tntramuscular temperature changes

8/7/2019 Tntramuscular Temperature Changes

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t n t r a m u s c u l a r T e m p e r a t u r e C h a n g e sI n R es p on s e T o P os t - E xerc i s eA p p l i ca t i on O f T w o C o l d M od a l i t i e sHomuth J , t l emmer J , Covass in T , Powel lJ : Un ive r s i ty o f Texas , Ar l ing ton , TX;Grand Va l ley S ta te Un ive r s i ty , A l lenda le ,M I; Mich igan S ta te Un ive r s i ty , Eas tL a n s i n g , M tC o n t e x t : Sports injur ies occur when themusculature is warm; however, most researchexamining the effect of cold modalities has beenc o n d u c t e d o n r e s t i n g , n o n - w a r m e dtissues,Therefore, determining which coldmoda l i ty dec reases in t ramuscu la r t i s suetemperature of warmed tissue will contribute tothe athletic trainer's knowledge on how to besttreat an injured athlete and allow them to retumto play quicker. Object ive: To determinechanges in pos t -exe rc i se in t ramuscu la rtemperature in response to ice bag or ice massagetherapy. Design: Random ized, control trial witha repeated measures crossover design. Setting:Re,search laboratory. Participants: Eighteenhealthy volunteens (age=23,060,45 yrs, height= 171,49+1,69cm,mass=73,06+2,2l kg),

ven t i on s : The independent variables weretreatment (control, 1,0 kg crushed ice pack, or 12oz ice massage) and time (30 second intervals).Intramuscular temperature was measured duringa 5-minute pre-exereise condition, a 2-minutepost-exercise baseline condition, and 20 minutesof modality treatment. Exercise was a 10-minutebout of aerobic treadmill exereise. During thetreatment phase, an ice pack or massage ice cupwas applied to the posterior aspect of the leftt r i ceps su rae . Add i t iona l ly , in t r amuscu la rtemperature was recorded during a 30-minutere-warming period without treatment. Lastly,intramuscular temperature was recorded for 50minutes during a non-cold m odality, control trial.Main Outconie Measures: Left triceps suraeintramuscular temperature measured 1 c m belowthe subcutaneous adipose layer, A repeatedmeasures ANOVA was used to com pare the threetreatments across m ultiple times for each subjectwith paired t-tests and pairwise comparisonsused for post hoc analysis. Results: Both coldmodalities decreased intramuscular temperaturewhen compared to the control condition. Icemassa ge reduced intram uscular temperature fix)m36,76 0,22C to 26,40 + 1,43 C (p < 0,001)

and crushed iced ftx)m 37,06 0,22C to 29,79 1,18C, During re-warming, intramusculartemperature continued to decline for 7 and 3minutes for the crushed ice pack and ice massag econditions, respectively. This was followed bya significant increase in temperattire that re main edlower than the resting intramuscular tem peraturefor ice massage (35,07 0,12 vs , 30,45+0,48C,p< 0,001) and crushed ice (35,13 0,20 vs,30 ,62 + 0 ,47C , p< 0 ,001) , In t ramuscu la rtemperature during the control trial was lowerthan ice massage and crushed iced (35,06 0,15vs 30,45 +0,48 and 30,62+ 0,47 C, respectively,p < 0,001 both). Ice massage showed a greaterrate of re-warming when compared to the icepack trial. Conclusions: After 20 minutes ofco ld moda l i ty , bo th cond i t ions dec reasedintramuscular temperature when compared tothe control condition. How ever, the ice massageshowed a greater ra te of cooling, a lowerintrarhuscular temperature, and a greater mte ofre-warming when compared to the ice bag.

Free Communications, Poster Presentations: Mild Traumatic Brain InjuryThursday, June 18,2009,1 :00PM-5 :00PM, Park View Lobby, Concourse Level; authors present 4:00PM-5 :00PMT h e C u m u l a t i ve E f f ec t s O fS u b c o n c u s s i v e H e a d I m p a c t s O nC l i n i ca l M e as u r es O f C on cu s s i onI n Y ou t h I ce H ock ey P l ayersMiha l ik JP , Gusk iewicz K M: Un ive r s i tyo f Nor th Caro l ina , Chape l H i l l , NC

Context: Sport-related concussions are amongthe most difficult injuries to manage in athletics.There is very little known about the effects ofrepeated head trauma in this young population.As novels methods of measuring biomechanicalcharacteristics of head impacts emerge, we areable to better understand the potential cumulativeeffects of subco ncussive forees in this age group.Objective: To study the effects of subconc ussivehead impacts on neurocognidve inction, posturalstability, and symptomatology in youth icehockey players. We hypothesized that therewould be no measurable declines in clinicalmeasures of concussion as a result of playerparticipation. Des ign: Prospective repeatedmeasures design. Setting: Research laboratoryand field. Patients or Other Participants: Aconvenient sam ple of 34 male ice hockey players(age= 13,570,59 years; height= 165,03+9,01 cm;mass=55,32l 1,49 kg; experience=6,712,28years) selected from two ice hockey teams.I n t e r v e n t i o n s : All c l in ica l measures o fconcussion were evaluated prior to the start ofthe season and repeated following the completionof the season. The Immediate Postconcussion

Assessment and Cognit ive Test ( ImPACT),Balance Error Scoring System (BESS), and 22-item Postconcussion Symptom Scale (PCSS),were used to evaluate neurocognidve fiinction,postural stability, and symptomatology. Headimpact data were collected during all game s andpractices over the course of the hockey seasonfrom six single-axis accelerometers embedd ed inReebok RBK helmets using the Head ImpactTelemetry System, The clinical measures ofconcussion have all been previously shown tobe rel iable and val id . Separate analyses ofcovar iance (ANCOVA) were employed toinvestigate the differences in postseason testing(POST) reladve to preseason baseline testing(PRE), The number of head impacts sustainedby each player over the course of the season,and the number of head impacts greater than60g, were used as covariates for these analyses.M ai n O u t com e M eas u res : Neurocognit ivescores from ImPA CT included compo site indicesof verbal memory, visual memory, visuomotorprocessing speed, and reacdon dme. Total numberof errors on the BESS and PCSS total symptomseverity score were also measured. Results:There were no significant differences in verbalm e m o r y ( P R E = 7 9 , 8 2 1 5 , 2 2 ; P O S T =8 2 , 7 6 1 2 , 0 l ; f = 0 , 3 5 2 ) , v i s u a l m e m o r y( P R E = 7 4 ,6 1 + 1 3 , 9 7 ; P 0 S T = 7 1 , 7 2 + 1 3 , 9 3 ;^=0,451) , or any of the other neurocognitiveou tcomes (P>0 ,05) , Pos tu ra l s t ab i l i ty( P R E = 15,31+4,43; P O S T = 1 5 , 5 0 + 4 , 7 5 ; P=

0 ,771) and to ta l symptom sever i ty sco re(PRE=4,32+6,43; POST=4,328,70; P=O,9I6)did not differ across the playing season. Thetotal number of head impac ts (median=371 ) andthe total number of severe head impacts greaterthan 60g (median=8) sustained over the courseof the season were not stadstically significantcovariates in any of our analyses. Conclusions:Repeated subconcussive head impacts sustainedover the course of a season do not appear toaffect neu rocognidve funcdon, postural stability,or symptomato logy in youth ice hockey players.Certified athletic trainers should continue tomana ge reported injuries using objecdve clinicalmeasures of concussion.

S ex D i f f eren ces I n B a l an ceP e r f o r m a n c e P r i o r T o A n d A c u t e l yF o l l o w i n g S p o r t s -R e l a t e d C o n c u s s i o nRegis te r -Miha l ik JK , Miha l ik JP ,Gusk iewicz KM: Unive r s i ty o f Nor thCaro l ina a t Chape l H i l l , Chape l H i l l , NC

Context: Ambiguity exists concerning true sexdifferences on clinical measures of concussion atbaseline and following injury. Balance assessm entis a commonly used clinical measure and littleevidence exists on sex differences related to thisclinical measu re of concussion. Objective: Thepurpose of this study was to exam ine differencesin balance perfonnance between males and

Journa l o f A th le t i c T ra in ing S -91


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females prior to and acutely following sports-related concussion in collegiate athletes usingdynamic posturography. t)esign: A prospectiveexperimental study design was used. Setting:Sports Medicine Reseaith Laboratory Patientsor Other Participants: Collegiate athletes wh ocompleted a pre-season and an acute post-injuryb a l a n c e a s s e s s me n t ( N = I O 8 ; ma l e s = 7 5 ;females=33) participated in the study (age= 18.83+1.27 years, height= 180.95+10.01 cm,mass= 83.29 19.63 kg). Only athletes issessedat pre-season baseline and within 3 days of injurywere included in the study (1.52+0.96 days topost-injury ev aluation). Interventions: Athleteswe re stratified as either m ale or fem ale bLsed onse l f - r epo r t on a p re - season base l inequestionnaire. A separate mixed mod el, repeatedmeasures analysis of variance was used toexamine each outcome measure. Main OutcomeM e a s u r e s : Senso ry Organ iza t ion Tes t(NeuroCom International) Composite Score,which represents overall balance performanceand the Vest ibular (VEST), Somatosensory(SOM), and Visual (VIS) Ratio scores .served a.soutcome measures . Results: There was nodifference (F,,^ =0.010; P=0.920) in overallcomposite balance performance between males(77.630.96) and females (77.80+1.45). Nosignificant interaction was found between sexand test-time (F,,,^ ,=0.029; P=0.865) for overallbalance performance. A significant main effecto f t e s t - t ime was obse rv ed (F^ ,^ |= I 7 .4 2 ;f


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motor .speed (I-VMS), reaction time (I-RT),impulse control (I-IC), and total symptom.s (I-TS). After completion of both tests, the subjects'scores were entered into SPSS 15.0 and analyzedusing the significance level of 0.05. Pearsoncorrelations were conducted between the SACc o mp o n e n t s a n d t h e I mPA CF" c o mp o s i t escores. In addition, multiple linear regressionswere performed to evaluate how well the collectionof the SAC components predicted each of theI mPA CT c o mp o s i t e s c o r e s . R e s u l t s :Pearson correlations revealed three significantrelationships between SAC components andtm P A C F " composite scores; S-DR and 1-VER[ r ( 3 2 ) = 0 . 3 6 2 , p = 0 . 0 4 2 ] , S - C a n d I - V M S[r(32)=0.563, p=0.001], S-C and 1-RT [r(32)=-0.377, p=0.034]. According to multiple linearreg re s s ion ou tpu t , combina t ions o f SACcomponents did not have the ability to predicti m P A C T ^ " c o m p o s i t e s c o r e s , p > 0 . 0 5 .Conc lus ions : Other than subtle similaritiesbetween the tests, this data suggests that theSA C a n d I mPA CT^ " p r o v i d e u n i q u econtributions to the understanding of cognitiveproces.ses. Therefore, athletic trainers shouldconsider using both the SAC andtests .

T t i e P r e va l e nc e O f C onc us s i ons A ndM u s c u l os t ie l e t a l I n j ur i e s A nd A c c e s sT o A pp r opr i a t e M e d i c a l C a r e A t E l i t eT a e k w o n d o T o u r n a m e n t s I n T h eR e publ i c O f K or e aFi fe GP, Har te r RA: Oregon Sta teUn ive r s i ty , Corva l l i s , ORContext: In the Olympic sport of taekwondo,high velocity kicks to the head are integral aspectsof toumam ent competition. Little is known aboutthe number o f concuss ions sus ta ined byparticipants, the type and availability of sportsmed ic ine ca re , and the a s se s smen t andmanagement protocols used to evaluate theseverity of concussions reported to medicalpersonnel. Objectives: To determine the numberand seve r i ty o f concuss ions and o the rmuscu loske le t a l i n ju r i e s sus ta ined wh i l eparticipating in full contact taekwondo sparringtournaments and to evaluate athletes' access toand perceptions of the m edical services providedat these e l i te tournaments . Des ign: Cross -sectional survey. Setting: Questionnaires wereadmini.stered to participants in elite taekwondotournaments in South Korea, specifically, the41 '" Taekw ondo National President's Cup in 2006and the 30" ' Korean Na t iona l Co l l eg ia t eTaekwondo Championships in 2007. Patientsor O ttier Participants: 256 World TaekwondoFederation certified black belt athletes ( 183 males,73 females) of Korean nationality [age (mean +SD) = 19.2 + 2.5 yrs, years of experience = 8.8+ 3.4 yrs, number of taekwondo tournamentsentered in las t 5 years = 23.7 + 13.9] .

Interventions: This investigation used a 28-question, paper-and-pencil Korean languagequestionnaire. Responses included dichotomous"yes" or "no" answers with follow-up questionssoliciting the nu mbero f concussions experienced,the duration of tinie lost following injury, andconcussion evaluation methods employed byattending medical personnel. Four Likert-scalequest ions were included to gauge a thle tes 'perceptions concerning the medical servicesprovided. Main Outcome M easures: We usednonpa rame t r i c f r equency ana lys i s andde.scriptive statistics to identify a medic al historyof concussion and/or concussion symptoms.Taekwondo athletes were also asked to indicatewhether they had sustained any of 7 differentcategories of musculoskeletal injury duringtou rnamen t compe t i t ion , e .g . , f r ac tu re ,dislocation, sprain. Results: 14 of 256 athletessurveyed (5.5% ) reported that they had sustaineda concussion during a taekwondo toumament,with 6 subjects (2.3%) indicating that they wered i squa l i f i ed f rom fu r the r tou rnamen tparticipation due to concussion. In contrast, 100of these black belt comp etitors (39.1 %) indicatedthat they experienced concussion symptomsafter a blow to the head or a fall during toumam entcompetition. With regard to musculoskeletalinjuries, 154athletes (60.2%) sustained 4 or morecategories of injury, with 80 (51.9%) of theseinjuries being so severe as to warrant toum amen tdi.squalification. Only 34.8 % of taekwond otoumament par t ic ipants surveyed agreed ors trongly agreed that medical s ta t ions wereacce.ssible at toumaments, while 32.8% thoughtthat medical personnel were readily available.Conclusions: While only 5.5% of taekwondoathletes surveyed had sustained a concussion,nearly 40 % experienced concussion sym ptomsas a result of toumament participation. None ofthe competi tors who susta ined concussionsunderwent formal post-concussion assessmentof .symptoms to grade the severity of their braininjury. This study funded by an UndergraduateResearch Innovation, Scho larship and Creativitygrant.

C ogn i t i ve A nd B at ane e P e r f or m anc eD ur i ng A S i ng l e T as k A nd A D ua l T as kIn Pt iys i cat ly Act ive Young Adul t sRoss LM, Reg i s t e r -Miha l ik JK, Miha l ikJP , Sh ie lds EW, Pren t i ce WE, Gusk iewiczKM: Un ive r s i ty o f Nor th Ca ro l ina ,Ch a p e l Hill, N CContext: Recent evidence sugge.sts deficienciesin the abi l i ty to spl i t a t tent ion fol lowingconcussion. Few studies have examined the roleo f sp l i t t i ng a t t en t ion in the concuss ionassessment paradigm. Objective: To examinethe effects of a dual task paradigm on proceduralreaction time and balance performance in healthycollege-aged participants. Design: Two dual-

t a sk pa rad igms were pe r fo rmed in acounterbalanced, repeated-measures design. Eachparadigm included a balance and a cognitive task.Setting: Sports medicine research laboratory.Patients or Other Pa rticipants: Thirty healthy,recreationally active college students including14 males and 16 females (age= 20.43 1.33 years;height= 173.449.28 cm; m ass=79.03 19.28 kg).Interventions: Subjects perfomied balance andcognitive tasks under a single task ;uid a dual taskcondition during two separate counterbalancedte.st sessions conducte d 14 day s ap;m. A validatedshortened version of the procedural reaction timete s t (PRT) f rom the Au toma ted Neuro -psychological Assessment Metr ics , and anadapted auditory procedural reaction time task(APRT), was used to assess cogni t ion. TheNeuroCom Sensory Organization Test (SOT)and the Balance Error Scoring System (BESS)assessed balance performance. For the dual tasks,the PRT was used during eyes open conditionson the SOT, and the APRT was used for eyesclosed conditions of the SOT and during theBESS. Main Outcome Measures: The SOTequilibrium score, the B ES S total error score, theave rage accu racy on the APRT, and thethroughput score from the PRT served as themiiin outcome measures for the .study. Results:On the SOT, overal l balance performances ign i f i can t ly improved be tween the f i r s t(80.33+4.96) and second (84.984.52) sessions(F , 25=35.695, P


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P o s t - C o n c u s s i v e S e l f - R e p o r tS y m p t o m s I n C o l l e g e S t u d e n t sPi l and SG, Gould TE: Univer s i ty ofS ou t he r n M i s s i s s i pp i , H a t t i e sbu r g , M SContext: Baseline assessments of concussionmeasures are recommended practice within theathletic population. This method allows directcomparisons to post-injury data and serves tofacilitate safer retum-to-play (RTP) decisions.However , t he conste l l a t ion of se l f - r epor tsymptoms (SRS) associated with concussioncan be exp erienced independent of brain injury.Thus , it must not be assumed that pre-injuryresponses to concussion-related symp tom scalesshould approximate a nul l score, nor shouldoverly elevated response scores be ignored. Tot h i s end , t ho r ough cha r ac t e r i za t i on andunder s t anding of potent i a l ly inf luent i a lconditions to baseline symptom scores across awide range of act ive populat ions should beobtained to provide clinicians the best possibleinformation towards making RTP decisions.Object ive: The purpose of this study was tocharacter ize SRS post-concussive symptoms

(PCS) in a sample (N=500) of healthy college-aged individuals. Design: A prospective, cross-sectional design involving a single testing session.Sett ing: Data was col lected in a laboratorylocated at a southeastem Division I institution.Patients or Other Part icipants: The groupwas comprised of heal thy, physical ly act ivevo l un t ee r s t uden t s ( m a l e n= 267 , age=21.812.77, females n=233, age=21.40+2.51 )majoring in a human performance discipline.Intervent ions : Test subjects were providedi n f o r m ed consen t i n acco r dance w i t h

I Irequirements from the involved institution. Eachsubject completed a health history questionnaireand the duration and severity components ofthe Head Injury Scale-revised (HlS-r). MainOutcome Measures: Frequency and descriptivereports along with two Mann-Whitney U teststo evaluate influences of previous history ofconcussion (yes/no) on mean composite HIS-r(duration and severity) .scores were performed.Resul t s : Over 70% of the sample repor tedexperiencing at least I P CS and '31.4% reportedexperiencing 3 or more PC S over the evaluated24-hour period. The most common PCS reported

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was drowsiness followed by fatigue, headache,sleepin g difficulty; difficulty conc entrating , feeling".slowed down", nausea, difficulty balancing andfeeling "in a fog]'. Twenty three pereent of thesample (n =i 15) reported having a prior historyof" concussion. Com posite scores de.scribing theduration (lengthl expe rienced o ver a 24-hourperiod) and|sevejity of PCS were significiuitlyhigher in the gt 'oup repor t ing a history ofconcussion compjared to those with no history(U=18688, p>.o4 U=18363, p>.05, respective-ly). Conclusions: Obtaining and interpretingbaseline and post-injury (follow-up) respon.sesto summative self-report symptom .scales is arecommended and vital part of the multi-facetedapproach to injury assessment. Therefore it isnecessary to characterize PCS ba.se-rates andexplore potent ial inf luencing var iables. Ourfin'dings, similar to those found in athletes, suggestthat both sport and non-sporting populationsreport a constellation of PCS at baseline and aprevious history of concussion increases SRSreporting.

Free Commemicat ioes , Poster Presemitatioes: Sex Dffereiices iThursday, June 18,2009,1 :00PM-5 : 00PM. Park View Lobby, Concourse Level'; authors present 4:00PM-5 :00PMS ex D i f f eren ces I n F ron t a l - P l an eK i n en i a t i c s A n d K i n e t i c s O f T h eK n e e A n d H i p D u r i n g R u n n i n g A n dR a p i d C h a n g e - O f - D i r e c t i o n T a s k sG ol den G M , P avo l M J , H of f m an M A :Oregon Sta t e Univer s i ty , Corval l i s , OR,and Univer s i ty of Cal i fornia , LosA nge l e s , C AContext: The disproport ionate incidence ofnon-contact anterior cruciate ligament (ACL)injuries in females remains perplexing. Frontal-plane knee kinematics and kinetics have beenimpl i ca t ed in ACL injury r i sk and, whi l ecorresponding sex differences exist for sidestepcut t ing (SSC), the SSC may not be ent i relyrepresentative of the rapid change-ot-directiontasks associated with AC L injury. Ob jective :To identify differences in frontal-plane k nee andhip kinematics and kinetics between sexes andtasks for var iat ions of the SSC maneuver .Design: Mixed-factor, sex-by-task design, withr epea t ed - m easu r e s f o r t a sk . S et t i n g : Abiomechanics laboratory. Patients or OtherParticipants: Twenty-one healthy collegiatebasketball and soccer players participated in asingle testing session (females n= 11:19.81 .5yrs;m a l e s n= 1 0 : 20 . 7+ 2 . 5y r s ) . I n t erven t i on s :Participants performed 10 trials each of straight-ahead mnning (RUN), right lateral false step (LFS,3 0% body height), left SSC (45 from the pathof travel), and LFS and SSC in combination( L F S + S S C ) , a ll a t 3 . 5+ 0 . 2 m s ' . T h r ee -

dimensional knee and hip angles and intemalmoments were obtained for the r ight lowerextremity. A body-f ixed f lexion-abduct ionfextemal rotation sequ ence by the distal segme ntwas assumed. Peak values were determinedbetween foot contact and 30 of knee flexion Iduring stance and averaged across trials. MainOutcome M easures: Sex- and task-differences LF S amplifies the| effects of a SSC. The more

abduction angles and adduction moments at theknee dur ing ear ly s t ance , accompanied bydecreased l i i p adduct ion angles , a pat t ernconsistent with increased ACL loading. A LFSappears to produce effects similar to a SSC onfrontal-plane knee and hip kinematics andkirietics, whereas prefacing a SSC by an opposing

in peak knee abduct ion angle (KABDa), hipadduct ion angle (HADDa) , knee adduct ionmoment (KAD Dm), and hip abduct ion moment(HABDm) were identified using ANOVA withpos t hoc T ukey ' s H S D ana l y s i s ( a= 0 . 05 ) ;Results: There was a main effect of condition(p < 0.001) on peak KABDa (RUN 3.6+0.5L F S 5 . 6 0 . 5 , S S C 6 . 1 o ' . 5 , L F S - S S G7.10.53 ) , KADDm (RUN: (3.1+0.1, LFS:|1.2+0.2, SSC: 2 .0+0.2 , LFS+ 'SSC: 3.90.1!%bw bh) , HADDa (RUN: 7 .30.5 , LFS '-7.9+0.8, SS C -5.7+0.9, LFS-SSC -16.6+0.8)|and HABDm (RUN: 5.5+0.5, LFS: 5.8+0.8]SSC: 4.3+0.8, LFS+SSC : 2.7+0.8 j%bw bh). PeakKAB Da and K AD Dm were greater for all threechange-of-direction tasks than foriRUN (p


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tntramuscular temperature changes

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