Showing papers in "Athletic Therapy Today in 2004"

Strategies for Establishing Trustworthiness in Qualitative Research

Abstract: S EVIDENCED BY the recently published qualitative studies related to athletic therapy, qualitative research has become a more prominent and accepted research paradigm. Qualitative research often seeks a depth of information and attempts to gain understanding and insight related to the meaning that individuals give to their experiences. This differs from quantitative research, which often seeks to measure one objective truth by collecting an aggregate of measurable data. Moreover, qualitative research is subjective and contextual, whereas quantitative research is objective and generalizable.1 For this reason, qualitative researchers commonly use interviews and observations to collect data. Like traditional forms of research, however, issues of quality are a concern for both qualitative researchers and practitioners. Because of the differences between qualitative and quantitative research methods, the traditional quality criteria of reliability and validity used with quantitative methods might be inappropriate for use with qualitative methods.1 In fact, qualitative researchers tend to use different terminology related to producing a “trustworthy” study. The purpose of this article is to provide an overview of strategies to ensure trustworthiness with qualitative research. To explicate how the various strategies of qualitative research differ from those quantitative studies, I will first relate them to the traditional concepts of reliability and validity but then describe how they differ. William A. Pitney, EdD, ATC/L • Northern Illinois University

“Dynamic Trendelenburg”: Single-Leg-Squat Test for Gluteus Medius Strength

Abstract: UNCTIONAL TESTING is often used to assess components of multilevel tasks. Although functional tests are used regularly, the reliability and validity of the tests are often not thoroughly investigated. The single-leg squat is one such test that is used by clinicians and has been suggested to assess general leg strength and muscle endurance.1 The single-leg squat is described with various techniques including a single-leg squat with hand support, squatting with an external load, and a lunge activity.2 No standardized method is used, and no relationship has been documented to determine what the single-leg-squat test is actually assessing. It has been suggested that the single-legsquat test can be used to assess various dysfunctions affecting the kinetic chain.3 Zeller et al. used a three-dimensional camera system to report kinematic differences between men and women performing a single-leg squat.2 They reported that women had approximately 4° more hip adduction than men did when performing the singleleg squat.2 Zeller et al. suggest that the increased hip adduction might be caused by difficulty in controlling the hip musculature resulting from a weak gluteus medius muscle.2 No information presently exists on the relationship between hip-adduction angles and gluteus medius strength. The Trendelenburg sign is a very simple test that indicates gluteus medius weakness4 and can be used to identify injuries that result from an unlevel pelvis. The injuries and disorders that can be caused by a weak gluteus medius are numerous and include torn anterior cruciate ligaments, eversion ankle sprains, shin splints, scoliosis, and other malalignment injuries up and down the kinetic chain.4,5 Novice clinicians might find it hard to iden tify a weak gluteus medius because the underlying cause of these disorders might be caused by the hip but manifest elsewhere along the kinetic chain. Maintenance of a single-leg stance is necessary during running, cutting, and decelerating activities.2 If a weak gluteus medius is present during these dynamic activities, it might be difficult to observe the pelvic drop as a clinician would during Trendelenburg’s test. A single-leg-squat test includes the static Trendelenburg position but incorporates movement into the test to make it more dynamic. It is hoped that the “dynamic Trendelenburg” can be used to identify gluteus medius weakness during more dynamic tasks than in the original Trendelenburg test. As an athlete performs a single-leg-squat test, the clinician must visually observe the task and base decisions regarding the athlete’s strength on these subjective observations. These observational practices are commonly used but are rarely put under the scrutiny of scientific examination. Previous research of a clinician’s ability to identify deviations from a normal movement pattern has yielded only low to moderate reliability.6 Thus these tests should be used with caution by clinicians when making decisions regarding athlete care. Several functional tests are available for clinicians to evaluate their athletes. In order to make sound clini

Mobility Screening for the Core

Abstract: ORE TRAINING” has gained popularity in recent years. Typical programs include a variety of abdominal training techniques, emphasizing isometrics with imposed loads through limb movement.1 Core training is used for rehabilitation and in most strength and conditioning programs. A consideration in addition to strength when designing core-training programs is core mobility. Anatomically, the core is defined as the lumbopelvic–hip complex.2 When considered as a functional unit, the core must be not only stable but also mobile to accommodate ranges of motion required for sport. A primary purpose of the core during athletic movement is to transfer momentum. The core transfers momentum from the lower extremities through the pelvis and spine to the upper extremity. A key point momentum transfer during most athletic movements, such as overhead throwing and hitting, is between the pelvis and upper torso.3,4 Rotational movement between these segments allows for an exponential increase in rotational velocity from the pelvis to the upper torso. Energy is then passed to the upper extremities and ultimately to the hand for throwing or to the implement for hitting. This process of increasingly greater rotational velocities between body segments is known as kinetic linking. Welch et al.4 describe a kinetic link as

Athletic Trainers in an Orthopedic Practice

Abstract: ATHLETIC TRAINERS at the University of Wisconsin Hospital have assisted orthopedic and primary-care sports-medicine physicians in the clinic since 1981. At the core of our success is the long-standing relationship of the certified athletic trainer and the team physician. We have extended the traditional on-the-field athletic training room model to the sports-medicine orthopedic clinic. This model has produced excellent clinic efficiency and flow and increased revenue for our hospital and physicians. Presently, the UW Health Sports Medicine Clinic has eight sportsmedicine-fellowship-trained physicians. Four of these have specialties in orthopedics, two in family medicine, and two in pediatrics. They are also the team physicians for the University of Wisconsin Athletic Department. A total of a 4.0 FTE equivalent of athletic trainers staff these clinics along with nurses, physician assistants, medical assistant, residents, and fellows. The athletic trainers are all hospital employees and are not employed by the physician group. The responsibilities of the various support staff are described in the sidebar.

Lower Extremity Functional-Performance Testing, Part 1

Abstract: © 2004 Human Kinetics • ATT 9(2), pp. 46-49 NE OF THE GREATEST clinical challenges facing athletic trainers is determining when an athlete is ready to return to functional activity. Functional-performance testing helps clinicians make these decisions. Specifically, functional-performance tests are designed to simulate, in a controlled manner, the stresses produced and imposed on the lower extremity during athletic participation. The outcome measure of a lower extremity functional-performance test is a summary variable that represents a patient’s sensorimotor function, muscle strength and power, flexibility, pain, and confidence.13 Single-leg-hop tests are a subset of lower extremity functional-performance tests. Their advantage is an ability to generate a bilateral comparison by testing each leg separately. As with all clinical measures, understanding expected outcomes (normal values) including a within-normal-limits bilateral comparison, reliability, and measurement precision is necessary to make appropriate clinical decisions. The purpose of this column, the first of three parts, is to provide a practical guide to assist with standardized implementation and interpretation of five selected single-leg-hop tests.

Mobility Screening for the Core: Interventions

Abstract: N THIS COLUMN, in the September issue, we established the importance of assessing the mobility of the core before aggressive stability or strength training. We included two functional-movement tests, the deep squat and total rotation, and associated secondary tests to identify movement deficits. In this issue we provide mobilization and exercise recommendations that can be employed to correct functional-movement deficits before participation in traditional core-training programs begins. The emphasis of this column is on functional-movement patterns for field and court sports. The purpose of the functional-movement tests is to identify abnormal movement patterns, and once they have been identified, mobilization and exercise interventions can be instituted to normalize the dysfunctional pattern. The exercise progressions are designed to be the foundation for enhancing overall core training. The intervention first focuses on the identified mobility deficit (isolation phase) and then incorporates the new motion into partial movement patterns (integration phase). Finally, the warm-up phase is designed to maintain the restored functionalmovement pattern. The isolation phase is designed to focus on the most limiting component of the movement pattern. The lack of mobility in a specific joint or in flexibility of a given muscle must be addressed before one can improve an entire movement strategy. The most limiting component is addressed through traditional joint mobilizations or muscle-flexibility activities. We prefer mobilizations with movement as described by Brian Mulligan1 and exercise techniques described by Cook2 and Cook and Voight.3 Other manual-therapy or stretching techniques familiar to athletic trainers can also be used. Once basic joint mobility and muscle length have been improved, newly gained motion will be integrated into partial movement patterns. This integration is performed through a series of self-stretches, focusing on gaining motor control of the pattern. The activities during this phase place the body in postures in which proper movement strategies are maximized. When appropriate, correction of asymmetrical movement is emphasized. Once the partial patterns of the integration phase can be performed without difficulty, the athlete is progressed to the final phase. The warm-up phase involves full-body functionalmovement patterns designed to maintain the jointmobility, muscle-length, and movement-pattern gains that have been achieved. The warm-up activities are primarily versions of the mobility screens. These activities must be performed with proper posture and positioning throughout the movement because compensatory movements will reinforce improper mechanics. These activities should be performed as part of a traditional warm-up before athletic activity or conditioning.

Using Reflective Journals in Athletic Training Clinical Education

Abstract: journal writing facilitates the linking of classroom work with clinical experiences.6 Other benefits from journals and logs include documentation of student progression and an increased ability to empathize, to develop observational skills, to learn from mistakes, and to define the meaning of a critical incident.6,7 Boud indicates that journal writing enables students to understand their own learning process, enhances creativity, enhances professional practice, and provides an alternative voice for those not good at expressing themselves verbally.4 Personal growth and development can occur through the self-expression of writing and intuition.5 Obviously, the development of students’ writing skills is also enhanced. Equally important are the less commonly recognized health benefits from stress reduction. Journal writing affords students the opportunity to release feelings and pent-up emotions. It provides a vent for frustration and anger. Stress and anxiety can be reduced. Students are afforded the opportunity of gaining a different perspective through writing about their clinical experiences.5,7 In addition, a journal or log allows students to share thoughts they might never have verbalized and to let the clinical instructor know about their learning experiences. It provides a mechanism for students to ask questions of the clinical instructor.6 Journal writing also provides a benefit to instructors by giving them insight into the personalities and needs of their students. This serves to humanize the student–faculty relationship.7 In order to maximize the learning benefits of a reflective journal for athletic training students, one S THE ABOVE QUOTES indicate, writing is an important tool for learning. Unfortunately, though, it is a commonly overlooked tool. This is particularly true in regard to athletic training clinical education. In this column I discuss using writing, specifically writing in reflective journals, as a means to enhance learning in clinical athletic training education.

Medical Care for Athletes with Hemophilia

Abstract: Hemophilia is a hereditary disease characterized by impaired coagulability of the blood resulting from either decreased production or decreased functional activity of a coagulation factor.1 The most common hereditary coagulation disorder is hemophilia A, which occurs in about 1 in every 10,000 males. This disorder results from a gene defect on the X chromosome that causes partial or complete deficiency of Factor VIII coagulant activity. Because hemophilia A is an X-linked recessive disorder, it affects males, who only have one X chromosome, and is carried by females, who sometimes show a lesser tendency to bleed, because females have two X chromosomes and the disorder is recessive. Although hemophilia A is known as an inherited disorder, nearly 30% of individuals with it have no prior family history, in which case it is most likely the result of spontaneous genetic mutation.1,2 Hemophilia B (Christmas disease) and hemophilia C (Rosenthal syndrome) involve partial or complete deficiency of Factors IX and XI, respectively. These disorders are not as common as hemophilia A, occurring in 1 in every 100,000 males.1 Clinical symptoms for both conditions include hemorrhage and hemarthrosis. Management Plan for Athletes With Hemophilia

The Safety and Efficacy of Creatine, Ephedra, and Anabolic-Steroid Precursors

Abstract: Anabolic-androgenic steroids (AASs) have been used by athletes for decades to increase lean body mass, strength, and overall athletic performance. The legal issues and dangers associated with AASs, however, have resulted in a reluctance to use them by many athletes and a search for a more natural method for improving performance. This has led to an increase in the popularity of nutritional supplements marketed as ergogenic aids. Because they are considered natural and are available without a prescription, there is a misconception that these supplements are all healthy and safe, which is not always true. Although there are numerous supplements currently marketed as ergogenic aids, the more popular ones are those containing creatine, ephedra, and AAS precursors.

Gender Dynamics in the Classroom and Clinical Education Settings, Part 1

Abstract: O NE OF THE MOST important principles of teaching and learning is effective communication. Successful teachers recognize that students learn differently and vary their methods accordingly. Conversely, the inability to communicate can hinder teaching and ultimately diminish student learning. The purpose of this column is to illustrate how an understanding of gender differences can enhance the instructor–student relationship and improve effectiveness when working with individuals of the opposite gender and to offer general strategies to enhance the experiences for both teachers and students.

Concepts in Rehabilitation of Patellofemoral Pain Syndrome

Abstract: © 2004 Human Kinetics • ATT 9(3), pp. 66-71 Patellofemoral pain syndrome (PFPS) is arguably one of the most frustrating musculoskeletal conditions a certified athletic trainer/therapist faces. Many articles have been written about the causes and treatment of PFPS, and perhaps this plethora of information adds to the frustration clinicians feel when attempting to choose from a variety of treatment options. This article presents suggestions for a clinical treatment for patellofemoral pain based on current research and theory.