Sports Health-A Multidisciplinary Approach最新文献

Background: Research on catastrophic injuries and medical conditions among majority girls' and women's sports are underrepresented. In this study, we describe the incidence, characteristics, and mechanisms of severe softball injuries/medical conditions between 2014 and 2021.

Hypothesis: Catastrophic injury and illness patterns will be observed with a higher incidence rate at the collegiate level.

Study design: Descriptive epidemiologic study.

Level of evidence: Level 3.

Methods: Events from the National Center for Catastrophic Sport Injury Research (NCCSIR) and National Electronic Injury Surveillance System (NEISS) were included. NCCSIR included catastrophic injuries during participation in high school (HS) or college sponsored girls'/women's softball resulting in death, temporary or permanent disability, or life-threatening injury. NEISS included severe girls'/women's softball injuries (product code 5034) among 13- to 17- and 18- to 24-year-olds among severe dispositions. National estimates were derived using a weighted sample for NEISS. Counts (%) and incidence rates (IR) per 100,000 participants overall and by age level, injury/medical event, and outcome were reported.

Results: NCCSIR captured 0.3 events per 100,000 participants (95% confidence interval, 0.1-0.5), and incidence was higher in college (IR, 2.5; 0.9-6.6) compared with HS (IR, 0.1; 0.1-0.4). Sudden cardiac arrest was the most common event (5, 63%), and 2 (25%) fatalities were reported. NEISS captured 10.2 events per 100,000 participants (9.7-10.8). Incidence was higher in 18- to 24-year-olds (IR, 8.9; 8.3-9.6) compared with 13- to 17-year-olds (IR, 4.2; 3.8-4.6), and no fatalities were captured.

Conclusion: Collegiate and 18- to 24-year-old athletes demonstrated a higher incidence of severe injuries than HS and 13- to 17-year-old athletes across both surveillance systems. NEISS captured a higher incidence of catastrophic events than NCCSIR. NCCSIR observed more cardiac events, whereas NEISS observed more head/face injuries.

Clinical relevance: Continued monitoring of severe injuries and medical events in softball is necessary to support response and prevention measures.

Background: Lateral epicondylitis is caused by overuse and manifests as pain, weakness, and difficulty with object manipulation. Platelet-rich plasma (PRP) and dextrose injections have shown promise in reducing pain and improving function.

Hypothesis: PRP is more effective for force precision control of the extensor carpi radialis brevis (ECRB) muscle than dextrose injection for patients with chronic lateral epicondylitis (CLE).

Study design: Randomized, double-blinded clinical trial.

Level of evidence: Level 1.

Methods: A total of 62 participants (25 healthy subjects and 37 CLE patients) were assigned randomly to either PRP (19) or dextrose (18) groups. Assessments included maximal voluntary contraction (MVC), wrist extension force, questionnaires, sonography, and electromyography assessments.

Results: PRP and dextrose had similar effects on clinical questionnaire scores. Compared with pre-test values, only PRP demonstrated a significant increase in MVC (PRP, 75.3 ± 107.7%; P < 0.01; dextrose, 34.0 ± 66.1%; P = 0.08), and greater reduction in force fluctuations (PRP, -27.4 ± 13.3%; P < 0.01; dextrose, -5.4 ± 33.2%; P = 0.22) during post-test wrist extension. After treatment, the PRP group experienced a roughly 41.7% increase in motor units (MUs) with recruitment thresholds (Rec_TH) (pre-test, 3.67 ± 6.15% MVC; post-test, 5.20 ± 8.02% MVC; P < 0.01). The dextrose group showed no significant change (-3.74%) in MU Rec_THs (pre-test, 3.48 ± 6.80% MVC; post-test, 3.35 ± 6.62% MVC; P = 0.75). PRP increased the MU discharge rate with Rec_THs at <30% MVC, whereas dextrose administration elevated MU discharge rate with Rec_THs >20% MVC.

Conclusion: PRP may be more effective than dextrose in improving neuromuscular control of the ECRB muscle, particularly for enhancing the scaling of force during wrist extension, attributed to distinct MU activation strategies.

Clinical relevance: Detailed comparison and head-to-head analysis of PRP and dextrose injections offers more options for patients considering injections.

Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). However, although there are well-documented benefits of sport and physical activity on mental health, many sportspeople still take the risk of competing in contact sports. Therefore, this infographic, supported by scientific evidence, aims to provide sportspeople with an informed decision on their participation. This infographic can be used by sports clubs or governing bodies to illustrate the risk that SRC has on the mental health of sportspeople. Likewise, it highlights the elevated risk of being in physical pain and being a female sportsperson. Therefore, this infographic provides a simple message to enhance the decision-making process of sportspeople, ensuring they are making a better-informed choice of their sporting participation and making their own cost/reward judgment.

Background: The elderly US population is growing quickly and staying active longer. However, there is limited information on sports-related injuries in older adults.

Hypotheses: (1) National estimate and incidence of sports-related orthopaedic injuries in the US elderly population have increased over the last 10 years, (2) types and causes of sports-related injuries in the elderly have changed, and (3) elderly sports-related injuries will increase more than the number of treating physicians by 2040.

Study design: Descriptive epidemiology study.

Level of evidence: Level 4.

Methods: The National Electronic Injury Surveillance System database was used to identify all patients aged ≥65 years with sports-related orthopaedic injuries in US emergency departments from 2012 to 2021. Surgeon and physician estimates were calculated using the Physician Compare database. Population data were obtained from US Census estimates and used to calculate annual incidence rates of injuries and to project total injuries through 2040. Injury characteristics were analyzed using Wilcoxon Rank-Sum tests and Chi-square or Fisher exact tests.

Results: An estimated 444,078 sports-related orthopaedic injuries occurred in the elderly from 2012 to 2021. There were significant increases in injuries (from 32,573 in 2012 to 50,909 in 2021; P < 0.01) and in the national incidence of injuries (from 78 per 100,000 in 2012 to 91 per 100,000 in 2021; P = 0.01). The number of sports-related injuries in the elderly is projected to reach 111,245 by 2040, an increase of 119% from 2021. The number of orthopaedic surgeons and sports medicine physicians is projected to increase by only 19.7% over the same timeperiod.

Conclusion: Sports-related orthopaedic injuries in the elderly are increasing in both number and incidence.

Clinical relevance: Orthopaedic surgeons and other practitioners should be prepared to treat an increasing number of active elderly patients.

Background: The cumulative effect of repetitive subconcussive head impacts on neurocognitive function during youth contact sports remains largely unknown. There is a paucity of literature evaluating cumulative helmet forces over a season and their correlation with preseason and postseason cognitive performance tasks such as the King-Devick test (KDT).

Hypothesis: Higher helmet forces recorded throughout a 10-week, 10-game youth football season would correlate with slower performance on postseason KDT.

Study design: Prospective cohort study.

Level of evidence: Level 3.

Methods: A cohort of 58 youth football players (ages 9-13 years) underwent pre- and postseason KDT. Players wore SpeedFlex helmets (Riddell) fitted with InSite Impact Response System helmet accelerometers (Riddell) which recorded impacts of ≥15g. Head impacts were tallied over a season and assigned a score of 1, 2, or 3 based on magnitude of g forces. Suspected concussions were correlated with KDT times and recorded instances of head impact. Pre- and postseason KDT scores were compared.

Results: During the season, 2013 head impacts were recorded. Median (range) total cumulative force score was 24 (5-476); 6 players sustained head impacts concerning for concussion, and 4 were clinically diagnosed with concussions. Overall, postseason KDT times improved compared with preseason, with a median (range) change of -4.8 seconds (-7.6, -1.1). Analysis showed no correlation between changes in KDT time and total cumulative force score over the season.

Conclusion: KDT times in youth football players did not change significantly based on head impact exposure over a single youth football season; most players' KDT times improved from preseason to postseason.

Clinical relevance: Although our study did not show significant cognitive impact as measured by KDT over a single youth football season, the long-term effects of concussion on the immature brain and how it can impact cognitive development remains largely unknown and should be an area of ongoing study.

Background: Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes.

Hypothesis: Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery.

Study design: Retrospective cohort study.

Level of evidence: Level 4.

Methods: Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold.

Results: A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m²) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04).

Conclusion: Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery.

Clinical relevance: Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Background: Exercise and its effect on cardiovascular diseases have been extensively studied in the elderly population. The difference in blood pressure (BP) between fit and unfit subjects can be >5 mmHg. It is not well established whether the positive effects of exercising on BP are associated with exercise type, be it aerobic or anaerobic (maximal muscle strength).

Hypothesis: Anaerobic training (maximal muscle strength) causes greater improvements than aerobic training on BP in active older adults.

Study design: Clinical trial.

Level of evidence: Level 4.

Methods: This clinical trial was carried out with 202 participants (n = 116 aerobic program [ABPG], n = 86 strength program [SBPG]; 58.05% female; age 67.61 ± 5.01 years). The training program was carried out between 2018 and 2021. Periodic evaluations of BP (systolic BP [SBP] and diastolic BP [DBP]) were conducted with a frequency of twice per year. BP comparisons were made by using 2 × 2 analysis of variance with repeated measurements over the course of the 4 years of the project.

Results: Throughout the training program, SBPG showed significant and consistent improvements in both SBP and DBP (P < 0.01). On the other hand, the ABPG reported a significant initial improvement (P < 0.01), which was not repeated in subsequent years. BP monitoring carried out over the 4 years showed a decrease in DBP and SBP, with this decrease being more pronounced in SBPG. However, the differences between the groups were not significant (2021; DBP, F = 1.227; P = 0.27; SBP, F = 0.826, P = 0.36).

Conclusion: Among persons aged ≥65 years, muscle strength training programs appear to be more effective in inducing exercise-related positive changes in BP and cardiovascular risk factors compared with aerobic exercise programs.

Clinical relevance: Muscle strength training programs result in favorable changes in BP and cardiovascular risk factors.

Background: Australian Rules Football athletes complete long preseasons, yet injuries occur frequently at early stages of the competitive season. Little is known about the high-speed running (HSR) prescription during a preseason or whether players are adequately prepared for competition. This study described absolute and relative preseason and in-season HSR demands of 2 professional Australian football teams.

Hypothesis: HSR and sprinting volumes are significantly lower in elite Australian Rules football athletes during in-season compared with preseason.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: During the 2019 season, HSR volume was collected for 2 professional Australian football teams (n = 55). Individual maximum speeds (V_max) were captured to calculate relative running speed thresholds, as reported in 5% increments from 70%V_max to 100%V_max.

Results: Weekly volume of running above 70%V_max (P = 0.01; r = 0.56) and 80%V_max (P = 0.01; r = 0.58) was significantly greater in the preseason than the in-season. The weekly volume completed above 90%V_max was not significantly greater in the preseason than the in-season (P = 0.10; r = 0.22). Individual variation in the distance completed at specific percentages of V_max expressed as a coefficient of variation was reported as 51% at 71% to 80%V_max, 39% at 81% to 90%V_max, and 41% at 91% to 100%V_max.

Conclusion: The volume of HSR completed by athletes is far greater in the initial 4 weeks of the preseason than in any other point in preseason or competitive phases. At the individual level, there is substantial variation in the distance covered. This supports the concept of a heavily individualized approach to high-speed prescription and monitoring.

Clinical relevance: Practitioners should carefully consider individual variation regarding sprinting volume during both preseason and in-season when prescribing and monitoring training to improve on-field performance and reduce the risk of injury.

Background: Overuse injuries in youth athletes are associated with risks, including sports specialization, biological maturation, female sex, and workload measures. As no assessment tool exists to evaluate risk accumulation, we developed a novel risk factor scoring system (Sport Training Assessment of Risk [STAR]) to assess participants' risk of overuse injury and explore association with return-to-play (RTP) time periods.

Hypothesis: (1) STAR will reach an acceptable predictive threshold in the assessment of overuse injury in youth athletes. (2) Higher STAR scores will be associated with increased RTP time periods after injury.

Study design: Longitudinal cohort study.

Level of evidence: Level 3.

Methods: Youth athletes with an injury sustained during competitive sport completed questionnaires. Association of questionnaire variables with injury risk type was evaluated via logistic regression analyses, and unweighted and weighted versions of a total risk score were developed. RTP was defined by physician clearance per electronic medical record review. Mantel-Haenszel chi-square tests and Kendall's rank correlation coefficients were used to assess the relationship between weighted total risk score and RTP time periods. The weighted STAR model was analyzed with receiver operating characteristic (ROC) curves.

Results: The weighted STAR model trended toward an acceptable level of prediction for overuse (nonserious + serious) injury (area under the ROC curve [AUC], 0.66; 95% CI, 0.61-0.71), but was less predictive for serious overuse injury (AUC, 0.63; 95% CI, 0.55-0.71). Weighted total risk score was weakly associated with return to full play (ρ = 0.11; P < 0.01), and potentially with return to modified play (ρ = -0.08; P = 0.04).

Conclusion: STAR may be a feasible tool for assessing overuse injury risk and RTP time periods in youth athletes but requires further development, as it did not reach an acceptable predictive threshold in this preliminary study.

Clinical relevance: Clinicians can use STAR to assess overuse injury risk in youth athletes.

Background: Many questions persist regarding the relationship between training load and injuries in volleyball, as well as the best method for calculating acute:chronic workload ratio (ACWR). This study aimed to investigate the relationship between different metrics of training load and risk of injury in male professional volleyball players.

Hypothesis: ACWR, as a training load measure, is useful for identifying injury risk in volleyball players, regardless of calculation method.

Study design: Longitudinal, prospective, and observational design conducted over 3 seasons of professional male volleyball.

Level of evidence: Level 3.

Methods: The study included 43 male volleyball players. Internal training load was quantified using the Session Rating of Perceived Exertion. From daily training load values, absolute measures and relative measures were computed. For relative measures, 7 days were employed for acute training load, and 21 and 28 days for chronic training load. A distinction was made between coupled calculation and uncoupled calculation. Injuries were documented using the Injury Surveillance Form proposed by the International Volleyball Federation.

Results: ACWR calculated in a coupled manner and by a rolling average demonstrated higher injury risks when analyzing the complete periods (odds ratio [OR] ACWR 7:28 = 2.040; ACWR 7:21 = 1.980) and competitive period (OR ACWR 7:28 = 2.044; ACWR 7:21 = 2.087). In contrast, during the preseason, the coupled exponential averages were more sensitive to the risk of injury (OR ACWR 7:28 = 4.370; ACWR 7.504).

Conclusion: Both measures using rolling averages and those calculated from exponential averages can be employed to identify the risk of injuries in volleyball athletes.

Clinical relevance: The findings of this study can be useful to coaching staff, fitness trainers, and healthcare professionals involved in the challenge of reducing the risk of injury in volleyball athletes. The need for continuous monitoring and real-time adjustments of training load is emphasized.