Sports Medicine最新文献

Objectives: In elite rugby union, suspected concussions lead to immediate removal from play for either permanent exclusion or a temporary 12-min assessment as part of the Head Injury Assessment 1 (HIA1) protocol. The study aims to retrospectively identify a head acceleration event (HAE) severity measure associated with HIA1 removals in elite rugby union using instrumented mouthguards (iMGs).

Methods: HAEs were recorded from 215 men and 325 women, with 30 and 28 HIA1 removals from men and women, respectively. Logistical regression was calculated to identify whether peak power, maximum principal strain (MPS) and/or the Head Acceleration Response Metric (HARM) were associated with HIA1 events compared to non-cases. Optimal threshold values were determined using the Youden Index. Area under the curve (AUC) was compared using a paired-sample approach. Significant differences were set at p < 0.05.

Results: All three severity measures (peak power, HARM, MPS) were associated with HIA1 removals in both the men's and women's game. Peak power performed most consistent of the three severity measures for HIA1 removals based on paired-sample AUC comparisons in the men's and women's games. The HARM and MPS were found to perform lower than peak linear acceleration in the women's game based on AUC comparisons (p = 0.006 and 0.001, respectively), with MPS performing lower than peak angular acceleration (p = 0.001).

Conclusion: Peak power, a measure based on fundamental mechanics and commonly communicated in sports performance, was the most effective metric associated with HIA1 removals in elite rugby. The study bridges the gap by identifying a consistent HAE severity measure applicable across sexes.

This is the second of two publications comprising the 2025 update to the 2014 Consensus Statement on treatment and return to play guidelines on the Female Athlete Triad (Triad). This paper pairs with the 2025 Update to the Female Athlete Triad Coalition Consensus Statement Part 1: State of the Science and Introduction of a New Adolescent Model (Sports Medicine, 2025), to focus on evidence-based revisions for screening, diagnosis, treatment, and clearance and return to play. Revised recommendations for managing eating disorders (ED)/disordered eating (DE) and non-pharmacological and pharmacological treatment of bone loss and abnormal menstrual cycles are included, as are the most recent clearance and return to play recommendations, inclusive of adolescent athletes. Recent research supports the adoption of revised criteria for defining and treating energy deficiency, moving away from the concept of an energy-availability threshold. Energy deficiency-induced menstrual disturbances can be reversed with a moderate increase in food intake and modest weight gain, but restoration of menses alone is not associated with high rates of ovulation or increased ovarian steroid levels until multiple consecutive normal length menstrual cycles are achieved. Revised guidelines for the diagnosis and treatment of functional hypothalamic oligo/amenorrhea are included with guidance on the confounding effects of hyperandrogenemia. Gynecological age and psychological stress are factors impacting the individual susceptibility to the Triad. The bone health spectrum of the Triad now includes bone stress injuries. Routes of administration via epidermal patch versus oral for pharmacological treatment of low bone density are discussed. The diagnosis, treatment, and return to play approaches for adolescents with the Triad are unique compared with those employed for adults and require age-appropriate clinical guidelines. The strength of the evidence-based statements is graded using an accepted taxonomy in which randomized controlled trials and observational data are considered the highest level of evidence.

This paper is the first of two publications comprising a 2025 update to the 2014 Consensus Statement on treatment and return-to-play guidelines on the Female Athlete Triad (Triad), defined as three inter-related components including energy status, reproductive function, and bone health. The Triad is initiated by exposure to varying degrees of energy deficiency with or without disordered eating/eating disorders with primary pathological outcomes to the reproductive and skeletal systems. This first paper includes a detailed update on the scientific underpinnings of the Triad and introduces a new Triad model specific to the adolescent female athlete. Energy deficiency and "metabolic compensation" are added to the energy status continuum to describe adaptations that reflect energy conservation. Ovarian steroid hormone exposure and functional hypothalamic oligo-amenorrhea are added to the reproductive function continuum. Bone stress injury is added to the bone health continuum. Rates of change are depicted for the induction and recovery of clinical outcomes within the adult model. Evidence-based statements are presented throughout the paper and supported by a high number of level A and B grades.

Breast cancer remains one of the leading causes of cancer-related mortality in women worldwide. A key driver of tumor progression and resistance to therapy is abnormal vascularization, which leads to heterogeneous blood flow, hypoxia, impaired drug delivery, and increased malignancy. Emerging clinical evidence suggests that breast tumor Doppler ultrasound parameters can predict pathological response to neoadjuvant chemotherapy, highlighting the potential of tumor blood flow as a prognostic biomarker. In this context, strategies to modulate tumor perfusion-particularly through non-pharmacological approaches-are of growing interest. Exercise has shown promise in promoting vascular remodeling, improving oxygenation, and enhancing treatment efficacy. This narrative review discusses current evidence on the role of tumor blood flow in disease progression and therapeutic response, with special emphasis on the modulatory effects of exercise training. We also explore how tumor blood flow is assessed, briefly outlining key methodologies such as Doppler ultrasound, contrast-enhanced imaging, and perfusion-related biomarkers, and their relevance for interpreting exercise-induced vascular adaptations, its association with tumor aggressiveness, and the interplay between exercise and oncological therapies. Understanding how exercise influences tumor hemodynamics may pave the way for innovative adjuvant strategies in breast cancer management.