Schroeder, Allison N.

Context Musculoskeletal (MSK) diagnostic ultrasound (US) is increasingly being utilized by physicians to evaluate athletes in outpatient clinics, on the sidelines, and in athletic training facilities. Having a thorough understanding of MSK US will help athletic trainers (ATs) better assist physicians who perform MSK US. Objective To determine if a longitudinal 6-month MSK anatomy and US course would increase ATs’ ability to acquire, label, and optimize US images of normal structures and improve their overall confidence in assisting with performing US and to determine if demographic factors, work-related factors, or higher self-reported confidence was associated with better performance. Design Prospective cohort study. Setting Academic institution. Other Participants Seventeen ATs working with sports medicine physicians at 3 institutions. Interventions Longitudinal 6-month MSK anatomy and US course. Main Outcome Measures Ultrasound image scores (normal structures scored on a 5-point scale) were assessed precourse, during the course, and postcourse. Scores were compared across time points for the assessed body regions (knee, ankle/foot, shoulder, elbow/wrist/hand, and hip). Associations with demographic factors, US experience, and AT self-reported confidence were explored. Results Seventeen ATs completed the course. There was a significant difference among the average overall precourse (average: 1.34/5, range: 0/5 to 4.23/5), during-course (average = 3.53/5; range, 2.6/5 to 4.37/5), and postcourse (average = 3.83/5; range, 2.33/5 to 4.67/5) image scores [χ2(2) = 24.47, P < .001]. There was a significant positive correlation between the numbers of days (rs[17] = 0.62, P = .01) and hours (rs[17] = 0.55, P = .02) per week that the AT spent observing or performing US scanning and the postcourse overall image scores. The ATs’ confidence in identifying structures when they scan and postcourse overall image scores were marginally correlated but not significant (rs[17] = 0.47, P = .06). Conclusions A comprehensive longitudinal MSK diagnostic US course may have resulted in significant improvements in an AT’s ability to acquire, label, and optimize US images of normal MSK structures that are commonly injured by active persons.

Abstract The utilization of sports ultrasound in the clinical practice of sports medicine physicians is growing rapidly. Simultaneously, ultrasound is being increasingly implemented as a teaching tool in undergraduate medical education. However, a sports ultrasound curriculum for medical students has not been previously described. In this article, we describe methods as well as barriers to implementing a sports ultrasound curriculum at the medical school level. Recommended content for the curriculum also is discussed. While educational goals and resources will vary among institutions, this article may serve as a general roadmap for the creation of a successful curriculum.

ABSTRACT Introduction/Purpose Little is currently known regarding coronavirus disease 2019 (COVID-19) symptomatology and return to exercise, training, and fitness after COVID-19 in adult recreational athletes. The purpose of this study was to determine which COVID-19-related symptoms are associated with prolonged return to sport in U.S. triathletes. Methods This was an online survey cohort study of USA Triathlon members (104 participants). Self-reported participant demographics, comorbid conditions, symptoms, and complications experienced with COVID-19 were assessed. Time required for the athlete to return to exercise, training, and normal fitness and whether symptoms worsened upon return to training were determined. Results Survey respondents were predominantly male (average age, 44.5 ± 1.9 yr) and healthy at baseline (91.0% had no risk factors for COVID-19 and 76.9% had no potential risk factors). After COVID-19, 50% of athletes returned to exercise in <1 wk, 30% returned to training in <1 wk, and 39% returned to normal fitness in <1 month. Thirty-five athletes (33.7%) felt worse upon return to training. Return to training took >14 d in more than 50% of athletes, and only 13% took >8 wk to return to normal fitness. Fever, shortness of breath, fatigue, and headache were all associated with prolonged return to exercise, training, and fitness (all P < 0.05). Conclusions Triathletes with COVID-19 who experienced fever, shortness of breath, headache, and fatigue should be counseled that they may have a more prolonged return to exercise, training, and normal fitness compared with those with less severe symptoms.

Objectives : Assess the relationships between wet bulb globe temperature (WBGT) and physiologic equivalent temperature (PET) at the start of a northern latitude marathon and their associations with medical stress and transfers to the emergency room (ER) when the race environment is unexpectedly warm, and participants are not acclimatized. Design : Retrospective review. Setting : Twin Cities Marathon from 1990 to 2019. Participants : Runners competing in the Twin Cities Marathon. Independent variables : Start WBGT (prospectively collected) and PET (retrospectively calculated). Main Outcome Measures : Marathon race starters and finishers and race day medical data (eg, medical stress, number of medical encounters, and number of ER visits). Results : The mean WBGT was 7.4°C (range −1.7°C to 22.2°C), and the meant PET was 5.2°C (range −16.7°C to 25.9°C). PET was not determined to be a significant predictor of medical stress (P = 0.71); however, a significant quadratic association between WBGT and medical stress was found (P = 0.006). WBGT (P = 0.002), but not PET (P = 0.07), was a significant predictor of the number of ER visits. Conclusions: Start WBGT was a better predictor of medical stress and ER visits than PET at the Twin Cities Marathon over a 30-year period. The start WBGT may be a better tool to predict race day environment medical safety.

Abstract Treatment of musculoskeletal conditions in athletes with extracorporeal shockwave therapy (ESWT) is gaining popularity as greater evidence supports its use. ESWT protocols (describing energy flux density, number of impulses, type of shockwave (focused or radial), number/frequency/duration of treatment session, area of application, and postprocedural therapy protocols) can be adjusted in the clinical setting. Protocols vary across studies, and optimal protocols for most indications are yet to be determined. ESWT can safely be used to treat various musculoskeletal conditions in athletes, including rotator cuff tendinopathy, lateral elbow epicondlyopathy, greater trochanteric pain syndrome, hamstring tendinopathy, patellar tendinopathy, Achilles tendinopathy, other tendinopathies, plantar fasciopathy, bone stress injuries, and medial tibial stress syndrome. ESWT can be used to treat in-season athletes, as it often requires no/minimal time away from sport and may result in rapid benefits. ESWT should be used in conjunction with physical therapy to facilitate longer-term gains in function and to optimize healing.