Subjects -> HEALTH AND SAFETY (Total: 1464 journals)
    - CIVIL DEFENSE (22 journals)
    - DRUG ABUSE AND ALCOHOLISM (87 journals)
    - HEALTH AND SAFETY (686 journals)
    - HEALTH FACILITIES AND ADMINISTRATION (358 journals)
    - OCCUPATIONAL HEALTH AND SAFETY (112 journals)
    - PHYSICAL FITNESS AND HYGIENE (117 journals)
    - WOMEN'S HEALTH (82 journals)

PHYSICAL FITNESS AND HYGIENE (117 journals)                     

Showing 1 - 116 of 116 Journals sorted alphabetically
ACSMs Health & Fitness Journal     Full-text available via subscription   (Followers: 14)
Acta Facultatis Educationis Physicae Universitatis Comenianae     Open Access   (Followers: 3)
Acta Kinesiologiae Universitatis Tartuensis     Open Access   (Followers: 1)
ACTIVE : Journal of Physical Education, Sport, Health and Recreation     Open Access   (Followers: 30)
Adapted Physical Activity Quarterly     Hybrid Journal   (Followers: 4)
Ágora para la Educación Física y el Deporte     Open Access  
Al.Qadisiya journal for the Sciences of Physical Education     Open Access  
American Journal of Sexuality Education     Hybrid Journal   (Followers: 4)
Annals of Applied Sport Science     Open Access   (Followers: 11)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 9)
Applied Physiology, Nutrition and Metabolism     Hybrid Journal   (Followers: 37)
Arab Journal of Nutrition and Exercise     Open Access  
Arquivos em Movimento     Open Access   (Followers: 1)
Arrancada     Open Access  
Asian Journal of Sport and Exercise Psychology     Open Access   (Followers: 4)
Baltic Journal of Sport and Health Sciences     Open Access   (Followers: 2)
BMC Obesity     Open Access   (Followers: 8)
BMC Sports Science, Medicine and Rehabilitation     Open Access   (Followers: 37)
Child and Adolescent Obesity     Open Access   (Followers: 3)
Childhood Obesity     Hybrid Journal   (Followers: 24)
Clinical Journal of Sport Medicine     Hybrid Journal   (Followers: 37)
Comparative Exercise Physiology     Hybrid Journal   (Followers: 21)
Cultura, Ciencia y Deporte     Open Access   (Followers: 1)
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity     Hybrid Journal   (Followers: 25)
eJRIEPS : Ejournal de la recherche sur l'intervention en éducation physique et sport     Open Access  
Environmental Health and Preventive Medicine     Open Access   (Followers: 4)
Éthique & Santé     Full-text available via subscription  
Fat Studies : An Interdisciplinary Journal of Body Weight and Society     Partially Free   (Followers: 2)
Food Science and Human Wellness     Open Access   (Followers: 4)
Frontiers in Sports and Active Living     Open Access   (Followers: 2)
Gelanggang Pendidikan Jasmani Indonesia     Open Access  
German Journal of Exercise and Sport Research : Sportwissenschaft     Hybrid Journal   (Followers: 2)
Geron     Full-text available via subscription  
Health and Quality of Life Outcomes     Open Access   (Followers: 14)
Health Education     Hybrid Journal   (Followers: 1)
Health Education Journal     Hybrid Journal   (Followers: 16)
Health Marketing Quarterly     Hybrid Journal   (Followers: 3)
Health Physics     Hybrid Journal   (Followers: 7)
Home Healthcare Now     Hybrid Journal   (Followers: 4)
Human Movement Science     Hybrid Journal   (Followers: 14)
IISE Transactions on Occupational Ergonomics and Human Factors     Hybrid Journal  
Indonesia Performance Journal     Open Access  
International Journal for Vitamin and Nutrition Research     Hybrid Journal   (Followers: 10)
International Journal of Applied Exercise Physiology     Open Access   (Followers: 54)
International Journal of Athletic Therapy & Training     Hybrid Journal   (Followers: 15)
International Journal of Behavioral Nutrition and Physical Activity     Open Access   (Followers: 31)
International Journal of Obesity     Hybrid Journal   (Followers: 93)
International Journal of Obesity Supplements     Full-text available via subscription   (Followers: 7)
International Journal of Qualitative Studies on Health and Well-Being     Open Access   (Followers: 21)
International Journal of Spa and Wellness     Hybrid Journal  
International Journal of Sport, Exercise & Training Sciences     Open Access   (Followers: 3)
International Journal of Yoga     Open Access   (Followers: 17)
Isokinetics and Exercise Science     Hybrid Journal   (Followers: 10)
Journal of Advanced Nutrition and Human Metabolism     Open Access   (Followers: 16)
Journal of American College Health     Hybrid Journal   (Followers: 3)
Journal of Athlete Development and Experience     Open Access   (Followers: 2)
Journal of Bioenergetics and Biomembranes     Hybrid Journal   (Followers: 1)
Journal of Exercise & Organ Cross Talk     Open Access   (Followers: 3)
Journal of Human Performance in Extreme Environments     Open Access   (Followers: 2)
Journal of Human Sport and Exercise     Open Access   (Followers: 16)
Journal of Motor Learning and Development     Hybrid Journal  
Journal of Physical Activity and Health     Hybrid Journal   (Followers: 11)
Journal of Physical Activity and Hormones     Open Access   (Followers: 2)
Journal of Physical Activity Research     Open Access   (Followers: 3)
Journal of Physical Education and Human Movement     Open Access  
Journal of Physical Education and Sport Sciences     Open Access   (Followers: 3)
Journal of Physical Education Health and Sport     Open Access   (Followers: 2)
Journal of Physical Education, Recreation & Dance     Full-text available via subscription   (Followers: 11)
Journal of Science in Sport and Exercise     Hybrid Journal   (Followers: 4)
Journal of Sport and Health Science     Open Access   (Followers: 23)
Journal of Sport Sciences and Fitness     Open Access   (Followers: 13)
Journal of Strength and Conditioning Research     Hybrid Journal   (Followers: 73)
Kinesiology : International Journal of Fundamental and Applied Kinesiology     Open Access   (Followers: 1)
Kinesiology Review     Hybrid Journal   (Followers: 4)
Malaysian Journal of Movement, Health & Exercise     Open Access   (Followers: 3)
Measurement in Physical Education and Exercise Science     Hybrid Journal   (Followers: 7)
Médecine & Nutrition     Full-text available via subscription  
Mental Health and Physical Activity     Hybrid Journal   (Followers: 16)
MHSalud : Movimiento Humano y Salud     Open Access  
Obesity     Hybrid Journal   (Followers: 58)
Obesity Research & Clinical Practice     Full-text available via subscription   (Followers: 20)
Obesity Reviews     Hybrid Journal   (Followers: 25)
Obesity Science & Practice     Open Access   (Followers: 1)
Open Obesity Journal     Open Access   (Followers: 1)
Pain Management in General Practice     Full-text available via subscription   (Followers: 12)
PALAESTRA : Adapted Sport, Physical Education, and Recreational Therapy     Full-text available via subscription   (Followers: 3)
Physical Activity and Health     Open Access   (Followers: 3)
Physical Education & Sport Pedagogy     Hybrid Journal   (Followers: 13)
Preventing Chronic Disease     Free   (Followers: 3)
Psychology of Sport and Exercise     Hybrid Journal   (Followers: 18)
Quality in Sport     Open Access  
Race and Yoga     Open Access  
RBNE - Revista Brasileira de Nutrição Esportiva     Open Access   (Followers: 1)
RBONE - Revista Brasileira de Obesidade, Nutrição e Emagrecimento     Open Access   (Followers: 1)
RBPFEX - Revista Brasileira de Prescrição e Fisiologia do Exercício     Open Access  
Research Quarterly for Exercise and Sport     Hybrid Journal   (Followers: 2)
Retos : Nuevas Tendencias en Educación Física, Deportes y Recreación     Open Access  
Revista Andaluza de Medicina del Deporte     Open Access   (Followers: 2)
Revista Brasileira de Atividade Física & Saúde     Open Access   (Followers: 1)
Revista Brasileira de Cineantropometria & Desempenho Humano     Open Access   (Followers: 1)
Revista Internacional de Medicina y Ciencias de la Actividad Física y del Deporte : International Journal of Medicine and Science of Physical Activity and Sport     Open Access   (Followers: 1)
Revue phénEPS / PHEnex Journal     Open Access  
Scandinavian Journal of Sport and Exercise Psychology     Open Access   (Followers: 3)
SIPATAHOENAN : South-East Asian Journal for Youth, Sports & Health Education     Open Access  
Spor Bilimleri Dergisi / Hacettepe Journal of Sport Sciences     Open Access  
Sport and Fitness Journal     Open Access   (Followers: 6)
Sport Science and Health     Open Access   (Followers: 2)
Sport Sciences for Health     Hybrid Journal   (Followers: 5)
SPORTIVE : Journal Of Physical Education, Sport and Recreation     Open Access  
Sports     Open Access   (Followers: 3)
Sports Biomechanics     Hybrid Journal   (Followers: 27)
Sports Health: A Multidisciplinary Approach     Hybrid Journal   (Followers: 4)
Strength & Conditioning Journal     Hybrid Journal   (Followers: 56)
Timisoara Physical Education and Rehabilitation Journal     Open Access   (Followers: 1)
Turkish Journal of Sport and Exercise     Open Access  
Yoga Mimamsa     Open Access   (Followers: 3)

           

Similar Journals
Journal Cover
Sports Health: A Multidisciplinary Approach
Journal Prestige (SJR): 1.107
Citation Impact (citeScore): 2
Number of Followers: 4  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1941-7381 - ISSN (Online) 1941-0921
Published by Sage Publications Homepage  [1175 journals]
  • 50 Years of Title IX

    • Free pre-print version: Loading...

      Authors: Genevra L. Stone
      Pages: 793 - 794
      Abstract: Sports Health, Volume 14, Issue 6, Page 793-794, November/December 2022.

      Citation: Sports Health
      PubDate: 2022-11-01T08:01:01Z
      DOI: 10.1177/19417381221129265
      Issue No: Vol. 14, No. 6 (2022)
       
  • The 2022 T. David Sisk Awards

    • Free pre-print version: Loading...

      Authors: Fábio Carlos Lucas de Oliveira, Raphael Einsfeld Simões Ferreira, Wesam Saleh A Al Attar
      Pages: 795 - 796
      Abstract: Sports Health, Volume 14, Issue 6, Page 795-796, November/December 2022.

      Citation: Sports Health
      PubDate: 2022-11-01T08:00:55Z
      DOI: 10.1177/19417381221126142
      Issue No: Vol. 14, No. 6 (2022)
       
  • 2022 Reviewer List

    • Free pre-print version: Loading...

      Pages: 938 - 939
      Abstract: Sports Health, Volume 14, Issue 6, Page 938-939, November/December 2022.

      Citation: Sports Health
      PubDate: 2022-11-01T08:01:15Z
      DOI: 10.1177/19417381221130069
      Issue No: Vol. 14, No. 6 (2022)
       
  • Sport-related Structural Brain Injury in High School and College American
           Football Athletes, 2002-2020: Effect of Lystedt Law

    • Free pre-print version: Loading...

      Authors: Barry P. Boden, Isaiah D.J. Brown, Jeremy M. Huckleby, Anwar E. Ahmed, Scott A. Anderson
      Abstract: Sports Health, Ahead of Print.
      Background:A previous report revealed an average of 7.2 (0.67 per 100,000 participants) sport-related structural brain injuries (SRSBIs) with macroscopic lesions per year in high school (HS) and college football players. The Lystedt law and other rule changes have been implemented with intent to reduce the risk of brain injury in football.Hypothesis:To update the profile of SRSBIs in HS and college football players and evaluate the efficacy of legislation intended to reduce brain injuries.Study Design:Descriptive epidemiology study.Level of Evidence:Level 4.Methods:We retrospectively reviewed 18 academic years (July 2002 through June 2020) of SRSBIs catalogued by the National Registry of Catastrophic Sports Injuries. The incidence of SRSBIs was assessed at the HS level during the pre (July 2002 through June 2009), transitional (July 2009 through June 2014), and post (July 2014 through June 2020) universal adoption time periods of the Lystedt law. In addition, the incidence of SRSBIs during the second half of the study (2011-2012 through 2019-2020) was compared with the first half of the study (2002-2003 through 2010-2011).Results:During the study period, there was a total of 228 SRSBIs (12.7 per year, 1.01 per 100,000 participants): 212 (93%, 11.8 per year, 1.00 per 100,000) in HS athletes and 16 (7%, 0.89 per year, 1.17 per 100,000) in college athletes. There were 52 fatalities (2.9 per year, 0.22 per 100,000 participants) with 46 (2.56 per year, 0.22 per 100,000) in HS athletes and 6 (0.33 per year, 0.43/100,000) in college athletes. There was no significant difference in risk of HS total SRSBIs or fatalities during the 3 Lystedt periods. The risk of combined SRSBI cases [relative risk (RR) = 1.22, P = 0.13] and fatalities (RR = 1.20, P = 0.52) was similar in the second half of the study compared with the first half of the study.Conclusion:Despite implementation of rule changes intended to reduce head injury, in particular the Lystedt law, the incidence of SRSBIs has remained unchanged. Further research is necessary to develop effective prevention programs for SRSBIs.Clinical Relevance:SRSBIs remain a persistent problem in HS and college American football. The recent head injury rule changes have not been effective at reducing SRSBIs.
      Citation: Sports Health
      PubDate: 2022-12-02T06:15:26Z
      DOI: 10.1177/19417381221134112
       
  • Running Mechanics After Repeated Sprints in Femoroacetabular Impingement
           Syndrome, Cam Morphology, and Controls

    • Free pre-print version: Loading...

      Authors: Basílio A.M. Gonçalves, David J. Saxby, Evy Meinders, Andrea Hams, Conor Lambert, Taryn Jones, Rod S. Barrett, Laura E. Diamond
      Abstract: Sports Health, Ahead of Print.
      Background:People with femoroacetabular with femoroacetabular impingement syndrome (FAIS) often report pain during sports involving repeated sprinting. It remains unclear how sports participation influences running biomechanics in individuals with FAIS.Hypothesis:Changes in running biomechanics and/or isometric hip strength after repeated sprint exercise would be greatest in individuals with FAIS compared with asymptomatic individuals with (CAM) and without cam morphology (Control).Study Design:Controlled laboratory study.Level of Evidence:Level 3.Methods:Three-dimensional hip biomechanics during maximal running (10 m) and hip strength were measured in 49 recreationally active individuals (FAIS = 15; CAM = 16; Control = 18) before and after repeated sprint exercise performed on a nonmotorized treadmill (8-16 × 30 m). Effects of group and time were assessed for biomechanics and strength variables with repeated-measures analyses of variance. Relationships between hip pain (Copenhagen Hip and Groin Outcome Score) and changes in hip moments and strength after repeated sprint exercise were determined using Spearman’s correlation coefficients (ρ).Results:Running speed, hip flexion angles, hip flexion and extension moments, and hip strength in all muscle groups were significantly reduced from pre to post. No significant between-group differences were observed before or after repeated sprint exercise. No significant relationships (ρ = 0.04-0.30) were observed between hip pain and changes in hip moments or strength in the FAIS group.Conclusion:Changes in running biomechanics and strength after repeated sprint exercise did not differ between participants with FAIS and asymptomatic participants with and without cam morphology. Self-reported pain did not appear to influence biomechanics during running or strength after repeated sprint exercise in participants with FAIS.Clinical Relevance:A short bout of repeated sprinting may not elicit changes in running biomechanics in FAIS beyond what occurs in those without symptoms. Longer duration activities or activities requiring greater hip flexion angles may better provoke pathology-related changes in running biomechanics in people with FAIS.
      Citation: Sports Health
      PubDate: 2022-12-02T06:08:51Z
      DOI: 10.1177/19417381221131570
       
  • Acute Effect of Resistance Training With Blood Flow Restriction on
           Perceptual Responses: A Systematic Review and Meta-Analysis

    • Free pre-print version: Loading...

      Authors: Victor Sabino de Queiros, Nicholas Rolnick, Ísis Kelly dos Santos, Ingrid Martins de França, Rony Jerônimo Lima, João Guilherme Vieira, Rodrigo Ramalho Aniceto, Gabriel Rodrigues Neto, Jason Azevedo de Medeiros, Jeferson Macedo Vianna, Breno Guilherme de Araújo Tinôco Cabral, Paulo Moreira Silva Dantas
      Abstract: Sports Health, Ahead of Print.
      Context:Several studies have compared perceptual responses between resistance exercise with blood flow restriction and traditional resistance exercise (non-BFR). However, the results were contradictory.Objectives:To analyze the effect of RE+BFR versus non-BFR resistance exercise [low-load resistance exercise (LL-RE) or high-load resistance exercise (HL-RE)] on perceptual responses.Data Sources:CINAHL, Cochrane Library, PubMed®, Scopus, SPORTDiscus, and Web of Science were searched through August 28, 2021, and again on August 25, 2022.Study Selection:Studies comparing the effect of RE+BFR versus non-BFR resistance exercise on rate of perceived exertion (RPE) and muscle pain/discomfort were considered. Meta-analyses were conducted using the random effects model.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 2.Data Extraction:All data were reviewed and extracted independently by 2 reviewers. Disagreements were resolved by a third reviewer.Results:Thirty studies were included in this review. In a fixed repetition scheme, the RPE [standardized mean difference (SMD) = 1.04; P < 0.01] and discomfort (SMD = 1.10; P < 0.01) were higher in RE+BFR than in non-BFR LL-RE, but similar in sets to voluntary failure. There were no significant differences in RPE in the comparisons between RE+BFR and non-BFR HL-RE; after sensitivity analyses, it was found that the RPE was higher in non-BFR HL-RE in a fixed repetition scheme. In sets to voluntary failure, discomfort was higher in RE+BFR versus non-BFR HL-RE (SMD = 0.95; P < 0. 01); however, in a fixed scheme, the results were similar.Conclusion:In sets to voluntary failure, RPE is similar between RE+BFR and non-BFR exercise. In fixed repetition schemes, RE+BFR seems to promote higher RPE than non-BFR LL-RE and less than HL-RE. In sets to failure, discomfort appears to be similar between LL-RE with and without BFR; however, RE+BFR appears to promote greater discomfort than HL-RE. In fixed repetition schemes, the discomfort appears to be no different between RE+BFR and HL-RE, but is lower in non-BFR LL-RE.
      Citation: Sports Health
      PubDate: 2022-11-23T04:50:08Z
      DOI: 10.1177/19417381221131533
       
  • Society News

    • Free pre-print version: Loading...

      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-11-16T06:31:06Z
      DOI: 10.1177/19417381221138250
       
  • The Missing Link

    • Free pre-print version: Loading...

      Authors: Edward M. Wojtys
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-11-15T05:43:43Z
      DOI: 10.1177/19417381221138769
       
  • Perceptions of Concussion and Associated Anxiety in Irish Collegiate
           Athletes

    • Free pre-print version: Loading...

      Authors: Siobhán O’Connor, Deirdre Geaney, Enda F. Whyte, Anthony P. Kontos, Philip J. O’Halloran, Erica Beidler
      Abstract: Sports Health, Ahead of Print.
      Background:Concussion nondisclosure and poor management after a concussion are a concern in Irish collegiate sports. How athletes perceive concussions and appraise their own concussion may affect their decisions and behaviors after a suspected concussion. However, this has yet to be examined in an Irish context. This study aimed to (1) establish concussion perceptions and associated anxiety in Irish collegiate athletes; (2) examine how sex, concussion, and mood disorder history influenced their perceptions; and (3) investigate factors associated with higher anxiety perceptions.Hypothesis:Irish collegiate athletes will display negative concussion perceptions and anxiety related to concussion, especially in female athletes and those without a concussion history.Study Design:Cross-sectional study.Level of Evidence:Level 3.Methods:Irish collegiate athletes [n = 268 (141 women,127 men), mean age = 21.5 ± 2.2 years] from high-risk sports completed a survey including the Perceptions of Concussion Inventory for Athletes (PCI-A), demographics, diagnosed concussion history, self-reported mood disorder history, and a concussion knowledge assessment. Differences in concussion perceptions by sex, concussion history, mood disorder history were examined using Mann-Whitney U tests, and factors associated with anxiety-related concussion perceptions were identified using multivariate logistic regression.Results:Over half (53.0%, n = 142) of participants reported concerns regarding concussion. The thoughts of sustaining a concussion made participants feel upset (63.4%, n = 170), fearful (47.7%, n = 128), and anxious (35.1%, n = 94). Women reported significantly higher anxiety (P < 0.01, r = 0.23), effects (P = 0.04, r = 0.12), and clarity (P = 0.01, r = 0.16) perception scores. Participants with a diagnosed concussion history displayed greater symptom variability perception scores (P = 0.04, r = 0.12), but lower anxiety (P = 0.03, r = 0.13) and treatment (P < 0.01, r = 0.19) beliefs on the PCI-A. No differences were observed for those with a history of a mood disorder (P> 0.05). A significant multivariate model was established (χ2 = 55.44, P < 0.01), with female sex [odds ratio (OR) = 1.53], concussion history (OR = 0.63), effects (OR = 1.31), and treatment (OR = 1.15) subscales associated with greater anxiety.Conclusion:Concerns about sustaining a concussion are prevalent in Irish collegiate athletes. Women displayed more negative perceptions and those with a concussion history displayed fewer perceived benefits of treatment.Clinical Relevance:The findings support the need for concussion awareness campaigns to provide accurate concussion information to mitigate anxiety-related concussion perceptions and injury belief misconceptions.
      Citation: Sports Health
      PubDate: 2022-11-11T06:37:51Z
      DOI: 10.1177/19417381221134103
       
  • Effect of the Length of the Microcycle on the Daily External Load,
           Fatigue, Sleep Quality, Stress, and Muscle Soreness of Professional Soccer
           Players: A Full-Season Study

    • Free pre-print version: Loading...

      Authors: José M. Oliva Lozano, José M. Muyor, Andrés Pérez-Guerra, David Gómez, Jorge Garcia-Unanue, Javier Sanchez-Sanchez, José Luis Felipe
      Abstract: Sports Health, Ahead of Print.
      Background:The aim of this study was to analyze the effect of the length of the microcycle (ie, training period from the day after the match to the following match) on the daily external load and perceived wellness of professional soccer players (Spanish LaLiga Smartbank).Hypothesis:The length of the microcycle has a significant effect on the daily external load and perceived wellness.Study Design:Longitudinal study.Level of Evidence:Level 3.Methods:Data were collected daily during a full season using perceived wellness questionnaires and electronic performance and tracking systems.Results:The length of the microcycle had a significant effect on volume- and intensity-related external load variables. There were differences between short, regular, and long microcycles depending on the day of the microcycle. These differences were observed in all external load variables. However, no significant differences between short, regular, or long microcycles were found on match day for any external load variable, except for high-intensity decelerations. Regarding the perceived wellness, the length of the microcycle had no effect on these variables, and there were no significant interactions between the length and the day of the microcycle.Conclusion:The length of the microcycle had a significant effect on volume- and intensity-related external load variables, but no significant effect on perceived wellness was observed.Clinical Relevance:These data may help strength and conditioning coaches understand that workload periodization should take this contextual variable into account, especially for external training load. In addition, this study may serve as a guide for practitioners to know the physical requirements of professional soccer players in Spanish LaLiga Smartbank, because the weekly external load profile and perceived wellness have been reported for different lengths of the microcycles. Thus, these data may be used for player load management.
      Citation: Sports Health
      PubDate: 2022-10-31T06:12:39Z
      DOI: 10.1177/19417381221131531
       
  • Individual-Specific Relationship Between External Training and Match Load
           and Creatine-Kinase Response in Youth National Team Soccer Players

    • Free pre-print version: Loading...

      Authors: Gabor Schuth, Gyorgy Szigeti, Gergely Dobreff, Alija Pasic, Tim Gabbett, Adam Szilas, Gabor Pavlik
      Abstract: Sports Health, Ahead of Print.
      Background:Previous studies have examined the relationship between external load and creatine-kinase (CK) response at the team level. This study aimed to build individualized CK prediction models for elite youth national team soccer players.Hypothesis:The CK response of youth soccer players can be categorized as being sensitive to micromovements (MM), high-velocity (HV) parameters, or the combination of both, measured during training sessions and matches.Study Design:Prospective cohort study.Level of Evidence:Level 4.Methods:A total of 25 U16-U17 youth national team soccer players were monitored during training sessions and matches using global positioning system (GPS) units. Individual CK values were measured every morning from whole blood. The data set consisted of 57 ± 17 individual datapoints per player. Individual prediction models were used to examine the relationship between external load and consecutive CK changes. Numerous models were built for each player using MM, HV parameters, or the combination of both. The performance of the models was described by the R2 and the root mean square error (RMSE, U/l for CK values).Results:The MM models were superior for 8 players (R2 = 0.68; RMSE = 113 U/l), followed by HV (8 players; R2 = 0.69; RMSE = 88 U/l) and the combined models (2 players; R2 = 0.64; RMSE = 141 U/l). For the remaining 7 players, the R2 of the models was
      Citation: Sports Health
      PubDate: 2022-10-31T06:05:57Z
      DOI: 10.1177/19417381221128822
       
  • Early Sport Specialization and Long-term Throwing Arm Health in College
           Baseball Players

    • Free pre-print version: Loading...

      Authors: Samuel J. Wilkins, David R. Bell, Leamor Kahanov, Malissa Martin, Eric G. Post
      Abstract: Sports Health, Ahead of Print.
      Background:Early sport specialization is associated with increased risk of overuse injuries in several sports, including baseball. However, limited evidence exists evaluating how early sport specialization affects patient-reported outcome measures as they age. The purpose of this study was to determine differences in Kerlan-Jobe Orthopedic Clinic (KJOC) Shoulder and Elbow Scores among collegiate baseball players based on the grade when a participant first reported high specialization behaviors.Hypothesis:Baseball players who were highly specialized at a younger age will have worse throwing arm health while participating in college.Study Design:Cross-sectional studyLevel of Evidence:Level 3Methods:A total of 752 college baseball players was contacted through their institution’s athletic trainer. We measured baseball specialization and KJOC scores using the validated Baseball and Sport Experience survey. Data were summarized using means and SDs, medians and interquartile ranges (IQRs), and frequencies and percentages. A Kruskal-Wallis test was used to determine differences in mean KJOC scale scores based on the earliest time the participant reported high-level specialization.Results:A total of 294 baseball players completed the survey (response rate: 39.1%). Of the 294 participants, 280 completed the KJOC scale questions to generate a total KJOC score (median: 90.5; IQR: 76.6-97.2). No significant differences in KJOC total scores (P = 0.78) existed based on the grade period in which the athlete was first highly specialized.Conclusion:Early baseball specialization as a youth baseball player may not impact throwing arm health in college baseball athletes.Clinical Relevance:Early specialization has been linked to increased risk for overuse injuries in certain sports, but may not lead to poorer throwing arm health in college baseball players. Sports medicine clinicians and researchers may use this information to educate various stakeholders about the benefits and risks associated with early sport specialization.
      Citation: Sports Health
      PubDate: 2022-10-07T04:49:40Z
      DOI: 10.1177/19417381221125719
       
  • A Field-expedient Arm Care Screening Tool Can Identify Musculoskeletal
           Risk Factors in Baseball Players

    • Free pre-print version: Loading...

      Authors: Kyle A. Matsel, Matt C. Hoch, Robert J. Butler, Philip M. Westgate, Terry R. Malone, Tim L. Uhl
      Abstract: Sports Health, Ahead of Print.
      Background:Preseason movement screening can identify modifiable risk factors, deterioration of function, and potential for injury in baseball players. Limited resources and time prevent high school baseball coaches from performing movement screens on their players.Hypothesis:The arm care screen (ACS) will be highly sensitive to detecting musculoskeletal risk factors.Study Design:Cross-sectionalLevel of evidence:Level 3Methods:A total of 150 baseball players were independently scored on the ACS electronically by reviewing a video recording of each player’s screening performance. Discriminability of the ACS was determined with a 2 × 2 contingency table dichotomizing musculoskeletal risk factors as present or absent based on a predetermined cutoff value and those who passed or failed the corresponding ACS subtest.Results:High sensitivity was observed on the reciprocal shoulder mobility (0.89; 95% CI 0.81-0.94), 90/90 total body rotation (0.86; 95% CI 0.79-0.92), and lower body diagonal reach (0.85; 95% CI 0.78-0.91) tests of the ACS suggesting sufficient ability to identify musculoskeletal impairments and risk factors.Conclusion:The ACS is a simplistic screening tool that the coach can administer to discriminate between youth, high school, and college-level baseball players who possess musculoskeletal risk factors. The ACS subtests demonstrated high sensitivity for correctly identifying musculoskeletal risk factors common in baseball players and can be useful as a screening tool for baseball coaches developing arm care exercise programs.Clinical Relevance:A field-expedient screen could provide coaches the ability to identify musculoskeletal risk factors that need to be addressed to minimize injury risk factors in a time-efficient manner.
      Citation: Sports Health
      PubDate: 2022-10-07T04:41:40Z
      DOI: 10.1177/19417381221125465
       
  • Eight Weeks of Pilates Training Improves Respiratory Measures in People
           With a History of COVID-19: A Preliminary Study

    • Free pre-print version: Loading...

      Authors: Behnam Bagherzadeh-Rahmani, Negin Kordi, Amir Hossein Haghighi, Cain C.T. Clark, Luca Brazzi, Emanuele Marzetti, Paulo Gentil
      Abstract: Sports Health, Ahead of Print.
      Background:Coronavirus disease 2019 (COVID-19) can result in prolonged and severe damage to the lungs and quality of life (QoL). This study was designed to investigate the effects of 8-week Pilates and Aqua-Pilates training on pulmonary function and QoL in patients with COVID-19.Hypothesis:Pilates and Aqua-Pilates training promotes similar changes on pulmonary function and QoL in people with a history of COVID-19.Study Design:Randomized controlled trial.Level of Evidence:Level 3.Methods:A total of 45 participants (24 men and 21 women) with a history of COVID-19 were assigned randomly to 3 groups: Pilates training (standard Pilates), Aqua-Pilates training (Pilates in water), and Control. The training protocol was performed for 8 weeks (3 sessions per week). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and the ratio of FEV1 to the FVC (FEV1/FVC) indices were measured by a spirometer. The 26-item questionnaire World Health Organization Quality of Life (WHOQOL) BREF was used to assess QoL. Data were analyzed using paired-sample t test and analysis of covariance with an alpha level
      Citation: Sports Health
      PubDate: 2022-10-03T05:54:34Z
      DOI: 10.1177/19417381221124601
       
  • Risk Factors for Athletic Pubalgia in Collegiate Football
           Student-Athletes: A Retrospective Cohort Study

    • Free pre-print version: Loading...

      Authors: Alexander J. Neuville, Clint L. Benge, Vehniah K. Tjong, Brian S. Lund, Geoffrey S. Baer, Brian E. Walczak
      Abstract: Sports Health, Ahead of Print.
      Background:Athletic pubalgia (AP) is an increasingly recognized injury among young athletes. This study aimed to evaluate the characteristics associated with AP in college football players.Hypothesis:Repetitive explosive movements that require aggressive core muscle activation results in AP in collegiate football players.Study Design:Retrospective cohort design.Level of Evidence:Level 3.Methods:Football student-athletes at a single Division I collegiate institution from January 2010 to December 2019 were included in the study. The primary outcome measure was surgery for AP. The odds of AP were determined using logistic regression, with the dependent variable being whether or not the student-athlete received AP surgery. Independent variables included Olympic weightlifting (OWL) exposure, primary playing position (skill position vs nonskill position), and body mass index (BMI).Results:A total of 1154 total student-athlete exposures met the inclusion criteria. Of the 576 student-athletes exposed to OWL (OWL occurred throughout entire calendar year), 20 developed AP, whereas 7 student-athletes not exposed to OWL (OWL was not performed at any point during calendar year) developed AP. Student-athletes exposed to OWL had a 2.86 (95% CI, 1.25-7.35; P = 0.02) times higher odds of AP than players not exposed after controlling for primary playing position and BMI. Skill position players had a 9.32 (95% CI, 1.71-63.96; P = 0.01) times higher odds of AP than nonskill position players when controlling for BMI and OWL training.Conclusion:Modifiable factors that increase exposure to repetitive explosive activities, such as OWL and playing a skill position, may be important considerations in developing AP.Clinical Relevance:The cause of AP is multifactorial and poorly understood. Identifying factors associated with AP informs athletes, athletic trainers, physicians, and coaches.
      Citation: Sports Health
      PubDate: 2022-09-29T04:55:53Z
      DOI: 10.1177/19417381221121127
       
  • Moderate and High Sport Specialization Level in Ice Hockey Athletes Is
           Associated With Symptomatic Cam Deformity

    • Free pre-print version: Loading...

      Authors: Mindy Nguyen, Sarah Bixby, Yi-Meng Yen, Patricia Miller, Andrea Stracciolini
      Abstract: Sports Health, Ahead of Print.
      Background:There is a known association between ice hockey and cam deformity in growing athletes. Similarly, the association between sport specialization and overuse injury in youth athletes has been well established. Limited research exists examining the relationship between cam deformity and sport specialization.Hypothesis/Purpose:Our hypothesis was that there would be a positive association with cam deformity and sport specialization category.Study Design:Retrospective chart review and cross-sectional questionnaire study.Level of Evidence:Level 4.Methods:Study participants included athletes aged 15 to 25 years with symptomatic femoroacetabular impingement (FAI) and considered ice hockey as their primary sport. All participants had completed Dunn lateral radiographs or hip magnetic resonance imaging as part of their clinical evaluation. All participants completed a survey regarding sport specialization level. Multivariable linear regression analysis controlling for sex was used to analyze the association between degree of sport specialization, age of sport specialization, position played, and level played. Comparisons in radiographic parameters across ice hockey groups were conducted using Student t tests and chi-square tests.Results:Sixty-six ice hockey participants made up the cohort. The majority reported high sport specialization (41/66, 62%). The mean age of sport specialization was 10.7 years (SD 3.5). Participants with moderate specialization had 25 times the odds of a cam deformity (odds ratio [OR] 25.2; 95% CI 1.5-410.7; P = 0.02) and those with high specialization had 9 times the odds of cam deformity (OR 9.3; 95% CI 1.2-74.2; P = 0.04) compared with those with a low degree of specialization, controlling for patient sex. No association was detected between the age of specialization and the likelihood of cam deformity when controlling for patient sex.Conclusion:Level of sport specialization was associated with a cam deformity in this cohort of youth ice hockey athletes.Clinical Relevance:This study suggests that an association exists.
      Citation: Sports Health
      PubDate: 2022-09-27T05:17:49Z
      DOI: 10.1177/19417381221123528
       
  • The Relationship of Knee-related Quality of Life with Function,
           Psychological Factors, Strength, Performance, and Postural Stability After
           ACL Reconstruction: A Cross-Sectional Study

    • Free pre-print version: Loading...

      Authors: Maria Larissa Azevedo Tavares, Pedro Olavo de Paula Lima, Thamyla Rocha Albano, Carlos Augusto Silva Rodrigues, Gabriel Peixoto Leão Almeida
      Abstract: Sports Health, Ahead of Print.
      Background:Patients after anterior cruciate ligament reconstruction (ACLR) have decreased health-related quality of life (QoL) compared with healthy control participants. Few studies have verified the predictors of QoL using Quality of Life Outcome Measure Questionnaire for Chronic Anterior Cruciate Ligament Deficiency (ACL-QoL), and no study has verified the relationship of psychological factors and knee function with ACL-QoL in patients after ACLR.Hypothesis:Knee functional status, muscle strength, performance in hop tests, postural stability, and psychological factors would be the predictors of QoL after ACLR.Study Design:Cross-sectional study.Level of Evidence:Level 4.Methods:A total of 131 participants who had undergone ACLR at least 6 months previously were evaluated. QoL was assessed using ACL-QoL; knee functional status, using International Knee Documentation Committee Subjective Knee (IKDC) and global rating scale (GRS); psychological readiness, using Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI); kinesiophobia, using Tampa Scale for Kinesiophobia (TSK-17); knee strength, using isokinetic dynamometer; performance, using single-leg hop tests; and postural stability, using Biodex Balance System. Pearson’s linear correlation and stepwise hierarchical multiple linear regression analyses were performed to verify the predictors of QoL.Results:ACL-QoL showed a moderate correlation with IKDC (r = 0.69), GRS (r = 0.55), ACL-RSI (r = 0.50), and TSK-17 (r = -0.49). ACL-QoL presented none to low correlations with the variables of muscle strength, postural stability, and performance in hop tests. The variables related to the knee functional status and psychological factors (IKDC, GRS, ACL-RSI, and TSK-17) were found to be the predictors of QoL (R2 = 0.56; P = 0.01).Conclusion:Knee functional status, psychological readiness, and kinesiophobia were the predictors of knee-related QoL in patients after ACLR.Clinical Relevance:These results can assist clinicians in the therapeutic monitoring of the factors that may interfere with QoL in patients after ACLR.
      Citation: Sports Health
      PubDate: 2022-09-26T05:09:22Z
      DOI: 10.1177/19417381221123517
       
  • Pedestrian Safety Among High School Runners: a Case Series

    • Free pre-print version: Loading...

      Authors: Erin Shore, Randi DeLong, Elaine Powell, Johna Register-Mihalik, Rebecca Stearns, Michael C. Koester, Kristen Kucera
      Abstract: Sports Health, Ahead of Print.
      Background:Participation in high school cross-country and track has increased over the last few decades. At the same time, the rate of pedestrian-involved motor vehicle crashes (MVCs) has also increased. In the context of organized sport, pedestrian safety among runners is often not highlighted, despite the risk of catastrophic injury.Purpose:To describe incidents of pedestrian-involved MVCs involving student athletes captured by the National Center for Catastrophic Sport Injury Research (NCCSIR) at the University of North Carolina at Chapel Hill.Study Design:Case series.Level of Evidence:Level 5.Methods:This study utilized surveillance data from the NCCSIR from 2011 to 2020. It presents descriptive statistics, including frequencies and percentages, detailed summaries, and a Haddon Matrix.Results:There were 8 incidents involving 11 student athletes, resulting in 9 fatalities. Of these, 5 cases occurred in the afternoon or early evening, 4 occurred in the Fall, and 6 occurred in a rural area. Haddon Matrix analyses of case descriptions indicate schools should implement a runner safety program for all new runners and ensure that runner safety measures are included in emergency action plans.Conclusion:Runner-related MVCs are relatively rare, but tragic, incidents. Pedestrian safety measures should be incorporated into school-sponsored practices and training runs.Clinical Relevance:Pedestrian safety should be incorporated into runner safety and injury prevention efforts.
      Citation: Sports Health
      PubDate: 2022-09-26T05:06:02Z
      DOI: 10.1177/19417381221123510
       
  • The Effect of Monophasic Oral Contraceptives on Muscle Strength and
           Markers of Recovery After Exercise-Induced Muscle Damage: A Systematic
           Review

    • Free pre-print version: Loading...

      Authors: Astrid Glenner-Frandsen, Cecilie With, Thomas P. Gunnarsson, Morten Hostrup
      Abstract: Sports Health, Ahead of Print.
      Context:Oral contraceptives (OCs) manipulate hormonal fluctuations of the menstrual cycle and affect physical performance. Most investigations on the effect of OCs on physical performance did not discriminate between different types of OCs. Thus, the effects of monophasic OCs (MOCs) - the most common type of OCs - on muscle strength and recovery from exercise are largely unknown.Objective:To examine the effect of MOC use on muscle strength and markers of recovery after exercise-induced muscle damage (EIMD) in premenopausal women.Data Sources:Electronic databases Embase, PubMed, SportDiscus, and Web of Science were searched for studies examining the effect of MOCs on acute muscle strength and recovery.Study Selection:Keywords applied for the study selection were oral contraceptive* AND muscle strength or oral contraceptive* AND muscle damage.Study Design:Systematic review.Level of Evidence:Lowest quality assessed for an included study in this review was serious risk of bias using ROBINS-I tool made from Cochrane for nonrandomized studies.Data Extraction:A total of 104 studies on muscle strength were identified, of which 11 met the inclusion criteria. Concerning recovery, 51 studies were identified, of which 4 met the inclusion criteria.Results:Of the 11 studies included, 10 showed no effect of MOCs on acute muscle strength. Of the 4 studies on recovery, 2 found a greater decrease in muscle strength, and 3 found higher creatine kinase (CK) levels after EIMD in MOC users than in nonusers. The included studies were all rated with moderate-to-serious risk of bias.Conclusion:These findings suggest that MOCs may impair recovery from EIMD as indicated by lowered muscle strength and elevated CK levels. There is insufficient evidence to conclude whether MOCs acutely affect muscle strength. Moderate-to-serious risk of bias in studies makes interpretation challenging.
      Citation: Sports Health
      PubDate: 2022-09-26T05:01:53Z
      DOI: 10.1177/19417381221121653
       
  • Effects of Moderate-Intensity Training Under Cyclic Hypoxia on
           Cardiorespiratory Fitness and Hematological Parameters in People Recovered
           From COVID-19: The Aerobicovid Study

    • Free pre-print version: Loading...

      Authors: Carlos Dellavechia de Carvalho, Danilo Rodrigues Bertucci, Felipe Alves Ribeiro, Gabriel Peinado Costa, Diana Mota Toro, Marta Camacho-Cardenosa, Javier Brazo-Sayavera, Carlos Arterio Sorgi, Marcelo Papoti, Átila Alexandre Trapé
      Abstract: Sports Health, Ahead of Print.
      Background:Recent studies have indicated that people who live at altitude have a lower incidence of coronavirus disease (COVID-19) and lesser severity in infection cases.Hypothesis:Hypoxia exposure could lead to health benefits, and it could be used in the recovery process as an additional stimulus to physical training to improve cardiorespiratory fitness (CRF).Study Design:Randomized controlled clinical trial.Level of Evidence:Level 2.Methods:The 43 participants, aged 30 to 69 years, were divided into control group (CG, n = 18) and 2 training groups: normoxia (NG, n = 9) and hypoxia (HG, n = 16). Before and after the intervention were evaluated the lactate threshold 2 (L2), peak oxygen uptake (VO2peak), and a blood sample was collected at rest to evaluate hematological adaptation. Both groups performed an 8-week moderate-intensity physical training on a bike. The HG were trained under normobaric hypoxic conditions (fractional inspired oxygen [FiO2] = 13.5%).Results:The 8-week intervention promoted a similar improvement in CRF of people recovered from COVID-19 in the HG (L2 = 34.6%; VO2peak = 16.3%; VO2peak intensity = 24.6%) and NG (L2 = 42.6%; VO2peak = 16.7%; VO2peak intensity = 36.9%). Only the HG presented differences in hematological variables (erythropoietin = 191.7%; reticulocytes = -32.4%; off-score = 28.2%) in comparison with the baseline.Conclusion:The results of the present study provide evidence that moderate-intensity training in normoxia or hypoxia promoted similar benefits in CRF of people recovered from COVID-19. Furthermore, the hypoxia offered an additional stimulus to training promoting erythropoietin increase and hematological stimulation.Clinical Relevance:The present exercise protocol can be used for the rehabilitation of people recovered from COVID-19, with persistent low CRF. In addition, this is the first study demonstrating that physical training combined with hypoxia, as well as improving CRF, promotes greater hematological stimulation in people recovered from COVID-19.
      Citation: Sports Health
      PubDate: 2022-09-26T04:58:22Z
      DOI: 10.1177/19417381221120639
       
  • Intrinsic Risk Factors for First-Time Noncontact ACL Injury: A Prospective
           Study of College and High School Athletes

    • Free pre-print version: Loading...

      Authors: Bruce D. Beynnon, Timothy W. Tourville, Helen C. Hollenbach, Sandy Shultz, Pamela Vacek
      Abstract: Sports Health, Ahead of Print.
      Background:A comprehensive understanding of the intrinsic risk factors for anterior cruciate ligament (ACL) disruption is important for identifying individuals at increased risk for suffering this trauma and developing interventions to mitigate risk.Hypothesis:A variety of risk factors predispose athletes to first-time, noncontact ACL injury and some of these differ between male and female athletes.Study Design:Prospective cohort study with nested case-control sampling.Level of Evidence:Level 2.Methods:Sport teams at 28 high schools and 8 colleges were monitored prospectively over 4 years, and 109 of 130 athletes who suffered their first noncontact ACL injury participated in the study. At the time of injury, matched control subjects were randomly selected from among the case’s teammates and a total of 227 athletes participated. Demographic characteristics, joint laxity, lower extremity alignment, strength, and personality characteristics were measured. The association of each risk factor with injury risk was assessed by conditional logistic regression.Results:The risk factors that were associated with ACL injury in both male and female athletes included having a parent with prior ACL injury and increases of the following variables: body weight, anterior displacement of the tibia relative to the femur, genu recurvatum, and generalized joint laxity. Risk factors that are unique to female athletes included increased body mass index, increased trunk flexion strength, and prior non-ACL knee injury. The risk factors specific to male athletes were decreased standing quadriceps angle, decreased hip adduction strength, and chronic disease.Conclusion:A diverse set of risk factors predispose both male and female athletes to ACL injury, whereas others appear to be sex-specific.Clinical Relevance:Different approaches for assessing risk and preventing ACL injury are needed for male and female athletes. In addition, personalized prevention strategies may be needed to target the specific characteristics that place an individual at increased risk of suffering this trauma.
      Citation: Sports Health
      PubDate: 2022-09-26T04:43:33Z
      DOI: 10.1177/19417381221121136
       
  • Influence of Graft Type on Lower Extremity Functional Test Performance and
           Failure Rate After Anterior Cruciate Ligament Reconstruction

    • Free pre-print version: Loading...

      Authors: Megan H. Roach, Michael J. Aderman, Shawn M. Gee, Karen Y. Peck, Sean P. Roach, Donald L. Goss, Matthew A. Posner, Chad A. Haley, Steven J. Svoboda, Kenneth L. Cameron
      Abstract: Sports Health, Ahead of Print.
      Background:Both autografts and allografts are used to reconstruct the anterior cruciate ligament (ACL) after injury; however, it is unclear whether graft source affects lower extremity functional test performance or failure rate in an active military population.Objective:To compare lower extremity functional test performance and graft failure rates between ACL grafts [allograft, hamstring, bone-patellar tendon-bone (BTB)].Study Design:Cross-sectional.Level of Evidence:Level 2.Methods:Ninety-eight cadets entering a US Service Academy with a history of unilateral ACL reconstruction (ACLR) agreed to participate. Before basic training, participants completed 4 lower extremity functional tests. Active injury surveillance was conducted within the study cohort to identify all subsequent graft failures.Results:Cadets with hamstring autografts outperformed the BTB and allograft groups on the Lower Quarter Y-Balance Test-Posteromedial direction and single-leg hop test, respectively. No differences were detected by graft type for the other functional tests. The incidence of subsequent ipsilateral graft failures in patients with autograft was 8.11%. No failures were observed in the allograft group during the follow-up period. After controlling for sex, joint hypermobility, and time since injury and surgery, the risk of graft failure was 9.8 times higher for patients with a hamstring autograft than with a BTB (P = 0.045).Conclusion:After ACLR, graft type appears to influence some single-limb measures of lower extremity function and the risk of subsequent failure. Hamstring autografts demonstrated better functional performance but increased risk of graft failure.Clinical Relevance:Surgeons need to weigh the pros and cons of all graft options in relation to the patient’s lifestyle. Regardless of graft type, individuals with an ACLR may require additional rehabilitation to regain neuromuscular control during dynamic single-limb tasks and mitigate graft failure.
      Citation: Sports Health
      PubDate: 2022-09-26T04:35:34Z
      DOI: 10.1177/19417381221119420
       
  • Are Current Prophylactic Programs Effective in Preventing Patellar
           Tendinopathy in Athletes and Recruits' A Meta-Analysis and Trial
           Sequential Analysis

    • Free pre-print version: Loading...

      Authors: Shaowei Wang, Buwei Lyu
      Abstract: Sports Health, Ahead of Print.
      Context:Patellar tendinopathy (PT), or jumper’s knee, is a chronic painful overuse patellar tendon injury. For PT, prevention is more important than treatment. However, there is still a lack of strong evidence to confirm the effectiveness of prevention.Objective:This study will analyze by meta-analysis the effect of a prophylactic program on high PT risk people (but without PT) in reducing PT occurrence.Data Sources:PubMed, Embase, the Cochrane Library, Scopus, and Ebscohost, from inception to January 11, 2022.Study Selection:A study comparing the effects of prophylactic programs and controls on the risk of PT was included in the analysis. After a database search with search terms ((patellar tendinopathy) OR (jumper’s knee) OR (patellar tendinitis) OR (patellar tendinosis) OR (patellar tendonitis)) AND ((Prevent*) OR (prophyla*)), a total of 1444 items were obtained. Of these, 11 studies with 6091 participants were eligible for inclusion in this meta-analysis.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 2.Data Extraction:The first author’s name, publication year, study design, country, population, mean age, sex, prophylactic program, control, study duration, and the frequency or incidence of PT in each group were extracted.Results:A total of 11 articles were included in the analysis. Overall, no significant difference was considered in the risk of PT between the prophylactic program and control groups based on the random-effect model (odds ratio [OR], 0.85; 95% CI, 0.67, 1.08; P = 0.18). In the recruit subgroup, there was even a tendency to elevate the risk of PT occurrence after prophylaxis was executed (OR, 1.89; 95% CI, 0.68, 5.28; P = 0.22). In athletes, the prophylactic program tended to decrease the risk of PT compared with the control (OR, 0.81; 95% CI, 0.63, 1.04; P = 0.10); however, the difference was not statistically significant. Trial sequential analysis results suggested that prophylaxis may still be effective for athletes, but this needs to be confirmed with a larger sample size.Conclusion:The risk of PT cannot be reduced with the current prophylactic program. However, for athletes, the negative results may be due to insufficient sample size.
      Citation: Sports Health
      PubDate: 2022-09-23T05:32:48Z
      DOI: 10.1177/19417381221121808
       
  • Therapeutic Exercises and Modalities in Athletes With Acute Hamstring
           Injuries: A Systematic Review and Meta-Analysis

    • Free pre-print version: Loading...

      Authors: Amornthep Jankaew, Jih-Ching Chen, Samatchai Chamnongkich, Cheng-Feng Lin
      Abstract: Sports Health, Ahead of Print.
      Context:Hamstring strain is a common injury to the lower limbs. Early intervention in the acute phase aids with restoring hamstring function and prevents secondary related injury.Objective:To systematically review and summarize the effectiveness of exercise-based interventions combined with physical modalities currently used in athletes with acute hamstring injuries.Data Sources:Five databases (EMBASE, Medline, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to July 2021.Study Selection:A total of 4569 studies were screened. Nine randomized controlled trials (RCTs) on the effect of therapeutic exercise programs with and without physical agents in athletes with acute hamstring injuries were identified for meta-analysis.Study Design:Systematic review and meta-analysisLevel of Evidence:Level 1Data Extraction:The studies were screened, and the evidence was rated using the PEDro scale. Nine RCTs with PEDro scores ranging between 3 and 9 were included and extracted pain intensity, time to return to play (TTRTP), and reinjury rate in the study.Results:Loading exercises during extensive lengthening were shown to facilitate TTRTP at P < 0.0001 but did not prevent recurrence (P = 0.17), whereas strengthening with trunk stabilization and agility exercise did not reduce the duration of injury recurrence (P = 0.16), but significantly reduced the reinjury rate (P < 0.007) at a 12-month follow-up. The results of the stretching programs and solely physical modalities could not be pooled in the statistical analysis.Conclusion:The meta-analysis indicated that a loading program helps athletes to return to sports on a timely basis. Although strengthening with trunk stabilization and agility exercise cannot significantly reduce recovery time, the program can prevent reinjury. The clinical effects of stretching programs and pure physical modality interventions could not be concluded in this study due to limited evidence.PROSPERO Registration:CRD42020183035
      Citation: Sports Health
      PubDate: 2022-08-23T05:10:51Z
      DOI: 10.1177/19417381221118085
       
  • Norm Values of Muscular Strength Across the Life Span in a Healthy Swiss
           Population: The COmPLETE Study

    • Free pre-print version: Loading...

      Authors: Eric Lichtenstein, Jonathan Wagner, Raphael Knaier, Denis Infanger, Ralf Roth, Timo Hinrichs, Arno Schmidt-Trucksaess, Oliver Faude
      Abstract: Sports Health, Ahead of Print.
      Background:Grip strength is used to estimate whole-body strength for health surveillance purposes. Explosive strength is considered important, yet economic measures able to detect early deterioration of neuromuscular capabilities are lacking. Whether handgrip maximum rate of force development (GRFD) or whole-body strength tests are better predictors of lower body power than handgrip maximum strength (GFmax) and their trajectories throughout the life span are unknown.Hypothesis:GRFD should be more closely related to lower body power than GFmax, and its trajectories over the life span should more closely follow that of lower body power.Study Design:Cross-sectional.Level of Evidence:Level 2b.Methods:A total of 613 healthy participants aged 20 to 91 years were tested for countermovement jump peak power, GFmax, handgrip rate of force development, and midthigh pull peak force (MTP). Cubic splines and linear models were built for age trajectories, generalized additive models for quintile curves, and linear regression was used to assess predictive quality.Results:Peak power (Pmax) declined linearly to 60% of young adult level, with GRFD, GFmax, and MTP remaining stable up to age 50 years and then declining more sharply to 52% to 71% of young adult levels. Trajectories were similar for male and female participants. GRFD (β = 0.17) and MTP (β = 0.08) were worse predictors of Pmax than GFmax (β = 0.24) in models adjusted for age, sex, lean body mass, and vigorous physical activity levels.Conclusion:GRFD was not superior to maximum strength in predicting lower body power. For health surveillance purposes, it therefore appears that GFmax tests are more economical and equally good predictors of lower body explosive strength at older age. The data provided can be used as norm values for healthy subjects.Clinical Relevance:Incorporating countermovement jump testing for early detection of declines in explosive capabilities might be advised.
      Citation: Sports Health
      PubDate: 2022-08-19T06:14:14Z
      DOI: 10.1177/19417381221116345
       
  • Self-Reported Outcomes in Early Postoperative Management After Shoulder
           Surgery Using a Home-Based Strengthening and Stabilization System With
           Telehealth

    • Free pre-print version: Loading...

      Authors: Justin J. Greiner, Nicholas P. Drain, Bryson P. Lesniak, Albert Lin, Volker Musahl, James J. Irrgang, Adam J. Popchak
      Abstract: Sports Health, Ahead of Print.
      Background:Multiple rehabilitation protocols after shoulder surgery have been proposed. The coronavirus pandemic adds an extra layer of complexity to postoperative rehabilitation after shoulder surgery.Hypothesis:The combined use of a home-based rehabilitation system, the Shoulder Strengthening and Stabilization System (SSS), and telehealth visits will lead to acceptable patient self-reported outcomes and satisfaction after shoulder surgery.Study Design:Prospective observational cohort.Level of Evidence:Level 4.Methods:A total of 132 patients were prescribed SSS after shoulder surgery. A virtual clinical specialist monitored patients through telehealth visits as prescribed by the treating physician. Data were collected prospectively during each telehealth visit. Patients completed an exit survey during their last telehealth visit.Results:The use of SSS with telehealth revealed a positive impact on postoperative shoulder rehabilitation (96%), pain (71%), and stiffness (92%) as reported by patients. Both pain scores and pain medication use decreased from the 1st to 8th postoperative telehealth session (P < 0.01). Nearly all (93%) patients recommended SSS after shoulder surgery upon completing the SSS protocol.Conclusion:Postoperative management of shoulder surgery with SSS combined with telehealth results in a reduction in patient pain levels in the early postoperative period. Patients reported high levels of improvement with SSS in shoulder rehabilitation, pain, and stiffness. The overwhelming majority (93%) of patients recommended SSS for postoperative shoulder rehabilitation and SSS yielded high patient satisfaction scores. Elucidating the impact of SSS on clinical outcomes and function in comparison with traditional rehabilitation protocols is warranted.Clinical Relevance:SSS in combination with telehealth was tolerated well by patients and may represent an alternative or adjunct to traditional rehabilitation protocols.
      Citation: Sports Health
      PubDate: 2022-08-06T04:29:42Z
      DOI: 10.1177/19417381221116319
       
  • Comparison of Anxiety and Depression Symptoms in Concussed and
           Nonconcussed Adolescents

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

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

    • Free pre-print version: Loading...

      Authors: Ehiamen T. Okoruwa, Alexandra Abbott, Michaela Stamm, Mary K. Mulcahey
      First page: 797
      Abstract: Sports Health, Ahead of Print.
      Background:Description of possible detrimental effects of sport specialization specific to adolescent female athletes is limited in current literature with no consensus on sport specialization classification.Hypothesis:Specialized female athletes will have higher rates of injury, body image issues, and menstrual dysfunction, regardless of the specialization classification utilized.Study Design:Cross-sectional.Level of Evidence:Level 3.Methods:Retrospective data was obtained from questionnaires from female athletes in local high schools (n = 229; 13–18 years of age). The 3-point specialization scale was used to analyze differences in injury rates, body image issues, and menstrual dysfunction within low, moderate, and highly specialized athletes. When comparing accuracy of specialization scales in identifying high risk athletes, three peer-reviewed specialization classification scales were utilized—a 3-point scale, a 6-point scale, and a binary self-selection scale. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for studied variables (a priori p ≤ 0.05).Results:Of 229 athletes surveyed, 219 (95.6%) completed the 3-point specialization classification questions and were included in the study. 91 athletes (41.6%) were categorized as low specialization (LS), 59 (26.9%) were moderately specialized (ModS), and 69 (31.5%) were highly specialized (HS). ModS athletes were more likely to have a history of stress fractures (SFx) compared to LS athletes (p = 0.02; OR 3.62; 95% CI 1.27–10.26). Compared to LS athletes, HS athletes were more likely to have injury history (p = 0.01; OR 2.93; 95% CI 1.38–6.24) and a history of concussion (p < 0.01; OR 5.00; 95% CI 1.86–13.42).Conclusion:Among female high school athletes, higher levels of specialization are associated with greater risk of injuries overall, and greater risk of concussions and SFx. This study did not demonstrate significant associations between specialization and body image issues or menstrual dysfunction.Clinical Relevance:This study further strengthens the association between injury and sport specialization and suggests that combining specialization scales better improves risk stratification which overall aids in preventing athlete injury.
      Citation: Sports Health
      PubDate: 2022-10-07T05:01:27Z
      DOI: 10.1177/19417381221123532
       
  • Age and Female Sex Are Important Risk Factors for Stress Fractures: A
           Nationwide Database Analysis

    • Free pre-print version: Loading...

      Authors: Nisha N. Kale, Cindy X. Wang, Victor. J. Wu, Cadence Miskimin, Mary K. Mulcahey
      First page: 805
      Abstract: Sports Health, Ahead of Print.
      Background:Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults.Hypothesis:Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients.Study Design:Epidemiological research.Level of Evidence:Level 3.Methods:Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis.Results:Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI
      Citation: Sports Health
      PubDate: 2022-03-04T10:30:28Z
      DOI: 10.1177/19417381221080440
       
  • Acute Effects of Beetroot Juice Supplements on Lower-Body Strength in
           Female Athletes: Double-Blind Crossover Randomized Trial

    • Free pre-print version: Loading...

      Authors: Jose Manuel Jurado-Castro, Julian Campos-Perez, Antonio Ranchal-Sanchez, Natalia Durán-López, Raúl Domínguez
      First page: 812
      Abstract: Sports Health, Ahead of Print.
      Background:Beetroot juice (BRJ) is used as an ergogenic aid, but no previous study has analyzed the effect this supplement has on the production of explosive force and muscular endurance in physically active women.Hypothesis:BRJ improves explosive force and muscular endurance in the lower limbs of physically active women.Study design:Randomized double-blind crossover study.Level of evidence:Level 3Methods:Fourteen physically active women performed a countermovement jump (CMJ) test, a back squat test for assessing velocity and power at 50% and 75% of one-repetition maximum (1RM), and the number of repetitions on a muscular endurance test consisting of 3 sets at 75% of 1RM in a resistance training protocol comprising 3 exercises (back squat, leg press, and leg extension). The participants performed the test in 2 sessions, 150 minutes after ingesting 70 mL of either BRJ (400 mg of nitrate) or a placebo (PLA).Results:A greater maximum height was achieved in the CMJ after consuming BRJ compared with a PLA (P = 0.04; effect size (ES) = 0.34). After a BRJ supplement at 50% 1RM, a higher mean velocity [+6.7%; P = 0.03; (ES) = 0.39 (–0.40 to 1.17)], peak velocity (+6%; P = 0.04; ES = 0.39 [−0.40 to 1.17]), mean power (+7.3%; P = 0.02; ES = 0.30 [−0.48 to 1.08]) and peak power (+6%; P = 0.04; ES = 0.20 [−0.59 to 0.98]) were attained in the back squat test. In the muscular endurance test, BRJ increased performance compared with the PLA (P < 0.00; ηp2 = 0.651).Conclusion:BRJ supplements exert an ergogenic effect on the ability to produce explosive force and muscular endurance in the lower limbs in physically active women.Clinical relevance:If physically active women took a BRJ supplement 120 minutes before resistance training their performance could be enhanced.
      Citation: Sports Health
      PubDate: 2022-05-21T11:38:19Z
      DOI: 10.1177/19417381221083590
       
  • Are Altered Kinematics in Runners With Patellofemoral Pain Sex
           Specific'

    • Free pre-print version: Loading...

      Authors: Bruna Calazans Luz, Ana Flávia dos Santos, Fábio Viadanna Serrão
      First page: 822
      Abstract: Sports Health, Ahead of Print.
      Background:Altered kinematics have been frequently observed in runners with patellofemoral pain (PFP), and few studies have aimed to understand the influence of sex on kinematics of this population. The aim of this study was to investigate whether altered hip and knee kinematics in runners with PFP are sex specific.Hypothesis:Kinematics will be different between female and male runners with and without PFP.Study Design:Case-control study.Level of Evidence:Level 2.Methods:Eighty-four runners were divided into 4 groups: 42 runners with PFP (20 women, 22 men) and 42 asymptomatic runners (21 women, 21 men). Three-dimensional gait analyses of the hip in the frontal and transverse plane and the knee in the frontal plane were analyzed at self-selected running speed on a treadmill. One-way analysis of covariance was used to test for differences in kinematic variables between groups.Results:Women with PFP ran with a significantly greater peak hip adduction compared with men with PFP (mean difference [MD] = 4.45°; P = 0.00; effect size [ES] = 0.58) and male control subjects (MD = 4.2°; P = 0.01; ES = 0.54) and greater hip adduction range of motion (ROM) than men with PFP (MD = 3.44°; P = 0.01; ES = 0.49). No significant differences were identified between women with and without PFP. Female control subjects ran with greater peak hip adduction than men with PFP (MD = 5.46°; P < 0.01; ES = 0.58) and male control subjects (MD = 5.21°; P < 0.01; ES = 0.55); greater hip adduction ROM than men with PFP (MD = 4.02°; P = 0.00; ES = 0.52) and male control subjects (MD = 2.91°;P = 0.04; ES = 0.36); and greater peak knee abduction than men with PFP (MD = 3.35°; P = 0.02; ES = 0.44) and male control subjects (MD = 3.69°; P = 0.01; ES = 0.4).Conclusion:Women have greater hip adduction than men regardless of the presence of PFP. There were no kinematics difference between women with and without PFP. Comparisons of hip internal rotation between all groups were nonsignificant.Clinical Relevance:Altered hip and knee kinematics does not appear to be sex specific in runners with PFP.
      Citation: Sports Health
      PubDate: 2022-05-21T05:20:07Z
      DOI: 10.1177/19417381221088582
       
  • Graft Choice for Anterior Cruciate Ligament Reconstruction in Women Aged
           25 Years and Younger: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Christine M. Etzel, Maheen Nadeem, Burke Gao, Abigail N. Boduch, Brett D. Owens
      First page: 829
      Abstract: Sports Health, Ahead of Print.
      Context:Although anterior cruciate ligament (ACL) tears are relatively common in athletic populations, few studies have systematically reviewed graft choice in young women.Objective:To quantitatively and qualitatively examine reported outcomes for graft choice in women aged 25 years and younger undergoing primary ACL reconstruction.Data Source:A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search in the PubMed (includes MEDLINE) and EMBASE databases was completed using a combination of key terms.Study Selection:Studies were included if they reported graft choice outcomes in women aged 25 years and younger.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:The following information was extracted: title, author, year of publication, number of female patients and age, graft type, follow-up, and patient-reported outcome measures. The following outcome scores were identified as being reported or not reported by each study: graft failure, contralateral ACL (CACL) rupture, IKDC (International Knee Documentation Committee), graft survival (Kaplan-Meier), Lysholm, Tegner, KT-1000, kneeling pain, return to sport, and Lachman.Results:Of 1170 identified articles, 16 met inclusion criteria, reporting on 1385 female patients aged 25 years and younger. Comparison of 655 bone–patellar tendon–bone (BPTB) versus 525 hamstring tendon (HT) autografts showed significant differences in mean failure rate between BPTB autografts (6.13% ± 2.58%) and HT autografts (17.35% ± 8.19%), P = 0.001. No statistically significant differences in CACL failure rates were found between BPTB autografts and HT autografts (P = 0.25). Pooled results for IKDC were possible in 3 of the HT autograft studies, showing a mean score of 88.31 (95% CI 83.53-93.08). Pooled Lysholm score results were possible in 2 of the HT autograft studies, showing a mean score of 93.46 (95% CI 91.90-95.01).Conclusion:In female patients aged 25 years and younger, BPTB autografts showed significantly less graft failure compared with HT autografts. However, BPTB autografts had comparable patient-reported outcomes compared with HT autografts with the available data. The overall state of evidence for graft choice in female patients aged 25 years and younger is low. Future studies should report statistics by age and sex to allow for further analysis of graft choice for this specific population that is known to be more vulnerable to ACL injury.
      Citation: Sports Health
      PubDate: 2022-03-28T05:50:45Z
      DOI: 10.1177/19417381221079632
       
  • New or Recurrent Knee Injury, Physical Activity, and Osteoarthritis in a
           Cohort of Female Athletes 2 to 3 Years After ACL Reconstruction and
           Matched Healthy Peers

    • Free pre-print version: Loading...

      Authors: Allison M. Ezzat, Mariana Brussoni, Louise C. Mâsse, Christian J. Barton, Carolyn A. Emery
      First page: 842
      Abstract: Sports Health, Ahead of Print.
      Background:At 2 to 3 years after anterior cruciate ligament reconstruction (ACLR), the relationship between known modifiable osteoarthritis (OA) risk factors and recurrent knee injury is unknown. This study aimed to determine the odds of new or recurrent traumatic knee injury in a cohort of young female athletes with ACLR 2 to 3 years postsurgery compared with healthy control participants. Secondary objectives were to explore the relationships of moderate and vigorous physical activity (MVPA) and body mass index (BMI) with knee injury, and to document self-reported MVPA satisfaction and beliefs about OA.Study Design:Prospective cohortLevel of Evidence:Level 2Methods:A total of 51 female athletes with unilateral ACLR 1 to 2 years previously and 51 age and sport-matched control participants underwent assessment of MVPA (GT3X accelerometers) and BMI. One year later, participants self-reported knee injuries. Bivariable conditional logistic regression explored the association between knee injury, MVPA, and BMI in each group (injury/control).Results:At 1-year follow-up (n = 101), 19.6% of the injured cohort and 6.0% of control participants sustained a new or recurrent knee injury. The odds of knee injury for the injury group increased 7-fold over controls [odds ratio (OR) = 7.00 (95% CI = 0.86, 56.90)], although this was not statistically significant. The OR for MVPA was 0.98 (95% CI = 0.93, 1.03) and BMI was OR = 1.24 (95% CI = 0.85, 1.82). Half (56.0%) of injury participants and 66% of controls were satisfied with their MVPA; 81.6% of injury participants believed they had increased knee OA risk compared with someone who had never had a knee injury.Conclusions:In the 2 to 3 years after ACLR, 1 in 5 young female athletes had a new or recurrent knee injury. Based on the point estimate, injured participants were more likely to suffer a traumatic knee injury than matched control participants. MVPA and BMI were not associated with increased odds of knee injury.Clinical Relevance:Clinicians should be encouraged to have in-depth conversations with female athletes with previous ACLR regarding enjoyable and sustainable MVPA participation to promote long-term joint health.
      Citation: Sports Health
      PubDate: 2022-05-02T06:09:16Z
      DOI: 10.1177/19417381221091791
       
  • The Influence of Exercise Intensity on Psychosocial Outcomes in
           Musculoskeletal Disorders: A Systematic Review

    • Free pre-print version: Loading...

      Authors: Sim Klaps, Sarah Haesevoets, Jeanine Verbunt, Albère Köke, Lotte Janssens, Annick Timmermans, Jonas Verbrugghe
      First page: 859
      Abstract: Sports Health, Ahead of Print.
      Context:Psychosocial parameters play an important role in the onset and persistence of chronic musculoskeletal disorders (CMSDs). Exercise therapy is a valuable therapeutic modality as part of CMSD rehabilitation. Hereby, exercise intensity is an important factor regarding changes in pain and disability in multiple CMSDs. However, the impact of exercise intensity on psychosocial outcomes remains poorly explored.Objective:To identify the effects of different modes of exercise intensity on psychosocial outcomes in persons with CMSDs.Data Sources:A systematic search was conducted up to November 2020 using the following databases: PubMed/MEDline, PEDro, Cochrane Library, and Web of Science.Study Selection:Studies reporting exercise therapy in CMSDs with a predefined display of exercise intensity and an evaluation of at least 1 psychosocial outcome were included.Study Design:Systematic review.Level of Evidence:Level 2a.Data Extraction:Data regarding demographics, exercise intensity, and psychosocial outcomes were included in a descriptive analysis. Methodological quality was assessed using the PEDro scale and Critical Appraisal Skills Programme (CASP) checklist.Results:A total of 22 studies, involving 985 participants (with fibromyalgia, chronic low back pain, knee osteoarthritis, psoriatic arthritis, and axial spondyloarthritis) were included (mean PEDro score = 5.77/10). The most common psychosocial outcomes were quality of life (QoL) (n = 15), depression (n = 10), and anxiety (n = 9). QoL improved at any exercise intensity in persons with fibromyalgia. However, persons with fibromyalgia benefit more from exercising at low to moderate intensity regarding anxiety and depression. In contrast, persons with chronic low back pain benefit more from exercising at a higher intensity regarding QoL, anxiety, and depression. Other CMSDs only showed limited or conflicting results regarding the value of certain exercise intensities.Conclusion:Psychosocial outcomes are influenced by the intensity of exercise therapy in fibromyalgia and chronic low back pain, but effects differ across other CMSDs. Future research is necessary to determine the exercise intensity that yields optimal exercise therapy outcomes in specific CMSDs.
      Citation: Sports Health
      PubDate: 2022-03-04T10:26:56Z
      DOI: 10.1177/19417381221075354
       
  • Quantitative Assessment of Balance for Accurate Prediction of Return to
           Sport From Sport-Related Concussion

    • Free pre-print version: Loading...

      Authors: Hamish A. Kerr, Eric H. Ledet, Juergen Hahn, Kathryn Hollowood-Jones
      First page: 875
      Abstract: Sports Health, Ahead of Print.
      Background:Determining when athletes are able to return to sport after sports-related concussion (SRC) can be difficult.Hypothesis:A multimodal algorithm using cognitive testing, postural stability, and clinical assessment can predict return to sports after SRC.Study Design:Prospective cohort.Level of Evidence:Level 2b.Methods:Athletes were evaluated within 2 to 3 weeks of SRC. Clinical assessment, Immediate Post Concussion and Cognitive Testing (ImPACT), and postural stability (Equilibrate) were conducted. Resulting data and machine learning techniques were used to optimize an algorithm discriminating between patients ready to return to sports versus those who are not yet recovered. A Fisher discriminant analysis with leave-one-out cross-validation assessed every combination of 2 to 5 factors to optimize the algorithm with lowest combination of type I and type II errors.Results:A total of 193 athletes returned to contact sports after SRC at a mean 84.6 days (±88.8). Twelve subjects (6.2%) sustained repeat SRC within 12 months after return to sport. The combination of (1) days since injury, (2) total symptom score, and (3) nondominant foot tandem eyes closed postural stability score created the best algorithm for discriminating those ready to return to sports after SRC with lowest type I error (13.85%) and type II error (11.25%). The model was able to discriminate between patients who were ready to successfully return to sports versus those who were not with area under the receiver operating characteristic (ROC) curve of 0.82.Conclusion:The algorithm predicts successful return to sports with an acceptable sensitivity and specificity. Tandem balance with eyes closed measured with a video-force plate discriminated athletes ready to return to sports from SRC when combined in multivariate analysis with symptom score and time since injury. The combination of these factors may pose advantages over computerized neuropsychological testing when evaluating young athletes with SRC for return to contact sports.Clinical Relevance:When assessing young athletes sustaining an SRC in a concussion clinic, measuring postural stability in tandem stance with eyes closed combined with clinical assessment and cognitive recovery is effective to determine who is ready to successfully return to sports.
      Citation: Sports Health
      PubDate: 2022-02-05T06:38:11Z
      DOI: 10.1177/19417381211068817
       
  • Load-Velocity Relationship Variables to Assess the Maximal Neuromuscular
           Capacities During the Back-Squat Exercise

    • Free pre-print version: Loading...

      Authors: Alejandro Pérez-Castilla, Ivan Jukic, Danica Janicijevic, Zeki Akyildiz, Deniz Senturk, Amador García-Ramos
      First page: 885
      Abstract: Sports Health, Ahead of Print.
      Background:The relationship between the external load lifted and movement velocity can be modeled by a simple linear regression, and the variables derived from the load-velocity (L-V) relationship were recently used to estimate the maximal neuromuscular capacities during 2 variants of the back-squat exercise.Hypothesis:The L-V relationship variables will be highly reliable and will be highly associated with the traditional tests commonly used to evaluate the maximal force and power.Study Design:Twenty-four male wrestlers performed 5 testing sessions (a 1-repetition maximum [1RM] session, and 4 experimental sessions [2 with the concentric-only back-squat and 2 with the eccentric-concentric back-squat]). Each experimental session consisted of performing 3 repetitions against 5 loads (45%-55%-65%-75%-85% of the 1RM), followed by single 1RM attempts.Level of Evidence:Level 3.Methods:Individual L-V relationships were modeled from the mean velocity collected under all loading conditions from which the following 3 variables were calculated: load-axis intercept (L0), velocity-axis intercept (v0), and area under the line (Aline = L0·v0/2). The back-squat 1RM strength and the maximum power determined as the apex of the power-velocity relationship (Pmax) were also determined as traditional measures of maximal force and power capacities, respectively.Results:The between-session reliability was high for the Aline (coefficient of variation [CV] range = 2.58%-4.37%; intraclass correlation coefficient [ICC] range = 0.98-0.99) and generally acceptable for L0 and v0 (CV range = 5.08%-9.01%; ICC range = 0.45-0.96). Regarding the concurrent validity, the correlations were very large between L0 and the 1RM strength (rrange = 0.87-0.88) and nearly perfect between Aline and Pmax (r = 0.98-0.99).Conclusion:The load-velocity relationship variables can be obtained with a high reliability (L0, v0, and Aline) and validity (L0 and Aline) during the back-squat exercise.Clinical Relevance:The load-velocity relationship modeling represents a quick and simple procedure to estimate the maximal neuromuscular capacities of lower-body muscles.
      Citation: Sports Health
      PubDate: 2022-02-04T04:54:11Z
      DOI: 10.1177/19417381211064603
       
  • Implications of the Gut Microbiome in Sports

    • Free pre-print version: Loading...

      Authors: Gerardo Miranda-Comas, Ryan C. Petering, Nadia Zaman, Richard Chang
      First page: 894
      Abstract: Sports Health, Ahead of Print.
      Context:Two-thirds of an individual’s gut microbiota is unique and influenced by dietary and exercise habits, age, sex, genetics, ethnicity, antibiotics, health, and disease. It plays important roles in nutrient and vitamin metabolism, inflammatory modulation, immune system function, and overall health of an individual. Specifically, in sports it may help decrease recovery time and improve athletic performance.Evidence Acquisition:PubMed and Medline databases were used for the literature search. Bibliographies based on the original search were utilized to pursue further literature search.Study Design:Clinical review.Level of Evidence:Level 4.Results:Diet and exercise play very important roles in the composition of the gut microbiota in the athletic and nonathletic individual. Ingestion of carbohydrates during and after exercise seems to have an anti-inflammatory effect postexercise. Supplementation with probiotic seems to aid in recovery after exercise, too, especially restoring the “normal” gut microbiota. Physically active individuals of all levels have more alpha diversity and “health-promoting gut species” in their microbiome than nonactive individuals, along with higher concentrations of short-chain fatty acids (SCFA) and SCFA-producing organisms. However, exercise interventions should be longer than 8 weeks to see these positive characteristics. Immune function is highly influenced by the gut microbiota’s response to exercise. A transient immune dysfunction occurs after prolonged high-intensity exercise, which correlates with microbiota dysregulation. Nevertheless, long-term exposure to exercise will enhance the immune response and lead to positive changes in the gut microbiota.Conclusion:Although the exact mechanisms of the effects that diet, exercise, and genetics have on the gut microbiota remain largely unknown, there is evidence that suggests overall health benefits. In the athletic population, these benefits can ultimately lead to performance improvement.
      Citation: Sports Health
      PubDate: 2022-01-17T09:17:00Z
      DOI: 10.1177/19417381211060006
       
  • Relative Validity and Reliability of Isometric Lower Extremity Strength
           Assessment in Older Adults by Using a Handheld Dynamometer

    • Free pre-print version: Loading...

      Authors: Pol Grootswagers, Anouk M. M. Vaes, Roland Hangelbroek, Michael Tieland, Luc J. C. van Loon, Lisette C. P. G. M. de Groot
      First page: 899
      Abstract: Sports Health, Ahead of Print.
      Background:Handheld dynamometry (HHD) is a practical alternative to traditional testing of lower extremity strength. However, its reliability and validity across different populations and settings are not clear.Hypothesis:We hypothesize that HHD is a valid and reliable device to assess lower extremity strength in a population of older adults.Study Design:Cross-sectional/cohort.Level of Evidence:Level 3.Methods:This study included 258 older adults (≥65 years). Isometric knee extension and flexion force were measured by 1 examiner, using an HHD (n = 222), including 3 repetitions to calculate within-day intrarater reliability. These measurements were repeated by the examiner in a subgroup (n = 23) to analyze intrarater reliability over a test-retest period of on average 8 weeks. In addition, HHD force measures were performed by a second examiner (n = 29) to analyze interrater reliability. In another subgroup (n = 77), isometric knee extension and flexion torque were measured by 1 examiner using both the HHD and Biodex System 4 to assess relative validity.Results:HHD and Biodex measurements were highly correlated and showed excellent concurrent validity. HHD systematically overestimated torque as compared with Biodex by 8 N·m on average. Same-day intrarater intraclass correlation coefficients (ICCs) ranged from 0.97 to 0.98. Interrater reliability ICCs ranged from 0.83 to 0.95.Conclusion:HHD represents a reliable and valid alternative to Biodex to rank individuals on leg strength, or to assess within-person changes in leg strength over time, because of the high validity and reliability. The HHD is less suited for absolute strength assessment because of significant systematic overestimations.Clinical Relevance:Clinicians are encouraged to use HHD to rank older adults on leg strength, or to assess within-person changes in leg strength over time, but not to compare readings with cut-offs or normative values.
      Citation: Sports Health
      PubDate: 2022-02-05T06:22:37Z
      DOI: 10.1177/19417381211063847
       
  • Beyond Distance: A Simple Qualitative Assessment of the Single-Leg Hop
           Test in Return-to-Play Testing

    • Free pre-print version: Loading...

      Authors: Stefano Di Paolo, Stefano Zaffagnini, Filippo Tosarelli, Alberto Grassi, Francesco Della Villa
      First page: 906
      Abstract: Sports Health, Ahead of Print.
      Background:Limb symmetry index in the single-leg hop (SLH) test has been questioned for its low predictive value in identifying secondary anterior cruciate ligament (ACL) injury. The purpose of this study was to describe a qualitative 2-dimensional (2D) scoring system for the assessment of the SLH test and associate it with the vertical ground-reaction forces (vGRF) and sagittal plane biomechanics evaluated through gold standard 3D motion analysis.Hypothesis:Stiff landings would be associated with low 2D scores.Study Design:Descriptive laboratory study.Level of Evidence:Level 4.Methods:Thirty-four competitive football (soccer) players (age 22.8 ± 4.1 years, 16 women) were enrolled. Each athlete performed a series of SLH tests. Three-dimensional motion analysis was recorded using 10 stereophotogrammetric cameras, a force platform, and 3 high-speed cameras. The 2D qualitative assessment was performed through a scoring system based on the video-analysis of sagittal plane joint kinematics. A score of 0/2 (inadequate), 1/2 (partially adequate), or 2/2 (adequate) was attributed to the movement, based on objective measurements. The vGRF was extracted from the force platform and grouped according to the results of the 2D evaluation.Results:Significantly higher vGRF (stiffer landing) was found for athletes obtaining a 0/2 score compared with those obtaining a 2/2 score (up to 0.8 body weight higher, P < 0.01). A significant negative rank correlation was found between the vGRF and the total score (ρ = −0.17, P = 0.03).Conclusion:The qualitative scoring system effectively identified stiff landings in the SLH for distance test.Clinical Relevance:The qualitative scoring system could be a user-friendly standardized method to assess athletes’ movement quality in return to sport clearance decision after ACL injury.
      Citation: Sports Health
      PubDate: 2022-01-27T06:41:46Z
      DOI: 10.1177/19417381211063450
       
  • Does Femoroacetabular Impingement Syndrome Affect Self-Reported Burden in
           Football Players With Hip and Groin Pain'

    • Free pre-print version: Loading...

      Authors: Mark J. Scholes, Joanne L. Kemp, Benjamin F. Mentiplay, Joshua J. Heerey, Rintje Agricola, Adam I. Semciw, Richard B. Souza, Thomas M. Link, Sharmila Majumdar, Matthew G. King, Peter R. Lawrenson, Kay M. Crossley
      First page: 920
      Abstract: Sports Health, Ahead of Print.
      Background:It is unknown if football players with femoroacetabular impingement (FAI) syndrome report worse burden than those with other causes of hip/groin pain, and to what extent this is mediated by cartilage defects and labral tears.Hypothesis:Football players with FAI syndrome would report worse burden than other symptomatic players, with the effect partially mediated by cartilage defects and/or labral tears.Study Design:Cross-sectional study.Level of Evidence:Level 4.Methods:Football (soccer and Australian football) players (n = 165; 35 women) with hip/groin pain (≥6 months and positive flexion–adduction–internal rotation test) were recruited. Participants completed 2 patient-reported outcome measures (PROMs; the International Hip Outcome Tool–33 [iHOT-33] and Copenhagen Hip and Groin Outcome Score [HAGOS]) and underwent hip radiographs and magnetic resonance imaging (MRI). FAI syndrome was determined to be present when cam and/or pincer morphology were present. Cartilage defects and labral tears were graded as present or absent using MRI. Linear regression models investigated relationships between FAI syndrome (dichotomous independent variable) and PROM scores (dependent variables). Mediation analyses investigated the effect of cartilage defects and labral tears on these relationships.Results:FAI syndrome was not related to PROM scores (unadjusted b values ranged from −4.693 (P = 0.23) to 0.337 (P = 0.93)) and cartilage defects and/or labral tears did not mediate its effect (P = 0.22-0.97).Conclusion:Football players with FAI syndrome did not report worse burden than those with other causes of hip/groin pain. Cartilage defects and/or labral tears did not explain the effect of FAI syndrome on reported burden.Clinical Relevance:FAI syndrome, cartilage defects, and labral tears were prevalent but unrelated to reported burden in symptomatic football players.
      Citation: Sports Health
      PubDate: 2022-03-24T03:47:56Z
      DOI: 10.1177/19417381221076141
       
  • Society News

    • Free pre-print version: Loading...

      First page: 940
      Abstract: Sports Health, Ahead of Print.

      Citation: Sports Health
      PubDate: 2022-09-30T12:42:10Z
      DOI: 10.1177/19417381221130057
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 44.200.169.3
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-