Background:Eccentric exercise is commonly used in the management of Achilles tendinopathy (AT) but its effectiveness for insertional AT has been questioned. Soft tissue treatment (Astym) combined with eccentric exercise could result in better outcomes than eccentric exercise alone.Hypothesis:Soft tissue treatment (Astym) plus eccentric exercise will be more effective than eccentric exercise alone for subjects with insertional AT.Study Design:Prospective randomized controlled trial.Level of Evidence:Level 2.Methods:Sixteen subjects were randomly assigned to either a soft tissue treatment (Astym) and eccentric exercise group or an eccentric exercise–only group. Intervention was completed over a 12-week period, with outcomes assessed at baseline, 4, 8, 12, 26, and 52 weeks. Outcomes included the Victorian Institute of Sport Assessment Achilles-Specific Questionnaire (VISA-A), the numeric pain rating scale (NPRS), and the global rating of change (GROC).Results:Significantly greater improvements on the VISA-A were noted in the soft tissue treatment (Astym) group over the 12-week intervention period, and these differences were maintained at the 26- and 52-week follow-ups. Both groups experienced a similar statistically significant improvement in pain over the short and long term. A significantly greater number of subjects in the soft tissue treatment (Astym) group achieved a successful outcome at 12 weeks.Conclusion:Soft tissue treatment (Astym) plus eccentric exercise was more effective than eccentric exercise only at improving function during both short- and long-term follow-up periods.Clinical Relevance:Soft tissue treatment (Astym) plus eccentric exercise appears to be a beneficial treatment program that clinicians should consider incorporating into the management of their patients with insertional AT.

Objective: To present recommendations for the prevention, recognition, and treatment of environmental cold injuries.Background: Individuals engaged in sport-related or workrelated 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.

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Context:Understanding the beliefs about and use of evidence-based practice (EBP) among athletic trainers (ATs) will help to determine appropriate strategies to improve implementation.Objective: To examine the ATs' beliefs about and use of EBP.Design: Cross-sectional study. Setting: Online survey instrument. Patients or Other Participants: A total of 467 ATs responded to the survey request, a response rate of 11.67%. A total of 385 (9.6%) completed the EBP Beliefs Scale and 342 (8.5%) completed the EBP Implementation Scale.Main Outcome Measure(s): The EBP Beliefs Scale and EBP Implementation Scale were administered. The surveys collected demographic information in addition to information about participants' beliefs regarding EBP and implementation of EBP in clinical practice.Results: The ATs demonstrated a level of neither agree nor disagree (56.00 6 7.86) on the EBP Beliefs Scale. Belief scores were higher among those ATs required to document for thirdparty reimbursement (P ¼ .001), those with access to current research through professional journals other than the Journal of Athletic Training (P ¼ .02), and those with a doctoral degree (P ¼ .01). A low level of implementation (9.00 6 11.38), representing the implementation of EBP approximately 0 times in the previous 8 weeks, was found on the EBP Implementation Scale. Implementation scores were higher among preceptors (P ¼ .01), those required to document for third-party reimbursement (P , .001), those with access to current research through professional journals (P ¼ .002), and those with a doctoral degree (P ¼ .01).Conclusions: Participants had a positive attitude toward EBP; however, they were not implementing EBP concepts when providing patient care. This suggests that additional information and EBP resources are needed so ATs can better implement EBP in practice. To provide the best patient care and to promote EBP within the profession, clinicians should make EBP a priority and advocate for EBP implementation.Key Words: evidence-based medicine, clinical practice, survey research Key PointsOverall, athletic trainers were neutral toward evidence-based practice but believed it results in the best clinical care for patients and is important to the credibility of the profession. Athletic trainers' level of implementation of evidence-based practice was low. Additional information and resources are needed so athletic trainers can better implement evidence-based practice. To provide the best patient care, promote evidence-based practice within the profession, and gain credibility with other health care professions, athletic trainers should become advocates for evidence-based practice and make it a priority.

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