Reference: Wang XQ, Zheng JJ, Yu ZW, et al. A metaanalysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012;7(12):e52082.Clinical Questions: Is core stability exercise more effective than general exercise in the treatment of patients with nonspecific low back pain (LBP)?Data Sources: The authors searched the following databases: China Biological Medicine disc, Cochrane Library, Embase, and PubMed from 1970 through 2011. The key medical subject headings searched were chronic pain, exercise, LBP, lumbosacral region, and sciatica.Study Selection: Randomized controlled trials comparing core stability exercise with general exercise in the treatment of chronic LBP were investigated. Participants were male and female adults with LBP for at least 3 months that was not caused by a specific known condition. A control group receiving general exercise and an experimental group receiving core stability exercise were required for inclusion in the meta-analysis. Core stability was defined as the ability to ensure a stable neutral spine position, but the type of exercise was not specified. Outcome measures of pain intensity, back-specific functional status, quality of life, and work absenteeism were recorded at 3-, 6-, and 12-month intervals.Data Extraction: The study design, participant information, description of interventions in the control and experimental groups, outcome measures, and follow-up period were extracted. The mean difference (MD) and 95% confidence interval (CI) were calculated to evaluate statistical significance. Risk of bias was assessed using the Cochrane Collaboration Recommendations, and all articles were rated as high risk for other bias with no further explanation given.Main Results: Five studies involving 414 patients were included. Four studies assessed pain intensity using the visual analog scale or numeric rating scale. In the core stability exercise group, the reduction in pain was significant at 3 months (MD ¼ À1.29, 95% CI ¼ À2.47, À0.11; P ¼ .003) but not at 6 months (MD ¼À0.50, 95% CI ¼À1.36, 0.35; P ¼ .26). Functional status was improved at 3 months (MD ¼ À7.14, 95% CI ¼ À11.64, À2.65; P ¼ .002) but not at 6 months (MD ¼À0.50, 95% CI ¼ 0.36, 0.35; P ¼ .26) or 12 months (MD ¼ À0.32, 95% CI ¼ À0.87, 0.23; P ¼ .25). All of the included studies assessed backspecific functional status: 4 used the Oswestry Disability Index and 1 used the Roland-Morris Disability Questionnaire. Patients in the core stability exercise groups experienced improved functional status versus the general exercise group at 3 months (MD ¼À7.14, 95% CI ¼À11.64, À2.65; P ¼ .002); no results were recorded at 6 or 12 months.Conclusions: In the short term, core stability exercise was more effective than general exercise for decreasing pain and increasing back-specific functional status in patients with LBP.

Context: Occupation or occupational setting shifts might be occurring in the athletic training profession, and differences between sexes might exist; however, little evidence exists to confirm this supposition.Objective: To evaluate trends in male and female athletic training employment patterns in terms of age and occupational setting.Design: Cross-sectional study. Setting:We requested demographic data from the National Athletic Trainers' Association (October 27, 2009) and obtained frequency totals of members by sex across the occupational life span by occupational setting.Patients or Other Participants: Our sample included 18 571 athletic trainers employed in the 3 largest classifications of occupational settings within the profession: college or university, clinical, and secondary school.Main Outcome Measure(s): We calculated frequencies and percentages to determine demographic and descriptive data. We analyzed the data using an analysis of variance to identify the differences between sexes across age and setting.Results: We observed trends in occupational setting and sex across ages 22 to 67 years. We identified differences between sexes across the ages 22 to 67 years (F 1,18 569 = 110 818.080, P < .001, η 2 = .068) and across occupational settings (F 1,18 569 = 61.908, P < .001, η 2 = .003), noting a marked decline in female athletic trainers in the workforce beginning around age 28 years and an increase in male athletic trainers in the secondary school setting beginning around their middle to late 40s. We observed differences at the intercept between setting and sex (F 1,18 569 = 63 529.344, P < .001, η 2 = .845), which were greater when observed across the ages (F 1,18 569 = 23 566 787.642, P < .001, η 2 = .939). Conclusions: We identified differences between sexes across settings and ages in addition to an overall decrease in the workforce among all professionals. A marked decline in female athletic trainers occurred at age 28 years, yet the male population increased at the secondary school level, suggesting a setting shift. Burnout, fatigue, pay scale, and a misunderstanding of professional culture and job duties might influence the exodus or shift in athletic training.Key Words: occupational setting, employment, job attrition, work-family balance, burnout, professional preparation Key Points• Differences existed between sexes for both occupational setting and age.• Female athletic trainers tended to leave the profession around age 28 years.• Male athletic trainers tended to shift into the secondary school setting in their middle to late 40s.• A general decline of athletic trainers in the workforce occurred after age 30. N ational employment trends have indicated an increase in female representation in the workforce from 40% in 1975 to 46% in 2005, with a projection that 51% of the workforce will be female by 2014. [1][2][3][4][5] The economic recession also might have affected labor pool statistics; 82% of the 2.5 million jobs lost since November 2008 were held by men, 4 further increasing the percenta...

Context: Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder.Objective: To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD.Design: Observational, repeated-measures study. Setting: Collegiate athletic training room.Patients or Other Participants: Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age 5 19 6 1 years, height 5 174 6 14 cm, mass 5 77.8 6 18.1 kg; 19 softball, 29 baseball players).Main Outcome Measure(s): We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc.Results: In the dominant shoulder, ER increased during the season (F 2,96 5 17.433, P , .001), but IR remained the same (F 2,96 5 1.839, P 5 .17). The total arc in the dominant shoulder increased between time intervals (F 2,96 5 14.030, P , .001); the mean difference between prefall and postspring measurements was 9.6946 (P , .001), and the mean difference between prefall and postspring measurements was 10.9906 (P , .001). In the nondominant shoulder, ER increased over the season (F 2,96 5 23.395, P , .001), but IR did not change over the season (F 2,96 5 0.087, P 5 .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F 2,96 5 18.552, P , .001). No changes were noted in GIRD over time. However, more athletes with GIRD were identified with the GIRD (IR difference) calculation in prefall (n 5 6) than in prespring (n 5 1) and postspring (n 5 4) (Cochran Q 5 5.2, P 5 .07). In addition, more athletes with GIRD were identified with the GIRD (% total arc) calculation in postspring (n 5 6) than in prefall (n 5 5) or prespring (n 5 4) (Cochran Q 5 2.6, P 5 .27).Conclusions: Healthy NCAA Division I and Division II athletes did not display changes in glenohumeral IR over an athletic season. However, they gained in ER and total arc during the season in both shoulders. Future researchers should investigate changes over multiple seasons. The 2 methods of calculating GIRD identified different athletes as having GIRD, indicating that additional investigation is warranted to determine the clinical benefits of each method.Key Words: shoulder, upper extremity, glenohumeral internal-rotation deficit Key Points N No changes occurred in internal rotation over the course of the season. N External rotation increa...

Stress fractures account for between 1% and 20% of athletic injuries, with 80% of stress fractures in the lower extremity. Stress fractures of the lower extremity are common injuries among individuals who participate in endurance, high load-bearing activities such as running, military and aerobic exercise and therefore require practitioner expertise in diagnosis and management. Accurate diagnosis for stress fractures is dependent on the anatomical area. Anatomical regions such as the pelvis, sacrum, and metatarsals offer challenges due to difficulty differentiating pathologies with common symptoms. Special tests and treatment regimes, however, are similar among most stress fractures with resolution between 4 weeks to a year. The most difficult aspect of stress fracture treatment entails mitigating internal and external risk factors. Practitioners should address ongoing risk factors to minimize recurrence.

Team physicians and athletic trainers should employ evidence-based, region- and population-specific EHI prevention guidelines. Sports medicine teams, coaches, and athletes should be aware of the increased risk of EHIs during August practices and the risk of prolonged practices during August.