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Barrack M.T.,University of California at Davis | Van Loan M.D.,University of California at Davis | Rauh M.J.,Rocky Mountain University of Health Professions | Rauh M.J.,San Diego State University | Nichols J.F.,San Diego State University
American Journal of Clinical Nutrition | Year: 2010

Background: Female adolescent runners have an elevated prevalence of low bone mass for age - an outcome that may be partially due to inadequate energy intake. Objective: The objective was to evaluate diet, menstrual history, serum hormone concentrations, and bone mass in female adolescent runners with normal or abnormal bone turnover. Design: Thirty-nine cross-country runners (age: 15.7 ± 0.2 y) participated in the study, which included a 7-d dietary assessment with the use of a food record and daily 24-h dietary recalls; serum measures of insulin-like growth factor I, estradiol, leptin, parathyroid hormone, progesterone, triiodothyronine, 25-hydroxycholecalciferol, bone-specific alkaline phosphatase (BAP), and cross-linked C-telopeptides of type I collagen (CTX); an evaluation of height, weight, bone mass, and body composition with the use of dual-energy X-ray absorptiometry; and a questionnaire to assess menses and sports participation. Age- and sex-specific BAP and CTX concentrations of at least the 97th percentile and no greater than the third percentile, respectively, were considered abnormal. Results: All abnormal BAP and CTX concentrations fell within the elevated (≥97%) range. Runners with an elevated bone turnover (EBT) (n = 13) had a lower body mass, fewer menstrual cycles in the past year, lower estradiol and 25-hydroxycholecalciferol concentrations, and a higher prevalence of body mass index <10% for age, vitamin D insufficiency, amenorrhea, and low bone mass. Girls with EBT consumed less than the recommended amounts of energy and had a higher prevalence of consuming <1300 mg Ca than did those with normal bone turnover. Conclusions: Runners with EBT had a profile consistent with energy deficiency. Nutritional support to increase energy, calcium intake, and 25-hydroxycholecalciferol concentrations may improve bone mineral accrual in young runners with EBT. This trial was registered at clinicaltrials.gov as NCT01059968. © 2010 American Society for Nutrition.


Rauh M.J.,San Diego State University | Rauh M.J.,Rocky Mountain University of Health Professions | Nichols J.F.,San Diego State University | Barrack M.T.,University of California at Davis
Journal of Athletic Training | Year: 2010

Context: Prior authors have reported associations among increased risk of injury and factors of the female athlete triad, as defined before the 2007 American College of Sports Medicine position stand, in collegiate and adult club sport populations. Little is known about this relationship in an adolescent competitive sports population. Objective: To examine the relationship among disordered eating, menstrual dysfunction, and low bone mineral density (BMD) and musculoskeletal injury among girls in high school sports. Design: Prospective cohort study. Setting: The sample consisted of 163 female athletes competing in 8 interscholastic sports in southern California during the 2003-2004 school year. Each participant was followed throughout her respective sport season for occurrence of musculoskeletal injuries. Main Outcome Measure(s): Data collected included daily injury reports, the Eating Disorder Examination Questionnaire that assessed disordered eating attitudes and behaviors, a dual-energy x-ray absorptiometry scan that measured BMD and lean tissue mass, anthropometric measurements, and a questionnaire on menstrual history and demographic characteristics. Results: Sixty-one athletes (37.4%) incurred 90 musculo-skeletal injuries. In our BMD z score model of ≤-1 SD, a history of oligomenorrhea/amenorrhea during the past year and low BMD (z score ≤-1 SD) were associated with the occurrence of musculoskeletal injury during the interscholastic sport season. In our BMD z score model of ≤-2 SDs, disordered eating (Eating Disorder Examination Questionnaire score ≥-4.0), a history of oligomenorrhea/amenorrhea during the past year, and a low BMD (z score ≤-2 SDs) were associated with musculoskeletal injury occurrence. Conclusions: These findings indicate that disordered eating, oligomenorrhea/amenorrhea, and low BMD were associated with musculoskeletal injuries in these female high school athletes. Programs designed to identify and prevent disordered eating and menstrual dysfunction and to increase bone mass in athletes may help to reduce musculoskeletal injuries. © by the National Athletic Trainers' Association, Inc.


Faigenbaum A.D.,The College of New Jersey | Myer G.D.,Cincinnati Childrens Hospital Medical Center | Myer G.D.,Sports Medicine Biodynamics Center | Myer G.D.,Rocky Mountain University of Health Professions
British Journal of Sports Medicine | Year: 2010

A literature review was employed to evaluate the current epidemiology of injury related to the safety and efficacy of youth resistance training. Several case study reports and retrospective questionnaires regarding resistance exercise and the competitive sports of weightlifting and powerlifting reveal that injuries have occurred in young lifters, although a majority can be classified as accidental. Lack of qualified instruction that underlies poor exercise technique and inappropriate training loads could explain, at least partly, some of the reported injuries. Current research indicates that resistance training can be a safe, effective and worthwhile activity for children and adolescents provided that qualified professionals supervise all training sessions and provide age-appropriate instruction on proper lifting procedures and safe training guidelines. Regular participation in a multifaceted resistance training programme that begins during the preseason and includes instruction on movement biomechanics may reduce the risk of sports-related injuries in young athletes. Strategies for enhancing the safety of youth resistance training are discussed.


Barrack M.T.,University of California at Davis | Rauh M.J.,Rocky Mountain University of Health Professions | Rauh M.J.,San Diego State University | Nichols J.F.,San Diego State University
Journal of Bone and Mineral Research | Year: 2010

We aimed to evaluate patterns of bonemineral accrual among a cross-sectional sample of female adolescent runners and girls participating in a nonendurance running sport. One-hundred and eighty-three interscholastic competitive female athletes (age 16.0±0.1 years), 93 endurance runners and 90 nonrunners, completed a menstrual and sports history questionnaire, had their height and weight measured, and underwent a dual-energy X-ray absorptiometry scan for the measurements of body composition and bone mass. For the majority of analyses, the girls were separated into four groups according to their age (13 to 14 years, 15 years, 16 years, and 17 to 18 years). Runners' height, weight, body mass index (BMI), percent body fat, lean tissue mass, number of menstrual cycles in the past year, and months of participation in a non-lean-build/variable-impact-loading sport were significantly lower than mean values for nonrunners. Although bone mass rose at all sites in the nonrunners between the ages of 13 to 14 years and 17 to 18 years, no such increase was noted in the runners. Runners compared with nonrunners exhibited significantly lower body weight and height-adjusted total body and lumbar spine bone mineral content (BMC) values and lower bonemineral density (BMD) Z-score values among the older (16 years and/or 17 to 18 years) but not younger (13 to 14 years and/or 15 years) age groups. These findings suggest that the runners, in contrast to the nonrunners, exhibited a suppressed bone mineral accrual pattern, which supports the notion that female adolescent endurance runners may be at risk for inadequate bone mass gains and thus a low peak BMD. © 2010 American Society for Bone and Mineral Research.


Ford K.R.,Cincinnati Childrens Hospital | Myer G.D.,Rocky Mountain University of Health Professions | Hewett T.E.,Cincinnati Childrens Hospital | Hewett T.E.,University of Cincinnati
American Journal of Sports Medicine | Year: 2010

Background: Yearly changes in active joint stiffness may help explain when neuromuscular sex differences emerge in adolescent athletes that may relate to increased anterior cruciate ligament injury risk in females. Hypothesis: Pubertal males would demonstrate increases in knee stiffness while pubertal females would not. Second, postpubertal female athletes would have significantly lower knee joint stiffness than postpubertal male athletes. Study Design: Cohort Study; Level of Evidence 2 and Cross-Sectional Study; Level of Evidence 3. Methods: Two hundred sixty-five females and 50 males participated in 2 testing sessions approximately 1 year apart. The subjects were classified as either pubertal (n = 182, age 12.4 ± 0.9 years) or postpubertal (n = 133, age 14.5 ± 1.4 years) based on the modified Pubertal Maturational Observational Scale at each visit. Active joint stiffness of the ankle, knee, and hip was estimated during a drop vertical jump. Stiffness was calculated as the slope of the moment-angle curve from a least squares linear regression during the stance phase. Results: All athletes showed increased active knee stiffness during the span of a year (P < 0.05). However, this increase was not different when stiffness was normalized to body mass. Only males demonstrated greater magnitudes of ankle and hip active stiffness (P < .05). Peak ankle and hip moments, but not knee moments, in postpubertal males were significantly greater than postpubertal females (P < .05). Females had a higher knee to hip moment ratio than males (P < .05). Conclusion: Both males and females showed increased active knee stiffness during the span of a year; males demonstrated increased ankle and hip active stiffness as well. Differences in hip joint posture at initial contact (greater flexion in males) and external hip flexion moment (greater flexion magnitude in males) may indicate that males use a different hip recruitment strategy during drop vertical jumps than females. © 2010 The Author(s).


Nichols J.F.,San Diego State University | Rauh M.J.,San Diego State University | Rauh M.J.,Rocky Mountain University of Health Professions
Journal of Strength and Conditioning Research | Year: 2011

This study tracked changes in bone mineral density (BMD) over a 7-year period in competitive male master cyclists (n = 19) and nonathletes (n = 18). Participants completed health/exercise history and food frequency (for calcium intake) questionnaires and underwent BMD testing by dual-energy X-ray absorptiometry. At initial and 7-year assessments, there was a consistent pattern of lower BMD in cyclists compared to nonathletes at all bone sites measured. Repeated measures analysis of covariance adjusted for changes in body mass index, lean mass, calcium intake, and exercise habits indicated a significant interaction at the total body site, indicating greater BMD decline in cyclists than nonathletes (p < 0.05). Among all study participants, those who reported participating in weight training or impact exercise since the baseline assessment lost significantly less BMD at the spine and femoral neck compared to participants who reported no weight training/impact exercise since baseline (p < 0.05). A significantly greater percentage of cyclists than nonathletes met the International Society of Clinical Densitometry criteria for osteopenia or osteoporosis at baseline (84.2% vs. 50.0%) and at follow-up (89.5% vs. 61.1%, p < 0.05). Further, 6 of the 19 (31.6%) cyclists who had osteopenia at baseline became osteoporotic, compared to 1 (5.6%) of the nonathletes. The high percentage of male master cyclists with low BMD, combined with a high risk for fracture from falls associated with competitive cycling, warrant attention among this population. Coaches and health professionals interacting with cyclists need to promote alternative exercise such as weight training, plyometrics, or other high impact activity as a complement to cycle training to help minimize bone loss in this population. © 2011 National Strength and Conditioning Association.


Fritz J.M.,University of Utah | Childs J.D.,U.S. Army | Wainner R.S.,Texas State University | Flynn T.W.,Rocky Mountain University of Health Professions
Spine | Year: 2012

Study Design. A retrospective cohort. Objective. To describe physical therapy utilization following primary care consultation for low back pain (LBP) and evaluate associations between the timing and content of physical therapy and subsequent health care utilization and costs. Summary of Background Data. Primary care management of LBP is highly variable and the implications for subsequent costs are not well understood. The importance of referring patients from primary care to physical therapy has been debated, and information on how the timing and content of physical therapy impact subsequent costs and utilization is needed. Methods. Data were extracted from a national database of employer-sponsored health plans. A total of 32,070 patients with a new primary care LBP consultation were identified and categorized on the basis of the use of physical therapy within 90 days. Patients utilizing physical therapy were further categorized based on timing (early [within 14 d] or delayed)] and content (guideline adherent or nonadherent). LBP-related health care costs and utilization in the 18-months following primary care consultation were examined. Results. Physical therapy utilization was 7.0% with significant geographic variability. Early physical therapy timing was associated with decreased risk of advanced imaging (odds ratio [OR] = 0.34, 95% confidence interval [CI]: 0.29, 0.41), additional physician visits (OR = 0.26, 95% CI: 0.21, 0.32), surgery (OR = 0.45, 95% CI: 0.32, 0.64), injections (OR = 0.42, 95% CI: 0.32, 0.64), and opioid medications (OR = 0.78, 95% CI: 0.66, 0.93) compared with delayed physical therapy. Total medical costs for LBP were $2736.23 lower (95% CI: 1810.67, 3661.78) for patients receiving early physical therapy. Physical therapy content showed weaker associations with subsequent care. Conclusion. Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy. Further research is needed to clarify exactly which patients with LBP should be referred to physical therapy; however, if referral is to be made, delaying the initiation of physical therapy may increase risk for additional health care consumption and costs. Copyright © 2012 Lippincott Williams & Wilkins.


Algar L.,Northeast Orthopaedic and Hand Surgery | Valdes K.,Rocky Mountain University of Health Professions
Journal of Hand Therapy | Year: 2014

In the hand therapy clinic, smartphones can be used as an educational resource, to view a photo or video of a home exercise program, or as a method of electronically documenting progress related to healing from an injury. Smartphone applications may also serve as appropriate therapy interventions to address deficits often presenting with common hand injuries. For individuals with trapeziometacarpal arthrosis, gaming can encourage radial abduction range of motion and neuromuscular control required for joint stability. People with distal radius fractures may benefit from smartphone applications for range of motion and proprioceptive training. These treatments may assist with addressing client-centered goals and be motivating in the current technology driven times. © 2014 Hanley and Belfus, an imprint of Elsevier Inc. All rights reserved.


Trademark
Rocky Mountain University Of Health Professions | Date: 2016-12-28

Educational publications, namely, books, articles in the fields of health sciences, nursing, physical therapy, occupational therapy, speech language pathology. Jackets; Pants; Scrubs not for medical purposes; Shirts; Shorts; Sweaters. Education services in the nature of courses at the university level; Educational services, namely, providing continuing professional education courses in the field of health sciences, nursing, physical therapy, occupational therapy, speech language pathology; Educational services, namely, providing online courses of instruction at the university level and distribution of course material in connection therewith.


Trademark
Rocky Mountain University Of Health Professions | Date: 2016-12-28

Educational publications, namely, books, articles in the fields of health sciences, nursing, physical therapy, occupational therapy, speech language pathology. Jackets; Pants; Scrubs not for medical purposes; Shirts; Shorts; Sweaters. Educational services, namely, providing continuing professional education courses in the field of health sciences, nursing, physical therapy, occupational therapy, speech language pathology; Educational services, namely, providing continuing professional education courses in the field of health sciences, nursing, physical therapy, occupational therapy, speech language pathology; Educational services, namely, providing online courses of instruction at the university level and distribution of course material in connection therewith.

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