JournalTOCs

Sports Health: A Multidisciplinary Approach
Journal Prestige (SJR): 1.107

Citation Impact (citeScore): 2
Number of Followers: 5

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1941-7381 - ISSN (Online) 1941-0921
Published by Sage Publications

[1176 journals]

The Importance of Sleep for Health and Athletic Performance
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  Authors: Chad A. Asplund
  Pages: 499 - 500
  Abstract: Sports Health, Volume 16, Issue 4, Page 499-500, July/August 2024.
  
  Citation: Sports Health
  PubDate: 2024-06-20T02:36:25Z
  DOI: 10.1177/19417381241257952
  Issue No: Vol. 16, No. 4 (2024)
Revolutionizing Student Athletes’ Success: The Transformative Impact of
Sleep and the Urgent Call for Later School Start Times
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  Authors: Joanna Fong-Isariyawongse
  Pages: 501 - 503
  Abstract: Sports Health, Volume 16, Issue 4, Page 501-503, July/August 2024.
  
  Citation: Sports Health
  PubDate: 2024-06-20T02:36:18Z
  DOI: 10.1177/19417381241257949
  Issue No: Vol. 16, No. 4 (2024)
Single-Task and Dual-Task Gait Performance After Sport-Related Concussion:
A Machine Learning Statistical Approach
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  Authors: Nicholas G. Murray, Brian Szekely, Madison R. Taylor, Kristen G. Quigley, Joseph McCarley, Nora Constantino, Kumiko Hashida, Kaori Tamura
  Abstract: Sports Health, Ahead of Print.
  Background:This study evaluated 2 different dual-task (DT) conditions during tandem gait (TG) to predict sport-related concussion (SRC) diagnosis.Hypothesis:The best (fastest) single-task (ST) gait will differ between groups (controls vs SRC; baseline vs SRC), with auditory pure switching task (APST) response rate being the most important behavioral variable to aid prediction of SRC.Study Design:Cohort design.Level of Evidence:Level 3.Methods:A total of 409 National Collegiate Athletic Association Division I student-athlete controls and 21 team-physician-diagnosed SRC participated. All data were collected at preseason physicals (baseline) and within 7 days of injury for SRC. Each participant completed 3 conditions of TG in a pseudorandomized order: (1) ST, (2) DT with serial-7s (SS) subtractions, and (3) DT with APST. Outcomes of time-to-complete for TG and behavioral (eg, responses per second) for SS and APST were recorded for each trial.Results:ST Trials 2 (P = 0.03) and 3 (P = 0.01) were significantly different between controls and SRC. ST Trial 3 (P = 0.04) was significantly different between baseline and SRC. Average responses per second for APST were significantly different between- (P < 0.01) and within- (P = 0.01) group.Conclusion:The results suggest that ST is significantly slower after SRC. However, DT (both SS and APST) time-to-complete are also important variables when predicting the SRC diagnosis. It is advised that both ST and DT be administered when making clinical decisions regarding postural instability after SRC.Clinical Relevance:The best ST TG time to complete gait is an important objective marker of concussion while DT paradigms, specifically SS and APST, are highly variable. DT may be more useful for clinical observable signs of SRC. Both SS and APST have unique usefulness, but APST response rate per second can be relied upon numerically for clinical decisions.
  Citation: Sports Health
  PubDate: 2024-08-08T05:36:40Z
  DOI: 10.1177/19417381241264289
Effects of Progressive and Velocity-Based Autoregulatory Resistance
Training on Lower-Limb Movement Ability in Taekwondo Athletes
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  Authors: Zijing Huang, Jing Dai, Lunxin Chen, Liang Yang, Min Gong, Duanying Li, Jian Sun
  Abstract: Sports Health, Ahead of Print.
  Background:Both autoregulatory progressive resistance exercise (APRE) and velocity-based resistance training (VBRT) utilize real-time monitoring of athlete physical performance to adjust training loads to provide appropriate training stimuli. However, the monitoring and adjustment approaches differ between both methods. This study aimed to compare the effects of APRE and VBRT on the muscle strength, power, and agility of college taekwondo athletes.Hypothesis:Eight weeks of APRE and VBRT will promote similar results to strength gains in regards maximal strength, but VBRT will be superior to APRE in explosive power and agility.Study Design:Clinical trial.Level of Evidence:Level 3.Methods:Thirty taekwondo athletes were divided randomly into 2 groups (VBRT/APRE), and all participants completed an 8-week APRE/VBRT intervention. Maximum strength, explosive power, and agility performance were assessed during the squat 1-repetition maximum (1RM), countermovement jump (CMJ), drop jump (DJ), kicking strength test (KST), taekwondo-specific agility test (TSAT), and hexagon test (HT).Results:Highly significant time effects (P < 0.01) were observed for squat 1RM, CMJ, and TSAT in both the APRE and VBRT groups. However, there were no significant group-by-time differences for any of the measured outcomes to intergroup (P> 0.05), but APRE had a small effect size (ES) over VBRT for CMJ (ES = 0.48, [math] = 0.06), TSAT (ES = 0.26, [math] = 0.02), and HT (ES = 0.42, [math] = 0.05).Conclusion:An 8-week autoregulatory APRE and VBRT can both effectively improve both the maximal strength, explosive power, and agility performance of taekwondo athletes, with APRE exhibiting potential advantages in improving CMJ, TSAT, and HT.Clinical Relevance:These results provide important insights into the selection of suitable resistance training programs by professional coaches, taking into account athlete needs, training efficiency, and safety considerations.
  Citation: Sports Health
  PubDate: 2024-08-07T12:54:48Z
  DOI: 10.1177/19417381241262024
Angle-Specific Analysis of Isokinetic Quadriceps and Hamstring Strength at
6 and 12 Months After Unilateral ACL Reconstruction
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  Authors: Huijuan Shi, Hongshi Huang, Hanjun Li, Yuanyuan Yu, Shuang Ren, Hui Liu, Yingfang Ao
  Abstract: Sports Health, Ahead of Print.
  Background:Quadriceps and hamstring strength deficits are related to the increased risk of reinjury after anterior cruciate ligament reconstruction (ACLR).Hypothesis:Knee angle-specific quadriceps and hamstring strength differences would be observed in patients with ACLR 6 and 12 months after surgery.Study Design:Case-series.Level of Evidence:Level 4.Methods:A total of 23 postprimary unilateral ACLR patients followed-up at 6 and 12 months postoperatively and 25 controls were included. Isokinetic knee extension and flexion strength were evaluated at 60 deg/s from 20° to 90°. Statistical parametric mapping were performed to explore the angle-specific strength and the limb symmetry index (LSI).Results:At 6 months postoperatively, the reconstructed leg demonstrated lower knee extension and flexion strength than the contralateral (20°-77°, 24°-90°) (P < 0.01) and control legs (22°-90°, 40°-82°) (P < 0.01). From 6 months to 12 months, knee extension (60°-90°) and flexion (20°-79°) strength improved in the reconstructed leg (P < 0.05), while LSI remained unchanged (P> 0.02). At 12 months, knee extension strength differences persisted in the reconstructed leg compared with the contralateral (20°-81°) and controls (25°-63°) (P < 0.01). ACLR patients had lower LSI of knee extension strength at 6 (20°-59°) and 12 (24°-57°) months postoperatively than the controls (P < 0.02).Conclusion:The reconstructed leg exhibited differences in knee extension strength compared with the contralateral and control legs. Although bilateral knee extension strength increased from 6 to 12 months postoperatively, LSI did not show improvement during this period.Clinical Relevance:Quadriceps restoration was observed only in knee flexion angles greater than 60° compared with controls. Future studies should investigate whether knee extension strength, especially in lower flexion angles, can be enhanced through rehabilitation programs. Furthermore, assessing the impact of this improvement on long-term outcomes and reinjury risk in ACLR patients is warranted.
  Citation: Sports Health
  PubDate: 2024-08-07T06:04:06Z
  DOI: 10.1177/19417381241264493
Effect of COVID-19 on Injury Incidence and Severity in Professional Female
Football Players: A Cohort Prospective Study
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  Authors: Víctor Moreno-Pérez, Javier Courel-Ibáñez, José María Oliva-Lozano, David Barrachina Celda, Miguel Ángel Buil, Israel Álvarez Miguel, Estrella Armada-Cortes, Pablo Gasulla-Angles, Honorio Martínez Martínez, Víctor Sebastía-Paredes, Joaquín González-Ródenas, Juan Del Coso
  Abstract: Sports Health, Ahead of Print.
  Background:Earlier statements suggested a negative impact of coronavirus disease 2019 (COVID-19) infection on sports performance and injury risk. With the COVID-19 pandemic under control and the dominance of a less-severe strain of the virus, there is a need to confirm whether these adverse effects still apply to the current situation.Hypothesis:Infected players would have a higher noncontact muscle injury incidence compared with noninfected counterparts.Study Design:Cohort observational study.Level of Evidence:Level 3.Methods:Seven teams (n = 147 players) competing in the Spanish professional women’s football league (Liga F) were prospectively monitored during the 2021-2022 season. Data from noncontact injuries were recorded and classified following the latest consensus statement from the International Olympic Committee. COVID-19 was certified by the medical staff by regular polymerase chain reaction analysis.Results:Ninety-two players suffered at least 1 noncontact muscle injury during the season. Injury incidence during the season was similar in players with COVID-19 (n = 83) and players without infection (5.1 ± 6.7 versus 4.9 ± 10.0 injuries/1000 h of play, respectively; P = 0.90). Players with COVID-19 were not more likely to suffer noncontact injuries compared with those players without infection (R2 = 0.02; odds ratio [OR] 95% confidence interval [95% CI] = 0.36-1.38; P = 0.31). There was no effect of COVID-19 on the days of absence due to injury (R2 = 0.01; OR 95% CI = 1.00-1.01; P = 0.44) or in the classification of the severity of the injury (P = 0.79).Conclusion:COVID-19 has no significant effect on noncontact injury incidence and severity in professional female football players.Clinical Relevance:Currently, COVID-19 infection does not alter noncontact muscle injury risk in professional football and requires no further attention in terms of injury management. Usual return-to-play protocols apply to COVID-19 considering the particularities of each player since the severity of infection, period of inactivity, and effects on the player’s health and performance.
  Citation: Sports Health
  PubDate: 2024-08-07T05:58:39Z
  DOI: 10.1177/19417381241262031
The Impact of Drive Leg Impulse and Slope on Throwing Velocity and
Kinematics in the Competitive Throwing Athlete
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  Authors: Mark A. Glover, Joseph A. Mylott, Arlen Gaba, Andrew J. Recker, Garrett S. Bullock, Brian R. Waterman, Kristen F. Nicholson
  Abstract: Sports Health, Ahead of Print.
  Background:Multiple studies have analyzed pitching kinematics using motion analysis technology, but lower extremity drive leg impulse (DLI) and drive leg slope (DLS) are not as well characterized. The purpose of this study was to investigate associations between DLI and DLS and pitch velocity as well as angular velocity of the pelvis, trunk, and humerus.Hypothesis:Increased DLI and DLS will be correlated positively with pitch velocity and associated with increased angular velocities in the humerus, trunk, and pelvis.Study Design:Retrospective case series.Level of Evidence:Level 4.Methods:Three-dimensional motion analyses data from 174 pitchers (age, 17.0 ± 1.0 years; height, 1.82 ± 0.07 m; weight, 80.0 ± 11.3 kg) throwing combined 613 fastball pitches were included. Pitchers threw 2 to 5 pitches, and the variables collected between pitches were averaged and recorded. Statistical analysis was performed using linear regressions to determine the association between DLS as well as DLI and pitch velocity and angular velocities of the pelvis, trunk, and humerus.Results:Pitchers with higher DLI were associated with lower pitch velocities (β = -22.32; 95% CI, -32.75 to -11.88, P < 0.01). There were no significant associations for DLS and velocity (β = -0.60; 95% CI, -1.48 to 0.29, P = 0.18) or DLS and DLI with rotational velocities except for DLI and trunk kinematics (β = -0.60; 95% CI, -1.48 to 0.29, P = 0.18).Conclusion:In the combined cohort, DLI correlated negatively with pitch velocity, although this relationship does not exist in the subgroup analysis. Higher DLS was found in pitchers with slower pitch velocities in the elite, high school, and youth groups, although not statistically significant. No associations were found with DLS and any angular velocities between any level of play analyzed in this study, suggesting no consistent association regardless of playing level.
  Citation: Sports Health
  PubDate: 2024-08-05T11:41:36Z
  DOI: 10.1177/19417381241264502
Training Load Monitoring in Elite Youth Women’s Artistic Gymnasts: A
Pilot Study
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  Authors: Elisângela Gamarano de Freitas, Paula Barreiros Debien, Cristiano Diniz da Silva, Paulo Daniel Sabino Carrara, Maurício Gattás Bara Filho
  Abstract: Sports Health, Ahead of Print.
  Background:Women’s artistic gymnastics (WAG) is a complex aesthetic sport in which athletes start at a young age and are exposed to high loads during their careers. Little is known about the external and internal training load characteristics among elite young gymnasts.Hypothesis:High training loads, with variations over the weeks, are expected. There is a relationship between external and internal load variables.Study Design:Cohort study.Level of Evidence:Level 3.Methods:Seven elite-level Brazilian youth artistic gymnasts (age, 11.3 ± 0.4 years; mass, 33.0 ± 7.0 kg; height, 137.7 ± 10.6 cm; experience, 4.0 ± 1.2 years) participated in this study. Five nonconsecutive microcycles were monitored. Both external and internal training loads were quantified by counting the number of elements in video recordings of training sessions and by the session rating of perceived exertion method.Results:A total of 168 individual training sessions were monitored. The microcycle that succeeded the main competition showed a significantly lower training load than ≥3 of the other 4 microcycles for all training load variables, except for vault elements, of which microcycle 4 was inferior only to the microcycle before the competition. Significant correlations were found between weekly internal training load and the total of elements and elements performed on uneven bars.Conclusion:Youth women’s artistic gymnasts present fluctuations in external and internal training load variables over the weeks close to a major competition. Training load management in this sport must consider the specificity of each apparatus, as they have different demands and training load behaviors.Clinical Relevance:A better comprehension of external and internal training loads in youth WAG and its apparatuses can benefit coaches and support staff and provide more information to overcome the challenge of training load management in gymnastics.
  Citation: Sports Health
  PubDate: 2024-08-05T11:40:09Z
  DOI: 10.1177/19417381241263342
Effectiveness of Injection Strategies on Patients With Patellar Tendonitis
(Jumpers’ Knee): A Network Meta-analysis of Randomized Controlled Trials
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  Authors: Shaowei Wang, Buwei Lyu
  Abstract: Sports Health, Ahead of Print.
  Context:Patellar tendonitis (PT) is a common degenerative disease of the patellar tendon that seriously affects the sports careers of elite athletes and activities of daily living of sports enthusiasts. Injection therapy is a prevalent invasive treatment for PT.Objective:This work comprehensively analyzes various injection treatments for PT that consider agent type and characteristics, frequency, and assessment timepoints by meta-analysis.Data Sources:PubMed, Embase, and the Cochrane Library were sources of data.Data Selection:Randomized controlled trials (RCTs) analyzing the effect of various injection strategies on the treatment of patients with PT were considered.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 2.Data Extraction:First author, year of publication, research location, registration information, patient type, sample size, age, sex, intervention, control treatment, and follow-up period in each study were extracted.Results:Nineteen RCTs were included in the analysis. In the network meta-analysis of Victorian Institute of Sports Assessment-Patellar (VISA-P) outcomes, polidocanol (standardized mean difference (SMD), 6.52; 95% CI 4.75, 8.30; P < 0.01), tenocyte-like cells (SMD, 4.08; 95% CI 2.92, 5.25; P < 0.01), and leukocyte-poor platelet-rich plasma (LP-PRP) plus high-volume image-guided injection (HVIGI) (SMD, 1.56; 95% CI 0.62, 2.50; P < 0.01) were significantly superior to noninjection conservative treatment, mainly at the 6-month follow-up timepoint. For visual analog scale results, multiple dry needling (DN) (SMD, -1.78; 95% CI -2.56, -1.00; P < 0.01), LP-PRP (SMD, -0.71; 95% CI -1.31, -0.12; P = 0.02), and LP-PRP plus HVIGI (SMD, -1.31; 95% CI -2.22, -0.39; P < 0.01) were significantly superior to blank, which was also mainly at the 6-month timepoint.Conclusion:Injection-related treatments: polidocanol, tenocyte-like cells, LP-PRP, and multiple DN showed potential short (1-3 months) or medium (6 months)-term treatment benefits. There is still no evidence for injection interventions with long-term therapeutic benefit.
  Citation: Sports Health
  PubDate: 2024-08-05T11:38:18Z
  DOI: 10.1177/19417381241263338
Assessing the Incidence of Head Trauma in Australian Mixed Martial Arts: A
Retrospective Analysis of Fight Outcomes
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  Authors: Daniel A. Brown, Garret Gross
  Abstract: Sports Health, Ahead of Print.
  Background:Mixed martial arts (MMA) is experiencing a surge in popularity in Australia. Previous research has suggested knockout (KO) and technical knockout (TKO) are frequent outcomes during competition, raising concern about the brain health of athletes. This study aims to describe fight outcomes in Australian MMA and to explore differences in fight-ending outcomes between male and female athletes, amateur and professional competition, and different weight classes.Hypothesis:There is no difference in the incidence of KO/TKO between level of competition, sex, and weight class.Study Design:Descriptive epidemiology study.Level of Evidence:Level 3.Methods:Retrospective analysis of 143 Australian MMA events from 2020 to 2023 was conducted using video replay to assess fight outcomes between sex and level of competition. Binary logistic regression analysis was used to determine relationships between weight class and KO/TKO fight outcomes.Results:Male competition (34%) had a significantly greater number of KO/TKO secondary to head strikes fight outcomes compared with female competition (23%) (P = 0.01). The KO/TKO rate secondary to head strikes for amateur and professional male competition was 16.6 and 18.7 per 100 athlete-exposures (AEs), respectively. The amateur and professional female rate was 12.6 and 7.4 per 100 AEs, respectively. Amateur male light heavyweight and heavyweight, and professional male heavyweight were at greater odds of a KO or TKO compared with other weight classes in their equivalent level of competition.Conclusion:There is a sex and professional level disparity in the incidence of fight-ending head trauma in Australian MMA. The study findings highlight the urgent need for targeted safety protocols and medical oversight, particularly for men in heavier weight classes.Clinical Relevance:This study highlights the need for enhanced safety protocols and medical oversight in Australian MMA, particularly for male athletes in heavier weight divisions.
  Citation: Sports Health
  PubDate: 2024-08-03T05:20:22Z
  DOI: 10.1177/19417381241263332
Effectiveness of 12-Week Core Stability Training on Postural Balance in
Soccer Players With Groin Pain: A Single-Blind Randomized Controlled Pilot
Study
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  Authors: Fatma Chaari, Sébastien Boyas, Haithem Rebai, Abderrahmane Rahmani, Sonia Sahli
  Abstract: Sports Health, Ahead of Print.
  Background:Core stability training (CST) is effective in improving postural balance, core endurance, and self-reported outcomes in different populations. This study aimed to investigate the effect of CST in soccer players with groin pain (GP).Hypothesis:CST would improve postural balance performance, core endurance, and self-reported outcomes in soccer players with GP.Study Design:Randomized controlled trial.Level of Evidence:Level 2.Methods:Soccer players with GP who met the selection criteria were assigned randomly to a CST (CSTG, n = 10) or a control (CG, n = 10) group. The CG undertook no additional physical activity program besides their usual training. The CSTG performed a 12-week CST comprising 76 ~75 min sessions. Static (force platform) and dynamic (Y-Balance test) postural balance, core endurance (McGill trunk endurance tests), and self-reported outcomes (Copenhagen Hip and Groin Outcome Score [HAGOS]) were assessed before and immediately after the 12-week CST.Results:Significant improvements were seen in dynamic postural balance (P = 0.04 to
  Citation: Sports Health
  PubDate: 2024-07-27T10:40:21Z
  DOI: 10.1177/19417381241259988
Impact of Psychological Factors on Rehabilitation After Anterior Cruciate
Ligament Reconstruction: A Systematic Review
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  Authors: Victoria J. Nedder, Akash G. Raju, Andrew J. Moyal, Jacob G. Calcei, James E. Voos
  Abstract: Sports Health, Ahead of Print.
  Context:Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, and the incidence of ACL reconstruction (ACLR) continues to increase. Current clinical practice guidelines (CPGs) recognize the role of psychological factors in rehabilitation, but patient-reported outcome measures (PROs) and psychological readiness are rarely incorporated into rehabilitation.Objective:The purpose of this review was to highlight the importance of psychological health after ACL injury, understand the current metrics used to monitor psychological recovery, and outline how psychological recovery can be better incorporated in current CPGs.Data Sources:A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA); 63 studies were identified with a PubMed search using the term “ACL Injuries/psychology”.Study Selection:Exclusion criteria included lack of consideration of psychological effects or studies validating PROs after ACLR. Studies were reviewed by multiple reviewers, and a total of 38 studies were included after applying exclusion criteria.Study Design:Systematic review.Level of Evidence:Level 3b.Data Extraction:Two independent reviewers analyzed the included articles to extract sample size, psychological readiness scale or other measures used, and key results.Results:Psychological outcomes, especially kinesiophobia and fear of reinjury, are seen commonly after ACLR. Psychological factors were shown to impede return to sport (RTS), alter measurable knee biomechanics, and potentially increase the risk for re-rupture. Targeted interventions such as kinesiotaping, knee bracing, and imagery training can help improve psychological and functional testing after ACLR.Conclusion:ACLR is often complicated by psychological factors. Psychological readiness is a crucial yet often unincorporated part of rehabilitation. Patients with higher levels of kinesiophobia and lower psychological readiness to RTS specifically should be identified to allow for administration of interventions, such as imagery training, knee bracing, or kinesiotaping, that can mitigate the negative effects of psychological outcomes and improve recovery.
  Citation: Sports Health
  PubDate: 2024-07-23T09:49:07Z
  DOI: 10.1177/19417381241256930
Validity of Rating of Perceived Exertion Scales in Relation to Movement
Velocity and Exercise Intensity During Resistance-Exercise: A Systematic
Review
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  Authors: Jorge L. Petro, Guido Ferrari, Luis A. Cardozo, Salvador Vargas-Molina, Leandro Carbone, Richard B. Kreider, Diego A. Bonilla
  Abstract: Sports Health, Ahead of Print.
  Context:Movement velocity (MV) may be a valid tool to evaluate and control the load in resistance training (RT). The rating of perceived exertion (RPE) also enables practical load management. The relationship between RPE and MV may be used to monitor RT intensity.Objective:To evaluate the validity and practicality of RPE scales related to MV and training intensity in resistance exercise. We hypothesize a positive correlation among RPE, MV, and load intensity in RT. Therefore, RPE may serve as a supplementary indicator in monitoring RT load.Data Sources:Boolean algorithms were used to search several databases (SPORTDiscus, EBSCO, PubMed, Scopus, and Google Scholar).Study Selection:Studies published from 2009 to 2023 included clinical trials (randomized or not) in healthy female and male subjects that analyzed the relationship between different RPE scales and MV in basic RT exercises.Study Design:Systematic review.Level of Evidence:Level 3.Results:A total of 18 studies were selected using different RPE scales with reported MV training loads. Participants included RT and untrained male and female subjects (15-31 years old). Two RPE scales (OMNI-RES and repetitions in reserve) were used. The selected studies showed moderate positive correlations among these RPE scales, MV, and training load (eg, percentage of 1-repetition maximum [%1-RM]). In addition, equations have been developed to estimate %1-RM and MV loss based on the OMNI-RES scale.Conclusion:Studies show that RPE scales and MV constitute a valid, economic, and practical tool for assessing RT load progression and complementing other training monitoring variables. Exercise professionals should consider familiarizing participants with RPE scales and factors that might influence the perception of exertion (eg, level of training, motivation, and environmental conditions).
  Citation: Sports Health
  PubDate: 2024-06-24T07:29:08Z
  DOI: 10.1177/19417381241260412
The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle
Morphology and Function in Chronic Ankle Instability Subjects: A
Randomized Controlled Trial
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  Authors: Khadijeh Kazemi, Khodabakhsh Javanshir, Feryal Saadi, Shahin Goharpey, Mohammad Jafar Shaterzadeh Yazdi, César Calvo-Lobo, Daniel López-López, Gholamhossein Nassadj
  Abstract: Sports Health, Ahead of Print.
  Background:Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI).Hypothesis:The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI.Study Design:A single-blind parallel-arm randomized controlled trial.Level of Evidence:Level 2.Methods:A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase.Results:Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG’s foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73).Conclusion:Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI.Clinical Relevance:The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.
  Citation: Sports Health
  PubDate: 2024-06-20T07:39:27Z
  DOI: 10.1177/19417381241258467
Risk Factors for Shoulder Injuries in Female Athletes Playing Overhead
Sports: A Systematic Review
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  Authors: Malia C. Steele, Tessa R. Lavorgna, Victoria K. Ierulli, Mary K. Mulcahey
  Abstract: Sports Health, Ahead of Print.
  Context:Sports involving overhead motions put substantial biomechanical demands on the shoulder and may result in injuries.Objective:To determine risk factors (RFs) for shoulder injuries in female athletes who play overhead sports and evaluate strategies to reduce shoulder injuries in these athletes.Data Sources:A systematic electronic search was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Databases included were PubMed, Tulane Matas Library Search Engine, and Google Scholar, with search terms: “Overhead injuries/Shoulder AND female athletes AND Risk Factors.”Study Selection:Of the initial 1574 studies identified, 314 were evaluated for eligibility by full-text review and 291 studies were excluded. Overall, 23 studies were included in this study. Studies were published from 2000 to 2021, subject age range was 15 to 35 years, with documented prevalence of shoulder injuries in female athletes playing overhead sports.Study Design:Systematic review.Level of Evidence:Level 2.Data Extraction:Two independent researchers completed abstract and full-text review. Data extraction used the Covidence and Cochrane Consumer guide template.Results:Volleyball was the most common sport with shoulder injuries (6/23; 26%) followed by softball 5/23 (22%), swimming 5/23 (22%), gymnastics 4/23 (17%), tennis 3/23 (13%), water polo 2/23 (8%), and basketball 1/23 (4%). Six RFs (dominant shoulder, volume/overuse, time in sport, older age at time of injury, past injury, and multidirectional instability) were described. Of the 23 studies, 9 (39%) identified the dominant shoulder as a RF for sustaining injury (mean risk ratio [RR], 2.04), while 6 (26%) cited volume of repetition and overuse as a prominent RF (RR, 1.45).Conclusion:This systematic review demonstrates important RFs for shoulder injuries in female athletes associated with playing overhead sports. Multiple prevention strategies are described. Prevention programs are helpful in reducing the risk of reinjury.
  Citation: Sports Health
  PubDate: 2024-06-20T07:34:47Z
  DOI: 10.1177/19417381241259987
Locomotor and Physiological Demands of Small-Sided Soccer Games in
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  Authors: Alejandro Rodríguez-Fernández, Filipe M. Clemente, Rodrigo Ramírez-Campillo, Javier Sánchez-Sánchez
  Abstract: Sports Health, Ahead of Print.
  Background:Small-sided games (SSGs) are frequent training drills in soccer. This study investigated whether type of game (ie, with/without goalkeepers) and wildcard ( without vs internal vs external wildcard) impact the physiological (heartrate [HR]) and locomotor (total distance [TD] covered) demands in regular and wildcard players and to evaluate between-player and within-player variability.Hypothesis:Demands are influenced by wildcard and game type, with higher demand (distance covered at high intensities and sprint speed) in regular players and with higher variability in SSG with wildcard players.Study Design:Descriptive/comparative study.Level of Evidence:Level 4.Methods:Twenty-four soccer players completed 6 SSG as 3 versus 3 without (NG) or with (GK) goalkeepers, and with internal (NG+IW and GK+IW) and external (NG+EW and GK+EW) wildcard. Average HR (HRavg), rate of perceived exertion, and locomotor demands (TD, medium [MID = 7.0-13.9 km h-1], high [HID = 14.0-20.9 km h-1] and sprint [SPD>21.0 km h-1] distance and peak speed [PS]) were registered.Results:The inclusion of GK and internal wildcard led to decreased HRavg and TD in regular players. Wildcard players positioned internally exhibited higher TD, PS, and lower HRavg than externally positioned wildcards. Regular players demonstrated higher TD, PS, MID, HID, HRavg and time spent in Z3 (>90% HRmax) compared with wildcard players in SSG played with external wildcard. Regular and wildcard players displayed great between- and within-player variability in high-intensity metrics.Conclusion:Specific game type and wildcard inclusion impact the physiological and locomotor demands in SSG, with variations observed between regular and wildcard players.Clinical Relevance:This study provides comprehensive information on the physiological and locomotor demands of SSG depending on the inclusion and position of goalkeepers and wildcards, which can be useful for strength and conditioning coaches when designing specific training tasks, individualizing training load and applying return-to-play programs.
  Citation: Sports Health
  PubDate: 2024-06-20T07:31:58Z
  DOI: 10.1177/19417381241257175
Epidemiology of Injuries Among National Basketball Association Players:
2013-2014 Through 2018-2019
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  Authors: Christina D. Mack, Mackenzie M. Herzog, Travis G. Maak, Asheesh Bedi, Rahul Gondalia, Peter Meisel, Frederick M. Azar, Jimmie Mancell, Aaron Nelson, John DiFiori
  Abstract: Sports Health, Ahead of Print.
  Background:Understanding the epidemiology of injuries to athletes is essential to informing injury prevention efforts.Hypothesis:The incidence and impact of basketball-related injuries among National Basketball Association (NBA) players from 2013-2014 through 2018-2019 is relatively stable over time.Study Design:Descriptive epidemiology study.Level of Evidence:Level 3.Methods:Injuries from 2013-2014 through 2018-2019 were analyzed using the NBA Injury and Illness Database from an electronic medical record system. Descriptive statistics were calculated for injuries by season, game-loss, and onset. Incidence rates were estimated using Poisson models and linear trend tests.Results:Between 552 and 606 players participated in ≥1 game per season during the study. Annual injury incidence ranged from 1550 to 1892, with 33.6% to 38.5% resulting in a missed NBA game. Game-loss injury rates ranged from 5.6 to 7.0 injuries per 10,000 player-minutes from 2014-2015 through 2018-2019 (P = 0.19); the rate was lower in 2013-2014 (5.0 injuries per 10,000 player-minutes), partly due to increased preseason injury rates and transition of reporting processes. The 6-year game-loss injury rate in preseason and regular season games was 6.9 (95% CI 6.0, 8.0) and 6.2 (95% CI 6.0, 6.5) injuries per 10,000 player-minutes; the rate in playoff games was lower (P < 0.01) at 2.8 (95% CI 2.2, 3.6). Most (73%) game-loss injuries had acute onset; 44.4% to 52.5% of these involved contact with another player.Conclusion:From 2013-2014 through 2018-2019, over one-third of injuries resulted in missed NBA games, with highest rates of game-loss injuries in preseason games and lowest rates in playoff games. Most game-loss injuries had acute onset, and half of those involved contact with another player.Clinical Relevance:These findings - through reliable data reporting by team medical staff in an audited system - can guide evidence-based injury reduction strategies and inform player health priorities.
  Citation: Sports Health
  PubDate: 2024-06-15T06:17:00Z
  DOI: 10.1177/19417381241258482
Causal Relationships of Ligamentous Injuries in the Knee on Corticospinal
Tract Structure: A Mendelian Randomization Analysis
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  Authors: Le Yu, Weichu Tao, Zhengbiao Jin, Yi Li, Xiao’ao Xue, Ru Wang, Yinghui Hua
  Abstract: Sports Health, Ahead of Print.
  Background:The association between ligamentous knee injuries and corticospinal tract (CST) structure has attracted attention; however, any causal relationship remains uncertain. We performed Mendelian randomization (MR) analysis to identify the causal effects of ligamentous knee injuries on the CST.Hypothesis:Ligamentous knee injuries impair CST microstructure (ie, by reducing fractional anisotropy [FA] and increasing mean diffusivity [MD]).Study Design:MR analysis.Level of Evidence:Level 2.Methods:MR uses genetic variants as instrumental variables to infer causal relationships between exposures and outcomes. Summary data for ligamentous injuries in knee and CST structure were obtained from genome-wide association study datasets. Significant and independent (5 × 10−6; r2 < 0.001; 10,000 kb) single-nucleotide polymorphisms were extracted for MR analysis. Three methods for MR analysis were used (hypothesis-driven 1-tailed inverse variance weighted, MR-Egger, and weighted median), and sensitivity analyses were conducted to test reliability and stability.Results:Results from 3 MR methods consistently demonstrated that ligamentous knee injuries increased MD of the right CST (β, 0.063; 90% CI, 0.003-0.123; P = 0.04), and weak statistical significance suggested increased MD of the left CST (β, 0.060; 90% CI, -0.002 to -0.121; P = 0.05). However, no significant causal relationships were observed in CST FA, and no significant pleiotropy or heterogeneity was observed. Sensitivity analysis utilizing 2-tailed tests had no significant associations between ligamentous knee injuries and changes in CST structure.Conclusion:There is statistically weak genetic evidence that corticospinal pathway abnormalities may evolve after ligamentous knee injuries, which manifests as abnormally organized neurites.Clinical Relevance:Ligamentous knee injuries require attention not only to damage to the structure of the knee joint itself but also to the process of maladaptive neuroplasticity that leads to structural and functional changes of the CST; novel interventions that target the corticospinal pathway may provide subsequent treatment of ligamentous knee injuries.
  Citation: Sports Health
  PubDate: 2024-06-15T06:09:40Z
  DOI: 10.1177/19417381241255342
Preventing Exertional Heat Stroke in Football: Time for a Paradigm Shift
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  Authors: Scott A. Anderson, E. Randy Eichner, Scott Bennett, Barry P. Boden, Bob Colgate, Ron Courson, Jon K. Davis, Gregory A. Elkins, Lawrence W. Judge, Mike Krueger, Kristen L. Kucera, Karissa Niehoff, Yvette Rooks, James B. Tucker, William O. Roberts
  Abstract: Sports Health, Ahead of Print.
  Context:Among American sports, football has the highest incidence of exertional heat stroke (EHS), despite decades of prevention strategies. Based on recent reports, 100% of high school and college EHS football fatalities occur during conditioning sessions. Linemen are the at-risk population, constituting 97% of football EHS deaths. Linemen heat up faster and cool down slower than other players.Evidence Acquisition:Case series were identified from organized, supervised football at the youth, high school, and collegiate levels and compiled in the National Registry of Catastrophic Sports Injuries. Sources for event occurrence were media reports and newspaper clippings, autopsy reports, certificates of death, school-sponsored investigations, and published medical literature. Articles were identified through PubMed with search terms “football,” “exertional heat stroke,” and “prevention.”Study Design:Clinical review.Level of Evidence:Level 5.Results:Football EHS is tied to (1) high-intensity drills and conditioning that is not specific to individual player positions, (2) physical exertion as punishment; (3) failure to modify physical activity for high heat and humidity, (4) failure to recognize early signs and symptoms of EHS, and (5) death when cooling is delayed.Conclusion:To prevent football EHS, (1) all training and conditioning should be position specific; (2) physical activity should be modified per the heat load; (3) understand that some players have a “do-or-die” mentality that supersedes their personal safety; (4) never use physical exertion as punishment; (5) eliminate conditioning tests, serial sprints, and any reckless drills that are inappropriate for linemen; and (6) consider air-conditioned venues for linemen during hot practices. To prevent EHS, train linemen based on game demands.Strength-of-Recommendation Taxonomy:n/a.
  Citation: Sports Health
  PubDate: 2024-06-14T01:27:54Z
  DOI: 10.1177/19417381241260045
Radial Tunnel Syndrome in a Collegiate Baseball Pitcher: A Case Report
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  Authors: Alex McCourt, Marissa Pazik, Ryan P. Roach, Toby Harkins, Giorgio Zeppieri, Robert Matthias, Kevin W. Farmer
  Abstract: Sports Health, Ahead of Print.
  A Division I baseball pitcher presented with chronic forearm pain in his throwing arm while pitching. Physical examination was remarkable for point tenderness over the radial tunnel. A postexertion magnetic resonance imaging (MRI) scan revealed edema around the posterior interosseous nerve. The patient underwent decompression of the nerve along with radial tunnel release, which resulted in full resolution of symptoms and return to full baseball activities. Radial tunnel syndrome is a rare phenomenon but can occur in throwing athletes. MRI immediately after a pitching session aided in accurate diagnosis and successful surgical management.
  Citation: Sports Health
  PubDate: 2024-06-13T08:45:14Z
  DOI: 10.1177/19417381241258479
Conditioning of Motor Evoked Responses After Anterior Cruciate Ligament
Reconstruction: Effects of Stimulus Intensity
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  Authors: Kazandra M. Rodriguez, Jungsun Moon, Chandramouli Krishnan, Riann M. Palmieri-Smith
  Abstract: Sports Health, Ahead of Print.
  Background:Operant conditioning of motor evoked torque (MEPTORQUE) can directly target the corticospinal pathway in patients with anterior cruciate ligament (ACL) reconstruction. However, it remains unclear whether operant conditioning can elicit short-term improvements in corticospinal excitability and whether these improvements are influenced by stimulus intensity.Hypothesis:Quadriceps MEPTORQUE responses can be upconditioned in a single session and will elicit short-term adaptations in corticospinal excitability, with higher stimulus intensities eliciting greater effects.Study Design:Randomized controlled laboratory study.Level of Evidence:Level 2.Methods:Thirty-six participants were assessed during a single session of an operant conditioning protocol. Participants were randomized into 1 of 3 groups for stimulus intensity used during operant conditioning based on the participant’s active motor threshold (AMT: 100%, 120%, and 140%). Quadriceps MEPTORQUE amplitude was evaluated during a block of control transcranial magnetic stimulation trials (CTRL) to establish baseline corticospinal excitability, and 3 blocks of conditioning trials (COND) during which participants trained to upcondition their MEPTORQUE. MEPTORQUE recruitment curves were collected to evaluate the effect of operant conditioning on acute corticospinal adaptations.Results:Participants with ACL reconstruction could upcondition their MEPTORQUE in a single session (P < 0.01; CTRL, 17.27 ± 1.28; COND, 21.35 ± 1.28 [mean ± standard error [SE] in N·m]), but this ability was not influenced by the stimulus intensity used during training (P = 0.84). Furthermore, significant improvements in corticospinal excitability were observed (P = 0.05; PRE, 687.91 ± 50.15; POST, 761.08 ± 50.15 [mean ± SE in N·m %AMT]), but stimulus intensity did not influence corticospinal adaptations (P = 0.67).Conclusion:Operant conditioning can elicit short-term neural adaptations in ACL-reconstructed patients. Future operant conditioning paradigms may effectively use any of the 3 stimulus intensities studied herein.Clinical Relevance:Operant conditioning may be a feasible approach to improve corticospinal excitability after ACL reconstruction.
  Citation: Sports Health
  PubDate: 2024-06-12T09:48:47Z
  DOI: 10.1177/19417381241257258
Effects of High-Velocity Versus Low-Velocity Resistance Training on Muscle
Echo Intensity in Healthy Young Women: A Randomized Controlled Trial
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  Authors: Zimin Wang, Masashi Taniguchi, Junya Saeki, Noriaki Ichihashi
  Abstract: Sports Health, Ahead of Print.
  Background:Improving muscle quality to prevent and treat muscle dysfunction is critical. However, effective measures to improve muscle quality remain poorly understood. We investigated the effects of high- and low-velocity resistance training (RT) on muscle quality, mass, and function before and after an 8-week intervention.Hypothesis:High-velocity RT would improve muscle quality more effectively than low-velocity RT.Study Design:Randomized controlled trial.Level of Evidence:Level 1.Methods:A total of 33 healthy young women (23.1 ± 2.2 years) were assigned randomly to high-velocity (n = 16) or low-velocity (n = 17) groups. Both groups underwent concentric knee extension RT with a 60% 1-repetition maximum (1RM) load, performing 10 repetitions of 4 sets, 3 times per week for 8 weeks. The high-velocity group was instructed to complete each repetition as quickly as possible (mean repetition duration of 0.5 seconds), while the low-velocity group was required to execute each repetition in 3 seconds. Before and after the 8-week intervention, quadriceps femoris echo intensity (EI), muscle thickness (MT), isokinetic peak torque (60 and 300 deg/s), rate of velocity development (RVD) at 300 deg/s, and 1RM were assessed. Split-plot factorial design analysis of variance was used to compare the group × time interaction.Results:A group×time interaction was observed for EI (P < 0.01). Only the high-velocity group showed a significant reduction in EI after the intervention. MT revealed a main effect of time (P < 0.01), with both groups significantly increasing MT. RVD showed a group × time interaction (P < 0.05), with significant increase only in the high-velocity group. Isokinetic peak torque and 1RM showed main effects of time (P < 0.01), with significant increases in both groups.Conclusion:High-velocity RT may be superior to low-velocity RT in enhancing muscle quality and RVD.Clinical Relevance:These results emphasize the importance of RT velocity for muscle quality improvement.
  Citation: Sports Health
  PubDate: 2024-06-12T09:35:21Z
  DOI: 10.1177/19417381241257181
Return to Running for Postpartum Elite and Subelite Athletes
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  Authors: Lisa Woodroffe, Tyler Slayman, Amanda Paulson, Natalie Kruse, Abigail Mancuso, Mederic Hall
  Abstract: Sports Health, Ahead of Print.
  Context:There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance and increased risk of injury. This paper addresses aspects that must be considered when building and monitoring a return to running program for a postpartum elite or subelite athlete, including pelvic floor and core stability, progressive reloading of the musculoskeletal system, monitoring of nutritional parameters, and considerations for lactation.Evidence Acquisition:PubMed and CINAHL (Cumulative Index for Nursing and Allied Health Literature) were searched with the following search strategy: (extreme sports OR elite athletes OR running OR exercise) AND (breastfeeding OR lactation OR bone density OR fetal weight OR gestational weight gain OR postpartum or post-partum OR postnatal OR post-natal OR pregnancy OR childbirth). The following information is based on best available evidence and clinical experience.Study Design:Clinical review.Level of Evidence:Level 4.Results:Due to the interplay between cardiovascular fitness, postpartum nutrition, lactation, and progressive reloading of the muscular and skeletal system, we propose a multimodal, multidisciplinary approach to safely and successfully allow an athlete to return to an elite level of competition.Conclusion:Return to running in the postpartum period is a highly individualized process that benefits from multidisciplinary, individualized care. This includes monitoring of nutrition, core and pelvic floor function, bone reloading, muscle and tendon reloading, and breastfeeding care when applicable.Strengh of recommendation taxonomy (SORT):C.
  Citation: Sports Health
  PubDate: 2024-06-12T09:29:27Z
  DOI: 10.1177/19417381241256973
Association of Premorbid Anxiety and Depression Symptoms in Concussion
Recovery in Collegiate Student-Athletes
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  Authors: Sabrina P. Sawlani, Joshua T. Goldman, Talin Babikian, David L. McArthur, Douglas Polster, Michael McCrea, Thomas McAllister, Christopher C. Giza, Justus D. Ortega, Nicholas Port, Margot Putukian, Jane McDevitt, Christopher C. Giza, Joshua T. Goldman, Holly J. Benjamin, Thomas Buckley, Thomas W. Kaminski, James R. Clugston, Luis A. Feigenbaum, James T. Eckner, Jason P. Mihalik, Scott Anderson, Christina L. Master, Anthony P. Kontos, Sara P.O. Chrisman, Kenneth Cameron, Stefan Duma, Christopher M. Miles
  Abstract: Sports Health, Ahead of Print.
  Background:Mental health disorders are linked to prolonged concussion symptoms. However, the association of premorbid anxiety/depression symptoms with postconcussion return-to-play timelines and total symptom burden is unclear.Objective:To examine the association of self-reported premorbid anxiety/depression symptoms in collegiate student-athletes with (1) recovery times until asymptomatic, (2) return-to-play, and (3) postconcussion symptom burden.Study Design:Athletes in the Concussion Assessment, Research and Education Consortium completed baseline concussion assessments (Sport Concussion Assessment Tool [SCAT3] and Brief Symptom Inventory-18 [BSI-18]). Athletes were tested postinjury at
  Citation: Sports Health
  PubDate: 2024-06-05T04:26:41Z
  DOI: 10.1177/19417381241255308
Society News
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  Abstract: Sports Health, Ahead of Print.
  
  Citation: Sports Health
  PubDate: 2024-06-03T09:49:16Z
  DOI: 10.1177/19417381241258200
Diving Into the Health Problems of Competitive Divers: A Systematic Review
of Injuries and Illnesses in Pre-elite and Elite Diving Athletes
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  Authors: Benjamin M. Currie, Michael K. Drew, Michael Hetherington, Gordon Waddington, Nicholas A.T. Brown, Liam A. Toohey
  Abstract: Sports Health, Ahead of Print.
  Context:The Olympic sport of diving involves the competitive disciplines of 3 m springboard and 10 m platform. Although it is generally accepted that lumbar spine injuries are common in diving athletes, the existing literature of health problems in diving athletes remains scarce.Objective:To identify the incidence, prevalence, and type of health problems that occur in competitive diving athletes.Data Sources:Medline, EMBASE, SportsDiscus, PsycINFO, and Google Scholar.Study Selection:Studies written in English investigating elite or pre-elite competitive diving (springboard, platform) injuries and/or illnesses were eligible. Two independent reviewers screened for inclusion by title, abstract, and full text in accordance with the eligibility criteria.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Data extraction was completed by 1 author using a structured form. A second author then independently reviewed and verified the extracted data, any discrepancies were resolved through consensus.Results:The search identified 2554 potential articles, with 28 studies meeting eligibility criteria. The surveillance setting of most studies was restricted to competition-based events, with the reported injury incidence proportion ranging from 2.1% to 22.2%. The reported injury incidence rate ranged from 1.9 to 15.5 per 1000 athlete-exposures. Injuries to the shoulder, lower back/lumbar spine, trunk, and wrist/hand were reported most frequently. The prevalence of low back pain was reported as high as 89% (lifetime), 43.1% (period), and 37.3% (point). The illness incidence proportion ranged from 0.0% to 22.2%, with respiratory and gastrointestinal illness reported most frequently.Conclusion:Up to 1 in 5 diving athletes sustain an injury and/or illness during periods of competition. A reporting bias was observed, with most cohort studies limiting surveillance to short competition-based periods only. This limits the current understanding of the health problems experienced by diving athletes to competition periods only and requires expansion to whole-of-year surveillance.
  Citation: Sports Health
  PubDate: 2024-06-03T09:46:20Z
  DOI: 10.1177/19417381241255329
Distal Tibiofibular Syndesmosis Injuries in the National Football League
(NFL): A Spectrum of Pathology That Correlates With Time to Return to Full
Participation
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  Authors: Andrew W. Kuhn, Michael J. Coughlin, Shane J. McGonegle, Mackenzie M. Herzog, Nate Weir, E. Meade Spratley, Cody M. O’Cain, Robert B. Anderson
  Abstract: Sports Health, Ahead of Print.
  Background:Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation.Hypothesis:In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation.Results:There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]).Conclusion:In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.
  Citation: Sports Health
  PubDate: 2024-05-28T09:25:41Z
  DOI: 10.1177/19417381241253223
Physical Therapy Intervention Effects on Alteration of Spinal Excitability
in Patients With Chronic Ankle Instability: A Systematic Review and
Meta-analysis
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  Authors: Chia-Wei Lin, Amornthep Jankaew, Cheng-Feng Lin
  Abstract: Sports Health, Ahead of Print.
  Context:Chronic ankle instability (CAI) is a common injury in athletes. Different forms of physical therapy have been applied to the population with CAI to assess their impact on spinal excitability.Objective:The purpose of this systematic review and meta-analysis was to investigate the effectiveness of various physical therapy interventions on the alteration of spinal excitability in patients with CAI.Data Sources:Four databases (EMBASE, MEDLINE, Cochrane CENTRAL, and Scopus) were searched from inception to November 2022.Study Selection:A total of 253 studies were obtained and screened; 11 studies on the effects of physical therapy intervention on the alteration of spinal excitability in patients with CAI were identified for meta-analysis.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 3a.Data Extraction:A total of 11 studies that included the maximal Hoffmann reflex normalized by the maximal muscle response (H/M ratio) in the peroneus longus and soleus muscles were extracted and summarized. The quality of the studies was assessed using the PEDro scale.Results:The extracted studies had an average PEDro score of 4.7 ± 1.4, indicating that most of them had fair-to-good quality. The physical therapy interventions included cryotherapy, taping, mobilization, proprioceptive training, and dry needling. The overall effects showed that the H/M ratios of the peroneus longus (P = 0.44, I2 = 0%) and soleus (P = 0.56,I2 = 22%) muscles were not changed by physical therapy in patients with CAI.Conclusion:The meta-analysis indicated that physical therapy interventions such as cryotherapy, taping, mobilization, proprioceptive training, and dry needling do not alter the spinal excitability in patients with CAI. Given that only 1 study reported ineffective changes in spinal excitability with dry needling, more research is essential to establish and validate its efficacy.PROSPERO Registration:CRD42022372998
  Citation: Sports Health
  PubDate: 2024-05-28T08:52:29Z
  DOI: 10.1177/19417381241253248
Effects of a Nonlinear Program on Different Health Parameters in the
Elderly
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  Authors: Salvador Vargas-Molina, Manuel García-Sillero, José Daniel Jiménez-García, Leandro Carbone, Diego A. Bonilla, Jorge L. Petro, Ramón Romance, Javier Benítez-Porres
  Abstract: Sports Health, Ahead of Print.
  Background:The aim of this research was to evaluate the impact of a nonlinear training program on visceral adipose tissue (VAT) and systolic (SBP) and diastolic (DBP) blood pressure, as well as the response of biochemical parameters such as fasting plasma glucose (FPG), total cholesterol (TC), high-density cholesterol (HDL-C), low-density cholesterol (LDL-C), and triglycerides (TG).Hypothesis:The nonlinear periodized program would produce greater improvements in outcomes than the linear periodized training program.Study Design:Randomized cross-sectional design.Level of Evidence:Level 3.Methods:Older adults with no previous training experience (10 male and 8 female [age, 64 ± 2.1 years; height, 165.12 ± 7.5 cm; body mass, 72.5 ± 11.4 kg; body max index, 26.5 ± 3.2 kg/m2]) were randomized to linear (n = 9, TT) or undulating (n = 9, UT) periodization. After a 3-week familiarization period, all participants performed 3 sessions of resistance training per week; 8 weeks of training were conducted for each group. Dual x-ray absorptiometry was used to measure VAT, and SBP and DBP were measured using an OMRON M3 digital automatic blood pressure monitor. Blood samples were collected between 8:00 a.m. and 9:30 a.m. after 12-hour overnight fasting.Results:Both interventions significantly (P < 0.05) decreased FPG, TC, LDL-C, and TG. A significant decrease in SBP and DBP was observed only in the UT group (P < 0.05). No significant between-group differences in outcomes were observed (P> 0.5). However, the effect size was marginally more pronounced for all outcomes in the UT group.Conclusion:An undulating periodization program was effective in improving VAT, TC, LDL-C, FPG, HDL-C, TG, and blood glucose levels in older adults.Clinical Relevance:Resistance training can be programmed in an undulating or traditional way in older adults based on improvements in health parameters, considering adherence and individual preferences.
  Citation: Sports Health
  PubDate: 2024-05-27T08:55:21Z
  DOI: 10.1177/19417381241253267
Epidemiology of Injury and Illness in North American Professional Men’s
Soccer: Comparing COVID-19 Lockdown With Previous Seasons
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  Authors: Stacey Hardin, Richard Silverman, Robert Brophy, Margot Putukian, Holly Silvers-Granelli
  Abstract: Sports Health, Ahead of Print.
  Background:After COVID-19 lockdown, studies across Europe and Asia examined its effect on professional soccer injury rates and severity; however, COVID-19 lockdown influence on injuries in United States men’s professional soccer has not been evaluated.Hypothesis:Injury and illness rates during the 2020 season were higher than the previous 2 seasons.Study Design:Retrospective observational cohort study.Level of Evidence:Level 3.Methods:Medical staff from participating Major League Soccer (MLS) clubs entered injuries and athletic exposures during the study period into a league-wide electronic medical record system. Injury rate and severity were analyzed to examine differentials between the 2020 COVID season and historical controls.Results:The injury incidence rate per 1000 hours in 2020 was 10.8, ie, higher than 2018 (5.4) and 2019 (5.0) (P < 0.05). Training injury incidence rate increased in 2020 (8.9) compared with 2018 (2.5) and 2019 (2.6) (P < 0.05), whereas match injury incidence decreased in 2020 (18.3) compared with 2018 (24.0) and 2019 (22.7) (P < 0.05). Incidence rates of lower extremity muscle injuries (6.04), anterior cruciate ligament (ACL) injuries (0.17), and concussions (0.49) were also higher in 2020 compared with 2018 (2.5, 0.07, 0.27) and 2019 (2.36, 0.05, 0.22) (P < 0.05). More injured players in 2020 missed>90 days (17.7%) than in 2018 (10.2%) and 2019 (10.1%) (P < 0.05). Incidence of all non-COVID-19 illness was higher in 2020 (3.93) than 2018 (1.53) and 2019 (1.32) (P < 0.05).Conclusions:During 2020, there were significant increases in incidence rates of overall injuries, training injuries, lower extremity muscular injuries, ACL injuries, concussions, and non-COVID illness, along with a higher percentage of players missing>90 days compared with the 2 previous seasons.Clinical Relevance:These results may help clarify the effects of future MLS inseason work stoppages and periods of restricted training.
  Citation: Sports Health
  PubDate: 2024-05-18T07:49:07Z
  DOI: 10.1177/19417381241253227
Does It Matter' Isometric or Isokinetic Assessment of Quadriceps Strength
Symmetry 9 Months After ACLR in Collegiate Athletes
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  Authors: Daniel G. Cobian, Keith A. Knurr, Mikel R. Joachim, Amy L. Bednarek, Andrew M. Broderick, Bryan C. Heiderscheit
  Abstract: Sports Health, Ahead of Print.
  Background:Greater quadriceps strength symmetry is associated with better outcomes after anterior cruciate ligament reconstruction (ACLR). Isometric and isokinetic assessments of quadriceps strength inform therapeutic exercise prescription and return-to-sport decisions. It is unclear whether isometric and isokinetic measures provide similar information post-ACLR.Hypothesis:Quadriceps strength symmetry is similar between isometric and isokinetic assessments. Isokinetic and isometric strength symmetries have similar associations to functional knee kinetics and self-reported knee function.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:NCAA Division I athletes (N = 35), 8.9 ± 2.5 months post-ACLR completed isometric and isokinetic quadriceps strength assessments, countermovement jumps (CMJs), and treadmill running. Self-reported knee function was assessed using the International Knee Documentation Committee Subjective Knee Form (IKDC). Agreement between isometric and isokinetic strength symmetry was assessed using Bland-Altman analysis, with associations to functional knee kinetics and IKDC assessed using Pearson correlations and linear regressions.Results:Mean difference in quadriceps strength symmetry between isokinetic and isometric assessments was 1.0% (95% limits of agreement of -25.1% to 23.0%). Functional knee kinetics during running and CMJ were moderately to strongly associated with isometric strength symmetry (r = 0.64-0.80, P < 0.01) and moderately associated with isokinetic strength symmetry (r = 0.41-0.58, P < 0.01). IKDC scores were weakly to moderately associated with isometric (r = 0.39, P = 0.02) and isokinetic (r = 0.49, P < 0.01) strength symmetry.Conclusion:Isokinetic and isometric assessments of quadriceps strength symmetry in collegiate athletes 9 months post-ACLR demonstrated strong agreement. Quadriceps strength symmetry is associated with functional knee kinetic symmetry post-ACLR.Clinical Relevance:Considerable individual variation suggests mode of contraction should be consistent throughout postoperative assessment. Isometric strength symmetry may be a better indicator of functional knee kinetic symmetry, while isokinetic strength symmetry may be associated more closely with patient-reported outcomes.
  Citation: Sports Health
  PubDate: 2024-05-14T08:55:12Z
  DOI: 10.1177/19417381241247819
How Does Physical and Psychological Recovery Vary Among Competitive and
Recreational Athletes After Anterior Cruciate Ligament Reconstruction'
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  Authors: Mandeep Kaur, Terese L. Chmielewski, Susan Saliba, Joe Hart
  Abstract: Sports Health, Ahead of Print.
  Background:The recovery and rehabilitation journey after anterior cruciate ligament reconstruction (ACLR) surgery can be different for competitive and recreational athletes as their motivation and goals toward sports are different.Hypothesis:Competitive athletes would present with better patient-reported outcomes and higher muscle strength compared with recreational athletes postsurgery. Second, competitive athletes would recover better (patient-reported outcome [PRO] measures and muscle strength) compared with recreational athletes at later stages.Study Design:Cross-sectional laboratory-based study.Level of Evidence:Level 2.Methods:A total of 245 patients with unilateral ACLR were categorized as competitive or recreational athletes and grouped into early (4-6.9 months) or late (7-10 months) stages of recovery. PRO were collected for psychological response (Tampa Scale Kinesiophobia; Anterior Cruciate Ligament-Return to Sport after Injury), perceived knee function (International Knee Documentation Committee subjective form [IKDC]), and quality of life (Knee injury and Osteoarthritis Outcome Score; Veteran Rand-12). Isokinetic, concentric knee extension strength was measured bilaterally with a multimodal dynamometer (System 4, Biodex Medical Systems) at a speed of 90° and 180°/s.Results:Competitive athletes had significantly higher scores for IKDC (P = 0.03), and quadriceps peak torque at 90°/s (P = 0.01) and 180°/s (P < 0.01) compared with recreational athletes. Competitive athletes had higher quadriceps strength at 90°/s (P < 0.01) and 180°/s (P = 0.02) in the late group. Recreational athletes displayed higher sports participation in the late group.Conclusion:Outcomes of ACLR may differ based on preinjury athletic level. Whereas competitive athletes had higher knee and muscle function than recreational athletes, psychological measures were not different among groups.Clinical Relevance:There is a need for more individualized care for patients with ACLR since there is variability among patient goals postsurgery. This information might help set realistic expectations for competitive and recreational athletes after surgery.
  Citation: Sports Health
  PubDate: 2024-05-13T05:46:45Z
  DOI: 10.1177/19417381241249413
Effects of Combining Transcranial Direct Current Stimulation With Balance
Training on Anticipatory Postural Adjustments in Persons With Chronic
Ankle Instability
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  Authors: Zivar Beyraghi, Roya Khanmohammadi, Mohammad Reza Hadian
  Abstract: Sports Health, Ahead of Print.
  Background:The combination of transcranial direct current stimulation (tDCS) with balance training could integrate central and peripheral neural mechanisms. This study aimed to investigate the effects of concurrent balance training and tDCS over the supplementary motor area (SMA) on anticipatory postural adjustments during gait initiation (GI) in persons with chronic ankle instability (CAI).Hypothesis:Balance training will increase the center of pressure (COP) velocity and displacement during GI phases in all participants, and those receiving real tDCS will show greater increases.Study Design:Randomized controlled trial.Level of Evidence:Level 2.Methods:A total of 32 subjects were allocated to 2 groups: (1) intervention (balance training plus real tDCS) and (2) control (balance training plus sham tDCS). Outcome measures were COP-related parameters (displacement and velocity) during phases of GI (anticipatory, weight transition, and locomotor).Results:The results showed that, in the anticipatory phase, the anteroposterior displacement of the COP was increased significantly at posttest relative to pretest across both groups, F(1,30) = 5.733, P = 0.02. In addition, both groups revealed an increase in the mediolateral COP velocity at posttest, F(1,30) = 10.523, P < 0.01. In the weight transition phase, both groups had higher mediolateral COP velocity at posttest, F(1,30) = 30.636, P < 0.01. In the locomotor phase, in both groups, the anteroposterior COP velocity was increased significantly at posttest compared with pretest, F(1,30) = 5.883, P = 0.02.Conclusion:Both groups demonstrated improvements in the anticipatory and execution phases of GI. Since no between-group difference was found, it can be interpreted that the anodal tDCS applied over the SMA has no added value over sham stimulation.Clinical Relevance:Balance training is beneficial for persons with CAI and can improve the anticipation and execution phases of GI without the aid of brain stimulation.
  Citation: Sports Health
  PubDate: 2024-05-08T10:23:08Z
  DOI: 10.1177/19417381241247746
Psychological Factors Are Related to Neuromuscular Asymmetries After
Anterior Cruciate Ligament Reconstruction
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  Authors: Joanna Borawski, Richard Arthur Brindle, Erin Florkiewicz, John S. Mason, Will Pitt, Kenneth L. Cameron, Michael S. Crowell
  Abstract: Sports Health, Ahead of Print.
  Background:After an anterior cruciate ligament reconstruction (ACLR), only 47% of military members return to full duty, possibly due to persistent neuromuscular asymmetries. Psychological factors may also contribute to reduced return to duty in military members.Hypothesis:Psychological factors and time since surgery would be associated negatively with neuromuscular asymmetries, asymmetries would be greater in cadets postsurgery when compared with healthy controls, and asymmetries would be greater at earlier timepoints after ACLR.Study Design:Case control.Level of Evidence:Level 4.Methods:This study examined the relationship between psychological factors and time since surgery with neuromuscular asymmetry, compared neuromuscular asymmetries between cadets with and without a history of ACLR, and explored differences in neuromuscular asymmetries at different timepoints in cadets with a history of ACLR. A total of 37 cadets post-ACLR (18.3 ± 9 months) and 28 controls participated. Psychological factors were assessed using the Tampa Scale of Kinesiophobia and Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI). Participants performed a drop-jump landing, joint positioning sense (JPS), and isometric quadriceps strength testing. Peak vertical ground-reaction forces (vGRF), absolute angle of replication, peak quadriceps torque, rate of torque development (RTD), and RTD time torque interval 200 ms (TTI200) were analyzed.Results:The ACL-RSI score was significantly related to limb symmetry index (LSI) peak quadriceps torque (r = 0.617, P < 0.01), LSI RTD (r = 0.367, P = 0.05), and LSI TTI200 (r = 0.0489, P < 0.01), but not time since surgery, JPS, or LSI peak vGRF. Cadets with a history of ACLR had significantly lesser ACL-RSI scores and greater asymmetries compared with controls.Conclusion:Reduced psychological readiness was associated with increased neuromuscular asymmetries after ACLR.Clinical Relevance:Clinicians should assess psychological readiness during rehabilitation after ACLR.
  Citation: Sports Health
  PubDate: 2024-05-08T10:18:12Z
  DOI: 10.1177/19417381241246754
Effect of Heat Acclimatization, Heat Acclimation, and Intermittent Heat
Training on Maximal Oxygen Uptake
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  Authors: Ryan A. Dunn, Lauren A. Fry, Yasuki Sekiguchi, Courteney L. Benjamin, Ciara N. Manning, Robert A. Huggins, Rebecca L. Stearns, Douglas J. Casa
  Abstract: Sports Health, Ahead of Print.
  Background:Maximal oxygen uptake (VO2max) is an important determinant of endurance performance. Heat acclimation/acclimatization (HA/HAz) elicits improvements in endurance performance. Upon heat exposure reduction, intermittent heat training (IHT) may alleviate HA/HAz adaptation decay; however, corresponding VO2max responses are unknown.Hypothesis:VO2max is maintained after HAz/HA; IHT mitigates decrements in aerobic power after HAz/HA.Study Design:Interventional study.Level of Evidence:Level 3.Methods:A total of 27 male endurance runners (mean ± SD; age, 36 ± 12 years; body mass, 73.03 ± 8.97 kg; height, 178.81 ± 6.39 cm) completed VO2max testing at 5 timepoints; baseline, post-HAz, post-HA, and weeks 4 and 8 of IHT (IHT4, IHT8). After baseline testing, participants completed HAz, preceded by 5 days of HA involving exercise to induce hyperthermia for 60 minutes in the heat (ambient temperature, 39.13 ± 1.37°C; relative humidity, 51.08 ± 8.42%). Participants were assigned randomly to 1 of 3 IHT groups: once-weekly, twice-weekly, or no IHT. Differences in VO2max, velocity at VO2max (vVO2), and maximal heart rate (HRmax) at all 5 timepoints were analyzed using repeated-measure analyses of variance with Bonferroni corrections post hoc.Results:No significant VO2max or vVO2 differences were observed between baseline, post-HAz, or post-HA (P = 0.36 and P = 0.09, respectively). No significant group or time effects were identified for VO2max or vVO2 at post-HA, IHT4, and IHT8 (P = 0.67 and P = 0.21, respectively). Significant HRmax differences were observed between baseline and post-HA tests (P < 0.01). No significant group or time HRmax differences shown for post-HA, IHT4, and IHT8 (P = 0.59).Conclusion:VO2max was not reduced among endurance runners after HA/HAz and IHT potentially due to participants’ similar aerobic training status and high aerobic fitness levels.Clinical Relevance:HAz/HA and IHT maintain aerobic power in endurance runners, with HAz/HA procuring reductions in HRmax.
  Citation: Sports Health
  PubDate: 2024-05-06T09:19:13Z
  DOI: 10.1177/19417381241249470
Influence of the External Workload on Calf Muscle Strain Injuries in
Professional Football Players: A Pilot Study
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  Authors: Aitor Soler, Fidel Agulló, Jose Hernández-Davó, Javier Raya-González, Juan Del Coso, Joaquín González-Ródenas, Víctor Moreno-Pérez
  Abstract: Sports Health, Ahead of Print.
  Background:The influence of external workload variables on the development of calf muscle strainsin football players has not been previously explored.Hypothesis:Overloaded players would have an increased risk of calf muscle strain injury.Study Design:Prospective observational study.Level of Evidence:Level 4.Methods:A total of 41 professional football players from 1 team were monitored for 2 consecutive seasons. Total distance covered (TD), and distances covered at high-intensity running, high sprint running, low (LACC) and high (HACC) acceleration, low (LDEC) and high (HDEC) deceleration, and at high metabolic load distance (HMLD) were monitored with GPS units. Accumulated players’ external workload in the week before injury was compared with the weekly mean value of the 6 weeks before injury occurred for each player.Results:Ten players (24.3%) suffered 16 calf muscle strain injuries (3.1 injuries per 1000 hours of match play; 0.5 injuries per 1000 hours of training exposure). Players with a calf muscle injury were older (p = 0.03), with higher body weight (p = 0.01) and height (p = 0.03). Injured players displayed substantially higher total training volume (p < 0.01), TD (p < 0.01), LACC (p < 0.01), LDEC (p < 0.01), HACC (p < 0.01), HDEC (p < 0.01), and HMLD (p = 0.03) in the week before injury, in comparison with the mean values of these variables in the 6 weeks before injury.Conclusion:A week with a higher-than-habitual external workload might increase the risk of calf muscle strain injury in professional football players. Calf muscle injuries were preceded by a week with unusually high workloads associated with accelerating and decelerating distances and higher training volumes.Clinical Relevance:Monitoring external workload indicators may be helpful in determine players with a higher risk of calf muscle strain injury due to excessive workload during training/competition.
  Citation: Sports Health
  PubDate: 2024-05-06T09:14:13Z
  DOI: 10.1177/19417381241247754
Rehabilitation Protocols in Elbow Medial Ulnar Collateral Ligament
Injuries: A Systematic Review of Articles Published in the Last 20 Years
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  Authors: Timothy R. Buchanan, Keegan M. Hones, Kevin A. Hao, Sravya Kamarajugadda, Brandon Portnoff, Jonathan O. Wright, Joseph J. King, Thomas W. Wright, Jongmin Kim, Bradley S. Schoch, Ryan P. Roach, William R. Aibinder
  Abstract: Sports Health, Ahead of Print.
  Context:Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management.Objective:This systematic review reports rehabilitation characteristics reported after UCL injuries and compares reported outcomes based on early versus delayed rehabilitation.Data Sources:Our search utilized PubMed/MEDLINE, Embase, Web of Science, and Cochrane to identify all articles on UCL rehabilitation published between January 1, 2002 and October 1, 2022.Study Selection:Studies in English with ≥5 patients that reported rehabilitation protocols for UCL injuries were evaluated.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Data included sample characteristics, time to achieve physical therapy milestones, outcome scores, and return-to-play (RTP) rate and timing.Results:Our review included 105 articles with a total of 15,928 elbows (98% male; weighted mean age, 23 years; follow-up, 47 months), with 15,077 treated operatively and 851 treated nonoperatively. The weighted mean time patients spent adhering to nonweightbearing status was 42 days. The mean time until patients were given clearance for active range of motion (ROM) 15 days, full ROM 40 days, and elbow strengthening exercises 32 days. The mean time until all restrictions were lifted was 309 days. The mean time to begin a throwing program was 120 days. Across all rehabilitation characteristics, protocols for patients undergoing nonoperative management started patients on rehabilitation earlier. After UCL reconstruction, earlier active ROM (≤14 days), elbow strengthening (≤30 days), no restrictions (≤180 days), and throwing (≤120 days) postoperatively led to earlier RTP without a negative effect on functional outcome scores.Conclusion:Current literature provides a spectrum of protocols for elbow UCL rehabilitation, regardless of management. Nonoperative patients began ROM activities, strengthening, and throwing programs sooner than operative patients, and earlier milestones led to earlier RTP.
  Citation: Sports Health
  PubDate: 2024-05-04T06:54:41Z
  DOI: 10.1177/19417381241249125
Fatigue Affects Body Acceleration During Vertical Jumping and Agility
Tasks in Elite Young Badminton Players
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  Authors: Kai-Chia Cheng, Ya-Lan Chiu, Chia-Liang Tsai, Yu-Liang Hsu, Yi-Ju Tsai
  Abstract: Sports Health, Ahead of Print.
  Background:Badminton is a sport demanding both high aerobic and anaerobic fitness levels, and fatigue can significantly impact game performance. However, relevant studies are limited, and none have employed a wearable inertial measurement unit (IMU) to investigate the effects of fatigue on athletic performance in the field.Hypothesis:Overall performance and body acceleration in both time and frequency domains during the fundamental badminton skills of vertical jumping and changes of direction will be affected by fatigue.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:A total of 38 young badminton players competing at the Division I level participated. Body accelerations while performing vertical jump and agility-T tests before and immediately after undergoing a fatigue protocol were measured by an IMU, positioned at the L4 to L5 level.Results:Jumping height decreased significantly by 4 cm (P < 0.01) after fatigue with greater downward acceleration (1.03 m/s2, P < 0.05) during the squatting subphase. Finishing time increased significantly by 50 ms only during the 10-m side-shuffling of the agility-T test (P = 0.02) after fatigue with greater peak and mean accelerations (3.83 m/s2, P = 0.04; 0.43 m/s2, P < 0.01), and higher median and mean frequency (0.38 Hz, P = 0.04, 0.11 Hz, P = 0.01).Conclusion:This study using a wearable IMU demonstrates the effects of fatigue on body acceleration in badminton players. The frequency-domain analysis further indicated that fatigue might lead to loss of voluntary control of active muscles and increased impacts on the passive elastic elements.Clinical Relevance:The findings imply that fatigue can lead to diminished athletic performance and highlight the potential for an increased risk of sports injuries. Consequently, maintaining precision in monitoring fatigue is crucial for elite young badminton players.
  Citation: Sports Health
  PubDate: 2024-04-18T12:19:48Z
  DOI: 10.1177/19417381241245908
Can Human Growth Hormone Accelerate Tendon and Ligament Injury
Recovery'
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  Authors: Keith M. Baumgarten, Eric S. Sandhurst, Hongli Sun
  Abstract: Sports Health, Ahead of Print.
  Background:Studies involving human fibroblasts and use of human growth hormone (HGH) administration for injury recovery are limited. It is plausible that if the administration of HGH to human cells increased cellular proliferation and differentiation, then HGH might be able to assist in accelerating recovery from injury.Hypothesis:HGH will increase proliferation and differentiation of human tendon and ligament fibroblasts in vitro based on both a single-dose and a sustained-dose model of HGH administration.Study Design:Basic science cellular study.Methods:Human tendon and ligament tissue were harvested from 24 patients. Tissue samples were digested with type I collagenase to isolate the target cell types. HGH was administered directly to isolated cells at doses ranging from 100 pg/mL to 10 µg/mL, either in a single-dose or a sustained-dose model. Proliferation was analyzed at days 4 and 7. Differentiation of ligament and tendon fibroblasts was assessed at day 14.Results:Administration of a single-dose of HGH to both cell types demonstrated similar or inferior cellular proliferation compared with controls after 7 days. For the sustained-dosing model of ligament fibroblasts, only the 100 ng/mL concentration demonstrated at least statistically similar or improved proliferation compared with controls. When examining the 100 ng/mL HGH concentration with larger sample sizes, cellular proliferation was not improved over controls for any cell type for the single- or sustained-dosing models. Proliferation for tendon fibroblasts was either similar or inferior to the control group at all concentrations of HGH. There was no clear dose-response relationship demonstrating enhanced collagen production with administration of HGH to suggest it enhances injury recovery.Conclusion:HGH administered to human tendon and ligament fibroblasts does not appear to positively affect cellular proliferation and differentiation.Clinical Relevance:This study does not support the use of HGH for accelerating recovery from injury.
  Citation: Sports Health
  PubDate: 2024-04-15T09:58:15Z
  DOI: 10.1177/19417381241245938
In-Season Training Load Variation - Heart Rate Recovery, Perceived
Recovery Status, and Performance in Elite Male Water Polo Players: A Pilot
Study
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  Authors: Petros G. Botonis, Gavriil G. Arsoniadis, Ilias Smilios, Argyris G. Toubekis
  Abstract: Sports Health, Ahead of Print.
  Background:Increased training and competition demands of the in-season period may disturb athlete fatigue and recovery balance. The aim of this study was to describe the training load distribution applied in a competitive period and the training adaptations and fatigue/recovery status of elite water polo players.Hypothesis:Effective workload management during tapering (TAP) would restore player recovery and enhance performance.Study Design:Case series.Level of Evidence:Level 4.Methods:Training load, perceived recovery, maximal speed in 100- and 200-meter swim, heart rate (HR) during submaximal swimming (HRsubmax) and HR recovery (HRR) were assessed in 7 outfield water polo players a week before starting a normal training microcycle (NM), after NM, and after congested (CON) and TAP training blocks in the lead-up to the Final Eight of the European Champions League.Results:Training load was higher in NM compared with CON and TAP by 28.9 ± 2.6% and 42.8 ± 2.1% (P < 0.01, d = 11.54, and d = 13.45, respectively) and higher in CON than TAP by 19.4 ± 4.2% (P < 0.01, d = 3.78). Perceived recovery was lower in CON compared with NM and TAP (P < 0.01, d = 1.26 and d = 3.11, respectively) but not different between NM and TAP (P = 0.13, d = 0.62). Both 100- and 200-meter swim performance was improved in TAP compared with baseline (P < 0.01, d = 1.34 and d = 1.12, respectively). No differences were detected among other training blocks. HRsubmax and most HRR were similar among the training periods.Conclusion:Effective management of training load at TAP can restore recovery and improve swimming performance without affecting HR responses.Clinical Relevance:Despite lower workloads, CON training impairs perceived recovery without affecting performance; however, a short-term training load reduction after a CON fixture restores recovery and improves performance.
  Citation: Sports Health
  PubDate: 2024-04-15T06:00:48Z
  DOI: 10.1177/19417381241245348
Novel Insights Into the Intratendinous Pressure Behavior of the Achilles
Tendon in Athletes
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  Authors: Lauren Pringels, Gilles Van Acker, Evi Wezenbeek, Arne Burssens, Luc Vanden Bossche MD
  Abstract: Sports Health, Ahead of Print.
  Background:In contrast to other musculoskeletal tissues, the normal pressure behavior of the Achilles tendon is poorly understood. This study aimed to explore the normal intratendinous and perfusion pressures of the Achilles tendon at rest and during exercise, and investigate potential correlations with tendon load and morphology.Hypothesis:Intratendinous and perfusion pressures of the Achilles tendon exhibit similarities to other musculoskeletal tissues and depend on tendon load and morphology.Study Design:Observational study.Level of Evidence:Level 3.Methods:A total of 22 recreational athletes were enrolled. Demographics, activity level, and blood pressures were recorded. Achilles tendon thickness and echogenicity were assessed 25 mm proximal to the posterosuperior calcaneal border. In this region, intratendinous and perfusion pressures of the Achilles tendon were measured at rest and during isometric plantarflexion up to 50 N, using the microcapillary infusion technique. Linear mixed models were used to investigate the effects of plantarflexion force, tendon thickness, and echogenicity on intratendinous and perfusion pressures.Results:At rest, intratendinous and perfusion pressures of the Achilles tendon were 43.8 ± 15.2 and 48.7 ± 18.4 mmHg, respectively. Intratendinous pressure increased linearly with plantarflexion force, reaching 101.3 ± 25.5 mmHg at 50 N (P < 0.01). Perfusion pressure showed an inverse relationship, dropping below 0 mmHg at 50 N (P < 0.01). Neither intratendinous nor perfusion pressures of the Achilles tendon correlated with tendon thickness or echogenicity.Conclusion:The normal intratendinous resting pressure of the Achilles tendon is higher than other musculoskeletal tissues, making it more susceptible to ischemia. During exercise, intratendinous pressure increases significantly to a level that lowers perfusion pressure, thereby compromising blood supply at already low plantarflexion forces.Clinical Relevance:Given the potential role of ischemia in Achilles tendinopathy, our findings caution against intratendinous injections, as they may exacerbate high intratendinous resting pressure, and against prolonged postexercise tendon stretching, as the associated rise in intratendinous pressure may impair the required hyperemic response.
  Citation: Sports Health
  PubDate: 2024-04-13T04:27:58Z
  DOI: 10.1177/19417381241245357
Effect of Low-Intensity Bloodflow Restriction Training on Nontraumatic
Knee Joint Conditions: A Systematic Review and Meta-analysis
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  Authors: PeiQiang Peng, Yuming Lu, YueTing Wang, Xin Sui, Zhenning Yang, Haiyan Xu, Shuang Zhang
  Abstract: Sports Health, Ahead of Print.
  Context:Nontraumatic knee conditions are common in clinical practice. Existing pharmaceutical and immobilization approaches provide limited pain relief and functional enhancement. Low-intensity bloodflow restriction training (LI-BFRT) is being investigated as a nonpharmacological alternative; however, its efficacy is uncertain.Objective:To assess the effectiveness of LI-BFRT for nontraumatic knee conditions and compare it with high-intensity resistance training (HI-RT) and low-intensity resistance training (LI-RT).Data Sources:PubMed, EBSCO, Science Direct, Cochrane Library, China Knowledge Infrastructure, Wanfang Data, and VIP databases were searched until May 30, 2023.Study Selection:Original randomized controlled trials involving nontraumatic knee joint conditions with interventions consisting mainly of LI-BFRT, HI-RT, or LI-RT. The results assessed mainly pain and muscle performance.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 1.Data Extraction:Sample characteristics, study design, country, disease, groups, evaluation time, duration, and outcomes were extracted.Results:A total of 13 randomized controlled trials were included in the systematic review. Compared with pretreatment, LI-BFRT significantly alleviated pain (weighted standardized mean difference [SMD], -1.33; 95% CI, -1.62 to -1.05), with better additional effects on hip muscle training (SMD, -3.14; 95% CI, -4.07 to -2.75). Compared with LI-RT, LI-BFRT significantly relieved pain in male patients (SMD, -1.47; 95% CI, -1.92 to -1.01). LI-BFRT significantly increased quadriceps cross-sectional area (SMD, 0.53; 95% CI, 0.27-0.78), knee extension strength (SMD, 0.84; 95% CI, 0.48-1.2), and leg press strength (SMD, 0.64; 95% CI, 0.34-0.94) compared with pretreatment. Its effects were superior to those of LI-RT and similar to those of HI-RT. However, sex differences in muscle strength improvement were observed.Conclusion:In patients with nontraumatic knee joint conditions, LI-BFRT effectively alleviated pain, increased muscle cross-sectional area, and enhanced muscle strength. LI-BFRT showed pain relief comparable with that of LI-RT while surpassing LI-RT in muscle growth and strength improvement.
  Citation: Sports Health
  PubDate: 2024-04-08T09:38:30Z
  DOI: 10.1177/19417381241235147
Return to Golf After Hip Arthroscopy: A Systematic Review of the
Literature
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  Authors: Jake X. Checketts, Olivia Panchal, B. Joshua Stephens, Amar Patel, Conner Howard, Tyler Hunt, Arjun K. Reddy, Beaun Checketts, Chad Hanson
  Abstract: Sports Health, Ahead of Print.
  Context:Patients experiencing pain from femoral acetabular impingement and considering hip arthroscopy may be concerned about their timeline to resume activities they enjoy, such as golf.Objective:The purpose of this study was to review current literature on return-to-play data after hip arthroscopy and to provide clinicians with data to set proper expectations with patients.Data Sources:The following terms were used to search PubMed and Embase electronic databases on October 18, 2023: hip, arthroscopy, arthroscopic, golf.Study Selection:Studies were included if they were in the English language, of Level 1 to 4 evidence, and contained data specific to golfers undergoing hip arthroscopy. Studies were excluded if they did not designate participants as golfers or did not specify return-to-play data. Editorials, case reports, and review articles were excluded. Screening was completed by 2 authors in a blind and duplicate manner.Study Design:Systematic review.Level of Evidence:Level II.Data Extraction:The following datapoints were extracted from each study: hip pathology and arthroscopic procedure data; number of players returning to golf and time from surgery to return; outcome score(s); and rehabilitation details. Descriptive statistics were calculated using Comprehensive Meta-Analysis software.Results:The search returned 400 studies, of which 4 were included for analysis. Of these 4 studies, 2 specified return-to-play time. Of 95 golfers, 90 (94.7%) returned to golf successfully after arthroscopic hip surgery. Subjective and objective outcome scores improved postoperatively, including an increased average drive distance.Conclusion:Return to golf after hip arthroscopy is highly probable, with approximately 95% of patients throughout literature returning to play. A mean return time of 4.7 months for professional golfers and 7.2 months for amateurs, alongside improved subjective outcomes and performance metrics postsurgery, suggest patients can expect a relatively quick return to the course with similar or improved performance.
  Citation: Sports Health
  PubDate: 2024-04-06T07:06:58Z
  DOI: 10.1177/19417381241235214
Association of Muscle Strength, Psychological Factors, and Central
Sensitization With Movement-Evoked Pain in Patients With Nonspecific
Chronic Low Back Pain: The BACKFIT Project
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  Authors: Víctor Segura-Jiménez, Gavriella Tsiarleston, Belén Donoso, Yolanda María Gil-Gutiérrez, Manuel Delgado-Fernández
  Abstract: Sports Health, Ahead of Print.
  Background:People with chronic pain might evade certain movements to prevent their experience of pain. Movement-evoked pain (MEP) might induce lower functionality during daily activities.Hypothesis:(1) MEP after physical fitness tests would vary depending on the main musculature involved in the test; (2) physical and psychological factors would be associated with MEP in patients with NSCLBP.Study Design:Cross-sectional design.Level of Evidence:Level 3.Methods:A total of 104 (69 women) patients aged 51.0 ± 10.3 years with NSCLBP participated. MEP was measured with a visual analog scale (VAS) at baseline and immediately after performing each physical fitness test, that is, the Biering-Sørensen, prone bridging, handgrip, chair-stand, and 8-foot time-up-and-go tests, measuring back extensor, back flexor, upper- and lower-body muscle strength, and motor agility, respectively. Global muscle strength was calculated with normalized index (z-score) procedure. Depression, anxiety, pain catastrophizing, and central sensitization were assessed with the Beck Depression Inventory II, State Trait Anxiety Inventory I, Pain Catastrophizing Scale, and Central Sensitization Inventory (CSI), respectively.Results:Patients showed greater pain after completion of the Biering-Sørensen (mean difference 95% CI, 0.02, 1.11), prone bridging (0.15, 1.21), lower pain after handgrip (-1.46, -0.52), and the 8-foot time-up-and-go (-1.43, 0.46) tests (all P ≤ 0.04). Lower global muscular strength (β between -0.18 and -0.30), and greater pain catastrophizing (β = 0.16), and CSI scoring (β between 0.18 and 0.27) were associated with greater MEP (all P ≤ 0.04).Conclusion:Greater MEP was observed after tests measuring core musculature strength than after tests measuring distal (limbs) strength and agility. Greater MEP was overall associated with lower muscle strength, greater pain catastrophizing, and central sensitization.Clinical Relevance:Fitness testing might be implemented as a complementary tool for the monitoring of NSCLBP in clinical settings.
  Citation: Sports Health
  PubDate: 2024-04-03T04:01:02Z
  DOI: 10.1177/19417381241235152
Beyond the Jump: A Scoping Review of External Training Load Metrics in
Volleyball
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  Authors: André Rebelo, João R. Pereira, Fábio Y. Nakamura, João Valente-dos-Santos
  Abstract: Sports Health, Ahead of Print.
  Context:Volleyball is a complex sport involving multifaceted movements and high-velocity actions, leading to diverse external training loads (ETLs) that have profound implications for player performance and injury risk.Objective:To provide a comprehensive overview of the measurement of ETL in volleyball, identify gaps in current understanding, and offer valuable insights for stakeholders in the field.Data Sources:The literature search was conducted across the following electronic databases: PubMed/Medline, Scopus, Web of Science, and SPORTDiscus.Study Selection:Studies were selected based on their relevance to the measurement of ETL in volleyball.Study Design:A scoping review methodology was chosen to map and summarize the broad body of literature related to ETL measurement in volleyball.Level of Evidence:Level 4.Data Extraction:Data related to ETL measurements in volleyball were extracted and analyzed from the selected studies, focusing on metrics utilized, player positions examined, and technologies employed.Results:A total of 18 studies related to ETL in volleyball were identified and examined for this review. Despite the importance of sagittal plane movements in volleyball, the review identified a substantial research gap regarding ETL measurements beyond this plane, as well as a lack of focus on the unique demands of different player positions like the liberos. The use of technologies such as inertial measurement units was prevalent, but more comprehensive measurement methods are needed.Conclusion:There is a critical need for diversified ETL metrics in volleyball, extending beyond the conventional sagittal plane measurements. The findings highlight a substantial research gap in addressing the unique demands of different player positions, notably the liberos. This study underscores the importance of incorporating multiplanar movement data, player-specific roles, and advanced measurement technologies to develop more tailored training programs and injury prevention strategies.
  Citation: Sports Health
  PubDate: 2024-04-01T06:28:53Z
  DOI: 10.1177/19417381241237738
UCL Throwing Injuries in Nonprofessional Baseball Players: A 14-Year
Retrospective Study
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  Authors: Jason L. Zaremski, Marissa Pazik, Harold Hunt, William S. Dodd, Binh K. Nguyen, Kevin W. Farmer, MaryBeth Horodyski
  Abstract: Sports Health, Ahead of Print.
  Background:This study evaluated treatment modality (surgical vs nonoperative) of medial ulnar collateral ligament (UCL) injuries in nonprofessional throwing baseball athletes by comparing type, severity, and location of UCL injury.Hypothesis:Baseball players with closed medial epicondyle physes and concomitant throwing-related UCL injury will be more likely to undergo surgical intervention than players with open medial epicondyle physes.Study Design:Retrospective.Level of Evidence:Level 5.Methods:A total of 119 baseball players with a mean age of 16.9 ± 2.5 years (range, 11-25 years) were included in the study. Datapoints included sex, age at time of injury, severity, and location of UCL injury, growth plate status, operative versus conservative management, and concomitant flexor forearm injury.Results:A total of 75 players were treated conservatively; 43 underwent UCL reconstruction (UCL-R), and 1 had an unknown treatment outcome. No significant difference was found for age related to treatment type, UCL-R (17.2 ± 2.2) versus conservative treatment (16.8 ± 2.6). Athletes with closed medial epicondylar growth plates were more likely to undergo UCL-R than athletes with open medial epicondylar growth plates (P = 0.02). There were no significant differences between UCL injury location (42 distal, 37 proximal, 18 combined tear locations, 11 complete tears, and 11 intact UCLs with inflammation) by treatment type (P = 0.09). There was a significant difference for UCL severity (11 complete tears, 96 partial tears) by treatment type (P = 0.03).Conclusion:Nonprofessional athletes with closed medial epicondylar growth plates and throwing-related UCL injuries were more likely to be treated surgically. Baseball athletes with partial tears, if skeletally immature, require further long-term evaluation.Clinical Relevance:Continued knowledge gains in this area of throwing medicine will further improve our treatment algorithms in nonprofessional baseball players.
  Citation: Sports Health
  PubDate: 2024-03-30T04:14:17Z
  DOI: 10.1177/19417381241238966
Interval Throwing Programs for Baseball Players: Methodological Assessment
of the Quality and Construct of Publicly Available Programs
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  Authors: Alexander M. Boos, Namit Sambare, Matthew V. Smith, Michael T. Freehill, Eric N. Bowman, Brandon J. Erickson, Peter N. Chalmers, Aaron Sciascia, Christopher L. Camp
  Abstract: Sports Health, Ahead of Print.
  Context:The quality and interprogram variability of publicly available throwing programs have not been assessed.Objective:To (1) identify publicly available interval throwing programs, (2) describe their components and structure, and (3) evaluate their quality, variability, and completeness.Data Sources:Google, Bing, Yahoo; keyword: “interval throwing program.”Study Selection:Baseball-specific publicly available programs.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Independent evaluation by 2 authors using a novel 21-item Quality Assessment Rubric (QAR).Results:Of the 99 included programs, 54% were designed for return from injury/surgery; 42% explicitly stated no expected timeline for completion, and approximately 40% did not provide criteria to initiate the program. Program construction was highly variable. There were broad-ranging shortest (mean: 40±8 ft, range: 20-45 ft) and longest (mean: 150±33 ft, range: 90-250 ft) long toss distances, and variable maximum numbers of mound pitches thrown before returning to game play (range: 40-120, mean: 85). Only 63% of programs provided guidelines for handling setbacks, and standardized warm-ups, arm care, and concomitant training were absent in 32%, 63%, and 47% of programs, respectively. Mean QAR completion rate and QAR item response rate were low (62 ± 4% [range, 24-91%], 62 ± 24% [range, 7-99%], respectively). Finally, only 20 (20%) programs provided at least 1 peer-reviewed reference, most of which were published>10 years ago.Conclusion:Publicly available interval throwing programs are readily available but demonstrate significant interprogram heterogeneity across multiple areas including target audience, program construction, progression, and execution. The quality and consistency of publicly available interval throwing programs is poor at this time, which may limit their utility and effectiveness for baseball players attempting to return to competition. This work identifies a multitude of deficiencies in currently available throwing programs that should be targets of future improvement efforts.
  Citation: Sports Health
  PubDate: 2024-03-28T12:21:31Z
  DOI: 10.1177/19417381241237011
Customized Landing Task for ACL Injury Risk Assessment: Kinematic
Sex-Related Differences
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  Authors: Claudia Brunetti, Rodrigo Rabello, Federico Adragna, Lucas Silva Zandonato, Alessandro Zucchetti, Filippo Bertozzi, Manuela Galli, Chiarella Sforza
  Abstract: Sports Health, Ahead of Print.
  Background:Women present a higher anterior cruciate ligament (ACL) injury rate than men, suggesting sex-related biomechanical differences. Task characteristics are often fixed for both sexes, possibly affecting the perceived difficulty. We investigated kinematic sex differences across landing tasks for ACL injury risk assessment, adjusted to participants’ anthropometrics/performance, and whether different tasks affect kinematic sex comparisons.Hypothesis:Female subjects would exhibit motion patterns more associated with ACL injury risk, and sex-related differences may depend on task type.Study Design:Descriptive laboratory study.Level of Evidence:Level 3.Methods:A total of 27 female and 29 male amateur players (18-30 years) executed horizontal hop, drop jump (DJ), and DJ followed by vertical or forward jump (length, proportional to maximal forward jump; box, 20% participant’s height). An optoelectronic system provided lower limb kinematics at initial contact and peaks until maximum knee flexion (KF), analyzed separately by multivariate analysis of variance (MANOVA) (α = 0.05).Results:At initial contact, the interaction term had significant effects on hip adduction (P < 0.01) and knee abduction (KAb) (P = 0.04); female participants demonstrated higher KAb (P < 0.01) and knee internal rotation (P = 0.05). For peaks analysis, the interaction term had no significant effects on any individual variable, although significant in MANOVA; female participants had higher KAb (P = 0.01) and lower KF (P = 0.04). Task type affected hip flexion and knee angles in both analyses.Conclusion:All variables in which significant sex-related differences were found are potential ACL injury risk factors, and all findings indicate that the analyzed female sample exhibited higher injury-related patterns. Although customized, male and female participants showed different landing strategies depending on the task.Clinical Relevance:The findings underline how female participants adopted potentially harmful kinematics while executing customized landing tasks (adjusted by subject’s anthropometrics/performance), which may enhance risk of ACL injury.
  Citation: Sports Health
  PubDate: 2024-03-28T06:48:17Z
  DOI: 10.1177/19417381241236893
Effects of Blood flow Restriction and Load on Mean Propulsive Velocity and
Subjective Perceived Exertion During Squat and Bench Press Exercises
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  Authors: Josep M. Serrano-Ramón, Marco A. García-Luna, Sergio Hernández-Sánchez, Juan M. Cortell-Tormo, Miguel García-Jaén
  Abstract: Sports Health, Ahead of Print.
  Background:The aim of this study was to determine the influence of different percentages of blood flow restriction (BFR) and loads on mean propulsive velocity (MPV) and subjective perceived exertion during squat (SQ) and bench press (BP) exercises.Hypothesis:Higher percentages of BFR will positively affect dependent variables, increasing MPV and reducing perceived exertion.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Eight healthy young male athletes took part. Two sets of 6 repetitions at 70% 1-repetition maximum (1RM), 2 sets of 4 repetitions at 80% 1RM, and 2 sets of 2 repetitions at 90% 1RM were performed randomly; 5-minute recoveries were applied in all sets. The varying arterial occlusion pressure (AOP) applied randomly was 0% (Control [CON]), 80%, and 100%.Results:No statistically significant differences in MPV were found during the BP exercise at any percentage of BFR at any percentage 1RM. During the SQ exercise, MPV results showed statistically significant increases of 5.46% (P = 0.04; ηp2 = 0.31) between CON and 100% AOP at 90% 1RM. The perceived exertion results for the BP exercise showed statistically significant reductions of -8.66% (P < 0.01; ηp2 = 0.06) between CON and 100% AOP at 90% 1RM. During the SQ exercise, the perceived exertion results showed significant reductions of -10.04% (P = 0.04; ηp2 = 0.40) between CON and 100% AOP at 80% 1RM; -5.47% (P = 0.02; ηp2 = 0.48) between CON and 80% AOP at 90% 1RM; and -11.83% (P < 0.01; ηp2 = 0.66) between CON and 100% AOP at 90% 1RM.Conclusion:BFR percentages ~100% AOP at 90% 1RM improved acutely MPV (only in SQ exercises) and reduced acutely perceived exertion (in both exercises). These findings are important to consider when prescribing resistance training for healthy male athletes.
  Citation: Sports Health
  PubDate: 2024-03-28T06:28:32Z
  DOI: 10.1177/19417381241236808
Impact of Lifting Straps on the Relationship Between Maximum Repetitions
to Failure and Lifting Velocity During the Prone Bench Pull Exercise
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  Authors: Sergio Miras-Moreno, Amador García-Ramos, Francisco J. Rojas-Ruiz, Alejandro Pérez-Castilla
  Abstract: Sports Health, Ahead of Print.
  Background:Fastest mean (MVfastest) and peak (PVfastest) velocity of the set have been proposed to predict the maximum number of repetitions to failure (RTF) during the Smith machine prone bench pull (PBP) exercise.Hypothesis:Goodness-of-fit would be higher for individualized compared with generalized RTF-velocity relationships and comparable for both execution equipment conditions (with or without straps), and the MVfastest and PVfastest associated with each RTF would be comparable between execution equipment and prediction methods (multiple- vs 2-point method).Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:After determining the PBP 1-repetition maximum (1RM), 20 resistance-trained male athletes performed 2 sessions randomly, with and without lifting straps, consisting of single sets to failure against the same load sequence (60% to 80% to 70% 1RM). Generalized (pooling data from all subjects) and individualized (separately for each subject using multiple-point or 2-point methods) RTF-velocity relationships were constructed.Results:Individualized RTF-velocity relationships were always stronger than generalized RFT-velocity relationships, but comparable with (MVfastest: r2 = 0.87-0.99]; PVfastest: r2 = 0.88-1.00]) and without (MVfastest: r2 = 0.82-1.00; PVfastest: r2 = 0.89-0.99]) lifting straps. The velocity values associated with each RTF were comparable between execution equipment (P ≥ 0.22), but higher for the multiple-point compared with the 2-point method (P < 0.01).Conclusion:The use of lifting straps during the Smith machine PBP exercise does not affect the goodness-of-fit of the RTF-velocity relationships or the velocity values associated with different RTFs. However, caution should be exercised when using different methods.Clinical Relevance:The benefits of the RTF-velocity relationships can be extrapolated when using lifting straps, and the 2-point method can also be used as a quick and more fatigue-free procedure. Nevertheless, it is imperative for coaches to ensure that these relationships are reflective of fatigue experienced during training.
  Citation: Sports Health
  PubDate: 2024-03-28T06:19:59Z
  DOI: 10.1177/19417381241235163
Relationship Between Running Biomechanics and Core Temperature Across a
Competitive Road Race
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  Authors: Alexandra F. DeJong Lempke, Michael R. Szymanski, Sarah B. Willwerth, Gabrielle J. Brewer, Kristin E. Whitney, William P. Meehan, Douglas J. Casa
  Abstract: Sports Health, Ahead of Print.
  Background:Outdoor races introduce environmental stressors to runners, and core temperature changes may influence runners’ movement patterns. This study assessed changes and determined relationships between sensor-derived running biomechanics and core temperature among runners across an 11.27-km road race.Hypothesis:Core temperatures would increase significantly across the race, related to changes in spatiotemporal biomechanical measures.Study Design:Cross-sectional cohort study.Level of Evidence:Level 3.Methods:Twenty runners (9 female, 11 male; age, 48 ± 12 years; height, 169.7 ± 9.1 cm; mass, 71.3 ± 13.4 kg) enrolled in the 2022 Falmouth Road Race were recruited. Participants used lightweight technologies (ingestible thermistors and wearable sensors) to monitor core temperature and running biomechanics throughout the race. Timestamps were used to align sensor-derived measures for 7 race segments. Observations were labeled as core temperatures generally within normal limits (
  Citation: Sports Health
  PubDate: 2024-03-27T09:34:29Z
  DOI: 10.1177/19417381241236877
Effects of Eccentric Versus Concentric Strengthening in Patients With
Subacromial Pain Syndrome: A Randomized Controlled Trial
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  Authors: Damla Karabay, Sevgi Sevi Yeşilyaprak, Mehmet Erduran, Cem Ozcan
  Abstract: Sports Health, Ahead of Print.
  Background:Subacromial pain syndrome (SPS) is the most common cause of shoulder pain. Therapeutic exercise is the first-line treatment for SPS; however, the ideal exercise type remains unclear. Here, we compared the effects of eccentric and concentric strengthening in patients with SPS.Hypothesis:Adding isolated eccentric strengthening to a multimodal physiotherapy program (MPP) would lead to greater improvements in outcomes compared with either MPP alone or adding isolated concentric strengthening to the MPP.Study Design:Randomized controlled trial.Level of Evidence:Level 2.Methods:A total of 45 patients were randomized to eccentric strengthening (ESG), concentric strengthening (CSG), and control (CG) groups; all groups received the MPP. The strengthening groups also performed group-specific strengthening. Shoulder pain, abduction and external rotation (ER) strength, joint position sense (JPS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand score were collected at baseline, after 12 weeks of treatment, and at week 24.Results:For CMS, ESG exhibited a greater, but not clinically meaningful, improvement than CSG and CG (P < 0.05). Eccentric abduction strength increased in ESG compared with CG. From baseline to follow-up, abduction strength increased in ESG compared with CSG and CG. Eccentric abduction strength increased in CSG compared with CG. JPS at abduction improved in the ESG compared with CG. Other between-group comparisons were not significant (P> 0.05).Conclusion:In SPS, eccentric strengthening provided added benefits, improving shoulder abduction strength and JPS at abduction, and was superior to concentric strengthening for improving shoulder abduction strength. Neither strengthening approach had an additional effect on shoulder function, pain, ER strength, or rotational JPS.Clinical Relevance:Clinicians could implement eccentric strengthening as a motor control retraining for strength and proprioception gain rather than for pain relief and reducing disability.
  Citation: Sports Health
  PubDate: 2024-03-27T05:22:02Z
  DOI: 10.1177/19417381241236817
Subjective Causes for Failure to Return to Sport After Anterior Cruciate
Ligament Reconstruction: A Systematic Review and Meta-analysis
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  Authors: Katie Yensen, Cory K. Mayfield, Ioanna K Bolia, Ryan A. Palmer, Michael Brown, Daniel R. Kim, Maya S. Abu-Zahra, Jacob L. Kotlier, Thomas Webb, Emmett Cleary, Nima Saboori, Frank A. Petrigliano, Alexander E. Weber
  Abstract: Sports Health, Ahead of Print.
  Context:While current literature has explored the outcomes of athletes who return to sport (RTS) after anterior cruciate ligament (ACL) injuries, less is known about the outcomes of those who are unsuccessful in returning to sport.Objective:To determine the rate of athletes who did not RTS after primary ACL reconstruction (ACLR) and to identify the specific subjective reasons for failure to RTS.Data Sources:A comprehensive search of the PubMed/MEDLINE, Scopus, and Web of Science databases was conducted through April 2021.Study Selection:Eligible studies included those explicitly reporting the rate of failure for RTS after ACLR as well as providing details on reasons for athletes’ inability to return; 31 studies met the inclusion criteria.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 2 to 4.Data Extraction:The reasons for failure to RTS referred to in our study are derived from those established previously in the studies included. Data were collected on the number of athletes, mean age, mean follow-up time, type of sport played, failure to RTS rate, and specific reasons for failure to return.Results:The weighted rate of failure to RTS after ACLR was 25.5% (95% CI, 19.88-31.66). The estimated proportion of psychosocial-related reasons cited for failure to RTS was significantly greater than knee-related reasons for failure RTS (55.4% vs 44.6%, P < 0.01). The most cited reason for failure to RTS was fear of reinjury (33.0%).Conclusion:This study estimates the rate of failure to RTS after ACLR to be 25.5%, with the majority of athletes citing fear of reinjury as the major deterrent for returning to sports. We highlight how factors independent of surgical outcomes may impact an athlete’s ability to return to play given that the predominant reason for no RTS after ACLR was unrelated to the knee.
  Citation: Sports Health
  PubDate: 2024-03-27T05:12:56Z
  DOI: 10.1177/19417381241231631
Utilizing the Pronated Forearm Technique for Measuring Glenohumeral
External Rotation in Baseball Players
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  Authors: Aaron Sciascia, Michael Smith, Joseph Holstedt, Logan Mattingly, W. Ben Kibler
  Abstract: Sports Health, Ahead of Print.
  Background:Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and total range of motion (TROM) have been linked with increased injury risk. GER capacity has been measured routinely with the forearm in neutral rotation (GERN), but a recent study reported GERN was greater than GER with the forearm in pronation (GERP) in Minor League pitchers. This work has not yet been replicated or extended to other groups.Hypothesis:GERP would be significantly less than GERN in Independent League baseball pitchers, and there would be no difference in GERP or GERN measurements between this new group and the previous group of Minor League pitchers.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Goniometric measurements were recorded for bilateral GIR, GERN, and GERP, and resulting TROM for 37 Independent League baseball pitchers. These data were compared with the previous study. All motions were compared individually between groups, between throwing and nonthrowing arm, and both within and between techniques (forearm neutral or pronated).Results:GERP was significantly less than GERN for both arms within each group tested (P < 0.01). Independent League pitchers had greater between arm differences for GIR (-16.9° vs -6.9°), GERN (+15.1° vs -0.6°), and GERP (+13.1° vs -5.9°) compared with Minor League pitchers. TROM for the Independent League pitchers was not statistically different for either measurement technique, while TROM for the throwing arm of the Minor League pitchers was statistically reduced with varying effect sizes (d = 0.35-0.99) compared with the nonthrowing arm (P < 0.01).Conclusion:This study confirmed earlier findings that the pronated forearm resulted in decreased GER capacity, illustrating the adaptive response to throwing and the need to evaluate for this variable.Clinical Relevance:GERP should be evaluated in all groups of pitchers, but there may be variations within tested groups.
  Citation: Sports Health
  PubDate: 2024-03-19T04:45:14Z
  DOI: 10.1177/19417381241235225
Favorable Clinical Outcomes After Humeral Head Depressor Muscle
Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff
Repair: A Randomized Controlled Trial
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  Authors: Caner Kararti, Anıl Özüdoğru, Hakkı Çağdaş Basat, İsmail Özsoy
  Abstract: Sports Health, Ahead of Print.
  Background:The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR.Hypothesis:We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR.Study Design:Randomized controlled single-blind study.Level of Evidence:Level 1B.Methods:A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized “DM-Co-A Training” was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality.Results:There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group (P < 0.05).Conclusion:A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.
  Citation: Sports Health
  PubDate: 2024-03-19T04:40:32Z
  DOI: 10.1177/19417381241235184
Relationship Between Postural Stability and Proprioception, Pain,
Quadriceps Strength, and Muscle Tightness in Athletes With Patellar
Tendinopathy
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  Authors: Thouraya Fendri, Bruno Beaune, Sofien Kasmi, Fatma Chaari, Sonia Sahli, Sébastien Boyas
  Abstract: Sports Health, Ahead of Print.
  Background:Athletes with patellar tendinopathy (PT) have postural stability deficits; however, the underlying mechanisms and factors responsible remain unknown. The effect on postural stability in PT of decreased quadriceps strength, altered proprioception, lower-limb muscle tightness, and knee pain, which explain postural stability deficiency in other populations, is uninvestigated.Hypothesis:Proprioceptive acuity, muscle tightness, quadriceps strength, and pain predict postural stability in athletes with PT.Study Design:Cross-sectional comparative study.Level of Evidence:Level 2.Methods:A total of 43 athletes with PT and 43 healthy athletes were enrolled. Static and dynamic postural stability, proprioceptive acuity, muscle tightness, quadriceps strength, and pain were evaluated using a force platform, Y-balance test (YBT), a weight discrimination protocol, a goniometer, an isometric dynamometer, and a valid questionnaire, respectively.Results:Athletes with PT had significantly worse static and dynamic postural stability in the affected limb (AL) compared with the nonaffected limb (NAL) (P < 0.01) and the control group (P < 0.01). Athletes suffering from PT revealed lower quadriceps strength (P < 0.01), proprioceptive acuity (P = 0.02), and higher muscle tightness in the AL compared with the NAL and controls. Quadriceps weakness of the AL and pain in athletes with PT explained the variance of dynamic postural stability impairment.Conclusion:Athletes with PT have postural stability deficiency compared with healthy peers. Our results demonstrate that quadriceps muscle weakness and pain are the factors that explain postural stability impairment.Clinical Relevance:These results can assist clinicians in the design of therapeutic balance rehabilitation programs by acting not only on pain relief but also on quadriceps strengthening through resistance training to avoid subsequent injuries in athletes with PT.
  Citation: Sports Health
  PubDate: 2024-03-05T06:26:51Z
  DOI: 10.1177/19417381241231617
Sex Differences in Quadriceps Atrophy After Anterior Cruciate Ligament
Tear
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  Authors: Meredith K. Owen, Kelsey R. Casadonte, Nicholas T. Thomas, Christine M. Latham, Camille R. Brightwell, Katherine L. Thompson, Gregory S. Hawk, Cale A. Jacobs, Darren L. Johnson, Christopher S. Fry, Brian Noehren
  Abstract: Sports Health, Ahead of Print.
  Background:Female athletes lag behind their male counterparts in recovery from anterior cruciate ligament (ACL) injury. Quadriceps muscle size and strength are crucial factors for regaining function after ACL injury, but little is known about how these metrics vary due to biological sex.Hypothesis:Female patients have reduced vastus lateralis fiber cross-sectional area (CSA) and lower quadriceps strength after ACL injury than male patients.Study Design:Cross-sectional study.Level of Evidence:Level 4.Methods:A total of 60 participants with recent ACL tear were evaluated for vastus lateralis muscle fiber CSA, isometric quadriceps peak torque, and quadriceps rate of torque development. Linear mixed models were fit to determine differences across sex and limb for each variable of interest.Results:The female group averaged almost 20% atrophy between limbs (P < 0.01), while the male group averaged just under 4% (P = 0.05). Strength deficits between limbs were comparable between female and male groups.Conclusion:Immediately after ACL injury, female patients have greater between-limb differences in muscle fiber CSA but between-limb strength deficits comparable with those of male patients.Clinical Relevance:These results indicate that the underpinnings of strength loss differ based on biological sex, and thus individual patients could benefit from a sex-specific treatment approach to ACL injury.
  Citation: Sports Health
  PubDate: 2024-03-04T09:32:09Z
  DOI: 10.1177/19417381241230612
Serial Ultrasonography for the Assessment of Healing of Lower Extremity
Bone Stress Injury and Correlation With Return to Sport/Exercise
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  Authors: Brett G. Toresdahl, Justin Conway, Theodore T. Miller, Marci A. Goolsby, Christian S. Geannette, Brianna Quijano, Lisa R. Callahan
  Abstract: Sports Health, Ahead of Print.
  Background:Lower extremity bone stress injuries (BSIs) are common among athletes who participate in high-impact activities. Conventional imaging is limited in assessing healing of BSIs.Hypothesis:Serial ultrasonography (US) can identify changes in appearance of lower extremity BSIs over time that can be correlated with symptoms and return to exercise/sport.Study Design:Cohort observational study.Level of Evidence:Level 3.Methods:Adults 18 to 50 years old with a recent exercise-associated BSI of distal tibia/fibula or metatarsals diagnosed by magnetic resonance imaging (MRI) were enrolled. US was performed every 2 weeks for 12 weeks. The sonographic appearance (soft tissue edema, periosteal reaction, hyperemia on power Doppler, callus) was correlated with the numerical rating scale (NRS) for pain and ability to return to sport/exercise.Results:A total of 30 patients were enrolled (mean age, 35.3 ± 7.7 years; 21 [70.0%] female). The tibia was most frequently affected (n = 15, 50.0%), followed by metatarsals (n = 14, 46.7%) and fibula (n = 1, 3.3%). At week 4, 25 of 30 (83.3%) had at least 1 US finding associated with the BSI. The degree of hyperemia was correlated with NRS at weeks 4 and 6 (Spearman correlations [ρ] 0.45 [0.09, 0.69] and 0.42 [0.07, 0.67], respectively), as well as return to sport/exercise at week 6 (ρ -0.45 [-0.68, -0.09]). US soft tissue edema was also correlated with NRS at week 6 (ρ 0.38 [0.02, 0.65]).Conclusion:Serial US of lower extremity BSIs can provide objective measures of healing. US findings were correlated with clinical outcomes at multiple timepoints.Clinical Relevance:US may have advantages over conventional imaging for monitoring healing of lower extremity BSIs. Further research is needed to better understand the prognostic value of these sonographic indicators of BSI healing and role in assessing readiness for return to sport/exercise.
  Citation: Sports Health
  PubDate: 2024-02-27T08:51:58Z
  DOI: 10.1177/19417381241231590
Effects of Caffeine-Taurine Co-Ingestion on Endurance Cycling Performance
in High Temperature and Humidity Environments
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  Authors: Peiqi Yu, Yongzhao Fan, Hao Wu
  Abstract: Sports Health, Ahead of Print.
  Background:Taurine (TAU) and caffeine (CAF), as common ergogenic aids, are known to affect exercise performance; however, the effects of their combined supplementation, particularly in high temperature and humidity environments, have not been studied.Hypothesis:The combination of TAU and CAF will have a greater effect on endurance cycle performance and improve changes in physiological indicators during exercise compared with TAU or CAF supplementation alone and placebo.Study Design:Single-blind crossover randomized controlled study.Level of Evidence:Level 1.Methods:Twelve university students majoring in physical education volunteered to receive 4 different supplement ingestions: (1) placebo (maltodextrin), (2) TAU, (3) CAF, (4) TAU + CAF. After a 7-day washout period, participants completed a time to exhaustion (TTE) test in the heat (35°C, 65% relative humidity).Results:All experimental groups improved TTE compared with the placebo group. Peak and mean power of countermovement jump were significantly higher in the CAF group compared with the placebo group before the exhaustion exercise (P = 0.02, d = 1.2 and P = 0.04, d = 1.1, respectively). Blood lactate was significantly lower after the exhaustion test in the TAU group compared with the CAF (P < 0.01, d = 0.8) and TAU + CAF (P < 0.01, d = 0.7) groups. Core temperature in the TAU group was significantly reduced in the placebo group later in the exhaustion test (P < 0.01, d = 1.9).Conclusion:In high temperature and humidity environments, acute TAU, CAF, and combined supplementation all improved TTE and did not affect recovery from lower limb neuromuscular fatigue compared with placebo, with TAU having the best effect. Combined supplementation failed to exhibit superimposed performance.Clinical Relevance:The results provide suggestions for the effects of TAU, CAF, and their combined intake on exercise performance in high temperature and humidity environments.
  Citation: Sports Health
  PubDate: 2024-02-26T09:53:55Z
  DOI: 10.1177/19417381241231627
Secondary School Athletic Trainers’ Perceptions of How Youth Sport
Specialization Impacts Workload
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  Authors: David R. Bell, Madison N. Renner, Mayrena I. Hernandez, Kevin M. Biese, Stephanie Adler, Emily Srygler
  Abstract: Sports Health, Ahead of Print.
  Background:Youth sport specialization is a growing trend in youth sports and is associated with an increased risk of injuries and burnout. However, it is unknown how sport specialization is perceived to be affecting the working environment of secondary school athletic trainers (ATs). The purpose of this paper is to describe how ATs perceive youth sport specialization impacting their workload and whether they perceive it to impact patient safety.Hypothesis:ATs will perceive that youth sport specialization impacts their workload and could impact patient safety.Study Design:A sequential, explanatory mixed methods design with 2 phases: (1) cross-sectional surveys and (2) individual interviews.Level of Evidence:Level 3.Methods:A total of 487 secondary school ATs completed the online survey (access rate, 8.4%; completion rate, 85.4%). The survey consisted of Likert questions and included sections about aspects of workload impacted by specialization, impacts on patient safety, demographics. Ten participants were selected to complete a semi-structured interview via video conference.Results:Approximately two-thirds of ATs perceive that sport specialization impacts their workload. (Somewhat, 38.6%; Quite a bit, 25.5%; A great deal, 5.5%) Attempts to reduce or modify patient activity and a patient’s time for rehabilitation were the highest rated aspects of workload impacted by sport specialization. Approximately 30% ATs (29.9%) perceive that sport specialization impacts their workload to where it may influence patient safety (Somewhat, 21.6%; Quite a bit, 6.4%; A great deal, 1.9%). Three themes and subsequent subthemes were identified from the qualitative interviews: (1) current youth sport expectations, (2) conflict between school and club sports, and (3) AT job impacts.Conclusion:Secondary school ATs perceive their workload to be negatively impacted by youth sport specialization and some believe it may impact patient safety.Clinical Relevance:Youth sport specialization is impacting youth sport stakeholders, including ATs, in a variety of ways.
  Citation: Sports Health
  PubDate: 2024-02-26T09:46:12Z
  DOI: 10.1177/19417381241231589
Ankle Injury Prevention Programs for Youth Sports: A Systematic Review and
Meta-analysis
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  Authors: Ryan Berkey, Afsar Sunesara, Lindsay Allen, Ryan Pontiff, Alison DeVries, Steve R. Fisher
  Abstract: Sports Health, Ahead of Print.
  Context:Previous research has demonstrated that using a multicomponent approach to ankle injury preventions can significantly reduce ankle injuries; however, these studies lack specific intervention recommendations.Objective:To evaluate the exercise components of prevention programs on ankle injuries specifically in high school athletes. Secondary objectives were to assess the overall effectiveness of prevention programs on ankle injuries in this population and how compliance and education may impact success.Data Sources:A total of 5 databases were searched through September 26, 2022.Study Selection:Study inclusion criteria included randomized control trials (RCTs) investigating exercise interventions in high school athletes aged 13 to 19 years, participation in sports competition, reporting of injury incidence, and specific exercise interventions used.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 1.Data Extraction:Pooled overall ankle injury incidence rate ratio and 95% CIs were calculated using random-effects meta-analysis.Results:A total of 10 studies were included, of which 9 used multicomponent exercise interventions and 1 used only balance training. Of the 10 studies, 3 demonstrated statistically significant reduction in ankle injuries. When data from all 10 studies were pooled and analyzed, there was a statistically significant overall reduction (incidence rate ratio, 0.74; 95% CI 0.60-0.91) in ankle injuries when comparing intervention groups with controls.Conclusion:The most effective injury prevention programs included multiple components, emphasized strengthening and agility exercises, and promoted high adherence to the intervention. The importance of coach and player education on how and why to perform an injury prevention program as well as the frequency and duration of programs was also important. Exercise-based injury prevention programs may reduce ankle injury incidence in youth athletes by 26% when pooling data from a multitude of sport types/settings.
  Citation: Sports Health
  PubDate: 2024-02-26T09:41:15Z
  DOI: 10.1177/19417381241231588
Higher Eccentric Hamstring Muscle Fatigue After Participation in a Soccer
Match in Young Female Athletes
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  Authors: Sebastiano Nutarelli, Jacopo Emanuele Rocchi, Manuela Salerno, Alessandro Sangiorgio, Luca Deabate, Giuseppe Filardo
  Abstract: Sports Health, Ahead of Print.
  Background:Hamstring (HS) strength deficits and imbalances have been identified as risk factors for sustaining anterior cruciate ligament (ACL) injuries and muscular strains, with HS injuries being the most prevalent muscle injuries in soccer athletes. The aim of this study was to investigate HS eccentric strength before and after a soccer match in both male and female soccer athletes.Hypothesis:Soccer athletes have changes in eccentric HS strength after a soccer game.Study Design:Cohort observational study.Level of Evidence:Level 3.Methods:HS eccentric strength (mean and absolute peak torque and total work) was measured in 64 healthy male and female competitive football athletes (14-25 years) with an automatic device during the execution of the Nordic hamstring exercise (NHE) test before and after a 90-minute soccer match. The anterior-knee laxity (AKL) was quantified with an arthrometer.Results:Mean and absolute eccentric HS peak torque decreased by 24.5 N.m (-12.34%; P < 0.01) and 21.9 N.m (-10.08%; P < 0.01) in female athletes, whereas their male peers improved by 19.9 N.m (+9.01%; P = 0.01) and by 20.9 N.m (+8.51%; P = 0.02), respectively. HS total work in female athletes decreased by 831.1 J (P < 0.01) compared with the male athlete reduction of 235.3 J. Both the pre- versus postmatch intersex mean and absolute eccentric HS peak torque changes were significant (P < 0.01), as were the changes in HS total work (P < 0.01). The pre- versus postmatch AKL difference and the dominant versus nondominant limb comparison of the strength parameters were not significantly different. Younger female athletes (14-19 years old) presented a greater decrease in mean and absolute peak HS eccentric strength compared with those in older female athletes and men.Conclusion:HS eccentric strength and work differ based on athlete sex, as measured by the NHE test. Mean peak, absolute peak, and total work showed greater reductions in female athletes than those in their male peers. The subgroup of 14- to 19-year-old female athletes experienced the highest reduction in strength parameters.
  Citation: Sports Health
  PubDate: 2024-02-26T09:33:30Z
  DOI: 10.1177/19417381241230613
The Psychology of ACL Injury, Treatment, and Recovery: Current Concepts
and Future Directions
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  Authors: Andrew J. Sheean, Mikalyn T. DeFoor, Kurt P. Spindler, Justin W. Arner, Aravind Athiviraham, Asheesh Bedi, Steven DeFroda, Justin J. Ernat, Salvatore J. Frangiamore, Clayton W. Nuelle, Andrew J. Sheean, Kurt P. Spindler, Asheesh Bedi
  Abstract: Sports Health, Ahead of Print.
  Context:Interest in the relationship between psychology and the outcomes of anterior cruciate ligament (ACL) reconstruction (ACLR) continues to grow as variable rates of return to preinjury level of activity continue to be observed.Evidence Acquisition:Articles were collected from peer-reviewed sources available on PubMed using a combination of search terms, including psychology, resilience, mental health, recovery, and anterior cruciate ligament reconstruction. Further evaluation of the included bibliographies were used to expand the evidence.Study Design:Clinical review.Level of Evidence:Level 4.Results:General mental health and wellbeing, in addition to a host of unique psychological traits (self-efficacy, resilience, psychological readiness and distress, pain catastrophizing, locus of control, and kinesiophobia) have been demonstrated convincingly to affect treatment outcomes. Moreover, compelling evidence suggests that a number of these traits may be modifiable. Although the effect of resilience on outcomes of orthopaedic surgical procedures has been studied extensively, there is very limited information linking this unique psychological trait to the outcomes of ACLR. Similarly, the available information related to other parameters, such as pain catastrophizing, is limited with respect to the existence of adequately sized cohorts capable of accommodating more rigorous and compelling analyses. A better understanding of the specific mechanisms through which psychological traits influence outcomes can inform future interventions intended to improve rates of return to preinjury level of activity after ACLR.Conclusion:The impact of psychology on patients’ responses to ACL injury and treatment represents a promising avenue for improving low rates of return to preinjury activity levels among certain cohorts. Future research into these areas should focus on specific effects of targeted interventions on known, modifiable risk factors that commonly contribute to suboptimal clinical outcomes.Strength-of-Recommendation Taxonomy (SORT):B.
  Citation: Sports Health
  PubDate: 2024-02-20T06:36:03Z
  DOI: 10.1177/19417381241226896
Upper Extremity Musculoskeletal Profiles in Tennis Players: A Systematic
Review
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  Authors: Natalie L. Myers, James L. Farnsworth, Sean M. Kennedy, Duane V. Knudson
  Abstract: Sports Health, Ahead of Print.
  Context:Tennis-specific musculoskeletal (MSK) screening can assess range of motion (ROM) and muscular imbalances. Identifying normative values before implementing a MSK screen is essential in contributing to athlete performance and injury risk profiles.Objective:To review upper extremity MSK data in healthy tennis players across age, sex, and level of play.Data Source:The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. A search was conducted in MEDLINE, SPORTDiscus, Embase, and CINAHL.Study Selection:This review included shoulder, elbow, and wrist ROM, isometric strength, or isokinetic strength in a tennis population. Each article was critically appraised to help identify the internal and external validity of each study.Study Design:Systematic review.Level of Evidence:Level 3.Data Extraction:A total of 41 studies met the search criteria. Each contributor organized the data elements of interest into data tables, with a second contributor assigned for review. Data elements of interest included player and study characteristics: ROM, isometric dynamometry, and isokinetic strength.Results:A total of 3174 players were included in the final studies. Most of the players included were competitive adolescents and young adults; 15 studies included ROM data. Male tennis players consistently had more external rotation (ER) gain (range, 1.8º to 8.8º) and internal rotation (IR) loss (range, -15.3º to -3.0º) when compared with their female counterparts (ER range, -2.5º to 5.8º; IR range, -10.4º to -3º). Shoulder IR and ER strength were measured in the majority of all the strength studies, with the external rotators generating at least two-thirds the strength of the internal rotators.Conclusion:Overall MSK data of tennis players indicate that shoulder strength values are often larger than nontennis players, but equal to or slightly lower than comparable athletes in other overhead sports. Adaptive changes of the glenohumeral joint and subsequent rotational motion are similar to those of other overhead athletes.
  Citation: Sports Health
  PubDate: 2024-02-16T07:42:38Z
  DOI: 10.1177/19417381231223540
Predictors of Running-Related Injury Among Recreational Runners: A
Prospective Cohort Study of the Role of Perfectionism, Mental Toughness,
and Passion in Running
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  Authors: Aynollah Naderi, Nasrin Alizadeh, Luis Calmeiro, Hans Degens
  Abstract: Sports Health, Ahead of Print.
  Background:The health benefits associated with recreational running are challenged by the occurrence of running-related injuries (RRIs). Effective preventive measures require knowledge of sport injury etiology. Psychological factors such as perfectionism, mental toughness, and passion are believed to predispose to sports injury by influencing training behaviors, motivation to run, and suppression of feelings of fatigue and pain. Yet their association with RRIs are understudied.Hypothesis:Perfectionism, mental toughness, and passion predict an increased risk of RRIs in recreational runners.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:A total of 143 recreational runners (age 34.9 ± 13.9 years, 37% women) with a response rate of 76.5% answered an online questionnaire about their characteristics, running behaviors, and psychological variables (perfectionism, mental toughness, and running passion) as well as a sports injury survey. Then, as a primary outcome, RRIs were recorded biweekly for 6 months. The incidence of injuries was expressed as RRI per 1000 hours of running. The association between predictive factors and RRIs was estimated using logistic regression.Results:The incidence of RRIs during follow-up was 5.16 per 1000 hours of running. The knee was the location injured most often (26.4%), followed by the foot (18.9%) and lower leg (13.2%). Higher obsessive passion (OP) for running (odds ratio [OR], 1.11; 95% CI, 1.04-1.20) and perfectionistic concerns (OR, 1.22; CI,1.05-1.41) were associated with a greater risk of RRIs, as were previous injury (OR, 2.49; CI,1.10-5.70), weekly running distance (OR,1.10; CI, 1.03-1.16), and both supinated (OR, 4.51; CI, 1.11-18.30) and pronated (OR, 3.55; CI, 1.29-9.80) foot type. Following a running schedule (OR, 0.24; CI, 0.09-0.66) was associated with a lower risk of RRIs.Conclusion:History of previous RRI, pronated and supinated foot type, weekly running distance, perfectionistic concerns, and OP increased RRI risk in recreational runners. Following a running schedule was a protective factor.Clinical Relevance:Multiple factors, including runners’ psychological characteristics, predict RRIs. These findings can inform the development of injury risk management strategies.
  Citation: Sports Health
  PubDate: 2024-02-05T06:55:57Z
  DOI: 10.1177/19417381231223475
Hip Pain in the Young Athlete: Femoroacetabular Impingement Syndrome
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  Authors: Omair Kazi, Alexander B. Alvero, Joshua Wright-Chisem, Shane J. Nho
  Abstract: Sports Health, Ahead of Print.
  
  Citation: Sports Health
  PubDate: 2024-02-02T09:09:49Z
  DOI: 10.1177/19417381231223515
Epidemiology and Sex-Specific Analysis of Basketball-Related Lower
Extremity Fractures: A 10-Year Analysis of National Injury Data
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  Authors: Avanish Yendluri, Joshua J. Chiang, Katrina S. Nietsch, Kyle K. Obana, David P. Trofa, John D. Kelly, Robert L. Parisien
  Abstract: Sports Health, Ahead of Print.
  Background:Basketball-related fractures involving the lower extremities frequently present to emergency departments (ED) in the United States (US). This study aimed to identify the primary mechanisms, distribution, and trends of these injuries.Hypothesis:We hypothesize that (1) lower extremity fracture frequency will decrease from 2013 to 2022, (2) the ankle will be the most common fracture site, and (3) noncontact twisting will be the most common injury mechanism.Study Design:Descriptive epidemiological.Level of Evidence:Level 3.Methods:The National Electronic Injury Surveillance System (NEISS) was queried for lower extremity fractures from basketball presenting to US EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury location, and disposition were recorded. The injury mechanism was characterized using the provided narrative. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression.Results:There were 6259 cases (NE: 185,836) of basketball-related lower extremity fractures. Linear regression analysis of annual trends demonstrated a significant decrease in lower extremity fractures over the study period (2013-2022: P = 0.01; R2 = 0.64). The most common injury mechanism was a noncontact twisting motion (NE: 49,897, 26.9%) followed by jumping (NE: 39,613, 21.3%). The ankle was the most common fracture site (NE: 69,936, 37.6%) followed by the foot (NE: 49,229, 26.49%). While ankle and foot fractures decreased significantly (P < 0.05), fractures of the lower leg, knee, toe, and upper leg showed no significant trends (P = 0.09, 0.75, 0.07, and 0.85, respectively).Conclusion:Basketball-related lower extremity fractures decreased from 2013 to 2022, with the ankle being the most common fracture site and most fractures arising from a noncontact twist. Increasing utilization of outpatient clinics may have contributed to the decline, particularly for ankle and foot fractures. The prevalence of ankle fractures and twisting-related injuries reinforces the importance of protective footwear and targeted strengthening protocols.
  Citation: Sports Health
  PubDate: 2024-01-29T11:27:01Z
  DOI: 10.1177/19417381231223479
Swimming Anatomy and Lower Back Injuries in Competitive Swimmers: A
Narrative Review
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  Authors: Connie Hsu, Brian Krabak, Brian Cunningham, Joanne Borg-Stein
  Abstract: Sports Health, Ahead of Print.
  Context:Competitive swimmers are at high risk of overuse musculoskeletal injuries due to their high training volumes. Spine injuries are the second most common musculoskeletal injury in swimmers and are often a result of the combination of improper technique, high loads on the spine in strokes that require hyperextension, and repetitive overuse leading to fatigue of the supporting trunk muscles. The purpose of this review is to summarize the current evidence regarding swimming biomechanics, stroke techniques, and common injuries in the lumbar spine to promote a discussion on the prevention and rehabilitation of lower back injuries in competitive swimmers.Evidence Acquisition:From a PUBMED/MEDLINE search, 16 articles were identified for inclusion using the search terms “swimming,” “low back” or “lumbar,” and “injury” or “injuries.”Study Design:Narrative review.Level of Evidence:Levels 4 and 5.Results:The trunk muscles are integral to swimming stroke biomechanics. In freestyle and backstroke, the body roll generated by the paraspinal and abdominal muscles is integral to efficient stroke mechanics by allowing synergistic movements of the upper and lower extremities. In butterfly and breaststroke, the undulating wave like motion of the dolphin kick requires dynamic engagement of the core to generate repetitive flexion and extension of the spine and is a common mechanism for hyperextension injuries. The most common lower back injuries in swimming were determined to be lumbar strain, spondylolysis and spondylolisthesis, facet joint pain, and disc disease. Most overuse swimming injuries can be treated conservatively with physical therapy and training adjustments.Conclusion:Managing swimmers with low back pain requires a basic knowledge of swimming technique and a focus on prevention-based care. Since most swimming injuries are secondary to overuse, it is important for providers to understand the mechanisms underlying the swimming injury, including an understanding of the biomechanics involved in swimming and the role of spine involvement in the 4 strokes that assist in stabilization and force generation in the water. Knowledge of the biomechanics involved in swimming and the significant demands placed on the spinal musculoskeletal system will aid the clinician in the diagnosis and management of injuries and assist in the development of a proper rehabilitation program aimed at correction of any abnormal swimming mechanics, treatment of pain, and future injury prevention.Strength of Recommendations:B. Recommendation based on limited quality or inconsistent patient-oriented evidence.
  Citation: Sports Health
  PubDate: 2024-01-24T03:09:45Z
  DOI: 10.1177/19417381231225213
Mental Health in Elite Coaches
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  Authors: Laura Baumann, Andres Ricardo Schneeberger, Alan Currie, Samuel Iff, Erich Seifritz, Malte Christian Claussen
  Abstract: Sports Health, Ahead of Print.
  Context:Coaches play an important role in promoting mental health in elite sports. However, they themselves are exposed to risks affecting their mental health, and their fears and worries are often overlooked. Moreover, it remains unclear how coaches’ mental health affects their athletes’ mental health.Objective:To create a compilation of the literature on (1) elite coaches’ mental health and (2) how coaches’ mental health influences elite athletes’ mental health. Building on this, recommendations for improving coaches’ psychological well-being should be elaborated upon and discussed.Data Sources:A literature search was conducted up to November 30, 2021, using the following databases: PubMed, PsycINFO, Scopus, Web of Science, and SportDiscus.Study Selection:Studies reporting elite coaches’ mental health symptoms and disorders and the influence of elite coaches’ mental health on elite athletes’ mental health were included.Study Design:Scoping review.Level of Evidence:Level 4.Data Extraction:Data regarding elite coaches’ mental health, as well as their influence on athletes’ mental health and performance, were included in a descriptive analysis. The PRISMA guidelines were used to guide this review.Results:Little research has been done on elite coaches’ mental health disorders, although studies confirm that they do experience, for example, symptoms of burnout, anxiety, and depression. The influence of coaches’ mental health on their athletes is underinvestigated, with research focused mainly on the influence of coaches’ stress.Conclusion:Knowledge about coaches’ mental health is still limited. Coaches’ poor mental health diminishes coaching performance and might impair athletes’ mental health. Coaches should receive more support, including sports psychiatric care and education on the importance of mental health. This could improve the mental health of both coaches and athletes, and positively affect athlete performance.
  Citation: Sports Health
  PubDate: 2024-01-22T03:59:06Z
  DOI: 10.1177/19417381231223472
Epidemiology of Stingers in the National Football League, 2015-2019
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  Authors: Joseph D. Lamplot, Camryn Petit, Rebecca Lee, Christina D. Mack, Mackenzie M. Herzog, Gary S. Solomon, Jed A. Diekfuss, Greg D. Myer, Kyle Hammond
  Abstract: Sports Health, Ahead of Print.
  Background:Transient traumatic neuropraxia of either the brachial plexus or cervical nerve root(s) is commonly described as a “stinger” or “burner” by the athlete. Stingers in American Football commonly occur acutely as isolated injuries; however, concomitant injuries, including cervical spine pathologies, have also been reported.Hypothesis:Among National Football League (NFL) athletes, the incidence rate of stingers is higher during the regular season than during the preseason and among positions with high velocity impacts such as running backs, linebackers, defensive backs, and receivers.Study Design:Retrospective epidemiology study.Level of Evidence:Level 4.Methods:Aggregation of all in-game injuries with a clinical impression of “neck brachial plexus stretch” or “neck brachial plexus compression” entered into the NFL injury surveillance database through the centralized league-wide electronic medical record system over 5 years (2015-2019 seasons). Incidence rates per player-play were calculated and reported.Results:A total of 691 in-game stingers occurred during the study period, with a mean of 138.2 per year. Average single-season injury risk for incident stinger was 3.74% (95% CI, 3.46%-4.05%). The incidence rate was higher during regular season games than during preseason games (12.26 per 100,000 player-plays [11.30-13.31] vs 8.87 [7.31-10.76], P < 0.01, respectively). The highest reported stinger incidence rates were among running backs and linebackers (both>15 per 100,000 player-plays). Among stingers, 76.41% did not miss time. Of those that resulted in time lost from football activities, mean time missed due to injury was 4.79 days (range, 3.17-6.41 days). Concomitant injuries were relatively low (7.09%).Conclusion:In-game stinger incidence was stable across the study period and occurred most frequently in running backs and linebackers. Stingers were more common during the regular season, and most players did not miss time. Concomitant injuries were relatively rare.Clinical Relevance:An improved understanding of the expected time loss due to stinger and concomitant injuries may provide insight for medical personnel in managing these injuries.
  Citation: Sports Health
  PubDate: 2024-01-17T05:04:20Z
  DOI: 10.1177/19417381231223413
Reliability and Validity of the Star Excursion Balance Test for Evaluating
Dynamic Balance of Upper Extremities
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  Authors: Qi-Hao Yang, Yong-Hui Zhang, Shu-Hao Du, Yu-Chen Wang, Hao-Ran Xu, Ji-Wei Chen, Yuan Mao, Xue-Qiang Wang
  Abstract: Sports Health, Ahead of Print.
  Background:Upper extremity (UE) dynamic balance is a significant physical fitness ability, which includes high-level neuromuscular proprioception, joint mobility, force, and coordination. The evaluation methods of UE dynamic balance are insufficient and lack experimental support. The Star Excursion Balance Test (SEBT) is a reliable assessment of dynamic balance and injury risk of the lower extremity.Hypothesis:The UE-SEBT is a reliable and reproducible approach for evaluating dynamic balance of UEs.Study Design:Observational study.Level of Evidence:Level 4.Methods:This cross-sectional study recruited 65 healthy adults. All participants were required to complete UE-SEBT, UE Y-balance test (UE-YBT), maximal voluntary isometric contraction (MVIC) of UE, closed kinetic chain UE stability test (CKCUEST), trunk flexor endurance test (TFET), trunk extensor endurance test (TEET), and lateral trunk endurance test (LTET). Intra- and inter-rater reliability and the correlation of UE-SEBT with other outcomes were measured.Results:Among the participants, the intra- and interoperator reliability of UE-SEBT in all directions and composite score achieved a moderate-to-excellent (intraclass correlation coefficients [ICC], 0.729-0.946) reliability. For validity, the UE-SEBT had a moderate to very strong correlation with UE-YBT (r = 0.315-0.755, P < 0.01) and a strong correlation with CKCUEST (r = 0.4-0.67, P < 0.01). Furthermore, the UE-SEBT performance showed weak-to-strong correlations with MVIC (r = 0.26-0.43, P < 0.05). UE-SEBT was also correlated with LTET, TEET, and TFET to varying degrees.Conclusion:UE-SEBT has good reliability and validity to assess UE dynamic balance compared with other tests.Clinical Relevance:UE-SEBT can be used as a clinical assessment method to evaluate UE dynamic balance and injury prevention.
  Citation: Sports Health
  PubDate: 2024-01-17T04:53:40Z
  DOI: 10.1177/19417381231221716
Impact of Running Exercise on Intervertebral Disc: A Systematic Review
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  Authors: Dingbo Shu, Siyu Dai, Jianping Wang, Fanjing Meng, Chuan Zhang, Zhenhua Zhao
  Abstract: Sports Health, Ahead of Print.
  Context:Running is one of the most popular sports worldwide. However, controversies exist regarding how running affects runner’s intervertebral discs (IVD).Objective:The purpose of this study was to systematically review studies that evaluated IVD morphology or composition changes in response to running exercise, to determine the impact of running exercise on IVD.Data Sources:A systematic literature search was performed for 4 major databases: PubMed, Cochrane, Embase, and Web of Science.Study Selection:Inclusion criteria were as follows: (1) healthy people without known IVD disease or major complications such as tuberculosis (IVD degeneration or low back pain are considered as minor complications); (2) subjects performed 1-time or regular running exercises; (3) pre and post comparison of runners or comparison between runners and healthy control subjects; (4) direct or indirect IVD morphology or composition measured; (5) IVD assessed before and after either acute or chronic running exercise, or compared cross-sectionally between runners and controls. Exclusion criteria were as follows: (1) reviews, editorials, letters or abstracts only; (2) animal studies; (3) subjects performed exercise other than running.Study Design:Systematic review.Level of Evidence:Level 3.Data Extraction:The extracted data included study design and primary outcomes of the included studies. The Newcastle-Ottawa scale (NOS) was used to evaluate study quality and risk of bias.Results:A total of 13 studies with 632 participants were included in the final analysis; 4 studies measured IVD changes using stature or spinal height, and the other 9 measured IVD changes using magnetic resonance imaging; 6 studies found that running acutely and negatively impacts IVD; 3 out of 5 cross-sectional studies found that IVD parameters are better for runners than controls; 1 longitudinal study found no significant difference in IVD before and after training for marathon in runners; 1 longitudinal study found no significant difference in changes of IVD between runners and controls after 15 years of follow-up.Conclusion:Negative changes in IVD exist for a short period of time after running, which may be due to the temporary compression pushing water content out of the disc. Cross-sectional studies suggest that long-term running exerts a mild positive effect on IVD; however, this inference has not been confirmed by high-quality longitudinal studies.
  Citation: Sports Health
  PubDate: 2024-01-11T07:40:22Z
  DOI: 10.1177/19417381231221125
Weightlifting Induced Spinal Accessory Nerve Palsy and Winged Scapula: A
Case Report
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  Authors: Adnine Anass, Taik Fatima Zahrae, Aharrane Fatima Zahra, Takhrifa Nihad, Fadel Hicham, Abourazzak Fatima Ezzahra
  Abstract: Sports Health, Ahead of Print.
  Winged scapula is a rare musculoskeletal condition with numerous etiologies including spinal accessory nerve (SAN) palsy. Sport activities are rarely implicated with few scattered case reports. We report a case of an 18-year-old bodybuilder who suffered SAN palsy secondary to weightlifting exercises. Physical examination revealed winged scapula with painful mobility of the shoulder. A scapular magnetic resonance imaging scan and electromyography of the trapezius muscle were performed and confirmed the diagnosis of SAN palsy. Through this case, we review the literature of common and rare causes of SAN palsy and outline accepted treatment options.
  Citation: Sports Health
  PubDate: 2024-01-11T07:27:05Z
  DOI: 10.1177/19417381231219218

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