Clinical Journal of Sport Medicine最新文献

Objective: To investigate the impact of high-intensity exercise on the vestibular and oculomotor systems in a group of sedentary and active males and females.

Design: Prospective observational study.

Setting: Performance laboratory; Institute of Sport, Exercise and Health, London.

Participants: Forty-five collegiate athletes and 30 age-matched sedentary participants.

Interventions: A baseline Vestibular and Oculomotor Screening (VOMS) test was performed on all participants before undertaking a self-paced 5-minute treadmill run maintaining an intensity of 17/20 on the Borg scale. Post-run, participants were tested using the VOMS tool a further 3 times with each test 30 seconds apart.

Main outcome measures: Symptom provocation on testing of the VOMS tool.

Results: At baseline testing, 25.3% of participants had 1 or more positive VOMS domains although there was no significant differences between sex, sport, or activity level. At postrun testing, 62.5% of participants had 1 or more positive VOMS domains; this was a significant change from baseline with large effect size (Z = 6.12, r = 0.72, P < 0.001).

Conclusions: High-intensity exercise has a deleterious impact on vestibular and oculomotor function. This change in function is consistent across all groups when considering activity level, sex, and sporting participation. These findings have implications when considering the timing of VOMS in relation to sporting participation and clinical testing that involves exercise.

Objective: Olympic athletes (OAs) represent a unique subset of highly trained subjects achieving extraordinary performance. Differences between OAs and elite/national athletes (EAs), defined as athletes not qualified for the Olympics, are not investigated.

Design: Therefore, we compared OAs with EAs enrolling 1472 athletes (63.6% OAs; 56.9%, men, mean age 25.8 ± 5.1 years) of power (24.7%), skills (12.5%), endurance (20.8%), and mixed (37.4%) disciplines performing clinical, anthropometric, echocardiographic, exercise stress, and blood test analysis.

Results: Olympic athletes were older (power: 25.9 ± 4.6 vs 24.1 ± 4.7, P = 0.0002; skills: 28.6 ± 6.5 vs 25.2 ± 6.5, P = 0.0003; endurance: 27.2 ± 4.5 vs 23.7 ± 3.9, P = 0.001; mixed: 27.9 ± 4.7 vs 22.8 ± 4.4, P = 0.001) and trained for more hours (power: 26.1 ± 10.9 vs 19.9 ± 7.5, P < 0.0001; skills: 29.1 ± 9.4 vs 21 ± 9.4, P = 0.0004; endurance: 26.4 ± 8.7 vs 19.4 ± 8.5, P = 0.001; mixed: 28.4 ± 9.5 vs 22.2 ± 9.2, P = 0.001) compared with EAs. No morphological cardiac differences were observed. At the exercise test, the maximum watt reached was similar (except that in power, P = 0.004). Olympic athletes showed statistically significant lower serum calcium, lower thyroid stimulating hormone, and relatively higher total and low-density lipoprotein cholesterol.

Conclusions: Olympic athletes are older, have a larger body mass, and can sustain a larger training volume than elite athletes. However, no major differences in cardiac remodeling or clinical and laboratory parameters differentiate these 2 groups. Expertise and volume of training appear to represent the critical factors to translate from the national to the Olympic level.

Objective: To investigate the prevalence of low back pain (LBP) and disk degeneration (DD) and the relationship of DD with LBP among elite cross-country skiers.

Design: A cross-sectional study of elite cross-country skiers.

Setting: Study participants were recruited during autumn 2022 among elite cross-country skiers and collegiate skiers who were selected to national teams' training groups.

Participants: The original study group consisted of 44 skiers (16 national team skiers and 28 sports academy skiers).

Interventions: The study protocol included a 1.5T lumbar spine MRI, a clinical examination, and an interview with questions about general health and training as well as selected patient-reported outcomes. The morphology of intervertebral disks from T12/L1 to L5/S1 on sagittal T2-weighted midline images was visually assessed using the Pfirrmann classification with a grade 3 or higher considered degenerated in this age group.

Main outcome measures: Cross-sectional occurrence of DD on MRI and self-reported LBP.

Results: Low back pain was reported by 33 (75%) skiers. Half of the skiers had at least 1 disk of ≥grade 3 in the Pfirrmann classification. At least 1 disk grade ≥3 in the Pfirrmann classification was found in 61% (20 of 33) of skiers with LBP and 18% (2 of 11) of skiers without LBP (P = 0.034).

Conclusions: The most important findings in our study were the high prevalence of self-reported LBP and a statistically significant difference in the occurrence of at least 1 degenerated disk in the Pfirrmann classification between skiers who reported LBP compared with those who did not.

Abstract: The Association of Ringside Physicians (ARP) emphasizes the importance of screening combat sports athletes for blood-borne infections, including hepatitis B, HIV, and hepatitis C, to mitigate transmission risks and ensure participant safety. Although transmission of hepatitis B and C and HIV in combat sports is rare, protecting athletes is of utmost importance. It is the recommendation of the ARP that all fighters participating in combat sports, in which the presence of blood is a common occurrence and is allowed during competition, should undergo testing for HIV, hepatitis B (HBV), and hepatitis C (HCV). Testing should be conducted using serum samples, because rapid tests are not considered acceptable for accurate results. Testing for HBV, HCV, and HIV should optimally be done within 3 months of competition, but within 6 months is acceptable. Athletes whose tests suggest active HBV, HCV, or HIV infection should be disqualified from competition in sports where blood is common and allowed. Athletes with cured prior HCV infection may be cleared for competition in all combat sports. Athletes with prior HBV infection and no detectable HBV DNA in blood can be cleared for competition in all combat sports. Athletes with latent HBV infection with detectable HBV DNA in blood have a small risk of disease reactivation, so they should not be cleared.

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: Identify the effect size of mild and moderate levels of exertion on common sideline concussion assessment tool scores in healthy adolescent athletes.

Design: Three arm randomized controlled trial.

Setting: High school training rooms.

Participants: Forty-seven healthy adolescents who participate in school sports and have not had a concussion within the past month.

Interventions: Participants performed the Sport Concussion Assessment Tool 5 (SCAT5) and Vestibular Ocular Motor Screen (VOMS) at rest. Participants were randomized to perform No Exertion (n = 16, 15-minute seated rest), Mild Exertion [n = 16, 50%-55% of heart rate (HR) max for 15 minutes on a treadmill], or Moderate Exertion (n = 15, 70%-75% of HR max). Participants then repeated the SCAT5 and VOMS immediately after a 2-minute cool down.

Main outcome measures: Effect size of change after exertion.

Results: Few differences were seen after mild and moderate levels of exertion. In the combined sample, there was a small increase in the number of modified balance error scoring system errors [d = -0.17 (-0.52, 0.19)], a medium degree of improvement in symptoms [d = 0.38 (0.01, 0.74)], and a small degree of improvement in cognitive scores [d = 0.20 (-0.16, 0.55)] after exercise. No differences on VOMS testing were observed.

Conclusions: The SCAT5 and VOMS seem to be consistent measures even after mild and moderate levels of exertion (HR <75% of age-appropriate maximum). A future study should aim to identify the effect of maximal exertion.

Objective: The objective of this study was to evaluate whether percussive massage reduces the intensity of quadriceps pain and perceived fatigue and improves perceived recovery and vertical jump after habitual running.

Design: Randomized clinical trial.

Settings: Road race.

Participants: Eighty-four runners aged 18 to 60 years, 1-year experience in running and a training frequency of twice a week, were included (experimental group: n = 39, 34.33 ± 1.61 years, 61% M, 5.68 ± 1.16 years of running experience; control group: n = 45; 34.51 ± 1.50 years; 71% M; 6.01 ± 1.02 years of running experience).

Interventions: The experimental group received 10 minutes of percussive massage on the quadriceps, and the control group received sham hip and knee joint mobilization.

Main outcome measures: Quadriceps pain intensity and fatigue (visual analog scale), perceived recovery (perceived global effect scale), and vertical jump after habitual running.

Results: The experimental group showed better results for quadriceps pain intensity (0.98; 95% confidence interval [CI], -1.63 to -0.34), fatigue (0.7; 95% CI, -1.45 to -0.05) and perceived recovery (0.54; 95% CI, 0.02-1.07), but not for vertical jump performance (0.95; 95% CI, -1.57-3.47).

Conclusions: Percussive massage improved pain intensity, fatigue, and perceived recovery after running but had no effect on vertical jump.

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: This study aimed to translate, culturally adapt, and validate the latest Sport Concussion Assessment Tool 6 (SCAT6) into simplified Chinese.

Design: This study adopted a mixed design with both qualitative and quantitative methods. The quantitative part of the study adopted a repeated measures design.

Setting: The translation and revision process were completed through online communications. The validation process was performed in person at the athletes' normal training facilities.

Participants: Thirty-two healthcare professionals and twenty-one athletes were invited into the expert panel and end-user panel for the qualitative part of the study. Thirty-nine elite or collegiate athletes were included in the quantitative part of the study.

Independent variables: No independent variables were assumed in the translation and the expert appraisal processes. Administrators were the independent variables for the inter-rater study and the testing sessions for the test-retest study.

Main outcome measures: Expert opinions were collected during the translation and appraisal process. Testing scores and time of completion were obtained from test-retest study and inter-rater examinations.

Results: Revision and alterations of the Chinese SCAT6 and supplementary materials were made according to the reviews from experts and end users. The internal consistency and the inter-rater reliability of the simplified Chinese SCAT6 for all subscales were excellent [intraclass correlation (ICC) ranged from 0.83 to 0.999], the test-retest reliability for all subscales were moderate to excellent (ICC ranged from 0.51 to 0.92). The average time to complete was 20.2 ± 3.5 minutes.

Conclusion: The simplified Chinese SCAT6 is a valid sport concussion assessment instrument for mainland China end users.

Graded exertion testing has diagnostic utility in the management of athletes with sport-related and recreation-related concussions, the results of which are used to prescribe individualized aerobic exercise treatment that facilitates recovery from sport-related concussion and reduces the incidence of symptoms persisting beyond 1 month. Current exertion protocols, such as the Buffalo Concussion Treadmill Test, however, are recommended for patients aged 13 years and older and are not appropriate for younger children with concussion. This practical management article describes a pediatric exertion test protocol using a standard, commercially available treadmill that is designed for patients aged 5 to 12 years with concussion. The Pediatric Concussion Treadmill Test (PCTT) uses age-appropriate walking speeds and symptom-reporting scales and provides additional guidelines on how to perform the test safely in younger children. The PCTT is intended to identify the presence and severity of concussion-related exercise intolerance and can function as an important component of a comprehensive medical evaluation of concussion in children.