{"id":6601,"date":"2019-10-25T15:23:53","date_gmt":"2019-10-25T20:23:53","guid":{"rendered":"http:\/\/thesportjournal.org\/?p=6601"},"modified":"2020-06-02T13:45:40","modified_gmt":"2020-06-02T18:45:40","slug":"aggressive-osteoblastoma-of-the-acetabulum-in-an-18-year-old-female-volleyball-player","status":"publish","type":"post","link":"https:\/\/thesportjournal.org\/article\/aggressive-osteoblastoma-of-the-acetabulum-in-an-18-year-old-female-volleyball-player\/","title":{"rendered":"Aggressive Osteoblastoma of the Acetabulum in an 18-Year-Old Female Volleyball Player"},"content":{"rendered":"\n

Author:<\/strong> Tayleigh Talmadge MAT, ATC<\/p>\n\n\n\n

Corresponding Author:<\/strong>
Valerie Moody PhD, LAT, ATC
32 Campus Dr. McGill 205
HHP Department
Missoula, MT 59812
406-243-2703 (office)
valerie.moody@umontana.edu<\/p>\n\n\n\n

Tayleigh Talmadge is a recent graduate of the Masters in\nAthletic Training Program at the University of Montana. Valerie Moody is a\nProfessor and Program Director of the Athletic Training Program at the\nUniversity of Montana.
\n<\/p>\n\n\n\n

Aggressive Osteoblastoma of the Acetabulum in an 18-Year-Old Female Volleyball Player
<\/h3>\n\n\n\n

Abstract<\/strong><\/p>\n\n\n\n

In a case study, an 18-year-old female volleyball player presented with persistent hip pain. Imaging revealed a lesion in the acetabulum and follow up biopsies led to the diagnosis of a benign osteoblastoma. The patient underwent a surgical resection and open reduction internal fixation of the acetabulum. Aggressive osteoblastomas of the acetabulum are rare in a young, active population; therefore, clinicians must be able to recognize the need to refer for further evaluation and understand the importance of a multidisciplinary individualized plan of care to ensure a successful return to play for the patient.<\/p>\n\n\n\n\n\n\n\n

Keywords<\/strong>: osteoblastoma, acetabulum, athlete
<\/p>\n\n\n\n

Introduction<\/strong><\/p>\n\n\n\n

An osteoblastoma\nis a rare bone tumor found in the medullary cavity or on the surface of long\nbones and posterior elements of the spine (12,14) Osteoblastomas represent\nabout 0.8% of all bone tumors and are more commonly seen in male adolescents\n(11,12). There are many clinical and histological similarities to a benign\nosteoid osteoma, but osteoblastomas are typically much larger in size\n(>1.5-2.0 cm) (14). Osteoblastomas are naturally benign but may exhibit\naggressive behavior (11). An aggressive osteoblastoma is a rare tumor that\nrepresents a borderline lesion between a benign osteoblastoma and cancerous\nosteosarcoma (11). Physical presentation of an aggressive osteoblastoma of the\nhip includes limited range of motion (ROM), chronic pain, night pain, radiating\npain, pain aggravated by weight-bearing or walking, and pain alleviated by\nanalgesic drugs (5,9,11,12,14). Osteoblastomas in the region of the hip are\nrarely encountered, especially an aggressive osteoblastoma of the acetabulum as\npresented in this case (11,14).<\/p>\n\n\n\n

There are three\nstages in osteoblastoma development. Stage 1 lesions are latent; Stage 2\nlesions are active; and Stage 3 lesions are aggressive osteoblastomas (5).\nSurgical treatment of an osteoblastoma of the acetabulum involves complete\nexcision of the lesion (5,9,12,14). For Stage 1 and 2 lesions, the recommended\ntreatment is extensive intra-lesioned curettage and packing of the defect with\na bone graft (5,9). For Stage 3 lesions, wide resection is performed, which involves\nexcision of the tumor along with surrounding edges of normal bone and soft\ntissue (5). Post-surgical complications, such as infections and blood clots,\nare common in patients following a total hip or knee arthroplasty, so it can be\ninferred that tumor excisions would result with similar occurrences (13). Staphylococcus aureus<\/em> (S. aureus) is the\nmost frequently identified pathogen following such invasive procedures (13).\nUnfortunately, there is little research regarding S. aureus infection\nprevalence following a resection of an osteoblastoma.<\/p>\n\n\n\n

Incidence of\nosteoblastoma in young, active populations is rare resulting in little\nknowledge regarding specific osteoblastoma return-to-play outcomes. It is\npertinent to all clinicians working with an athletic population to recognize\nearly signs and symptoms, know when to refer, and develop a multidisciplinary\nindividualized plan of care for an athlete suffering of a non-sport specific\ncondition. The purpose of this case study is to discuss the assessment,\ntreatment, and recovery of an 18-year-old Caucasian female volleyball player\ndiagnosed with an aggressive osteoblastoma of the acetabulum of the hip.<\/p>\n\n\n\n

Athlete Presentation<\/strong><\/p>\n\n\n\n

The athlete first\nrecognized pain in her right hip during her junior year of high school\nvolleyball. She presented with a chief complaint of deep, aching pain from her\nouter hip to upper groin. Intermittent pain progressed over the course of a\nyear and a half later to persistent pain every day. Pain management consisted\nof over the counter pain relievers for a year and a half. Despite the pain, the\nathlete was able to compete throughout her senior year of high school\nvolleyball without limitation. She was recruited to play collegiate volleyball\nand was expected to begin play in the fall following high school graduation.<\/p>\n\n\n\n

The athlete\u2019s initial imaging was four months before her freshman year of the collegiate volleyball season. Multi-planar single photon emission computed tomography (SPECT) was performed and the radiologist discovered a 4.8 x 2.4 x 4.2cm lesion in the medial right acetabulum, with internal high attenuation foci suggestive of calcium or chondroid matrix with abnormally increased radiotracer uptake. The lesion had completely eroded through the acetabulum, leaving the patient at risk for pathologic fracture (Figure 1). The athlete had a drill biopsy performed, as well as two open biopsies. The biopsy results proved inconclusive until the second open biopsy confirmed the diagnosis, and the tumor was labeled as benign. She underwent a resection and open reduction internal fixation (ORIF) to remove the osteoblastoma from her acetabulum. This procedure placed a titanium plate and five screws into her pelvis (Figure 2). The surgical site became infected with S. aureus two weeks later leading to an incision and drainage of the infection. She was prescribed Oxycodone, Ondansetron (Zofran\/anti-nausea), sulfamethoxazole-trimethoprim (Bactrim), as well as doxycycline (Vibramycin) and enoxaparin 40 mg\/0.4 mL injection (Lovenox) to treat pain and fight the infection for two weeks.<\/p>\n\n\n\n

\"MRI
Figure 1: MRI aggressive osteoblastoma of the acetabulum <\/figcaption><\/figure>\n\n\n\n
\"Post-operative
Figure 2: Post-operative X-ray ORIF acetabulum <\/figcaption><\/figure>\n\n\n\n

From the first\nbiopsy until the surgical resection, the athlete was on crutches and was\npartial weight-bearing. Following the resection, she was completely\nnon-weight-bearing for two weeks to minimize the load on the plate and screws\nin her pelvis. After those two weeks, she was partial weight-bearing. At 4-weeks,\npelvic X-rays were taken, and the subject progressed to weight-bearing as\ntolerated. Initially, her physical therapist advised she perform light\nhip\/pelvis stretching and passive ROM exercises. Athletic trainers assumed\noversight of her rehabilitation upon arrival at college. Her rehabilitation\nprotocol was guided largely by existing protocols from hip labral repair and\nACL-reconstruction focusing on strengthening the hip, hamstrings, and core. The\nathlete\u2019s criteria to return-to-play (RTP), as established by her physician,\nincluded full practice sessions performed at 100% effort without symptom\nprovocation. She has successfully returned to play 2-years out from her\nsurgical resection and ORIF.<\/p>\n\n\n\n

The athlete\u2019s primary care provider believed she was suffering a stress fracture in the low back, so further imaging was requested. Her physician indicated that she suffered of low back pain and radicular pain into her right hip for 1.5 years and the pain had progressively worsened over 3.5 months. Following SPECT imaging, the radiologist found an assimilation joint on the right at S1-S2 with mildly increased radiotracer uptake, compatible with Bertolotti\u2019s syndrome. Following the second open biopsy, the cytologist stated that the lesion appeared to represent an osteoblastic lesion with atypia and at least focally aggressive features, leading to the final diagnosis of an aggressive osteoblastoma of the acetabulum. Differential diagnoses included osteosarcoma, aggressive osteoblastoma, and less likely, clear cell chondrosarcoma.<\/p>\n\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Hip pain in the young adult is non-specific and can be due to sports-related or non-sports related conditions (10). Pain is commonly caused by overuse or stress injury, acute injury, or sports-related activity exacerbated by a congenital predisposition (10). Due to the non-specific clinical features and low prevalence, the diagnosis of an osteoblastoma is often missed or delayed (14). As a rare cause of hip pain in a young adult athlete, this case of an aggressive osteoblastoma of the acetabulum provides clinicians a differential diagnosis if conservative treatment fails.<\/p>\n\n\n\n

The challenge for the clinician is to apply the knowledge from the literature that describes regional hip problems to clearly identify the anatomical structure and pathological process that requires immediate treatment or referral (10). The athlete\u2019s chief complaint was a chronic deep, aching pain from her outer hip to upper groin. From this pain description, the clinician should know that a complaint of groin pain often has an intra-articular etiology, whereas lateral hip pain is usually associated with an extra-articular etiology (7). In general, a pain that is deep, aching and non-specific is likely to be joint in nature (10). However, localization of hip pain may be difficult, as it may be felt in several different areas simultaneously (10).<\/p>\n\n\n\n

The clinician must\nask about the mechanism of injury, whether it be acute or chronic in nature.\nInitially, the athlete complained of pain only once every three months, eventually\nprogressing to every day. An osteoblastoma often presents with a gradual onset\nof worsening symptoms that may or may not affect athletic performance. These\ncircumstances should prompt the clinician to seek further evaluation (10). The\ntypical presentation of an osteoblastoma is hip pain that is relieved with\nadministration of analgesics like non-steroidal anti-inflammatory drugs\n(NSAIDs) (5, 12). Clinicians should be wary of red flags such as excessive use\nof NSAIDs for worsening symptoms.<\/p>\n\n\n\n

The various combinations\nof special tests of the hip challenge the clinician to choose those that\nprovide the most clinically relevant information (7). Based on subjective and\nobjective assessments, the clinician may refer the patient for imaging to confirm\na diagnosis, determine the extent of damage, and guide treatment and\nrehabilitation (10). The radiographic examination should include a plain\nradiograph, computed tomography (CT) and magnetic resonance imaging (MRI) scan\n(6). For the detection of osteoblastomas, CT appears to be a more valuable\nimaging tool than MRI because it can clearly demonstrate tumor size, location,\ncentral calcification within the lesion, and delineate the cortical destruction\nor soft-tissue extension (14).<\/p>\n\n\n\n

For Stage 1 and 2 lesions, the recommended treatment procedure is extensive intra-lesioned curettage and packing of the defect with a bone graft (5,9). For Stage 3 lesions, wide resection is performed. Such excisions are usually curative for osteoblastomas (5). Resection of sub-chondral lesions requires removal of the overlying cartilage and is not feasible in lesions in the major weight bearing areas of the acetabulum or femoral head (3). The subject\u2019s osteoblastoma was classified as aggressive in the acetabulum of the hip, a major weight-bearing area, and surgeons found this case to be a surgical dilemma. The surgeon ultimately decided on performing a surgical resection and ORIF.<\/p>\n\n\n\n

There is no\nspecific rehabilitation protocol for patients recovering from a surgical\nresection and ORIF for an osteoblastoma of the acetabulum. The most similar\npathology with documented RTP outcomes is that of an acetabular fracture. Fractures\nof the acetabulum are most common in young, active people and are known to be\nassociated with a high degree of disability and poor functional outcomes due to\nthe variable degree of involvement of the hip joint(4). In a study with\npatients who underwent internal fixation for an isolated acetabular fracture,\nthere was a significant reduction in the level of activity and frequency of\nsport (6). Nevertheless, 42% were able to return to their previous level of\nactivities, and 67% were able to participate in sport at some level (4).<\/p>\n\n\n\n

Throughout the treatment and recovery process, it is vital that clinicians understand the relationship between mental and physical health to support their patients who suffer a rare, complicated pathology like an osteoblastoma. With early complications, like S. aureus infection, the athlete may experience frustration and fear that they may not overcome these obstacles to progress in her rehabilitation. To promote overall well-being, the clinician should actively engage in short- and long-term goal-setting with the patient and encourage proper self-care of the patient (1).<\/p>\n\n\n\n

To optimize\npost-surgical outcomes, it is vital for clinicians to practice cross collaboration\nwith other members of the multidisciplinary team. The assessment, diagnosis,\ntreatment, and recovery of a pathology with non-specific features really\nchallenges a healthcare team\u2019s teamwork requiring commitment and focus on developing\nan individualized plan of care to accomplish the patient\u2019s short- and long-term\ngoals (8). The development of specific goals involves honest and constant\ncommunication among the patient and involved healthcare providers (8).\nReturning to play may be the athlete\u2019s primary goal, but there is life beyond\nsport, and it is up to the multidisciplinary team to discuss the athlete\u2019s\nfuture goals and aspirations, and strive to achieve these.<\/p>\n\n\n\n

The athlete\u2019s RTP\nis yet to be determined considering there is little research regarding the RTP\nfollowing a surgical resection and ORIF of an osteoblastoma in the acetabulum.\nHowever, a recent case study of an 18-year-old multi-sport female athlete with an\nosteoblastoma in the lumbosacral region revealed that the patient returned and\nremained active in sports following her tumor excision and sacral hemi\nlaminectomy (2).The timeline in which the subject returned to play\nwas not specified, but the case represents a successful return-to-play outcome\nof an athlete suffering of an osteoblastoma.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

An aggressive\nosteoblastoma of the acetabulum of the hip is extremely rare but is important\nto consider as a differential diagnosis of chronic hip pain. Information should\nbe gathered regarding sports participation, time spent training versus time\nresting, the location, quality, and duration of pain, as well as the mechanism\nof injury (2). Although current literature is lacking in return-to-play\noutcomes following a resection of an aggressive osteoblastoma, the clinician is\nresponsible for developing a multidisciplinary individualized plan of care for\nthe athlete. Just as importantly, a cross-collaborative approach to care is\nvital to the success of the athlete\u2019s return-to-play outcome.<\/p>\n\n\n\n

Applications in Sport<\/strong><\/p>\n\n\n\n

This article is written for coaches, athletic trainers, and other sports health related personnel to gain a better understanding of the importance of early diagnosis of an injury as well as working collaboratively to treat an athlete to facilitate return to sport.
<\/strong><\/p>\n\n\n\n

Referrences<\/strong><\/p>\n\n\n\n

  1. Ayers DC, Franklin PD, Ring DC. The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedic. AOA Critical Issues. 2013;165:7-13.<\/li>
  2. Blauwet C, Borg-Stein J. Osteoblastoma as the Cause of Persistent Lumbosacral Pain in a Female High School Athlete. Curr Sports Med Rep<\/em>. 2012;11(1):24-27.<\/li>
  3. Frank JS, Gambacorta PL, Eisner EA. Hip Pathology in the Adolescent Athlete. J Am Acad Orthop Surg<\/em>. 2013;21:665-674.<\/li>
  4. Giannoudis P V., Nikolaou VS, Kheir E, Mehta S, Stengel D, Roberts CS. Factors Determining Quality of Life and Level of Sporting Activity after Internal Fixation of an Isolated Acetabular Fracture. J Bone Jt Surg – Br Vol<\/em>. 2009;91-B(10):1354-1359.<\/li>
  5. G\u00fcnel U, Da\u01e7lar B, G\u00fcnel N. Long-Term Follow-Up of a Hip Joint Osteoblastoma After Intralesional Curettage and Cement Packing: A Case Report. Acta Orthop Traumatol Turc<\/em>. 2013;47(3):218-222.<\/li>
  6. Haddad FS. The Young Adult Hip in Sport<\/em>. Springer-Verlag London. 2014;284-286.<\/li>
  7. Marwan YA, Abatzoglou S, Esmaeel AA, et al. Hip Arthroscopy for the Management of Osteoid Osteoma of the Acetabulum: A Systematic Review of the Literature and Case Report. BMC Musculoskelet Disord<\/em>. 2015;16(1):1-7.<\/li>
  8. Momsen AM, Rasmussen JO, Nielsen CV, Iversen MD, Lund H. Multidisciplinary Team Care in Rehabilitation: An Overview of Reviews. J Rehabil Med<\/em>. 2012;44(11):901-912.<\/li>
  9. Patel S, Agrawal A, Maheshwari R, Chauhan VD. Periosteal Osteoblastoma of the Pelvis: A Rare Case. Iran J Med Sci<\/em>. 2015;40(1):77-80.<\/li>
  10. Pilavaki M, Petsatodis G, Petsatodis E, Cheva A, Palladas P. Imaging of an Unusually Located Aggressive Osteoblastoma of the Pelvis: A Case Report. Hippokratia<\/em>. 2011;15(1):87-89.<\/li>
  11. Sharma A, Gogoi P, Arora R, Haq RU, Dhammi IK, Bhatt S. Aggressive Osteoblastoma of the Acetabulum: A Diagnostic Dilemma. J Clin Orthop Trauma<\/em>. 2018;9:S21-S25.<\/li>
  12. Von Chamier G, Holl-Wieden A, Stenzel M, et al. Pitfalls in Diagnostics of Hip Pain: Osteoid Osteoma and Osteoblastoma. Rheumatol Int<\/em>. 2010;30(3):395-400.<\/li>
  13. Weiser MC, Moucha CS. The Current State of Screening and Decolonization for the Prevention of Staphylococcus aureus Surgical Site Infection after Total Hip and Knee Arthroplasty. J Bone Jt Surgery-American Vol<\/em>. 2015;97(17):1449-1458.<\/li>
  14. Yang CY, Chen CF, Chen WM, et al. Osteoblastoma in the Region of the Hip. J Chinese Med Assoc<\/em>. 2013;76(2):115-120.<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"

    Author: Tayleigh Talmadge MAT, ATC Corresponding Author:Valerie Moody PhD, LAT, […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"jetpack_publicize_message":"","jetpack_is_tweetstorm":false,"jetpack_publicize_feature_enabled":true,"jetpack_social_options":[]},"categories":[290,904],"tags":[1516,914,1515],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p4btio-1It","jetpack-related-posts":[{"id":8014,"url":"https:\/\/thesportjournal.org\/article\/evaluating-the-impact-of-concentrated-match-scheduling-in-college-volleyball-during-the-covid-19-pandemic\/","url_meta":{"origin":6601,"position":0},"title":"Evaluating the Impact of Concentrated Match Scheduling in College Volleyball during the COVID-19 Pandemic","date":"October 8, 2021","format":false,"excerpt":"Authors:\u00a0 Mark Mitchell, Yoav Wachsman, and Monica Fine Corresponding Author:Mark Mitchell, DBAProfessor of MarketingAssociate Dean, Wall College of BusinessNCAA Faculty Athletics Representative (FAR)Coastal Carolina UniversityP. O. Box 261954Conway, SC\u00a0 29528mmitchel@coastal.edu(843) 349-2392 Mark Mitchell, DBA is Professor of Marketing at Coastal Carolina University in Conway, SC. Yoav Wachsman, PhD is Professor\u2026","rel":"","context":"In "Sports Management"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":136,"url":"https:\/\/thesportjournal.org\/article\/effects-of-creatine-supplementation\/","url_meta":{"origin":6601,"position":1},"title":"Effects of Creatine Supplementation on Body Composition, Strength, and Power of Female Volleyball Players","date":"February 15, 2008","format":false,"excerpt":"Submitted by: Jon YeanSub Lim, Ed.D., Department of Health and Physical Education, Northern State University Abstract The purpose of this study was to investigate the effect of creatine supplementation on body composition, muscular strength, and power during 10 weeks of training in female collegiate volleyball players. Thirty-six athletes (19 -\u2026","rel":"","context":"In "Sports Exercise Science"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]},{"id":1821,"url":"https:\/\/thesportjournal.org\/article\/differences-of-body-dimensions-in-female-volleyball-players-cadets-in-relation-to-volleyball-playing-position-2\/","url_meta":{"origin":6601,"position":2},"title":"Differences of body dimensions in female volleyball players (cadets) in relation to volleyball playing position","date":"April 24, 2014","format":false,"excerpt":"Submitted by Aleksandra Vujmilovi\u0107 and Tamara Karali\u0107 ABSTRACT This research presents a test of the hypothesis that there are differences in morphological characteristics, which affect effective realization of the elements of the game, which are influenced by many factors from the area of anthropological status of the volleyball players. The\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"Capture","src":"https:\/\/i0.wp.com\/thesportjournal.org\/wp-content\/uploads\/2014\/04\/Capture1.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":5891,"url":"https:\/\/thesportjournal.org\/article\/relationship-between-physical-training-ratings-of-perceived-exertion-and-mental-toughness-in-female-ncaa-division-i-volleyball-players\/","url_meta":{"origin":6601,"position":3},"title":"Relationship Between Physical Training, Ratings of Perceived Exertion, and Mental Toughness in Female NCAA Division I Volleyball Players","date":"August 9, 2018","format":false,"excerpt":"Authors: Mathieu Castello, Jacob P Reed, Robin Lund, Mick Mack Kinesiology, Allied Health, and Human Services University of Northern Iowa Cedar Falls, IA 50614 Corresponding Author: Jacob Reed University of Northern Iowa 203 Wellness and Recreation Center Cedar Falls, IA 50614 Phone: 319-273-2071 Email: jacob.reed@uni.edu Relationship Between Physical Training, Ratings\u2026","rel":"","context":"In "Sports Studies and Sports Psychology"","img":{"alt_text":"Table 2","src":"https:\/\/i0.wp.com\/thesportjournal.org\/wp-content\/uploads\/2018\/08\/Table-2.jpg?resize=350%2C200","width":350,"height":200},"classes":[]},{"id":6236,"url":"https:\/\/thesportjournal.org\/article\/comparison-of-coinciding-anticipation-timing-and-reaction-time-performances-of-adolescent-female-volleyball-players-in-different-playing-positions\/","url_meta":{"origin":6601,"position":4},"title":"Comparison of Coinciding Anticipation Timing and Reaction Time Performances of Adolescent Female Volleyball Players in Different Playing Positions","date":"January 10, 2019","format":false,"excerpt":"Authors:Ahmet Rahmi G\u00fcnay * (1), Halil Ibrahim Ceylan (2), Filiz Fatma \u00c7olako\u011folu (3), \u00d6zcan Sayg\u0131n (4) (1, 2, 4) Mugla Sitki Kocman University, Faculty of Sports Sciences, Turkey. (3) Gazi University, Faculty of Sports Sciences, Turkey. Corresponding Author:Halil Ibrahim Ceylan, Research AssistantMugla Sitki Kocman University, Faculty of Sports SciencesKotekli\/Mugla, 48000halil.ibrahimceylan60@gmail.com\u2026","rel":"","context":"In "Commentary"","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/thesportjournal.org\/wp-content\/uploads\/2019\/01\/Figure-1.png?resize=350%2C200&ssl=1","width":350,"height":200},"classes":[]},{"id":362,"url":"https:\/\/thesportjournal.org\/article\/making-the-grade\/","url_meta":{"origin":6601,"position":5},"title":"Making the Grade: Academic Success in Today\u2019s Athlete","date":"January 8, 2010","format":false,"excerpt":"Jennifer Dilley-Knoles, North Central Texas College; Jeffrey S. Burnett, Fort Hays State University; Kayla W. Peak, Tarleton State University Abstract The overall importance placed on an athlete\u2019s academic eligibility can be extremely stressful for both the coach and the student-athlete. In order to compete the athlete must remain academically eligible;\u2026","rel":"","context":"In "Contemporary Sports Issues"","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts\/6601"}],"collection":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/comments?post=6601"}],"version-history":[{"count":4,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts\/6601\/revisions"}],"predecessor-version":[{"id":7293,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/posts\/6601\/revisions\/7293"}],"wp:attachment":[{"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/media?parent=6601"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/categories?post=6601"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/thesportjournal.org\/wp-json\/wp\/v2\/tags?post=6601"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}