Rate and risk of anterior cruciate ligament injury among sportswomen in Slovenia

Context:

Anterior cruciate ligament (ACL)-injury rate is greater among female athletes than among male athletes.

Objective:

To investigate the rate and risk of ACL injury among Slovenian sportswomen playing professional basketball, team handball, or volleyball.

Design:

Prospective cohort study.

Setting:

The Slovenian National Organizations of basketball, team handball, and volleyball.

Patients or Other Participants:

During the 2003–2004 season, we prospectively followed 585 Slovenian sportswomen registered in the Slovenian National Organizations of basketball, team handball, and volleyball.

Main Outcome Measure(s):

We asked sportswomen and coaches to document the occurrence of every significant traumatic knee injury requiring medical attention. Injury rate and injury risk were calculated for sportswomen in each sport group. To calculate injury rate, we estimated the average exposure of each sportswoman during the research period.

Results:

During the 2003–2004 season, 585 Slovenian sportswomen sustained 12 ACL injuries. The ACL-injury risk was different in athletes participating in the various sports, with basketball players having the greatest ACL-injury risk and volleyball players having the lowest ACL-injury risk (P  =  .04). The risk of ACL injury among Slovenian sportswomen was 2.1 per 100 athletes (95% confidence interval  =  0.9, 3.2), whereas the rate of ACL injury was 0.037 per 1000 exposure hours (95% confidence interval  =  0.016, 0.06).

Conclusions:

Overall differences in injury risk were found among sports, but no differences were noted among divisions within sports. No differences for injury rate were observed between or within sports. The rate and risk of ACL injury among Slovenian sportswomen are high, with basketball players having the greatest ACL-injury risk.     

Risk Factors for Self-Reported Exercise-Related Leg Pain in High School Cross-Country Athletes

Context:

Prevention of exercise-related leg pain (ERLP) has not been successful because ERLP risk factors are not well known.

Objective:

To determine the percentage of high school cross-country (XC) athletes who reported a history of ERLP in their running careers, to identify the percentage of athletes who reported an occurrence of ERLP during 1 XC season, and to investigate the association of selected factors (age, high school year, years of high school running, sex, ERLP history, body mass index [BMI], foot type, and training distance) and the occurrence of ERLP.

Design:

Prospective cohort study.

Setting:

Six local high schools.

Patients or Other Participants:

One hundred twenty-five high school XC athletes (62 females, 63 males).

Main Outcome Measure(s):

All athletes completed an initial ERLP questionnaire, and foot type was visually assessed. After the season, athletes were asked to complete a Web-based questionnaire regarding the seasonal occurrence of ERLP. Statistical analyses of differences (t tests) and associations (χ², relative risk) were conducted.

Results:

A total of 103 of the 125 athletes (82.4%) reported a history of ERLP, with 81 athletes reporting ERLP occurrence within the month preceding completion of the initial questionnaire. Bilateral medial leg pain was the most common ERLP presentation. More than half of the athletes (58.4%) with an ERLP history reported that the pain had interfered with XC participation. Ninety-three athletes responded to the postseason questionnaire, and 45 (48.0%) reported ERLP seasonal occurrence. Most athletes (97.8%) who experienced the seasonal occurrence of ERLP had a history of ERLP. No associations were noted between ERLP history or seasonal occurrence and age, high school year, years of high school running, sex, BMI, foot type, or training distance.

Conclusions:

Both a history of ERLP and the seasonal occurrence of ERLP were common among these XC athletes. The only risk factor identified for ERLP season occurrence was ERLP history.     

Risk of hepatitis B and C infections in Tehranian wrestlers

Context:

Although bloodborne infections are among the most important global health issues, limited data are available on bloodborne infections in athletes.

Objective:

To determine and compare the prevalence of markers of hepatitis B (HBV) and hepatitis C (HCV) viruses and the risk factors for these infections among wrestlers in Tehran and among a control group of athletes in the same geographic area who took part in low- to moderate-contact sports (ie, volleyball and soccer).

Design:

Case-control study.

Setting:

Laboratory.

Patients or Other Participants:

A total of 420 male wrestlers were randomly selected from 28 wrestling clubs in Tehran using a cluster-sample–setting method. The control group (205 volleyball players from 21 clubs and 205 soccer players from 16 clubs) was selected from the same geographic area.

Main Outcome Measure(s):

The risk factors for HBV and HCV and serum levels of anti-HBcAg (antibodies to the HBV core antigen), HBsAg (HBV surface antigen), and anti-HCV (antibodies to HCV) in both groups.

Results:

The prevalence of anti-HBcAg was 13.4% (95% confidence interval [CI] = 10.2%, 16.7%) in wrestlers and 10.9% (95% CI = 7.9%, 14.0%) in the control group. The prevalence of HBsAg was 1.2% (95% CI = 0.2%, 2.2%) in wrestlers and 0.5% (95% CI = −0.2%, 1.2%) in the control group. The prevalence of anti-HCV was 0.5% (95% CI = −0.2%, 1.1%) in wrestlers and 0 in the control group. Some risk factors for bloodborne infections were more common in the wrestlers than in the control group.

Conclusions:

Within the limits of our study, we found no evidence that participation in Tehranian wrestling increased HBV or HCV transmission when compared with transmission in athletes participating in low- to moderate-contact sports. Prevention of bloodborne infections in Tehranian wrestlers should be focused not only on appropriate care for bleeding injuries but also on general risk factors for these conditions.     

Sports nutrition knowledge among collegiate athletes, coaches, athletic trainers, and strength and conditioning specialists

Context:

Coaches, athletic trainers (ATs), strength and conditioning specialists (SCSs), and registered dietitians are common nutrition resources for athletes, but coaches, ATs, and SCSs might offer only limited nutrition information. Little research exists about sports nutrition knowledge and current available resources for nutrition information for athletes, coaches, ATs, and SCSs.

Objective:

To identify resources of nutrition information that athletes, coaches, ATs, and SCSs use; to examine nutrition knowledge among athletes, coaches, ATs, and SCSs; and to determine confidence levels in the correctness of nutrition knowledge questions within all groups.

Design:

Cross-sectional study.

Setting:

National Collegiate Athletic Association Division I, II, and III institutions across the United States.

Patients and Other Participants:

The 579 participants consisted of athletes (n = 185), coaches (n = 131), ATs (n = 192), and SCSs (n = 71).

Main Outcome Measure(s):

Participants answered questions about nutrition resources and domains regarding basic nutrition, supplements and performance, weight management, and hydration. Adequate sports nutrition knowledge was defined as an overall score of 75% in all domains (highest achievable score was 100%).

Results:

Participants averaged 68.5% in all domains. The ATs (77.8%) and SCSs (81.6%) had the highest average scores. Adequate knowledge was found in 35.9% of coaches, 71.4% of ATs, 83.1% of SCSs, and only 9% of athletes. The most used nutrition resources for coaches, ATs, and SCSs were registered dietitians.

Conclusions:

Overall, we demonstrated that ATs and SCSs have adequate sports nutrition knowledge, whereas most coaches and athletes have inadequate knowledge. Athletes have frequent contact with ATs and SCSs; therefore, proper nutrition education among these staff members is critical. We suggest that proper nutrition programming should be provided for athletes, coaches, ATs, and SCSs. However, a separate nutrition program should be integrated for ATs and SCSs. This integrative approach is beneficial for the continuity of care, as both categories of professionals might be developing and integrating preventive or rehabilitative programs for athletes.     

National athletic trainers' association position statement: preventing sudden death in sports

Objective:

To present recommendations for the prevention and screening, recognition, and treatment of the most common conditions resulting in sudden death in organized sports.

Background:

Cardiac conditions, head injuries, neck injuries, exertional heat stroke, exertional sickling, asthma, and other factors (eg, lightning, diabetes) are the most common causes of death in athletes.

Recommendations:

These guidelines are intended to provide relevant information on preventing sudden death in sports and to give specific recommendations for certified athletic trainers and others participating in athletic health care.     

The assessment of airway maneuvers and interventions in university Canadian football, ice hockey, and soccer players

Context:

Managing an airway in an unconscious athlete is a lifesaving skill that may be made more difficult by the recent changes in protective equipment. Different airway maneuvers and techniques may be required to help ventilate an unconscious athlete who is wearing full protective equipment.

Objective:

To assess the effectiveness of different airway maneuvers with football, ice hockey, and soccer players wearing full protective equipment.

Design:

Crossover study.

Setting:

University sports medicine clinic.

Patients or Other Participants:

A total of 146 university varsity athletes, consisting of 62 football, 45 ice hockey, and 39 soccer players.

Intervention(s):

Athletes were assessed for different airway and physical characteristics. Three investigators then evaluated the effectiveness of different bag-valve-mask (BVM) ventilation techniques in supine athletes who were wearing protective equipment while inline cervical spine immobilization was maintained.

Main Outcome Measure(s):

The effectiveness of 1-person BVM ventilation (1-BVM), 2-person BVM ventilation (2-BVM), and inline immobilization and ventilation (IIV) was judged by each investigator for each athlete using a 4-point rating scale.

Results:

All forms of ventilation were least difficult in soccer players and most difficult in football players. When compared with 1-BVM, both 2-BVM and IIV were deemed more effective by all investigators for all athletes. Interference from the helmet and stabilizer were common reasons for difficult ventilation in football and ice hockey players.

Conclusions:

Sports medicine professionals should practice and be comfortable with different ventilation techniques for athletes wearing full equipment. The use of a new ventilation technique, termed inline immobilization and ventilation, may be beneficial, especially when the number of responders is limited.     

Social Support Patterns of Collegiate Athletes Before and After Injury

Context:

Social support has been identified as an important factor in facilitating recovery from injury. However, no previous authors have prospectively assessed the change in social support patterns before and after injury.

Objective:

To examine the preinjury and postinjury social support patterns among male and female collegiate athletes.

Design:

Prospective observational study.

Setting:

A Big Ten Conference university.

Patients or Other Participants:

A total of 256 National Collegiate Athletic Association Division I male and female collegiate athletes aged 18 or older from 13 sports teams.

Main Outcome Measure(s):

Injury incidence was identified using the Sports Injury Monitoring System. Social support was measured using the 6-item Social Support Questionnaire. Data on preinjury and postinjury social support patterns were compared.

Results:

Male athletes reported more sources of social support than female athletes, whereas female athletes had greater satisfaction with the support they received. Athletes'' social support patterns changed after they became injured. Injured athletes reported relying more on coaches (P  =  .003), athletic trainers (P < .0001), and physicians (P  =  .003) for social support after they became injured. Athletes also reported greater postinjury satisfaction with social support received from friends (P  =  .019), coaches (P  =  .001), athletic trainers (P < .0001), and physicians (P  =  .003).

Conclusions:

Our findings identify an urgent need to better define the psychosocial needs of injured athletes and also strongly suggest that athletic trainers have a critical role in meeting these needs.     

Disordered Eating in a Digital Age: Eating Behaviors,Health, and Quality of Life in Users of Websites With Pro-Eating Disorder Content

Background

Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users.

Objective

To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life.

Methods

We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores.

Results

We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m²; 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores.

Conclusions

Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors.     

Sleep Disordered Breathing in Children in a General Population Sample: Prevalence and Risk Factors

Study Objectives:

Assess the prevalence based on clinically meaningful criteria (i.e., blood pressure) and identify risk factors of sleep disordered breathing (SDB) in a representative sample of elementary school children.

Design:

A random sample of the local elementary school children (K-5) were assessed using a two-phased strategy. In phase I a brief questionnaire was completed by a parent of each child in local elementary schools (N = 5,740), with a response rate of 78.5%. In phase II, randomly selected children and their parent spent a night in our sleep laboratory (N = 700) with a response rate of 70.0%.

Setting:

University sleep laboratory

Participants:

Children enrolled in local elementary schools.

Intervention:

None

Measurement & Results:

Each child was assessed with a full polysomnogram and completed a history/physical examination including an electrocardiogram, otolaryngology examination, and pulmonary evaluation. The prevalence of moderate SDB (apnea-hypopnea index ≥ 5) was 1.2%. The independent risk factors included nasal abnormalities and minority associated only with mild (1 < AHI < 5) SDB and snoring and waist circumference associated with all levels of SDB. Tonsil size, based on visual inspection, was not an independent risk factor.

Conclusion:

The prevalence of AHI ≥ 5 was 1.2% in a representative sample of elementary school children. Risk factors for SDB included waist circumference, nasal abnormalities (e.g., chronic sinusitis/rhinitis), and minority. The strong linear relationship between waist circumference and BMI across all degrees of severity of SDB suggests that, as in adults, metabolic factors may be among the most important risk factors for SDB in children.

Citation:

Bixler EO; Vgontzas AN; Lin HM; Liao D; Calhoun S; Vela-Bueno A; Fedok F; Vlasic V. Sleep disordered breathing in children in a general population sample: prevalence and risk factors. SLEEP 2009;32(6):731-736.     

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.     

Key Factors for Providing Appropriate Medical Care in Secondary School Athletics: Athletic Training Services and Budget

Context:

Research suggests that appropriate medical care for interscholastic athletes is frequently lacking. However, few investigators have examined factors related to care.

Objective:

To examine medical care provided by interscholastic athletics programs and to identify factors associated with variations in provision of care.

Design:

Cross-sectional study.

Setting:

Mailed and e-mailed survey.

Patients or Other Participants:

One hundred sixty-six South Carolina high schools.

Intervention(s):

The 132-item Appropriate Medical Care Assessment Tool (AMCAT) was developed and pilot tested. It included 119 items assessing medical care based on the Appropriate Medical Care for Secondary School-Age Athletes (AMCSSAA) Consensus Statement and Monograph (test-retest reliability: r  =  0.89). Also included were items assessing potential influences on medical care. Presence, source, and number of athletic trainers; school size; distance to nearest medical center; public or private status; sports medicine supply budget; and varsity football regional championships served as explanatory variables, whereas the school setting, region of state, and rate of free or reduced lunch qualifiers served as control variables.

Main Outcome Measure(s):

The Appropriate Care Index (ACI) score from the AMCAT provided a quantitative measure of medical care and served as the response variable. The ACI score was determined based on a school''s response to items relating to AMCSSAA guidelines.

Results:

Regression analysis revealed associations with ACI score for athletic training services and sports medicine supply budget (both P < .001) when controlling for the setting, region, and rate of free or reduced lunch qualifiers. These 2 variables accounted for 30% of the variance in ACI score (R²  =  0.302). Post hoc analysis showed differences between ACI score based on the source of the athletic trainer and the size of the sports medicine supply budget.

Conclusions:

The AMCAT offers an evaluation of medical care provided by interscholastic athletics programs. In South Carolina schools, athletic training services and the sports medicine supply budget were associated with higher levels of medical care. These results offer guidance for improving the medical care provided for interscholastic athletes.     

Shoulder Injuries Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years

Context:

The shoulder is one of the most commonly injured body sites among athletes. Little previous research describes shoulder injury patterns in high school athletes.

Objective:

To describe and compare shoulder injury rates and patterns among high school athletes in 9 sports (football, soccer, basketball, baseball, and wrestling for boys and soccer, volleyball, basketball, and softball for girls).

Design:

Prospective injury surveillance study.

Setting:

Injury data were collected from 100 nationally representative US high schools via High School Reporting Information Online.

Patients or Other Participants:

Athletes from participating high schools injured while involved in a school-sanctioned practice or competition in 1 of the above sports during the 2005–2006 and 2006–2007 school years.

Main Outcome Measure(s):

Shoulder injury rates, diagnoses, severity, and mechanisms.

Results:

During the 2005–2006 and 2006–2007 school years, athletes in this study sustained 805 shoulder injuries during 3 550 141 athlete-exposures (AEs), for an injury rate of 2.27 shoulder injuries per 10 000 AEs. This corresponds to an estimated 232 258 shoulder injuries occurring nationwide during this time. Shoulder injuries were more likely to occur during competition than practice (rate ratio  =  3.01, 95% confidence interval  =  2.62, 3.46). Shoulder injury rates per 10 000 AEs were highest in football (5.09), wrestling (4.34), and baseball (1.90). Common shoulder injury diagnoses included sprains/strains (39.6%), dislocations/separations (23.7%), contusions (11.5%), and fractures (6.6%). Although 44.8% of athletes sustaining a shoulder injury returned to play in less than 1 week, 22.9% were out of play for more than 3 weeks, and 6.2% of shoulder injuries required surgery. Common mechanisms of shoulder injury included player-to-player contact (57.6%) and contact with the playing surface (22.8%).

Conclusions:

High school shoulder injury rates and patterns varied by sport. Continued surveillance is warranted to understand trends and patterns over time and to develop and evaluate evidence-based preventive interventions.     

Dietary Restraint Is Non-Genetically Associated with Change in Body Mass Index: The Healthy Twin Study

Purpose

We aimed to examine if past and more recent body mass index (BMI) changes are associated with eating behavior (EB) traits and whether these associations are due to non-genetic factors.

Materials and Methods

In 1321 Korean twins and family members, recent and past BMI change groups were defined using quartiles of BMI change between first and second visits over 2.4±0.9 years and BMI change between 20 years old and second visit, respectively. We applied linear mixed analysis for relationships of past or recent BMI change groups and each EB (restrained, external, and emotional EB using the Dutch Eating Behavior Questionnaire) assessed at second visit after adjusting for household effect and covariates (age, gender, education, medical history of diabetes, hypertension, and dyslipidemia, alcohol use, physical activity, smoking habit, and calorie intake). In monozygotic twin pairs, paired t-test for within-pair comparison and conditional logistic regression analysis were conducted regarding EB.

Results

Greater past BMI change was associated with higher restrained eating scores (P for trend=0.031), whereas greater recent BMI change was associated with higher external eating scores (P for trend=0.046). In co-twin-control analysis, twins with greater past BMI change were more likely to have higher restrained eating scores as compared with their co-twins with lower past BMI change (odds ratio 1.80; 95% confidence interval 1.13-2.87), whereas there were no associations between recent BMI change and external eating scores.

Conclusion

Greater BMI change since 20 years old is associated with higher dietary restraint, and non-genetic factors explain this relationship.     

Positive airway pressure adherence in veterans with posttraumatic stress disorder

Study Objectives:

To determine the short-term positive airway pressure (PAP) adherence rates and to identify non–mask-related risk factors associated with 30-day nonadherence to PAP in a population of veterans with obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD).

Design:

A retrospective study.

Settings:

A Veterans Affairs hospital.

Patients:

One hundred forty-eight PTSD veterans newly diagnosed with OSA and a control group of OSA without PTSD matched for age, gender, BMI, and severity of OSA.

Interventions:

N/A

Measurements and Results:

At 30-day follow-up, adherence to PAP was significantly lower in the PTSD group compared to the control group (41% versus 70%, respectively; P < 0.001). Veterans with adequate PAP adherence were more likely to experience sleepiness at baseline compared to nonadherent subjects (ESS 14.4 ± 5.3 versus 12.3 ± 5.9, respectively; P = 0.04). Nightmares were more frequently reported in those who were PAP nonadherent (P = 0.002). Mask discomfort, claustrophobia, and air hunger were the reported reasons for PAP nonadherence in the PTSD group.

Conclusion:

PAP usage and adherence were lower in PTSD veterans with OSA than veterans without PTSD. Excessive sleepiness predicted PAP adherence while frequent nightmares were correlated with poor adherence to PAP therapy.

Citation:

El-Solh AA; Ayyar L; Akinnusi M; Relia S; Akinnusi O. Positive airway pressure adherence in veterans with posttraumatic stress disorder. SLEEP 2010;33(11):1495-1500.     

Clavicular fracture in a collegiate football player: a case report of rapid return to play

Objective:

To present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a National Collegiate Athletic Association Division I football athlete.

Background:

While attempting to catch a pass during practice, the athlete jumped up and then landed on the tip of his shoulder. On-the-field evaluation was inconclusive, with a sideline evaluation diagnosis of clavicular fracture. Postinjury radiographs revealed a midshaft clavicular fracture.

Differential Diagnosis:

Spiral oblique midshaft clavicular fracture.

Treatment:

The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole plate was performed.

Uniqueness:

Surgical treatment for clavicular fractures is becoming increasingly common. This is the first report of an advanced rehabilitation protocol for surgical repair. We suggest that new rehabilitation protocols for clavicular repairs be investigated now that surgical treatment is being pursued more frequently.

Conclusions:

More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.     

Sleep Disturbance Immediately Prior to Trauma Predicts Subsequent Psychiatric Disorder

Study Objectives:

This study investigated the extent to which sleep disturbance in the period immediately prior to a traumatic event predicted development of subsequent psychiatric disorder.

Design:

Prospective design cohort study

Setting:

Four major trauma hospitals across Australia

Patients:

A total of 1033 traumatically injured patients were initially assessed during hospital admission and followed up at 3 months (898) after injury

Measures:

Lifetime psychiatric disorder was assessed in hospital with the Mini-International Neuropsychiatric Interview. Sleep disturbance in the 2 weeks prior to injury was also assessed using the Sleep Impairment Index. The prevalence of psychiatric disorder was assessed 3 months after traumatic injury.

Results:

There were 255 (28%) patients with a psychiatric disorder at 3 months. Patients who displayed sleep disturbance prior to the injury were more likely to develop a psychiatric disorder at 3 months (odds ratio: 2.44, 95% CI: 1.62–3.69). In terms of patients who had never experienced a prior disorder (n = 324), 96 patients (30%) had a psychiatric disorder at 3 months, and these patients were more likely to develop disorder if they displayed prior sleep disturbance (odds ratio: 3.16, 95% CI: 1.59–4.75).

Conclusions:

These findings provide evidence that sleep disturbance prior to a traumatic event is a risk factor for development of posttraumatic psychiatric disorder.

Citation:

Bryant RA; Creamer M; O''Donnell M; Silove D; McFarlane AC. Sleep disturbance immediately prior to trauma predicts subsequent psychiatric disorder. SLEEP 2010;33(1):69-74.     

Keeping Your Head in the Game: Sport-Specific Imagery and Anxiety Among Injured Athletes

Context:

The use of sport-specific imagery during rehabilitation is sparse. Athletes who used imagery (either facilitative or debilitative) during injury rehabilitation were compared with injured athletes who did not use imagery. Return-to-practice anxiety in the groups was investigated also.

Objective:

To (1) explore debilitative images used during rehabilitation, (2) examine athlete and injury characteristics in relation to variations in imagery content and return-to-practice anxiety, (3) compare the frequency of imagery use early in injury rehabilitation with that just before return to practice, and (4) examine the relationship between image use and return-to-practice anxiety.

Design:

Observational design.

Setting:

Athletic training facilities.

Patients or Other Participants:

Thirty-six injured National Collegiate Athletic Association Division I collegiate athletes sustaining at least an 8-day practice suspension due to injury.

Main Outcome Measure(s):

Sport Imagery Questionnaire, Sport Anxiety Scale.

Results:

Athletes used both facilitative and debilitative images during different phases of rehabilitation. Men used more sport skill, strategy, and excitement imagery content than did women, who reported higher scores for worry and concentration disruption than did men. Athletes used fewer images related to their sport skills and strategies early in rehabilitation than just before they returned to practice. Additionally, athletes who used more arousal and less strategic imagery experienced more somatic anxiety.

Conclusions:

Similar to research findings on healthy athletes, sport-specific image content in injured athletes is related to return-to-practice anxiety during rehabilitation, and some of the images were perceived as debilitative. Practitioners should advise injured athletes to use sport-specific imagery, especially that related to sport skills and strategies, but they should caution athletes against using arousal imagery, because it may elevate somatic anxiety before return to practice. Image content recommendations should encompass the cognitive and motivational functions of imagery, and the practitioner should assess if any image used by the athlete is debilitative.