Laryngeal fracture in a high school football player

Laryngeal injuries are rare in the athletic setting, but such sports as football, basketball, and hockey often place the athlete in a position to receive blunt trauma to the throat area. Such an injury has the potential of developing into a life-threatening situation. A high school athlete sustained a fractured larynx during a football game. The injury required surgical repair. Unfortunately, because this type of injury is uncommon in sports, many athletic training books do not extensively address soft tissue and cartilaginous injuries to the structures of the anterior neck. Athletic trainers must be able to recognize the signs and symptoms of a laryngeal injury and refer the athlete for immediate medical attention.     

Fracture through the distal femoral epiphysis

Injuries to the distal femoral epiphysis are not common, but when they do occur, at least half of them occur in sports. Many athletic trainers work with skeletally immature athletes, thereby increasing the likelihood that they will face this type of injury. The case of a 14-year-old football player who sustained a Salter-Harris III fracture of his medial femoral condyle is presented to illustrate the classic natural history and prognosis of this injury. To properly evaluate this injury, the athletic trainer must understand the anatomy of the immature skeleton and be able to recognize signs that epiphyseal injury has occurred. These injuries frequently result in long-term complications such as leg-length discrepancy, although this and other complications can be minimized or eliminated through proper immediate treatment. Athletic trainers must be aware of these injuries and include them in their differential evaluation, since immediate treatment can mean the difference between permanent leg-length discrepancy or deformity and an uncomplicated recovery with the athlete returning to full athletic activity.     

National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

Objective:

To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete.

Background:

The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment.

Recommendations:

Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.     

Principles of Liability for Athletic Trainers: Managing Sport-Related Concussion

OBJECTIVE: To provide an overview of the general legal principles of negligence for sports medicine professionals and apply these principles to situations involving athletes with head injury. DATA SOURCES: Case law dating back to 1976 and recent studies of sport-related concussion. SUMMARY: One of the most difficult problems facing athletic trainers and team physicians is the recognition and treatment of sport-related concussion. Providing medical clearance for sports participation and treatment of athletic injuries involves legal as well as medical issues. The threat of lawsuits exists for the sports medicine professional, whether the athlete is allowed to play or not. In general, established medical malpractice principles govern claims by athletes for injury or death caused by improper treatment by health care providers. The elements of negligence are examined, as well as the primary defenses an athletic trainer would use in court and risk management techniques to avoid litigation. CONCLUSIONS/RECOMMENDATIONS: Athletic trainers may protect themselves from liability by including standardized cognitive or postural stability testing in preparticipation examinations, using objective tests rather than subjective judgement to evaluate athletes who have sport-related concussion, working closely with physicians, and keeping excellent records.     

Classification of Sport-Related Head Trauma: A Spectrum of Mild to Severe Injury

OBJECTIVE: To identify the types of injuries the human brain incurs as a result of traumatic forces applied to the cranium. In athletic events and endeavors, the full spectrum of intracranial hemorrhages in various compartments, raised intracranial pressure, and diffuse nonhemorrhagic damage may be seen. In this review, we describe these serious injuries and the more common mild traumatic brain injury in their clinical presentations and relate concussion classification to the overall picture of traumatic brain injury. METHODS: Our cumulative experience with athletic injuries, both at the catastrophic and mild traumatic brain injury levels, has led us to a management paradigm that serves to guide us in the classification and treatment of these athletes. DISCUSSION: The occurrence of intracranial injuries in sports has now been well documented. Intracranial hematomas (epidural, subdural, and parenchymal) and cerebral contusions can result from head injury. Many patients sustain a diffuse brain injury, resulting in elevated intracranial pressures, without a blood clot or mass lesion. The classification of concussion and the use of concussion guidelines are not uniform. However, the major emphases are agreed upon: the close and careful scrutiny of the athlete, an expeditious but reliable neurologic examination, and proper on-field management. Return-to-play decisions are based on many factors that affect normal functioning, both on and off the playing field. CONCLUSIONS: Sufficient knowledge now exists to allow us to carefully evaluate the injured athlete, to place him or her in the management scheme to minimize the potential for permanent cerebral dysfunction, and to know when the athlete can safely return to contact sport participation.     

Traumatic Hemarthrosis of the Knee Secondary to Hemophilia A in a Collegiate Soccer Player: A Case Report

OBJECTIVE: To present the case of a collegiate soccer player who suffered from a traumatic knee hemarthrosis secondary to hemophilia A. This case presents an opportunity to discuss the participation status of athletes with hemophilia. BACKGROUND: Hemophilia is a hereditary blood disease characterized by impaired coagulability of the blood. Hemophilia A is the most common of the severe, inherited bleeding disorders. This type, also called classic hemophilia, is due to a deficiency of clotting factor VIII. The athlete with hemophilia A reported pain and loss of function of his knee during a soccer game despite the absence of injury. DIFFERENTIAL DIAGNOSIS: Anterior cruciate ligament tear, intra-articular fracture, meniscus tear, capsular tear, hemarthrosis. TREATMENT: After the injury, the athlete was admitted to the hospital, where his knee joint was aspirated and he was infused with factor VIII. Later, he participated in traditional knee rehabilitation and was returned to play at the discretion of the orthopaedist and the hematologist. UNIQUENESS: In past participation guidelines, individuals with bleeding disorders were disqualified from athletic participation; however, with advances in medical care, these individuals may be permitted to participate in accordance with the law. CONCLUSIONS: Individuals with hemophilia participate in athletics; therefore, team physicians and athletic trainers must be prepared to care for these individuals.     

Dental Injuries in Intermediate and High School Athletes: A 15-Year Study at Punahou School

OBJECTIVE: To determine the rate, type, and severity of dental injuries recorded for intermediate and high school interscholastic athletic participants. DESIGN AND SETTING: A longitudinal study (1988-2003) of intermediate and high school athletes utilizing the same certified athletic trainers to evaluate and record all injury data. SUBJECTS: Sports participation included 123 teams in 19 female, 18 male, and 2 coed sports. Of 2445 Punahou School intermediate and high school students, on average, 1340 students (623 females, 717 males) annually participated in interscholastic athletics. MEASUREMENTS: Dental injuries were defined as injuries to the jaw, teeth, and oral soft tissue (lip, mouth, cheek, and tongue). Soft tissue injuries requiring physician or dentist referral were recorded. Other soft tissue injuries were treated as skin abrasions and were not recorded. Actual days lost from activity were recorded. The estimated injury rate was determined (injuries/1000 athlete-sessions). Mouth-guard use was recorded. RESULTS: During the 15-year study, 19 492 injuries were reported, with 56 (0.2%) recorded as dental injuries (23 tooth, 20 jaw, and 13 soft tissue). Injury rates were highest for girls' wrestling (0.243, confidence interval = 0-2.3), boys' judo (0.189, confidence interval = 0-3.6), and boys' soccer (0.127, confidence interval = 0.4-1.4). The football injury rate was 0.029 (confidence interval = 0.04-0.29), with no tooth injuries. CONCLUSIONS: The incidence and injury rate of dental injuries was extremely low for all reported sports. A universal definition of dental injuries must be established to facilitate injury data collection and analysis.     

Subsequent injury patterns in girls' high school sports

CONTEXT: Girls' participation in high school sports has increased 79.5% since 1975-1976. The incidence of injury among boys in high school sports has been well documented, but information regarding the incidence, severity, and type of injury among girls in high school sports is limited. OBJECTIVE: To examine the effects of subsequent injuries among high school girls in 5 sports. DESIGN: Observational cohort.Setting: Existing data from the 1995-1997 National Athletic Trainers' Association High School Injury Surveillance database. PATIENTS OR OTHER PARTICIPANTS: Girl athletes (n = 25 187 player-seasons) participating in 5 varsity high school sports: basketball, field hockey, soccer, softball, and volleyball. MAIN OUTCOME MEASURE(S): Injury status, body location, injury type, time lost from injury, and number of players at risk for injury as recorded by athletic trainers and submitted to the Sports Injury Monitoring System. RESULTS: Overall, 23.3% of the athletes had 2 or more injuries within a sport; basketball and soccer athletes were most vulnerable. Overall, the probability of an athlete sustaining 3 or more injuries was 38.6%, and the risk was highest for field hockey players (61.9%). The risk of subsequent injury at a new body location was almost 2 times higher than reinjury at the same body location (risk ratio = 1.7, 95% confidence interval = 1.6, 1.8) and was similar for all sports except volleyball. Only in softball was the proportion of reinjuries causing 8 or more days lost from participation greater than the proportion of new injuries causing similar time loss. Softball and volleyball had the highest proportion of reinjuries at the shoulder, especially rotator cuff strains. The proportion of knee reinjuries was significantly higher than new injuries for all sports except soccer. The proportion of anterior cruciate ligament injuries was significantly higher for volleyball players only. Overall, the proportion of reinjuries was significantly higher for stress fractures and musculoskeletal condition injuries. CONCLUSIONS: Patterns of subsequent injury risk appear to vary among these 5 sports. Almost one quarter of the athletes incurred 2 or more injuries over a 3-year period, so the effects of subsequent injuries deserve more consideration.     

Discrepancies in perceptions held by injured athletes and athletic trainers during the initial injury evaluation

Fifty injured athletes and six athletic trainers participated in this study, the purpose of which was to determine whether perceptions held by the athlete were similar to the perceptions of the athletic trainer during the initial evaluation. We developed a questionnaire to examine six areas: the athlete's understanding of the injury and the rehabilitation program, objective elements, the athlete's frame of reference, type of communication, short-term objectives and long-term goals, and the development of a rehabilitation strategy. A Cohen's kappa was used to determine interrater agreement/disagreement. Fifty-two percent of the athletes reported that they did not understand the rehabilitation process associated with their injury. There were significant discrepancies between the perceptions held by the athlete and the athletic trainer for items in all but one of the six areas examined—the objective elements of the evaluation. It appears that a significant level of miscommunication occurred between the athlete and the athletic trainer during the initial injury evaluation. Athletic trainers need to develop better communication skills so that athletes can gain a better understanding of their injuries and requirements for rehabilitation.     

National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses

OBJECTIVE: To present recommendations for the prevention, recognition, and treatment of exertional heat illnesses and to describe the relevant physiology of thermoregulation. BACKGROUND: Certified athletic trainers evaluate and treat heat-related injuries during athletic activity in "safe" and high-risk environments. While the recognition of heat illness has improved, the subtle signs and symptoms associated with heat illness are often overlooked, resulting in more serious problems for affected athletes. The recommendations presented here provide athletic trainers and allied health providers with an integrated scientific and practical approach to the prevention, recognition, and treatment of heat illnesses. These recommendations can be modified based on the environmental conditions of the site, the specific sport, and individual considerations to maximize safety and performance. RECOMMENDATIONS: Certified athletic trainers and other allied health providers should use these recommendations to establish on-site emergency plans for their venues and athletes. The primary goal of athlete safety is addressed through the prevention and recognition of heat-related illnesses and a well-developed plan to evaluate and treat affected athletes. Even with a heat-illness prevention plan that includes medical screening, acclimatization, conditioning, environmental monitoring, and suitable practice adjustments, heat illness can and does occur. Athletic trainers and other allied health providers must be prepared to respond in an expedient manner to alleviate symptoms and minimize morbidity and mortality.     

Catastrophic Head Injuries in High School and Collegiate Sports

OBJECTIVE: To describe the incidence of catastrophic head injuries in a variety of high school and college sports. DESIGN AND SETTING: Data on catastrophic head injuries were compiled in a national surveillance system maintained by the National Center for Catastrophic Sports Injury Research. The data were compiled with the assistance of coaches, athletic trainers, athletic directors, executive officers of state and national athletic organizations, a national newspaper clipping service, professional associates of the researchers, and national sport organizations. SUBJECTS: Data included all high school and college athletic programs in the United States. MEASUREMENTS: Background information on the athlete (age, height, weight, experience, previous injury, etc), accident information, immediate and postaccident medical care, type of injury, and equipment involved. Autopsy reports were used when available. RESULTS: A football-related fatality has occurred every year from 1945 through 1999, except for 1990. Head-related deaths accounted for 69% of football fatalities, cervical spinal injuries for 16.3%, and other injuries for 14.7%. High school football produced the greatest number of football head-related deaths. From 1984 through 1999, 69 football head-related injuries resulted in permanent disability. Sixty-three of the injuries were associated with high school football and 6 with college football. Although football has received the most attention, other sports have also been associated with head-related deaths and permanent disability injuries. From 1982 through 1999, 20 deaths and 19 permanent disability injuries occurred in a variety of sports. Track and field, baseball, and cheerleading had the highest incidence of these catastrophic injuries. Three deaths and 3 injuries resulting in permanent disability have occurred in female participants. CONCLUSIONS/RECOMMENDATIONS: Reliable data collection systems and continual analysis of the data can help us to reduce the number of catastrophic head-related injuries. I include additional recommendations for injury prevention.     

Self-reported comfort in athletic training of gender-specific and non-gender-specific injuries and issues

Context: To assist athletes in maintaining optimal health, athletic trainers must work with athletes of both sexes.Objective: To examine athletic trainers'' comfort levels in providing care for gender-specific and non-gender-specific injuries and issues.Design: We mailed 235 Gender Comfort in Athletic Training Questionnaires to program directors, who were asked to distribute and collect them.Setting: We randomly selected 21 athletic training education program directors and invited them by e-mail to participate in the study. Fourteen program directors representing the 10 National Athletic Trainers'' Association districts agreed to participate.Patients or Other Participants: A total of 192 participants returned completed questionnaires, for a response rate of 82% (103 women, 89 men; 101 senior athletic training students, 91 certified athletic trainers).Main Outcome Measure(s): The questionnaire consisted of 17 injuries and issues common to both female and male athlete scenarios. Three gender-specific items were added to each scenario. Responses were scored on a 5-point scale anchored by 1 (very uncomfortable) and 5 (very comfortable). Participants were asked to indicate the reason for any degree of discomfort. Internal consistency, determined by the Cronbach alpha, was .92 for the female athlete scenario and .93 for the male athlete scenario.Results: We found significant differences between women and men certified athletic trainers for the female and male athlete scenarios. Overall, women were more comfortable caring for female injuries and issues, whereas men were more comfortable caring for male injuries and issues. Certified athletic trainers reported more comfort overall than athletic training students. The most common underlying reason reported for discomfort in caring for female and male injuries and issues was experience level.Conclusions: Athletic training education programs should provide early and more deliberate experiences with injuries and issues of a more intimate nature, including those that are gender specific and non-gender specific. These experiences may increase athletic trainers'' level of comfort in providing care to athletes of the opposite sex.     

Sex Differences and the Incidence of Concussions Among Collegiate Athletes

OBJECTIVE: To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997-1998, 1998-1999, and 1999-2000 seasons. DESIGN AND SETTING: A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997-2000 academic years. SUBJECTS: Collegiate athletes participating in men's and women's soccer, lacrosse, basketball, softball, baseball, and gymnastics. MEASUREMENTS: Certified athletic trainers from participating NCAA institutions recorded weekly injury and athlete-exposure data from the first day of preseason practice to the final postseason game. Injury rates and incidence density ratios were computed. Incidence density ratio is an estimate of the relative risk based on injury rates per 1000 athlete-exposures. RESULTS: Of 14 591 reported injuries, 5.9% were classified as concussions. During the 3-year study, female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) concussions during games, compared with male athletes, who sustained 148 (5.2%) concussions during practices and 254 (6.4%) concussions during games. Chi-square analysis revealed significant differences between male and female soccer players (chi(2)(1) = 12.99, P =.05) and basketball players (chi(2)(1) = 5.14, P =.05). CONCLUSIONS: Female athletes sustained a higher percentage of concussions during games than male athletes. Of all the sports, women's soccer and men's lacrosse were found to have the highest injury rate of concussions. Incidence density ratio was greatest for male and female soccer players.     

An epidemiologic comparison of high school sports injuries sustained in practice and competition

CONTEXT: More than 7 million US high school students play sports. OBJECTIVE: To compare practice and competition injury rates and patterns in 5 boys' sports (football, soccer, basketball, wrestling, and baseball) and 4 girls' sports (soccer, volleyball, basketball, and softball) during the 2005-2006 school year. DESIGN: Prospective injury surveillance study. SETTING: Injury data were collected from 100 nationally representative United States high schools via High School RIO (Reporting Information Online). PATIENTS OR OTHER PARTICIPANTS: Athletes from participating high schools injured while participating in a school-sanctioned practice or competition in one of the above sports. MAIN OUTCOME MEASURE(S): Practice and competition injury rates, body site, diagnosis, and severity. RESULTS: High school athletes participating in these 9 sports at participating schools sustained 4350 injuries during the 2005-2006 school year, which corresponds to an estimated 1 442 533 injuries nationally. The rate of injury per 1000 athlete-exposures was higher in competition (4.63) than in practice (1.69) (rate ratio [RR] = 2.73, 95% confidence interval [CI] = 2.58, 2.90). Of all sports, football had the highest competition (12.09) and practice (2.54) injury rates per 1000 athlete-exposures. Compared with injuries sustained during practice, higher proportions of competition injuries were head/face/neck injuries (proportion ratio [PR] = 1.61, 95% CI = 1.34, 1.94), particularly in boys' soccer (PR = 7.74, 95% CI = 2.53, 23.65) and girls' basketball (PR = 6.03, 95% CI = 2.39, 15.22). Competition injuries were more likely to be concussions (PR = 2.02, 95% CI = 1.56, 2.62), especially in boys' soccer (PR = 6.94, 95% CI = 2.01, 23.95) and girls' basketball (PR = 5.83, 95% CI = 2.06, 16.49). Higher proportions of competition injuries caused the athlete to miss more than 3 weeks of play (PR = 1.28, 95% CI = 1.08, 1.52), particularly in baseball (PR = 3.47, 95% CI = 1.48, 8.11) and volleyball (PR = 2.88, 95% CI = 1.01, 8.24). CONCLUSIONS: Rates and patterns of high school sport injuries differed between practice and competition. Providing athletic trainers with this information is a crucial step in developing the targeted, evidence-based interventions required to effectively reduce injury rates among the millions of high school student-athletes.     

Hypopituitarism after multiple concussions: a retrospective case study in an adolescent male

OBJECTIVE: To describe the development of hypopituitarism in an adolescent athlete after multiple concussions and to raise awareness among sports medicine clinicians concerning the growing concern of hypopituitarism in concussion injury surveillance and management. BACKGROUND: A 14-year-old, previously healthy male athlete suffered 4 head traumas over a 4-month period. The first 3 traumas were considered by the athlete to be minor and were not reported to medical personnel. The fourth trauma was a medically diagnosed concussion suffered during soccer play. Over the next year, the patient noted a decline in strength and conditioning and a failure to grow. DIFFERENTIAL DIAGNOSIS: After physical examination and a full battery of endocrine tests, the patient, then 16.5 years old, was diagnosed with hypopituitarism. Follow-up interviews provided evidence that at least 2 of the 3 head injuries suffered before the last concussion could also be considered concussions, which may have contributed to the severity of the last head injury. TREATMENT: The patient is currently being treated with physiologic replacement hormones (growth hormone, cortisol, and thyroxine), with resumption of linear growth and strength. He is progressing well. UNIQUENESS: In the past few years in the medical literature, increased attention has been drawn to the occult occurrence of hypopituitarism after traumatic brain injury in adults. Initial reports indicate that children are also at risk. To our knowledge, this is the first reported case of hypopituitarism after mild traumatic brain injury in the sports medicine literature. CONCLUSIONS: Symptoms of hypopituitarism are often masked by trauma and postconcussion symptoms and may not appear until months or years after the trauma incident, which can lead to significant delay in proper diagnosis and treatment. We urge greater vigilance by, and training of, sports medicine clinicians toward the goal of recognizing the possibility of pituitary disorders after sports concussion.     

The problem-oriented approach to sports injury evaluations

The problem-oriented approach to sports injury evaluations is used successfully throughout the United States by various health care providers, and can be used by certified athletic trainers to enhance the evaluation and management of sports injuries. The problem-oriented medical record is used successfully to provide effective communications and as a learning tool in health-related education. In this paper, I present a problem-oriented system for evaluating and keeping medical records on sports injuries. The process of collecting data through interviews and organizing that information is the focus.     

Pancreatic Laceration in a Female Collegiate Soccer Athlete: A Case Report

Objective:

To characterize the diagnosis of pancreatic trauma in an athletic population and to raise awareness among health care providers of the possibility of this life- and organ-threatening injury.

Background:

An 18-year-old, previously healthy female collegiate soccer athlete sustained a direct blow from an opponent''s knee between the left and right upper abdominal quadrants while attempting to head the ball. She initially presented with only minimal nausea and discomfort, but this progressed to abdominal pain, tenderness, spasm, and vomiting. She was referred to the emergency department, where she was diagnosed with a pancreatic laceration.

Differential Diagnosis:

Duodenal, hepatic, or splenic contusion or laceration; hemorrhagic ovarian cyst.

Treatment:

The patient underwent a distal pancreatectomy and total splenectomy.

Uniqueness:

Pancreatic injuries, particularly those severe enough to warrant surgical intervention, are extremely rare in athletes.

Conclusions:

Recognition of a pancreatic injury can be very challenging outside the hospital setting. This is problematic, because a delay in diagnosis is a significant source of preventable morbidity and mortality after this rare injury. Thus, early identification depends on a high index of suspicion, a thorough examination, and close observation. It is imperative that athletic trainers and other health care professionals be able to identify this condition so that referral and management can occur without delay.Key Words: abdomen, blunt trauma, cholangiopancreatography, pancreatectomy, splenectomyInjuries to the pancreas from blunt trauma are relatively uncommon and rarely occur during athletic training and competition.^1–3 However, these injuries are associated with high morbidity and mortality because they are difficult to detect and diagnosis is often delayed.⁴ Identification of a serious intra-abdominal condition is often challenging, as many injuries may not be apparent during the initial assessment.^1,5 Furthermore, the mechanisms of injury often result in associated damage that may divert an athletic trainer''s attention from a potentially life- or organ-threatening intra-abdominal condition. We present this case of a pancreatic laceration in a collegiate female soccer athlete to inform health care professionals in the sports setting about this uncommon but life-threatening condition. This case is unique in that this injury rarely occurs in athletes, but it was severe enough to warrant removal of the spleen and a a large section of the pancreas.     

National Athletic Trainers' Association Position Statement: Environmental Cold Injuries

Objective:

To present recommendations for the prevention, recognition, and treatment of environmental cold injuries.

Background:

Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk.

Recommendations:

These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.     

National Athletic Trainers' Association position statement: prevention of pediatric overuse injuries

Objective:

To provide certified athletic trainers, physicians, and other health care professionals with recommendations on best practices for the prevention of overuse sports injuries in pediatric athletes (aged 6–18 years).

Background:

Participation in sports by the pediatric population has grown tremendously over the years. Although the health benefits of participation in competitive and recreational athletic events are numerous, one adverse consequence is sport-related injury. Overuse or repetitive trauma injuries represent approximately 50% of all pediatric sport-related injuries. It is speculated that more than half of these injuries may be preventable with simple approaches.

Recommendations:

Recommendations are provided based on current evidence regarding pediatric injury surveillance, identification of risk factors for injury, preparticipation physical examinations, proper supervision and education (coaching and medical), sport alterations, training and conditioning programs, and delayed specialization.     

A survey of athletic trainers as health care advocates for testicular and breast self-examination in athletic populations

There have been no previous studies of athletic trainers' educational practices regarding breast or testicular cancer, so we surveyed athletic trainers regarding: 1) the incidence of cancer among athletes, 2) educational practices concerning breast/testicular cancer, 3) educational practices regarding breast/testicular self-examination, 4) breast/testicular concerns of athletes, 5) breast self-examination and testicular self-examination among athletic trainers. A researcher-developed questionnaire was randomly distributed to athletic trainers at the 1994 NATA convention, and SPSS-X was used to analyze results, using Chi-square. One alarming finding was that 28% of athletic trainers surveyed had worked with an athlete who had cancer. Twenty-two percent of the athletic trainers surveyed reported that a female athlete had brought a breast concern to them, and 51% reported that a male athlete had brought a testicular concern to them. Most of the athletic trainers surveyed do not educate athletes about breast or testicular cancer and do not teach athletes about self-examination procedures, but do perform breast self-examination or testicular self-examination on themselves. Acting as a role model is an important step toward the education of athletes in our care, but more must be done. As health care professionals, athletic trainers must become more proactive, rather than reactive, when dealing with cancer prevention.