Subjects -> MEDICAL SCIENCES (Total: 8196 journals)
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SPORTS MEDICINE (77 journals)

Showing 1 - 79 of 79 Journals sorted alphabetically
American Journal of Sports Medicine     Hybrid Journal   (Followers: 162)
American Journal of Sports Science and Medicine     Open Access   (Followers: 39)
Archives of Sports Medicine and Physiotherapy     Open Access   (Followers: 2)
Arthroscopy, Sports Medicine, and Rehabilitation     Open Access   (Followers: 2)
Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology     Open Access   (Followers: 6)
Asian Journal of Sports Medicine     Open Access   (Followers: 11)
B&G Bewegungstherapie und Gesundheitssport     Hybrid Journal   (Followers: 2)
Baltic Journal of Sport and Health Sciences     Open Access   (Followers: 2)
Biomedical Human Kinetics     Open Access   (Followers: 8)
BMJ Open Sport & Exercise Medicine     Open Access   (Followers: 18)
British Journal of Sports Medicine     Hybrid Journal   (Followers: 78)
Case Studies in Sport and Exercise Psychology     Hybrid Journal   (Followers: 7)
Case Studies in Sport Management     Full-text available via subscription   (Followers: 7)
Ciencia y Deporte     Open Access   (Followers: 1)
Clinical Journal of Sport Medicine     Hybrid Journal   (Followers: 35)
Clinics in Sports Medicine     Full-text available via subscription   (Followers: 32)
Current Sports Medicine Reports     Full-text available via subscription   (Followers: 21)
European Journal of Sport Science     Hybrid Journal   (Followers: 66)
Exercise and Sport Sciences Reviews     Hybrid Journal   (Followers: 55)
German Journal of Exercise and Sport Research : Sportwissenschaft     Hybrid Journal   (Followers: 2)
International Journal of Athletic Therapy & Training     Hybrid Journal   (Followers: 15)
International Journal of Kinesiology and Sports Science     Open Access   (Followers: 18)
International Journal of Sport Nutrition & Exercise Metabolism     Hybrid Journal   (Followers: 83)
International Journal of Sports Medicine     Hybrid Journal   (Followers: 33)
International Journal of Sports Physiology and Performance     Hybrid Journal   (Followers: 22)
Journal of Aging and Physical Activity     Hybrid Journal   (Followers: 11)
Journal of Athletic Enhancement     Hybrid Journal   (Followers: 6)
Journal of Clinical Sport Psychology     Hybrid Journal   (Followers: 8)
Journal of Education, Health and Sport     Open Access   (Followers: 3)
Journal of Exercise & Organ Cross Talk     Open Access   (Followers: 4)
Journal of Functional Morphology and Kinesiology     Open Access  
Journal of Human Kinetics     Open Access   (Followers: 16)
Journal of ISAKOS     Hybrid Journal  
Journal of Physical Education Health and Sport     Open Access   (Followers: 1)
Journal of Reconstructive Microsurgery Open     Open Access  
Journal of Science and Medicine in Sport     Hybrid Journal   (Followers: 37)
Journal of Sport & Social Issues     Hybrid Journal   (Followers: 10)
Journal of Sport and Exercise Psychology     Hybrid Journal   (Followers: 22)
Journal of Sport Rehabilitation     Hybrid Journal   (Followers: 16)
Journal of Sports Medicine     Open Access   (Followers: 19)
Journal of Sports Science and Medicine     Open Access   (Followers: 22)
Journal of Sports Sciences     Hybrid Journal   (Followers: 34)
Journal of the International Society of Sports Nutrition     Open Access   (Followers: 55)
Knie Journal     Hybrid Journal  
Medicine & Science in Sports & Exercise     Hybrid Journal   (Followers: 59)
Motor Control     Hybrid Journal   (Followers: 7)
Movement & Sport Sciences : Science & Motricité     Full-text available via subscription   (Followers: 1)
OA Sports Medicine     Open Access   (Followers: 6)
Open Access Journal of Sports Medicine     Open Access   (Followers: 15)
Operative Techniques in Sports Medicine     Full-text available via subscription   (Followers: 1)
Physical Therapy in Sport     Hybrid Journal   (Followers: 41)
Physician and Sportsmedicine     Open Access   (Followers: 6)
Research in Sports Medicine: An International Journal     Hybrid Journal   (Followers: 11)
Revista Andaluza de Medicina del Deporte     Open Access   (Followers: 2)
Revista Brasileira de Cineantropometria & Desempenho Humano     Open Access   (Followers: 1)
Saudi Journal of Sports Medicine     Open Access   (Followers: 1)
Scandinavian Journal of Medicine & Science In Sports     Hybrid Journal   (Followers: 29)
Science & Sports     Hybrid Journal   (Followers: 9)
Science and Medicine in Football     Hybrid Journal   (Followers: 1)
Spor Bilimleri Dergisi / Hacettepe Journal of Sport Sciences     Open Access  
Spor ve Performans Araştırmaları Dergisi / Ondokuz Mayıs University Journal of Sports and Performance Researches     Open Access  
Sport Science and Health     Open Access   (Followers: 1)
Sport Sciences for Health     Hybrid Journal   (Followers: 5)
Sport, Education and Society     Hybrid Journal   (Followers: 12)
Sport, Ethics and Philosophy     Hybrid Journal   (Followers: 2)
Sport, Exercise, and Performance Psychology     Full-text available via subscription   (Followers: 12)
Sportphysio     Hybrid Journal  
Sports Health: A Multidisciplinary Approach     Hybrid Journal   (Followers: 4)
Sports Medicine     Full-text available via subscription   (Followers: 38)
Sports Medicine - Open     Open Access   (Followers: 12)
Sports Medicine and Arthroscopy Review     Full-text available via subscription   (Followers: 10)
Sports Medicine and Health Science     Open Access  
Sports Medicine International Open     Open Access   (Followers: 2)
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology     Open Access   (Followers: 16)
Sportverletzung · Sportschaden     Hybrid Journal   (Followers: 2)
Sri Lankan Journal of Sports and Exercise Medicine     Open Access  
Translational Sports Medicine     Hybrid Journal  
Video Journal of Sports Medicine     Open Access  
Zeitschrift für Sportpsychologie     Hybrid Journal  
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  [1174 journals]
  • Getting Ready for Fall Sports

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      Pages: 458 - 459
      Abstract: Sports Health, Volume 14, Issue 4, Page 458-459, July/August 2022.

      Citation: Sports Health
      PubDate: 2022-06-20T08:50:29Z
      DOI: 10.1177/19417381221101543
      Issue No: Vol. 14, No. 4 (2022)
       
  • Comparison of Anxiety and Depression Symptoms in Concussed and
           Nonconcussed Adolescents

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      Authors: Ari M. Fish, Julia Vanni, Fairuz N. Mohammed, Daniele Fedonni, Kristina B. Metzger, Jamie Shoop, Christina L. Master, Kristy B. Arbogast, Catherine C. McDonald
      Abstract: Sports Health, Ahead of Print.
      Background:Few studies have examined psychiatric symptoms during the acute phase following a concussion in adolescents. Thus, this study compares anxiety and depression in acutely concussed and nonconcussed adolescents.Hypothesis:Acutely concussed adolescents will report greater anxiety and depressive symptoms compared with nonconcussed adolescents.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:Data were collected from 282 adolescents (111 concussed within 28 days of injury, 171 nonconcussed), 13 to 18 years of age, who completed Patient-Reported Outcome Measurement Information System (PROMIS) Anxiety and Depressive Symptoms measures. We calculated average T-scores for anxiety and depression across both groups and compared the proportion of those who scored above normal limits. Finally, we calculated risk ratios for anxiety and depression scores above normal limits.Results:Average T-scores for anxiety did not differ in concussed versus nonconcussed adolescents (mean: 45.9 [SD 10.84] vs 45.2 [8.1], respectively, P = 0.54), whereas average T-scores for depression were significantly higher in concussed versus nonconcussed adolescents (46.0 [10.88] vs 42.8 [8.48], respectively, P < 0.01). The proportion of concussed adolescents above normal limits for depression was greater than nonconcussed adolescents (32.4% vs 20.5%, respectively, P = 0.02). Post hoc sensitivity analyses excluding those with a history of anxiety or depression demonstrated a 1.45 (95% CI, 0.97, 2.01) and 1.56 (95% CI, 0.95, 2.56) increased risk of an above-normal anxiety and depression score for concussed compared with nonconcussed adolescents, respectively, although both were nonsignificant.Conclusion:Although we found few significant differences between the 2 groups, the results highlight that many concussed adolescents met the threshold for above-average symptoms on the depression and anxiety PROMIS measures.Clinical Relevance:In adolescents, there is increased risk for psychiatric sequalae in the acute period after a concussion. As such, we suggest that clinicians consider incorporating depression screening when caring for adolescents after a concussion.
      Citation: Sports Health
      PubDate: 2022-08-03T05:51:40Z
      DOI: 10.1177/19417381221113840
       
  • Retrospective Review of Radiographic Imaging of Tibial Bony Stress
           Injuries in Adolescent Athletes With Positive MRI Findings: A Comparative
           Study

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      Authors: Eric D. Nussbaum, Catherine King, Robert Epstein, Jaynie Bjornaraa, Patrick S. Buckley, Charles J. Gatt
      Abstract: Sports Health, Ahead of Print.
      Background:It is difficult to diagnose and grade bony stress injury (BSI) in the athletic adolescent population without advanced imaging. Radiographs are recommended as a first imaging modality, but have limited sensitivity and, even when findings are present, advanced imaging is often recommended.Hypothesis:It was hypothesized that the significance of radiographs is underestimated for BSI in the adolescent with positive clinical examination and history findings.Study design:Case seriesLevel of evidence:Level 4Methods:A total of 80 adolescent athletes with a history of shin pain underwent clinical examination by an orthopaedic surgeon. On the day of clinical examination, full-length bilateral tibial radiographs and magnetic resonance imaging (MRI) scans were obtained. MRI scans were reviewed using Fredericson grading for BSI. At the completion of the study, radiographic images were re-evaluated by 2 musculoskeletal (MSK) radiologists, blinded to MRI and clinical examination results, who reviewed the radiographs for evidence of BSI. Radiographic results were compared with clinical examination and MRI findings. Sensitivity, specificity, negative predictive value, and positive predictive value were calculated based on comparison with MRI.Results:All radiographs were originally read as normal. Of the tibia studied, 80% (127 of 160) showed evidence of BSI on MRI. None of the original radiographs demonstrated a fracture line on initial review by the orthopaedic surgeons. Retrospective review by 2 MSK radiologists identified 27% of radiographs (34 of 127) with evidence of abnormality, which correlated with clinical examination and significant findings on MRI. Review of radiographs found evidence of new bone on 0 of 28 Fredericson grade 0, 0 of 19 Fredericson grade I, 11 of 80 (13.7%) Fredericson grade II, 18 of 28 (64%) Fredericson grade III, and 5 of 5 (100%) Fredericson grade IV. Sensitivity of radiographs showed evidence of new bone on 27% (34 of 127) of initial radiographs, with presence more common with greater degree of BSI, as 23 of 33 (70%) were higher-grade injuries (III of IV) of BSI. Specificity and positive predictive value were 100%, while negative predictive value was 17%.Conclusion:These findings highlight the importance of initial radiographs in identifying high-grade BSI. As radiographs are readily available in most office settings of sports medicine physicians, this information can influence the management of adolescent athletic BSI without the need to delay treatment to obtain an MRI.Clinical Relevance:Adolescent athletes with radiographic evidence of BSI should be treated in a timely and more conservative manner, given the likelihood of higher-grade BSI. In addition, clinicians knowledgeable of the radiographic findings of high-grade BSI should feel more confident that a negative initial radiograph is not likely to be a high-grade BSI and can modify their treatment plans accordingly.
      Citation: Sports Health
      PubDate: 2022-08-03T05:49:45Z
      DOI: 10.1177/19417381221109537
       
  • Analysis of the Evidence Underpinning the American Academy of Orthopedic
           Surgeons Knee Osteoarthritis Clinical Practice Guidelines

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      Authors: Philo Waters, Reece Anderson, J. Michael Anderson, Jared Scott, Byron Detweiler, Sam Streck, Micah Hartwell, Trevor Torgerson, Matt Vassar
      Abstract: Sports Health, Ahead of Print.
      Context:Clinical practice guidelines (CPGs) are vital to establishing a standardized and evidence-based approach in medicine. These guidelines rely on the use of methodologically sound clinical trials, and the subsequent reporting of their methodology.Objective:To evaluate the completeness of randomized controlled trials (RCTs) underpinning CPGs published by the American Academy of Orthopedic Surgeons (AAOS) for management of osteoarthritis of the knee.Data Sources:We searched the most recent AAOS CPGs for surgical and nonsurgical management of osteoarthritis of the knee for RCTs. To estimate the necessary sample size, we performed a power analysis using OpenEpi 3.0 (openepi.com).Study Selection:Two authors independently screened the reference sections of the included CPGs. Included studies met the definition of an RCT, were retrievable in the English language, and were cited in at least one of the included CPGs.Study Design:Meta-AnalysisLevel of Evidence:Level 1aData Extraction:We performed double-blind screening and extraction of RCTs included in the AAOS CPGs. We evaluated each RCT for adherence to the Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. A multiple regression analysis was conducted to assess CONSORT adherence against characteristics of included studies (ie, type of intervention, funding source, etc).Results:Our study included 179 RCTs. The overall adherence was 68.5% with significant differences between those published before and since the development of the 2010 CONSORT guidelines (P = 0.02). We found that RCTs receiving funding from industry/private sources as well as studies that included a conflict of interest statement showed more completeness than RCTs that reported receiving no funding (P < 0.01).Conclusion:We found suboptimal CONSORT adherence for RCTs cited in AAOS CGPs for management of osteoarthritis of the knee. Therefore, the CPGs are likely supported by outdated evidence and lack of high-quality reporting. It is important that evidence used to guide clinical decision making be of the highest quality in order to optimize patient outcomes. In order for clinicians to confer the greatest benefits to their patients, CPGs should provide the totality of evidence and emphasize emerging high-quality RCTs to ensure up-to-date, evidence-based clinical decision-making.
      Citation: Sports Health
      PubDate: 2022-08-02T05:16:54Z
      DOI: 10.1177/19417381221112674
       
  • The FIFA 11+ Kids Injury Prevention Program Reduces Injury Rates Among
           Male Children Soccer Players: A Clustered Randomized Controlled Trial

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      Authors: Wesam Saleh A. Al Attar, Mario Bizzini, Hosam Alzahrani, Saud Alarifi, Hussain Ghulam, Mashaer Alyami, Msaad Alzhrani, Ross H. Sanders
      Abstract: Sports Health, Ahead of Print.
      Background:The Fédération Internationale de Football Association (FIFA) 11+ Kids is an exercise-based injury prevention program developed by an international group of experts to prevent injuries among child soccer players.Hypothesis:It was hypothesized that the FIFA 11+ Kids program would be more effective than performing a typical warm-up regimen in reducing overall injuries among soccer players aged 7 to 13 years.Study Design:A clustered randomized controlled trial.Level of Evidence:Level 1.Methods:A total of 94 boys’ soccer teams, including 780 players, were randomly allocated into an experimental or control group. Complete datasets were collected from 45 teams (377 players) and 43 teams (363 players) in the experimental and control groups, respectively. The experimental group underwent the FIFA 11+ Kids program as a warm-up during training sessions and matches at least twice a week, and the control group continued performing their usual warm-ups. Participants were prospectively followed during 1 season (6 months). The primary outcomes included the incidence of overall and recurrent injuries and their mechanism and severity. The secondary outcome was the rate of compliance with the intervention program.Results:A total of 43 injuries were reported in the experimental group in 50,120 hours of exposure (0.85 injuries/1000 exposure hours). A total of 86 injuries were reported in the control group in 42,616 hours of exposure (2.01 injuries/1000 exposure hours). The injury risk ratio was 0.43 (0.29-0.61), suggesting that the experimental group experienced 57% fewer injuries than those in the control group.Conclusion:The FIFA 11+ Kids program reduced overall injury rates in children playing soccer more than the usual warm-ups.Clinical Relevance:The results of this study provide evidence for children’s coaches to consider including the FIFA 11+ Kids program in their warm-up regimen. Such a program may prevent injury risk and decrease absenteeism and injury-related financial burdens.
      Citation: Sports Health
      PubDate: 2022-07-29T05:05:14Z
      DOI: 10.1177/19417381221109224
       
  • Nonsteroidal Anti-inflammatory and Corticosteroid Injections for Shoulder
           Impingement Syndrome: A Systematic Review and Meta-analysis

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      Authors: Rhushi Ziradkar, Thomas M. Best, Daniel Quintero, Kristopher Paultre
      Abstract: Sports Health, Ahead of Print.
      Context:To determine optimal treatment strategies for shoulder impingement syndrome (SIS).Objective:To compare subacromial nonsteroidal anti-inflammatory injections (SNIs) and subacromial corticosteroid injections (SCIs) on pain relief and functional improvement in individuals with SIS. Second, to perform a cost analysis of the 2 injections.Data Sources:MEDLINE, SPORTDiscus, CINAHL, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials using several keywords.Study Selection:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized, and 10 studies comparing changes in pain or function in humans with SIS receiving SNIs or SCIs were included. Quality and risk of bias were assessed using the Consolidated Standards of Reporting Trials (CONSORT) 2010 scale and the Cochrane Collaboration tool.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 1Data Extraction:Baseline and follow-up scores of the visual analog, Constant-Murley, and University of California Los Angeles shoulder scales were extracted to calculate effect sizes (ESs), represented as Cohen d. Metaregression and publication bias analyses were performed. Procedural and medication costs were extracted from Medicare guidelines.Results:A total of 7 high and 3 good quality studies were included, with a mean score of 21.1. Only 1 study had a high risk of bias. The meta-analyses produced pooled ESs of 0.05 (P = 0.83), 0.12 (P = 0.71), and 0.07 (P = 0.79) for each scale, respectively, with CIs crossing 0. Procedural costs were equal between groups, whereas ketorolac was the least costly medication ($0.47). There was no significant difference in side effects between the 2 injections.Conclusion:SNIs are as effective as SCIs for short-term pain relief and improving function in patients with subacromial impingement syndrome. In addition, they are less expensive and cause no major difference in complications, providing a viable, cost-effective alternative for injection therapy in patients with SIS.
      Citation: Sports Health
      PubDate: 2022-07-28T04:48:00Z
      DOI: 10.1177/19417381221108726
       
  • Mask Use for Athletes: A Systematic Review of Safety and Performance
           Outcomes

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      Authors: Ariana Lott, Timothy Roberts, Cordelia W. Carter
      Abstract: Sports Health, Ahead of Print.
      Context:With the current Centers for Disease Control and Prevention recommendations for mask use to minimize transmission of coronavirus 2019 (COVID-19) coupled with concern for future pandemics that would require mask wearing, providing data-driven guidance with respect to athletic performance is essential.Objective:The purpose of this study was to perform a systematic review of existing literature on the use of face masks while exercising to assess the physiologic effects of face masks worn during athletic activities.Data Sources:A systematic review was conducted of studies on face mask use during exercise according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Potential studies were identified through searches of MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases.Study Selection:Screening was completed independently by 2 coauthors who sought to identify studies that described the effects of oronasal mask use, if any, on sports/exercise/physical activity, for any age, gender, or level of sport. Articles describing mask effects without exercise, articles published before 1980, and non-English language studies were excluded.Study Design:Systematic reviewLevel of Evidence:Level 3Data Extraction:Data extraction focused on physiologic parameters measured during physical activity performed while wearing a face mask.Results:Twenty-two articles met all inclusion criteria. Study analysis revealed that the use of masks in healthy volunteers during exercise had no significant effect on physiologic parameters measured including heart rate (HR), respiratory rate (RR), oxygen saturation, and perceived exertion. Of the studies that investigated N95 masks in the healthy adult population, 2 reported modest changes in RR and maximum power output indicative of decreased athletic performance when subjects were exercising at maximum effort. Similar findings were seen in studies of subpopulations including children and pregnant women.Conclusion:Available data suggest that healthy individuals can perform moderate-to-vigorous exercise while wearing a face mask without experiencing changes in HR, RR, and oxygen saturation that would compromise individual safety or athletic performance. In the specific situation in which an N95 mask is worn, maximum power generated may be impaired.What is known about the subject:To date, there has been no systematic review of the existing literature to provide a clear consensus on whether face mask use significantly impacts athletic performance. Mask use has been demonstrated safe in the workplace; however, the use of face masks during exercise has not been examined on a large scale, particularly with respect to physiologic parameters.What this study adds to existing knowledge:This analysis highlights that available data suggest that healthy individuals can perform heavy exercise in face masks with minimal physiologic changes. This is the first systematic review of studies analyzing exercise use wearing masks. With the evidence presented here commonly cited concerns about both safety and performance decrements with mask use during physical activities may be allayed.
      Citation: Sports Health
      PubDate: 2022-07-20T06:15:28Z
      DOI: 10.1177/19417381221111395
       
  • Sleep and the Young Athlete

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      Authors: Rachel A. Coel, George G.A. Pujalte, Andres I. Applewhite, Tracy Zaslow, George Cooper, Angie N. Ton, Holly J. Benjamin
      Abstract: Sports Health, Ahead of Print.
      Context:Sleep plays a vital role in cognitive and physical performance. Teenage athletes (ages 13-19 years) are considered especially at risk for disordered sleep and associated negative cognitive, physical, and psychosomatic effects. However, there is a paucity of evidence-based recommendations to promote sleep quality and quantity in athletes who fall within this age range. We performed a review of the literature to reveal evidence-based findings and recommendations to help sports instructors, athletic trainers, physical therapists, physicians, and other team members caring for young athletes provide guidance on sleep optimization for peak sports performance and injury risk reduction.Methods:PubMed, Scopus, and Cochrane CENTRAL were searched on May 11, 2016, and then again on September 1, 2020, for relevant articles published to date.Study Design:Narrative review.Level of Evidence:Level 4.Results:Few studies exist on the effects disordered sleep may have on teenage athletes. By optimizing sleep patterns in young athletes during training and competitions, physical and mental performance, and overall well-being, may be optimized. Adequate sleep has been shown to improve the performance of athletes, although further studies are needed.Conclusion:Twenty-five percent of total sleep time should be deep sleep, with a recommended sleep time of 8 to 9 hours for most young athletes. Screen and television use during athletes’ bedtime should be minimized to improve sleep quality and quantity. For young athletes who travel, jet lag can be minimized by allowing 1 day per time zone crossed for adjustment, limiting caffeine intake, planning meals and onboard sleeping to coincide with destination schedules, timing arrivals in the morning whenever possible, and using noise-canceling headphones and eyeshades.Strength-of-Recommendation Taxonomy (SORT):B.
      Citation: Sports Health
      PubDate: 2022-07-20T06:12:48Z
      DOI: 10.1177/19417381221108732
       
  • 30-Second Chair Stand Test Predicts Countermovement Jump Performance in
           Young Adults

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      Authors: Mansour M. Alotaibi, Marzouq K. Almutairi, Harshvardhan Singh, Matthew P. Ithurburn, Donald H. Lein
      Abstract: Sports Health, Ahead of Print.
      Background:The countermovement jump (CMJ) is a valid and reliable test of lower extremity (LE) muscle power. However, the CMJ may not be appropriate during early-stage rehabilitation of injuries. Functional muscle strength tests (FMSTs) could evaluate LE muscle power with lower joint reaction forces.Hypothesis:The lateral step-up test (LSUT), 5 times sit to stand (5×STS), and 30-s chair stand test (30CST) could predict CMJ jump height (JHt) and jump peak power (JPow).Study Design:Cross-sectional study.Level of Evidence:Level 2.Methods:Eighty-one young adults performed 3 CMJs to measure JHt and JPow using an electronic jump mat and speed analyzer. Participants also performed three FMSTs: 1 trial of the LSUT and a modified trial of LSUT touching the ground with the heel only (MLSUT); 2 trials of the 5×STS; and 2 trials of the 30CST, in a randomized order. Spearman rho correlations and hierarchal multiple linear regressions were used to determine whether FMST performances predicted JHt and JPow, after controlling for sex, body height, and body mass.Results:30CST, LSUT, MLSUT, sex, body mass, and body height were significantly associated with JHt (P < 0.05). LSUT, sex, body height, and body mass were significantly associated with JPow (P < 0.05). Hierarchical regression analyses showed that the 30CST significantly predicted JHt (P < 0.01) and JPow (P = 0.03), independent of sex, body height, and body mass.Conclusion:30CST performance predicted JHt and JPow in young adults.Clinical Relevance:The 30CST is easy to perform, requires equipment found readily in clinics, and predicts LE muscle power. This test could be used to track progress during the early stages of LE injury rehabilitation.
      Citation: Sports Health
      PubDate: 2022-07-20T06:04:32Z
      DOI: 10.1177/19417381221105040
       
  • The Impact of Statewide Limitations of Practice on High School Injury
           Incidence During the COVID-19 Season: An Ecological Study

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      Authors: Garrett Bullock, Albert Prats-Uribe, Charles A. Thigpen, Lisa Boyer, Kate Varnado, Jason Pequette, Ellen Shanley
      Abstract: Sports Health, Ahead of Print.
      Background:Abrupt training stoppage can increase injury incidence and risk following return to sport. The rate of coronavirus disease 2019 (COVID-19) infections in the general population has resulted in the abrupt stoppage of high school education and sport. The objective of this study was to (1) compare injury incidence proportion (IP) and excess injury in high school athletes before and during the COVID-19 pandemic; and (2) stratify by identified gender.Hypothesis:The COVID-19 academic year will demonstrate increased injury incidence, and injury incidence will be similar between genders.Study Design:Ecological.Level of Evidence:Level 2.Methods:High schools (6 states; 176 high schools) were matched between prepandemic and pandemic years. Injury IP with 95% confidence interval (CI) was calculated. Interrupted time series models with robust errors were performed to assess the IP ratio and excess injury incidence between prepandemic and pandemic academic calendar years.Results:A total of 98,487 athletes participated in high school sport in the prepandemic year and 72,521 athletes in the pandemic year; 15,477 injuries were reported in the prepandemic year compared with 14,057 injuries during the pandemic year. Injury IP (CI) was 15.7 (15.5-15.9) and 19.4 (19.1-19.7) for the prepandemic and pandemic years, respectively. Injury incidence ratio increased by 1.3 (1.2-1.5) between the prepandemic and pandemic years. Excess injuries were 1812 greater in the pandemic year compared with the prepandemic year. Female and male athlete incidence ratios were similar.Conclusion:Prolonged sport stoppage due to the COVID-19 pandemic resulted in increased injury incidence compared with the previous high school academic year.Clinical Relevance:High school sports stakeholders should consider longer periods of ramp up for training in lieu of future sport stoppages compared with usual preseason training. These data may also have more generalizable implications to other abrupt sport and physical activity stoppage scenarios such as earthquakes and hurricanes.
      Citation: Sports Health
      PubDate: 2022-06-29T12:39:27Z
      DOI: 10.1177/19417381221106693
       
  • Functional Resistance Training Differentially Alters Gait Kinetics After
           Anterior Cruciate Ligament Reconstruction: A Pilot Study

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      Authors: Edward P. Washabaugh, Scott R. Brown, Riann M. Palmieri-Smith, Chandramouli Krishnan
      Abstract: Sports Health, Ahead of Print.
      Background:Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)–acutely alter gait kinetics in this population.Hypothesis:The type of FRT device will affect ground-reaction forces (GRFs) during and after the training. Specifically, the uni- and bidirectional braces will increase GRFs when compared with the elastic band.Study Design:Crossover study.Level of Evidence:Level 2.Methods:A total of 15 individuals with ACL reconstruction received FRT with each device over 3 separate randomized sessions. During training, participants walked on a treadmill while performing a tracking task with visual feedback. Sessions contained 5 training trials (180 seconds each) with rest between. Vertical and anterior-posterior GRFs were assessed on the ACL-reconstructed leg before, during, and after training. Changes in GRFs were compared across devices using 1-dimensional statistical parametric mapping.Results:Resistance applied via bidirectional brace acutely increased gait kinetics during terminal stance/pre-swing (ie, push-off), while resistance applied via elastic band acutely increased gait kinetics during initial contact/loading (ie, braking). Both braces behaved similarly, but the unidirectional brace was less effective for increasing push-off GRFs.Conclusion:FRT after ACL reconstruction can acutely alter gait kinetics during training. Devices can be applied to selectively alter gait kinetics. However, the long-term effects of FRT after ACL reconstruction with these devices are still unknown.Clinical Relevance:FRT may be applied to alter gait kinetics of the involved limb after ACL reconstruction, depending on the device used.
      Citation: Sports Health
      PubDate: 2022-06-29T12:38:31Z
      DOI: 10.1177/19417381221104042
       
  • The Relationship Between Maximum Shoulder Horizontal Abduction and
           Adduction on Peak Shoulder Kinetics in Professional Pitchers

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      Authors: Joseph E. Manzi, Brittany Dowling, Nicolas Trauger, Benjamin R. Hansen, Theodore Quan, Elizabeth Dennis, Michael C. Fu, Joshua S. Dines
      Abstract: Sports Health, Ahead of Print.
      Background:Repetitive horizontal shoulder abduction during pitching can cause increased contact between the posterosuperior aspect of the glenoid and the greater tuberosity of the humeral head, theoretically putting baseball pitchers at increased risk of shoulder internal impingement and other shoulder pathologies.Hypothesis:Increased shoulder horizontal abduction is associated with increased shoulder anterior force, while increased horizontal adduction is associated with increased shoulder distraction force.Study Design:Descriptive laboratory study.Level of Evidence:Level 4.Methods:A total of 339 professional baseball pitchers threw 8 to 10 fastball pitches using 3D motion capture (480 Hz). Pitchers were divided into 2 sets of quartiles based on maximum shoulder horizontal abduction and adduction. Elbow flexion, shoulder external rotation, and peak shoulder kinetics were compared between quartiles with post hoc linear regressions conducted for the entire cohort.Results:At maximum shoulder horizontal abduction, there was no difference in ball velocity between quartiles (P = 0.76). For every 10º increase in maximum shoulder horizontal abduction, shoulder anterior force decreased by 2.2% body weight (BW) (P < 0.01, B = −0.22, β = −0.38), shoulder adduction torque decreased by 0.5%BW × body height (BH) (P < 0.01, B = −0.05, β = −0.19), and shoulder horizontal adduction torque decreased by 0.4%BW × BH (P < 0.01, B = −0.04, β = −0.48). For every 10º increase in maximum shoulder horizontal adduction, shoulder anterior force increased by 2%BW and ball velocity decreased by 1.2 m/s (2.7 MPH).Conclusion:Professional pitchers with the least amount of maximum horizontal adduction had faster ball velocity and decreased shoulder anterior force. Pitchers with greater maximum shoulder horizontal abduction had decreased shoulder anterior force, shoulder adduction torque, and shoulder horizontal adduction torque. To maximize ball velocity as a performance metric while minimizing shoulder anterior force, pitchers can consider decreasing maximum shoulder adduction angles at later stages of the pitch.Clinical Relevance:Identifying risk factors for increased throwing shoulder kinetics (ie, shoulder anterior force, shoulder adduction torque) has potential implications in injury prevention. Specifically, mitigating shoulder anterior forces may be beneficial in reducing risk of injury.
      Citation: Sports Health
      PubDate: 2022-06-28T06:55:28Z
      DOI: 10.1177/19417381221104038
       
  • Blood Flow Restriction Therapy Preserves Lower Extremity Bone and Muscle
           Mass After ACL Reconstruction

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      Authors: Robert A. Jack, Bradley S. Lambert, Corbin A. Hedt, Domenica Delgado, Haley Goble, Patrick C. McCulloch
      Abstract: Sports Health, Ahead of Print.
      Background:Muscle atrophy is common after an injury to the knee and anterior cruciate ligament reconstruction (ACLR). Blood flow restriction therapy (BFR) combined with low-load resistance exercise may help mitigate muscle loss and improve the overall condition of the lower extremity (LE).Purpose:To determine whether BFR decreases the loss of LE lean mass (LM), bone mass, and bone mineral density (BMD) while improving function compared with standard rehabilitation after ACLR.Study Design:Randomized controlled clinical trialMethods:A total of 32 patients undergoing ACLR with bone-patellar tendon-bone autograft were randomized into 2 groups (CONTROL: N = 15 [male = 7, female = 8; age = 24.1 ± 7.2 years; body mass index [BMI] = 26.9 ± 5.3 kg/m2] and BFR: N = 17 [male = 12, female = 5; age = 28.1 ± 7.4 years; BMI = 25.2 ± 2.8 kg/m2]) and performed 12 weeks of postsurgery rehabilitation with an average follow-up of 2.3 ± 1.0 years. Both groups performed the same rehabilitation protocol. During select exercises, the BFR group exercised under 80% arterial occlusion of the postoperative limb (Delfi tourniquet system). BMD, bone mass, and LM were measured using DEXA (iDXA, GE) at presurgery, week 6, and week 12 of rehabilitation. Functional measures were recorded at week 8 and week 12. Return to sport (RTS) was defined as the timepoint at which ACLR-specific objective functional testing was passed at physical therapy. A group-by-time analysis of covariance followed by a Tukey’s post hoc test were used to detect within- and between-group changes. Type I error; α = 0.05.Results:Compared with presurgery, only the CONTROL group experienced decreases in LE-LM at week 6 (−0.61 ± 0.19 kg, −6.64 ± 1.86%; P < 0.01) and week 12 (−0.39 ± 0.15 kg, −4.67 ± 1.58%; P = 0.01) of rehabilitation. LE bone mass was decreased only in the CONTROL group at week 6 (−12.87 ± 3.02 g, −2.11 ± 0.47%; P < 0.01) and week 12 (−16.95 ± 4.32 g,−2.58 ± 0.64%; P < 0.01). Overall, loss of site-specific BMD was greater in the CONTROL group (P < 0.05). Only the CONTROL group experienced reductions in proximal tibia (−8.00 ± 1.10%; P < 0.01) and proximal fibula (−15.0±2.50%,P < 0.01) at week 12 compared with presurgery measures. There were no complications. Functional measures were similar between groups. RTS time was reduced in the BFR group (6.4 ± 0.3 months) compared with the CONTROL group (8.3 ± 0.5 months; P = 0.01).Conclusion:After ACLR, BFR may decrease muscle and bone loss for up to 12 weeks postoperatively and may improve time to RTS with functional outcomes comparable with those of standard rehabilitation.
      Citation: Sports Health
      PubDate: 2022-06-28T06:54:29Z
      DOI: 10.1177/19417381221101006
       
  • A Minority of Athletes Pass Symmetry Criteria in a Series of Hop and
           Strength Tests Irrespective of Having an ACL Reconstructed Knee or Being
           Noninjured

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      Authors: Jonas L. Markström, Josefine E. Naili, Charlotte K. Häger
      Abstract: Sports Health, Ahead of Print.
      Background:Between-leg symmetry in 1-leg hop and knee strength performances is considered important after anterior cruciate ligament reconstruction (ACLR) to facilitate a safer return to sport. While few athletes with ACLR demonstrate symmetry in test batteries, reference data for noninjured athletes are lacking, thus questioning how ACLR-specific poor symmetry is.Hypothesis:Athletes with ACLR (hamstring autograft) show lower symmetry and have a lower proportion of symmetric individuals than noninjured athletes for knee flexion strength but not for hop for distance, vertical hop, and knee extension strength.Study design:Cross-sectional.Level of Evidence:Level 3.Methods:A total of 47 athletes with ACLR (median 13.0 months post-ACLR) who had returned to their sport, and 46 noninjured athletes participated. Symmetry was calculated between the worse and better legs for each test and combinations of them using the limb symmetry index (LSIWORSE-BETTER, ranging from 0% to 100%). The 2 groups were compared for these values and the proportions of individuals classified as symmetric (LSIWORSE-BETTER ≥90%) using independent t-tests and Fisher’s exact tests, respectively.Results:Athletes with ACLR were less symmetric than noninjured athletes for knee flexion strength with a lower LSIWORSE-BETTER (83% vs 91%, P < 0.01) and a lower proportion of symmetric individuals (39% vs 63%, P = 0.04). No differences between groups were revealed for the hop tests, knee extension strength, or combinations of tests (P> 0.05). Only 17% of the athletes with ACLR and 24% of the noninjured athletes demonstrated symmetric performances for all 4 tests.Conclusion:Athletes with ACLR (hamstring autograft) showed poorer symmetry in knee flexion strength than noninjured athletes, although both groups had few individuals who passed the test battery’s symmetry criteria.Clinical relevance:Symmetry is uncommon among athletes irrespective of ACLR and should be considered regarding expected rehabilitation outcomes and return-to-sport decisions post-ACLR.
      Citation: Sports Health
      PubDate: 2022-06-28T06:52:59Z
      DOI: 10.1177/19417381221097949
       
  • Sports Imaging of COVID-19: A Multi-Organ System Review of Indications and
           Imaging Findings

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      Authors: Ali Rashidi, Jan Fritz
      Abstract: Sports Health, Ahead of Print.
      Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. Although coronavirus disease-19 (COVID-19) affects every population group, the sports community and athletes require special consideration of the effects on cardiovascular, musculoskeletal, neurologic, and respiratory systems. A comprehensive understanding of imaging indications, findings, and features of COVID-19 supports appropriate imaging utilization and effective patient management and treatment.Purpose:To review the spectrum of sports imaging in COVID-19 infection, organ system manifestations, vaccine effects, and complications in recreational and competitive athletes.Study Design:Narrative review.Level of Evidence:Levels 4 and 5.Methods:Based on a PubMed database search, studies describing the imaging findings of COVID-19 infection, organ system manifestations, vaccine effects, and complications in recreational and competitive athletes were included.Results:On March 11, 2020, World Health Organization officially declared COVID-19 a global pandemic. As of May 9, 2022, more than 515 million confirmed cases of COVID-19 were reported globally. While the multisystem effects of COVID-19 are incompletely understood, the role of imaging in diagnosing, monitoring, and prognosticating active disease, long-term effects, and complications is evolving. In the respiratory system, imaging plays an important role in diagnosing, characterizing, and monitoring pulmonary COVID-19 infections, barotrauma, and COVID-19-associated chronic pulmonary opacities and fibrotic-like lung changes. Ultrasonography, computed tomography, and magnetic resonance imaging aid in the timely diagnosis of ischemic, embolic, and thrombotic peripheral and central cardiovascular events, including deep venous thrombosis, pulmonary embolism, myocarditis, and stroke. COVID-19-associated musculoskeletal and peripheral nervous system manifestations include rhabdomyolysis and myonecrosis, plexus and peripheral neuropathies, Guillain-Barré syndrome, and shoulder injury related to vaccine administration.Conclusions:In athletes, COVID-19 infections and associated effects on cardiovascular, musculoskeletal, neurologic, and respiratory systems require special consideration. With the increasing understanding of the multisystem effects of COVID-19, the role of imaging in diagnosing, monitoring, and prognosticating active disease, long-term effects, and complications is evolving. A comprehensive understanding of imaging indications, COVID-19 imaging features, and organ system effects aids in appropriate imaging utilization and effective patient management and treatments.
      Citation: Sports Health
      PubDate: 2022-06-24T05:48:15Z
      DOI: 10.1177/19417381221106448
       
  • Test-Retest, Interrater Reliability, and Minimal Detectable Change of the
           Dynamic Exertion Test (EXiT) for Concussion

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      Authors: Aaron M. Sinnott, Shawn R. Eagle, Victoria Kochick, Michael W. Collins, R. J. Elbin, Christopher Connaboy, Anthony P. Kontos, Indira R. Bricker, Patrick J. Sparto, Shawn D. Flanagan
      Abstract: Sports Health, Ahead of Print.
      Background:The Dynamic Exertion Test (EXiT) was developed to inform return-to-play (RTP) decision-making following clinical recovery from sport-related concussion (SRC). The purpose of the current study was to document intrarater and test-retest reliability and minimal detectable change (MDC) scores for physiological [heart rate (HR) and blood pressure], performance (change-of-direction task completion time and errors), and clinical outcomes (endorsed symptoms, perceived exertion) of EXiT, and interrater reliability of performance outcomes.Hypothesis:Healthy athletes would exhibit stable physiological responses to the EXiT across visits, demonstrate consistent change-of-direction task completion time between consecutive trials at each visit, and the fastest time (of 2 trials) across visits, and endorse equivocal symptoms and effort across visits.Study Design:Cross-sectional, test-retest.Level of Evidence:Level 3.Methods:Seventy-nine (female: 34 [43%], 19.6 ± 5.0 years) athletes completed the EXiT at 2 study visits (8.7 ± 4.7 days between visits). Two-way, mixed, intraclass correlation coefficients (ICCs) were used to evaluate intrarater and test-retest reliability. Cronbach’s alpha was used to document the internal consistency of symptoms at each visit, and MDC scores were calculated on the physiological, performance, and clinical outcomes.Results:Measured and percentage of age-estimated maximum HR were reliable following EXiT (ICC = 0.579-0.618). Change-of-direction task completion time (MDC range = 0.75-8.70 s) had good-to-excellent test-retest (ICC = 0.703-0.948) and interrater (ICC = 0.932-0.965) reliability. Symptoms had a high internal consistency at visits 1 (α = 0.894) and 2 (α = 0.805) and were reliable across visits (ICC = 0.588).Conclusion:The current investigation established test-retest reliability in addition to MDC scores of an objective dynamic exercise assessment among healthy adolescent and adult athletes. The EXiT may be an objective approach to inform RTP decision-making following SRC recovery.Clinical Relevance:The EXiT is a clinically feasible exertion-based assessment that can be readily administered in a variety of outpatient clinical settings.
      Citation: Sports Health
      PubDate: 2022-06-09T08:22:09Z
      DOI: 10.1177/19417381221093556
       
  • Characterization of Musculoskeletal Injuries in Gymnastics Participants
           From 2013 to 2020

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      Authors: J. Alex Albright, Ozair Meghani, Nicholas J. Lemme, Brett D. Owens, Ramin Tabaddor
      Abstract: Sports Health, Ahead of Print.
      Background:Many studies have analyzed gymnastics-related injuries in collegiate and elite athletes, but there is minimal literature analyzing the epidemiological characteristics of injuries in the greater gymnastics community.Hypothesis:A higher incidence of injuries in younger gymnasts between the ages of 6 and 15 years compared with those 16 years and older and a difference in the distribution of injuries between male and female gymnasts.Study Design:Retrospective cross-sectional study.Level of Evidence:Level 3.Methods:The National Electronic Injury Surveillance System (NEISS) was queried for all gymnastics-related musculoskeletal injuries presenting to the emergency department (ED) between 2013 and 2020. Incidence was calculated as per 100,000 person-years using the weighted estimates provided by NEISS and national participation data. Chi-square and column proportion z-testing was used to analyze where appropriate.Results:The incidence of gymnastics-related musculoskeletal injuries was 480.7 per 100,000 person-years. Most ED visits were children between the ages of 6 and 15 years (84.0%). Younger gymnasts (ages 6 to 10) were most likely to experience a lower arm fracture, while those over the age of 10 years were most likely to experience an ankle sprain (P < 0.01). Men and boys presented with a much greater proportion of shoulder injuries (8.0% vs 3.9%), while women and girls presented with a greater proportion of elbow injuries (9.9 % vs 5.9%) and wrist (10.5% vs 8.3%) injuries (P < 0.01).Conclusion:As hypothesized, most gymnastics-related injuries between 2013 and 2020 were athletes between 6 and 15 years old. Many of these athletes are attempting new, more difficult, skills and are at increased risk of more acute injury when attempting skills they may be unfamiliar with.Clinical Relevance:With increased pressure to specialize at an early age to maintain competitiveness and learn new, higher-level skills compared with their peers, younger athletes are most susceptible to acute injury. New injury prevention strategies could be implemented to help this high-risk population compete and train safely.
      Citation: Sports Health
      PubDate: 2022-06-08T06:19:31Z
      DOI: 10.1177/19417381221099005
       
  • The Relationship Between Human-rated Errors and Tablet-based Postural Sway
           During the Balance Error Scoring System in Military Cadets

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      Authors: Jeremy D. Ross, Matthew C. Hoch, Steven R. Malvasi, Kenneth L. Cameron, Megan H. Roach
      Abstract: Sports Health, Ahead of Print.
      Background:The Balance Error Scoring System (BESS) is commonly accepted as a valid measure of postural stability. However, reliability values have varied, and subtle changes undetectable with the human eye may exist postinjury. The inertial measurement unit in commercially available tablets has been used to quantify postural sway (instrumented Balance Error Scoring System [iBESS] volume). However, iBESS has not been validated in a military population, and the stability of the tests beyond 1 week is unknown.Hypothesis:iBESS volume is capable of objectively measuring postural sway during the traditional BESS.Study Design:Prospective repeated-measures study.Level of Evidence:Level 3.Methods:Eighty-three cadets (40.96% women; age 20.0 ± 1.44 years; height 68.7 ± 4.1 inches; weight 166.7 ± 30.2 lb) with no history of concussion or lower extremity injury agreed to participate. All participants completed the BESS at baseline and 6 months post baseline. During testing, a tablet equipped with an inertial measurement unit was positioned on the participant’s sacrum to capture postural sway.Results:Moderate to strong correlations were exhibited between baseline measurements for single-limb (SL)-firm (r = 0.84; P < 0.01), tandem (TAN)-firm (r = 0.85; P < 0.01), double-limb (DL)-foam (r = 0.50; P < 0.01), SL-foam (r = 0.59; P < 0.01), and TAN-foam (r = 0.79; P < 0.01). Balance improved significantly at 6 months for SL-firm human-rated errors (Effect Size [ES] = 0.32) and for SL-firm (ES = 0.38), DL-foam (ES = 0.21), and SL-foam iBESS volume (ES = 0.35). Moderate to strong correlations were exhibited between human-rated and iBESS change scores for SL-firm (r = 0.71; P < 0.01), TAN-firm (r = 0.75; P < 0.01), and TAN-foam (r = 0.71; P < 0.01), and a weak correlation was exhibited for DL-foam (r = 0.29; P < 0.01) and SL-foam (r = 0.40; P < 0.01).Conclusion:Moderate to strong correlations existed between human-rated BESS errors and iBESS volume at baseline and between change scores. In addition, iBESS volume may be more sensitive to balance changes than the human-rated BESS.Clinical Relevance:This evidence supports the use of iBESS volume as a valid measure of postural stability in military cadets. iBESS volume may provide clinicians with an objective and more sensitive measure of postural stability than the traditional human-rated BESS.
      Citation: Sports Health
      PubDate: 2022-06-04T05:07:48Z
      DOI: 10.1177/19417381221093566
       
  • Achilles Tendon Repairs: Identification of Risk Factors for and Economic
           Impact of Complications and Reoperation

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      Authors: Nikunj N. Trivedi, Kunal Varshneya, J. Blake Calcei, Kenneth Lin, Kyle R. Sochaki, James E. Voos, Marc R. Safran, Jacob G. Calcei
      Abstract: Sports Health, Ahead of Print.
      Background:Compared with nonoperative management, Achilles tendon repair is associated with increased rates of complications and increased initial healthcare cost. However, data are currently lacking on the risk factors for these complications and the added healthcare cost associated with common preoperative comorbidities.Hypothesis:Identify the independent risk factors for complications and reoperation after acute Achilles tendon repair and calculate the added cost of care associated with having each preoperative risk factor.Study Design:Retrospective cohort study.Level of evidence:Level 3.Methods:A retrospective review of a large commercial claims database was performed to identify patients who underwent primary operative management for Achilles tendon rupture between 2007 and 2016. The primary outcome measures of the study were risk factors for (1) postoperative complications, (2) revision surgery, and (3) increased healthcare resource utilization.Results:A total of 50,279 patients were included. The overall complication rate was 2.7%. The most common 30-day complication was venous thromboembolism (1.2%). The rate of revision surgery was 2.5% at 30 days and 4.3% at 2 years. Independent risk factors for 30-day complications in our cohort included increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Independent risk factors for revision surgery within 2 years included female sex, tobacco use, hypertension, obesity, and the presence of any postoperative complication. The average 5-year cost of operative intervention was $17,307. The need for revision surgery had the largest effect on 5-year overall cost, increasing it by $6776.40. This was followed by the presence of a postoperative complication ($3780), female sex ($3207.70), and diabetes ($3105).Conclusion:Achilles tendon repair is a relatively low-risk operation. Factors associated with postoperative complications include increasing age, hyperlipidemia, hypertension, female sex, obesity, and diabetes. Factors associated with the need for revision surgery include female sex, hypertension, obesity, and the presence of any postoperative complication. Female sex, diabetes, the presence of any complication, and the need for revision surgery had the largest added costs associated with them.Clinical Relevance:Surgeons can use this information for preoperative decision-making and during the informed consent process.
      Citation: Sports Health
      PubDate: 2022-05-30T04:59:04Z
      DOI: 10.1177/19417381221087246
       
  • Biopsychosocial Factors Associated With Return to Preinjury Sport After
           ACL Injury Treated Without Reconstruction: NACOX Cohort Study 12-Month
           Follow-up

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      Authors: Diane Slater, Joanna Kvist, Clare L. Ardern
      Abstract: Sports Health, Ahead of Print.
      Background:The limited research on prognosis after nonsurgical management of anterior cruciate ligament (ACL) injury has focused on physical factors. We aimed to assess relationships between key patient-reported outcomes, in line with a biopsychosocial approach, and returning to preinjury sport at 12 months after ACL injury treated without reconstruction.Hypothesis:We hypothesized that biopsychosocial factors would be associated with returning to preinjury sport at 12 months after ACL injury.Study Design:Prospective single cohort study.Level of Evidence:Level 2.Methods:Patients who had an ACL injury and did not have reconstruction during the first year after injury were recruited from healthcare clinics in Sweden, and followed up at 3, 6, and 12 months after injury. Return to preinjury sport at 12 months was the primary outcome. Explanatory variables were psychological readiness to return to sport, knee-related quality of life, and self-reported knee function. Using generalized estimating equations, we evaluated the relationships between the explanatory variables and the primary outcome at each timepoint.Results:Data were analyzed for 88 participants with a median age of 27 years (15-40 years). Soccer was the most frequently reported preinjury sport (n = 22). Forty participants (46%) had returned to their preinjury sport at 12 months after ACL injury. The odds of returning to preinjury sport at 12 months increased with higher self-reported knee function at 6 months (odds ratio [OR], 1.1; 95% CI, 1.0-1.1), and the odds of being returned to the preinjury sport at 12 months doubled for every 1-point increase (1-10 scale) in psychological readiness to return to sport measured at 12 months (OR, 1.9; 95% CI, 1.2-3.2).Conclusion:Superior self-reported knee function at 6 months and greater psychological readiness to return to sport at 12 months were associated with returning to the preinjury sport 1 year after ACL injury treated without reconstruction.Clinical Relevance:Consider highlighting the relevance of biopsychosocial factors to returning to preinjury sport after ACL injury when discussing prognosis during shared decision-making.
      Citation: Sports Health
      PubDate: 2022-05-28T05:15:27Z
      DOI: 10.1177/19417381221094780
       
  • Elite Athletes With COVID-19: Time to Let Them Compete' Letter to the
           Editor

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      Authors: Brett G. Toresdahl, Ankit B. Shah, Irfan M. Asif
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-05-28T05:10:47Z
      DOI: 10.1177/19417381221093572
       
  • Comparison of the H:Q Ratio Between the Dominant and Nondominant Legs of
           Soccer Players: A Meta-Analysis

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      Authors: Fabian D. Lutz, Christopher J. Cleary, Hannah M. Moffatt, Violet E. Sullivan, Dain P. LaRoche, Summer B. Cook
      Abstract: Sports Health, Ahead of Print.
      Context:Soccer players often have a dominant (D) leg, which could influence the relative strength between the quadriceps and hamstrings. The hamstring-to-quadriceps (H:Q) ratio can be assessed on a dynamometer at various velocities to provide information on injury risk.Objective:To assess the concentric hamstrings and concentric quadriceps strength ratio (conventional H:Q ratio) assessed in D and nondominant (ND) legs at various speeds in male soccer players.Data Sources:A systematic literature search was completed from inception to 2020 in PubMed, Academic Search Ultimate, CINAHL, and SPORTDiscus.Study Selection:Keywords associated with the H:Q ratio were connected with terms for soccer players. Titles and abstracts were screened by 2 reviewers based on inclusion and exclusion criteria related to sex, playing level, language, and measurement. A total of 81 studies were reviewed and 17 studies (21%) were used.Study Design:A meta-analysis with random effects modeling generated standardized mean differences with 95% CIs between legs and speeds.Level of Evidence:Level 3.Data Extraction:A total of 38 cohorts were identified, with 14, 13, and 11 cohorts assessed at low, intermediate, and high velocities, respectively. The Quality Assessment Tool for Observational Cohort and Cross-sectional Studies from the National Institutes of Health was used.Results:The mean H:Q ratio at low velocities was 59.8 ± 9.5% in D leg and 58.6 ± 9.9% in ND leg, 64.2 ± 10.7% (D) and 63.6 ± 11.3% (ND) at the intermediate velocity, and 71.9 ± 12.7% (D) and 72.8 ± 12.7% (ND) at the high velocity. Low, intermediate, and high velocities had small effects of 0.13, 0.10, and -0.06, respectively.Conclusion:Conventional H:Q ratios vary across velocities but did not differ between D and ND limbs in male soccer players. This study may provide the foundation to establish norms and clinically meaningful differences.
      Citation: Sports Health
      PubDate: 2022-05-27T06:07:08Z
      DOI: 10.1177/19417381221095096
       
  • Acute Effects of Beetroot Juice Supplements on Lower-Body Strength in
           Female Athletes: Double-Blind Crossover Randomized Trial

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      Authors: Jose Manuel Jurado-Castro, Julian Campos-Perez, Antonio Ranchal-Sanchez, Natalia Durán-López, Raúl Domínguez
      Abstract: Sports Health, Ahead of Print.
      Background:Beetroot juice (BRJ) is used as an ergogenic aid, but no previous study has analyzed the effect this supplement has on the production of explosive force and muscular endurance in physically active women.Hypothesis:BRJ improves explosive force and muscular endurance in the lower limbs of physically active women.Study design:Randomized double-blind crossover study.Level of evidence:Level 3Methods:Fourteen physically active women performed a countermovement jump (CMJ) test, a back squat test for assessing velocity and power at 50% and 75% of one-repetition maximum (1RM), and the number of repetitions on a muscular endurance test consisting of 3 sets at 75% of 1RM in a resistance training protocol comprising 3 exercises (back squat, leg press, and leg extension). The participants performed the test in 2 sessions, 150 minutes after ingesting 70 mL of either BRJ (400 mg of nitrate) or a placebo (PLA).Results:A greater maximum height was achieved in the CMJ after consuming BRJ compared with a PLA (P = 0.04; effect size (ES) = 0.34). After a BRJ supplement at 50% 1RM, a higher mean velocity [+6.7%; P = 0.03; (ES) = 0.39 (–0.40 to 1.17)], peak velocity (+6%; P = 0.04; ES = 0.39 [−0.40 to 1.17]), mean power (+7.3%; P = 0.02; ES = 0.30 [−0.48 to 1.08]) and peak power (+6%; P = 0.04; ES = 0.20 [−0.59 to 0.98]) were attained in the back squat test. In the muscular endurance test, BRJ increased performance compared with the PLA (P < 0.00; ηp2 = 0.651).Conclusion:BRJ supplements exert an ergogenic effect on the ability to produce explosive force and muscular endurance in the lower limbs in physically active women.Clinical relevance:If physically active women took a BRJ supplement 120 minutes before resistance training their performance could be enhanced.
      Citation: Sports Health
      PubDate: 2022-05-21T11:38:19Z
      DOI: 10.1177/19417381221083590
       
  • Are Altered Kinematics in Runners With Patellofemoral Pain Sex
           Specific'

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      Authors: Bruna Calazans Luz, Ana Flávia dos Santos, Fábio Viadanna Serrão
      Abstract: Sports Health, Ahead of Print.
      Background:Altered kinematics have been frequently observed in runners with patellofemoral pain (PFP), and few studies have aimed to understand the influence of sex on kinematics of this population. The aim of this study was to investigate whether altered hip and knee kinematics in runners with PFP are sex specific.Hypothesis:Kinematics will be different between female and male runners with and without PFP.Study Design:Case-control study.Level of Evidence:Level 2.Methods:Eighty-four runners were divided into 4 groups: 42 runners with PFP (20 women, 22 men) and 42 asymptomatic runners (21 women, 21 men). Three-dimensional gait analyses of the hip in the frontal and transverse plane and the knee in the frontal plane were analyzed at self-selected running speed on a treadmill. One-way analysis of covariance was used to test for differences in kinematic variables between groups.Results:Women with PFP ran with a significantly greater peak hip adduction compared with men with PFP (mean difference [MD] = 4.45°; P = 0.00; effect size [ES] = 0.58) and male control subjects (MD = 4.2°; P = 0.01; ES = 0.54) and greater hip adduction range of motion (ROM) than men with PFP (MD = 3.44°; P = 0.01; ES = 0.49). No significant differences were identified between women with and without PFP. Female control subjects ran with greater peak hip adduction than men with PFP (MD = 5.46°; P < 0.01; ES = 0.58) and male control subjects (MD = 5.21°; P < 0.01; ES = 0.55); greater hip adduction ROM than men with PFP (MD = 4.02°; P = 0.00; ES = 0.52) and male control subjects (MD = 2.91°;P = 0.04; ES = 0.36); and greater peak knee abduction than men with PFP (MD = 3.35°; P = 0.02; ES = 0.44) and male control subjects (MD = 3.69°; P = 0.01; ES = 0.4).Conclusion:Women have greater hip adduction than men regardless of the presence of PFP. There were no kinematics difference between women with and without PFP. Comparisons of hip internal rotation between all groups were nonsignificant.Clinical Relevance:Altered hip and knee kinematics does not appear to be sex specific in runners with PFP.
      Citation: Sports Health
      PubDate: 2022-05-21T05:20:07Z
      DOI: 10.1177/19417381221088582
       
  • Is Workload Associated With Hamstring and Calf Strains in Professional
           Baseball Players' An Analysis of Days of Rest, Innings Fielded, and
           Plate Appearances

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      Authors: Peter N. Chalmers, Kathryn Mcelheny, John D’Angelo, Kevin Ma, Dana Rowe, Brandon J. Erickson
      Abstract: Sports Health, Ahead of Print.
      Background:The influence of player workload on hamstring and calf injuries in professional baseball players remains unknown.Hypothesis:Increased workload would significantly increase hamstring and calf strain injury risk.Study Design:Case-control.Level of Evidence:Level 3.Methods:All professional baseball players who sustained a hamstring or calf injury between 2011 and 2017 were identified using the Major League Baseball (MLB) Health and Injury Tracking System (HITS). A separate player usage dataset was used to determine workload. We then compared these variables between player games 2, 6, 12, and>12 weeks before a documented calf strain to player games from a noncalf injury control group. In a paired analysis, we compared the acute workload (2, 6, and 12 weeks) before injury with the injured player’s workload>12 weeks before injury.Results:There were 175 unique calf strains (71% occurred in position players) and 1042 unique hamstring strains (97.8% occurred in position players) documented in the MLB HITS database from 2011 to 2017. In all time periods, position players with fewer days rest, more innings fielded, and more plate appearances were associated with a higher risk of subsequent hamstring and calf strains. Having only 1 day rest was associated with a 2.08-fold increase in percentage of players who sustained a subsequent calf strain compared with those with 4 days rest. Position players with>5 days of rest had a 4.03-fold decrease in percentage of players who sustained a hamstring strain compared with players with 1 day rest. Position players who fielded>9 innings per game had a 2.01-fold increase in percentage of players with a subsequent calf strain and a 3.68-fold increase in percentage of players who sustained a subsequent hamstring strain compared with players who only fielded 1 innings per game.Conclusion:Position players with fewer days rest, more innings fielded, and more plate appearance per game had an increased risk of sustaining a hamstring or calf injury.Clinical Relevance:Increased workload had a direct relationship with risk of hamstring and calf strains in professional baseball players. Teams should consider more days rest for position players to avoid calf injuries.
      Citation: Sports Health
      PubDate: 2022-05-19T10:18:30Z
      DOI: 10.1177/19417381221093557
       
  • Velocity-Based Resistance Training Monitoring: Influence of Lifting
           Straps, Reference Repetitions, and Variable Selection in
           Resistance-Trained Men

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      Authors: Ivan Jukic, Amador García-Ramos, James J. Tufano
      Abstract: Sports Health, Ahead of Print.
      Background:Using lifting straps during pulling exercises (such as deadlift) may increase absolute velocity performance. However, it remains unclear whether lifting straps could also reduce the degree of relative fatigue measured by velocity decline and maintenance in a training set.Hypothesis:There will be less mean velocity decline (MVD) and greater mean velocity maintenance (MVM) for deadlifts performed with (DLw) compared with without (DLn) lifting straps, and an underestimation of MVD and MVM when using the first compared with the fastest repetition as a reference repetition.Study Design:Randomized cross over design.Level of Evidence:Level 3.Methods:A total of 16 resistance-trained men performed a familiarization session, 2 1-repetition maximum [1RM] sessions (1 with and 1 without lifting straps), and 3 randomly applied experimental sessions consisting of 4 sets of 4 repetitions: (1) DLw against the 80% of DLn 1RM (DLwn), (2) DLn against the 80% of the DLn 1RM (DLnn), and (3) DLw against the 80% of the DLw 1RM (DLww). MVD and MVM were calculated using the first and the fastest repetition as the reference repetition.Results:MVD was significantly lower during DLwn and DLnn compared with DLww (P < 0.01), whereas MVM was greater during DLwn and DLnn compared with DLwn (P < 0.01) with no differences between DLwn and DLnn for both MVD and MVM (P> 0.05). The second repetition of the set was generally the fastest (54.1%) and lower MVD and higher MVM were observed when the first repetition was used as the reference repetition (P < 0.05).Conclusions:Lifting straps were not effective at reducing MVD and increasing MVM when the same absolute loads were lifted. Furthermore, using the first repetition as the reference repetition underestimated MVD, and overestimated MVM.Clinical relevance:The fastest repetition should be used as the reference repetition to avoid inducing excessive fatigue when the first repetition is not the fastest.
      Citation: Sports Health
      PubDate: 2022-05-19T09:23:09Z
      DOI: 10.1177/19417381221095073
       
  • Biopsychosocial Model Domains in Clinical Practice Guidelines for Return
           

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      Authors: Jeffeson Hildo Medeiros de Queiroz, Yanka Aparecida Bandeira Murakawa, Shamyr Sulyvan de Castro, Gabriel Peixoto Leão Almeida, Rodrigo Ribeiro de Oliveira
      Abstract: Sports Health, Ahead of Print.
      Context:The current status of return-to-sport (RTS) criteria can be understood from the International Classification of Functioning, Disability, and Health (ICF), which emphasizes an individual-centered approach and inclusion of all domains of human functioning, and ensures the multifactorial and biopsychosocial nature of decision-making.Objective:To analyze the inclusion of biopsychosocial model domains in clinical practice guidelines (CPGs) for RTS after anterior cruciate ligament (ACL) injury, as well as the quality of these CPGs.Study Design:Systematic review of CPGs.Level of Evidence:Level 1.Search Strategy:Two independent reviewers developed the search strategy, and a third reviewer corrected and compiled the developed strategies used.Data Sources:Ovid/Medline, Embase, and PEDro without restriction dates.Study Selection:CPGs for RTS after ACL injury at any age or sport level, and published in English.Data Extraction:Two independent reviewers codified the RTS criteria recommended in the CPGs according to the ICF domains, and the Appraisal of Guidelines for Research and Evaluation II (AGREE II Checklist) was used for critical appraisal.Results:A total of 715 records were identified, and 7 CPGs were included. Frequency distribution of the biopsychosocial model domains was as follows: body functions (37.77%), activity and participation (20.00%), body structure (13.33%), environmental factors (11.11%), and personal factors (8.88%). In the AGREE II Checklist, the lowest mean domain scores were for rigor of development (37.86 ± 36.35) and applicability (49.29 ± 22.30), and 71.42% were of low or moderate quality.Conclusion:The CPGs cannot address the biopsychosocial model domains satisfactorily and some do not address all the ICF conceptual model components, emphasizing body functions and activity and participation domains. Therefore, the functioning model advocated by the World Health Organization has not yet been adequately incorporated into the recommendations for RTS after ACL injury. Moreover, most CPGs are of limited quality.
      Citation: Sports Health
      PubDate: 2022-05-18T04:43:33Z
      DOI: 10.1177/19417381221094582
       
  • Elite Junior Australian Football Players With Impaired Wellness Are at
           Increased Injury Risk at High Loads

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      Authors: Timothy J.H. Lathlean, Stuart V. Newstead, Paul B. Gastin
      Abstract: Sports Health, Ahead of Print.
      Background:Elite junior Australian football players experience high training loads across levels of competition and training. This, in conjunction with impaired wellness, can predispose athletes to injury.Hypothesis:Elite junior Australian football players exposed to high loads with poor wellness are more likely to be at risk of injury than those with improved wellness.Study Design:Longitudinal prospective cohort study.Level of Evidence:Level 3.Methods:Data were collected and analyzed from 280 players across the 2014 season. Internal load was measured via session rating of perceived exertion. Player wellness was reported according to ratings of sleep quality, fatigue, soreness, stress, and mood. Week- and month-based training load measures were calculated, representing a combination of absolute and relative load variables. Principal component analysis factor loadings, based on 17 load and wellness variables, were used to calculate summed variable covariates. Injury was defined as “any injury leading to a missed training session or competitive match.” Associations between covariates and injury risk (yes/no) were determined via logistic generalized estimating equations.Results:A significant interaction term between load and wellness on injury was found [odds ratio (OR) 0.76; 95% CI 0.62-0.92; P < 0.01), indicating that wellness acts as a “dimmer switch” of load on injury. Further, there was evidence of moderated mediation (OR 0.71; 95% CI 0.57-0.87; P < 0.01). When wellness was low, injury risk started to increase substantially at a 1-week load of 3250 au.Conclusions:Subjective measures of training load are associated with injury risk through a nonlinear relationship. This relationship is further influenced by player wellness, which can amplify the risk of injury. There is evidence that higher stress is linked with injury and that soreness and sleep mediate any stress-injury relationship.Clinical Relevance:Coaching efforts to manage training load and player adaptive responses, including wellness, may reduce the risk of injury, with stress, soreness, and sleep particularly relevant at this level.
      Citation: Sports Health
      PubDate: 2022-05-07T06:06:34Z
      DOI: 10.1177/19417381221087245
       
  • The Physiological Effects of Face Masks During Exercise Worn Due to
           COVID-19: A Systematic Review

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      Authors: Iván Asín-Izquierdo, Eva Ruiz-Ranz, Marta Arévalo-Baeza
      Abstract: Sports Health, Ahead of Print.
      Context:Use of facemasks in sport has been a particularly complex issue during the COVID-19 pandemic.Objectives:A systematic review to examine the physiological effects the different types of masks have on healthy adults when doing physical exercise.Data sources:PubMed, SPORTDiscus, Scopus, and Litcovid were searched up to March 20, 2021, following the PRISMA model. Articles published in the last 5 years with healthy adults.Study Selection:A total of 633 studies related to the use of masks during physical exercise were found, of which 8 articles met the criteria to be included.Study Design:Systematic review.Level of Evidence:Level 2.Data Extraction:The search process and the review of the articles were carried out by independent expert researchers. The risk of bias and the methodological quality of the different studies included in the systematic review were calculated following the Cochrane criteria using an adaptation for random cross-studies. Once the information was properly structured, the results were extracted, and the findings of the study analyzed.Results:There were significant changes in the following physiological variables when engaging in physical exercise using masks: 25% in the heart rate and dyspnea, 37.5% in the rating of perceived exertion, 50% in the pulmonary variables, and 37.5% in discomfort. The oxygen saturation, blood pressure, systolic blood pressure, diastolic blood pressure, and the concentration of blood lactate did not present any significant effect in this study.Conclusions:The usage of masks by a healthy adult population during the performance of physical exercise has shown minimal effects with regard to physiological, cardiorespiratory, and perceived responses. Some symptoms can be dyspnea, effort perceived, or discomfort, among others. These findings indicate that the use of masks is not harmful to individuals’ health. It does not present any significant detrimental effect on physical performance or risk to their well-being. However, further experiments are required to corroborate the findings of this review.
      Citation: Sports Health
      PubDate: 2022-05-05T04:26:34Z
      DOI: 10.1177/19417381221084661
       
  • Increased Knee and Meniscal Injury Incidence in Professional Baseball
           Pitchers With Wider, Positive Stride Width

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      Authors: Joseph E. Manzi, Nicolas Trauger, Theodore Quan, Michael C. Ciccotti, Joseph J. Ruzbarsky, Joshua S. Dines
      Abstract: Sports Health, Ahead of Print.
      Background:Professional baseball pitchers sustain 75% of knee injuries while at the pitcher’s mound, yet no pitching motion has been associated directly with such injuries. Stride width is a potential, modifiable risk factor worth investigating.Hypothesis:Increased stride width in both the positive and negative directions (deviations from neutral stride width) would correlate with increased incidence of knee injury in pitchers.Study Design:Descriptive laboratory.Level of Evidence:Level 5.Methods:Professional pitchers (n = 199) were evaluated with motion capture (480 Hz) while pitching. Injury history over 10 years was recorded at face-to-face interviews with pitchers. Players were subsequently grouped into stride width tertiles, compared for previous injury incidence of the lower extremities. Regressions were performed to observe performance benefits of stride width with ball velocity, accuracy, or consistency in pitch location as secondary outcomes.Results:Of the 40 lower extremity injuries reported, meniscal injury (27.5%) was the most common, followed by foot stress fracture (20.0%). Significant differences in injury incidence were noted between the least and most positive stride width tertiles: lower extremity (10.4% vs 25.8%, respectively; P = 0.03), knee (3.0% vs 15.2%, respectively; P = 0.02), and meniscal (0.0% vs 12.1%; P = 0.00). Stride width of pitchers with meniscal injury in the lead (32.6 ± 7.1 cm, n = 5; P = 0.02) and stance leg (33.5 ± 10.6 cm, n = 5; P = 0.03) was significantly more positive than that of uninjured pitchers (21.1 ± 11.5 cm, n = 164). No significant relationships were established between stride width and ball velocity (P = 0.54) or pitch location metrics (P> 0.05).Conclusion:Pitchers with increased positive, stride width had significantly higher incidence of lower extremity injury (knee and meniscus). Wider, positive stride width may increase the degree of external rotation on the lead knee in a loaded state, which can place the medial side of the knee (and meniscus) at higher risk of injury.Clinical Relevance:Decreasing stride width may be beneficial for professional pitchers to reduce the rate of lower extremity injury, while also preserving performance metric outcomes.
      Citation: Sports Health
      PubDate: 2022-05-03T05:32:59Z
      DOI: 10.1177/19417381221092024
       
  • Slipped Capital Femoral Epiphysis Associated With Athletic Activity

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      Authors: Randall T. Loder, Zachary J. Gunderson, Seungyup Sun, Raymond W. Liu, Eduardo V. Novais
      Abstract: Sports Health, Ahead of Print.
      Background:Little data exist regarding the association of slipped capital femoral epiphysis (SCFE) and sporting activities.Hypothesis:There is no association between SCFE and sporting activities.Study Design:Retrospective review of all SCFE cases at our institution from 2010 through March 2021.Level of Evidence:Level 3.Methods:All patients with idiopathic SCFE were reviewed looking for the presence/absence of sporting activities and symptom onset. Also collected were the age, symptom duration, and weight/height of the patient, sex, race, and stable/unstable nature of the SCFE. The severity of the SCFE was measured using the lateral epiphyseal-shaft angle.Results:There were 193 children (110 boys, 83 girls) with idiopathic SCFEs. The SCFE was stable in 147, unstable in 45, and unknown in 1. The average age was 12.1 ± 1.8 years, average SCFE angle 38° ± 20° and symptom duration 4.0 ± 5.1 months. An association with a sporting activity was present in 64 (33%). The sporting activity was basketball (18), football (11), baseball/softball (10), and others (23). Football, basketball, and soccer predominated in boys, baseball and running sports were equal between boys and girls, and cheerleading/gymnastics/dancing predominated in girls. Differences showed that those involved in sports had a slightly lower body mass index (BMI) (88th percentile vs 95th percentile, P = 0.00). There were no differences between those involved and those not those involved in sporting activities for symptom duration, SCFE severity, sex, race, or stable/unstable SCFE type.Conclusion:Sporting activities are associated with the onset of symptoms in 1 of 3 of patients with SCFE, refuting the null hypothesis.Clinical Relevance:A high level of suspicion for SCFE should be given when any peripubertal athlete presents with hip or knee pain regardless of BMI/obesity status, and appropriate imaging performed.
      Citation: Sports Health
      PubDate: 2022-05-03T05:26:07Z
      DOI: 10.1177/19417381221093045
       
  • New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis in a
           Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and
           Matched Healthy Peers

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      Authors: Allison M. Ezzat, Mariana Brussoni, Louise C. Mâsse, Christian J. Barton, Carolyn A. Emery
      Abstract: Sports Health, Ahead of Print.
      Background:At 2 to 3 years after anterior cruciate ligament reconstruction (ACLR), the relationship between known modifiable osteoarthritis (OA) risk factors and recurrent knee injury is unknown. This study aimed to determine the odds of new or recurrent traumatic knee injury in a cohort of young female athletes with ACLR 2 to 3 years postsurgery compared with healthy control participants. Secondary objectives were to explore the relationships of moderate and vigorous physical activity (MVPA) and body mass index (BMI) with knee injury, and to document self-reported MVPA satisfaction and beliefs about OA.Study Design:Prospective cohortLevel of Evidence:Level 2Methods:A total of 51 female athletes with unilateral ACLR 1 to 2 years previously and 51 age and sport-matched control participants underwent assessment of MVPA (GT3X accelerometers) and BMI. One year later, participants self-reported knee injuries. Bivariable conditional logistic regression explored the association between knee injury, MVPA, and BMI in each group (injury/control).Results:At 1-year follow-up (n = 101), 19.6% of the injured cohort and 6.0% of control participants sustained a new or recurrent knee injury. The odds of knee injury for the injury group increased 7-fold over controls [odds ratio (OR) = 7.00 (95% CI = 0.86, 56.90)], although this was not statistically significant. The OR for MVPA was 0.98 (95% CI = 0.93, 1.03) and BMI was OR = 1.24 (95% CI = 0.85, 1.82). Half (56.0%) of injury participants and 66% of controls were satisfied with their MVPA; 81.6% of injury participants believed they had increased knee OA risk compared with someone who had never had a knee injury.Conclusions:In the 2 to 3 years after ACLR, 1 in 5 young female athletes had a new or recurrent knee injury. Based on the point estimate, injured participants were more likely to suffer a traumatic knee injury than matched control participants. MVPA and BMI were not associated with increased odds of knee injury.Clinical Relevance:Clinicians should be encouraged to have in-depth conversations with female athletes with previous ACLR regarding enjoyable and sustainable MVPA participation to promote long-term joint health.
      Citation: Sports Health
      PubDate: 2022-05-02T06:09:16Z
      DOI: 10.1177/19417381221091791
       
  • A Controlled Trial of the Effects of Neuromuscular Training on Physical
           Performance in Male and Female High School Athletes

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      Authors: Daphne I. Ling, Joseph Janosky, Brandon Schneider, James Russomano, Caroline Boyle, James Kinderknecht, Robert G. Marx
      Abstract: Sports Health, Ahead of Print.
      Background:Neuromuscular training (NMT) has demonstrated efficacy as an intervention to decrease the risk of anterior cruciate ligament injuries and improve sports performance. The effect of this training on the mechanisms that contribute to improved physical performance has not been well defined.Hypothesis:Athletes in the NMT group will have better mechanisms of fundamental movements and agility tests that may contribute to improved sports performance.Study Design:Prospective cohort studyLevel of Evidence:Level 2Methods:Eight high school teams (111 athletes, 53% male, mean age 16 years) participated, with half performing NMT. Physical performance was measured using the dorsaVi ViPerform system, a US Food and Drug Administration-cleared wireless sensor system. Agility was assessed using a timed 3-cone test. Independent sample t tests were used to compare differences between the intervention and control groups.Results:Matched pre- and postseason data were collected from 74 athletes after excluding athletes with injury and those lost to follow-up. Significant improvements were observed in the NMT group for loading/landing speed ratios during a single-leg hop test (right lower extremity = −0.19 [–0.37, 0.03], P = 0.03 and left lower extremity = −0.27 [–0.50, −0.03], P = 0.03). The control group had lower ground reaction forces compared with the NMT group (P < 0.02), while significant improvements were found in the NMT group for initial peak acceleration (P < 0.02) and cadence (P = 0.01) during a straight-line acceleration/deceleration test. For the 3-cone agility test, the postseason time decreased compared with preseason in the NMT group, whereas the time for the control group increased (–0.37 s vs 0.14 s, P < 0.00).Conclusion:The results demonstrate that NMT administered by sports medicine clinicians can significantly improve some physical performance of fundamental movements in high school athletes.Clinical Relevance:Coaches should be trained to effectively deliver NMT in order to improve sports performance.
      Citation: Sports Health
      PubDate: 2022-05-02T06:05:18Z
      DOI: 10.1177/19417381221089917
       
  • The Effects of Fatigue on Muscle Synergies in the Shoulders of Baseball
           Players

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      Authors: Stephen J. Thomas, Gabriel C. Castillo, Matthew Topley, Ryan W. Paul
      Abstract: Sports Health, Ahead of Print.
      Background:Muscle synergies are defined as the central nervous system’s organizational structure for movement. Muscle synergies change after muscular fatigue, with certain synergies assuming the primary role to compensate for fatigue within another muscle synergy. Owing to the high eccentric forces imposed upon the external rotators (ie, posterior rotator cuff), pitchers that continue to throw while fatigued are at a significantly higher risk of shoulder and/or elbow injury; however, the neuromuscular compensation strategies of baseball players in response to fatigue are currently unknown.Hypothesis:Players would utilize the same muscle synergy structure following external rotation (ER) fatigue; however, muscle coefficients of nonfatigued muscles would increase (ie, compensate for the external rotators) after fatigue.Study Design:Cross-sectional study conducted in a controlled, laboratory setting.Methods:Nine players from an intercollegiate competitive club baseball team voluntarily participated in this study. Surface electromyography was used on 14 muscles of the glenohumeral and scapulothoracic joints of the dominant arm during a reaching protocol. Players completed a baseline reaching protocol (prefatigue), then an ER fatigue protocol until maximum concentric ER was reduced by 40%, and finally repeated the same reaching protocol (postfatigue). Principal component analysis was used to extract muscle synergies, the variance accounted for (VAF) of each synergy, and muscle coefficients. Prefatigue was compared with postfatigue using paired t tests for all dependent variables.Results:Four muscle synergies were extracted for both pre- and postfatigue. The VAF for the ER/abduction synergy decreased significantly (prefatigue, 34.6%; postfatigue, 32.4%; P = 0.03), showing a decreased reliance on ER/abduction during the reaching task after fatigue. Within synergy 1, the pectoralis major muscle coefficient (−0.489 vs −0.552; P = 0.01; effect size = 1.68) decreased significantly from prefatigue to postfatigue, indicating that the pectoralis major assumed more of an antagonist role during ER/abduction. Within synergy 2 (forward reaching), there were no significant changes in VAF or muscle coefficients observed. For the third synergy, muscle coefficients increased for the serratus anterior (P = 0.02) and middle deltoid (P = 0.01), whereas in the fourth synergy, the pectoralis major (P = 0.01) increased and teres major (P = 0.01) and biceps brachii (P = 0.05) muscle coefficients decreased.Conclusion:The decreased VAF of the ER/abduction synergy after fatigue indicate that other muscles within that synergy could not fully compensate to maintain function. Interestingly, the changes in muscle coefficients suggest that players relied less on the internal rotation (IR) synergy and more on the cross-body synergy following fatigue. This may be due to imbalances between ER and IR while maintaining balance between cross-abduction and adduction.Clinical Relevance:Clinicians may consider implementing low-load, high-repetition training programs to develop posterior shoulder endurance and prolong the onset of muscular fatigue.
      Citation: Sports Health
      PubDate: 2022-05-02T06:00:36Z
      DOI: 10.1177/19417381221084982
       
  • Chronic Effects of Pitching on Muscle Thickness and Strength of the
           Scapular Stabilizers in Professional Baseball Players

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      Authors: Ohsana Valle, Scott S. Sheridan, Joseph J. Rauch, Joseph J. Sarver, Ryan W. Paul, Stephen J. Thomas
      Abstract: Sports Health, Ahead of Print.
      Background:The posterior scapular muscles eccentrically contract to disperse the high forces observed in the deceleration phase of pitching. Muscular adaptations often occur following chronic eccentric loading, however, no study has evaluated the adaptations of the posterior scapular muscles with regard to throwing and their relationship with humeral retroversion (HR) in professional pitchers.Hypothesis:Significant chronic adaptations in muscle thickness (MT) and strength of the trapezius and rhomboids would be observed in healthy professional baseball pitchers, and there would be a significant relationship between humeral adaptations (ie, HR) and posterior scapular muscle adaptations (ie, strength and MT).Study Design:Cross-sectional; Level 3.Methods:A total of 28 healthy male professional baseball pitchers (age, 22 ± 2 years; mass, 95 ± 17 kg; height, 190 ± 7 cm) were included in the study. Bilateral isometric muscle strength of the upper trapezius (UT), middle trapezius, lower trapezius (LT), and rhomboids was measured during a maximum voluntary isometric contraction. Diagnostic ultrasound images of the UT, middle trapezius, LT, rhomboid major, and rhomboid minor muscles were collected bilaterally to measure MT. HR was also quantified bilaterally with ultrasound. Paired sample t tests were used to compare dominant and nondominant strength and MT. Pearson correlation coefficients were used to assess the relationship between HR, isometric strength, and MT.Results:A significantly increased MT of the LT was found on the dominant arm compared with the nondominant arm (5.4 ± 1.1 mm vs 4.4 ± 1.5 mm; P = 0.00). The Pearson correlation coefficient demonstrated a significant weak negative relationship between HR and rhomboid major MT (P = 0.03; R = −0.36), and a significant weak negative correlation between HR and middle trapezius isometric strength (P = 0.03; R = −0.37).Conclusion:LT thickness was greater in the throwing arm compared with the nonthrowing arm of pitchers, suggesting a positive adaptation of the LT. Interestingly, there was a weak negative relationship between HR and both rhomboid major MT and middle trapezius isometric strength. This negative relationship suggests that since increased HR leads to decreased internal rotation range of motion during deceleration, the scapula may be forced into anterior tilt and protraction, which can place excessive eccentric load on the rhomboid major and middle trapezius.
      Citation: Sports Health
      PubDate: 2022-04-25T11:01:09Z
      DOI: 10.1177/19417381221085004
       
  • The Clinician’s Guide to Baseball Pitching Biomechanics

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      Authors: Alek Z. Diffendaffer, Michael S. Bagwell, Glenn S. Fleisig, Yuki Yanagita, Megan Stewart, E. Lyle Cain, Jeffrey R. Dugas, Kevin E. Wilk
      Abstract: Sports Health, Ahead of Print.
      Context:Improper baseball pitching biomechanics are associated with increased stresses on the throwing elbow and shoulder as well as an increased risk of injury.Evidence Acquisition:Previous studies quantifying pitching kinematics and kinetics were reviewed.Study Design:Clinical review.Level of Evidence:Level 5.Results:At the instant of lead foot contact, the elbow should be flexed approximately 90° with the shoulder at about 90° abduction, 20° horizontal abduction, and 45° external rotation. The stride length should be about 85% of the pitcher’s height with the lead foot in a slightly closed position. The pelvis should be rotated slightly open toward home plate with the upper torso in line with the pitching direction. Improper shoulder external rotation at foot contact is associated with increased elbow and shoulder torques and forces and may be corrected by changing the stride length and/or arm path. From foot contact to maximum shoulder external rotation to ball release, the pitcher should demonstrate a kinematic chain of lead knee extension, pelvis rotation, upper trunk rotation, elbow extension, and shoulder internal rotation. The lead knee should be flexed about 45° at foot contact and 30° at ball release. Corrective strategies for insufficient knee extension may involve technical issues (stride length, lead foot position, lead foot orientation) and/or strength and conditioning of the lower body. Improper pelvis and upper trunk rotation often indicate the need for core strength and flexibility. Maximum shoulder external rotation should be about 170°. Insufficient external rotation leads to low shoulder internal rotation velocity and low ball velocity. Deviation from 90° abduction decreases the ability to achieve maximum external rotation, increases elbow torque, and decreases the dynamic stability in the glenohumeral joint.Conclusion:Improved pitching biomechanics can increase performance and reduce risk of injury.SORT:Level C.
      Citation: Sports Health
      PubDate: 2022-04-23T12:49:21Z
      DOI: 10.1177/19417381221078537
       
  • Preliminary Analysis of Closed Kinetic Chain Upper Extremity Stability
           Test Differences Between Healthy and Previously Injured/In-Pain Baseball
           Pitchers

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      Authors: Jeff W. Barfield, Nicole M. Bordelon, Kyle W. Wasserberger, Gretchen D. Oliver
      Abstract: Sports Health, Ahead of Print.
      Background:A comprehensive examination of the kinetic chain during an overhead athlete’s upper extremity assessment, such as the closed kinetic chain upper extremity stability test (CKCUEST), may help clinicians identify potential upper extremity dysfunction.Hypothesis:Body position observed on dominant and nondominant hand touch during a CKCUEST trial differs between players with previous injury/pain history compared with healthy counterparts.Study Design:Descriptive laboratory study.Level of Evidence:Level 5.Methods:Seventeen baseball pitchers were recruited to participate (18.03 ± 2.01 years; 185.40 ± 6.57 cm; 83.92 ± 13.87 kg). A medical history questionnaire was used to separate participants into groups, either previous injury/pain or healthy. Kinematic and kinetic data were collected on the participants performing the CKCUEST with an electromagnetic tracking system. Kinematics were analyzed using a pair of 1-way multivariate analyses of variance (MANOVAs).Results:The MANOVA for nondominant hand touch in the CKCUEST revealed a significant difference in lumbopelvic-hip complex (LPHC) kinematics between previously injured/pain group and healthy group (Λ = 0.37; F4,12 = 5.12; P = 0.01).Conclusions:The previously injured/pain group displayed less pelvic axial rotation and dominant hip abduction during the nondominant touch indicating more LPHC stability during the nondominant touch. In conclusion, differences were observed in LPHC kinematics during the CKCUEST nondominant touch between a healthy and previously injured/pain group perhaps due to the increased awareness provided through rehabilitative programs for the previously injured/pain group.Clinical Relevance:Clinicians can use this information to help address kinetic chain movement efficiency within baseball pitchers. This study provides evidence of LPHC kinematic differences during the nondominant touch of baseball pitchers and may enhance the use of the CKCUEST as a return-to-play assessment.
      Citation: Sports Health
      PubDate: 2022-04-20T09:42:53Z
      DOI: 10.1177/19417381221083316
       
  • Medical Encounters Among 94,033 Race Starters During a 16.1-km Running
           Event Over 3 Years in the Netherlands: SAFER XXVI

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      Authors: Nicola Sewry, Tom Wiggers, Martin Schwellnus
      Abstract: Sports Health, Ahead of Print.
      BackgroundThere are limited data on the medical encounters (MEs) occurring during mass community-based running events of shorter distances (10-21.1 km). The aim of this study was to determine the incidence and nature of MEs during the largest mass participation running event in the Netherlands.HypothesisWe hypothesize that the incidence and nature of MEs will be similar to other running events.Study DesignDescriptive epidemiological study over 3 years of a 16.1-km (10-mile) running event.Level of Evidence:Level 4.MethodsWe investigated a total of 94,033 race starters at the 2017-2019 Dam tot Damloop (16.1 km), a point-to-point road race from Amsterdam to Zaandam, the Netherlands. All MEs were recorded by race medical staff on race day each year. MEs were retrospectively coded by severity, organ system, and final specific diagnosis (2019 consensus statement definition on mass community-based events). Incidence (I) per 1000 starters (95% CIs) were calculated for all MEs and serious/life-threatening MEs.Results:The overall incidence (per 1000 starters) of all MEs was 2.75 (95% CI, 2.44-3.11), the overall incidence of serious/life-threatening MEs was 1.20 (95% CI, 1.00-1.45; 44% of MEs). Heat illnesses accounted for most MEs: hypothermia I = 0.54 (95% CI, 0.41-0.71) and hyperthermia I = 0.46 (95% CI, 0.34-0.62). Central nervous system MEs were also common (dizziness/nausea, I = 0.79; 95% CI 0.63-0.99), followed by the cardiovascular system MEs (exercise-associated postural hypotension, I = 0.36; 95% CI, 0.26-0.51).ConclusionThe overall incidence of MEs was low compared with longer-distance races (21.1-90 km), but the incidence and relative frequency of serious/life-threatening MEs (44% of all MEs) was much higher. Heat illness (hypothermia and exertional heat stroke) accounted for most serious/life-threatening MEs.Clinical relevance:There is a need to implement prevention strategies and interventions by specialized medical practitioners in this and similar events.
      Citation: Sports Health
      PubDate: 2022-04-06T01:00:51Z
      DOI: 10.1177/19417381221083594
       
  • Severe Lacerations in Alpine Ski Racing: A Case Series and Review of the
           Literature

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      Authors: William M. Holden, Michael S. Barnum, Mitchell C. Tarka, Christoph A. Niederhauser, Ryan P. Jewell, Nathan K. Endres
      Abstract: Sports Health, Ahead of Print.
      Lacerations in alpine ski racers caused by the sharp metal edge of the ski are potentially severe and even life-threatening injuries. To date, there has been little published on these injuries. This case series reports on 5 cases of severe lacerations in alpine ski racers and details slope side management, initial evaluation, and definitive treatment. By publishing this case series, it is hoped to promote further investigation into the mechanism of these injuries and strategies for prevention.Study Design:Case series.Level of evidence:Level 4C.
      Citation: Sports Health
      PubDate: 2022-03-31T08:14:07Z
      DOI: 10.1177/19417381221076521
       
  • Injury Trends for School Rugby Union in Ireland: The Need for
           Position-specific Injury-prevention Programs

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      Authors: Therese M. Leahy, Ian C. Kenny, Mark J. Campbell, Giles D. Warrington, Helen Purtill, Roisin Cahalan, Thomas M. Comyns, Andrew J. Harrison, Mark Lyons, Liam G. Glynn, Kieran O’Sullivan
      Abstract: Sports Health, Ahead of Print.
      Background:Concern has been raised over the injury risk to school Rugby union (Rugby) players and the potential long-term health consequences. Despite the increase in studies for this cohort, the influence of playing position on injury incidence and presentation is unclear.Purpose:To describe the incidence, nature and severity of match injuries for school Rugby in Ireland overall, and as a function of playing position.Study Design:Prospective cohort study.Methods:Data were collected from 15 male (aged 16-19 years) school Senior Cup teams across 2 seasons. In total, 339 players participated in season 1, whereas 326 players participated in season 2. Injury data were recorded onto a bespoke online platform. Match exposure was also recorded.Results:The incidence rate of match injuries (24-hour time loss) was 53.6 per 1000 hours. Across both seasons, 6810 days were lost from play due to injury. Forwards (65.4 per 1000 hours) sustained significantly more (P < 0.05) injuries than backs (40.5 per 1000 hours). The head, shoulder, knee, and ankle were the most common injured body regions; however, forwards sustained significantly more (P < 0.05) head and shoulder injuries than backs. The tackle was responsible for the majority of injuries in both groups. The highest proportion of injuries occurred during the third quarter.Conclusion:Clear differences in injury presentation and incidence were evident when comparing forwards versus backs. The high rate of head and shoulder injuries in the forwards suggest the need for more targeted injury-prevention strategies and further research on education and laws around the tackle event. The spike of injuries in the third quarter suggests that fatigue or inadequate half-time warm-up may be a contributing factor warranting further exploration.Clinical Relevance:This study demonstrates clear differences in injury presentation according to playing position in school Rugby and highlights the need for a more tailored approach to the design and implementation of injury-prevention strategies.Level of Evidence:Level 3
      Citation: Sports Health
      PubDate: 2022-03-31T08:13:33Z
      DOI: 10.1177/19417381221078531
       
  • The Association Between Chronological Age and Maturity Status on Lower
           Body Clinical Measurements and Asymmetries in Elite Youth Tennis Players

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      Authors: Alejandro Lopez-Valenciano, Francisco Ayala, Mark B.A. De Ste Croix, David Barbado, Víctor Moreno-Perez, David Sanz-Rivas, Jaime Fernandez-Fernandez
      Abstract: Sports Health, Ahead of Print.
      Background:Tennis is one of the most popular sports among youths. At elite levels, a notable increase in injury incidence and a temporary decline in performance may occur when children progress through puberty. However, limited research has explored maturity-associated variations in clinical measurements suggested as predictors of injury and tennis performance in elite youth players. Therefore, the main purpose of this study was to analyze the association between chronological age and maturity status on several measures of neuromuscular capability and physical performance as well as bilateral (interlimb) asymmetries in elite youth tennis players.Hypothesis:Youth tennis players around peak height velocity (PHV) will show higher growth-related impairments or deficits in measures of neuromuscular capability and physical performance than their less (pre-PHV) and more (post-PHV) mature counterparts irrespective of sex.Level of evidence:Level 4.Methods:A total of 68 male (age, 13.7 ± 1.1 years; height, 162.4 ± 9.4 cm; body mass, 51.4 ± 10.3 kg [Mean values ± SD]) and 60 female (age, 13.6 ± 1.1 years; height, 162.8 ± 7.2 cm; body mass, 52.7 ± 7.5 kg [Mean values ± SD]) elite youth tennis players from 2 different age groups (under 13 [U13] and under 15 [U15]) and maturity status (pre-PHV, around PHV, and post-PHV), were tested during national training camps. Tests included the Y Balance Test, isometric hip abduction and adduction strength, hip ranges of motion (ROMs), and countermovement jump (CMJ) height. Bayesian analysis was used to establish any significant between-group differences.Results:Only dynamic balance (in boys; Bayesian factor [BF10] = 88.2) and jump height (in both boys and girls; BF10>100) were significatively associated with chronological age, whereby the U15 group showed lower Y Balance Test reach distances (−6%; standardized effect size δ = 0.62) but higher CMJ height scores (+18%; δ = 0.73) than the U13 group. Although boys jump higher (+11%; δ = 0.62) and were stronger in isometric hip adduction strength (+14%; δ = 0.92) than girls, the latter had greater hip internal ROM values (+15%; δ = 0.75). Furthermore, relevant maturity-associated effects (BF10 = 34.6) were solely observed for the CMJ test in boys, with the most mature players demonstrating higher jump height scores (+12%; δ = 0.93). Finally, a significant percentage (>25%) of tennis players, independent of sex, demonstrated bilateral asymmetries in hip ROM, hip strength, and jump height values.Conclusion:The findings of this study show that in U13 and U15 male and female tennis players, there were neither positive nor negative maturity-associated variations in the clinical measurements analyzed (with the exception of jump height in male players). The high proportion of tennis players showing bilateral asymmetries in dynamic balance, hip ROM, and strength and jump performance highlight the need of future studies to analyze these factors in relation to unilateral tennis-specific adaptations in the musculoskeletal and sensorimotor systems.Clinical relevance:These results may help to better understand how different clinical measurements are associated with the process of growth and maturation in elite youth tennis players and may aid in the design of specific training interventions during these stages of development.
      Citation: Sports Health
      PubDate: 2022-03-30T05:16:30Z
      DOI: 10.1177/19417381221083319
       
  • Contrast With Compression Therapy Enhances Muscle Function Recovery and
           Attenuates Glycogen Disruption After Exercise

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      Authors: Vincent M. Colantuono, Ryan Oakley, Disa L. Hatfield, Luis Penailillo, Shabnam Lateef, Jacob E. Earp
      Abstract: Sports Health, Ahead of Print.
      Background:Exercise-associated muscle damage (EAMD) temporally impairs muscle function and intramuscular glycogen storage. Contrast with compression (CwC) therapy provides localized EAMD treatment with minimal changes in core/tissue temperature that can impair glycogen resynthesis.Hypothesis:CwC will enhance the recovery of strength, power, and joint mobility, reduce markers of EAMD, and attenuate the disruption of glycogen storage observed after damaging exercise.Study Design:Randomized controlled trial with crossover design.Level of Evidence:Level 2.Methods:Ten men completed 2 bouts of eccentric elbow flexor exercise, separated by 1 week, using contralateral arms. After each bout, participants received either CwC therapy (at 0, 24, and 48 h postexercise) or no therapy with intervention order and limb randomly assigned. Prior to (pre-exercise) and 1, 24, 48, and 72 h after each exercise bout, muscular strength, muscular power, intramuscular glycogen, creatine kinase, muscle thickness, muscle soreness, pressure pain threshold, active elbow flexion, passive elbow extension, and dietary intake were assessed. Comparisons were made between conditions over time (interaction effects) using separate repeated-measures analyses of variance/multivariate analyses of variance and effect sizes (Cohen d) to describe treatment effect at each time point.Results:Significant interaction effects were observed for muscular strength (d = 0.67-1.12), muscular power (d = 0.20-0.65), intramuscular glycogen (d = 0.29-0.81), creatine kinase (d = 0.01-0.96), muscle thickness (d = 0.35-0.70), muscle soreness (d = 0.18-0.85), and active elbow flexion (d = 0.65-1.17) indicating a beneficial effect of CwC over time (P ≤ 0.05). In contrast, no significant interaction effect was observed for pressure pain threshold or passive elbow extension (P> 0.05).Conclusion:These results support the use of CwC for the recovery of muscle function after damaging exercise in male patients and indicate that CwC attenuates, but does not remove, the disruption of intramuscular glycogen stores observed after intense eccentric exercise.Clinical Relevance:Glycolysis-dependent athletes may benefit from CwC therapy after training/competition that causes EAMD.
      Citation: Sports Health
      PubDate: 2022-03-28T05:52:25Z
      DOI: 10.1177/19417381221080172
       
  • Graft Choice for Anterior Cruciate Ligament Reconstruction in Women Aged
           25 Years and Younger: A Systematic Review

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      Authors: Christine M. Etzel, Maheen Nadeem, Burke Gao, Abigail N. Boduch, Brett D. Owens
      Abstract: Sports Health, Ahead of Print.
      Context:Although anterior cruciate ligament (ACL) tears are relatively common in athletic populations, few studies have systematically reviewed graft choice in young women.Objective:To quantitatively and qualitatively examine reported outcomes for graft choice in women aged 25 years and younger undergoing primary ACL reconstruction.Data Source:A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search in the PubMed (includes MEDLINE) and EMBASE databases was completed using a combination of key terms.Study Selection:Studies were included if they reported graft choice outcomes in women aged 25 years and younger.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:The following information was extracted: title, author, year of publication, number of female patients and age, graft type, follow-up, and patient-reported outcome measures. The following outcome scores were identified as being reported or not reported by each study: graft failure, contralateral ACL (CACL) rupture, IKDC (International Knee Documentation Committee), graft survival (Kaplan-Meier), Lysholm, Tegner, KT-1000, kneeling pain, return to sport, and Lachman.Results:Of 1170 identified articles, 16 met inclusion criteria, reporting on 1385 female patients aged 25 years and younger. Comparison of 655 bone–patellar tendon–bone (BPTB) versus 525 hamstring tendon (HT) autografts showed significant differences in mean failure rate between BPTB autografts (6.13% ± 2.58%) and HT autografts (17.35% ± 8.19%), P = 0.001. No statistically significant differences in CACL failure rates were found between BPTB autografts and HT autografts (P = 0.25). Pooled results for IKDC were possible in 3 of the HT autograft studies, showing a mean score of 88.31 (95% CI 83.53-93.08). Pooled Lysholm score results were possible in 2 of the HT autograft studies, showing a mean score of 93.46 (95% CI 91.90-95.01).Conclusion:In female patients aged 25 years and younger, BPTB autografts showed significantly less graft failure compared with HT autografts. However, BPTB autografts had comparable patient-reported outcomes compared with HT autografts with the available data. The overall state of evidence for graft choice in female patients aged 25 years and younger is low. Future studies should report statistics by age and sex to allow for further analysis of graft choice for this specific population that is known to be more vulnerable to ACL injury.
      Citation: Sports Health
      PubDate: 2022-03-28T05:50:45Z
      DOI: 10.1177/19417381221079632
       
  • Effects of Gradient and Speed on Uphill Running Gait Variability

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      Authors: Johnny Padulo, Moshe Ayalon, Fabio A. Barbieri, Roberto Di Capua, Christian Doria, Luca P. Ardigò, Antonio Dello Iacono
      Abstract: Sports Health, Ahead of Print.
      Background:The aim of this study was to investigate the effects of gradient and speed on running variability (RV) and local dynamic stability (LDS) during uphill running.Hypotheses:(1) Both gradient and speed increase metabolic effort, in terms of heart rate (HR) and perceived exertion (CR10), in line with the contemporary literature, and (2) gradient increases RV and impairs LDS.Study design:“Crossover” observational design.Level of Evidence:Level 3.Methods:A total of 25 runners completed 10-minute running trials in 3 different conditions and in a randomized order: gradient at 0% (0CON), 2% (2CON), and 2% at isoefficiency speed (2IES). 0CON and 2CON speeds were calculated as the “best 10-km race performance” minus 1 km·h−1, whereas 2IES speed was adjusted to induce the same metabolic expenditure as 0CON. HR and perceived exertion as well as running kinematic variables were collected across all trials and conditions. Running variability was calculated as the standard deviation of the mean stride-to-stride intervals over 100 strides, while LDS was expressed by the Lyapunov exponent (LyE) determined on running cycle time over different running conditions.Results:Increases in HR and CR10 were observed between 0CON and 2CON (P < 0.001) and between 2IES and 2CON (P < 0.01). Higher RV was found in 2CON compared with 0CON and 2IES (both P < 0.001). Finally, the largest LyE was observed in 2IES compared with 0CON and 2CON (P = 0.02 and P = 0.01, respectively).Conclusion:Whereas RV seems to be dependent more on metabolic effort, LDS is affected by gradient to a greater extent.Clinical Relevance:Running variability could be used to monitor external training load in marathon runners.
      Citation: Sports Health
      PubDate: 2022-03-28T05:49:09Z
      DOI: 10.1177/19417381211067721
       
  • Prospective Evaluation of Pain Flares and Time Until Pain Relief Following
           Musculoskeletal Corticosteroid Injections

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      Authors: Daniel M. Cushman, Jacqueline K. Kobayashi, John C. Wheelwright, Joy English, Nicholas Monson, Masaru Teramoto, Ryan Dunn, Madison Lash, Marisol Zarate
      Abstract: Sports Health, Ahead of Print.
      Background:Corticosteroid injections are used ubiquitously within musculoskeletal medicine. One of the most common side effects is a postinjection pain flare, though little is known regarding this phenomenon.Hypothesis:Some risk factors are related to postinjection pain flare following an ultrasound-guided corticosteroid injection.Study Design:Prospective clinical research study.Level of Evidence:Level 2.Methods:Patients undergoing ultrasound-guided corticosteroid injections in an academic orthopaedic and sports medicine clinic were approached to participate. Patients completed a survey immediately following their injection and again 2 weeks later, asking them about their pain and side effects. A postinjection pain flare was defined as an increase in pain, as defined by the patient.Results:A total of 140 patients completed the entirety of the study, with 29 (20.7%) patients reporting a flare of pain. There was a significant effect of younger age on the development of a pain flare after the injection, estimated as 5.5% decreased odds of developing a flare per year of age (P < 0.01). Gender, injection location, body mass index (BMI), preinjection pain, and corticosteroid type had no contributing effect. When patients obtained relief following the corticosteroid injection, 60.4% had improved pain within 3 days, whereas over 93.7% obtained relief within a week.Conclusion:Pain flares seem to affect approximately 1 in 5 patients. With increasing age, the likelihood of postinjection pain flare becomes less likely. Sex, injection location, BMI, preinjection pain, and corticosteroid type do not seem to significantly relate to an increase in pain following injection.Clinical Relevance:Corticosteroid injections are common procedures in the orthopaedic and sports medicine settings. Younger patients can be counseled on the higher likelihood of a pain flare following a corticosteroid injection.
      Citation: Sports Health
      PubDate: 2022-03-25T05:45:08Z
      DOI: 10.1177/19417381221076470
       
  • Neural Correlates of Self-Reported Knee Function in Individuals After
           Anterior Cruciate Ligament Reconstruction

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      Authors: Cody R. Criss, Adam S. Lepley, James A. Onate, Janet E. Simon, Christopher R. France, Brian C. Clark, Dustin R. Grooms
      Abstract: Sports Health, Ahead of Print.
      Background:Anterior cruciate ligament (ACL) rupture is a common knee injury among athletes and physically active adults. Despite surgical reconstruction and extensive rehabilitation, reinjuries are common and disability levels are high, even years after therapy and return to activity. Prolonged knee dysfunction may result in part from unresolved neuromuscular deficits of the surrounding joint musculature in response to injury. Indeed, “upstream” neurological adaptations occurring after injury may explain these persistent functional deficits. Despite evidence for injury consequences extending beyond the joint to the nervous system, the link between neurophysiological impairments and patient-reported measures of knee function remains unclear.Hypothesis:Patterns of brain activation for knee control are related to measures of patient-reported knee function in individuals after ACL reconstruction (ACL-R).Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:In this multicenter, cross-sectional study, participants with unilateral ACL-R (n = 25; 10 men, 15 women) underwent task-based functional magnetic resonance imaging testing. Participants performed repeated cycles of open-chain knee flexion/extension. Neural activation patterns during the movement task were quantified using blood oxygen level–dependent (BOLD) signals. Regions of interest were generated using the Juelich Histological Brain Atlas. Pearson product-moment correlations were used to determine the relationship between mean BOLD signal within each brain region and self-reported knee function level, as measured by the International Knee Documentation Committee index. Partial correlations were also calculated after controlling for time from surgery and sex.Results:Patient-reported knee function was positively and moderately correlated with the ipsilateral secondary somatosensory cortex (r = 0.57, P = 0.005) and the ipsilateral supplementary motor area (r = 0.51, P = 0.01).Conclusion:Increased ipsilateral secondary sensorimotor cortical activity is related to higher perceived knee function.Clinical Relevance:Central nervous system mechanisms for knee control are related to subjective levels of knee function after ACL-R. Increased neural activity may reflect central neuroplastic strategies to preserve knee functionality after traumatic injury.
      Citation: Sports Health
      PubDate: 2022-03-24T03:52:32Z
      DOI: 10.1177/19417381221079339
       
  • Does Femoroacetabular Impingement Syndrome Affect Self-Reported Burden in
           Football Players With Hip and Groin Pain'

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      Authors: Mark J. Scholes, Joanne L. Kemp, Benjamin F. Mentiplay, Joshua J. Heerey, Rintje Agricola, Adam I. Semciw, Richard B. Souza, Thomas M. Link, Sharmila Majumdar, Matthew G. King, Peter R. Lawrenson, Kay M. Crossley
      Abstract: Sports Health, Ahead of Print.
      Background:It is unknown if football players with femoroacetabular impingement (FAI) syndrome report worse burden than those with other causes of hip/groin pain, and to what extent this is mediated by cartilage defects and labral tears.Hypothesis:Football players with FAI syndrome would report worse burden than other symptomatic players, with the effect partially mediated by cartilage defects and/or labral tears.Study Design:Cross-sectional study.Level of Evidence:Level 4.Methods:Football (soccer and Australian football) players (n = 165; 35 women) with hip/groin pain (≥6 months and positive flexion–adduction–internal rotation test) were recruited. Participants completed 2 patient-reported outcome measures (PROMs; the International Hip Outcome Tool–33 [iHOT-33] and Copenhagen Hip and Groin Outcome Score [HAGOS]) and underwent hip radiographs and magnetic resonance imaging (MRI). FAI syndrome was determined to be present when cam and/or pincer morphology were present. Cartilage defects and labral tears were graded as present or absent using MRI. Linear regression models investigated relationships between FAI syndrome (dichotomous independent variable) and PROM scores (dependent variables). Mediation analyses investigated the effect of cartilage defects and labral tears on these relationships.Results:FAI syndrome was not related to PROM scores (unadjusted b values ranged from −4.693 (P = 0.23) to 0.337 (P = 0.93)) and cartilage defects and/or labral tears did not mediate its effect (P = 0.22-0.97).Conclusion:Football players with FAI syndrome did not report worse burden than those with other causes of hip/groin pain. Cartilage defects and/or labral tears did not explain the effect of FAI syndrome on reported burden.Clinical Relevance:FAI syndrome, cartilage defects, and labral tears were prevalent but unrelated to reported burden in symptomatic football players.
      Citation: Sports Health
      PubDate: 2022-03-24T03:47:56Z
      DOI: 10.1177/19417381221076141
       
  • Age and Female Sex Are Important Risk Factors for Stress Fractures: A
           Nationwide Database Analysis

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      Authors: Nisha N. Kale, Cindy X. Wang, Victor. J. Wu, Cadence Miskimin, Mary K. Mulcahey
      Abstract: Sports Health, Ahead of Print.
      Background:Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults.Hypothesis:Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients.Study Design:Epidemiological research.Level of Evidence:Level 3.Methods:Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis.Results:Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI
      Citation: Sports Health
      PubDate: 2022-03-04T10:30:28Z
      DOI: 10.1177/19417381221080440
       
  • Hip Abductor Strength Asymmetry: Relationship to Upper Extremity Injury in
           Professional Baseball Players

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      Authors: Hillary A. Plummer, Zhongjie Cai, Hannah Dove, Geoff Hostetter, Thomas Brice, Audrey Chien, Jonathan C. Sum, Andrew Hawkins, Bernard Li, Lori A. Michener
      Abstract: Sports Health, Ahead of Print.
      Background:Hip strength is an important factor for control of the lumbo-pelvic-hip complex. Deficits in hip strength may affect throwing performance and contribute to upper extremity injuries.Hypothesis:Deficits in hip abduction isometric strength would be greater in those who sustained an upper extremity injury and hip strength would predict injury incidence.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:Minor League baseball players (n = 188, age = 21.5 ± 2.2 years; n = 98 pitchers; n = 90 position players) volunteered. Hip abduction isometric strength was assessed bilaterally with a handheld dynamometer in side-lying position, expressed as torque using leg length (N·m). Hip abduction strength asymmetry was represented by [(trail leg/lead leg) × 100]. Overuse or nontraumatic throwing arm injuries were prospectively tracked. Poisson regression models were used to estimate relative risk ratios associated with hip asymmetry; confounders, including history of prior overuse injury in the past year, were included.Results:Hip abduction asymmetry ranged from 0.05% to 57.5%. During the first 2 months of the season, 18 players (n = 12 pitchers) sustained an upper extremity injury. In pitchers, for every 5% increase in hip abduction asymmetry, there was a 1.24 increased risk of sustaining a shoulder or elbow injury. No relationship between hip abduction strength and injury was observed for position players.Conclusion:Hip abduction asymmetry in pitchers was related to subsequent upper extremity injuries. The observed risk ratio indicates that hip abduction asymmetry may contribute a significant but small increased risk of injury.Clinical Relevance:Hip abduction muscle deficits may affect pitching mechanics and increase arm stress. Addressing hip asymmetry deficits that exceed 5% may be beneficial in reducing upper extremity injury rates in pitchers.
      Citation: Sports Health
      PubDate: 2022-03-04T10:28:08Z
      DOI: 10.1177/19417381221078830
       
  • The Influence of Exercise Intensity on Psychosocial Outcomes in
           Musculoskeletal Disorders: A Systematic Review

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      Authors: Sim Klaps, Sarah Haesevoets, Jeanine Verbunt, Albère Köke, Lotte Janssens, Annick Timmermans, Jonas Verbrugghe
      Abstract: Sports Health, Ahead of Print.
      Context:Psychosocial parameters play an important role in the onset and persistence of chronic musculoskeletal disorders (CMSDs). Exercise therapy is a valuable therapeutic modality as part of CMSD rehabilitation. Hereby, exercise intensity is an important factor regarding changes in pain and disability in multiple CMSDs. However, the impact of exercise intensity on psychosocial outcomes remains poorly explored.Objective:To identify the effects of different modes of exercise intensity on psychosocial outcomes in persons with CMSDs.Data Sources:A systematic search was conducted up to November 2020 using the following databases: PubMed/MEDline, PEDro, Cochrane Library, and Web of Science.Study Selection:Studies reporting exercise therapy in CMSDs with a predefined display of exercise intensity and an evaluation of at least 1 psychosocial outcome were included.Study Design:Systematic review.Level of Evidence:Level 2a.Data Extraction:Data regarding demographics, exercise intensity, and psychosocial outcomes were included in a descriptive analysis. Methodological quality was assessed using the PEDro scale and Critical Appraisal Skills Programme (CASP) checklist.Results:A total of 22 studies, involving 985 participants (with fibromyalgia, chronic low back pain, knee osteoarthritis, psoriatic arthritis, and axial spondyloarthritis) were included (mean PEDro score = 5.77/10). The most common psychosocial outcomes were quality of life (QoL) (n = 15), depression (n = 10), and anxiety (n = 9). QoL improved at any exercise intensity in persons with fibromyalgia. However, persons with fibromyalgia benefit more from exercising at low to moderate intensity regarding anxiety and depression. In contrast, persons with chronic low back pain benefit more from exercising at a higher intensity regarding QoL, anxiety, and depression. Other CMSDs only showed limited or conflicting results regarding the value of certain exercise intensities.Conclusion:Psychosocial outcomes are influenced by the intensity of exercise therapy in fibromyalgia and chronic low back pain, but effects differ across other CMSDs. Future research is necessary to determine the exercise intensity that yields optimal exercise therapy outcomes in specific CMSDs.
      Citation: Sports Health
      PubDate: 2022-03-04T10:26:56Z
      DOI: 10.1177/19417381221075354
       
  • Location of Hamstring Injuries Based on Magnetic Resonance Imaging: A
           Systematic Review

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      Authors: Sylvain Grange, Gustaaf Reurink, Anh Quoc Nguyen, Camille Riviera-Navarro, Clément Foschia, Pierre Croisille, Pascal Edouard
      Abstract: Sports Health, Ahead of Print.
      Context:Hamstring muscle injury location using magnetic resonance imaging (MRI) is not so well described in the literature.Objective:To describe the location of hamstring injuries using MRI.Data Sources:PubMed, Web of Science, Scopus, SPORTDiscus, Cochrane Library.Study Selection:The full text of studies, in English, had to be available. Case reports and reviews were excluded. Included studies must report the location of hamstring injuries using MRI within 8 days of the acute injury.Study Design:Systematic review.Level of Evidence:Level 4.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:From the 2788 references initially found in 5 databases, we included 34 studies, reporting a total of 2761 acute hamstring injuries. The most frequent muscle head involved was the long head of the biceps femoris (BFLH) (70%), followed by the semitendinosus (ST) (15%), generally associated with BFLH. The most frequent tissue affected was the myotendinous junction (MTJ) accounting for half the cases (52%). Among all lesions, the distribution between proximal, central, and distal lesions looked homogenous, with 34.0%, 33.4% and 32.6%, respectively. The stretching mechanism, while only reported in 2 articles, represented 3% of all reported mechanisms, appears responsible for a specific lesion involving the proximal tendon of the semimembranosus (SM), and leading to a longer time out from sport.Conclusion:BFLH was the most often affected hamstring injuries and MTJ was the most affected tissue. In addition, the distal, central, and proximal locations were homogeneously distributed. We also noted that MRI descriptions of hamstring injuries are often poor and did not take full advantage of the MRI strengths.Systematic Review Registration:Before study initiation, the study was registered in the PROSPERO International prospective register of systematic reviews (registration number CRD42018107580).
      Citation: Sports Health
      PubDate: 2022-02-12T05:23:04Z
      DOI: 10.1177/19417381211071010
       
  • Chronic Adaptations of Shoulder Muscle Synergies in Healthy Baseball
           Players

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      Authors: Morgan Wambold, Chris Taylor, Carole A. Tucker, Ryan W. Paul, Stephen J. Thomas
      Abstract: Sports Health, Ahead of Print.
      Background:Previous research has demonstrated that muscle synergy structure can adapt owing to training and injury; however, muscle synergies have not been evaluated in baseball players.Hypothesis:The throwing arm would have a similar muscle synergy structure but different levels of individual muscle activity within each synergy, relative to the nonthrowing arm.Study Design:Cross-sectional study in a controlled laboratory setting.Methods:Fourteen healthy competitive baseball players were included. Participants were tested bilaterally during a center-out planar reaching task using the KINARM robot, where kinematic data and surface electromyography data from 14 glenohumeral and scapular muscles were synchronized. Principal component analysis was used to extract muscle synergies, the variance accounted for (VAF) of each synergy, and individual muscle coefficients. The dominant (DOM) arm was compared with the nondominant (NDOM) arm using paired t tests for all dependent variables.Results:The same number of muscle synergies were extracted on the DOM and NDOM arms, along with no differences in VAF. In the first synergy, the infraspinatus (DOM 0.798 vs NDOM 0.587, P = 0.038) and lower trapezius (DOM 0.872 vs NDOM 0.480, P = 0.005) muscle coefficients significantly increased on the DOM arm. The second synergy had a significantly increased anterior deltoid (DOM 0.764 vs NDOM 0.374, P = 0.003) and a significantly decreased posterior deltoid (DOM −0.069 vs NDOM 0.197, P = 0.041) muscle coefficient on the DOM arm.Conclusion:The DOM shoulder exhibits a higher proportion of infraspinatus and lower trapezius muscle activation during the external rotation and abduction synergy. Also, the DOM shoulder has increased muscle activation of the teres major and latissimus dorsi during the internal rotation synergy, and increased muscle activation of the pectoralis major during the cross-body adduction synergy, compared with the NDOM shoulder.Clinical Relevance:By exploring these neuromuscular adaptations, the improved understanding of muscle synergy adaptations in baseball players will help optimize injury prevention and rehabilitation techniques.
      Citation: Sports Health
      PubDate: 2022-02-09T11:44:44Z
      DOI: 10.1177/19417381211069564
       
  • Effects of Blood Flow Restriction Training on Clinical Outcomes for
           Patients with ACL Reconstruction: A Systematic Review

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      Authors: Mark Colapietro, Brandon Portnoff, Sayers John Miller, Wayne Sebastianelli, Giampietro L Vairo
      Abstract: Sports Health, Ahead of Print.
      Context:Knee muscle atrophy and weakness are common impairments after anterior cruciate ligament (ACL) reconstruction. Blood flow restriction (BFR) training represents a new approach to treat such impairments. However, limited evidence currently exists to support this intervention in related patients.Objective:To appraise literature comparing the effects of BFR training with conventional therapy on knee muscle morphological and strength properties in ACL-reconstructed patients.Data Sources:PubMed, SPORTDiscus, CINAHL, and Cochrane Central Register databases were searched for relevant articles from January 1991 through April 2021.Study Selection:Articles were minimum Level 3 evidence focusing on knee muscle morphologic as well as extensor and flexor strength outcomes in ACL-reconstructed patients of all graft types.Study Design:Systematic review.Level of Evidence:Level 2.Data Extraction:Critical appraisal instruments (Downs and Black checklist, Cochrane Collaboration tool, ROBINS-1 tool) were used to evaluate study quality. We independently calculated effect sizes (ESs) (Cohen d) between groups in each study. The Strength of Recommendation Taxonomy grading scale was used for clinical recommendations.Results:Six articles (4 randomized control studies, 1 nonrandomized study, and 1 case-control study) met inclusion criteria. Exercises paired with BFR training included open kinetic chain, closed kinetic chain, and passive applications. Diverse assessments and time of intervention were observed across studies. ESs ranged from trivial to large in favor of BFR training for muscle morphological (d = 0.06 to 0.81) and strength assessments (d = −0.12 to 1.24) with CIs spanning zero.Conclusion:At this time, grade B or inconsistent and limited-quality patient-oriented evidence exists to support using BFR training to improve or maintain thigh muscle size as well as knee extensor and flexor strength in ACL-reconstructed patients. ESs indicated no consistent clinically meaningful differences when compared with conventional therapy. Subsequent analyses should be repeated as new evidence emerges to update practice guidelines.
      Citation: Sports Health
      PubDate: 2022-02-08T08:26:49Z
      DOI: 10.1177/19417381211070834
       
  • Quantitative Assessment of Balance for Accurate Prediction of Return to
           Sport From Sport-Related Concussion

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      Authors: Hamish A. Kerr, Eric H. Ledet, Juergen Hahn, Kathryn Hollowood-Jones
      Abstract: Sports Health, Ahead of Print.
      Background:Determining when athletes are able to return to sport after sports-related concussion (SRC) can be difficult.Hypothesis:A multimodal algorithm using cognitive testing, postural stability, and clinical assessment can predict return to sports after SRC.Study Design:Prospective cohort.Level of Evidence:Level 2b.Methods:Athletes were evaluated within 2 to 3 weeks of SRC. Clinical assessment, Immediate Post Concussion and Cognitive Testing (ImPACT), and postural stability (Equilibrate) were conducted. Resulting data and machine learning techniques were used to optimize an algorithm discriminating between patients ready to return to sports versus those who are not yet recovered. A Fisher discriminant analysis with leave-one-out cross-validation assessed every combination of 2 to 5 factors to optimize the algorithm with lowest combination of type I and type II errors.Results:A total of 193 athletes returned to contact sports after SRC at a mean 84.6 days (±88.8). Twelve subjects (6.2%) sustained repeat SRC within 12 months after return to sport. The combination of (1) days since injury, (2) total symptom score, and (3) nondominant foot tandem eyes closed postural stability score created the best algorithm for discriminating those ready to return to sports after SRC with lowest type I error (13.85%) and type II error (11.25%). The model was able to discriminate between patients who were ready to successfully return to sports versus those who were not with area under the receiver operating characteristic (ROC) curve of 0.82.Conclusion:The algorithm predicts successful return to sports with an acceptable sensitivity and specificity. Tandem balance with eyes closed measured with a video-force plate discriminated athletes ready to return to sports from SRC when combined in multivariate analysis with symptom score and time since injury. The combination of these factors may pose advantages over computerized neuropsychological testing when evaluating young athletes with SRC for return to contact sports.Clinical Relevance:When assessing young athletes sustaining an SRC in a concussion clinic, measuring postural stability in tandem stance with eyes closed combined with clinical assessment and cognitive recovery is effective to determine who is ready to successfully return to sports.
      Citation: Sports Health
      PubDate: 2022-02-05T06:38:11Z
      DOI: 10.1177/19417381211068817
       
  • Relative Validity and Reliability of Isometric Lower Extremity Strength
           Assessment in Older Adults by Using a Handheld Dynamometer

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      Authors: Pol Grootswagers, Anouk M. M. Vaes, Roland Hangelbroek, Michael Tieland, Luc J. C. van Loon, Lisette C. P. G. M. de Groot
      Abstract: Sports Health, Ahead of Print.
      Background:Handheld dynamometry (HHD) is a practical alternative to traditional testing of lower extremity strength. However, its reliability and validity across different populations and settings are not clear.Hypothesis:We hypothesize that HHD is a valid and reliable device to assess lower extremity strength in a population of older adults.Study Design:Cross-sectional/cohort.Level of Evidence:Level 3.Methods:This study included 258 older adults (≥65 years). Isometric knee extension and flexion force were measured by 1 examiner, using an HHD (n = 222), including 3 repetitions to calculate within-day intrarater reliability. These measurements were repeated by the examiner in a subgroup (n = 23) to analyze intrarater reliability over a test-retest period of on average 8 weeks. In addition, HHD force measures were performed by a second examiner (n = 29) to analyze interrater reliability. In another subgroup (n = 77), isometric knee extension and flexion torque were measured by 1 examiner using both the HHD and Biodex System 4 to assess relative validity.Results:HHD and Biodex measurements were highly correlated and showed excellent concurrent validity. HHD systematically overestimated torque as compared with Biodex by 8 N·m on average. Same-day intrarater intraclass correlation coefficients (ICCs) ranged from 0.97 to 0.98. Interrater reliability ICCs ranged from 0.83 to 0.95.Conclusion:HHD represents a reliable and valid alternative to Biodex to rank individuals on leg strength, or to assess within-person changes in leg strength over time, because of the high validity and reliability. The HHD is less suited for absolute strength assessment because of significant systematic overestimations.Clinical Relevance:Clinicians are encouraged to use HHD to rank older adults on leg strength, or to assess within-person changes in leg strength over time, but not to compare readings with cut-offs or normative values.
      Citation: Sports Health
      PubDate: 2022-02-05T06:22:37Z
      DOI: 10.1177/19417381211063847
       
  • Load-Velocity Relationship Variables to Assess the Maximal Neuromuscular
           Capacities During the Back-Squat Exercise

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      Authors: Alejandro Pérez-Castilla, Ivan Jukic, Danica Janicijevic, Zeki Akyildiz, Deniz Senturk, Amador García-Ramos
      Abstract: Sports Health, Ahead of Print.
      Background:The relationship between the external load lifted and movement velocity can be modeled by a simple linear regression, and the variables derived from the load-velocity (L-V) relationship were recently used to estimate the maximal neuromuscular capacities during 2 variants of the back-squat exercise.Hypothesis:The L-V relationship variables will be highly reliable and will be highly associated with the traditional tests commonly used to evaluate the maximal force and power.Study Design:Twenty-four male wrestlers performed 5 testing sessions (a 1-repetition maximum [1RM] session, and 4 experimental sessions [2 with the concentric-only back-squat and 2 with the eccentric-concentric back-squat]). Each experimental session consisted of performing 3 repetitions against 5 loads (45%-55%-65%-75%-85% of the 1RM), followed by single 1RM attempts.Level of Evidence:Level 3.Methods:Individual L-V relationships were modeled from the mean velocity collected under all loading conditions from which the following 3 variables were calculated: load-axis intercept (L0), velocity-axis intercept (v0), and area under the line (Aline = L0·v0/2). The back-squat 1RM strength and the maximum power determined as the apex of the power-velocity relationship (Pmax) were also determined as traditional measures of maximal force and power capacities, respectively.Results:The between-session reliability was high for the Aline (coefficient of variation [CV] range = 2.58%-4.37%; intraclass correlation coefficient [ICC] range = 0.98-0.99) and generally acceptable for L0 and v0 (CV range = 5.08%-9.01%; ICC range = 0.45-0.96). Regarding the concurrent validity, the correlations were very large between L0 and the 1RM strength (rrange = 0.87-0.88) and nearly perfect between Aline and Pmax (r = 0.98-0.99).Conclusion:The load-velocity relationship variables can be obtained with a high reliability (L0, v0, and Aline) and validity (L0 and Aline) during the back-squat exercise.Clinical Relevance:The load-velocity relationship modeling represents a quick and simple procedure to estimate the maximal neuromuscular capacities of lower-body muscles.
      Citation: Sports Health
      PubDate: 2022-02-04T04:54:11Z
      DOI: 10.1177/19417381211064603
       
  • The Role of Hyaluronic Acid for Soft Tissue Indications: A Systematic
           Review and Meta-Analysis

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      Authors: Moin Khan, Ajaykumar Shanmugaraj, Carlos Prada, Ashaka Patel, Eric Babins, Mohit Bhandari
      Abstract: Sports Health, Ahead of Print.
      Context:Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries.Objective:To evaluate the treatment effect and role of HA for available soft tissue indications.Data Sources:A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators.Study Design:Meta-analysis of RCTs.Level of Evidence:Level 1.Results:Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain 12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I2 = 94%), and elbow tendinopathy (2 trials, I2 = 99%). We identified uncertain benefit for trigger finger (2 trials, I2 = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each.Conclusion:This systematic review and meta-analysis support HA’s efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials.
      Citation: Sports Health
      PubDate: 2022-02-04T04:52:55Z
      DOI: 10.1177/19417381211073316
       
  • Validating the Cambridge Protocol: Reliability of Hip Muscle Strength
           Measurements Using a Motorized Dynamometer and Electromyography

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      Authors: Arman Memarzadeh, Andrew Paul Morrison, Viviane Merzbach, Michael Ferrandino, Arvind Arora, Leica S. Claydon-Mueller, Vikas Khanduja
      Abstract: Sports Health, Ahead of Print.
      Background:Muscle weakness is common after injury in athletes and in the presence of hip pathology. It will cause abnormal hip biomechanics and can predict future injury. However, objective measurement of hip muscle strength is difficult to perform accurately and reliably. Therefore, it is challenging to determine when an athlete has returned to preinjury levels of strength. In addition, there is currently no standardized method of obtaining measurements, which prevents the data being compared or shared between research centers.Purpose:The purpose of this study is to comprehensively assess the inter- and intraobserver reliability of our standardized muscle strength measurement protocol.Study Design:Descriptive laboratory study.Level of Evidence:Level 3, inception cohort study.Methods:A total of 16 healthy male volunteers (age = 28.3 ± 7.9 years) were recruited. Those with a previous history of hip injuries or disorders were excluded. These volunteers underwent strength testing according to the Cambridge Protocol on 4 separate occasions, performed by 2 independent assessors. Maximal voluntary contractions, fatigue torque fluctuations, and electromyography measurements were recorded. Intra- and interobserver reliability was assessed using intraclass correlation coefficient (ICC).Results:Good-to-excellent correlation was seen for both intra- and interobserver reliability across almost all hip movements for maximal contractions: ICC ranged 0.78 to 0.93 and 0.78 to 0.96, respectively. The standard error of the mean for all hip movements was also extremely low at 2% to 3%.Conclusion:The Cambridge Protocol is a highly reliable method for objective measurement of hip muscle strength. We recommend future studies use this protocol, or the principles underpinning it, to enable data sharing and comparison across different studies.Clinical Relevance:This is a description and analysis of hip muscle strength measurement. If widely used, it will allow for accurate and objective strength assessment and closer monitoring of hip injuries and pathology.
      Citation: Sports Health
      PubDate: 2022-02-01T10:05:21Z
      DOI: 10.1177/19417381211056869
       
  • Protective Sport Bracing for Athletes With Mid-Season Shoulder Instability

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      Authors: Hayden P. Baker, Pranav Krishnan, Ozair Meghani, Aravind Athiviraham, Sherwin Ho, Brett D. Owens
      Abstract: Sports Health, Ahead of Print.
      Context:In-season glenohumeral instability is a common clinical dilemma faced by physicians who care for athletes. Both nonoperative and operative management of athletes with in-season glenohumeral instability have been well described. Functional bracing remains less understood as a treatment modality. This review aims to provide an update on the most recent literature regarding the use of functional bracing for shoulder instability.Evidence Acquisition:MEDLINE (PubMed and Ovid platforms), Web of Science, Embase, and Cochrane Database of Systemic Reviews were searched for articles available in English through June 1, 2021. The search terms shoulder brace, shoulder instability, athlete, in-season, glenohumeral instability, anterior shoulder instability, posterior shoulder instability, and bracing were used.Study Design:Clinical review.Level of Evidence:Level 3.Results:Research on the clinical outcomes of functional bracing remains mixed for patients with shoulder instability. Two studies have demonstrated improved return to play with functional bracing, while 1 study demonstrated no difference in return to play between braced athletes and nonbraced athletes with anterior instability. One previous study demonstrated that prophylactic use of bilateral shoulder stabilizing braces significantly decreased time lost due to injury in athletes with posterior instability. Previous biomechanical studies have demonstrated improved proprioception with brace wear as well as successful limitation of active shoulder range of motion.Conclusion:Bracing in athletes with shoulder instability remains an important nonoperative treatment modality. While clinical benefits are yet to be validated through high-quality studies, preliminary results suggest a potential benefit to recovery, with minimal downsides. Nevertheless, the use of bracing remains an individual choice but is especially recommended in settings of high-risk sports for shoulder instability, such as football.
      Citation: Sports Health
      PubDate: 2022-01-27T06:47:42Z
      DOI: 10.1177/19417381211069069
       
  • Beyond Distance: A Simple Qualitative Assessment of the Single-Leg Hop
           Test in Return-to-Play Testing

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      Authors: Stefano Di Paolo, Stefano Zaffagnini, Filippo Tosarelli, Alberto Grassi, Francesco Della Villa
      Abstract: Sports Health, Ahead of Print.
      Background:Limb symmetry index in the single-leg hop (SLH) test has been questioned for its low predictive value in identifying secondary anterior cruciate ligament (ACL) injury. The purpose of this study was to describe a qualitative 2-dimensional (2D) scoring system for the assessment of the SLH test and associate it with the vertical ground-reaction forces (vGRF) and sagittal plane biomechanics evaluated through gold standard 3D motion analysis.Hypothesis:Stiff landings would be associated with low 2D scores.Study Design:Descriptive laboratory study.Level of Evidence:Level 4.Methods:Thirty-four competitive football (soccer) players (age 22.8 ± 4.1 years, 16 women) were enrolled. Each athlete performed a series of SLH tests. Three-dimensional motion analysis was recorded using 10 stereophotogrammetric cameras, a force platform, and 3 high-speed cameras. The 2D qualitative assessment was performed through a scoring system based on the video-analysis of sagittal plane joint kinematics. A score of 0/2 (inadequate), 1/2 (partially adequate), or 2/2 (adequate) was attributed to the movement, based on objective measurements. The vGRF was extracted from the force platform and grouped according to the results of the 2D evaluation.Results:Significantly higher vGRF (stiffer landing) was found for athletes obtaining a 0/2 score compared with those obtaining a 2/2 score (up to 0.8 body weight higher, P < 0.01). A significant negative rank correlation was found between the vGRF and the total score (ρ = −0.17, P = 0.03).Conclusion:The qualitative scoring system effectively identified stiff landings in the SLH for distance test.Clinical Relevance:The qualitative scoring system could be a user-friendly standardized method to assess athletes’ movement quality in return to sport clearance decision after ACL injury.
      Citation: Sports Health
      PubDate: 2022-01-27T06:41:46Z
      DOI: 10.1177/19417381211063450
       
  • Injury History and Perceived Knee Function as Risk Factors for Knee Injury
           in Youth Team-Sports Athletes

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      Authors: Jussi Hietamo, Anni Rantala, Jari Parkkari, Mari Leppänen, Marko Rossi, Ari Heinonen, Kathrin Steffen, Pekka Kannus, Ville Mattila, Kati Pasanen
      Abstract: Sports Health, Ahead of Print.
      Background:The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned.Hypothesis:Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses.Results:In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes’ age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses.Conclusion:Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury.Clinical Relevance:The treatment and rehabilitation of the present acute knee injury and secondary prevention of reinjury should be emphasized in youth team-sports athletes.
      Citation: Sports Health
      PubDate: 2022-01-17T10:26:11Z
      DOI: 10.1177/19417381211065443
       
  • Exploring the Use of Player Load in Elite Soccer Players

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      Authors: José M. Oliva-Lozano, Daniele Conte, Víctor Fortes, José M. Muyor
      Abstract: Sports Health, Ahead of Print.
      Background:The aims of this study were to (1) analyze the distribution of the player load (PLTOTAL) in 3 axes of movement (PLAP, anterior-posterior; PLML, medial-lateral; PLV, vertical) during elite soccer matches, (2) investigate the effect of playing position on PL-related variables, and (3) explore the association between PLTOTAL and distance covered by the players.Hypothesis:Despite different load distribution between axes of movement, PLTOTAL might be used as a body load indicator for all playing positions.Study Design:Longitudinal study.Level of Evidence:Level 3.Methods:Data were collected from elite soccer players using WIMU Pro tracking systems, which included inertial sensors.Results:The axis of movement had a significant effect on the distribution of the load (P < 0.001; conditional R2 = 0.91), with the greatest contribution from the PLV (P < 0.001; d = 5.41-5.86). Moreover, no effect of playing position on PLTOTAL, PLV, PLML, or PLAP was observed (P> 0.05). Finally, a large correlation was found between PLTOTAL and distance covered, and the linear mixed model showed that distance may be predicted by the PLTOTAL (conditional R2 = 0.81; P < 0.001).Conclusion:Differences in load distribution were based on the axis of movement, although playing position had no effect on any variable. The selection of either distance covered, which is representative of a 2-dimensional analysis, or PLTOTAL, which is representative of a 3-dimensional analysis, may be adequate for monitoring locomotor demands or accelerometer-derived load.Clinical Relevance:Training strategies that focus on the vertical component of match play should be adopted. In addition, given that PLTOTAL is an accelerometry-based metric, which combines the accelerations in anterior-posterior, medial-lateral, and vertical planes, strength and conditioning coaches may use this parameter as a measure of total body load.
      Citation: Sports Health
      PubDate: 2022-01-17T09:29:06Z
      DOI: 10.1177/19417381211065768
       
  • Implications of the Gut Microbiome in Sports

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      Authors: Gerardo Miranda-Comas, Ryan C. Petering, Nadia Zaman, Richard Chang
      Abstract: Sports Health, Ahead of Print.
      Context:Two-thirds of an individual’s gut microbiota is unique and influenced by dietary and exercise habits, age, sex, genetics, ethnicity, antibiotics, health, and disease. It plays important roles in nutrient and vitamin metabolism, inflammatory modulation, immune system function, and overall health of an individual. Specifically, in sports it may help decrease recovery time and improve athletic performance.Evidence Acquisition:PubMed and Medline databases were used for the literature search. Bibliographies based on the original search were utilized to pursue further literature search.Study Design:Clinical review.Level of Evidence:Level 4.Results:Diet and exercise play very important roles in the composition of the gut microbiota in the athletic and nonathletic individual. Ingestion of carbohydrates during and after exercise seems to have an anti-inflammatory effect postexercise. Supplementation with probiotic seems to aid in recovery after exercise, too, especially restoring the “normal” gut microbiota. Physically active individuals of all levels have more alpha diversity and “health-promoting gut species” in their microbiome than nonactive individuals, along with higher concentrations of short-chain fatty acids (SCFA) and SCFA-producing organisms. However, exercise interventions should be longer than 8 weeks to see these positive characteristics. Immune function is highly influenced by the gut microbiota’s response to exercise. A transient immune dysfunction occurs after prolonged high-intensity exercise, which correlates with microbiota dysregulation. Nevertheless, long-term exposure to exercise will enhance the immune response and lead to positive changes in the gut microbiota.Conclusion:Although the exact mechanisms of the effects that diet, exercise, and genetics have on the gut microbiota remain largely unknown, there is evidence that suggests overall health benefits. In the athletic population, these benefits can ultimately lead to performance improvement.
      Citation: Sports Health
      PubDate: 2022-01-17T09:17:00Z
      DOI: 10.1177/19417381211060006
       
  • More Than Skin Deep: Dermatologic Conditions in Athletes

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      Authors: George G.A. Pujalte, Lorena M.C. Costa, Adrianna D. Clapp, R. John Presutti, Jason C. Sluzevich
      Abstract: Sports Health, Ahead of Print.
      Context:Athletes are a unique group of patients whose activities, particularly in high-contact sports such as wrestling and football, place them at high risk of developing skin conditions. The correct diagnosis of sports dermatoses requires familiarity with their clinical characteristics. It is critical that primary care physicians recognize the most common skin disorders to provide prompt treatment and prevent transmission.Evidence Acquisition:The Mayo Clinic library obtained articles from 2012 onward related to dermatologic conditions in athletes.Study Design:Review article.Level of Evidence:Level 3.Results:Dermatologic diseases in athletes are often infectious and contagious due to close-contact sports environments. Sports-related dermatoses include bacterial infections, such as impetigo, ecthyma, folliculitis, abscesses, furuncles, carbuncles, erysipelas, and cellulitis; fungal infections, such as tinea and intertrigo; viral infections, such as herpes, verrucae, and molluscum contagiosum; and noninfectious conditions, such as acne, blisters, and contact dermatitis.Conclusion:This article aims to address the manifestations of the most common cutaneous diseases in athletes on the first primary care visit. It discusses the appropriate tests and most recent evidence-based treatments for each ailment. It also addresses return-to-play recommendations related to the guidelines and regulations of selected sports organizations in the United States.Strength of Recommendation Taxonomy (SORT):C.
      Citation: Sports Health
      PubDate: 2022-01-17T09:09:44Z
      DOI: 10.1177/19417381211065026
       
  • Age and Gender Differences in Injuries and Risk Factors in Elite Junior
           and Professional Tennis Players

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      Authors: Robyn Porter Rice, Kathryn Roach, Neva Kirk-Sanchez, Bret Waltz, Todd S. Ellenbecker, Neeru Jayanthi, Michele Raya
      First page: 466
      Abstract: Sports Health, Ahead of Print.
      Background:Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population.Hypothesis:Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM.Results:A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides.Conclusion:Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments.Clinical Relevance:Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.
      Citation: Sports Health
      PubDate: 2022-01-17T10:21:31Z
      DOI: 10.1177/19417381211062834
       
  • Elbow Ulnar Collateral Ligament Injuries in Overhead Athletes: An
           Infographic Summary

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      Authors: Jason L. Zaremski
      First page: 527
      Abstract: Sports Health, Ahead of Print.
      Ulnar collateral ligament (UCL) injuries of the elbow are common in throwing athletes. Given that the UCL’s primary function is to provide valgus stability during the deceleration phase of throwing, injury to the UCL will render throwing difficult to nearly impossible.15 Injuries will occur more so in the sports of baseball, softball, and javlineers participating in track and field.5,10,14 Data has indicated that valgus torque reaches 64 N-m and proximal forces as high as 1000 N to prevent elbow distraction. Further, angular velocity across elbow may reach 1900-2480 degrees/second.6,8 Imaging modalities that have the greatest accuracy for diagnosis include magnetic resonance imaging (MRI), MRI-arthrogram, and stress ultrasonography.2,3,11,12 Treatment of UCL injury depends on multiple factors. These include if the injury is a partial tear or complete tear and the location (distal versus proximal) of the partial tear.7 Further, complete tears, as well as partial distal tears, are more likely to undergo surgical intervention.1,13 Treatment decision-making is primarily dependent on following factors: location, severity, if the patient is a throwing athlete, and if the patient is in his or her last year of his/her throwing career due to the length of the rehabilitation process if surgery is pursued.15 Return-to-play success rates when treated conservatively vary from anywhere from 42% to 100%. Conservative treatment includes rest, rehabilitation, platelet-rich plasma injections, and a throwing program.4 Surgical treatment has evolved significantly with various reconstructive techniques and (when indicated) surgical repair with internal bracing. Return-to-play rates are high, ranging from 80% to 95% with low complication rates, but rehabilitation for reconstruction can range from 12-18 months or longer. Therefore, patients must be made aware of the commitment to the rehabilitation process if electing to undergo surgical reconstruction.9
      Citation: Sports Health
      PubDate: 2022-05-13T05:33:35Z
      DOI: 10.1177/19417381221098622
       
  • Best Practices for Coaching an Athlete With Mental Health Concerns

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      Authors: Jane M. Simoni
      First page: 530
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-05-02T05:55:29Z
      DOI: 10.1177/19417381221091794
       
  • Corrigendum to “Relationships Between WUT (Body Weight, Urine Color, and
           Thirst Level) Criteria and Urine Indices of Hydration Status”

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      First page: 575
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-04-25T01:56:03Z
      DOI: 10.1177/19417381221084711
       
  • Society News

    • Free pre-print version: Loading...

      First page: 601
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-05-28T05:02:07Z
      DOI: 10.1177/19417381221103126
       
 
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