Clinical Journal of Sport Medicine最新文献

Objective: Develop a clinically pragmatic dual-task balance test to identify balance problems in acutely concussed adolescents more accurately than the current standard.

Design: Observational cohort study.

Setting: Pediatric emergency department.

Participants: Adolescents aged 10 to 18 years with acute (<48 hours) concussion.

Independent variables: Single tasks: balance (mBESS errors); cognitive function (Oral Trail-Making Test-B [OTMT-B] completion rate and accuracy); vestibular-oculomotor function (gaze stabilization test); and symptom change (pre-/post-test numeric pain rating scale). Dual tasks: (1) balance + cognitive function; (2) balance + vestibular-oculomotor function.

Main outcome measures: Primary outcome was change in center-of-pressure (COP) on a force plate (95% ellipse sway area), during single and dual tasks. We evaluated associations between clinical outcomes and gold-standard COP sway area using Spearman correlation coefficients and P-values.

Results: Eighty-three adolescents (median [IQR] age = 12.86 [11.52-15.41 years; 62.65% male; median [IQR] time from injury = 3.03 [2.08-13.37] hours) were included. Balance errors during dual-task gaze stabilization with tandem stance correlated more strongly with sway area (rs = 0.77, P < 0.001) than with mBESS balance errors (double-leg stance, rs = 0.44, P < 0.001; tandem stance, rs = 0.58, P < 0.001; single-leg stance, rs = 0.39, P < 0.001). Cognitive dual task (OTMT-B completion rate) was associated with fewer balance errors and decreased sway area in tandem stance (rs = -0.28, P = 0.02) and single-leg stance (rs = -0.21, P = 0.07). Pre-/post-test symptom change was not associated with sway area.

Conclusions: Dual-task gaze stabilization with tandem stance ("sharpened BESS" [sBESS]) is a new vestibular dual task that is more strongly associated with gold-standard balance performance in concussed adolescents than mBESS. Diagnostic and prognostic accuracy studies are needed to determine the clinical utility of sBESS to inform concussion diagnosis and return to sport decisions.

Objective: To assess the prevalence of ultrasound-detected abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among Division I collegiate athletes and to identify associated demographic and sport-related risk factors.

Design: Multi-institutional, 3-year observational study.

Setting: Preseason screening evaluations conducted at collegiate athletic programs.

Patients: A total of 533 Division I collegiate athletes representing 18 sports.

Interventions: All participants underwent ultrasound imaging of bilateral patellar tendons, Achilles tendons, and plantar fasciae. Abnormalities were defined as the presence of hypoechogenicity, morphologic thickening, or neovascularity.

Main outcome measures: Prevalence of sonographic abnormalities and their association with demographic and sport-specific variables, along with the presence or absence of symptoms at the time of scanning.

Results: The highest prevalence of abnormalities was observed in the patellar tendon (36.1%), followed by the Achilles tendon (7.1%) and plantar fascia (2.4%). Most abnormalities were asymptomatic, although athletes with abnormalities were significantly more likely to report current pain. Older age was associated with increased risk of Achilles tendon and plantar fascia abnormalities, while male sex and participation in explosive or running sports were linked to higher prevalence of patellar tendon abnormalities.

Conclusions: This study represents the largest known assessment of tendon and fascia ultrasound abnormalities in a collegiate athlete cohort. Findings support the use of ultrasound as an accessible, real-time diagnostic tool for early identification of subclinical pathology, which may allow for targeted interventions aimed at reducing time-loss injuries and optimizing long-term athlete health.

Abstract: Adhesive capsulitis (AC) is a pathologic process in which excessive collagen depositions form across a joint leading to stiffness, pain, and limited joint mobility. Our case is a 48-year-old man who presented with right hip pain. Approximately 5 months after arthroscopic labral repair, he reported recurrence of the pain and limited range of motion in the hip. A therapeutic hip hydrodilatation was performed using ultrasound-guidance and an anterior approach. One month after the hydrodilatation, ported resolution of the pain and hip internal rotation was symmetric. Most patients with AC of the hip can be managed nonsurgically with anti-inflammatory drugs, corticosteroid injections, and physical therapy. However, patients with persistent pain and limited range of motion after these treatment options typically are only left with the option of surgery. There is a lack of data on pressure hydrodilatation or distention for AC of the hip. In this case report, the patient developed AC after labral surgery and was successfully treated with pressure hydrodilatation. Resolution of the patient's symptoms suggests that this procedure can potentially be performed in postsurgical AC without adverse events.

Objective: Blood flow restriction (BFR) is a method used to affix a pneumatic cuff to the uppermost part of a leg. Blood flow restriction is often combined with low load-blood flow restriction training (LL-BFRt) to enhance strength and promote muscle hypertrophy. Therefore, this research aimed to examine the effect of LL-BFRt, sham LL-BFRt, and high load-resistance training (HL-Rt) on quadriceps strength (QS), dynamic stability, and functional performance.

Design: Single-blinded randomized trial method.

Setting: A private physical therapy clinic in Bali, Indonesia.

Participants: Data were collected from 63 basketball and rugby players assigned to 3 intervention groups, namely, LL-BFRt, sham LL-BFRt, and HL-Rt, through block randomization.

Independent variables: Each participant received intervention consisting of 45-minute sessions twice per week for 8 weeks.

Outcome measures: Quadriceps strength, star excursion balance test (SEBT), and single-leg hop test (SLHT) were evaluated in baseline, 4 weeks, and 8 weeks of the intervention period.

Results: In LL-BFRt and HL-Rt groups, QS, SEBT, and SLHT scores were significantly improved during 8-week intervention period, except in sham LL-BFRt group. Furthermore, there was a significant improvement in LL-BFRt ( QS: 9.2-33.5 Newton; SEBT: 1.2-11.1 cm; SLHT: 1.3-9.8 cm, P -values < 0.05) and HL-Rt groups ( QS: 15.4-35.9 Newton; SEBT: 2.2-9.0 cm; SLHT: 4.5-15.8 cm, P < 0.05) compared with sham LL-BFRt.

Conclusions: The improvements attained by participants using LL-BFRt and HL-Rt were comparable and capable of improving QS, SEBT, and SLHT more than sham LL-BFRt.

Trial registration: NCT05951036.

Abstract: A 49-year-old short-board goofy-stance competitive surfer presented with a 3-month history of bilateral, left foot pain associated with tender soft tissue plantar nodules. Magnetic resonance imaging of the left foot revealed foci of fibrotic tissue within the subcutaneous tissue adjacent to the first and fifth metatarsophalangeal joints compatible with surfers' knots . The patient underwent conservative treatment with oral ibuprofen as needed before competitions, topical diclofenac gel, wide toe box shoes, and use of a double-thick traction pad on his surfboard to alleviate the friction between the metatarsophalangeal joints of his left foot and the surfboard. He reported improvement of symptoms and full return to surfing at 8-month follow-up. We present a case of surfers' knots overlying the left first and fifth metatarsophalangeal joints of a male competitive surfer and highlight recommendations for successful conservative treatment options for symptomatic athletes.

Objective: Anterior cruciate ligament reconstruction (ACLR) leads to high rates of knee post-traumatic osteoarthritis (PTOA). Physical activity may mitigate PTOA risk but levels after ACLR have not been extensively studied. We aimed to review self-reported and device-measured physical activity levels in individuals with ACLR and compare them with international guidelines, and with uninjured controls.

Data sources: MEDLINE, Embase, Scopus, Google Scholar, Cochrane Library, Web of Science, and SPORTDiscus were searched from inception to 22 June 2023.

Main results: Of the 5391 studies identified on our initial search, 15 satisfied the inclusion criteria for analysis (N = 544 individuals with ACLR). Across all studies, the average physical activity levels for individuals with ACLR were 343 ± 185 moderate-to-vigorous physical activity (MVPA) min/wk and 8453 ± 233 steps/day. In studies measuring the proportion of individuals with ACLR reaching MVPA guidelines, 147/213 (69%) achieved ≥150 min/wk. Of those using step counts, 22/85 (26%) achieved ≥10 000 steps/day. Individuals with ACLR engaged in less physical activity than uninjured controls (SMD = -0.37 [95% CI = -0.60 to -0.15]; P < 0.001).

Conclusions: Individuals typically meet recommended MVPA, but not steps, after ACLR. Optimal volume, type, and weight-bearing nature of physical activity should be further investigated given the beneficial role of moderate mechanical loading in knee health. Our findings suggest that steps per day may represent a potentially modifiable prevention target and may help guide the future development of tailored physical activity guidelines for PTOA prevention after ACLR.

Prospero registration number: CRD42022330699.

Objective: To investigate the relationship between isokinetic knee extension peak torque and specific biomechanical variables during hop tests in patients 6 months postanterior cruciate ligament reconstruction (ACLR).

Design: Prospective, cross-sectional study analyzing the correlations between isokinetic knee extension torque and biomechanical outcomes across various functional tests.

Setting: Sports clinic with a specialized biomechanics laboratory.

Participants: Sixty-one patients (47 males, 14 females), aged 16 to 55 years, who had undergone ACLR, participated. All met the inclusion criteria and completed the follow-up testing at 6 months postsurgery.

Assessment of risk factors: Key independent variables included isokinetic knee extension peak torque. Participants completed standardized functional tests: single-leg and double-leg drop jumps, single-leg hop tests, and double-leg countermovement jumps.

Main outcome measures: Outcome measures included biomechanical parameters related to dynamic knee stability, including peak knee extensor moments, knee joint power during push-off, peak knee flexion and valgus, and vertical ground reaction force and braking forces.

Results: Moderate correlations were observed between knee extension peak torque and select biomechanical variables, including peak knee extensor moments during single-leg drop jumps, knee joint power during push-off phases in both single and double-leg drop jumps, and peak braking forces in single-leg hop tests. However, these relationships suggest that additional factors play essential roles in dynamic stability.

Conclusions: Although quadriceps strength is moderately linked to key biomechanical markers, our findings indicate that a more comprehensive assessment, integrating both strength and biomechanical evaluation, could enhance ACLR rehabilitation strategies. This combined approach may better support recovery and minimize reinjury risk.

Objective: To explore perceptions of professional male footballers from an English Premier League club on heading in football and the Football Association's (FA) Heading Guidelines.

Design: Focus group interview using a 6-stage thematic analysis approach.

Setting: A Premier League football club in England.

Patients or participants: Eight male professional footballers.

Assessment of risk factors: Risk factors related to heading in football were discussed, including the safety of the game and long-term implications of heading.

Main outcome measures: Perceptions of heading in professional male football and the existing Heading Guidelines.

Results: Many footballers perceived the risk of sustaining a head injury to be much lower compared with other sports and stated that the potential long-term risk associated with heading is not a pressing concern. Some justified continuing to play football and head the ball by reasoning that significant safety-related changes have already been made to football. Heading is viewed as a fundamental skill, but players argue that it is already limited in training, further negating the need for Heading Guidelines. Finally, footballers expressed that if they were to follow current FA Heading Guidelines, this would negatively affect their development causing selection and career progression issues.

Conclusions: This is the first study to explore the perceptions of professional footballers related to heading and the current Heading Guidelines in England. To increase buy-in and adherence to current and future iterations of Heading Guidelines, the perceptions of footballers and other key stakeholders should be taken into consideration, along with the scientific evidence base.

Objective: The purposes of this study were to (1) describe the physical effects (injuries) and associated risk factors during flag football season and (2) evaluate in-season mental health of female flag football athletes.

Design: Prospective cohort study.

Participants: We conducted a 4-month longitudinal pilot study of female adolescents participating in a season of high school flag football and nonathlete controls.

Setting: Preseason/in-season questionnaires.

Interventions: Not applicable.

Main outcome measures: Participants completed preseason and weekly in-season questionnaires assessing physical activity (PA), injuries, stress, mood, and energy. We calculated sport-related injury rates and used a multivariable Cox proportional hazards model to assess factors associated with injuries sustained.

Results: Nintey-eight participants (n = 83 flag football) participated (mean age = 16.3 ± 1.1 years): 23 sport-related injuries were reported. The injury rate was 7.25 injuries/1000 exposure hours. There were no significant predictors of injury risk. Flag football athletes reported significantly greater in-season physical activity than nonathletes (9.6 ± 4.7 vs 4.5 ± 6.4 h/wk; P < 0.001) but physical activity level was not associated with energy level, mood, or stress. After adjusting for physical activity level and school year, flag football participation was associated with significantly higher energy levels during the season relative to nonathletes (β = 0.94; 95% confidence interval, 0.13-1.76; P = 0.02).

Conclusions: The injury rate was 7.25 injuries/1000 exposure hours, and no variables were associated with injury risk. The complex nature of injury makes prediction challenging. Physical activity was not associated with mental health outcomes. Flag football participation was associated with significantly higher energy levels. Flag football may provide some benefit to athlete mental health independent of physical activity.

Objective: To (1) report the prevalence of hip pain in professional table tennis players registered at a National Sports Institute, (2) describe their hip pathologies, and (3) evaluate expectations regarding hip pain before and after becoming high-level athletes.

Design: Case series.

Setting: French National Sports Institute.

Patients: Nineteen professional table tennis players.

Interventions: None.

Main outcome measures: UCLA activity score, training information, prevalence of hip pain, expectations regarding hip pain, and hip joint injuries/pathologies.

Results: The cohort comprised 19 table tennis players, 6 women and 13 men, aged 24.9 ± 4.1 years. Before playing table tennis professionally, 8 players thought that becoming high-level players could cause pain at their joints; however, none thought that becoming high-level players could cause pain at their hip joint. Eleven athletes reported experiencing hip pain, with 8 having femoroacetabular impingement (FAI), which was concomitant with chondropathy in 6, hip dysplasia in 5, and coxarthrosis in 3. Five athletes required femoroplasty for FAI or total hip arthroplasty for coxarthrosis. All athletes who underwent surgery returned to sport. At the time of the questionnaire, 15 athletes thought it was common for high-level table tennis players to have hip pain.

Conclusions: Professional table tennis players registered at the institute had a high prevalence of hip pain (58%) and FAI (42%), with 26% of athletes requiring surgery. These findings could allow coaches to align expectations in professional table tennis players, as well as to anticipate hip pathologies and design specific prevention programs.