0.05)]; females [SLJ and plyometrics (p = 0.04); SLH and scrimmage (p = 0.02)].
Conclusion:
This study provides normative data for off‐season training habits and preseason functional test measures in a D III athlete population. Greater SLJ and SLH measures were associated with increased time during off‐season training.
Clinical Relevance:
The findings between functional tests and off‐season training activities may be useful for sports medicine professionals and strength coaches when designing their preseason training programs.
Level of Evidence:
4
PMCID: PMC4127507  PMID: 25133073
college; field test; functional test; single‐leg hop; standing long jump
3.  LOWER EXTREMITY FUNCTIONAL TESTS AND RISK OF INJURY IN DIVISION III COLLEGIATE ATHLETES 
Purpose/Background:
Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single‐leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time‐loss sports‐related low back or lower extremity injury.
Methods:
A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury.
Results:
Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time‐loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side‐to‐side asymmetry between SLH distances had a 4‐fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3‐fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury.
Conclusions:
The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population.
Clinical Relevance:
The single‐leg hop for distance and the lower extremity functional test, when administered to Division III athletes during the preseason, may help identify those at risk for a time‐loss low back or lower extremity injury.
Level of Evidence:
2
PMCID: PMC3679628  PMID: 23772338
epidemiology; functional test; single‐leg hop; lower extremity functional test
4.  SHOULDER RANGE OF MOTION, PITCH COUNT, AND INJURIES AMONG INTERSCHOLASTIC FEMALE SOFTBALL PITCHERS: A DESCRIPTIVE STUDY 
Background/Purpose:
Injury rates for softball players are similar to baseball players yet information regarding risk factors, pitching, and physical characteristics for high school windmill softball pitchers is limited. This information is needed to guide prevention, training, and rehabilitation efforts. The purpose of this study was to report descriptive data regarding the physical characteristics and pitching volume experienced by high school softball pitchers during one academic season. A secondary aim was to track and describe upper extremity injuries suffered by high school softball pitchers throughout the course of the 2009 season.
Methods:
Twelve uninjured female softball pitchers (13‐18y) from 5 Greenville, South Carolina high schools participated. Prior to the 2009 season, the pitchers' shoulder internal, external, total arc of rotation and horizontal adduction PROM was measured. During the 10‐week season, aggregate pitch counts (pitch volume) and occurrence of upper extremity injury were tracked for each pitcher.
Results:
Mean preseason internal, external, and total arc of rotation PROM was observed to be similar between the pitchers' dominant and non‐dominant shoulders. The PROM measures of horizontal abduction (HA) appear to demonstrate a side‐to‐side difference with less HA on the dominant arm of the pitchers who were examined. Subjects threw in an average of 10.1 games (±4.9) during the season. Six pitchers threw in 60% or more of the team's games and 3 of 12 pitchers pitched less than 25% of games. Pitchers averaged 61.8 pitches per game (±31.5) and 745.8 (±506.4) per season. Pitch count data did not appear to be different between injured and non‐injured pitchers.
Conclusions:
Knowledge of pitch volume can be used to prepare windmill softball pitchers for the seasonal stresses, guide establishment of goals when recovering from injury, or assist in training for an upcoming season. Further research is needed to examine larger samples of pitchers over multiple seasons and years.
Level of Evidence:
III
PMCID: PMC3474308  PMID: 23091788
Pitch count; shoulder; softball
5.  THE RELATIONSHIP BETWEEN ISOTONIC PLANTAR FLEXOR ENDURANCE, NAVICULAR DROP, AND EXERCISE-RELATED LEG PAIN IN A COHORT OF COLLEGIATE CROSS-COUNTRY RUNNERS 
Purpose:
The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP).
Background:
Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries.
Methods:
Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP.
Results:
While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2–38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1–48.9) more likely to develop an in-season occurrence of ERLP.
Conclusion:
While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP.
Level of Evidence:
2b.
PMCID: PMC3362985  PMID: 22666641
exercise related leg pain; medial tibial stress syndrome; running; shin splints
6.  DIFFERENCES IN DYNAMIC BALANCE SCORES IN ONE SPORT VERSUS MULTIPLE SPORT HIGH SCHOOL ATHLETES 
Purpose/Background:
Researchers have previously reported on the importance of dynamic balance in assessing an individual's risk for injury during sport. However, to date there is no research on whether multiple sport participation affects dynamic balance ability. Therefore, the purpose of this study was to determine if there was a difference in dynamic balance scores in high school athletes that competed in one sport only as compared athletes who competed in multiple sports, as tested by the Lower Quarter Y Balance Test (YBT-LQ).
Methods:
Ninety-two high school athletes who participated in one sport were matched, by age, gender and sport played, to athletes who participated in the same sport as well as additional sports. All individuals were assessed using the YBT-LQ to examine differences in composite reach score and reach direction asymmetry between single sport and multiple sport athletes. The greatest reach distance of three trials in each reach direction for right and left lower-extremities was normalized by limb length and used for analysis. A two-way ANOVA (gender x number of sports played) was used to statistically analyze the variables in the study.
Results:
No significant interactions or main effects related to number of sports played were observed for any YBT-LQ score (p>0.05). Male athletes exhibited significantly greater normalized reach values for the posteromedial, posterolateral, and composite reach while also exhibiting a larger anterior reach difference when compared to the females. Athletes who participated in multiple sports had similar performances on the YBT-LQ when compared to athletes who participated in a single sport.
Conclusions:
The findings of this study suggest that the number of sports played by a high school athlete does not need to be controlled for when evaluating dynamic balance with the YBT-LQ.
PMCID: PMC3325637  PMID: 22530189
Lower Quarter Y Balance Test; Pre-Participation testing; Multiple-sport athlete

Results 1-6 (6)