Sports Health-A Multidisciplinary Approach最新文献

Context: Despite fastpitch softball's growing popularity, there is limited evidence-based guidance to aid practitioners in developing pitching-specific injury prevention and performance enhancement strategies. This commentary describes the biomechanics across each phase of the softball pitch and provides explanation of common biomechanical errors during the pitch as well as training strategies and exercise recommendations to foster optimal pitcher development.

Evidence acquisition: A review of softball pitching biomechanics research available in electronic databases including PubMed, Medline, and EBSCO.

Study design: Clinical review.

Level of evidence: Level 4.

Results: The 4 primary phases of the windmill softball pitch include the wind-up, stride, acceleration, and follow-through.

Conclusion: Specific training strategies are recommended to combat the various flaws associated with each phase of the softball pitch. Evaluating body composition, functional characteristics like strength and range of motion of the shoulders, trunk, and hips, as well as assessing energy flow may result in improved performance and minimize risk of injury.

Background: The volume and frequency of throwing activity are among the most significant risk factors for developing overuse injuries in youth athletes. Despite introducing systematic guidelines for 'pitch counts,' throwing injuries continue to rise. Using technology to create enhanced measures of workload exposure in this unique population of athletes may help generate more effective and personalized injury prevention strategies.

Hypothesis: The wrist-worn sensor system (PhySens) will: 1) accurately detect and differentiate throwing activity from other baseball movements, and 2) accurately predict ball velocity, arm slot angle, and elbow valgus torque.

Study design: Descriptive laboratory study.

Level of evidence: Level 5.

Methods: Youth pitchers (n = 10) performed a standardized protocol of pitching, field-throwing, and batting. Pitching velocity and biomechanical data were simultaneously captured by the PhySens and traditional 3-dimensional motion capture. The accuracy of the pitching detection algorithm (throw vs batting) was analyzed by comparing truth data with throwing events cataloged by the device. Ball velocity, elbow valgus torque, and arm slot angle predictions were assessed with Pearson correlation coefficients and Bland-Altman plots.

Results: A total of 230 events (pitches and bat swings) were analyzed. Pitch detection was excellent, with a sensitivity of 99.4% and specificity 97.9%. Pearson correlations were significant and excellent across all predicted variables, with ball velocity r = 0.96, elbow valgus torque r = 0.95, and arm slot angle r = 0.87. The system demonstrated excellent estimations of ball velocity, elbow valgus torque, and arm slot angle.

Conclusion: This novel single-sensor wrist worn device was highly accurate in detecting pitching events, predicting ball velocity, and estimating arm slot angle and elbow valgus torque.

Clinical relevance: Throwing volume is highly associated with overuse injuries in youth baseball players. Sensor-based measures of workload monitoring can address inherent limitations related to human error and underestimation of true throwing exposure.

Background: Few studies have explored relationships between low back pain (LBP) and physical characteristics (physique, muscle strength, tightness, and flexibility) in female rhythmic gymnasts (RGs).

Hypothesis: Due to their extreme flexibility, modifiable physical factors for LBP in RGs are not related to muscle tightness.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: College female RGs (n = 95) were categorized into LBP and non-LBP groups based on questionnaires and orthopaedic surgeon interview. Physical assessments included whole-body bone mineral content and density, trunk lean body mass, and scoliosis presence by dual-energy X-ray absorptiometry scans, presence of abnormal findings and spine alignment by magnetic resonance imaging scans, hip muscle strength testing (flexion, extension, and abduction), range of motion (ROM), and flexibility testing. LBP and non-LBP groups were compared, and multivariate regression analysis performed.

Results: RGs with LBP exhibited significantly longer practice time, lower hip flexion muscle strength on the nondominant side versus dominant side, lower active straight leg raise on the nondominant side versus dominant side, and lower hip external rotation (ER) ROM on the nondominant side versus dominant side. A history of LBP was also associated with current LBP. Multivariate logistic regression analysis revealed that a history of LBP (odds ratio [OR], 6.33; 95% CI, 1.56-25.62), differences in hip flexion strength (OR, 0.96; 95% CI, 1.00-1.08), and differences in hip ER ROM (OR, 1.12; 95% CI, 1.03-1.19) were factors associated with LBP.

Conclusion: LBP was experienced by 27.3% RGs and associated not only with a history of LBP and a deficit in hip flexor strength on the nondominant side but also a deficit in hip ER ROM on the nondominant side.

Clinical relevance: Focusing on hip flexor strength and hip ER ROM on the nondominant side may be of value for LBP rehabilitation and prevention in RGs.

Background: Large language model (LLM)-based artificial intelligence (AI) chatbots, such as ChatGPT and Gemini, have become widespread sources of information. Few studies have evaluated LLM responses to questions about orthopaedic conditions, especially osteochondritis dissecans (OCD).

Hypothesis: ChatGPT and Gemini will generate accurate responses that align with American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines.

Study design: Cohort study.

Level of evidence: Level 2.

Methods: LLM prompts were created based on AAOS clinical guidelines on OCD diagnosis and treatment, and responses from ChatGPT and Gemini were collected. Seven fellowship-trained orthopaedic surgeons evaluated LLM responses on a 5-point Likert scale, based on 6 categories: relevance, accuracy, clarity, completeness, evidence-based, and consistency.

Results: ChatGPT and Gemini exhibited strong performance across all criteria. ChatGPT mean scores were highest for clarity (4.771 ± 0.141 [mean ± SD]). Gemini scored highest for relevance and accuracy (4.286 ± 0.296, 4.286 ± 0.273). For both LLMs, the lowest scores were for evidence-based responses (ChatGPT, 3.857 ± 0.352; Gemini, 3.743 ± 0.353). For all other categories, ChatGPT mean scores were higher than Gemini scores. The consistency of responses between the 2 LLMs was rated at an overall mean of 3.486 ± 0.371. Inter-rater reliability ranged from 0.4 to 0.67 (mean, 0.59) and was highest (0.67) in the accuracy category and lowest (0.4) in the consistency category.

Conclusion: LLM performance emphasizes the potential for gathering clinically relevant and accurate answers to questions regarding the diagnosis and treatment of OCD and suggests that ChatGPT may be a better model for this purpose than the Gemini model. Further evaluation of LLM information regarding other orthopaedic procedures and conditions may be necessary before LLMs can be recommended as an accurate source of orthopaedic information.

Clinical relevance: Little is known about the ability of AI to provide answers regarding OCD.

Background: The ability to identify patients with long-term poor outcomes using clinical and functional information is limited. Identifying prognostic factors to improve long-term outcomes after anterior cruciate ligament (ACL) injury can influence and inform targeted interventions for this population.

Hypothesis: Preoperative functional tests and patient-reported outcome measures are predictive of postoperative functional recovery and satisfaction in patients undergoing first-time ACL repair, second-time ACL repair on the same knee, and bilateral ACL repair.

Study design: Quasi-experimental prospective study.

Level of evidence: Level 3.

Methods: A total of 88 patients with ACL reconstruction were included. Subjective knee scoring systems and functional performance tests were used for evaluation and analyzed for correlation with results.

Results: The first time ACL injury group had lower scores in the various self-report scales: Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Rating Scale, International Knee Documentation Committee (IKDC), and Lower Extremity Functional Scale (LEFS).

Conclusion: Reduction in self-reported knee function and Y balance test performance after ACL injury are predictive factors for recovery. Estimates exceeded clinically important thresholds. Those who had already undergone surgery had clinically better thresholds, highlighting the assessing these measures when designing presurgical rehabilitation programs.

Background: Recent research indicates a potential link between effusion-synovitis and knee pain in athletes. This study investigates the association of knee effusion-synovitis with self-reported knee pain in elite female athletes, leveraging ultrasound imaging for effusion-synovitis assessment.

Hypothesis: Presence of knee effusion-synovitis is associated with increased self-reported knee pain in Division I female athletes.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: A total of 53 NCAA Division I female athletes underwent bilateral knee ultrasound to identify effusion-synovitis. The Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain subscale assessed knee pain. A 1-way analysis of variance compared KOOS pain, symptoms, activities during daily living (ADL), and quality of life (QoL) scores across groups with no, unilateral, and bilateral effusion-synovitis.

Results: Among the athletes, 49.1% showed no effusion-synovitis, 26.4% had unilateral, and 24.5% had bilateral effusion-synovitis. There were no differences in self-reported pain scores (F = 0.027; P = 0.97), ADL (F = 0.256; P = 0.78), or QoL (F = 0.120; P = 0.88) between any groups. In addition, the frequency of effusion-synovitis was as follows: for the right limb, Grade 0 = 35 (66%), Grade 1 = 15 (28%), Grade 2 = 1 (2%), and Grade 3 = 2 (4%); for the left limb, Grade 0 = 31 (58%), Grade 1 = 19 (36%), Grade 2 = 3 (6%), and Grade 3 = 0 (0%).

Conclusion: The presence of effusion-synovitis, irrespective of being unilateral or bilateral, was not associated with self-reported knee pain in elite female athletes. This suggests that lower grades of effusion-synovitis may not significantly impact knee pain.

Clinical relevance: The findings of this study challenge existing assumptions about the impact of effusion-synovitis on knee pain in athletes, contributing to the nuanced understanding of knee joint health in sports medicine.

Context: Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population.

Evidence acquisition: Nonsystematic review with critical appraisal of existing literature.

Study design: Clinical review.

Level of evidence: Level 4.

Results: Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy.

Conclusion: With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.

Background: There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This study aimed to investigate the association between psychological distress, skipped meals, and insufficient sleep, and the occurrence of back pain among adolescent female soccer players.

Hypothesis: Psychological distress, skipped meals, and insufficient sleep are associated with the occurrence of back pain.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: Swedish adolescent female soccer players aged 12 to 17 years, without back pain at baseline, were included. The exposures psychological distress, skipped meals, and insufficient sleep were assessed at baseline. The players were followed for 1 year with a weekly web-based survey, where back pain intensity was measured on a numeric rating scale (NRS) ranging from 0 to 10. The outcome back pain was defined as reporting low back pain and/or upper back/neck pain intensity of ≥4 on the NRS. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard rate ratio (HRR) with 95% CI for the association between each exposure and the outcome back pain, adjusted for age at baseline and parents' education.

Results: In total, 351 players were included, and 141 players reported back pain at some point during the 1-year follow-up. The adjusted HRR for back pain was 1.79 (95% CI, 1.11-2.91) for insufficient sleep, 1.45 (95% CI, 0.97-2.17) for psychological distress, and 0.98 (95% CI, 0.61-1.59) for skipped meals.

Conclusion: Insufficient sleep and psychological distress are associated with the occurrence of back pain among female adolescent soccer players.

Clinical relevance: Our results contribute to the understanding of what may influence the occurrence of back pain in adolescence, offering potential strategies for the prevention of back pain in adolescent female soccer players.

Background: Lower extremity muscle tears are common sports injuries. The British Athletics Muscle Injury Classification (BAMIC) may provide clinical guidance for tears although its value in American football and college athletes is unknown.

Hypothesis: Clinical outcomes, specifically time to return to play (RTP) (TRTP), in college American football athletes with activity-related hamstring (HS) and quadriceps (QD) tears will be associated with BAMIC.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: American football college athletes who sustained a HS or QD tear and underwent magnetic resonance imaging within 7 days at 1 institution during the 2023 season were included. TRTP and reinjury rate (RIR) for HS and QD tears classified by BAMIC and injury characteristics were evaluated.

Results: Of the 24 HS and 10 QD tears in 21 (17.3%) of 121 athletes (20 ± 1.2 years; 100.0% male), most (60.0%) were BAMIC 2a-3b. Most (89.3%) injuries occurred before the season, and all occurred in practice. Overall median TRTP was 26 days (interquartile range, 17.8-33.0), translating to about 4 weeks missed play. The RIR was 19.0% (4/21). Most (75.0%) reinjuries occurred before RTP. There was no significant relationship between BAMIC and TRTP, although TRTP was less for grade 0 injuries and greater TRTP for injury site "c," albeit with small effect sizes.

Conclusion: Activity-related HS and QD tears are common in American football college athletes, particularly in preseason and practice. Injured athletes missed about 3 to 4 games, regardless of BAMIC, with 1 in 5 athletes suffering a reinjury. There was no relationship between BAMIC or muscle group and TRTP.

Clinical relevance: This appraisal of BAMIC in college and American football athletes highlights the prevalence of muscle tears and the need for prevention. Although BAMIC lacked value in this study, larger studies are needed to evaluate BAMIC in this population.

Context: Flag football is a rapidly growing sport with injuries frequently presenting to emergency departments (EDs). Current literature on flag football lacks mechanisms of injury and any information pertaining to female athletes. The purpose of this study was to examine demographic-specific injury trends in those playing flag football.

Evidence acquisition: The National Electronic Injury Surveillance System (NEISS) was queried for flag football injuries presenting to United States EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury site, diagnosis, and disposition were recorded. NEISS narratives were used to identify mechanisms of injury. National estimates (NEs) were calculated using the NEISS statistical sample weight. Annual injury trends were evaluated by linear regression.

Study design: Descriptive epidemiology study.

Level of evidence: Level 3.

Results: There were 2508 flag football injuries (NE, 86,443) analyzed from 2013 to 2022; 78.2% were sustained by male athletes. Linear regression analysis revealed no significant trend in annual injuries (P = 0.16) from 2013 to 2022. The most common mechanism of injury was player-player collision (35.7%). The 2 age groups most affected by flag football injuries were middle school-aged (11-13 years) (20.8%) and high school-aged (14-18 years) (23.7%). The area of the body most affected for pediatric (<18 years) groups was the head, while adults most frequently injured their fingers. In addition, the most common mechanism for the pediatric age group was fracture (21.3%), whereas adult age groups most frequently suffered from strain/sprain injuries.

Conclusion: The number of injuries from flag football identified in this study has not decreased throughout the last decade, aside from 2020 - potentially due to the prevalence of COVID-19. Collisions were the most frequent mechanism of injury across all age groups. Whereas younger athletes frequently sustained head injuries and fractures, older athletes typically sustained strain/sprain injuries and finger injuries.