Pub Date : 2026-03-23DOI: 10.1007/s40279-026-02411-w
Chelsea Oester,Dean Norris,Ric Lovell,Charles Pedlar,Georgie Bruinvels,Judd T Kalkhoven
Menstrual health in sport is a complex domain shaped by biological, psychological and contextual factors. Central to these interactions is the menstrual cycle, a fundamental physiological process that affects female athletes across multiple dimensions. While research in this area is growing, it often lacks a unifying sport-specific framework to guide theory development, data interpretation and practical application. This article addresses this gap by proposing an overarching conceptual framework (i.e. nomological network) to integrate diverse constructs related to menstrual health in sport to support a more coherent theory-driven approach across both laboratory and field settings. The framework brings together key elements, with the construct of menstrual-related effects representing the primary mechanisms through which menstrual-related phenomena are theorised to causally influence sport-related outcomes such as performance, health, participation and behaviour. When constructs are linked to outcomes through clearly identified mechanistic pathways, it enhances the biological and theoretical plausibility of any proposed relationship, reinforces its justification within a broader system of theory, and strengthens the evidential basis for validation. However, while useful for organising constructs, shaping research questions and hypotheses, and stimulating theory-driven inquiry, the proposed framework is largely informal and therefore offers primarily heuristic value. It is insufficient on its own for formalised empirical testing. For this reason, the adoption of causal directed acyclic graphs is advocated for investigating specific research questions through robust statistical analysis, causal modelling and validation. Directed acyclic graphs are mathematical models that explicitly encode variables, hypothesised causal pathways, mechanisms and confounders in a formal causal structure that enables systematic and testable estimation of causal effects, including from observational data. This approach enhances transparency and interpretability, facilitates refinement of model specifications and supports more rigorous validation processes. Ultimately, the integration of a heuristic conceptual framework with the formal methodology of causal directed acyclic graphs provides both a structured and theory-driven foundation for organising knowledge and the formal modelling approach required to address specific research questions and strengthen empirical inquiry in menstrual health in sport research.
{"title":"An Overarching Conceptual Framework for Menstrual Health in Sport Research: Theory, Causality and Validation.","authors":"Chelsea Oester,Dean Norris,Ric Lovell,Charles Pedlar,Georgie Bruinvels,Judd T Kalkhoven","doi":"10.1007/s40279-026-02411-w","DOIUrl":"https://doi.org/10.1007/s40279-026-02411-w","url":null,"abstract":"Menstrual health in sport is a complex domain shaped by biological, psychological and contextual factors. Central to these interactions is the menstrual cycle, a fundamental physiological process that affects female athletes across multiple dimensions. While research in this area is growing, it often lacks a unifying sport-specific framework to guide theory development, data interpretation and practical application. This article addresses this gap by proposing an overarching conceptual framework (i.e. nomological network) to integrate diverse constructs related to menstrual health in sport to support a more coherent theory-driven approach across both laboratory and field settings. The framework brings together key elements, with the construct of menstrual-related effects representing the primary mechanisms through which menstrual-related phenomena are theorised to causally influence sport-related outcomes such as performance, health, participation and behaviour. When constructs are linked to outcomes through clearly identified mechanistic pathways, it enhances the biological and theoretical plausibility of any proposed relationship, reinforces its justification within a broader system of theory, and strengthens the evidential basis for validation. However, while useful for organising constructs, shaping research questions and hypotheses, and stimulating theory-driven inquiry, the proposed framework is largely informal and therefore offers primarily heuristic value. It is insufficient on its own for formalised empirical testing. For this reason, the adoption of causal directed acyclic graphs is advocated for investigating specific research questions through robust statistical analysis, causal modelling and validation. Directed acyclic graphs are mathematical models that explicitly encode variables, hypothesised causal pathways, mechanisms and confounders in a formal causal structure that enables systematic and testable estimation of causal effects, including from observational data. This approach enhances transparency and interpretability, facilitates refinement of model specifications and supports more rigorous validation processes. Ultimately, the integration of a heuristic conceptual framework with the formal methodology of causal directed acyclic graphs provides both a structured and theory-driven foundation for organising knowledge and the formal modelling approach required to address specific research questions and strengthen empirical inquiry in menstrual health in sport research.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-23DOI: 10.1007/s40279-026-02415-6
Chris J Esh,Sarah Carter,Valérie Bougault,Olivier Girard,Dina C Janse van Rensburg,Bryna C R Chrismas,Tim Meyer,Lee Taylor
The Men's 2026 Fédération Internationale de Football Association (FIFA) World Cup (Canada, Mexico and the USA) will expose teams to an unprecedented combination of environmental challenges (heat, altitude, air pollution, allergens and travel). Conditions will vary significantly between host cities, creating a significant threat to player health and performance. These unique stressors may require teams to adopt and adapt strategies to best protect player health and performance. A related open access Sports Medicine review outlines these environmental challenges and the evidence-based guidelines to prepare for and mitigate their effects. Motivation for the present review stems from the unique practical and logistical complexities of 'tournament football'-especially at the expanded 2026 FIFA World Cup-alongside the limitations of previous football-facing reviews, where 'evidence-informed practice' is often not underpinned by football-specific research and thus limits external/ecological validity. Building on the recommendations of the main review, this partner review focuses on integrating those guidelines into practice. It aims to provide teams with a practice-compatible framework to implement evidence-based strategies to protect player health and optimise performance at the 2026 FIFA World Cup.
{"title":"One Step Further: Integrating Evidence-Based Guidelines into Practice to Address Environmental Challenges at the Men's 2026 FIFA World Cup.","authors":"Chris J Esh,Sarah Carter,Valérie Bougault,Olivier Girard,Dina C Janse van Rensburg,Bryna C R Chrismas,Tim Meyer,Lee Taylor","doi":"10.1007/s40279-026-02415-6","DOIUrl":"https://doi.org/10.1007/s40279-026-02415-6","url":null,"abstract":"The Men's 2026 Fédération Internationale de Football Association (FIFA) World Cup (Canada, Mexico and the USA) will expose teams to an unprecedented combination of environmental challenges (heat, altitude, air pollution, allergens and travel). Conditions will vary significantly between host cities, creating a significant threat to player health and performance. These unique stressors may require teams to adopt and adapt strategies to best protect player health and performance. A related open access Sports Medicine review outlines these environmental challenges and the evidence-based guidelines to prepare for and mitigate their effects. Motivation for the present review stems from the unique practical and logistical complexities of 'tournament football'-especially at the expanded 2026 FIFA World Cup-alongside the limitations of previous football-facing reviews, where 'evidence-informed practice' is often not underpinned by football-specific research and thus limits external/ecological validity. Building on the recommendations of the main review, this partner review focuses on integrating those guidelines into practice. It aims to provide teams with a practice-compatible framework to implement evidence-based strategies to protect player health and optimise performance at the 2026 FIFA World Cup.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"112 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-21DOI: 10.1007/s40279-026-02406-7
Lola Masson,Guillaume Y Millet,Hugo A Kerhervé
Running is a unique mode of locomotion, a gait with clear ground contact and aerial phases, during which the body experiences dynamic deformations at various scales. At each stride, the centre of mass lowers and rises under the action of articulated body segments with muscles and tendons stretching and shortening, inducing tissue loading. The capacity to resist such deformations, to dissipate or transmit forces or to store and release energy are all commonly lumped together within the concept of stiffness. Stiffness is commonly considered to be a major performance factor in running as it may impact running economy. This review (i) provides a brief overview of the various definitions and methods of measurement of the lower limbs' stiffness in the context of running; (ii) synthesizes the current understanding of how stiffness, measured at the various scales, relates to running performance and economy; (iii) analyses the effects of running-induced fatigue on stiffness and their subsequent consequences on running performance and (iv) explores how stiffness can be adjusted to enhance running performance via acute strategies (equipment, warm-up) or long-term training. Current evidence suggests a direct link between stiffness and running economy, but the underlying mechanisms remain unclear across measurement scales. Despite the variety of methods available, stiffness at the tissue level is still underexplored, particularly in relation to performance and running-induced fatigue. More research is needed to identify an optimal stiffness level and clarify how acute or chronic interventions may beneficially-or detrimentally-modulate stiffness and running performance.
{"title":"Stiffness and Running Performance: From the Tissue to the Body: A Narrative Review.","authors":"Lola Masson,Guillaume Y Millet,Hugo A Kerhervé","doi":"10.1007/s40279-026-02406-7","DOIUrl":"https://doi.org/10.1007/s40279-026-02406-7","url":null,"abstract":"Running is a unique mode of locomotion, a gait with clear ground contact and aerial phases, during which the body experiences dynamic deformations at various scales. At each stride, the centre of mass lowers and rises under the action of articulated body segments with muscles and tendons stretching and shortening, inducing tissue loading. The capacity to resist such deformations, to dissipate or transmit forces or to store and release energy are all commonly lumped together within the concept of stiffness. Stiffness is commonly considered to be a major performance factor in running as it may impact running economy. This review (i) provides a brief overview of the various definitions and methods of measurement of the lower limbs' stiffness in the context of running; (ii) synthesizes the current understanding of how stiffness, measured at the various scales, relates to running performance and economy; (iii) analyses the effects of running-induced fatigue on stiffness and their subsequent consequences on running performance and (iv) explores how stiffness can be adjusted to enhance running performance via acute strategies (equipment, warm-up) or long-term training. Current evidence suggests a direct link between stiffness and running economy, but the underlying mechanisms remain unclear across measurement scales. Despite the variety of methods available, stiffness at the tissue level is still underexplored, particularly in relation to performance and running-induced fatigue. More research is needed to identify an optimal stiffness level and clarify how acute or chronic interventions may beneficially-or detrimentally-modulate stiffness and running performance.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"83 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147493059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s40279-026-02404-9
Javier Pecci,Nicol van Dyk,Gregory D Myer,Borja Sañudo
OBJECTIVEThe objective was to systematically identify and categorize return-to-play (RTP) domains and criteria used following muscle injuries in male soccer players, and to describe the certainty of the evidence according to the number, design and methodological quality of the studies implementing RTP criteria within each domain.METHODSIn total, six databases were searched up to 10 March 2024. Studies reporting RTP criteria for hamstring, adductor, quadriceps, and calf injuries, as well as general criteria for all muscle injuries, were included. The certainty of evidence for RTP criteria was assessed on the basis of the studies citing each criterion.RESULTSOut of 58,057 records, 135 studies met the inclusion criteria. Strength and pain criteria are the most cited tests for determining RTP clearance following hamstring injuries, particularly criteria related to between-limb knee flexors/extensors strength symmetry and no pain during soccer-specific actions. Range of motion criteria (active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness demonstrated the highest certainty of evidence in RTP decision making after hamstring injuries. RTP criteria following adductor injuries showed a moderate-to-very-low certainty of evidence across domains. Criteria for quadriceps and calf injuries ranged from low to very low evidence, while general lower limb muscle injury criteria had only very low evidence. Following adductor injuries, the highest evidence (moderate) was shown by pain assessments and completing at least one full team training session.CONCLUSIONSSymmetry between limbs in knee flexor and extensor strength combined with no pain during soccer-specific actions were the most frequently implemented RTP criteria for hamstring injuries. In addition, range of motion evaluation (i.e., active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness assessments have been more consistently employed in higher-quality intervention studies than other domains following hamstring injuries in soccer players. Pain assessments, completing at least one full team training session and restoring strength levels are the most cited criteria for RTP following adductor injuries. The evidence base describing RTP criteria for quadriceps and calf injuries is limited and is not implemented in randomized controlled trials with high methodological quality, highlighting the need for further robust research in these domains.TRIAL REGISTRATION NUMBERPROSPERO CRD42022363836.
{"title":"Return-to-Play Criteria Following Lower Limb Muscle Injuries in Soccer: A Systematic Review with Evidence Synthesis.","authors":"Javier Pecci,Nicol van Dyk,Gregory D Myer,Borja Sañudo","doi":"10.1007/s40279-026-02404-9","DOIUrl":"https://doi.org/10.1007/s40279-026-02404-9","url":null,"abstract":"OBJECTIVEThe objective was to systematically identify and categorize return-to-play (RTP) domains and criteria used following muscle injuries in male soccer players, and to describe the certainty of the evidence according to the number, design and methodological quality of the studies implementing RTP criteria within each domain.METHODSIn total, six databases were searched up to 10 March 2024. Studies reporting RTP criteria for hamstring, adductor, quadriceps, and calf injuries, as well as general criteria for all muscle injuries, were included. The certainty of evidence for RTP criteria was assessed on the basis of the studies citing each criterion.RESULTSOut of 58,057 records, 135 studies met the inclusion criteria. Strength and pain criteria are the most cited tests for determining RTP clearance following hamstring injuries, particularly criteria related to between-limb knee flexors/extensors strength symmetry and no pain during soccer-specific actions. Range of motion criteria (active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness demonstrated the highest certainty of evidence in RTP decision making after hamstring injuries. RTP criteria following adductor injuries showed a moderate-to-very-low certainty of evidence across domains. Criteria for quadriceps and calf injuries ranged from low to very low evidence, while general lower limb muscle injury criteria had only very low evidence. Following adductor injuries, the highest evidence (moderate) was shown by pain assessments and completing at least one full team training session.CONCLUSIONSSymmetry between limbs in knee flexor and extensor strength combined with no pain during soccer-specific actions were the most frequently implemented RTP criteria for hamstring injuries. In addition, range of motion evaluation (i.e., active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness assessments have been more consistently employed in higher-quality intervention studies than other domains following hamstring injuries in soccer players. Pain assessments, completing at least one full team training session and restoring strength levels are the most cited criteria for RTP following adductor injuries. The evidence base describing RTP criteria for quadriceps and calf injuries is limited and is not implemented in randomized controlled trials with high methodological quality, highlighting the need for further robust research in these domains.TRIAL REGISTRATION NUMBERPROSPERO CRD42022363836.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"146 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s40279-026-02413-8
Abbie E Smith-Ryan,Sam R Moore,Michelle Arent,Elena Cantu,Lissette Cornejo,Anthony C Hackney,Johanna K Ihalainen,Ritva S Mikkonen,Georgie Bruinvels
This paper synthesizes current research on women's football to develop comprehensive, evidence-informed nutritional strategies tailored to the specific demands of the sport. Four key themes are addressed: (1) energy requirements in women's football; (2) macronutrient and nutrient-timing applications around training and match play, including an illustrative case study; (3) supporting a player with inadequate energy intake, including an illustrative case study; and (4) nutritional considerations relating to fluctuations in female sex hormones. Rather than providing another descriptive narrative review, this synthesis translates research findings into practical strategies for implementation in real-world performance environments. Adequate energy availability is identified as a fundamental nutritional priority. Carbohydrate and protein intake are emphasized as essential for sustaining training quality, supporting recovery, and maximizing match performance. Nutrient timing is highlighted as a critical determinant of in-season performance and effective match preparation. Consideration is also given to the influence of hormonal fluctuations on thermoregulation and menstrual cycle-related symptoms, alongside nutritional strategies to mitigate these effects. This synthesis underscores the importance of individualized nutritional strategies to optimize health, performance, and return-to-play outcomes in women footballers.
{"title":"Fueling Women's Football: Evidence-Informed Practical Nutrition Strategies for Performance and Health.","authors":"Abbie E Smith-Ryan,Sam R Moore,Michelle Arent,Elena Cantu,Lissette Cornejo,Anthony C Hackney,Johanna K Ihalainen,Ritva S Mikkonen,Georgie Bruinvels","doi":"10.1007/s40279-026-02413-8","DOIUrl":"https://doi.org/10.1007/s40279-026-02413-8","url":null,"abstract":"This paper synthesizes current research on women's football to develop comprehensive, evidence-informed nutritional strategies tailored to the specific demands of the sport. Four key themes are addressed: (1) energy requirements in women's football; (2) macronutrient and nutrient-timing applications around training and match play, including an illustrative case study; (3) supporting a player with inadequate energy intake, including an illustrative case study; and (4) nutritional considerations relating to fluctuations in female sex hormones. Rather than providing another descriptive narrative review, this synthesis translates research findings into practical strategies for implementation in real-world performance environments. Adequate energy availability is identified as a fundamental nutritional priority. Carbohydrate and protein intake are emphasized as essential for sustaining training quality, supporting recovery, and maximizing match performance. Nutrient timing is highlighted as a critical determinant of in-season performance and effective match preparation. Consideration is also given to the influence of hormonal fluctuations on thermoregulation and menstrual cycle-related symptoms, alongside nutritional strategies to mitigate these effects. This synthesis underscores the importance of individualized nutritional strategies to optimize health, performance, and return-to-play outcomes in women footballers.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"17 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-16DOI: 10.1007/s40279-025-02336-w
Claire L Samanna,Patrick J Owen,Ulrike H Mitchell,Katja Ehrenbrusthoff,Tobias Saueressig,Eva Moreira,Nitin K Arora,Niamh L Mundell,Jamie L Tait,Lars Donath,Vera Karner,Daniel L Belavý
BACKGROUNDThe structure and function of human tissue, such as bone, muscle and tendon, can be improved with targeted exercise training. However, the effects of exercise training on intervertebral disc tissue remain unclear.OBJECTIVEWe aimed to examine the impact of physical loading exposure (exercise training, sport and physical activity) on intervertebral disc (IVD) health compared to non-physical loading (or lower volume of the same physical loading) controls.METHODSWe conducted a systematic review and meta-analysis. Seven electronic databases (PubMed, CINAHL, SPORTDiscus, EMBASE, CENTRAL, Web of Science and Scopus) and two trial registries (World Health Organization International Clinical Trials Registry Platform and National Institutes of Health) were searched from inception to 3 June, 2025. Forward and backward citation tracking was conducted for included reports. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE). Risk of bias was assessed using Cochrane RoB2 and Johanna Briggs Institute critical appraisal checklists. We included randomised controlled trials (n = 2), cohort (n = 9) and cross-sectional studies (n = 28) of any physical loading compared to controls with continuous measurements of IVD health (e.g. T2-relaxation, IVD height) via magnetic resonance imaging and/or categorically graded measures of IVD degeneration (e.g. Pfirrmann grade).RESULTSForty-five reports of 39 studies (participants: 4152) were included. The pairwise random-effects meta-analysis estimated the standardised mean difference (Hedges' g) of continuous outcomes for combined physical loading and independent subgroups and odds ratios (Paule-Mandel estimator) of categorical outcomes for combined physical loading only. A meta-analysis revealed upright bipedal loading (mostly running; Hedges' g [95% confidence interval] 0.31 [0.12, 0.50]; P = 0.002; n = 7, GRADE: very low) was associated with better IVD health; however, no other subgroup of physical loading was associated with better or worse IVD health. Combined physical loading revealed greater odds of IVD degeneration via reduced signal intensity (odds ratio [95% confidence interval] 2.80 [1.53, 5.11], P = 0.001; n = 5, GRADE: low); however, no other measure of IVD degeneration was significant.CONCLUSIONSRunning was the only physical loading exposure associated with better IVD health. The mixed results from the combined physical loading analyses suggest that the type of physical loading plays a role in IVD health. As our estimates rely on observational data, prospective running interventions that examine the causal effect on IVD health appear warranted.CLINICAL TRIAL REGISTRATIONThe review was prospectively registered with International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022366391]. See Supplement P of the Electronic Supplementary Material for protocol deviations since registration.
背景：人体组织的结构和功能，如骨骼、肌肉和肌腱，可以通过有针对性的运动训练来改善。然而，运动训练对椎间盘组织的影响尚不清楚。目的：我们旨在研究与非物理负荷（或相同物理负荷的较小体积）对照相比，物理负荷暴露（运动训练、运动和身体活动）对椎间盘（IVD）健康的影响。方法：我们进行了系统综述和荟萃分析。7个电子数据库（PubMed、CINAHL、SPORTDiscus、EMBASE、CENTRAL、Web of Science和Scopus）和两个试验注册库（世界卫生组织国际临床试验注册平台和国立卫生研究院）从成立到2025年6月3日进行了检索。对纳入的报告进行了前向和后向引文跟踪。证据的确定性采用分级建议评估、发展和评价标准（GRADE）进行评估。偏倚风险采用Cochrane RoB2和约翰娜·布里格斯研究所关键评估清单进行评估。我们纳入了随机对照试验（n = 2）、队列研究（n = 9）和横断面研究（n = 28），通过磁共振成像连续测量IVD健康状况（如t2松弛、IVD高度）和/或IVD退化分类分级测量（如Pfirrmann分级），与对照组进行比较。结果纳入39项研究45篇报道（4152名受试者）。两两随机效应荟萃分析估计了联合体力负荷和独立亚组连续结果的标准化平均差（Hedges’g），以及仅联合体力负荷的分类结果的优势比（Paule-Mandel估计量）。一项荟萃分析显示直立双足负荷（主要是跑步；Hedges' g[95%可信区间]0.31 [0.12,0.50];P = 0.002; n = 7， GRADE：非常低）与更好的IVD健康相关；然而，没有其他亚组的物理负荷与更好或更差的IVD健康相关。联合物理负荷显示，通过降低信号强度，IVD变性的几率更大（优势比[95%置信区间]2.80 [1.53,5.11],P = 0.001; n = 5， GRADE：低）；然而，没有其他测量IVD变性是显著的。结论跑步是唯一与IVD健康状况相关的体力负荷暴露。综合物理负荷分析的混合结果表明，物理负荷类型在IVD健康中起作用。由于我们的估计依赖于观察数据，因此检查IVD健康因果关系的前瞻性运行干预措施似乎是有根据的。临床试验注册：该综述已在国际前瞻性系统评价注册（PROSPERO）前瞻性注册[CRD42022366391]。注册后的协议偏差见电子补充材料补充P。
{"title":"The Impact of Exercise on Intervertebral Disc Health: A Systematic Review and Meta-Analysis.","authors":"Claire L Samanna,Patrick J Owen,Ulrike H Mitchell,Katja Ehrenbrusthoff,Tobias Saueressig,Eva Moreira,Nitin K Arora,Niamh L Mundell,Jamie L Tait,Lars Donath,Vera Karner,Daniel L Belavý","doi":"10.1007/s40279-025-02336-w","DOIUrl":"https://doi.org/10.1007/s40279-025-02336-w","url":null,"abstract":"BACKGROUNDThe structure and function of human tissue, such as bone, muscle and tendon, can be improved with targeted exercise training. However, the effects of exercise training on intervertebral disc tissue remain unclear.OBJECTIVEWe aimed to examine the impact of physical loading exposure (exercise training, sport and physical activity) on intervertebral disc (IVD) health compared to non-physical loading (or lower volume of the same physical loading) controls.METHODSWe conducted a systematic review and meta-analysis. Seven electronic databases (PubMed, CINAHL, SPORTDiscus, EMBASE, CENTRAL, Web of Science and Scopus) and two trial registries (World Health Organization International Clinical Trials Registry Platform and National Institutes of Health) were searched from inception to 3 June, 2025. Forward and backward citation tracking was conducted for included reports. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation criteria (GRADE). Risk of bias was assessed using Cochrane RoB2 and Johanna Briggs Institute critical appraisal checklists. We included randomised controlled trials (n = 2), cohort (n = 9) and cross-sectional studies (n = 28) of any physical loading compared to controls with continuous measurements of IVD health (e.g. T2-relaxation, IVD height) via magnetic resonance imaging and/or categorically graded measures of IVD degeneration (e.g. Pfirrmann grade).RESULTSForty-five reports of 39 studies (participants: 4152) were included. The pairwise random-effects meta-analysis estimated the standardised mean difference (Hedges' g) of continuous outcomes for combined physical loading and independent subgroups and odds ratios (Paule-Mandel estimator) of categorical outcomes for combined physical loading only. A meta-analysis revealed upright bipedal loading (mostly running; Hedges' g [95% confidence interval] 0.31 [0.12, 0.50]; P = 0.002; n = 7, GRADE: very low) was associated with better IVD health; however, no other subgroup of physical loading was associated with better or worse IVD health. Combined physical loading revealed greater odds of IVD degeneration via reduced signal intensity (odds ratio [95% confidence interval] 2.80 [1.53, 5.11], P = 0.001; n = 5, GRADE: low); however, no other measure of IVD degeneration was significant.CONCLUSIONSRunning was the only physical loading exposure associated with better IVD health. The mixed results from the combined physical loading analyses suggest that the type of physical loading plays a role in IVD health. As our estimates rely on observational data, prospective running interventions that examine the causal effect on IVD health appear warranted.CLINICAL TRIAL REGISTRATIONThe review was prospectively registered with International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022366391]. See Supplement P of the Electronic Supplementary Material for protocol deviations since registration.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"15 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-16DOI: 10.1007/s40279-026-02394-8
John Warmenhoven,Ian Shrier,Garrett S Bullock,Alex O Holcombe,Sophia Nimphius,Paolo Menaspà,Aaron J Coutts,Franco M Impellizzeri
Historically, sport science and medicine researchers have had difficulty obtaining adequate sample sizes, limiting their ability to make accurate generalizations to populations of athletes. To move towards better and more generalizable research, sport could look to other fields of research, and draw upon collaborative approaches for performing science. These include concepts such as big teams approaches for conducting experimental research, developing data repositories centred on a holistic inter-disciplinary view of the athlete and exploring privacy preserving meta-analytic inspired concepts such as federated analyses or pooled synthetic data. These approaches have enormous potential but do come with their own difficulties and risks. There are challenges surrounding the collection, ownership and perception of data, particularly in high-performance sport contexts. This conceptual review is a step towards presenting possible solutions, which could be tested, documented and sculpted to fit the high-performance and professional sport environment, with the aim of improving the processes underpinning scientific enquiry in sport.
{"title":"Unifying to Advance Understanding: Collaborative, Community-Driven and 'Open' Approaches for Better Science in Sport.","authors":"John Warmenhoven,Ian Shrier,Garrett S Bullock,Alex O Holcombe,Sophia Nimphius,Paolo Menaspà,Aaron J Coutts,Franco M Impellizzeri","doi":"10.1007/s40279-026-02394-8","DOIUrl":"https://doi.org/10.1007/s40279-026-02394-8","url":null,"abstract":"Historically, sport science and medicine researchers have had difficulty obtaining adequate sample sizes, limiting their ability to make accurate generalizations to populations of athletes. To move towards better and more generalizable research, sport could look to other fields of research, and draw upon collaborative approaches for performing science. These include concepts such as big teams approaches for conducting experimental research, developing data repositories centred on a holistic inter-disciplinary view of the athlete and exploring privacy preserving meta-analytic inspired concepts such as federated analyses or pooled synthetic data. These approaches have enormous potential but do come with their own difficulties and risks. There are challenges surrounding the collection, ownership and perception of data, particularly in high-performance sport contexts. This conceptual review is a step towards presenting possible solutions, which could be tested, documented and sculpted to fit the high-performance and professional sport environment, with the aim of improving the processes underpinning scientific enquiry in sport.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"60 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147465087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-13DOI: 10.1007/s40279-026-02417-4
André Rebelo,Chris Bishop,Robin T Thorpe,Anthony N Turner,Tim J Gabbett
Athlete monitoring is widely used to support training and recovery decisions in elite sport, yet practitioners often face challenges related to data quality, feasibility, and the interpretation of short-term readiness signals within longer-term training adaptation. This narrative review synthesizes conceptual and applied developments in athlete monitoring through the lens of 'training effects', encompassing positive adaptation, maintenance, or maladaptation arising from training, competition, and contextual stressors. We distinguish assessment as isolated or periodic measurement from monitoring as repeated, systematic data collection used to track change over time. Building on contemporary conceptual models, readiness is positioned as an operational proxy for training effects that can inform day-to-day decision making when interpreted longitudinally and within context. We integrate the Minimal, Adequate, and Accurate framework to support tool selection that is economical in resource use, sufficient to meet clearly defined objectives, and grounded in valid and reliable measurement. Tools and metrics are organized according to the primary construct they inform: training load, athlete state and training response. We summarize practical considerations across neuromuscular, subjective, physiological, biochemical, and sleep-related indicators, emphasizing interpretive scope, measurement variability, and implementation constraints. To operationalize individualized monitoring, we outline pragmatic approaches using athlete-specific baselines and distribution-based thresholds (e.g., standard deviation intervals, minimum detectable change), alongside decision-making considerations related to Type I and Type II errors. Overall, this framework aims to reconcile scientific rigor with real-world feasibility, supporting practitioner decision making while acknowledging that monitoring should function as a decision-support process rather than a stand-alone determinant of performance outcomes.
{"title":"Monitoring Training Effects in Athletes: A Multidimensional Framework for Decision-Making.","authors":"André Rebelo,Chris Bishop,Robin T Thorpe,Anthony N Turner,Tim J Gabbett","doi":"10.1007/s40279-026-02417-4","DOIUrl":"https://doi.org/10.1007/s40279-026-02417-4","url":null,"abstract":"Athlete monitoring is widely used to support training and recovery decisions in elite sport, yet practitioners often face challenges related to data quality, feasibility, and the interpretation of short-term readiness signals within longer-term training adaptation. This narrative review synthesizes conceptual and applied developments in athlete monitoring through the lens of 'training effects', encompassing positive adaptation, maintenance, or maladaptation arising from training, competition, and contextual stressors. We distinguish assessment as isolated or periodic measurement from monitoring as repeated, systematic data collection used to track change over time. Building on contemporary conceptual models, readiness is positioned as an operational proxy for training effects that can inform day-to-day decision making when interpreted longitudinally and within context. We integrate the Minimal, Adequate, and Accurate framework to support tool selection that is economical in resource use, sufficient to meet clearly defined objectives, and grounded in valid and reliable measurement. Tools and metrics are organized according to the primary construct they inform: training load, athlete state and training response. We summarize practical considerations across neuromuscular, subjective, physiological, biochemical, and sleep-related indicators, emphasizing interpretive scope, measurement variability, and implementation constraints. To operationalize individualized monitoring, we outline pragmatic approaches using athlete-specific baselines and distribution-based thresholds (e.g., standard deviation intervals, minimum detectable change), alongside decision-making considerations related to Type I and Type II errors. Overall, this framework aims to reconcile scientific rigor with real-world feasibility, supporting practitioner decision making while acknowledging that monitoring should function as a decision-support process rather than a stand-alone determinant of performance outcomes.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"57 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDThe rate of injury in invasion team sports is often greater than in non-invasion sports. A preventative measure to reduce injury risk is to implement in-game rule changes aimed at modifying game events or player behaviour.OBJECTIVEThis study reviewed the use of in-game rule changes in invasion team sports with the aim of reporting the level of utilisation, effectiveness, and unintended consequences.DESIGNScoping review.DATA SOURCESScopus, MEDLINE, SPORTDiscus, CINAHL, Web of Science.RESULTSIn total, 2205 studies were identified, 116 full texts were screened and 47 were included in the final review. Seven sports were found to have assessed in-game rule changes with the most common being ice hockey (n = 18), tackle football (n = 11) and rugby union (n = 7). Rule changes were found to have had the intended effect in 28 studies, while nine found no change and four reported an increase in the rate or cause of injury. The unintended consequences associated with a rule change were assessed by four studies with a further two evaluating several rule changes across multiple seasons.CONCLUSIONSIn-game rule changes were investigated in half of the sports included in the search. Evidence suggests rule changes can be an effective method for reducing injury risk, although unintended consequences need to be considered. Rule changes should be evaluated in a variety of contexts, with an emphasis being placed on researching female populations to address the extensive knowledge gap.
背景：侵入性团体运动的受伤率往往高于非侵入性运动。减少受伤风险的预防措施是执行旨在修改游戏事件或玩家行为的游戏规则改变。目的：本研究回顾了入侵团队运动中游戏规则变化的使用情况，目的是报告使用率、有效性和意想不到的后果。DESIGNScoping审查。DATA SOURCESScopus， MEDLINE, SPORTDiscus， CINAHL, Web of Science。结果共纳入2205项研究，116篇全文被筛选，47篇纳入最终综述。有7项运动评估了游戏规则的变化，其中最常见的是冰球（n = 18）、铲球足球（n = 11）和橄榄球联盟（n = 7）。在28项研究中发现，规则的变化产生了预期的效果，而9项研究没有发现变化，4项研究报告了伤害率或原因的增加。四项研究评估了与规则变化相关的意外后果，另外两项研究评估了多个季节的几项规则变化。结论在搜索中包含的一半运动中调查了比赛规则的变化。有证据表明，改变规则是降低受伤风险的有效方法，尽管需要考虑意想不到的后果。应在各种情况下评价规则的变化，重点是研究女性人口，以解决广泛的知识差距。
{"title":"Evaluating the Use of In-Game Rule Changes as a Primary Prevention Approach to Reduce Injury Risk in Invasion Team Sports: A Scoping Review.","authors":"Hamish Gornall,Haley Truscott,Isla J Shill,Mike Ashford,Debbie Palmer","doi":"10.1007/s40279-026-02405-8","DOIUrl":"https://doi.org/10.1007/s40279-026-02405-8","url":null,"abstract":"BACKGROUNDThe rate of injury in invasion team sports is often greater than in non-invasion sports. A preventative measure to reduce injury risk is to implement in-game rule changes aimed at modifying game events or player behaviour.OBJECTIVEThis study reviewed the use of in-game rule changes in invasion team sports with the aim of reporting the level of utilisation, effectiveness, and unintended consequences.DESIGNScoping review.DATA SOURCESScopus, MEDLINE, SPORTDiscus, CINAHL, Web of Science.RESULTSIn total, 2205 studies were identified, 116 full texts were screened and 47 were included in the final review. Seven sports were found to have assessed in-game rule changes with the most common being ice hockey (n = 18), tackle football (n = 11) and rugby union (n = 7). Rule changes were found to have had the intended effect in 28 studies, while nine found no change and four reported an increase in the rate or cause of injury. The unintended consequences associated with a rule change were assessed by four studies with a further two evaluating several rule changes across multiple seasons.CONCLUSIONSIn-game rule changes were investigated in half of the sports included in the search. Evidence suggests rule changes can be an effective method for reducing injury risk, although unintended consequences need to be considered. Rule changes should be evaluated in a variety of contexts, with an emphasis being placed on researching female populations to address the extensive knowledge gap.","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"2 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
INTRODUCTIONAcute posterior cruciate ligament (PCL) injuries occur during high-impact sports including American Football, soccer, and skiing. While many of these injuries can be managed nonsurgically, surgery is necessary in some cases, particularly in cases of instability. Clear and standardized return-to-sport (RTS) criteria during rehabilitation following PCL reconstruction (PCL-R) are lacking.OBJECTIVESThis scoping review aims to identify and analyze existing RTS guidelines for PCL-R and propose improvements on the basis of frameworks from anterior cruciate ligament reconstruction, laying the groundwork for future research.METHODSFollowing the PRISMA-ScR guidelines, studies were included if they evaluated RTS criteria after isolated PCL-R in adult athletes. The search strategy involved a three-step approach, including initially limited searches, keyword identification, and a final comprehensive search of five electronic databases (MEDLINE, Embase, CINAHL, SCOPUS, and PEDro). The inclusion criteria encompassed studies involving athletes aged > 18 with isolated PCL-R. Exclusion criteria were studies involving multi-ligament injuries, revision surgeries, or nonEnglish publications.RESULTSA total of 13 studies met the inclusion criteria, reporting diverse RTS criteria. RTS timelines were mentioned in four studies (31%), generally ranging from less than 6 up to 12 months. Clinical criteria, including range of motion (ROM) and pain, were reported in eight studies (63%). Full knee extension and near-complete flexion recovery were generally required before RTS, although specific flexion thresholds were not consistently defined. In addition, the absence of pain or the presence of only minimal pain was commonly expected before clearance. Strength assessments were included in five studies (38%), and were frequently assessed via isokinetic testing, with only one study adopting a limb symmetry index (LSI) ≥ 90% as a clearance criterion. Performance criteria, such as hop tests, were used in four studies (31%), often employing a LSI threshold of over 90%. Patient-reported outcome measures (PROMs) were assessed in 11 studies (85%). Scores such as the IKDC and Lysholm demonstrated significant postsurgical improvements, often exceeding 90 and 85, respectively, at the time of RTS.CONCLUSIONSThis review highlights the absence of standardized RTS criteria following PCL-R. Clinicians should consider integrating objective criteria when assessing RTS, including full ROM recovery, minimal or no pain, quadriceps and hamstring strength symmetry of ≥ 90% LSI, performance-based tests such as hop tests (commonly using an LSI > 90%), and PROMs (e.g., IKDC > 90, Lysholm > 85).
{"title":"Redefining the Paradigm: Advancing Evidence-Based Return-to-Sport Criteria Following Isolated Posterior Cruciate Ligament Reconstruction: A Scoping Review.","authors":"Emanuele Tortoli,Alice Gerini,Leonardo Pellicciari,Alli Gokeler","doi":"10.1007/s40279-026-02409-4","DOIUrl":"https://doi.org/10.1007/s40279-026-02409-4","url":null,"abstract":"INTRODUCTIONAcute posterior cruciate ligament (PCL) injuries occur during high-impact sports including American Football, soccer, and skiing. While many of these injuries can be managed nonsurgically, surgery is necessary in some cases, particularly in cases of instability. Clear and standardized return-to-sport (RTS) criteria during rehabilitation following PCL reconstruction (PCL-R) are lacking.OBJECTIVESThis scoping review aims to identify and analyze existing RTS guidelines for PCL-R and propose improvements on the basis of frameworks from anterior cruciate ligament reconstruction, laying the groundwork for future research.METHODSFollowing the PRISMA-ScR guidelines, studies were included if they evaluated RTS criteria after isolated PCL-R in adult athletes. The search strategy involved a three-step approach, including initially limited searches, keyword identification, and a final comprehensive search of five electronic databases (MEDLINE, Embase, CINAHL, SCOPUS, and PEDro). The inclusion criteria encompassed studies involving athletes aged > 18 with isolated PCL-R. Exclusion criteria were studies involving multi-ligament injuries, revision surgeries, or nonEnglish publications.RESULTSA total of 13 studies met the inclusion criteria, reporting diverse RTS criteria. RTS timelines were mentioned in four studies (31%), generally ranging from less than 6 up to 12 months. Clinical criteria, including range of motion (ROM) and pain, were reported in eight studies (63%). Full knee extension and near-complete flexion recovery were generally required before RTS, although specific flexion thresholds were not consistently defined. In addition, the absence of pain or the presence of only minimal pain was commonly expected before clearance. Strength assessments were included in five studies (38%), and were frequently assessed via isokinetic testing, with only one study adopting a limb symmetry index (LSI) ≥ 90% as a clearance criterion. Performance criteria, such as hop tests, were used in four studies (31%), often employing a LSI threshold of over 90%. Patient-reported outcome measures (PROMs) were assessed in 11 studies (85%). Scores such as the IKDC and Lysholm demonstrated significant postsurgical improvements, often exceeding 90 and 85, respectively, at the time of RTS.CONCLUSIONSThis review highlights the absence of standardized RTS criteria following PCL-R. Clinicians should consider integrating objective criteria when assessing RTS, including full ROM recovery, minimal or no pain, quadriceps and hamstring strength symmetry of ≥ 90% LSI, performance-based tests such as hop tests (commonly using an LSI > 90%), and PROMs (e.g., IKDC > 90, Lysholm > 85).","PeriodicalId":21969,"journal":{"name":"Sports Medicine","volume":"88 1","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147393803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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