Subjects -> HEALTH AND SAFETY (Total: 1543 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (725 journals)
    - WOMEN'S HEALTH (82 journals)

PHYSICAL FITNESS AND HYGIENE (130 journals)                     

Showing 1 - 130 of 130 Journals sorted alphabetically
ACSMs Health & Fitness Journal     Full-text available via subscription   (Followers: 15)
Acta Facultatis Educationis Physicae Universitatis Comenianae     Open Access   (Followers: 4)
Acta Kinesiologiae Universitatis Tartuensis     Open Access   (Followers: 1)
ACTIVE : Journal of Physical Education, Sport, Health and Recreation     Open Access   (Followers: 30)
Adapted Physical Activity Quarterly     Hybrid Journal   (Followers: 5)
African Journal for Physical, Health Education, Recreation and Dance     Full-text available via subscription   (Followers: 7)
Ágora para la Educación Física y el Deporte     Open Access  
Al.Qadisiya journal for the Sciences of Physical Education     Open Access  
American Journal of Sexuality Education     Hybrid Journal   (Followers: 4)
Annals of Applied Sport Science     Open Access   (Followers: 10)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 11)
Applied Physiology, Nutrition and Metabolism     Hybrid Journal   (Followers: 34)
Apunts. Medicina de l'Esport     Full-text available via subscription   (Followers: 1)
Arab Journal of Nutrition and Exercise     Open Access   (Followers: 1)
Archives of Exercise in Health and Disease     Open Access   (Followers: 7)
Arquivos de Ciências do Esporte     Open Access  
Arquivos em Movimento     Open Access   (Followers: 1)
Arrancada     Open Access   (Followers: 1)
Athletic Training & Sports Health Care     Full-text available via subscription   (Followers: 24)
BMC Obesity     Open Access   (Followers: 8)
BMC Sports Science, Medicine and Rehabilitation     Open Access   (Followers: 35)
Childhood Obesity     Hybrid Journal   (Followers: 24)
Clinical Journal of Sport Medicine     Hybrid Journal   (Followers: 36)
Comparative Exercise Physiology     Hybrid Journal   (Followers: 24)
Cultura, Ciencia y Deporte     Open Access   (Followers: 2)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 24)
eJRIEPS : Ejournal de la recherche sur l'intervention en éducation physique et sport     Open Access  
Environmental Health and Preventive Medicine     Open Access   (Followers: 4)
Éthique & Santé     Full-text available via subscription  
Fat Studies : An Interdisciplinary Journal of Body Weight and Society     Partially Free   (Followers: 3)
Fisioterapia em Movimento     Open Access  
Fitness & Performance Journal     Open Access   (Followers: 3)
Food Science and Human Wellness     Open Access   (Followers: 5)
Frontiers in Sports and Active Living     Open Access   (Followers: 2)
Gelanggang Pendidikan Jasmani Indonesia     Open Access  
German Journal of Exercise and Sport Research : Sportwissenschaft     Hybrid Journal   (Followers: 4)
Geron     Full-text available via subscription  
Global Journal of Health and Physical Education Pedagogy     Full-text available via subscription   (Followers: 2)
Health and Quality of Life Outcomes     Open Access   (Followers: 15)
Health Education Journal     Hybrid Journal   (Followers: 17)
Health Marketing Quarterly     Hybrid Journal   (Followers: 3)
Health Physics     Hybrid Journal   (Followers: 7)
Home Healthcare Now     Hybrid Journal   (Followers: 5)
Human Movement     Open Access   (Followers: 14)
Human Movement Science     Hybrid Journal   (Followers: 17)
IISE Transactions on Occupational Ergonomics and Human Factors     Hybrid Journal  
Indonesia Performance Journal     Open Access  
İnönü Üniversitesi Beden Eğitimi ve Spor Bilimleri Dergisi     Open Access  
International Journal for Vitamin and Nutrition Research     Hybrid Journal   (Followers: 12)
International Journal of Applied Exercise Physiology     Open Access   (Followers: 59)
International Journal of Athletic Therapy & Training     Hybrid Journal   (Followers: 15)
International Journal of Behavioral Nutrition and Physical Activity     Open Access   (Followers: 30)
International Journal of Men's Health     Full-text available via subscription   (Followers: 5)
International Journal of Obesity     Hybrid Journal   (Followers: 94)
International Journal of Obesity Supplements     Full-text available via subscription   (Followers: 8)
International Journal of Qualitative Studies on Health and Well-Being     Open Access   (Followers: 21)
International Journal of Spa and Wellness     Hybrid Journal  
International Journal of Sport, Exercise & Training Sciences     Open Access   (Followers: 2)
International Journal of Yoga     Open Access   (Followers: 17)
Isokinetics and Exercise Science     Hybrid Journal   (Followers: 12)
Journal of American College Health     Hybrid Journal   (Followers: 4)
Journal of Athlete Development and Experience     Open Access   (Followers: 1)
Journal of Bioenergetics and Biomembranes     Hybrid Journal   (Followers: 1)
Journal of Human Performance in Extreme Environments     Open Access   (Followers: 2)
Journal of Human Sport and Exercise     Open Access   (Followers: 19)
Journal of Motor Learning and Development     Hybrid Journal  
Journal of Physical Activity and Health     Hybrid Journal   (Followers: 11)
Journal of Physical Activity and Hormones     Open Access   (Followers: 1)
Journal of Physical Activity Research     Open Access   (Followers: 5)
Journal of Physical Education and Human Movement     Open Access  
Journal of Physical Education and Sport Sciences     Open Access   (Followers: 2)
Journal of Physical Education Health and Sport     Open Access   (Followers: 1)
Journal of Physical Education, Recreation & Dance     Full-text available via subscription   (Followers: 15)
Journal of Science in Sport and Exercise     Hybrid Journal   (Followers: 4)
Journal of Sport and Health Science     Open Access   (Followers: 22)
Journal of Sport Sciences and Fitness     Open Access   (Followers: 16)
Journal of Strength and Conditioning Research     Hybrid Journal   (Followers: 77)
Journal of Yoga & Physical Therapy     Open Access   (Followers: 7)
Jurnal Pendidikan Kesehatan Rekreasi     Open Access   (Followers: 3)
Kerbala Magazine of Physical Edu. Seiences     Open Access   (Followers: 2)
Kinesiology : International Journal of Fundamental and Applied Kinesiology     Open Access  
Kinesiology Review     Hybrid Journal   (Followers: 6)
Krankenhaus-Hygiene - Infektionsverhütung     Full-text available via subscription  
Measurement in Physical Education and Exercise Science     Hybrid Journal   (Followers: 7)
Médecine & Nutrition     Full-text available via subscription  
Mental Health and Physical Activity     Hybrid Journal   (Followers: 17)
MHSalud : Movimiento Humano y Salud     Open Access  
Obesity     Hybrid Journal   (Followers: 58)
Obesity Research & Clinical Practice     Full-text available via subscription   (Followers: 21)
Obesity Reviews     Hybrid Journal   (Followers: 26)
Obesity Science & Practice     Open Access   (Followers: 1)
Open Obesity Journal     Open Access   (Followers: 1)
Pain Management in General Practice     Full-text available via subscription   (Followers: 12)
PALAESTRA : Adapted Sport, Physical Education, and Recreational Therapy     Full-text available via subscription   (Followers: 4)
Physical Activity and Health     Open Access   (Followers: 3)
Physical Education & Sport Pedagogy     Hybrid Journal   (Followers: 12)
Preventing Chronic Disease     Free   (Followers: 2)
Psychology of Sport and Exercise     Hybrid Journal   (Followers: 20)
Quality in Sport     Open Access   (Followers: 1)
Race and Yoga     Open Access   (Followers: 5)
RBNE - Revista Brasileira de Nutrição Esportiva     Open Access   (Followers: 1)
RBONE - Revista Brasileira de Obesidade, Nutrição e Emagrecimento     Open Access  
RBPFEX - Revista Brasileira de Prescrição e Fisiologia do Exercício     Open Access  
Research Quarterly for Exercise and Sport     Hybrid Journal  
Retos : Nuevas Tendencias en Educación Física, Deportes y Recreación     Open Access  
Revista Andaluza de Medicina del Deporte     Open Access   (Followers: 2)
Revista Brasileira de Atividade Física & Saúde     Open Access  
Revista Brasileira de Ciências do Esporte     Open Access   (Followers: 1)
Revista Brasileira de Cineantropometria & Desempenho Humano     Open Access   (Followers: 1)
Revista Brasileira de Educação Física e Esporte     Open Access   (Followers: 2)
Revista da Educação Física : UEM     Open Access   (Followers: 1)
Revista Iberoamericana de Psicología del Ejercicio y el Deporte     Open Access  
Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte : International Journal of Medicine and Science of Physical Activity and Sport     Open Access   (Followers: 1)
Revue phénEPS / PHEnex Journal     Open Access  
Scandinavian Journal of Sport and Exercise Psychology     Open Access   (Followers: 8)
SIPATAHOENAN : South-East Asian Journal for Youth, Sports & Health Education     Open Access  
Spor Bilimleri Dergisi / Hacettepe Journal of Sport Sciences     Open Access  
Sport and Fitness Journal     Open Access   (Followers: 5)
Sport Health     Full-text available via subscription   (Followers: 3)
Sport Sciences for Health     Hybrid Journal   (Followers: 5)
Sport- und Präventivmedizin     Hybrid Journal   (Followers: 3)
SPORTIVE : Journal Of Physical Education, Sport and Recreation     Open Access   (Followers: 5)
Sports     Open Access   (Followers: 2)
Sports Biomechanics     Hybrid Journal   (Followers: 29)
Sports Health: A Multidisciplinary Approach     Hybrid Journal   (Followers: 4)
Strength & Conditioning Journal     Hybrid Journal   (Followers: 64)
Timisoara Physical Education and Rehabilitation Journal     Open Access   (Followers: 4)
Turkish Journal of Sport and Exercise     Open Access  
Yoga Mimamsa     Open Access   (Followers: 2)
Здоровье человека, теория и методика физической культуры и спорта     Open Access  


Similar Journals
Journal Cover
Sports Health: A Multidisciplinary Approach
Journal Prestige (SJR): 1.107
Citation Impact (citeScore): 2
Number of Followers: 4  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1941-7381 - ISSN (Online) 1941-0921
Published by Sage Publications Homepage  [1093 journals]
  • Bone Health
    • Authors: Edward M. Wojtys
      Pages: 423 - 424
      Abstract: Sports Health, Volume 12, Issue 5, Page 423-424, September/October 2020.

      Citation: Sports Health
      PubDate: 2020-08-28T08:03:45Z
      DOI: 10.1177/1941738120946738
      Issue No: Vol. 12, No. 5 (2020)
  • Society News
    • Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2020-10-08T03:36:52Z
      DOI: 10.1177/1941738120965942
  • Kinesiotaping for the Rehabilitation of Rotator Cuff–Related Shoulder
           Pain: A Randomized Clinical Trial
    • Authors: Fábio Carlos Lucas de Oliveira, Benoit Pairot de Fontenay, Laurent Julien Bouyer, François Desmeules, Jean-Sébastien Roy
      Abstract: Sports Health, Ahead of Print.
      Background:Kinesiotaping (KT) has been widely used in clinical practice. Current evidence is insufficient to support the use of KT for treating rotator cuff–related shoulder pain (RCRSP), as its mid- and long-term effects have not been investigated.Hypotheses:Individuals using KT will achieve faster improvements in symptoms and functional limitations compared with those not using it. They will also present a greater increase in pain-free range of motion (ROM) and acromiohumeral distance (AHD) at the end of the treatment.Study Design:Randomized controlled trial (NCT02881021).Level of evidence:Therapy, level 1b.Methods:A total of 52 individuals with RCRSP, randomly assigned to 1 of 2 groups (experimental: KT; control: no-KT), underwent a 6-week rehabilitation program composed of 10 physical therapy sessions. KT was added to the treatment of the KT group. Symptoms and functional limitations were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (primary outcome); Brief Pain Inventory (BPI); and Western Ontario Rotator Cuff (WORC) index at baseline, 3 weeks, 6 weeks, 12 weeks, and 6 months. AHD, pain-free ROM, and full ROM were measured at baseline and at week 6. The effects of KT were assessed using a nonparametric analysis for longitudinal data.Results:No significant group × time interactions (0.112 ≤ P ≤ 0.726) were found for all outcomes. Time effects were observed as both groups showed significant improvements for all studied outcomes (DASH, BPI, and WORC, p < 0.0001; AHD, p = 0.017; pain-free ROM, p < 0.0001; and full ROM abduction, p ≤ 0.0001).Conclusion:Whereas symptoms, functional limitations, ROM, and AHD improved in both groups, the addition of KT did not lead to superior outcomes compared with exercise-based treatment alone, in the mid and long term, for individuals with RCRSP.Clinical Relevance:Clinicians should not expect supplementary mid- or long-term gains with KT to reduce pain, improve shoulder function and ROM, or increase AHD if a rehabilitation program focusing on shoulder neuromuscular control is concurrently provided as treatment for individuals with RCRSP.
      Citation: Sports Health
      PubDate: 2020-09-28T04:25:36Z
      DOI: 10.1177/1941738120944254
  • COVID-19 Surveillance in Youth Soccer During Small Group Training: A Safe
           Return to Sports Activity
    • Authors: Jonathan A. Drezner, Sophia M. Drezner, Kennedy N. Magner, Jasmin T. Ayala
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2020-09-28T04:19:54Z
      DOI: 10.1177/1941738120964458
  • Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate
           Ligament Reconstruction
    • Authors: Majd Marrache, Matthew J. Best, Micheal Raad, Jacob D. Mikula, Raj M. Amin, John H. Wilckens
      Abstract: Sports Health, Ahead of Print.
      Introduction:Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction.Hypothesis:Regional differences in opioid prescribing patterns after ACL reconstruction are present.Study Design:Descriptive epidemiology study.Level of Evidence:Level 4.Methods:The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed.Results:A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present (P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017).Conclusion:This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing.Clinical Relevance:Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.
      Citation: Sports Health
      PubDate: 2020-09-23T05:32:12Z
      DOI: 10.1177/1941738120954432
  • Recruitment of Shoulder Complex and Torso Stabilizer Muscles With Rowing
           Exercises Using a Suspension Strap Training System
    • Authors: James W. Youdas, Mary Kleis, Erik T. Krueger, Stephen Thompson, Whitney A. Walker, John H. Hollman
      Abstract: Sports Health, Ahead of Print.
      Background:Suspension training systems, which use body weight resistance under unstable conditions, may be effective for muscle strengthening in persons with scapular dyskinesis or subacromial impingement syndrome.Hypothesis:Greater arm, scapular, and trunk muscle recruitment will occur during horizontal abduction row exercises.Study Design:Descriptive laboratory study.Level of Evidence:Level 5.Methods:Surface electromyography data were collected from 28 participants (14 men, 14 women). A total of 13 right-sided muscles were studied at a sampling frequency of 1000 Hz. Maximal voluntary isometric contractions (MVICs) were established. Participants completed 3 repetitions per exercise in random order. We compared muscle recruitment during 3 rowing exercises: low row, high row, and horizontal abduction row. Data were compared with repeated-measures analyses of variance and post hoc Bonferroni corrections.Results:For high row and horizontal abduction row conditions, the upper, middle, and lower trapezius and posterior deltoid demonstrated>60% MVIC magnitudes of recruitment, and the upper erector spinae demonstrated 40% to 60% MVIC magnitudes of recruitment, respectively. In contrast, in the low row exercise, 40% to 60% MVIC magnitudes of recruitment were observed only in the middle trapezius, latissimus dorsi, and posterior deltoid.Conclusion:With the suspension system, high row and horizontal abduction row exercises promote muscle strengthening (>50% MVIC) in the upper, middle, and lower fibers of the trapezius, posterior deltoid, and upper erector spinae.Clinical Relevance:Rowing exercises performed with suspension straps may be recommended for muscle strengthening in patients with scapular dyskinesis and subacromial impingement syndrome as well as for healthy persons in need of enhanced scapular muscle performance.
      Citation: Sports Health
      PubDate: 2020-09-17T02:38:37Z
      DOI: 10.1177/1941738120945986
  • Understanding Cannabis-Based Therapeutics in Sports Medicine
    • Authors: Gretchen E. Maurer, Neilson M. Mathews, Kevin T. Schleich, Tyler G. Slayman, Britt L. Marcussen
      Abstract: Sports Health, Ahead of Print.
      Context:With increased use of cannabis-based products by the public for both recreational and medical use, sports medicine clinicians should be informed of historical context, current legal considerations, and existing evidence with regard to efficacy, safety, and risks in the athletic community.Evidence Acquisition:A review of, MEDLINE, and CINAHL from 2015 to present was conducted with emphasis on the most recent literature using search terms, cannabis, nabiximols, cannabinoids, pain management, THC, CBD, and marijuana. Bibliographies based on original search were utilized to pursue further literature search.Study Design:Clinical review.Level of Evidence:Level 3.Results:At present, limited high-quality studies exist for use of cannabinoids for acute pain, chronic pain, or concussion. None of the trials involving cannabinoids included the athletic population. Thus, results from this clinical review are extrapolated to conditions of the sports medicine population. For acute pain, 2 small-randomized double-blinded crossover trials concluded no immediate effect of cannabinoid therapy. More robust evidence exists for treatment of chronic pain conditions through meta-analysis and systemic reviews. Cannabinoid therapy exhibits moderate efficacy as a treatment for some chronic pain conditions. Investigations included a broad spectrum of chronic pain conditions, including neuropathic, musculoskeletal, inflammatory, and central pain conditions, and reveal reduction in pain and improvement of quality of life with limited adverse effects. For concussion, evidence is based on preclinical in vitro and animal models revealing possible neuroprotective effects as well as 2 clinical studies involving the presence of cannabinoids for concussion (some sports-related), but there are no high-quality trials evaluating efficacy for treatment with cannabinoids at this time.Conclusion:Although various biochemical explanations exist on the use of cannabinoid therapy through modulation of the endocannabinoid system for several medical issues affecting athletes, recommendations from clinicians must be extrapolated from a majority of research done in the nonathletic population. Lack of strong-quality clinical evidence, coupled with inconsistent federal and state law as well as purity issues with cannabis-based products, make it difficult for the sports medicine clinician to widely recommend cannabinoid therapeutics at present. Future larger, higher quality clinical research studies with standardized pure extracts will better guide appropriate medical use going forward. At present, evidence for a multitude of therapeutic applications is emerging for cannabinoid treatment approaches. With emphasis placed on patient-centered clinical decisions, cannabinoids hold promise of treatment for athletes with chronic pain conditions. Clinicians who treat the athletic community must consider legal and ethical issues when discussing and recommending the use of cannabinoids, with acknowledgment of inconsistencies in purity of various formulations and concerns of drug testing.
      Citation: Sports Health
      PubDate: 2020-09-16T02:16:45Z
      DOI: 10.1177/1941738120956604
  • Effect of Plyometric Training on Sport Performance in Adolescent Overhead
           Athletes: A Systematic Review
    • Authors: Leyla Eraslan, Birgit Castelein, Valentien Spanhove, Ceren Orhan, Irem Duzgun, Ann Cools
      Abstract: Sports Health, Ahead of Print.
      Context:Plyometric training has been shown to be beneficial in adolescent overhead athletes. However, existing research on the effects of plyometrics on sport performance has been limited.Objective:To systematically review the current literature to investigate whether plyometric training intervention improves upper- and lower-body sport performance.Data Sources:Two electronic databases (MEDLINE and Web of Science) were searched using specific Medical Subject Headings (MeSH) terms up to February 2019, and hand-searching was performed by looking to relevant studies that were cited in other studies.Study Selection:A total of 932 items were identified and were further assessed for the eligibility in the systematic review. For a study to be eligible, each of the following inclusion criteria had to be met: (1) participants were aged 13 to 18 years and selected from a sports or athletic population and the study (2) involved the evaluation of a plyometric training intervention with an aim to improve sports performance; (3) must have included a control intervention and/or control group; (4) included a quantitative objective measure of sport performance variables concerning throwing, jumping, running, and sprinting; and (5) was published in English.Study Design:Systematic review.Level of Evidence:Level 3.Data Extraction:A first screening was conducted based on title and abstract of the articles. In the second screening, the full text of the remaining articles was evaluated for the fulfillment of the inclusion criteria.Results:A total of 14 studies were included in this review. The methodological quality of the included studies ranged from low to moderate. There is moderate evidence that plyometric training intervention improves throwing and jumping performances. There is also preliminary evidence that plyometric training intervention improves sprint performance.Conclusion:The current evidence suggests that sport performance consisting of throwing capacity, jumping ability, and sprint performance significantly improved due to plyometric training interventions in adolescent overhead athletes.
      Citation: Sports Health
      PubDate: 2020-09-09T08:57:06Z
      DOI: 10.1177/1941738120938007
  • Does Functional Bracing of the Unstable Shoulder Improve Return to Play in
           Scholastic Athletes' Returning the Unstable Shoulder to Play
    • Authors: Adam Kwapisz, Ellen Shanley, Amit M. Momaya, Chris Young, Michael J. Kissenberth, Stefan J. Tolan, Keith T. Lonergan, Douglas J. Wyland, Richard J. Hawkins, Stephan G. Pill, John M. Tokish
      Abstract: Sports Health, Ahead of Print.
      Background:Functional bracing is often used as an adjunct to nonoperative treatment of anterior shoulder instability, but no study has evaluated the effectiveness of in-season bracing. The purpose of this study was to examine successful return to play in a nonoperative cohort of adolescent athletes with in-season shoulder instability and compare those athletes treated with bracing to those who were not.Hypothesis:The use of functional bracing will improve success rates in a cohort of athletes treated nonoperatively for in-season shoulder instability.Study Design:Cohort study.Level of Evidence:Level 3.Methods:A total of 97 athletes with anterior shoulder instability were followed for a minimum of 1 year. The mean age was 15.8 ± 1.4 years (range, 12.0-18.0 years). All athletes were treated with initial nonoperative management. Twenty athletes (21%) were also treated with bracing while 77 (79%) were not. The athlete completing the current season and 1 subsequent season without surgery or time lost from shoulder injury was defined as a successful outcome.Results:There was no statistical difference in nonoperative success rates between the braced and nonbraced athletes (P = 0.33). Braced athletes (n = 20) returned to play 80% of the time, while nonbraced athletes (n = 77) returned at a rate of 88%. Of the braced athletes, 85% were football players (n = 17). A football-only comparison demonstrated no difference between braced failures (26%) and nonbraced failures (16%) (P = 0.47).Conclusion:This is the first study to evaluate the utility of functional bracing in returning an athlete to sport and completing a full subsequent season without surgery or time loss due to injury of the shoulder. In adolescent athletes with shoulder instability treated nonoperatively, functional bracing did not result in increased success rates when compared with no bracing.Clinical Relevance:The data from this study indicate that functional bracing may not improve success rates for athletes with shoulder instability.
      Citation: Sports Health
      PubDate: 2020-09-03T03:20:26Z
      DOI: 10.1177/1941738120942239
  • Injectable Ketorolac and Corticosteroid Use in Athletes: A Systematic
    • Authors: Timothy R. Jelsema, Anthony C. Tam, James L. Moeller
      Abstract: Sports Health, Ahead of Print.
      Context:The use of injectable medications to help athletes quickly return to the field of play after injury is common. Understanding the effects and risks of these medications will help providers make informed decisions regarding their use in this patient population.Objective:To evaluate the utilization, efficacy, and adverse effects of injectable ketorolac and corticosteroids in athletes.Data Sources:This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, Embase, Cochrane, Web of Science, and Secondary references were appraised for relevant articles. No randomized controlled trials or other prospective studies were identified. Articles included retrospective database reviews and physician survey studies.Study Selection:A total of 6 studies met the inclusion and exclusion criteria and were reviewed by 2 independent reviewers with a third consulted in the case of disagreement, which was not needed.Study Design:Systematic review.Level of Evidence:Level 5.Data Extraction:Two reviewers recorded rate of use, effectiveness of treatment, and reported side effect data.Results:Most studies centered around the football athlete, either professional or collegiate. Professional football game day use of intramuscular ketorolac declined from 93.3% (28/30) in 2002 to 48% in 2016. Collegiate football game day use of intramuscular ketorolac declined from 62% in 2008 to 26% in 2016. Game day corticosteroid injection was far lower than ketorolac usage. Both medications were reported to be effective with few adverse events.Conclusion:Use of injectable ketorolac is common but declining in professional and college football. Pain control efficacy is good, and risk of adverse events is low. The incidence of injectable corticosteroid use in athletes is unknown. Use of injectable corticosteroids in athletes allows for early return to sport activities with no reported complications.
      Citation: Sports Health
      PubDate: 2020-09-02T05:09:00Z
      DOI: 10.1177/1941738120946008
  • Muscle Atrophy After ACL Injury: Implications for Clinical Practice
    • Authors: Lindsey K. Lepley, Steven M. Davi, Julie P. Burland, Adam S. Lepley
      Abstract: Sports Health, Ahead of Print.
      Context:Distinct from the muscle atrophy that develops from inactivity or disuse, atrophy that occurs after traumatic joint injury continues despite the patient being actively engaged in exercise. Recognizing the multitude of factors and cascade of events that are present and negatively influence the regulation of muscle mass after traumatic joint injury will likely enable clinicians to design more effective treatment strategies. To provide sports medicine practitioners with the best strategies to optimize muscle mass, the purpose of this clinical review is to discuss the predominant mechanisms that control muscle atrophy for disuse and posttraumatic scenarios, and to highlight how they differ.Evidence Acquisition:Articles that reported on disuse atrophy and muscle atrophy after traumatic joint injury were collected from peer-reviewed sources available on PubMed (2000 through December 2019). Search terms included the following: disuse muscle atrophy OR disuse muscle mass OR anterior cruciate ligament OR ACL AND mechanism OR muscle loss OR atrophy OR neurological disruption OR rehabilitation OR exercise.Study Design:Clinical review.Level of Evidence:Level 5.Results:We highlight that (1) muscle atrophy after traumatic joint injury is due to a broad range of atrophy-inducing factors that are resistant to standard resistance exercises and need to be effectively targeted with treatments and (2) neurological disruptions after traumatic joint injury uncouple the nervous system from muscle tissue, contributing to a more complex manifestation of muscle loss as well as degraded tissue quality.Conclusion:Atrophy occurring after traumatic joint injury is distinctly different from the muscle atrophy that develops from disuse and is likely due to the broad range of atrophy-inducing factors that are present after injury. Clinicians must challenge the standard prescriptive approach to combating muscle atrophy from simply prescribing physical activity to targeting the neurophysiological origins of muscle atrophy after traumatic joint injury.
      Citation: Sports Health
      PubDate: 2020-08-31T05:35:57Z
      DOI: 10.1177/1941738120944256
  • Muscle Activation Differences During Eccentric Hamstring Exercises
    • Authors: Sonay Guruhan, Nihan Kafa, Zeynep B. Ecemis, Nevin A. Guzel
      Abstract: Sports Health, Ahead of Print.
      Background:The hamstring muscles play a critical role in the prevention of lower limb injuries. However, it is still unclear which exercises are more effective in terms of muscle activation.Hypothesis:In healthy individuals, there are differences between muscular activations of the biceps femoris (BF), semitendinosus (ST), and semimembranosus (SM) muscles during eccentric hamstring exercises.Study Design:Cross-sectional.Level of Evidence:Level 2.Methods:A total of 31 healthy participants (18 male; mean age, 22.5 years; SD, 3.1) were included in this study. The maximum voluntary isometric contraction of the hamstring muscles was measured using an isokinetic dynamometer. The participants were asked to perform one of the following exercises randomly (3 repetitions each): stiff-leg deadlift (SLDL), unilateral stiff-leg deadlift (USLDL), Nordic hamstring exercise (NHE), and ball leg curl (BLC). Activation of the BF, ST, and SM muscles was measured using surface electromyography during the exercises. In the statistical analysis of this study, factorial analysis of variance was used to compare the effects of each exercise on the muscle groups and to analyze which exercise type was more effective for each muscle group.Results:The NHE led to higher muscle activation than the other exercises (P < 0.001). When exercise type and muscle interaction were examined, SM activation was lower than BF (P = 0.04) and ST (P = 0.001) during NHE (P < 0.05). The highest level of muscular activation was recorded during the NHE in both male and female participants.Conclusion:The NHE may be the most effective exercise for the hamstring muscles as it leads to greater muscle activation. SLDL, USLDL, and BLC exercises may be preferred at the beginning of strength training programs since they lead to lower muscular activation compared with the NHE.Clinical Relevance:To select the optimum hamstring exercise, it is important to know the activation levels of the hamstring muscles during different eccentric exercises.
      Citation: Sports Health
      PubDate: 2020-08-28T05:41:35Z
      DOI: 10.1177/1941738120938649
  • Longitudinal Assessment of Depressive Symptoms After Sport-Related
           Concussion in a Cohort of High School Athletes
    • Authors: Erin Hammer, Scott Hetzel, Adam Pfaller, Tim McGuine
      Abstract: Sports Health, Ahead of Print.
      Background:The long-term effect of sport-related concussion on mood in adolescent athletes is largely unknown.Hypothesis:Longitudinal measures of depression will worsen acutely after sport-related concussion and improve with concussion symptom resolution.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:A population-based sample of 2160 high school athletes from 31 urban, suburban, and rural high schools completed preseason baseline concussion symptom evaluation and Patient Health Questionnaire–9 (PHQ-9) assessments over 2 years. Athletic trainers recorded onset of sport-related concussion, and concussed athletes completed the PHQ-9 assessment within 24 to 72 hours, 7 days, date of return to sport, 3 months, 6 months, and 12 months after sport-related concussion. Scores at each time point were compared to baseline with mixed-effects models and repeated-measures analysis of variance. Sex-based differences were assessed using mixed-effect models.Results:Of the 2160 athletes enrolled in the study, 125 (5.8%; 80 males, 45 females) sustained a sport-related concussion. PHQ-9 scores worsened from baseline at 24 to 72 hours (+1.05; 95% CI, 0.26-1.84; P = 0.003) and 7 days (+0.91; 95% CI, 0.23-1.60; P = 0.006). However, PHQ-9 scores improved from baseline to date of return to sport (−1.38; 95% CI, −2.20 to −0.55; P < 0.001), 3 months (−1.08; 95% CI, −1.88 to −0.28; P = 0.003), 6 months (−1.19; 95% CI, −2.04 to −0.34; P = 0.001), and 12 months after sport-related concussion (−0.76; 95% CI, −1.43 to −0.08; P = 0.028). Female athletes reported more severe concussion symptoms 24 to 72 hours after sport-related concussion compared with male athletes (female, 20.5 [interquartile range (IQR), 10.0-36.2]; male, 9.0 [IQR, 4.0-19.5]; P = 0.003). Neither PHQ-9 scores nor change in PHQ-9 scores differed between male and female athletes at any time point.Conclusion:Sport-related concussion did not worsen longitudinal measures of depressed mood in this cohort of high school athletes.Clinical Relevance:Emotional symptoms are common after sport-related concussion, but typically resolve by return to sport.
      Citation: Sports Health
      PubDate: 2020-08-28T05:36:56Z
      DOI: 10.1177/1941738120938010
  • The Association Between Sports- or Physical Activity–Related Concussions
           and Suicidality Among US High School Students, 2017
    • Authors: Gabrielle F. Miller, Lara DePadilla, Sherry Everett Jones, Brad N. Bartholow, Kelly Sarmiento, Matthew J. Breiding
      Abstract: Sports Health, Ahead of Print.
      Background:This study examined the association between sports- or physical activity–related concussions and having seriously considered attempting suicide, made a suicide plan, or attempted suicide (ie, suicidality), and tested potential moderators of the association.Hypothesis:Risk factors such as persistent feelings of sadness or hopelessness, low academic grades, few hours of sleep, and current alcohol or marijuana use will increase the odds of suicidality among those who self-reported sports- or physical activity–related concussions, while protective factors such as physical activity and having played on a sports team will decrease the odds.Study Design:Cross-sectional study.Level of Evidence:Level 4.Methods:This study used data from the 2017 Youth Risk Behavior Survey, a biennial, school-based, nationally representative survey of US students in grade levels 9 to 12 (N = 14,765). Logistic regression models examined associations between self-reported sports- or physical activity–related concussions and suicidality among the students, and whether physical activity, having played on a sports team, persistent feelings of sadness or hopelessness, academic grades, hours of sleep, or current alcohol or marijuana use moderated those associations.Results:Sports- or physical activity–related concussions were found to be associated with suicidality. The associations remained significant in models that adjusted for demographic characteristics, and they did not appear to be moderated by physical activity, having played on sports team, academic grades, or sleep.Conclusions:Given the findings of this study and others, health care providers are advised to ask students who have experienced a concussion about their emotional well-being as part of their symptom-based assessment, using validated, age- appropriate concussion symptom scales. Comprehensively assessing students who have experienced a sports- or physical activity–related concussion for persistent feelings of sadness or hopelessness may alert providers to thoughts of suicidal ideation and will allow for earlier intervention.Clinical Relevance:If thoughts of suicide are discovered among adolescents with a concussion, or if other risk factors are observed, referrals to medical and mental health providers for a more comprehensive assessment may be warranted.
      Citation: Sports Health
      PubDate: 2020-08-26T04:34:47Z
      DOI: 10.1177/1941738120939913
  • Evidence-Based Physical Examination for the Diagnosis of Subscapularis
           Tears: A Systematic Review
    • Authors: Andrew Dakkak, Michael K. Krill, Matthew L. Krill, Benedict Nwachukwu, Frank McCormick
      Abstract: Sports Health, Ahead of Print.
      Context:There is a renewed interest in diagnosing and treating subscapularis tears, but there is a paucity of clinical guidance to optimize diagnostic decision-making.Objective:To perform a literature review to evaluate advanced maneuvers and special tests in the diagnosis of subscapularis tears and create a diagnostic algorithm for subscapularis pathology.Data Sources:PubMed, MEDLINE, Ovid, and Cochrane Reviews databases.Study Selection:Inclusion criteria consisted of level 1 and 2 studies published in peer-reviewed scientific journals that focused on physical examination.Study Design:Systematic review.Level of Evidence:Level 2.Data Extraction:Individual test characteristics (bear hug, belly press, lift-off, Napoleon, and internal rotation lag sign) were combined in series and in parallel to maximize clinical sensitivity and specificity for any special test evaluated in at least 2 studies. A secondary analysis utilized subjective pretest probabilities to create a clinical decision tree algorithm and provide posttest probabilities.Results:A total of 3174 studies were identified, and 5 studies met inclusion criteria. The special test combination of the bear hug and belly press demonstrated the highest positive likelihood ratio (18.29). Overall, 3 special test combinations in series demonstrated a significant impact on posttest probabilities. With parallel testing, the combination of bear hug and belly press had the highest sensitivity (84%) and lowest calculated negative likelihood ratio (0.21).Conclusion:The combined application of the bear hug and belly press physical examination maneuvers is an optimal combination for evaluating subscapularis pathology. Positive findings using this test combination in series with a likely pretest probability yield a 96% posttest probability; whereas, negative findings tested in parallel with an unlikely pretest probability yield a 12% posttest probability.
      Citation: Sports Health
      PubDate: 2020-08-21T04:41:39Z
      DOI: 10.1177/1941738120936232
  • Returning Athletes Back to High School Sports in the COVID-19 Era:
           Preparing for the Fall
    • Authors: Irfan M. Asif, Cindy J. Chang, Alex B. Diamond, Neha Raukar, Jason L. Zaremski
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2020-08-20T08:25:42Z
      DOI: 10.1177/1941738120953851
  • Effects of Foot Strike Techniques on Running Biomechanics: A Systematic
           Review and Meta-analysis
    • Authors: Yilin Xu, Peng Yuan, Ran Wang, Dan Wang, Jia Liu, Hui Zhou
      Abstract: Sports Health, Ahead of Print.
      Content:Distance running is one of the most popular physical activities, and running-related injuries (RRIs) are also common. Foot strike patterns have been suggested to affect biomechanical variables related to RRI risks.Objective:To determine the effects of foot strike techniques on running biomechanics.Data Sources:The databases of Web of Science, PubMed, EMBASE, and EBSCO were searched from database inception through November 2018.Study Selection:The initial electronic search found 723 studies. Of these, 26 studies with a total of 472 participants were eligible for inclusion in this meta-analysis.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 4.Data Extraction:Means, standard deviations, and sample sizes were extracted from the eligible studies, and the standard mean differences (SMDs) were obtained for biomechanical variables between forefoot strike (FFS) and rearfoot strike (RFS) groups using a random-effects model.Results:FFS showed significantly smaller magnitude (SMD, −1.84; 95% CI, −2.29 to −1.38; P < 0.001) and loading rate (mean: SMD, −2.1; 95% CI, −3.18 to −1.01; P < 0.001; peak: SMD, −1.77; 95% CI, −2.21 to −1.33; P < 0.001) of impact force, ankle stiffness (SMD, −1.69; 95% CI, −2.46 to −0.92; P < 0.001), knee extension moment (SMD, −0.64; 95% CI, −0.98 to −0.3; P < 0.001), knee eccentric power (SMD, −2.03; 95% CI, −2.51 to −1.54; P < 0.001), knee negative work (SMD, −1.56; 95% CI, −2.11 to −1.00; P < 0.001), and patellofemoral joint stress (peak: SMD, −0.71; 95% CI, −1.28 to −0.14; P = 0.01; integral: SMD, −0.63; 95% CI, −1.11 to −0.15; P = 0.01) compared with RFS. However, FFS significantly increased ankle plantarflexion moment (SMD, 1.31; 95% CI, 0.66 to 1.96; P < 0.001), eccentric power (SMD, 1.63; 95% CI, 1.18 to 2.08;P < 0.001), negative work (SMD, 2.60; 95% CI, 1.02 to 4.18; P = 0.001), and axial contact force (SMD, 1.26; 95% CI, 0.93 to 1.6; P < 0.001) compared with RFS.Conclusion:Running with RFS imposed higher biomechanical loads on overall ground impact and knee and patellofemoral joints, whereas FFS imposed higher biomechanical loads on the ankle joint and Achilles tendon. The modification of strike techniques may affect the specific biomechanical loads experienced on relevant structures or tissues during running.
      Citation: Sports Health
      PubDate: 2020-08-19T04:39:35Z
      DOI: 10.1177/1941738120934715
  • Effects of Static and Dynamic Stretching With Strengthening Exercises in
           Patients With Patellofemoral Pain Who Have Inflexible Hamstrings: A
           Randomized Controlled Trial
    • Authors: Jin Hyuck Lee, Ki-Mo Jang, Eunseon Kim, Hye Chang Rhim, Hyeong-Dong Kim
      Abstract: Sports Health, Ahead of Print.
      Background:Patellofemoral pain (PFP) syndrome is closely associated with muscle tightness. However, studies regarding the effects of stretching exercises on PFP patients with inflexible hamstrings are scarce. The aim of the study was to compare the effects between static and dynamic hamstring stretching in patients with PFP who have inflexible hamstrings.Hypothesis:Compared with static hamstring stretching, dynamic hamstring stretching will improve the parameters of hamstring flexibility, knee muscle strength, muscle activation time, and clinical outcomes in this patient population.Study Design:Prospective randomized controlled trial.Level of Evidence:Level 2.Methods:A total of 46 patients (25, static stretching; 21, dynamic stretching) participated. Hamstring flexibility was assessed according to the popliteal angle during active knee extension. Muscle strength and muscle activation time were measured using an isokinetic device. Clinical outcomes were evaluated using the visual analog scale (VAS) for pain and the anterior knee pain scale (AKPS).Results:There were no differences in hamstring flexibility and knee muscle strength of the affected knees between the groups (P> 0.05). Significantly improved muscle activation time and clinical outcomes of the affected knees were observed in the dynamic stretching group compared with the static stretching group (all Ps < 0.01 for hamstring, quadriceps, VAS, and AKPS).Conclusion:In patients with PFP who have inflexible hamstrings, dynamic hamstring stretching with strengthening exercises was superior for improving muscle activation time and clinical outcomes compared with static hamstring stretching with strengthening exercises.Clinical Relevance:Clinicians and therapists could implement dynamic hamstring stretching to improve function and reduce pain in patients with PFP who have inflexible hamstrings.
      Citation: Sports Health
      PubDate: 2020-08-13T04:15:18Z
      DOI: 10.1177/1941738120932911
  • ACL Injuries Aren’t Just for Girls: The Role of Age in Predicting
           Pediatric ACL Injury
    • Authors: David A. Bloom, Adam J. Wolfert, Andrew Michalowitz, Laith M. Jazrawi, Cordelia W. Carter
      Abstract: Sports Health, Ahead of Print.
      Background:Female athletes have a higher rate of anterior cruciate ligament (ACL) injuries than male athletes; however, the role of age in mediating this injury risk has not been explored. The purpose of this study was to characterize the relationship between age and sex in predicting ACL injury in the pediatric population.Hypothesis:Prepubescent boys are more likely to sustain an ACL injury than prepubescent girls.Study Design:Descriptive epidemiological study.Level of Evidence:Level 4.Methods:Data were collected from the Statewide Planning and Research Cooperative System database for the state of New York from 1996 to 2016. The database was queried for patients aged ≤19 years who had been diagnosed with an ACL tear using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 844.2 or the ICD-10 (10th Revision) codes S83.512A/S83.511A/S83.519A. Patient age and sex at time of ACL injury diagnosis were recorded. Chi-square analysis was used to compare the frequency of ACL injury between groups, with statistical significance set atP < 0.05.Results:A total of 20,128 patients aged ≤19 years were diagnosed with an ACL tear (10,830 males, 9298 females; male:female, 1.16:1). In all, 129 patients aged
      Citation: Sports Health
      PubDate: 2020-08-11T05:41:06Z
      DOI: 10.1177/1941738120935429
  • Opioid Use in Athletes: A Systematic Review
    • Authors: Seper Ekhtiari, Ibrahim Yusuf, Yosra AlMakadma, Austin MacDonald, Timothy Leroux, Moin Khan
      Abstract: Sports Health, Ahead of Print.
      Context:The opioid epidemic has been well-documented in the general population, but the literature pertaining to opioid use and misuse in the athletic population remains limited.Objectives:The objectives of this study were to seek answers to the following questions: (1) what are the rates of opioid use and misuse among athletes, (2) do these rates differ compared with the nonathletic population, and (3) are there specific subgroups of the athletic population (eg, based on sport, level of play) who may be at higher risk'Data Sources:The Embase, MEDLINE, and PubMed were used for the literature search.Study Selection:Records were screened in duplicate for studies reporting rates of opioid use among athletes. All study designs were included.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Data regarding rates of opioid use, medication types, prescription patterns, and predictors of future opioid use were collected. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria for clinical studies and 5 key domains previously identified for survey studies.Results:A total of 11 studies were eligible for inclusion (N = 226,256 athletes). Studies included survey studies and retrospective observational designs. Opioid use among professional athletes at any given time, as reported in 2 different studies, ranged from 4.4% to 4.7%, while opioid use over a National Football League career was 52%. High school athletes had lifetime opioid use rates of 28% to 46%. Risk factors associated with opioid use included Caucasian race, contact sports (hockey, football, wrestling), postretirement unemployment, and undiagnosed concussion. Use of opioids while playing predicted use of opioids in retirement.Conclusion:Overall, opioid use is prevalent among athletes, and use during a playing career predicts postretirement use. This issue exists even at the high school level, with similar rates to professional athletes. Further higher quality observational studies are needed to better define patterns of opioid use in athletes.
      Citation: Sports Health
      PubDate: 2020-08-06T05:00:46Z
      DOI: 10.1177/1941738120933542
  • Are Weightbearing Restrictions Required After Microfracture for Isolated
           Chondral Lesions of the Knee' A Review of the Basic Science and
           Clinical Literature
    • Authors: Deeptee Jain, Elshaday S. Belay, John A. Anderson, William E. Garrett, Brian C. Lau
      Abstract: Sports Health, Ahead of Print.
      Context:A strict rehabilitation protocol is traditionally followed after microfracture, including weightbearing restrictions for 2 to 6 weeks. However, such restrictions pose significant disability, especially in a patient population that is younger and more active.Evidence Acquisition:An extensive literature review was performed through PubMed and Google Scholar of all studies through December 2018 related to microfracture, including biomechanical, basic science, and clinical studies. For inclusion, clinical studies had to report weightbearing status and outcomes with a minimum 12-month follow-up.Study Design:Clinical review.Level of Evidence:Level 3.Results:Review of biomechanical and biology studies suggest new forming repair tissue is protected from shear forces of knee joint loading by the cartilaginous margins of the defect. This margin acts as a shoulder to maintain axial height and allow for tissue remodeling up to at least 12 months after surgery, well beyond current weight bearing restriction trends. A retrospective case-control study showed that weightbearing status postoperatively had no effect on clinical outcomes in patients who underwent microfracture for small chondral (
      Citation: Sports Health
      PubDate: 2020-07-28T09:17:23Z
      DOI: 10.1177/1941738120938662
  • Concussion Epidemiology in Youth Sports: Sports Study of a Statewide High
           School Sports Program
    • Authors: Benjamin J. Chun, Troy Furutani, Ross Oshiro, Casey Young, Gale Prentiss, Nathan Murata
      Abstract: Sports Health, Ahead of Print.
      Background:Current research on concussion incidence in youth athletes (age
      Citation: Sports Health
      PubDate: 2020-07-27T04:50:12Z
      DOI: 10.1177/1941738120932570
  • HPV Immunization in High School Student-Athletes Receiving
           Preparticipation Physical Evaluations at Mass Event Versus Other Venues
    • Authors: Andrew K. Cunningham, Meaghan M. Rourke, James L. Moeller, Melissa Nayak
      Abstract: Sports Health, Ahead of Print.
      Background:The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned.Hypothesis:Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE.Study Design:Retrospective cohort study.Level of Evidence:Level 3.Methods:The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status.Results:A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete’s PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014).Conclusion:Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates.Clinical Relevance:HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.
      Citation: Sports Health
      PubDate: 2020-07-14T03:40:02Z
      DOI: 10.1177/1941738120932504
  • Clinical Evaluation Techniques for Injury Risk Assessment in Elite
           Swimmers: A Systematic Review
    • Authors: Kaitlyn R. Schlueter, Joshua A. Pintar, Katherine J. Wayman, Lynda J. Hartel, Matthew S. Briggs
      Abstract: Sports Health, Ahead of Print.
      Context:Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce.Objective:To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers.Data Sources:PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018.Study Selection:Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology.Study Design:Systematic review and qualitative analysis.Level of Evidence:Level 3.Data Extraction:PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool.Results:A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region.Conclusion:Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.
      Citation: Sports Health
      PubDate: 2020-07-10T05:35:48Z
      DOI: 10.1177/1941738120920518
  • Malnutrition in Orthopaedic Sports Medicine: A Review of the Current
    • Authors: Jihoon T. Choi, Brandon Yoshida, Omid Jalali, George F. Hatch
      Abstract: Sports Health, Ahead of Print.
      Context:Malnutrition is well-studied in various aspects of the orthopaedic literature, most commonly in relation to arthroplasty, spine surgery, and trauma. However, the management of nutritional deficiencies is commonly overlooked among orthopaedic sports medicine providers. The purpose of this article is to analyze the available sports medicine literature to review the associations between malnutrition and the management of orthopaedic sports medicine patients from a treatment and performance standpoint.Evidence Acquisition:PubMed was searched for relevant articles published from 1979 to 2019.Study Design:Clinical review.Level of Evidence:Level 4.Results:Few studies exist on the implications of macronutrient deficiencies specific to orthopaedic sports medicine procedures. Interestingly, micronutrient disorders—namely, hypovitaminosis D and iron deficiency—have been well studied and may lead to worse postoperative outcomes, injury rates, and athletic performance. Nutritional supplementation to correct such deficiencies has been shown to mitigate these effects, though further study is required.Conclusion:Nutritional deficiencies are highly prevalent in orthopaedic sports medicine patients, and practitioners should be aware of their potential effects on treatment and performance outcomes. Management of such deficiencies and their effect on surgical patients remain an area of potential future research. Future studies are warranted in order to explore the potential therapeutic role of nutritional supplementation to prevent complications after common orthopaedic sports medicine procedures, improve athletic performance, and reduce injury rates.
      Citation: Sports Health
      PubDate: 2020-07-08T02:35:44Z
      DOI: 10.1177/1941738120926168
  • Decreased Physical Activity and Sleep, Not Sport Specialization, Predict
           Illness in Middle School Athletes
    • Authors: Andrew Watson, Eric Post, Kevin Biese, Stephanie Kliethermes, M. Alison Brooks, David Bell
      Abstract: Sports Health, Ahead of Print.
      Background:The relationships between sport specialization, physical activity, sleep, and illness in younger athletes are unknown. Therefore, the purpose of this study was to evaluate the independent effects of sport specialization, sleep, and physical activity on illness in middle school athletes.Hypothesis:Decreased sleep, decreased physical activity, and higher levels of sport specialization will be associated with an increased risk of illness among middle school athletes.Study Design:Prospective cohort study.Level of Evidence:Level 4.Methods:Parents of middle school–aged children reported baseline sport specialization (low, moderate, or high) as well as sleep duration, physical activity, and illnesses every week throughout the academic year. A mixed-effects logistic regression model was used to assess the association between illness and specialization while accounting for sleep and physical activity for the prior week as fixed effects and each individual as a random effect.Results:A total of 233 children (mean age, 12.1 ± 1.2 years; 61% male) participated, of whom 41%, 25%, and 34% were categorized as low, moderate, and high specialization, respectively. The proportion of individuals who experienced illness did not differ by specialization level (low, 76%; moderate, 70%; high, 59%; P = 0.064). In the multivariable model, the odds of illness compared with the low specialization group was not significantly different for moderate (odds ratio [OR], 0.93; 95% CI, 0.70-1.23; P = 0.61) or high specialization (OR, 0.76; 95% CI, 0.56-1.03; P = 0.073). A decreased risk of illness was associated with greater prior week sleep (OR, 0.79; 95% CI, 0.69-0.91; P < 0.001) and physical activity (OR, 0.94; 95% CI, 0.92-0.96; P < 0.001).Conclusion:Sport specialization is not associated with an increased risk of illness among middle school athletes, while increased sleep duration and physical activity appear to reduce the risk of illness.Clinical Relevance:Interventions to promote physical activity and improve sleep may reduce the risk of illness in early adolescent athletes.
      Citation: Sports Health
      PubDate: 2020-07-06T08:44:10Z
      DOI: 10.1177/1941738120927599
  • Ten Years of Sports Health: Authorship Characteristics and Levels of
    • Authors: Ryan P. Judy, Spencer Talentino, Asheesh Bedi, Bryson P. Lesniak
      Abstract: Sports Health, Ahead of Print.
      Context:Sports Health: A Multidisciplinary Approach, now 10 years into production, has been ranked a top-25 journal in sport sciences and has tripled its impact throughout its existence.Objective:To evaluate authorship trends and levels of evidence (LOE) of articles published in Sports Health from 2009 to 2018. The secondary aim was to analyze funding sources and internationalization throughout the journal’s tenure.Data Sources:All clinical studies published in Sports Health between the years 2009 and 2018 were examined.Study Selection:All publications from the provided years were electronically reviewed by 2 reviewers and evaluated for inclusion criteria. Editorials, society news, memorials, letters to the editor, and corrigenda were excluded.Study Design:Systematic review.Level of Evidence:Level 5.Data Extraction:Articles were examined for number of authors, presence of female authorship, funding, country of origin, international collaboration, academic degree or certification of first and senior authors, and LOE. Clinical articles were assigned LOE based on guidelines from the University of Oxford’s Centre for Evidence-Based Medicine.Results:A total of 654 articles were examined. The percentage of high-LOE studies increased throughout the study period. The percentage of publications with female authors also increased throughout the study period. The mean number of authors per article increased from 3.2 to 4.6 over the 10-year period (P < 0.05). The percentage of publications with international collaboration stayed consistent, while the number of countries per year increased during the study period. Overall, institutions from 23 countries have published in Sports Health since its inception to the time of this study.Conclusion:Female authorship in Sports Health surpasses industry standards, and the percentage of high-LOE studies remains remarkably high. Sports Health has stayed true to its multidisciplinary scope, as evidenced by the authors’ varying degrees and numerous countries that publish in the journal.
      Citation: Sports Health
      PubDate: 2020-07-06T02:59:25Z
      DOI: 10.1177/1941738120922163
  • The Nonoperative Instability Severity Index Score (NISIS): A Simple Tool
    • Authors: John M. Tokish, Charles A. Thigpen, Michael J. Kissenberth, Stefan J. Tolan, Keith T. Lonergan, John M. Tokish, Jonathan F. Dickens, Richard J. Hawkins, Ellen Shanley
      Abstract: Sports Health, Ahead of Print.
      Background:The management of the adolescent athlete after initial shoulder instability remains controversial.Hypothesis:Individual risk factors in athletes with shoulder instability who are managed nonoperatively can be integrated into a scoring system that can predict successful return to sport.Study Design:Retrospective cohort study.Level of Evidence:Level 4.Methods:A total of 57 scholastic athletes with primary anterior shoulder instability who were managed nonoperatively were reviewed. Success was defined as a return to index sport at the same level and playing at least 1 subsequent season without missed time as a result of the shoulder. Patient-specific risk factors were individually evaluated, and odds ratios were calculated. A 10-point Nonoperative Injury Severity Index Score (NISIS) incorporated the risk factors for failure. This score was then retrospectively applied with regression analysis and a chi-square analysis to determine the overall optimal score that predicted failure of nonoperative management.Results:In total, 6 risk factors for failure were included in the NISIS: age (>15 years), bone loss, type of instability, type of sport (contact vs noncontact), male sex, and arm dominance. Overall, 79% of patients treated nonoperatively were able to successfully return to sport. Nearly all (97%) low-risk patients (NISIS
      Citation: Sports Health
      PubDate: 2020-07-01T05:36:28Z
      DOI: 10.1177/1941738120925738
  • Hypertrophy of Lumbopelvic Muscles in Inactive Women: A 36-Week Pilates
    • Authors: Cecilia Dorado, Ana López-Gordillo, José A. Serrano-Sánchez, José A.L. Calbet, Joaquín Sanchis-Moysi
      Abstract: Sports Health, Ahead of Print.
      Background:The use of Pilates in various fields of sport sciences and rehabilitation is increasing; however, little is known about the muscle adaptations induced by this training method.Hypothesis:A standardized Pilates training program for beginners (9 months; 2 sessions of 55 minutes per week) will increase the muscle volume and reduce potential side-to-side asymmetries of the quadratus lumborum, iliopsoas, piriformis, and gluteus muscles (gluteus maximus, medius, and minimus).Study Design:Controlled laboratory study.Level of Evidence:Level 3.Method:A total of 12 inactive, healthy women (35.7 ± 5.4 years) without previous experience in Pilates were randomly selected to participate in a supervised Pilates program (36 weeks, twice weekly). Muscle volume (cm3) was determined using magnetic resonance imaging at the beginning and end of the intervention program. Side-to-side asymmetry was calculated as [(left – right volume) × 100/right volume].Results:Small, nonsignificant (P> 0.05) differences in the volume of the quadratus lumborum, iliopsoas, piriformis, and gluteus muscles were observed between pre– and post–Pilates program timepoints. Before and after Pilates, side-to-side asymmetry was less than 6% and nonsignificant in all muscles analyzed.Conclusion:Modern Pilates performed twice weekly for 9 months did not elicit substantial changes in the volume and degree of asymmetry of the selected lumbopelvic muscles in inactive women.Clinical Relevance:The benefits of Pilates in rehabilitation or training are likely elicited by neuromuscular rather than morphological adaptations. Pilates has no significant impact on muscle volume and does not alter side-to-side ratios in muscle volume (degree of asymmetry) of the lumbopelvic muscles.
      Citation: Sports Health
      PubDate: 2020-05-12T03:32:51Z
      DOI: 10.1177/1941738120918381
  • Uninjured Youth Athlete Performance on Single-Leg Hop Testing: How Many
           Can Achieve Recommended Return-to-Sport Criterion'
    • Authors: Elliot M. Greenberg, Julie Dyke, Anne Leung, Michael Karl, J. Todd Lawrence, Theodore Ganley
      Abstract: Sports Health, Ahead of Print.
      Background:Current anterior cruciate ligament reconstruction (ACLR) guidelines utilize single-leg hop tests (SLHTs) to assist in return-to-sport decision making. A limb symmetry index (LSI) of ≥90% is often required; however, after ACLR, most youth athletes cannot achieve this standard. Reporting the performance of age-matched normative controls will allow clinicians to compare post-ACLR performance with noninjured peers, improving the utility of SLHTs. The purpose of this study was to report hop test LSI within healthy youth athletes and determine whether athlete performance surpasses post-ACLR requirements.Hypothesis:The LSI for the majority of healthy youth athletes will be ≥90%.Study Design:Cross-sectional cohort study.Level of Evidence:Level 3.Methods:Each participant performed a single hop (SH), triple hop (TrH), crossover hop (CrH), and timed hop (TiH). A 3-trial mean was utilized to calculate an LSI (nondominant/dominant leg [self-reported kicking leg]) for each hop. The frequency of pass/fail at ≥90% LSI was calculated. Pearson correlation coefficients analyzed the relationship between the different hops, and a 2-way analysis of variance determined the effects of age and sex on LSI.Results:A total of 340 participants (54% male; mean age, 10.9 ± 1.5 years; range, 8-14 years) were included. The mean LSI was>95% for each SLHT (SH, 97.9% [SD, 0.7]; TrH, 96.6% [SD, 0.6]; CrH, 96.8% [SD, 0.8]; TiH, 96.5% [SD, 0.6]). When analyzed as a test battery, only 45% of participants achieved this standard. Significantly weak to moderate correlations existed among hop tests (P < 0.01; r = 0.342-0.520). Age and sex had no effect on LSI (P < 0.05).Conclusion:While the mean LSI in our sample was>95% for each individual hop test, participant performance across all SLHT components varied, such that less than half of healthy athletes could achieve ≥90% LSI across all hops.Clinical Relevance:Current guidelines require ≥90% LSI on SLHTs. The majority of healthy youth athletes could not achieve this standard, which questions the validity of this LSI threshold in youth athletes after ACLR.
      Citation: Sports Health
      PubDate: 2020-05-11T07:34:12Z
      DOI: 10.1177/1941738120911662
  • One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After
           ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20
    • Authors: Sue Barber-Westin, Frank R. Noyes
      Abstract: Sports Health, Ahead of Print.
      Context:Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures.Objective:To determine RTS rates; the effect of participation in high-risk sports, sex, and graft type on ACL reinjury rates; and whether objective test criteria before RTS correlate with lower reinjury rates.Data Sources:A systematic review of the literature from inception to May 31, 2019, was conducted using the PubMed and Cochrane databases.Study Selection:Studies on transphyseal ACLR in athletes
      Citation: Sports Health
      PubDate: 2020-05-06T07:57:30Z
      DOI: 10.1177/1941738120912846
  • Identification of Risk Factors Prospectively Associated With
           Musculoskeletal Injury in a Warrior Athlete Population
    • Authors: Deydre S. Teyhen, Scott W. Shaffer, Stephen L. Goffar, Kyle Kiesel, Robert J. Butler, Daniel I. Rhon, Phillip J. Plisky
      Abstract: Sports Health, Ahead of Print.
      Background:Musculoskeletal injuries are a primary source of disability. Understanding how risk factors predict injury is necessary to individualize and enhance injury reduction programs.Hypothesis:Because of the multifactorial nature of musculoskeletal injuries, multiple risk factors will provide a useful method of categorizing warrior athletes based on injury risk.Study Design:Prospective observational cohort study.Level of Evidence:Level 2.Methods:Baseline data were collected on 922 US Army soldiers/warrior athletes (mean age, 24.7 ± 5.2 years; mean body mass index, 26.8 ± 3.4 kg/m2) using surveys and physical measures. Injury occurrence and health care utilization were collected for 1 year. Variables were compared in healthy versus injured participants using independent t tests or chi-square analysis. Significantly different factors between each group were entered into a logistic regression equation. Receiver operating characteristic curve and accuracy statistics were calculated for regression variables.Results:Of the 922 warrior athletes, 38.8% suffered a time-loss injury (TLI). Overall, 35 variables had a significant relationship with TLIs. The logistic regression equation, consisting of 11 variables of interest, was significant (adjusted R2 = 0.21; odds ratio, 5.7 [95% CI, 4.1-7.9]; relative risk, 2.5 [95% CI, 2.1-2.9]; area under the curve, 0.73). Individuals with 2 variables had a sensitivity of 0.89, those with 7 or more variables had a specificity of 0.94.Conclusion:The sum of individual risk factors (prior injury, prior work restrictions, lower perceived recovery from injury, asymmetrical ankle dorsiflexion, decreased or asymmetrical performance on the Lower and Upper Quarter Y-Balance test, pain with movement, slower 2-mile run times, age, and sex) produced a highly sensitive and specific multivariate model for TLI in military servicemembers.Clinical Relevance:A better understanding of characteristics associated with future injury risk can provide a foundation for prevention programs designed to reduce medical costs and time lost.
      Citation: Sports Health
      PubDate: 2020-03-05T05:55:16Z
      DOI: 10.1177/1941738120902991
  • When to Abandon the Arthroscopic Bankart Repair: A Systematic Review
    • Authors: Benjamin J. Levy, Nathan L. Grimm, Robert A. Arciero
      First page: 425
      Abstract: Sports Health, Ahead of Print.
      Context:Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed.Objective:To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature.Data Sources:An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE).Study Selection:Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar).Results:A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely
      Citation: Sports Health
      PubDate: 2020-07-27T04:42:59Z
      DOI: 10.1177/1941738120940676
  • Association Between Physical Fitness and Bone Strength and Structure in 3-
           to 5-Year-Old Children
    • Authors: Alejandro Gómez-Bruton, Jorge Marín-Puyalto, Borja Muñiz-Pardos, Gabriel Lozano-Berges, Cristina Cadenas-Sanchez, Angel Matute-Llorente, Alba Gómez-Cabello, Luis A. Moreno, Alex Gonzalez-Agüero, Jose A. Casajus, Germán Vicente-Rodríguez
      First page: 431
      Abstract: Sports Health, Ahead of Print.
      Background:The positive association between physical fitness and bone structure has been widely investigated in children and adolescents, yet no studies have evaluated this influence in young children (ie, preschoolers).Hypothesis:Fit children will present improved bone variables when compared with unfit children, and no sex-based differences will emerge in the sample.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Handgrip strength, standing long jump (SLJ), speed/agility, balance, and cardiorespiratory fitness (CRF) were assessed using the Assessing FITness levels in PREschoolers (PREFIT) test battery in 92 children (50 boys; age range, 3-5 years). A peripheral quantitative computed tomography scan was performed at 38% of the length of the nondominant tibia. Cluster analysis from handgrip strength, SLJ, speed/agility, and CRF was developed to identify fitness groups. Bone variables were compared between sexes and between cluster groups. The association between individual physical fitness components and different bone variables was also tested.Results:Three cluster groups emerged: fit (high values on all included physical fitness variables), strong (high strength values and low speed/agility and CRF), and unfit (low strength, speed/agility, and CRF). The fit group presented higher values than the strong and unfit groups for total and cortical bone mineral content, cortical area, and polar strength strain index (all P < 0.05). The fit group also presented a higher cortical thickness when compared with the unfit group (P < 0.05). Handgrip, SLJ, and speed/agility predicted all bone variables except for total and cortical volumetric bone mineral density. No differences were found for bone variables between sexes.Conclusion:The results suggest that global fitness in preschoolers is a key determinant for bone structure and strength but not volumetric bone mineral density.Clinical Relevance:Physical fitness is a determinant for tibial bone mineral content, structure, and strength in very young children. Performing physical fitness tests could provide useful information related to bone health in preschoolers.
      Citation: Sports Health
      PubDate: 2020-05-22T04:23:42Z
      DOI: 10.1177/1941738120913645
  • Physical Fitness and Bone Health in Young Athletes and Nonathletes
    • Authors: Duarte Henriques-Neto, João P. Magalhães, Megan Hetherington-Rauth, Diana A. Santos, Fátima Baptista, Luís B. Sardinha
      First page: 441
      Abstract: Sports Health, Ahead of Print.
      Background:Physical activity (PA) and physical fitness (PF) are crucial for bone health. However, children participating in competitive sports with high PA are at a greater risk of fracture from trauma or overuse. Given the importance of bone development during adolescence, associations between commonly used physical fitness tests with distal third radius (R-SoS) and midshaft tibia (T-SoS) speed of sound by quantitative ultrasound were assessed in adolescent athletes and nonathletes.Hypothesis:The relationship between physical fitness tests and R-SoS and T-SoS will differ depending on sex and athletic status.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Physical fitness of 285 boys (156 athletes) and 311 girls (74 athletes) aged 10 to 18 years was assessed through strength, speed, agility, and cardiorespiratory tests. Linear regression was used to assess the associations of physical fitness tests with R-SoS and T-SoS.Results:For boys, favorable associations were observed between physical fitness tests with R-SoS in athletes and T-SoS in both athletes and nonathletes (P < 0.05). For nonathlete girls, favorable associations were found for handgrip (R-SoS and T-SoS, both P < 0.05), whereas the progressive aerobic cardiovascular endurance run, vertical jump, speed at 20 m and 40 m were only favorably associated with T-SoS. For athlete girls, the association between handgrip (P = 0.03), vertical jump, and 4 × 10 m shuttle run (P < 0.05) with T-SoS was significantly related to a bone outcome.Conclusion:The handgrip test and vertical jump were associated with T-SoS in boys and girls independent of sport status. These results suggest that physical fitness is associated with bone health in adolescents, particularly boys, and that the relationship between physical fitness and bone may differ depending on sex and athletic status.Clinical Relevance:Physical fitness tests are simple, easy-to-use tools for monitoring bone health and should be used by sport and health professsionals to promote healthy sport participation and prevent bone injuries.
      Citation: Sports Health
      PubDate: 2020-07-14T08:01:25Z
      DOI: 10.1177/1941738120931755
  • Evaluating an Algorithm and Clinical Prediction Rule for Diagnosis of Bone
           Stress Injuries
    • Authors: Nathaniel S. Nye, Carlton J. Covey, Mary Pawlak, Cara Olsen, Barry P. Boden, Anthony I. Beutler
      First page: 449
      Abstract: Sports Health, Ahead of Print.
      Background:A novel algorithm and clinical prediction rule (CPR), with 18 variables, was created in 2014. The CPR generated a bone stress injury (BSI) score, which was used to determine the necessity of imaging in suspected BSI. To date, there are no validated algorithms for imaging selection in patients with suspected BSI.Hypothesis:A simplified CPR will assist clinicians with diagnosis and decision making in patients with suspected BSI.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:A total of 778 military trainees with lower extremity pain were enrolled. All trainees were evaluated for 18 clinical variables suggesting BSI. Participants were monitored via electronic medical record review. Then, a prediction model was developed using logistic regression to identify clinical variables with the greatest predictive value and assigned appropriate weight. Test characteristics for various BSI score thresholds were calculated.Results:Of the enrolled trainees, 204 had imaging-confirmed BSI in or distal to the femoral condyles. The optimized CPR selected 4 clinical variables (weighted score): bony tenderness (3), prior history of BSI (2), pes cavus (2), and increased walking/running volume (1). The optimized CPR with a score ≥3 yielded 97.5% sensitivity, 54.2% specificity, and 98.2% negative predictive value. An isolated measure, bony tenderness, demonstrated similar statistical performance.Conclusion:The optimized CPR, which uses bony tenderness, prior history of BSI, pes cavus, and increased walking/running volume, is valid for detecting BSI in or distal to the femoral condyles. However, bony tenderness alone provides a simpler criterion with an equally strong negative predictive value for BSI decision making.Clinical Relevance:For suspected BSI in or distal to the femoral condyles, imaging can be deferred when there is no bony tenderness. When bony tenderness is present in the setting of 1 or more proven risk factors and no clinical evidence of high-risk bone involvement, presumptive treatment for BSI and serial radiographs may be appropriate.
      Citation: Sports Health
      PubDate: 2020-08-07T02:53:30Z
      DOI: 10.1177/1941738120943540
  • Comorbid Medical Conditions in Young Athletes: Considerations for
           Preparticipation Guidance During the COVID-19 Pandemic
    • Authors: Kimberly G. Harmon, Paul S. Pottinger, Aaron L. Baggish, Jonathan A. Drezner, Andrew M. Luks, Alexis A. Thompson, Sankar Swaminathan
      First page: 456
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2020-06-24T04:45:08Z
      DOI: 10.1177/1941738120939079
  • Cardiopulmonary Considerations for High School Student-Athletes During the
           COVID-19 Pandemic: NFHS-AMSSM Guidance Statement
    • Authors: Jonathan A. Drezner, William M. Heinz, Irfan M. Asif, Casey G. Batten, Karl B. Fields, Neha P. Raukar, Verle D. Valentine, Kevin D. Walter
      First page: 459
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2020-07-09T08:00:02Z
      DOI: 10.1177/1941738120941490
  • Rapid Posterior Tibial Reduction After Noncontact Anterior Cruciate
           Ligament Rupture: Mechanism Description From a Video Analysis
    • Authors: Alberto Grassi, Filippo Tosarelli, Piero Agostinone, Luca Macchiarola, Stefano Zaffagnini, Francesco Della Villa
      First page: 462
      Abstract: Sports Health, Ahead of Print.
      Background:The mechanisms of noncontact anterior cruciate ligament (ACL) injuries are an enormously debated topic in sports medicine; however, the late phases of injury have not yet been investigated.Hypothesis:A well-defined posterior tibial translation can be visualized with its timing and patterns of knee flexion after ACL injury.Study Design:Case series.Level of Evidence:Level 4.Methods:A total of 137 videos of ACL injuries in professional male football (soccer) players were screened for a sudden posterior tibial reduction (PTR) in the late phase of noncontact ACL injury mechanism. The suitable videos were analyzed using Kinovea software for sport video analysis. The time of initial contact of the foot with the ground, the foot lift, the start of tibial reduction, and the end of tibial reduction were assessed.Results:A total of 21 videos exhibited a clear posterior tibial reduction of 42 ± 11 ms, after an average of 229 ± 81 ms after initial contact. The tibial reduction occurred consistently within the first 50 to 60 ms after foot lift (55 ± 30 ms) and with the knee flexed between 45° and 90° (62%) or more than 90° (24%).Conclusion:A rapid posterior tibial reduction is consistently present in the late phases of noncontact ACL injuries in some male soccer players, with a consistent temporal relationship between foot lift from the ground and consistent degrees of knee flexion near or above 90°.Clinical Relevance:This study provides insight into the late phases of ACL injury. The described mechanism, although purely theoretical, could be responsible for commonly observed intra-articular lesions.
      Citation: Sports Health
      PubDate: 2020-07-22T04:51:07Z
      DOI: 10.1177/1941738120936673
  • Is Low-Intensity Isometric Handgrip Exercise an Efficient Alternative in
           Lifestyle Blood Pressure Management' A Systematic Review
    • Authors: Andrés F. Loaiza-Betancur, Iván Chulvi-Medrano
      First page: 470
      Abstract: Sports Health, Ahead of Print.
      Context:High blood pressure is one of the leading preventable causes of cardiovascular death worldwide. In this regard, several studies have shown interest in the benefits of isometric exercise on blood pressure regulation.Objective:To assess whether low-intensity isometric handgrip exercise (LI-IHE) is an effective strategy to lower blood pressure levels in prehypertensive and hypertensive patients.Data Source:This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO. Potentially eligible studies were identified after a systematic search conducted on 4 international databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, and SPORTDiscus.Study Selection:We included randomized controlled trials that comprised patients who received LI-IHE.Study Design:Systematic review with meta-analysis.Level of Evidence:Level 3.Data Extraction:Data related to patient characteristics, exercise programs, risk-of-bias assessment, and outcomes of interest were systematically reviewed independently by 2 authors.Results:The following reductions (mean differences) were observed after LI-IHE: systolic blood pressure (SBP), (MD) = −5.43 mm Hg; (95% CI, −8.47 to −2.39; P = 0.0005); diastolic blood pressure (DBP), −2.41 mm Hg (95% CI, −4.33 to −0.48; P = 0.01); mean arterial pressure (MAP), −1.28 mm Hg (95% CI, −2.99 to 0.44; P = 0.14).Conclusion:LI-IHE seems to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged
      Citation: Sports Health
      PubDate: 2020-08-10T04:35:36Z
      DOI: 10.1177/1941738120943882
  • Risk Factors of Overuse Shoulder Injuries in Overhead Athletes: A
           Systematic Review
    • Authors: Camille Tooth, Amandine Gofflot, Cédric Schwartz, Jean-Louis Croisier, Charlotte Beaudart, Olivier Bruyère, Bénédicte Forthomme
      First page: 478
      Abstract: Sports Health, Ahead of Print.
      Context:Shoulder injuries are highly prevalent in sports involving the upper extremity. Some risk factors have been identified in the literature, but consensus is still lacking.Objectives:To identify risk factors of overuse shoulder injury in overhead athletes, as described in the literature.Data Sources:A systematic review of the literature from the years 1970 to 2018 was performed using 2 electronic databases: PubMed and Scopus.Study Selection:Prospective studies, written in English, that described at least 1 risk factor associated with overuse shoulder injuries in overhead sports (volleyball, handball, basketball, swimming, water polo, badminton, baseball, and tennis) were considered for analysis.Study Design:Systematic review.Level of Evidence:Level 3.Data Extraction:Data were extracted from 25 studies. Study methodology quality was evaluated using the Modified Coleman Methodology Score.Results:Intrinsic factors, previous injury, range of motion (lack or excess), and rotator cuff weakness (isometric and isokinetic) highly increase the risk of future injuries. Additionally, years of athletic practice, body mass index, sex, age, and level of play seem to have modest influence. As for the effect of scapular dysfunction on shoulder injuries, it is still controversial, though these are typically linked. Extrinsic factors, field position, condition of practice (match/training), time of season, and training load also have influence on the occurrence of shoulder injuries.Conclusion:Range of motion, rotator cuff muscle weakness, and training load are important modifiable factors associated with shoulder injuries. Scapular dysfunction may also have influence. The preventive approach for shoulder injury should focus on these factors.
      Citation: Sports Health
      PubDate: 2020-08-06T04:04:18Z
      DOI: 10.1177/1941738120931764
  • Acute Effects of Weighted Baseball Throwing Programs on Shoulder Range of
    • Authors: Michael M. Reinold, Leonard C. Macrina, Glenn S. Fleisig, Monika Drogosz, James R. Andrews
      First page: 488
      Abstract: Sports Health, Ahead of Print.
      Background:Baseball pitching injuries are increasing at an alarming rate. While weighted ball throwing programs may be effective at increasing pitching velocity, previous research has identified a 24% injury rate and a 3.3° increase in shoulder external rotation (ER) range of motion (ROM) after performing a 6-week program. However, previous research has not investigated, separately, the immediate effects of throwing underloaded and overloaded balls on ROM. The purpose of this study was to examine the acute effects of throwing differently weighted baseballs on shoulder ROM. By analyzing these differences, it may be possible to determine the specific weight range that may lead to the greatest increase in ROM and potential injury risk.Hypothesis:Throwing with weighted balls will result in an increase in shoulder ER ROM.Study Design:Randomized controlled trial.Level of Evidence:Level 2.Methods:A total of 16 male high school baseball pitchers agreed to participate in this study. The participants were (mean ± SD) 17.1 ± 1.0 years of age, 1.81 ± 0.09 m tall, and had a mass of 79.2 ± 11.1 kg. Each participant was tested on 3 different days, 1 week apart, with 3 different conditions in random order: (1) underload throwing, using regulation 5-oz baseballs and 4- and 2-oz balls; (2) overload throwing, using 5-, 6-, and 9-oz balls; and (3) extreme overload throwing, using 5-, 16-, and 32-oz balls. Each testing session began by measuring passive shoulder ROM (external rotation and internal rotation) using standard goniometric measurements. Participants then performed 3 throws with each weighted ball from 3 different positions (kneeling, rocker, and run-and-gun) for a total of 27 throws each test session. ROM measurements were repeated at the end of each test session. The effect of each throwing condition on ROM was compared from pre- to posttraining using a paired t test (P ≤ 0.05).Results:There was no significant difference in ER after throwing at underloaded weights. The overload condition showed a statistically significant increase of 3.3° in external rotation (P = 0.05). The extreme overload condition showed a statistically significant increase in ER of 8.4° (P < 0.001). There were no differences in internal rotation for any group.Conclusion:A significant increase in shoulder ER was observed immediately after throwing overload weighted balls. This effect increased as the weights of the balls increased.Clinical Relevance:Throwing with overload weighted baseballs causes an immediate increase in shoulder ER ROM. It is unknown why these changes occur; however, the results may explain both the increase in velocity and injury rates previously observed from throwing weighted balls. The current study results may be used to develop more scientifically validated weighted ball programs. Heavier balls should be used with caution, and ROM should be monitored during implementation of these programs.
      Citation: Sports Health
      PubDate: 2020-06-29T04:35:36Z
      DOI: 10.1177/1941738120925728
  • The Application of Double Elastic Band Exercise in the 90/90 Arm Position
           for Overhead Athletes
    • Authors: Masaaki Tsuruike, Todd S. Ellenbecker, Connor Lauffenburger
      First page: 495
      Abstract: Sports Health, Ahead of Print.
      Background:Traditional exercises performed with the shoulder in the position of 90° abduction and external rotation with elbow flexion (90/90) while using a single elastic band showed moderate activity of both the lower trapezius (LT) and infraspinatus (IS) muscle. The purpose of this study was to investigate activity of the teres minor (TMi) and the LT muscles during standing external rotation exercise with the shoulder in the 90/90 position with 2 elastic bands in both the frontal and the scapular plane.Hypothesis:TMi, IS, and LT muscle activities will vary depending on whether the shoulder is positioned in the frontal or scapular plane with the application of 2 elastic bands. Also, the serratus anterior (SA) and teres major (TMa) muscles will produce different muscular activity patterns during exercises performed with 2 elastic bands in the frontal plane compared with the TMi and LT muscles.Study Design:Controlled laboratory studyLevel of Evidence:Level 4.Methods:A total of 21 collegiate baseball players volunteered to participate. The electromyography (EMG) activities of the TMi, IS, LT, SA, TMa, middle deltoid (MD), posterior deltoid, and upper trapezius (UT) muscles were measured with the 90/90 arm position during both isometric and oscillation resistance exercises with 2 elastic bands oriented in the frontal and scapular planes.Results:A significant difference was observed in EMG activity of both the TMi and the LT muscles between single and double elastic band applications in the frontal plane (P < 0.05). In contrast, EMG activity of the IS, SA, and TMa muscles was significantly increased in the scapular plane compared with the frontal plane (P < 0.05).Conclusion:The standing 90/90 position effectively increased both TMi and LT muscle EMG activity with the double elastic band in the frontal plane while minimizing UT and MD muscle activity. EMG activity of the IS, SA, and TMa muscles increased with exercise in the scapular plane as compared with the frontal plane.Clinical Relevance:Oscillation movement under double elastic band application differentiated external rotator muscle and scapular muscle activities between the frontal and scapular plane during the 90/90 exercise in the frontal plane compared with the scapular plane. Clinicians can utilize each of the scapular and frontal positions based on their desired focus for muscular activation.
      Citation: Sports Health
      PubDate: 2020-07-28T03:12:04Z
      DOI: 10.1177/1941738120935441
  • Society News
    • First page: 501
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2020-08-05T03:49:03Z
      DOI: 10.1177/1941738120947364
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