BMJ Open Sport & Exercise Medicine最新文献

Objective: Handball is a popular team sport with injury risks, especially to the shoulder. This systematic review aims to assess the effectiveness of prevention programmes in reducing the incidence of shoulder injuries in handball.

Design: Systematic review with meta-analysis.

Data sources: The systematic review was conducted using Embase, PubMed and Cochrane databases with specified keywords.

Eligibility criteria for selecting studies: Inclusion criteria encompassed randomised clinical trials focusing on adult and youth handball players, involving a preventive programme with specific exercises to reduce shoulder injuries, with a control group maintaining regular warm-up.

Results and summary: The initial database search identified 224 records (107 articles from Embase, 85 from PubMed and 32 from Cochrane). Five articles met inclusion criteria which recruited 1872 players (977 females/895 males). The programmes were varied but all included muscle strengthening exercises. Depending on the programme, they also incorporated exercises concerning range of motion, scapular, trunk and neuromuscular. Results from three studies included in the meta-analysis showed no significant difference in shoulder injury incidence rates between prevention programme and usual warm-up (OR: 0.73; 95% CI: 0.45 to 1.17; n=747).

Conclusion: This study did not demonstrate the effectiveness of prevention programmes for handball shoulder injuries and emphasises the need for more standardised research protocols to improve knowledge in this area.

Prospero registration number: CRD42022356497.

Abstract:

Objective: To (1) describe the incidence and characteristics of injuries and illnesses reported by Team USA athletes competing in the 2024 Paris Summer Olympic Games (PSOG) and Paralympic Games (PSPG); (2) compare injury and illness incidence between Olympic and Paralympic cohorts and (3) quantify the burden of respiratory and thermoregulatory illnesses under standard (post-COVID) public health conditions.

Methods: The United States Olympic & Paralympic Committee (USOPC) Injury and Illness Surveillance system was used to document the details of all injuries and illnesses reported by any of the 862 athletes, alternates and guides competing for Team USA in the PSOG and PSPG. Illness and injury incidence per 1000 athlete-days (AD) and incidence ratios (IR) were calculated, both with 95% CI.

Results: Team USA Paralympic athletes sustained 20.5 injuries per 1000 AD versus 14.6 among Olympic athletes (IR (95% CI): 1.4 (1.1 to 1.8)). Illness incidence was 15.7 per 1000 AD among Paralympic athletes versus 8.3 in Olympic athletes (IR (95% CI): 1.9 (1.4 to 2.6)). Among Team USA Paralympic athletes, injuries sustained outside of sport settings accounted for 38.5% (30/78) of all Paralympic injuries, the largest single setting category. The most common system affected by illness at both PSOG and PSPG was the respiratory system, with 7.4% of all athletes reporting a respiratory illness. Despite concerns ahead of the Games related to extreme heat, only two (0.3%) Olympic athletes and zero (0.0%) Paralympic athletes from Team USA reported a heat-related illness.

Conclusion: Injury and illness rates were higher among Team USA Paralympic athletes compared with Olympic athletes during the Paris 2024 Games. Respiratory illnesses were the most frequent medical problem, despite a pre-Games prevention campaign, highlighting the need for stronger infection-control strategies at future Games. The absence of heat illness suggests current heat-mitigation measures were effective. Comprehensive injury-prevention and illness-prevention strategies are needed for both Olympic and Paralympic athletes, with additional attention to the environmental and accessibility risks that disproportionately affect Paralympic competitors.

Menstrual cycle tracking is increasingly recognised as an important aspect of supporting female athletes. However, its application in football remains inconsistent and under-researched. This consensus statement, initiated by the Union of European Football Associations Medical and Anti-Doping Unit, provides evidence-informed guidance on best practices for menstrual cycle tracking in women's football. Developed using the RAND-UCLA appropriateness method, the consensus involved a multidisciplinary expert panel that reviewed the literature and reached agreement on 82 statements across five key domains: the rationale for tracking, meaningful metrics, appropriate methods, implementation strategies and methodological considerations for research. The consensus underscores that while current evidence linking menstrual cycle phases to performance or injury risk remains inconclusive, tracking can support athlete well-being by identifying menstrual irregularities, managing symptoms and enhancing player education and autonomy. Practical recommendations are provided for measuring cycle characteristics, ovulation, hormonal profiles and symptoms, whereas ethical and cultural considerations are emphasised. This statement aims to promote standardised, athlete-centred tracking protocols and establish priorities for practice and future research in female football.

Previous research has shown that stakeholders in the competitive alpine skiing communities consider risk management to be crucial in sports injury prevention. However, to date, there is a lack of a publicly available systematic and structured risk management approach for the competitive alpine skiing context. This work describes the codevelopment process of a risk management framework with stakeholders in the field of competitive alpine skiing. A panel of international experts invited through personal requests and with expertise in health protection and performance enhancement in competitive alpine skiing convened three times through online group meetings to co-develop a risk management framework through different activities. The underlying discussions focused on the fundamental questions of 'why', 'what', 'who', 'how' and 'for whom' and included the debate on specific examples from sports practice. The outcome after three meetings was a risk management framework. This framework includes a competitive alpine skiing-specific prevention wheel that integrates different stakeholder views relevant to different levels, their risk priorities, the main five domains and intervention areas identified from the literature, the graded and progressive timescale to intervene and the potential targets for risk management interventions. Moreover, the framework includes a decision-making tree, which operationalises the prevention wheel into a step-by-step sequence for risk management, including risk identification, risk assessment and risk mitigation. It should help stakeholders recognise their responsibilities and the potential actions they can take. Practical examples are provided to demonstrate how to apply the framework and to illustrate the complexity and dynamic interaction of the various factors in the competitive alpine skiing setting. The risk management framework developed lays a strong foundation for creating a safer environment for alpine skiers. It likewise contributes to providing overall awareness of the complexity and inter-relations of risks and prevention measures in the sport. By doing so, this framework has the potential to initiate further processes and on-field translation to sustainably and long-term improve athlete health and safety in competitive alpine skiing.

Objective: To describe the prevalence and nature of Olympic-career related injuries and illnesses, and behaviours during injury/illness, in Olympians in the 4 years prior to their participation at the Tokyo 2020 and Beijing 2022 Olympic Games.

Methods: 315 current Olympians from 70 countries completed a cross-sectional online survey, distributed by direct email through National Olympian Associations and World Olympians Association databases. Questions included Olympic sport exposure, significant training and competition injury and illness history (lasting >2 weeks) and athlete behaviours during injury/illness.

Results: 65% of Olympians were women (35% men), representing 51 sports (37 summer, 14 winter), aged 28.6 years (4.6). Overall, 58.5% (95% CI 52.2% to 64.9%) of summer and 55.6% (95% CI 44.7% to 66.4%) of winter Olympians were injured, with knee injuries most frequent (19.6% summer, 27.8% winter Olympians). Injury rates were similar between males and females. 17.1% (95% CI 12.3% to 21.9%) of summer and 23.5% (95% CI 13.1% to 31.3%) of winter Olympians were ill, with respiratory illness most frequent. Illness rates were (non-significantly) higher for female versus male winter Olympians (adjusted relative risk 2.04 (95% CI 0.73 to 5.76)) but similar between male and female summer Olympians. 78% of Olympians said they put the most pressure on themselves to return from injury/illness quickly. Almost half reported using painkillers during injury, while one-quarter continued full training/competition during injury/illness. Injury and illness prevalence followed similar bimodal and trimodal seasonal patterns for summer and winter Olympians, respectively.

Conclusions: Olympians report a significant history of injury and illness across the 4 years before the Olympic Games. A biopsychosocial approach that supports athletes during injury/illness absences is needed. Concurrent injury/illness prevention strategies should be considered to reduce the burden of both injuries and illnesses at key times in an athlete's season.

Background and aims: Within adolescent female rugby union, various effective injury prevention strategies are available to players to mitigate injury. However, little is known regarding the players' attitudes, beliefs and behaviours towards those strategies, as well as injuries. The primary aim of the study was to investigate the attitudes, beliefs, behaviours and injury-reporting behaviours of adolescent female rugby players regarding injury and injury prevention strategies. The secondary aim was to examine associations between individual factors (eg, player demographics) and injury-reporting behaviours.

Methods: Participants completed an online cross-sectional survey and were recruited from under-16 and under-18 rugby teams in schools/colleges, clubs and developing player pathway programmes in England.

Results: 1062 players were contacted to participate, 424 responded and 422 met the eligibility criteria; 79 participants had incomplete responses. 14% of players had not previously reported a suspected concussion to a coach/medical staff member, and 37% of players had previously not reported sustaining one or more musculoskeletal (MSK) injuries to a coach/medical staff member. Factors cited for non-disclosure of concussion and MSK injuries included not wanting to miss rugby sessions (43% and 39%) and not knowing that symptom(s) were related to an injury (11% and 17%). Players held positive attitudes, beliefs and behaviours towards injury and injury prevention, but their understanding of the effectiveness of protective equipment varied.

Conclusion: This study provides a greater understanding of adolescent female rugby players' attitudes, beliefs and behaviours towards injury and injury prevention and aids in the development of effective injury prevention initiatives.

Objectives: To evaluate the association between tackle characteristics and suspected concussion among Canadian high school girls' rugby union players.

Methods: A case-control video-analysis study was used to examine the association between a priori tackle characteristics (eg, type, height, head position) and suspected concussion. For every concussive tackle event, six non-concussive tackle events were matched for game and team. Penalised logistic regression was used to estimate ORs with 95% CIs for concussion given tackle characteristics.

Results: 33 concussive tackle events, including 38 concussions, were identified. 20 were ball carrier concussions (53%). 261 (228 non-concussive, 33 concussive) tackle events, including 632 individual tackler and ball carrier instances, were coded. All ball carrier head contact intensity types were associated with concussion compared with no head contact. A trip tackle type (OR: 4.41, 95% CI 1.25 to 15.61), illegal tackle type (OR: 4.41, 95% CI 2.67 to 7.29), deceleration (OR: 14.03, 95% CI 4.65 to 42.30) and no change of speed (OR: 18.81, 95% CI 10.04 to 35.24) increased concussion odds for ball carriers. A tap (OR: 10.64, 95% CI 2.00 to 56.62) and trip tackle type (OR: 5.91, 95% CI 3.18 to 10.99), two (OR: 3.38, 95% CI 1.13 to 10.07) or three (OR: 13.91, 95% CI 1.74 to 111.53) tacklers within the event, and a head-down position (OR: 40.54, 95% CI 27.78 to 59.18) increased concussion odds for tacklers. Higher tackler contact on ball carrier (tackle height) increased concussion odds for ball carrier (reference: knee-to-upper-leg; waist-to-sternum OR: 2.27, 95% CI 1.08 to 4.80; sternum-to-armpit OR: 5.65, 95% CI 1.40 to 22.87) and tacklers (sternum-to-armpit OR: 4.20, 95% CI 1.26 to 14.03).

Conclusion: Numerous tackle characteristics were associated with ball carrier and tackler concussion. This is the first study to identify tackle height on ball carrier as a risk factor for concussion in girls' rugby. Future directions should consider tackle training programmes and lower tackle height as potential concussion prevention solutions.

Objectives: To identify how exercise adherence is reported in research which focuses on enhancing cardiorespiratory and muscular fitness in stroke survivors.

Design: Systematic scoping review.

Data sources: Scopus, PubMED/MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, PsycINFO/PsycARTICLES and Web of Science.

Eligibility criteria for selecting studies: The review sought published reports involving a cardiorespiratory or resistance training exercise intervention for people who experienced a stroke ≥6 months prior to participation. Reports were screened by two reviewers and were assessed for methodological quality using the Mixed Methods Appraisal Tool.

Results: 37 reports (randomised trials=30, interventions without control=5, non-randomised trial=1, dose escalation trial=1; total n=1347 participants) out of 6732 records met the inclusion criteria. 29 reports (78%) documented intervention adherence by describing participant completion rates, indicating 65-100% adherence. Exercise session adherence within intervention was identifiable in 16 reports (43%), 12 of which recorded session attendance, signifying 61-100% adherence. There were also measures of the intensity or duration participants sustained during sessions in 14 studies. Only one study measured postintervention (ie, at least 3 months after intervention completion) exercise adherence, and two studies actively supported participants' exercise motivation.

Conclusion: Adherence is commonly measured by intervention completion rates. Despite its importance for intervention effectiveness, less than half of studies measured exercise session adherence within interventions. Future research should address this limitation to better understand how stroke survivors engage with exercise.

Objectives: Hamstring strain injury (HSI) is the most common time-loss injury in football and is prone to recurrence. This exploratory study aimed to describe the relationship between short-term external training load (TL) and HSI occurrence in male senior football players at the professional level.

Methods: TL data in terms of global positioning system (GPS) variables and HSI incidence were collected over four seasons from 25 senior professional football players. GPS variables included total distance (TD), very intense accelerations (>3.00 m/s²), very intense decelerations (<-3.00 m/s²), high-speed running distance (>19.8 km/hour), maximal sprint distance (>29.8 km/hour) and maximal velocity. For each injury case, TL during the 7 and 14 days preceding the injury was compared with matched control periods from the same player.

Results: 25 hamstring injuries were included for analysis. Large interindividual variation in TL patterns was observed, with some players exhibiting higher and others lower TL in the periods preceding injury compared with control periods. No consistent group-level trends were identified between injured and control periods.

Conclusion: This exploratory study found considerable individual variability in TL prior to HSI and no clear group-level patterns. These findings suggest that short-term TL metrics alone may have limited utility in predicting HSI risk at the group level in professional football players.

Background: Injury surveillance is fundamental for understanding and managing risks in elite football. The simultaneous organisation of Union of European Football Associations (UEFA) EURO 2024 and Confederación Sudamericana de Fútbol (CONMEBOL) Copa America 2024 created a unique chance to use a standardised method across two major men's tournaments, providing descriptive insights into injury rates and patterns in various competitive settings.

Objective: To analyse the incidence, severity and burden of time-loss injuries across both tournaments.

Methods: A prospective injury surveillance study was conducted using standardised methodologies from UEFA's Elite Club Injury Study and International Olympic Committee reporting guidelines. Injury incidence rates (IRs) were calculated per 1000 hours of exposure, and injury burden was measured in tournament days lost per 1000 hours.

Results: A total of 85 injuries were recorded, resulting in an overall IR of 4.0 per 1000 hours (95% CI: 3.1 to 4.8). Match injury rates (16.3 per 1000 hours; 95% CI: 11.9 to 20.7) were significantly higher than training rates (1.8 per 1000 hours; 95% CI: 1.2 to 2.4). Injury rates were comparable between UEFA EURO (3.9 per 1000 hours; 95% CI: 2.9 to 4.9) and CONMEBOL Copa America (4.2 per 1000 hours; 95% CI: 2.6 to 5.7). The injury burden was higher in UEFA EURO (30.0 vs 18.3 days lost per 1000 hours). Muscle injuries (58%) and lower extremity injuries (86%) were the most common.

Conclusions: Injury patterns were broadly similar across tournaments, with lower extremity injuries, particularly muscle injuries, being the most common. The study highlights the presence and impact of pre-existing injuries on player availability and underscores the practical value of harmonised injury surveillance, even in small sample contexts, to enhance international data comparability and support future multi-tournament analyses.