Clinical Journal of Sport Medicine最新文献

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.

Objective: Less-experienced fencers may present with a different injury profile compared with higher-level athletes. Goal of this study is to analyze the epidemiology of fencing injuries in the United States across all experience levels and age groups.

Design: Retrospective cross-sectional study.

Setting: Raw and weighted data from the National Electronic Injury Surveillance System database from 2003 to 2022 and 2022 United States Fencing Association membership data were analyzed by 2 Division I level fencers to determine eligibility.

Participants: Athletes presenting to emergency departments in the United States with fencing-related injuries.

Independent variables: Age, sex, and type and nature of athletes' injury are independent variables.

Main outcome measures: Incidence rate was calculated, and weighted χ 2 tests and Poisson regression determined statistically significant associations among injury incidences.

Results: A weighted estimate of 4551 fencing injuries across the United States demonstrated that mean and median ages of patients were 24.26 and 18 years, respectively, with a male:female ratio of 1.26:1. The incidence was 5.72 injuries per 1000 athlete-years. The most common injury was strain/sprain (28.0%) followed by lacerations (16.8%), and the most common location was the finger (17.7%).

Conclusions: Fencing-related injuries are most common in the Division age group. Strain/sprain injuries seem more common at higher levels of fencing, whereas lacerations have a sizable presence at lower levels. Male fencers have a significantly higher risk of the 2 most common injuries. Regulation at national or individual coaching levels could reduce laceration injuries in less-experienced fencers.

Objective: To compare match event rates and suspected injury and concussion rates between 7-a-side (7s) and 15-a-side (15s) female and male high school rugby union players using video analysis (VA).

Design: Cross-sectional video analysis study.

Setting: Alberta high school rugby competitions.

Participants: Senior high school rugby players (ages 14-18 years) in Calgary, Alberta, participating in the March to June 2022 season.

Assessment of risk factors: Video analysis of high school rugby matches in 7s and 15s.

Main outcome measures: Univariate Poisson regression analyses were used to determine rates of match events, video-identified suspected injuries, and suspected concussions per 1000-player-hours. Incidence rates and incidence rate ratios (IRR) were used to compare between 7s and 15s (15s referent group) and females and males (male referent group).

Results: Suspected injury rates ranged from 115.0 to 223.6/1000 match hours, while suspected concussion rates ranged from 61.5 to 93.2/1000 hours. The male 7s cohort reported the highest suspected injury and suspected concussion rate, with no significant differences between male or female cohorts across formats. The tackle accounted for 84.6% of all injuries. Despite 30% more tackles in female compared with male 15s, tackle-related injury rates were similar between sexes [IRR = 1.1 (95% CIs: 0.7-1.6)].

Conclusions: This study did not find any differences in suspected injury or suspected concussion rates between sexes or formats of the game. The proportion of injuries recorded in the tackle and the high reported suspected injury rates does suggest the need for further investigation into tackle proficiency, injury prevention intervention evaluation, and potential law changes.

Objective: Acute respiratory infections (ARinf), including SARS-CoV-2 infection, can affect multiple organ systems that may influence return to sport (RTS) in athletes. Factors associated with multiorgan involvement in athletes with ARinf are lacking. The aim of this study was to explore whether factors such as demographics, sport participation, history of comorbidities/allergies, and number of acute symptoms are associated with multiorgan involvement in athletes with recent SARS-CoV-2 infection.

Design: Prospective cohort study with cross-sectional analysis.

Setting: Institutional clinical research facilities.

Participants: Ninety-five athletes (18-60 years) underwent a comprehensive medical assessment 10 to 28 days after SARS-CoV-2 infection.

Independent factors: Demographics, sport participation, history of comorbidities/allergies, and the number of acute symptoms (in 3 subgroups:1 = ≤5, 2 = 6-9, or 3 ≥ 10).

Main outcome measures: Number of organs involved in athletes with recent SARS-CoV-2 infection.

Results: The number of organ systems involved was not associated with demographics (age, sex), sport participation (level and type), or history of comorbidities and allergies. However, the number of organ systems involved was significantly higher in athletes with 6 to 9 symptoms (subgroup 2) compared with those with ≤5 symptoms (subgroup 1) and this was more pronounced when comparing athletes with ≥10 symptoms (subgroup 3) with those with ≤5 symptoms (subgroup 1) ( P < 0.0001).

Conclusions: Total number of acute symptoms of SARS-CoV-2 infection is related to number of organ systems involved, which is a measure of disease severity, and could therefore influence RTS decision making. Future studies should explore whether this observation holds for athletes with ARinf caused by other pathogens.

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.

Abstract: This report details the first documented instance of a clay shoveler's fracture in a professional swimmer, underscoring an uncommon injury pattern in a sport typically associated with minimal impact. Initially managed with conventional interventions, the case progressed to reveal complications such as nonunion and a subsequent fracture upon reassessment. This discovery underscores the imperative for comprehensive evaluation and vigilance in sports medicine, challenging prevailing assumptions about the safety of swimming. Highlighting the need for meticulous follow-up and refined treatment strategies, this case enhances our understanding of athlete care and informs proactive measures to mitigate risks in similar athletic settings.

Objectives: Compare incidence of head injury, number of falls, and helmet use between English and Western riders.

Design: Cross-sectional study.

Setting: Online flyers.

Participants: Competitive college equestrian athletes.

Assessment of risk factors: This study assesses the difference in risk of head injury between the English and Western disciplines of riding.

Main outcome measures: The difference in risk of head injury between the English and Western disciplines of riding.

Results: Three hundred fifty-seven equestrian athletes between 18 and 24 years of age who ride competitively for their college or university's team participated in this study. Of these athletes, 297 athletes competed in English style riding, and 60 competed in Western style riding. There was a significantly higher proportion of English-style equestrians who reported always wearing a helmet while riding (92.5%), in comparison with just 23.3% of Western style riders. There were significantly more Western equestrians than English equestrians who reported multiple head injuries because of falls in the previous year.

Conclusions: All equestrians have a high incidence of head injuries; however, Western riders reported a higher number of falls in the previous year than their English counterparts. In addition, Western riders reported less consistent helmet use when compared with their English counterparts, who are more likely to always wear helmets when riding. This study highlights important differences in the risk of head injury between participation in Western and English riding.

Abstract: Criteria that identify combat sports athletes with significantly increased risk of injury and mortality in combat sports competition include the following:• Age younger than 13 years or older than 35 years (LOE V).• Three consecutive losses, particularly by KO/TKO (professional) or Referee Stops Contest (RSC) (amateur) (LOE III).• Inactivity exceeding 1 year (professional) (LOE V).• No prior wins (LOE V).• Significant mismatches in record, experience, age, or physical conditioning (LOE V).• History of concussion, lack of full recovery and clearance from most recent concussion, or history of other significant neurological injury (LOE II).• Severe prebout hypertension (SBP >160 or DBP >100 mm Hg in adults, or stage 2 hypertension in pediatric athletes) (LOE V).• Any medical condition identified on licensing or prebout medical examination that compromises defensive abilities (LOE V).

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: To investigate the relationship between hip and knee muscle volume and neuromuscular function (isokinetic strength, rate of torque development, and torque variability) in women with patellofemoral pain (PFP).

Design: Cross-sectional study.

Setting: University research laboratory.

Participants: Twenty women with PFP.

Main outcome measures: Isokinetic strength (60 degrees/second and 180 degrees/second), rate of torque development, and torque variability were assessed with an isokinetic dynamometer for hip extension, hip abduction, knee extension, and knee flexion. Muscle volume of the lower extremity muscles (cm3/kg·m) was quantified through magnetic resonance imaging. Pearson r correlation or Spearman ρ coefficients were calculated to evaluate the relationship between muscle volume and neuromuscular function, with significance set at P < 0.05.

Results: Muscle volume for all muscle groups was moderately correlated with isokinetic strength at 60 degrees/second, r ≥ 0.452, P ≤ 0.046. Hip abduction and extension were moderately correlated with isokinetic strength at 180 degrees/second, r ≥ 0.485, P ≤ 0.030; however, no significant correlations were identified between muscle volume and rate of force development or torque variability, P < 0.05.

Conclusions: The results suggest that isokinetic strength is associated with hip and knee muscle volume in women with PFP; however, additional measures of neuromuscular function (rate of torque development and torque variability) are not associated with muscle volume in lower extremity muscles.