ABPTS SCS cheat sheet

Neuromuscular training programs reduce ACL injury incidence in athletes by roughly 50% (pooled risk ratio ~0.5), with greatest effect in female athletes under 18.

The FIFA 11+ program is a 20-minute warm-up with running, strength/plyometric, and balance components performed at least twice weekly; adherence drives effect size.

Landing biomechanics linked to ACL risk: knee valgus moment, decreased knee flexion at initial contact, and increased quadriceps dominance relative to hamstrings.

Hamstring strain risk factors include prior strain (strongest predictor), eccentric strength deficit, and increasing age; Nordic hamstring programs reduce incidence.

Acute:chronic workload ratio >1.5 is associated with elevated injury risk; ratios <0.8 are associated with reduced capacity and also higher risk.

Concussion prevention: rule changes and technique training reduce head impacts; no helmet conclusively prevents concussion in sport.

Overuse injury in youth athletes is associated with >8 hours/week of organized sport and sport specialization; guidelines recommend hours/week not exceeding age in years.

Screening tests (e.g., Y-balance, FMS) have limited predictive validity for injury; use them to identify modifiable deficits, not to predict individual injury.

Ottawa Ankle Rules: radiograph indicated if pain in malleolar zone plus bone tenderness at posterior edge of either malleolus or navicular base or inability to bear weight 4 steps.

Ottawa Knee Rules: radiograph if age ≥55, isolated patellar tenderness, fibular head tenderness, inability to flex knee to 90°, or inability to bear weight 4 steps.

Lachman test is the most sensitive examination for ACL tear (highest sensitivity, best in acute setting); pivot shift is highly specific but less sensitive.

Anterior drawer is more sensitive for ACL with the knee flexed ~90°; the McMurray test has low sensitivity but higher specificity for meniscal tears.

Ankle syndesmotic injury: squeeze test, external rotation stress test, and dorsiflexion-external rotation test assess the distal tibiofibular joint.

SLAP and labral tests (e.g., O'Brien, Speed, apprehension) have modest diagnostic accuracy; diagnosis often requires imaging or arthroscopy.

Cervical spine clearance in trauma: NEXUS criteria or Canadian C-Spine Rule determine need for imaging in alert, stable patients.

Sensitivity rules out (SnNout); specificity rules in (SpPin) - a highly sensitive test with a negative result is most useful for exclusion.

Tendinopathy management: progressive loading (isometric for pain modulation, then eccentric/heavy slow resistance) is first-line; corticosteroid injections provide short-term relief but worse long-term outcomes.

Early ACL reconstruction versus rehabilitation-first: both are reasonable; delayed reconstruction with prehab may improve outcomes for some patients.

RICE has largely been replaced by PEACE & LOVE (protection, elevation, avoid anti-inflammatories, compression, education; load, optimism, vascularization, exercise) for soft tissue injury.

Progressive tendon loading parameters: 3-4 sets of 15 reps at ~70% 1RM for heavy slow resistance, 3 times weekly for 12 weeks.

Return-to-play after muscle strain follows criteria-based progression: pain-free full ROM, strength ≥90% contralateral, sport-specific drills, then full contact.

Blood flow restriction training at 20-30% 1RM with 50-80% arterial occlusion pressure can increase strength and hypertrophy when high loads are contraindicated.

Rehabilitation phases should overlap and be criteria-based rather than time-based; progression is guided by objective measures (strength, ROM, functional tests).

Cryotherapy reduces pain and swelling but does not accelerate tissue healing; prolonged immobilization delays return to function.

Return-to-sport decision requires shared decision-making and consideration of tissue healing, strength symmetry (≥90%), psychological readiness, and sport demands.

The Acute:Chronic Workload Ratio (ACWR) uses 1-week acute load divided by 4-week rolling average; values between 0.8 and 1.3 are considered the 'sweet spot'.

Adequate sleep (7-9 hours for adults) improves reaction time, sprint speed, and injury resistance; sleep deprivation impairs performance and increases injury risk.

Periodization: linear (progressive overload) vs undulating (daily/weekly variation); both improve strength when total volume is equated.

Plyometric progression: land → jump in place → jumps for distance → depth jumps; ground contact time and quality drive adaptation.

Return-to-sport testing batteries (e.g., hop tests, isokinetic strength, agility) have limited predictive validity; use as one component of a multifactorial decision.

Sport-specific conditioning should replicate competition demands (work:rest ratios, movement patterns, environmental conditions) to optimize transfer.

Psychological readiness tools (e.g., ACL-RSI) predict return-to-sport outcomes and should be included in clearance decisions.

Informed consent requires disclosure of diagnosis, proposed intervention, risks/benefits, alternatives, and the patient's right to refuse.

Patient education should use teach-back and plain language (≈6th-8th grade reading level) to confirm understanding.

Scope of practice is defined by state licensure and professional standards; delegating tasks to unlicensed personnel requires supervision and documented competency.

Confidentiality is governed by HIPAA and state law; disclosure without consent is permitted only for specific exceptions (e.g., serious threat, mandated reporting).

Documentation should be objective, timely, and include assessment, intervention, response, and plan; late or altered records undermine credibility.

Conflict of interest: financial relationships with vendors or referral sources must be disclosed; kickbacks for referrals are prohibited under federal law (Anti-Kickback Statute).

Cultural humility and shared decision-making improve adherence; health literacy and language barriers affect outcomes and must be addressed.

Ethical principles: autonomy, beneficence, nonmaleficence, justice; when principles conflict, document reasoning and involve the patient.

Levels of evidence: systematic reviews of RCTs (Level I) → RCT (II) → cohort (III) → case-control/case series (IV) → expert opinion (V).

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive predictive value depends on prevalence.

Number needed to treat (NNT) = 1/absolute risk reduction; lower NNT indicates greater clinical benefit.

Minimal clinically important difference (MCID) is the smallest change patients perceive as beneficial; distinct from statistical significance.

Internal validity threats: selection bias, attrition bias, detection bias, performance bias; randomized allocation and blinding mitigate them.

Effect size measures: Cohen's d (0.2 small, 0.5 medium, 0.8 large); standardized mean difference allows pooling across scales.

Quality improvement uses PDSA (Plan-Do-Study-Act) cycles and run charts/statistical process control to monitor change over time.

GRADE rates certainty of evidence as high/moderate/low/very low based on risk of bias, inconsistency, indirectness, imprecision, and publication bias.