Clinical Journal of Sport Medicine最新文献

Objective: To compare clinical assessment findings between elite athletic populations with and without a clinical diagnosis of posterior ankle impingement syndrome (PAIS).

Design: Cross-sectional case-control study.

Setting: Elite ballet and sport.

Participants: Ten male and female professional ballet dancers and athletes with a clinical diagnosis of PAIS and were matched for age, sex, and activity to 10 professional ballet dancers and athletes without PAIS.

Independent variables: Posterior ankle pain on body chart and a positive ankle plantarflexion pain provocation test.

Main outcome measures: Single-leg heel raise (SLHR) endurance test, range of motion testing for weight-bearing ankle dorsiflexion, passive ankle plantarflexion, and first metatarsophalangeal joint dorsiflexion, and Beighton score for generalized joint hypermobility. Participants also completed the Cumberland Ankle Instability Tool (CAIT) questionnaire.

Results: The group with PAIS achieved significantly fewer repetitions on SLHR capacity testing ( P = 0.02) and were more symptomatic for perceived ankle instability according to CAIT scores ( P = 0.004).

Conclusions: Single-leg heel raise endurance capacity was lower, and perceived ankle instability was greater in participants with PAIS. The management of this presentation in elite dancers and athletes should include the assessment and management of functional deficits.

Objective: To compare clinical measures between patients with chronic exertional compartment syndrome (CECS) and healthy controls and evaluate running biomechanics, physical measurements, and exertional intracompartmental (ICP) changes in adolescent athletes with lower leg CECS.

Design: Cross-sectional case-control study.

Setting: Large tertiary care hospital and affiliated injury prevention center.

Participants: Forty-nine adolescents with CECS (39 F, 10 M; age: 16.9 ± 0.8 years; body mass index (BMI): 23.1 ± 2.9 kg/m 2 ; symptom duration: 8 ± 12 months) were compared with 49 healthy controls (39 F, 10 M; age: 6.9 ± 0.8 years; BMI: 20.4 ± 3.7 kg/m 2 ).

Interventions: All participants underwent gait analyses on a force plate treadmill and clinical lower extremity strength and range of motion testing. Patients with chronic exertional compartment syndrome underwent Stryker monitor ICP testing.

Main outcome measures: Symptoms, menstrual history, and ICP pressures of the patients with CECS using descriptive statistics. Mann-Whitney U and χ 2 analyses were used to compare CECS with healthy patients for demographics, clinical measures, and gait biomechanics continuous and categorical outcomes, respectively. For patients with CECS, multiple linear regressions analyses were used to assess associations between gait biomechanics, lower extremity strength and range of motion, and with ICP measures.

Results: The CECS group demonstrated higher mass-normalized peak ground reaction force measures (xBW) compared with controls (0.21 ± 0.05 xBW ( P < 0.001) and were more likely to have impact peak at initial contact ( P = 0.04). Menstrual dysfunction was independently associated with higher postexertion ICP (ß = 14.6; P = 0.02).

Conclusions: The CECS group demonstrated increased total force magnitude and vertical impact transient peaks. In women with CECS, menstrual dysfunction was independently associated with increased postexertion ICP. These biomechanical and physiological attributes may play a role in the development of CECS.

Objectives: This study explored the link between early sports specialization and injury rates in youth divers, a relationship that remains largely unexplored within diving.

Design: Cross-sectional survey.

Setting: Members of the USA Diving Organization and collegiate male and female divers participated in an online survey, reporting their sports involvement and injury history.

Participants: One hundred eighty-two male and female divers aged 8 to 25 years were recruited through USA Diving or US collegiate team databases.

Independent variables: Early/late specialization (based on age <12 or 12 years or older), gender (M/F), springboard and/or platform divers, experience (junior/senior, regional/zone/national/international), hours of dryland/water training, and prior sport exposure.

Main outcome measures: Injury history obtained on questionnaire.

Results: One hundred eighty-two divers were surveyed; 70% female. Age to start diving and age to concentrate solely on diving were significantly associated with certain injuries (P < 0.05). Beginning diving before age 13 years of age was significantly associated with lower odds of injuries in the shoulder and wrist (P = 0.013 and 0.018, respectively), after adjusting for select covariates. Age of specialization was not significantly associated with injuries in any body part (P > 0.05), after adjusting for covariates. Greater years of diving experience was significantly associated with diving injuries in all 11 body parts (P < 0.05).

Conclusions: This study indicates that early sports specialization is associated with decreased injury rates in elite youth divers who specialized before age 13 years, particularly for head/neck, shoulder, and wrist injuries. Moreover, we observed a positive correlation between experience and injury rate. Further investigation should focus on distinguishing between acute and overuse injuries.

Objective: Identify key flexibility and point-of-care musculoskeletal ultrasound (POCUS) measures for prognosticating return-to-play (RTP) following a first hamstring strain injury (HSI) and informing the clinical decision-making process.

Design: Exploratory prospective cohort study.

Setting: Sport medicine and rehabilitation clinic of a Canadian university.

Participants: One hundred and sixty-seven elite Canadian university football athletes followed over 5 seasons.

Interventions: Clinical and POCUS measures collected within 7 days after HSI and preseason clinical measures.

Main outcome measures: Active knee extension (AKE) and Straight Leg Raise (SLR) to quantify hamstring flexibility, POCUS-related outcomes to characterize tissue alteration, and RTP until full sport resumption were documented (categorized as Early [1-40 days] or Late [>40 days] RTP).

Results: A total of 19 and 14 athletes were included in the Early RTP (mean RTP = 28.84 ± 8.62 days) and Late RTP groups (mean 51.93 ± 10.54 days), respectively, after having been diagnosed with a first HSI. For the clinical results, height and a greater flexibility asymmetry measure with the AKE or SLR when compared with both ipsilateral preseason and acute contralateral values significantly increases the chance of facing a long delay before returning to play (ie, RTP). For the POCUS-related results, the Peetrons severity score, extent of the longitudinal fibrillary alteration, and novel score lead to similar results.

Conclusions: Early hamstring flexibility asymmetry following acute HSI, particularly the AKE, along with some POCUS-related measures are valuable in prognosticating late RTP following among Canadian university football athletes.

Objective: The primary aim was to compare differences in live game pitch counts (LGPCs) with all pitch counts (APCs) over the course of a youth baseball season.

Design: Prospective longitudinal study.

Setting: Midwest youth travel baseball.

Participants: Ten male baseball players part of a youth baseball travel team.

Variables: Demographic data, pitch counts (practice, game, warm-up, and bullpen), innings pitched, and recommended rest days.

Main outcome measures: Live pitch counts compared with APCs and the relationship to recommended rest days.

Results: During the season, 7866 pitches were recorded among 9 pitchers. By using the LGPC method alone, 42.5% of the pitches were unaccounted for. When considering age-specific rest days suggested by Pitch Smart Guidelines (PSGs), there were 104 rest days unaccounted for by using the live game pitch method.

Conclusion: There is a high number of unaccounted for pitches and an underestimation of rest days per outing when using live game methods. Revisions to the PSGs that include all pitches should be considered to accurately reflect pitching volume, which may be associated with the rising rate of injuries among these athletes.

Objective: Patients with clinical tendinopathy often demonstrate significant abnormalities with ultrasound (US) imaging. Tendon abnormalities likely precede pain in these patients. The purpose of this review was to systematically evaluate the available literature regarding the utility of US imaging as a method to predict Achilles and patellar tendon pain.

Design: Systematic review and meta-analysis. Inclusion criteria were as follows: prospective studies of Achilles and patellar tendon pain development with baseline US measurements, follow-up clinical measurements, and English-language studies published after 2000. Exclusion criteria were prior rupture or surgery and presence of rheumatologic disorder.

Setting: N/A.

Patients: Athletes without Achilles or patellar tendon pain at baseline.

Interventions: N/A.

Main outcome measures: Risk ratios (RRs) were identified for the development of pain in those with Achilles or patellar tendon sonographic abnormalities.

Results: This review of 16 studies included 810 Achilles and 1156 patellar tendons from a variety of sports and demonstrated that the RR for pain development from abnormal Patellar and Achilles tendons was 6.07 [95% confidence interval (CI), 2.88-12.81; P < 0.001] and 3.96 [95% CI, 2.21-7.09; P < 0.001], respectively. The positive and negative predictive values of an abnormal US finding were 27.2% and 92.0% for the Achilles tendon and 27.2% and 93.5% for the patellar tendon, respectively.

Conclusions: This systematic review and meta-analysis identified that the use of asymptomatic US scanning of the Achilles or patellar tendon has a low positive predictive value but a high negative predictive value for the future development of pain.

Objective: To compare clinical outcomes following steroid injections using the anterior and posterior approaches.

Design: Systematic review with meta-analysis.

Setting: Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies.

Patients: Patients with adhesive capsulitis.

Interventions: Glenohumeral steroid injections using either anterior or posterior approach.

Main outcome measures: Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs.

Results: We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications.

Conclusions: While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.

Objective: Investigate the effect of cumulative head impacts on saccade latency and errors, measured across two successive football seasons.

Design: Participants were acquired from a sample of convenience-one Canadian university football team. Head impacts were collected during training camp, practices, eight regular season games, and four playoff games in each season. Saccade measurements were collected at five time points-before and after training camp, at midseason, after regular season, and after playoffs.

Setting: Two seasons following players from a single USports football team during practices and games.

Participants: Players who completed a baseline saccade measurement and a minimum of one follow-up measurement were included in the study. A total of 127 players were monitored across two competitive seasons, including 61 players who participated in both seasons.

Independent variables: Head impact measurements were collected using helmet-mounted sensors.

Main outcome measures: Saccade latency and number of errors were measured using high-speed video or electro-oculography.

Results: On average, each head impact increased prosaccade latency by 5.16 × 10 -3 ms (95% confidence interval [CI], 2.26 × 10 -4 -1.00 × 10 -2 , P = 0.03) and antisaccade latency by 5.74 × 10 -3 ms (95% CI, 7.18 × 10 -4 -1.06 × 10 -2 , P = 0.02). These latency increases did not decrease between the two seasons; in fact, prosaccade latencies were 23.20 ms longer (95% CI, 19.40-27.14, P < 0.001) at the second season's baseline measurement than the first. The number of saccade errors was not affected by cumulative head impacts.

Conclusions: Repetitive head impacts in Canadian university football result in cumulative declines in brain function as measured by saccade performance.

Clinical relevance: Football organizations should consider implementing policies focused on reducing head impacts to improve player safety.

Objective: Assessment of physical activity and exercise prescription has been widely supported by many organizations, yet provision of such services remains limited in the United States. We sought to uncover why such services have not been widely adopted.

Design: The American Medical Society for Sports Medicine organized a task force to canvas physicians and survey the American Medical Society for Sports Medicine membership.

Setting: Peer-to-peer and telecommunication discussions and web-based questionnaires.

Participants: Sports medicine physicians in the United States.

Interventions: None.

Main outcome measures: Percentage of sports medicine physicians who provide exercise management services and mechanisms of billing for exercise management, identify barriers to such services, and identify industry collaborations for promoting physical activity through physicians.

Results: Three of 4 sports medicine physicians spend at least 1 min encouraging exercise with patients, using Evaluation and Management codes to bill or receive credit. Exercise counseling is often bundled within other patient care. Few health plans leverage the patient's relationship with a primary care physician to promote exercise. Most employed sports medicine physicians do not receive incentives to incorporate exercise counseling into practice, and only 1 in 6 have decision-making authority to hire an exercise professional. Major obstacles are the lack of a business model and knowledge about exercise prescription.

Conclusion: The existing E&M codes adequately characterize the work, but physicians desire greater payment or credit for providing exercise management services. Physicians desire to do more exercise prescription, but health system bureaucracy, inadequate support, and economic disincentives are barriers to the provision of exercise management services.

Objective: To determine whether an investigational head-neck cooling device, Pro2cool, can better reduce symptom severity compared with standard postconcussion care in early adolescent athletes after a sports-related concussion.

Design: Prospective, longitudinal, randomized trial design conducted over a 28-day period.

Setting: Six pediatric medical centers in Ohio and Michigan.

Participants: The study enrolled 167 male and female 12- to 19-year-old athletes who experienced a sports-related concussion within 8 days of study enrollment and registering a Sports Concussion Assessment Tool 5 (SCAT5) composite score >7.

Interventions: Pro2cool, an investigational head-neck cooling therapy device, was applied at 2 postinjury time points compared with postconcussion standard of care only.

Main outcome measures: Baseline SCAT5 composite symptom severity scores were determined for all subjects. Sports Concussion Assessment Tool 5 scores for concussed athletes receiving cooling treatment were analyzed across 6 independent postenrollment time points compared with subjects who did not receive cooling therapy and only standard care. Adverse reactions and participate demographics were also compared.

Results: Athletes who received Pro2cool cooling therapy (n = 79) experienced a 14.4% greater reduction in SCAT5 symptom severity scores at the initial visit posttreatment, a 25.5% greater reduction at the 72-hour visit posttreatment, and a 3.4% greater reduction at the 10-day visit compared with subjects receiving only standard care (n = 88). Overall, 36 adverse events (increased blood pressure, decreased pulse, and dizziness) were reported, with 13 events associated with the device, of which 3 were classified as moderate in severity.

Conclusions: This study demonstrates the efficacy and safety of head and neck cooling for the management of concussion symptoms in adolescent athletes of an age group for which little to no prior data are available.