BMJ Open Sport & Exercise Medicine最新文献

Haemophilia, a genetic disorder characterised by deficient clotting factors, often leads to musculoskeletal complications such as haemophilic arthropathy. These complications result in reduced functional capacity, muscle weakness and kinesiophobia, which further exacerbate physical inactivity and psychological distress. The World Federation of Haemophilia recommends including regular physical activity in the management plans for individuals with haemophilia, emphasising its benefits for bone and muscle strengthening, improved coordination, maintenance of healthy body weight and enhanced self-esteem. This study aims to evaluate the effectiveness of an adapted physical activity (APA) programme in individuals with haemophilia. The primary objective is to analyse changes in functional capacity following participants' completion of the exercise programme. Additionally, the study evaluates the programme's impact on joint mobility, kinesiophobia, limitations in daily activities and static and dynamic balance. It is hypothesised that the APA programme may improve or maintain joint mobility, increase muscle strength, enhance proprioception and reduce fear of movement (kinesiophobia), thus contributing to an overall improvement in physical function in participants. The intervention is carefully designed to prioritise safety and proper execution. It incorporates low-impact, low- to moderate-intensity exercises tailored to individual joint functionality. Supervised by qualified professionals, the programme aims to minimise excessive joint loading and prevent haemarthrosis while promoting muscle strength, joint mobility and proprioception. The programme is structured into 1-hour sessions held twice weekly for 6 months. Each session has three sections: warm-up, the main part (strength, mobility, proprioception and balance exercises) and cool-down.

Background/aim: In baseball pitching, neuromuscular fatigue and its manifestations on muscle strength, muscle soreness and pain perception affect pitching performance. The purpose of this study was to quantify the evolution of grip strength, muscle soreness and pain threshold perception and pitching velocity in baseball pitchers throughout a simulated 75-pitch game.

Methods: 30 high-level amateur male baseball pitchers were recruited. Repeated measure analysis of covariance with age as a covariate (p<0.05) was used to identify significant differences across blocks of pitches for grip strength, muscle soreness, pain threshold perception and pitching velocity.

Results: Dominant arm grip strength (55.67±12.32 kg to 48.62±12.25 kg ; -12.66%) and pitching velocity (119.87±8.00 km/hour to 118.75±6.90 km/hour ; -0.93%) declined while muscle soreness perception increased in dominant arm forearm flexors (1.65±1.16 to 4.19±2.02 ; 25.38%), biceps (1.81±1.39 to 4.31±1.85 ; 25%) and non-dominant arm forearm flexors (1.38±1.10 to 2.12±1.63 ; 7.31%) across the pitching blocks (p<0.05).

Conclusion: In summary, a pitch count of 75 fastball pitches triggered an acute decline in grip strength combined with an increase in muscle soreness perception of the throwing arm in baseball pitchers.

Objectives: External risk factors connected to club, team and coaching are believed to be important in the causation of hamstring injuries, but little is known about the preventive measures used. The objective was to analyse the association between preventive factors and hamstring muscle injury burden.

Methods: 14 teams participated in the Union of European Football Associations Champions/Europa Leagues from 2019/2020 to 2022/2023. An open question was sent out in January 2023 to the four teams with the lowest hamstring muscle injury burden, asking why their teams had successfully avoided hamstring muscle injuries and which preventive methods they had used. A questionnaire that investigated the use of these methods was sent to all 14 teams in February 2023. A multiple linear regression model was applied, using injury burden as an outcome variable and the questionnaire responses as possible explanatory variables possibly adjusted for team and season.

Results: The preventive methods included factors such as the level of communication between the coach, the medical staff and the performance staff. The adjusted multiple linear regression model indicated that communication between the medical staff and the performance staff was negatively associated with an increased hamstring muscle injury burden, where for every 'higher' grade of the communication variable, the average injury burden decreased by 4.1 (95% CI -8.2 to -0.04, p=0.048) days per 1000 hours.

Conclusions: Better communication between the medical and the performance staff and continuous involvement of the medical staff in load management was associated with a lower hamstring injury burden in male professional football teams.

Objective: This study describes the magnitude and burden of injuries and illnesses in elite Dutch female adolescent and young adult handball players.

Design: A retrospective open cohort study.

Methods: 10 consecutive seasons were studied using a database including all injuries and illnesses needing medical attention. In total, 102 handball players, who participated in a full-time programme of the Dutch Handball Academy between August 2009 and July 2019, were included. Injuries were classified according to the consensus statement of the International Olympic Committee. Exposure hours were categorised into training and competition exposure. Training exposure included all handball and strength and conditioning sessions. Burden was defined as the injury duration in days divided by the total exposure hours.

Results: In total, 916 injuries in 101 players and 95 illnesses in 59 players were reported. The average seasonal prevalence was 83.2% for acute injuries and 78.7% for repetitive injuries. The overall incidence rate was 4.24/1000 exposure hours with an incidence of 23.06/1000 competition hours and 2.19/1000 practice hours. The highest average seasonal prevalence and burden were observed for repetitive injuries of the lumbosacral spine, knee and lower leg and acute injuries of the ankle and knee.

Conclusion: High injury prevalence proportions and competition incidence rates were observed. Repetitive injuries of the lumbosacral spine, knee and lower leg, as well as acute injuries of the knee and ankle, formed the largest problem. Future prevention programmes in elite Dutch adolescent and young adult female handball players should therefore focus on these injuries.

This paper presents a protocol for a randomised control trial to compare the effect and durability of the effect of corrective exercise, and manual therapy focused on the back versus hip versus back and hip on disability, function, pressure pain threshold, pressure pain mapping, health and psychological status of the elderly with chronic back and hip pain. A total of 75 elderly participants will be assigned randomly into three groups, including back-focused exercises (n=25), hip-focused exercises (n=25) and back-focused and hip-focused exercises (n=25). Primary outcomes (disability and function) and secondary outcomes (pressure pain threshold, pressure pain mapping, health status and psychological factors) will be evaluated before, immediately after and 6 months after the 8 week exercise intervention. The data will be analysed using a general linear model repeated measures analysis of variance including both within and between factors (three groups*three times) with Bonferroni adjustments used as a post-hoc test at a significant level of 0.05. This trial will demonstrate whether back versus hip versus back-focused and hip-focused manual therapy can better improve the disability, function, pressure pain threshold, pressure pain mapping, health and psychological status of the elderly with chronic back and hip pain. If successful, this study's findings and information will potentially have implications for addressing back and hip pain in the elderly population by an alternative multidisciplinary approach. Trial registration number: IRCT20220911055941N1.

Objective: This cross-sectional study describes the concussion knowledge and attitudes of male and female 14-18 year-old school rugby union players in England.

Methods: Data from 515 (male 421, female 94) players from 19 schools were collected via the specifically designed Rugby Union Concussion Knowledge and Attitude Survey (RUCKAS-YOUTH) between 2019 and 2022. Knowledge and attitude questions were grouped into themes and analysed against primary cohorts of sex, school status and age group and secondary cohorts of stated Rugby Football Union (RFU) education conduction, concussion history and rugby experience. Associations between knowledge and attitudes were then explored.

Results: No association between total concussion knowledge and attitude was found. Mean concussion knowledge was 79.3% (26.2/33±2.9). The mean concussion attitude safety score was 76% (129.3/170±14.8). RFU 'Don't Be a HEADCASE' module completion was low (16.9%) and was not associated with concussion knowledge. Private school participants reported significantly safer attitudes towards concussion (77.8%, 132.2±14.0) than state school pupils (74.5%, 126.6±15.1), but not greater concussion knowledge. Male and female participants held similar knowledge and attitudes towards concussion, as did participants across the age spectrum. Concussion attitude safety was significantly greater in players with 7-15 years of playing experience than in the younger cohort (U=27 563.0 p=0.005).

Conclusion: The RUCKAS-YOUTH survey provides a detailed description of UK youth rugby concussion knowledge and attitudes. The survey results indicate that attitudes towards concussion, particularly those that influence symptom disclosure, should be a primary focus of concussion risk reduction interventions once key gaps in knowledge are addressed.

Objectives: Lateral ankle sprains (LAS) are among the most common injuries in professional football (soccer). Despite this, the severity and possible long-term consequences of LAS remain trivialised. This multicentre observational study in German elite football provides insights into time-loss and recurrence rates after LAS. Time-loss and recurrence rates are outcome measures vital for the future evaluation of rehabilitation protocols.

Methods: 798 male football players representing 34 teams from 13 professional German football clubs participated in this study during the 2021-2022 season, followed by a 12-month follow-up period. Data collection and reporting were carried out in accordance with the UEFA recommendations for the standardised collection of data on football injuries. Time-loss, recurrence rate and standardised severity grades (I-III) after LAS were recorded for professionals, U23, U19 and U17, respectively.

Results: A total of 187 ankle injuries were reported, with 115 out of the total being analysed. The overall time-loss was 29.89 days, with significant differences between youth elite players and professionals (32.96 vs 15.53 days lost; p<0.001). Professional players demonstrated the shortest time-loss in all LAS injury grades. Time-loss decreased with advancing age (R ²=0.03, F(1, 106)=3.16, p=0.078). Grade I LAS's time-loss differs significantly from grades II and III (p<0.001). A recurrent LAS was recorded in 34 players. The overall LAS recurrence rate was 25.6%.

Conclusion: This study provides data on time-loss and recurrence, which serve as reference values for future evaluation of rehabilitation concepts after LAS in elite football players.

Background: The Aspetar Sports Injury and Illness Prevention Programme introduced the Aspetar IP² NetWork, a customizable injury prevention programme for professional football clubs in Qatar during the 2020/2021 season. It includes 23 focus areas selected by stakeholders to prevent sports-related health issues.

Objective: To assess the real world implementation of the IP² NetWork preventive focus areas during the first season after introduction, focusing on team adoption and player compliance.

Methods: A survey was conducted among team physicians, physiotherapists and fitness coaches from the 18 professional football clubs in Qatar. The survey examined the implementation of the IP² NetWork focus areas and the roles of the different professionals in managing these areas.

Results: 17 out of 18 clubs reported using IP² focus areas, applying an average of 11.4 areas (range 4-21). The most commonly used strategies were the Nordic hamstring exercise, cold water immersion, taping and concussion prevention. Team physicians led 38% of the focus areas, followed by physiotherapists (25%) and fitness coaches (24%), with 11% managed collaboratively. Fitness coaches primarily handled exercise-based areas like warm-ups and load monitoring. Preventive measures were applied to the full squad in 81% of cases, with 19% targeting at-risk players. Player compliance was high, with 86% of focus areas adopted by all or most players, rising to 97% for players identified to be at greater risk of injury or illness.

Conclusion: Implementing the IP² focus areas was widespread among teams in Qatar, with strong collaboration between medical staff. Player compliance, especially among at-risk players, was excellent, demonstrating the programme's feasibility and effectiveness in real-world settings.

Objective: This study aims to prospectively analyse current demographics, distribution and severity of climbing injuries in adolescents. We hypothesised that the injury distribution of adolescent climbers would differ from adults, as presented in the literature and that primary periphyseal stress injuries of the finger (PPSI) will be very common and correlate with training hours and climbing level.

Methods: We performed a prospective single-centre injury surveillance of all adolescent (<18 years of age) climbers who presented between 2017 and 2020. A standard questionnaire, including questions for medical history, injury and training data and an examination protocol, was conducted in all patients. Injuries were graded, and risk factors, anthropometric specifics and stages of development were analysed. Injury epidemiology of adolescents was then compared with adults as presented in the literature.

Results: 137 independent climbing-related injuries were found in 95 patients. Injury onset was acute in 67 (48.9%) and chronic in 70 (51.8%). Forty-one injuries (29.9%) occurred during bouldering, 18 (13.1%) during lead climbing, 2 (1.5%) in speed climbing and 1 (0.7%) while training on the campus board. Average International Climbing and Mountaineering Federation injury score was 1.5±0.5 (range 0-3). Females had more training hours (p=0.004), more campus board use (p=0.004) and more acute injuries than males (p<0.001). 82% of the injuries affected the upper extremity and the most frequent injury was PPSI (45.3% of all injuries). Finger injuries were significantly more common in males than in females (p<0.05). The injury distribution in adolescent climbers differed significantly from adults (p<0.001).

Conclusions: Injured adolescent climbers had mostly chronic injuries affecting the upper extremity, with almost half of the injuries being PPSIs of the fingers. Further preventive measures targeting this type of injury need to be identified. Reducing the use of the finger crimp grip, monitoring the load, ensuring adequate recovery and targeted education appear to be crucial.

The primary aim is to assess the impact of a multidomain intervention that integrates education, exercise, psychological techniques and machine learning feedback on the duration athletes remain free from injury complaints leading to participation restriction (ICPR) during a 20-week summer competitive athletics season. The secondary aims are to assess the intervention's effect on reducing (i) the incidence, (ii) the burden, (iii) the period prevalence and (iv) the weekly prevalence of ICPR during the same timeframe. We will perform a two-arm randomised controlled trial. This study will involve an intervention group and a control group of competitive athletes licensed with the French Federation of Athletics, aged between 18 and 45, over an outdoor athletics competitive season lasting 20 weeks (March to July 2025). Data will be collected before the start (demographic, training and injury history) and one time per day (training and competition volume/intensity, perceived physical and psychological state, and illness and injury incidents) for both groups. The intervention group will be required to (i) view a series of 12 educational videos on injury prevention, (ii) engage in discipline-specific exercise programmes, (iii) implement stress and anxiety management techniques and (iv) view daily the injury prognostic feedback generated by the athlete's collected data based on machine learning. Outcomes will be analysed over the final 14 weeks of follow-up to allow time for the intervention to establish any potential efficacy. The primary outcome will be the time-to-event for each ICPR. Secondary outcomes will include (i) incidence, (ii) burden, (iii) period prevalence and (iv) weekly prevalence of ICPR. The primary outcome will be analysed using a Prentice-Williams-Peterson gap-time model. In contrast, the secondary outcomes will employ Poisson (i, ii), logistic (iii) and generalised estimating equations (iv) regression models, respectively.