Current sports medicine reports最新文献

Abstract: Bone stress injury is a common musculoskeletal condition presenting with insidious bony pain that is progressive and occurs with a number of intrinsic or extrinsic risk factors, particularly with a recent change in training. When elicited, the presence of bony tenderness remains the most important component of the physical exam, although reproduction at deeper sites is a challenge and requires a high index of suspicion and imaging for diagnosis. MRI should be utilized as the gold standard for diagnosis, grading, and return-to-sport timing prognosis when available, with plain radiographs used as first-line imaging. Careful management of training loads, appropriate periodization and rest, gradual progression, resistance training, and nutrition optimization are important for bone stress injury prevention. In bone stress injury treatment, identification of low-risk versus high-risk sites in conjunction with addressing modifiable risk factors and a two-phased approach of mechanical load control and pain-free progression will optimize recovery.

Abstract: Patellofemoral pain syndrome is a common cause of anterior knee pain. It has a prevalence of 22.7% in the general population and tends to affect females more than males. Understanding the anatomy of the hip, knee, ankle, and foot helps to assess biomechanical risk factors that contribute to the development of patellofemoral pain syndrome. At the knee, decreased knee flexion angle, knee flexion and extension strength, and increased frontal plane projection angle have been shown to increase the risk of developing patellofemoral pain syndrome. Increased femoral internal rotation, weak hip external rotators, and an increased dynamic Q angle have been identified as hip biomechanical risk factors. Foot and ankle risk factors include excessive foot pronation, pes planus, pes cavus, and limited ankle dorsiflexion. Biopsychosocial factors, like kinesiophobia, also may contribute to patellofemoral pain syndrome. It is important to consider all these factors together when assessing and treating patients with anterior knee pain.

Abstract: Posterior ankle impingement (PAI) is the result of bony or soft tissue abnormalities in the posterior region of the ankle directly behind the talus. Os trigonum, an accessory bone resulting from failure of complete mineralization, and the Stieda process, an elongated process of the posterolateral talus, are the most common bony abnormalities. The flexor hallucis longus tendon travels between the posterolateral and posteromedial tubercles of the talus in a fibro-osseous sheath. Here it is subject to tenosynovitis. Repetitive or forceful plantarflexion is the main risk factor for PAI. Management of bony abnormalities is generally surgical, while soft tissue abnormalities can be managed with a combination of activity modification, orthoses, and selected injections.

Abstract: Glenohumeral instability is a common injury affecting contact and collision athletes. Male sex, younger age at time of first dislocation, and contact sports participation are risk factors for recurrent instability. MRI is the gold standard to evaluate soft tissue structures, while CT is beneficial in quantifying glenoid bone loss and identifying on-track and off-track Hill-Sachs lesions. The management of shoulder instability in contact athletes is a nuanced, individualized process, taking into consideration the athlete's sport and playing position, hand dominance, timing of the in-season injury, and athlete's long-term goals. Shared decision-making is essential. Nonoperative management may allow athletes to return to sport the same season but carries a high risk of recurrent instability events and subsequent glenoid bone loss. Operative management confers a higher success rate in return to play but prevents in-season return to competition. Surgical approach is dependent on soft tissue damage, glenoid bone loss, and humeral head injury.

Abstract: In 2022, 48.7 million U.S. individuals aged 12+ reported problematic substance use with only 4.6% of those needing treatment successfully accessing it. Addiction recovery is a nonlinear journey requiring transformative behavior change, and exercise can support that process, providing empowerment and connectedness. We reviewed the role of exercise in recovery from substance use within and outside of formal treatment. Various forms of exercise (e.g., aerobic, muscle strengthening, outdoor, mind-body, etc.) provide important mental, physical, and social benefits integral to sustaining recovery and supporting long-term well-being. More research exists for formal treatment settings, although the availability of community-based exercise programs and recovery supports are increasing. Recommendations include greater integration of people in addiction recovery into exercise programs, developing inclusive and supportive exercise communities that directly address stigma, and exploring benefits of more diverse forms of exercise. Exercise is medicine for addiction recovery, and a paradigm shift toward holistic health and well-being is required.

Abstract: Contemporary obesity management medications have been shown to be highly efficacious for weight loss and improvements in many related health outcomes. However, a potential concern is the reduction in lean body mass, and possibly muscle mass, that may accompany the weight loss that is achieved. Physical activity and structured exercise have been suggested as potential strategies for attenuating these reductions, yet there is a paucity of research to support that these benefits will be realized. The effects of exercise may be most effective for enhancing the quality of lean tissue and muscle tissue, suggesting a need to pivot to these as important outcomes for patients treated with an obesity management medication. Thus, the inclusion of exercise in the treatment of patients with obesity who are prescribed an obesity management medication should be primarily focused on the health benefits beyond weight loss, with programming focused on the individual health needs of the patient.