Sports Health: A Multidisciplinary Approach

Alterations in glenohumeral internal rotation (GIR), glenohumeral external rotation (GER), and total range of motion (TROM) have been linked with increased injury risk. GER capacity has been measured routinely with the forearm in neutral rotation (GERN), but a recent study reported GERN was greater than GER with the forearm in pronation (GERP) in Minor League pitchers. This work has not yet been replicated or extended to other groups.

GERP would be significantly less than GERN in Independent League baseball pitchers, and there would be no difference in GERP or GERN measurements between this new group and the previous group of Minor League pitchers.

Cross-sectional study.

Level 3.

Goniometric measurements were recorded for bilateral GIR, GERN, and GERP, and resulting TROM for 37 Independent League baseball pitchers. These data were compared with the previous study. All motions were compared individually between groups, between throwing and nonthrowing arm, and both within and between techniques (forearm neutral or pronated).

GERP was significantly less than GERN for both arms within each group tested (P < 0.01). Independent League pitchers had greater between arm differences for GIR (-16.9° vs -6.9°), GERN (+15.1° vs -0.6°), and GERP (+13.1° vs -5.9°) compared with Minor League pitchers. TROM for the Independent League pitchers was not statistically different for either measurement technique, while TROM for the throwing arm of the Minor League pitchers was statistically reduced with varying effect sizes (d = 0.35-0.99) compared with the nonthrowing arm (P < 0.01).

This study confirmed earlier findings that the pronated forearm resulted in decreased GER capacity, illustrating the adaptive response to throwing and the need to evaluate for this variable.

GERP should be evaluated in all groups of pitchers, but there may be variations within tested groups.

This study evaluated treatment modality (surgical vs nonoperative) of medial ulnar collateral ligament (UCL) injuries in nonprofessional throwing baseball athletes by comparing type, severity, and location of UCL injury.

Baseball players with closed medial epicondyle physes and concomitant throwing-related UCL injury will be more likely to undergo surgical intervention than players with open medial epicondyle physes.

Retrospective.

Level 5.

A total of 119 baseball players with a mean age of 16.9 ± 2.5 years (range, 11-25 years) were included in the study. Datapoints included sex, age at time of injury, severity, and location of UCL injury, growth plate status, operative versus conservative management, and concomitant flexor forearm injury.

A total of 75 players were treated conservatively; 43 underwent UCL reconstruction (UCL-R), and 1 had an unknown treatment outcome. No significant difference was found for age related to treatment type, UCL-R (17.2 ± 2.2) versus conservative treatment (16.8 ± 2.6). Athletes with closed medial epicondylar growth plates were more likely to undergo UCL-R than athletes with open medial epicondylar growth plates (P = 0.02). There were no significant differences between UCL injury location (42 distal, 37 proximal, 18 combined tear locations, 11 complete tears, and 11 intact UCLs with inflammation) by treatment type (P = 0.09). There was a significant difference for UCL severity (11 complete tears, 96 partial tears) by treatment type (P = 0.03).

Nonprofessional athletes with closed medial epicondylar growth plates and throwing-related UCL injuries were more likely to be treated surgically. Baseball athletes with partial tears, if skeletally immature, require further long-term evaluation.

Continued knowledge gains in this area of throwing medicine will further improve our treatment algorithms in nonprofessional baseball players.

The quality and interprogram variability of publicly available throwing programs have not been assessed.

To (1) identify publicly available interval throwing programs, (2) describe their components and structure, and (3) evaluate their quality, variability, and completeness.

Google, Bing, Yahoo; keyword: “interval throwing program.”

Baseball-specific publicly available programs.

Systematic review.

Level 4.

Independent evaluation by 2 authors using a novel 21-item Quality Assessment Rubric (QAR).

Of the 99 included programs, 54% were designed for return from injury/surgery; 42% explicitly stated no expected timeline for completion, and approximately 40% did not provide criteria to initiate the program. Program construction was highly variable. There were broad-ranging shortest (mean: 40±8 ft, range: 20-45 ft) and longest (mean: 150±33 ft, range: 90-250 ft) long toss distances, and variable maximum numbers of mound pitches thrown before returning to game play (range: 40-120, mean: 85). Only 63% of programs provided guidelines for handling setbacks, and standardized warm-ups, arm care, and concomitant training were absent in 32%, 63%, and 47% of programs, respectively. Mean QAR completion rate and QAR item response rate were low (62 ± 4% [range, 24-91%], 62 ± 24% [range, 7-99%], respectively). Finally, only 20 (20%) programs provided at least 1 peer-reviewed reference, most of which were published >10 years ago.

Publicly available interval throwing programs are readily available but demonstrate significant interprogram heterogeneity across multiple areas including target audience, program construction, progression, and execution. The quality and consistency of publicly available interval throwing programs is poor at this time, which may limit their utility and effectiveness for baseball players attempting to return to competition. This work identifies a multitude of deficiencies in currently available throwing programs that should be targets of future improvement efforts.

Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management.

This systematic review reports rehabilitation characteristics reported after UCL injuries and compares reported outcomes based on early versus delayed rehabilitation.

Our search utilized PubMed/MEDLINE, Embase, Web of Science, and Cochrane to identify all articles on UCL rehabilitation published between January 1, 2002 and October 1, 2022.

Studies in English with ≥5 patients that reported rehabilitation protocols for UCL injuries were evaluated.

Systematic review.

Level 4.

Data included sample characteristics, time to achieve physical therapy milestones, outcome scores, and return-to-play (RTP) rate and timing.

Our review included 105 articles with a total of 15,928 elbows (98% male; weighted mean age, 23 years; follow-up, 47 months), with 15,077 treated operatively and 851 treated nonoperatively. The weighted mean time patients spent adhering to nonweightbearing status was 42 days. The mean time until patients were given clearance for active range of motion (ROM) 15 days, full ROM 40 days, and elbow strengthening exercises 32 days. The mean time until all restrictions were lifted was 309 days. The mean time to begin a throwing program was 120 days. Across all rehabilitation characteristics, protocols for patients undergoing nonoperative management started patients on rehabilitation earlier. After UCL reconstruction, earlier active ROM (≤14 days), elbow strengthening (≤30 days), no restrictions (≤180 days), and throwing (≤120 days) postoperatively led to earlier RTP without a negative effect on functional outcome scores.

Current literature provides a spectrum of protocols for elbow UCL rehabilitation, regardless of management. Nonoperative patients began ROM activities, strengthening, and throwing programs sooner than operative patients, and earlier milestones led to earlier RTP.

Despite increased youth and adolescent participation in fast-pitch softball and the reporting of upper extremity injuries, there remains a relative paucity of research examining shoulder and elbow injuries in high school and collegiate softball athletes.

To evaluate the reported incidence, setting, and positional factors associated with shoulder and elbow injuries in high school and collegiate fast-pitch softball players.

PubMed, Ovid, Medline, EMBASE, Scopus, Cochrane Central, and Clinicaltrials.gov.

English-language articles reporting the incidence of shoulder and/or elbow injuries occurring in high school or collegiate fast-pitch softball players were included. Biomechanical studies, review articles, abstract only texts, previous systematic reviews, and meta-analyses were excluded.

Systematic review.

Level 4.

Two reviewers independently evaluated studies. Data related to the reported incidence of shoulder and elbow injuries, injury setting, position, and rate of return to play after injury were recorded.

A total of 22 studies were identified. In high school athletes, shoulder injury rates ranged from 0.88 to 1.14 per 10,000 athletic exposures (AE), with elbow injury rates ranging from 0.41 to 0.71 per 10,000 AE. In collegiate athletes, reported injury rates ranged from 3.76 to 5.93 per 10,000 AE for shoulder and 1.5 to 3.39 per 10,000 AE for elbow injuries. Shoulder and elbow injuries were reported more commonly during competition in high school athletes, and with greater frequency in the practice setting in collegiate athletes. No association between injury incidence and position was appreciated at either the high school or collegiate level. Most (81%-96%) athletes were able to return to sport within 3 weeks of injury.

The incidence of shoulder and elbow injuries was greater in collegiate softball athletes than in high school athletes.

Among American sports, football has the highest incidence of exertional heat stroke (EHS), despite decades of prevention strategies. Based on recent reports, 100% of high school and college EHS football fatalities occur during conditioning sessions. Linemen are the at-risk population, constituting 97% of football EHS deaths. Linemen heat up faster and cool down slower than other players.

Case series were identified from organized, supervised football at the youth, high school, and collegiate levels and compiled in the National Registry of Catastrophic Sports Injuries. Sources for event occurrence were media reports and newspaper clippings, autopsy reports, certificates of death, school-sponsored investigations, and published medical literature. Articles were identified through PubMed with search terms “football,” “exertional heat stroke,” and “prevention.”

Clinical review.

Level 5.

Football EHS is tied to (1) high-intensity drills and conditioning that is not specific to individual player positions, (2) physical exertion as punishment; (3) failure to modify physical activity for high heat and humidity, (4) failure to recognize early signs and symptoms of EHS, and (5) death when cooling is delayed.

To prevent football EHS, (1) all training and conditioning should be position specific; (2) physical activity should be modified per the heat load; (3) understand that some players have a “do-or-die” mentality that supersedes their personal safety; (4) never use physical exertion as punishment; (5) eliminate conditioning tests, serial sprints, and any reckless drills that are inappropriate for linemen; and (6) consider air-conditioned venues for linemen during hot practices. To prevent EHS, train linemen based on game demands.

n/a.

Earlier statements suggested a negative impact of coronavirus disease 2019 (COVID-19) infection on sports performance and injury risk. With the COVID-19 pandemic under control and the dominance of a less-severe strain of the virus, there is a need to confirm whether these adverse effects still apply to the current situation.

Infected players would have a higher noncontact muscle injury incidence compared with noninfected counterparts.

Cohort observational study.

Level 3.

Seven teams (n = 147 players) competing in the Spanish professional women’s football league (Liga F) were prospectively monitored during the 2021-2022 season. Data from noncontact injuries were recorded and classified following the latest consensus statement from the International Olympic Committee. COVID-19 was certified by the medical staff by regular polymerase chain reaction analysis.

Ninety-two players suffered at least 1 noncontact muscle injury during the season. Injury incidence during the season was similar in players with COVID-19 (n = 83) and players without infection (5.1 ± 6.7 versus 4.9 ± 10.0 injuries/1000 h of play, respectively; P = 0.90). Players with COVID-19 were not more likely to suffer noncontact injuries compared with those players without infection (R² = 0.02; odds ratio [OR] 95% confidence interval [95% CI] = 0.36-1.38; P = 0.31). There was no effect of COVID-19 on the days of absence due to injury (R² = 0.01; OR 95% CI = 1.00-1.01; P = 0.44) or in the classification of the severity of the injury (P = 0.79).

COVID-19 has no significant effect on noncontact injury incidence and severity in professional female football players.

Currently, COVID-19 infection does not alter noncontact muscle injury risk in professional football and requires no further attention in terms of injury management. Usual return-to-play protocols apply to COVID-19 considering the particularities of each player since the severity of infection, period of inactivity, and effects on the player’s health and performance.

Mental health disorders are linked to prolonged concussion symptoms. However, the association of premorbid anxiety/depression symptoms with postconcussion return-to-play timelines and total symptom burden is unclear.

To examine the association of self-reported premorbid anxiety/depression symptoms in collegiate student-athletes with (1) recovery times until asymptomatic, (2) return-to-play, and (3) postconcussion symptom burden.

Athletes in the Concussion Assessment, Research and Education Consortium completed baseline concussion assessments (Sport Concussion Assessment Tool [SCAT3] and Brief Symptom Inventory-18 [BSI-18]). Athletes were tested postinjury at <6 hours, 24 to 48 hours, time of asymptomatic and start of return-to-play protocol, unrestricted return-to-play, and 6 months after injury. Injured athletes were categorized into 4 groups based on BSI-18 scores: (1) B-ANX, elevated anxiety symptoms only; (2) B-DEP, elevated depression symptoms only; (3) B-ANX&DEP, elevated anxiety and depression symptoms; and (4) B-NEITHER, no elevated anxiety or depression symptoms. Relationship between age, sex, BSI-18 group, SCAT3 total symptom and severity scores, and time to asymptomatic status and return-to-play was assessed with Pearson’s chi-squared test and robust analysis of variance.

Level 3.

Among 1329 athletes with 1352 concussions, no respondents had a self-reported premorbid diagnosis of anxiety/depression. There was no difference in time until asymptomatic or time until return-to-play between BSI-18 groups (P = 0.15 and P = 0.11, respectively). B-ANX, B-DEP, and B-ANX&DEP groups did not have higher total symptom or severity scores postinjury compared with the B-NEITHER group.

Baseline anxiety/depression symptoms in collegiate student-athletes without a mental health diagnosis are not associated with longer recovery times until asymptomatic, longer time to return-to-play, or higher postconcussion total symptom and severity scores compared with athletes without baseline symptoms.

Anxiety and depression symptoms without a clear mental health diagnosis should be considered differently from other comorbidities when discussing prolonged recovery in collegiate student-athletes.

Sports involving overhead motions put substantial biomechanical demands on the shoulder and may result in injuries.

To determine risk factors (RFs) for shoulder injuries in female athletes who play overhead sports and evaluate strategies to reduce shoulder injuries in these athletes.

A systematic electronic search was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Databases included were PubMed, Tulane Matas Library Search Engine, and Google Scholar, with search terms: “Overhead injuries/Shoulder AND female athletes AND Risk Factors.”

Of the initial 1574 studies identified, 314 were evaluated for eligibility by full-text review and 291 studies were excluded. Overall, 23 studies were included in this study. Studies were published from 2000 to 2021, subject age range was 15 to 35 years, with documented prevalence of shoulder injuries in female athletes playing overhead sports.

Systematic review.

Level 2.

Two independent researchers completed abstract and full-text review. Data extraction used the Covidence and Cochrane Consumer guide template.

Volleyball was the most common sport with shoulder injuries (6/23; 26%) followed by softball 5/23 (22%), swimming 5/23 (22%), gymnastics 4/23 (17%), tennis 3/23 (13%), water polo 2/23 (8%), and basketball 1/23 (4%). Six RFs (dominant shoulder, volume/overuse, time in sport, older age at time of injury, past injury, and multidirectional instability) were described. Of the 23 studies, 9 (39%) identified the dominant shoulder as a RF for sustaining injury (mean risk ratio [RR], 2.04), while 6 (26%) cited volume of repetition and overuse as a prominent RF (RR, 1.45).

This systematic review demonstrates important RFs for shoulder injuries in female athletes associated with playing overhead sports. Multiple prevention strategies are described. Prevention programs are helpful in reducing the risk of reinjury.

Traumatic shoulder instability is a common injury in the general population and the military. Surgical stabilization surgery reduces recurrence rates compared with nonsurgical management. Time since surgery is generally the primary measure of return to sport. There is a gap in knowledge on psychological variables and time since surgery and their relationship to rotator cuff strength and functional performance.

It was hypothesized that, after shoulder stabilization surgery, psychological factors and time since surgery will be associated positively with objective physical performance tests, that physical performance will differ significantly between postsurgery cadets and healthy controls, and that surgical stabilization of the nondominant arm will demonstrate greater range of motion deficits than surgical intervention on the dominant arm.

Case-control study.

Level 4.

The 52 participants (26 postsurgical [6-24 months after surgery] and 26 healthy controls) were all military cadets. Outcome measures were patient-reported outcomes, range of motion, isometric strength, and functional performance.

No significant relationships existed between time since surgery and psychological factors to rotator cuff strength or functional performance. Significant differences were found between groups in self-reported outcomes, including the Shoulder Instability Return to Sport After Injury scale, Single Assessment Numeric Evaluation, Numeric Pain Rating Scale, quickDASH, flexion and external rotation (ER), and ER limb symmetry. Those who received dominant-sided shoulder surgery demonstrated a greater mean active range of motion deficit than those who received nondominant-sided surgery. Both groups demonstrated a significant loss in ER, but dominant-sided surgical participants also demonstrated significant flexion loss.

Time since surgery and psychological variables did not demonstrate a relationship to rotator cuff strength and functional performance. Significant differences existed between the stabilization surgical participants and healthy controls in all patient-reported outcomes. Surgical participants with dominant-sided shoulder surgery demonstrated a greater mean motion deficit when compared with those who received nondominant-sided surgery.

Core stability training (CST) is effective in improving postural balance, core endurance, and self-reported outcomes in different populations. This study aimed to investigate the effect of CST in soccer players with groin pain (GP).

CST would improve postural balance performance, core endurance, and self-reported outcomes in soccer players with GP.

Randomized controlled trial.

Level 2.

Soccer players with GP who met the selection criteria were assigned randomly to a CST (CSTG, n = 10) or a control (CG, n = 10) group. The CG undertook no additional physical activity program besides their usual training. The CSTG performed a 12-week CST comprising 76 ~75 min sessions. Static (force platform) and dynamic (Y-Balance test) postural balance, core endurance (McGill trunk endurance tests), and self-reported outcomes (Copenhagen Hip and Groin Outcome Score [HAGOS]) were assessed before and immediately after the 12-week CST.

Significant improvements were seen in dynamic postural balance (P = 0.04 to <0.01), HAGOS scores (P = 0.02 to <0.01), and core endurance measures (P < 0.01) in the CSTG in posttest compared with pretest session and compared with CG. Static bipedal postural balance measures showed significant improvements (eyes open, P = 0.02; eyes closed, P < 0.01) in the CSTG in posttest compared with pretest session. However, no significant differences (P > 0.05) were observed between CSTG and CG after the training period.

A 12-week CST improved static (foam surface) and dynamic postural balance, core endurance measures, and HAGOS scores.

The beneficial effect of CST on improving postural balance, core endurance, and self-reported outcomes in soccer players with GP suggests that this training would be an important feature of rehabilitation programs for these players. Coaches and clinicians should prioritize CST training when designing rehabilitation programs.

Both autoregulatory progressive resistance exercise (APRE) and velocity-based resistance training (VBRT) utilize real-time monitoring of athlete physical performance to adjust training loads to provide appropriate training stimuli. However, the monitoring and adjustment approaches differ between both methods. This study aimed to compare the effects of APRE and VBRT on the muscle strength, power, and agility of college taekwondo athletes.

Eight weeks of APRE and VBRT will promote similar results to strength gains in regards maximal strength, but VBRT will be superior to APRE in explosive power and agility.

Clinical trial.

Level 3.

Thirty taekwondo athletes were divided randomly into 2 groups (VBRT/APRE), and all participants completed an 8-week APRE/VBRT intervention. Maximum strength, explosive power, and agility performance were assessed during the squat 1-repetition maximum (1RM), countermovement jump (CMJ), drop jump (DJ), kicking strength test (KST), taekwondo-specific agility test (TSAT), and hexagon test (HT).

Highly significant time effects (P < 0.01) were observed for squat 1RM, CMJ, and TSAT in both the APRE and VBRT groups. However, there were no significant group-by-time differences for any of the measured outcomes to intergroup (P > 0.05), but APRE had a small effect size (ES) over VBRT for CMJ (ES = 0.48, η 2 p = 0.06), TSAT (ES = 0.26, η 2 p = 0.02), and HT (ES = 0.42, η 2 p = 0.05).

An 8-week autoregulatory APRE and VBRT can both effectively improve both the maximal strength, explosive power, and agility performance of taekwondo athletes, with APRE exhibiting potential advantages in improving CMJ, TSAT, and HT.

These results provide important insights into the selection of suitable resistance training programs by professional coaches, taking into account athlete needs, training efficiency, and safety considerations.

Patellar tendonitis (PT) is a common degenerative disease of the patellar tendon that seriously affects the sports careers of elite athletes and activities of daily living of sports enthusiasts. Injection therapy is a prevalent invasive treatment for PT.

This work comprehensively analyzes various injection treatments for PT that consider agent type and characteristics, frequency, and assessment timepoints by meta-analysis.

PubMed, Embase, and the Cochrane Library were sources of data.

Randomized controlled trials (RCTs) analyzing the effect of various injection strategies on the treatment of patients with PT were considered.

Systematic review and meta-analysis.

Level 2.

First author, year of publication, research location, registration information, patient type, sample size, age, sex, intervention, control treatment, and follow-up period in each study were extracted.

Nineteen RCTs were included in the analysis. In the network meta-analysis of Victorian Institute of Sports Assessment-Patellar (VISA-P) outcomes, polidocanol (standardized mean difference (SMD), 6.52; 95% CI 4.75, 8.30; P < 0.01), tenocyte-like cells (SMD, 4.08; 95% CI 2.92, 5.25; P < 0.01), and leukocyte-poor platelet-rich plasma (LP-PRP) plus high-volume image-guided injection (HVIGI) (SMD, 1.56; 95% CI 0.62, 2.50; P < 0.01) were significantly superior to noninjection conservative treatment, mainly at the 6-month follow-up timepoint. For visual analog scale results, multiple dry needling (DN) (SMD, -1.78; 95% CI -2.56, -1.00; P < 0.01), LP-PRP (SMD, -0.71; 95% CI -1.31, -0.12; P = 0.02), and LP-PRP plus HVIGI (SMD, -1.31; 95% CI -2.22, -0.39; P < 0.01) were significantly superior to blank, which was also mainly at the 6-month timepoint.

Injection-related treatments: polidocanol, tenocyte-like cells, LP-PRP, and multiple DN showed potential short (1-3 months) or medium (6 months)-term treatment benefits. There is still no evidence for injection interventions with long-term therapeutic benefit.

The association between ligamentous knee injuries and corticospinal tract (CST) structure has attracted attention; however, any causal relationship remains uncertain. We performed Mendelian randomization (MR) analysis to identify the causal effects of ligamentous knee injuries on the CST.

Ligamentous knee injuries impair CST microstructure (ie, by reducing fractional anisotropy [FA] and increasing mean diffusivity [MD]).

MR analysis.

Level 2.

MR uses genetic variants as instrumental variables to infer causal relationships between exposures and outcomes. Summary data for ligamentous injuries in knee and CST structure were obtained from genome-wide association study datasets. Significant and independent (5 × 10⁻⁶; r² < 0.001; 10,000 kb) single-nucleotide polymorphisms were extracted for MR analysis. Three methods for MR analysis were used (hypothesis-driven 1-tailed inverse variance weighted, MR-Egger, and weighted median), and sensitivity analyses were conducted to test reliability and stability.

Results from 3 MR methods consistently demonstrated that ligamentous knee injuries increased MD of the right CST (β, 0.063; 90% CI, 0.003-0.123; P = 0.04), and weak statistical significance suggested increased MD of the left CST (β, 0.060; 90% CI, -0.002 to -0.121; P = 0.05). However, no significant causal relationships were observed in CST FA, and no significant pleiotropy or heterogeneity was observed. Sensitivity analysis utilizing 2-tailed tests had no significant associations between ligamentous knee injuries and changes in CST structure.

There is statistically weak genetic evidence that corticospinal pathway abnormalities may evolve after ligamentous knee injuries, which manifests as abnormally organized neurites.

Ligamentous knee injuries require attention not only to damage to the structure of the knee joint itself but also to the process of maladaptive neuroplasticity that leads to structural and functional changes of the CST; novel interventions that target the corticospinal pathway may provide subsequent treatment of ligamentous knee injuries.

Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI).

The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI.

A single-blind parallel-arm randomized controlled trial.

Level 2.

A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase.

Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG’s foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73).

Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI.

The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.

Understanding the epidemiology of injuries to athletes is essential to informing injury prevention efforts.

The incidence and impact of basketball-related injuries among National Basketball Association (NBA) players from 2013-2014 through 2018-2019 is relatively stable over time.

Descriptive epidemiology study.

Level 3.

Injuries from 2013-2014 through 2018-2019 were analyzed using the NBA Injury and Illness Database from an electronic medical record system. Descriptive statistics were calculated for injuries by season, game-loss, and onset. Incidence rates were estimated using Poisson models and linear trend tests.

Between 552 and 606 players participated in ≥1 game per season during the study. Annual injury incidence ranged from 1550 to 1892, with 33.6% to 38.5% resulting in a missed NBA game. Game-loss injury rates ranged from 5.6 to 7.0 injuries per 10,000 player-minutes from 2014-2015 through 2018-2019 (P = 0.19); the rate was lower in 2013-2014 (5.0 injuries per 10,000 player-minutes), partly due to increased preseason injury rates and transition of reporting processes. The 6-year game-loss injury rate in preseason and regular season games was 6.9 (95% CI 6.0, 8.0) and 6.2 (95% CI 6.0, 6.5) injuries per 10,000 player-minutes; the rate in playoff games was lower (P < 0.01) at 2.8 (95% CI 2.2, 3.6). Most (73%) game-loss injuries had acute onset; 44.4% to 52.5% of these involved contact with another player.

From 2013-2014 through 2018-2019, over one-third of injuries resulted in missed NBA games, with highest rates of game-loss injuries in preseason games and lowest rates in playoff games. Most game-loss injuries had acute onset, and half of those involved contact with another player.

These findings - through reliable data reporting by team medical staff in an audited system - can guide evidence-based injury reduction strategies and inform player health priorities.

The Olympic sport of diving involves the competitive disciplines of 3 m springboard and 10 m platform. Although it is generally accepted that lumbar spine injuries are common in diving athletes, the existing literature of health problems in diving athletes remains scarce.

To identify the incidence, prevalence, and type of health problems that occur in competitive diving athletes.

Medline, EMBASE, SportsDiscus, PsycINFO, and Google Scholar.

Studies written in English investigating elite or pre-elite competitive diving (springboard, platform) injuries and/or illnesses were eligible. Two independent reviewers screened for inclusion by title, abstract, and full text in accordance with the eligibility criteria.

Systematic review.

Level 4.

Data extraction was completed by 1 author using a structured form. A second author then independently reviewed and verified the extracted data, any discrepancies were resolved through consensus.

The search identified 2554 potential articles, with 28 studies meeting eligibility criteria. The surveillance setting of most studies was restricted to competition-based events, with the reported injury incidence proportion ranging from 2.1% to 22.2%. The reported injury incidence rate ranged from 1.9 to 15.5 per 1000 athlete-exposures. Injuries to the shoulder, lower back/lumbar spine, trunk, and wrist/hand were reported most frequently. The prevalence of low back pain was reported as high as 89% (lifetime), 43.1% (period), and 37.3% (point). The illness incidence proportion ranged from 0.0% to 22.2%, with respiratory and gastrointestinal illness reported most frequently.

Up to 1 in 5 diving athletes sustain an injury and/or illness during periods of competition. A reporting bias was observed, with most cohort studies limiting surveillance to short competition-based periods only. This limits the current understanding of the health problems experienced by diving athletes to competition periods only and requires expansion to whole-of-year surveillance.

Small-sided games (SSGs) are frequent training drills in soccer. This study investigated whether type of game (ie, with/without goalkeepers) and wildcard ( without vs internal vs external wildcard) impact the physiological (heartrate [HR]) and locomotor (total distance [TD] covered) demands in regular and wildcard players and to evaluate between-player and within-player variability.

Demands are influenced by wildcard and game type, with higher demand (distance covered at high intensities and sprint speed) in regular players and with higher variability in SSG with wildcard players.

Descriptive/comparative study.

Level 4.

Twenty-four soccer players completed 6 SSG as 3 versus 3 without (NG) or with (GK) goalkeepers, and with internal (NG+IW and GK+IW) and external (NG+EW and GK+EW) wildcard. Average HR (HR_avg), rate of perceived exertion, and locomotor demands (TD, medium [MID = 7.0-13.9 km h^-1], high [HID = 14.0-20.9 km h^-1] and sprint [SPD >21.0 km h^-1] distance and peak speed [PS]) were registered.

The inclusion of GK and internal wildcard led to decreased HR_avg and TD in regular players. Wildcard players positioned internally exhibited higher TD, PS, and lower HR_avg than externally positioned wildcards. Regular players demonstrated higher TD, PS, MID, HID, HR_avg and time spent in Z3 (>90% HR_max) compared with wildcard players in SSG played with external wildcard. Regular and wildcard players displayed great between- and within-player variability in high-intensity metrics.

Specific game type and wildcard inclusion impact the physiological and locomotor demands in SSG, with variations observed between regular and wildcard players.

This study provides comprehensive information on the physiological and locomotor demands of SSG depending on the inclusion and position of goalkeepers and wildcards, which can be useful for strength and conditioning coaches when designing specific training tasks, individualizing training load and applying return-to-play programs.

There is little evidence to guide elite athletes who desire returning to competition after giving birth to a child. Ultimately, this can result in decreased performance and increased risk of injury. This paper addresses aspects that must be considered when building and monitoring a return to running program for a postpartum elite or subelite athlete, including pelvic floor and core stability, progressive reloading of the musculoskeletal system, monitoring of nutritional parameters, and considerations for lactation.

PubMed and CINAHL (Cumulative Index for Nursing and Allied Health Literature) were searched with the following search strategy: (extreme sports OR elite athletes OR running OR exercise) AND (breastfeeding OR lactation OR bone density OR fetal weight OR gestational weight gain OR postpartum or post-partum OR postnatal OR post-natal OR pregnancy OR childbirth). The following information is based on best available evidence and clinical experience.

Clinical review.

Level 4.

Due to the interplay between cardiovascular fitness, postpartum nutrition, lactation, and progressive reloading of the muscular and skeletal system, we propose a multimodal, multidisciplinary approach to safely and successfully allow an athlete to return to an elite level of competition.

Return to running in the postpartum period is a highly individualized process that benefits from multidisciplinary, individualized care. This includes monitoring of nutrition, core and pelvic floor function, bone reloading, muscle and tendon reloading, and breastfeeding care when applicable.

C.

Movement velocity (MV) may be a valid tool to evaluate and control the load in resistance training (RT). The rating of perceived exertion (RPE) also enables practical load management. The relationship between RPE and MV may be used to monitor RT intensity.

To evaluate the validity and practicality of RPE scales related to MV and training intensity in resistance exercise. We hypothesize a positive correlation among RPE, MV, and load intensity in RT. Therefore, RPE may serve as a supplementary indicator in monitoring RT load.

Boolean algorithms were used to search several databases (SPORTDiscus, EBSCO, PubMed, Scopus, and Google Scholar).

Studies published from 2009 to 2023 included clinical trials (randomized or not) in healthy female and male subjects that analyzed the relationship between different RPE scales and MV in basic RT exercises.

Systematic review.

Level 3.

A total of 18 studies were selected using different RPE scales with reported MV training loads. Participants included RT and untrained male and female subjects (15-31 years old). Two RPE scales (OMNI-RES and repetitions in reserve) were used. The selected studies showed moderate positive correlations among these RPE scales, MV, and training load (eg, percentage of 1-repetition maximum [%1-RM]). In addition, equations have been developed to estimate %1-RM and MV loss based on the OMNI-RES scale.

Studies show that RPE scales and MV constitute a valid, economic, and practical tool for assessing RT load progression and complementing other training monitoring variables. Exercise professionals should consider familiarizing participants with RPE scales and factors that might influence the perception of exertion (eg, level of training, motivation, and environmental conditions).

Although the lower extremities are essential for movement function and human gait, no normalized isometric maximum strength values, which include the factors gender, age, weight, height, and body mass index (BMI), have been defined to date for orthopaedic patients.

To systematically analyze the isometric maximal muscle strength of a cohort in an orthopaedic outpatient clinic and to evaluate its relation to gender, age, weight, height, BMI, and the differences between diseases.

Cross-sectional study.

Level 4.

Isometric maximal muscle strength of knee extension, knee flexion, hip abduction, and hip adduction was measured in orthopaedic patients of an outpatient clinic using a specific muscle strength measurement device. Correlation analysis was performed for age, gender, height, weight, and BMI. Patients were grouped by disease characteristics.

The cohort consisted of 311 subjects (sex: 164 male, 147 female; age: 48.63 years, SD = 16.595; BMI: 26.56 kg/m², SD = 4.9). Age correlated significantly with maximal isometric muscle strength. At the age of 54 years onward, based on 133 patients, a decline in maximum isometric muscle strength was detected. Gender showed a strong influence on maximal isometric muscle strength, with significantly higher values for male patients. Furthermore, weight and height, but not BMI, correlated significantly with muscle strength.

For clinical studies comparing different evidence-based training interventions for rehabilitation, it is important to consider determinants such as gender, age, weight, and height for isometric maximum strength measurement. For further validation, follow-up examinations taking into account the performance level, other target groups, and other muscle groups are required to avoid the wide dispersion of isometric maximum strength values. These results and associated determinants are highly clinically relevant and can be used as a reference for further studies in the field of musculoskeletal regeneration.

Improving muscle quality to prevent and treat muscle dysfunction is critical. However, effective measures to improve muscle quality remain poorly understood. We investigated the effects of high- and low-velocity resistance training (RT) on muscle quality, mass, and function before and after an 8-week intervention.

High-velocity RT would improve muscle quality more effectively than low-velocity RT.

Randomized controlled trial.

Level 1.

A total of 33 healthy young women (23.1 ± 2.2 years) were assigned randomly to high-velocity (n = 16) or low-velocity (n = 17) groups. Both groups underwent concentric knee extension RT with a 60% 1-repetition maximum (1RM) load, performing 10 repetitions of 4 sets, 3 times per week for 8 weeks. The high-velocity group was instructed to complete each repetition as quickly as possible (mean repetition duration of 0.5 seconds), while the low-velocity group was required to execute each repetition in 3 seconds. Before and after the 8-week intervention, quadriceps femoris echo intensity (EI), muscle thickness (MT), isokinetic peak torque (60 and 300 deg/s), rate of velocity development (RVD) at 300 deg/s, and 1RM were assessed. Split-plot factorial design analysis of variance was used to compare the group × time interaction.

A group×time interaction was observed for EI (P < 0.01). Only the high-velocity group showed a significant reduction in EI after the intervention. MT revealed a main effect of time (P < 0.01), with both groups significantly increasing MT. RVD showed a group × time interaction (P < 0.05), with significant increase only in the high-velocity group. Isokinetic peak torque and 1RM showed main effects of time (P < 0.01), with significant increases in both groups.

High-velocity RT may be superior to low-velocity RT in enhancing muscle quality and RVD.

These results emphasize the importance of RT velocity for muscle quality improvement.