Sports Health-A Multidisciplinary Approach最新文献

Background: Injury prevention training using a global systems approach was designed to develop integrated trunk-lower extremity neuromuscular control using whole-body, rotational forces about the vertical Z-axis during simulated sports movements.

Hypothesis: Compared with traditional hip-focused exercises, injury prevention training using a global systems approach could improve kinetic and kinematic measures related to anterior cruciate ligament injury.

Study design: Controlled laboratory study.

Level of evidence: Level 3.

Methods: A total of 39 male and female athletes received 6 weeks of either global systems approach (n = 20), or hip-focused strengthening, balance, and plyometrics training (n = 19) exercises. Before and after the training program, participants performed a single-leg vertical drop jump task on their dominant leg. Peak vertical ground-reaction forces (GRFs), peak knee abduction, internal rotation moments, peak hip flexion, hip adduction, knee flexion, knee abduction, contralateral pelvic drop, and lateral trunk flexion angles were assessed. Biomechanical data were compared between the 2 groups using a random-intercept linear mixed-models analysis.

Results: A significant group × time interaction effect was found for vertical GRFs (P = 0.01; change difference relative to baseline: 4.5%), knee abduction moment (P = 0.01; 14.8%), hip adduction (P < 0.01; 16.7%), knee abduction (P < 0.01; 13.8%), contralateral pelvic drop (P < 0.01; change difference: 26.6%), and lateral trunk flexion (P = 0.04; 20.37%) angles, favoring the global systems approach group after 6 weeks of training.

Conclusion: Participants who trained using the global systems approach had significantly decreased lateral trunk flexion, hip adduction, knee abduction and contralateral pelvic drop angles, peak vertical GRFs, and peak knee abduction moment during a single-leg vertical drop jump compared with participants who trained with hip-focused exercises.

Clinical relevance: Incorporating additional external resistance at the proximal trunk results in improved biomechanics compared with conventional hip-focused exercises.

Background: Operative treatment of chronic exertional compartment syndrome (CECS) with fasciotomy is effective for symptomatic resolution, but outcomes at medium- to long-term follow-up are unclear.

Hypothesis: Patients will have favorable satisfaction at medium- to long-term follow-up and a high return to sport (RTS) rate after fasciotomy for treatment of CECS.

Study design: Cross-sectional.

Level of evidence: Level 3.

Methods: Retrospective review of patients who underwent fasciotomy for treatment of CECS from 2010 to 2021. Outcomes were assessed using Tegner Activity Scale, symptom resolution, patient satisfaction, return to activities, and EQ-5D-5L survey.

Results: Fifty patients (23 male and 27 female) were included. Mean age at time of surgery was 29.0 ± 11.6 years with mean follow-up 6.0 ± 2.3 years (range, 2.6-10.9). Tegner activity scores at final follow-up were improved compared with symptom onset (mean, 5.2 vs 3.3; P < 0.01). Increased preoperative symptom duration correlated with decreased RTS (β = -0.447; P = 0.01) and return to work (RTW) (β = -0.572; P = 0.01). Patients with a previous psychiatric diagnosis (n = 15) had lower rates of RTS (β = -0.358; P = 0.03) and RTW (β = -0.471, P = 0.02). Mean time to RTS was 5.5 ± 6.1 months. Mean visual analogue scale satisfaction rate was 74.4; 36 (72.0%) patients would be willing to have their fasciotomy again. Patients with fasciotomy of 1 to 2 compartments had higher Tegner score at final follow-up (P = 0.02) than those who had fasciotomy of >3 compartments; 19 (38.0%) patients reported experiencing paresthesia after their operation. No patients experienced major complications.

Conclusion: Medium- to long-term outcomes of patients with CECS treated with fasciotomy demonstrated high satisfaction levels and high RTS rate. However, rate of minor complications including paresthesia, swelling, and cramping was high.

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: Head injury rates in lacrosse may be higher among women compared with men. Understanding these trends can guide appropriate injury prevention for female athletes.

Hypotheses: Injuries most commonly involve the head, with no significant decline over the study period; contact with other players would be the most common injury mechanism.

Study design: Descriptive epidemiological.

Level of evidence: Level 3.

Methods: The National Electronic Injury Surveillance System (NEISS) was queried (January 1, 2008 to December 31, 2022) for women's lacrosse injuries presenting to United States (US) emergency departments (EDs). Patient demographics, injury diagnosis, body part injured, disposition, and clinical narrative were extracted. The provided narrative identified the mechanism of injury. Linear regression analysis assessed trends over time.

Results: An estimated 57,635 women's lacrosse injuries occurred during the study period extrapolated from 1899 evaluated NEISS cases. The mean age was 15.81 ± 5.35 years, with 68.3% of injuries sustained by high school (14- to 18-year-old) players. Over one-third of all injuries were to the head (national estimate [NE], 19,358; 33.6%), followed by the ankle (NE, 10,475; 18.2%), then the knee (NE, 6969; 12.1%). Strain/sprains were most common (NE, 19,402; 33.7%) followed by closed head injury (CHI)/sports-related concussion (SRC) (NE, 11,794; 20.5%) and contusion/abrasion (NE, 10,605; 18.4%). ED presentations of CHIs/SRCs and fractures remained elevated with no significant decline over the study period (P > 0.05), despite a significant decrease in strains/sprains and contusions/abrasions (P < 0.01 and P = 0.01, respectively). The most common injury mechanism was collision/contact with another player (NE, 10,664; 18.5%).

Conclusion: An estimated one-third of women's lacrosse players in the study sample had a head injury. CHIs and SRCs accounted for 20.5% of all injuries.

Clinical relevance: Given the high proportion of contact-related head injuries, headgear mandates and improved player safety protocols may be warranted.

Background: Evidence as to how patient thigh muscle strength and limb loading (LL) during a squatting task recovers throughout rehabilitation after anterior cruciate ligament reconstruction (ACLR) is lacking.

Hypothesis: Patients will improve LL and strength throughout rehabilitation. Changes in LL and strength over time will be positively correlated.

Study design: Prospective cohort study.

Level of evidence: Level 3.

Methods: A total of 60 participants (28 male/32 female; age, 22.5 ± 9.35 years) participated in 2 visits post-ACLR, assessing LL and strength. Using an instrumented pressure mat, patients completed 3 sets of 3 repetitions of bodyweight squats. Peak force (N), unilateral cumulative load (%), and quadriceps and hamstring isokinetic peak torque (N·m) were calculated and recorded bilaterally. LL and peak torque were compared over time and between limbs.

Results: A significant limb-by-time interaction was observed for LL peak force (N), where patients underloaded the ACLR limb at visit 1 compared with the contralateral limb (P < 0.01). Patients increased their ACLR LL across visits (P = 0.04). A limb-by-time interaction for quadriceps peak torque (N·m) was observed where the ACLR limb increased peak torque across visits (P < 0.01); however, strength deficits persisted at visit 2 (P < 0.01) when compared with the nonoperative limb. Weak correlations were observed between all change scores metrics (r, 0.20-0.25).

Conclusion: Patients recovering from ACLR exhibited more symmetric loading during a squatting task and improved their lower extremity strength over time. Changes in strength were not related to changes in LL during a squatting task over time.

Clinical relevance: Squatting tasks are safe and easily implemented throughout ACLR recovery. As changes in functional LL and strength recovery are not related, both should be considered in serial postoperative testing for more comprehensive function and strength assessments.

Background: Softball pitchers accrue high rates of injury. Research suggests certain mechanics at discrete pitch events are related with pain. Here, we examine relationships between peak throwing shoulder kinetics and trunk/pelvis kinematics and compare trunk/pelvis kinematics between pitchers who were healthy and those currently experiencing pain.

Hypothesis: (1) Peak shoulder kinetics would be positively related to greater trunk and pelvis flexion, lateral flexion, and rotation; and (2) pitchers in pain would exhibit greater trunk and pelvis flexion, lateral flexion, and rotation during the pitch than those who were pain-free.

Study design: Cross-sectional study.

Methods: A total of 42 high school pitchers (height, 1.71 ± 0.06 m; weight, 75.0 ± 15.9 kg; age, 16 ± 2 years) were separated into 2 groups based on presence or absence of pain. Peak kinetic data from 3 pitches per pitcher were averaged and used as dependent variables. Kinematic data were averaged across 3 trials, and time normalized to 101 datapoints between foot contact and follow-through of the pitch. Statistical parametric mapping regressions were used to assess the relationships between peak shoulder kinetics and waveform of trunk and pelvis kinematics.

Results: Pelvic lateral tilt significantly predicted peak throwing shoulder superior (P = 0.05) and lateral (P = 0.04) force. Pelvis rotation predicted peak superior force (P = 0.02). Waveform analyses revealed no waveform differences between healthy pitchers and those currently experiencing pain.

Conclusion: Peak shoulder kinetic variables are related with pelvic positioning during the pitch; however, trunk and pelvis kinematics do not differ according to presence of pain.

Clinical relevance: Pitchers in pain do not adopt specific trunk and pelvic alterations during the pitch, potentially concealing the effects of pain from visual identification. Coaches and clinicians need to discuss health status with pitchers versus relying on visual observations to understand pain and injury risk.

Background: Shoulder injuries are prevalent in adolescent water polo (WP) players. Study aimed to determine whether preseason shoulder characteristics (range of motion [ROM], flexibility, and strength) and core endurance can identify athletes at risk of future shoulder injuries.

Hypothesis: Shoulder characteristics, including changes in ROM (internal rotation [IR], external rotation [ER], and total), strength (IR and ER), pectoralis minor flexibility, shoulder capsule flexibility, and core endurance, would be risk factors for shoulder reinjury in athletes with previous overuse injuries compared with noninjured athletes.

Study design: Prospective cohort study.

Level of evidence: Level 3.

Methods: At baseline, 53 male youth WP players (mean age, 16.6 ± 3.5 years) were assigned to Group 1 (with previous shoulder injuries [G1, n = 26]) and Group 2 (without previous shoulder injuries [G2, n = 27]). ROM, flexibility, strength, and core muscle endurance were assessed preseason. After a 12-month follow-up, players were again divided into those who developed new shoulder injuries (G3, n = 27) and those who remained healthy (G4, n = 26).

Results: Total of 26 players (49%) had previous shoulder injuries at baseline. At baseline, decreased pectoralis minor flexibility, IR, total ROM, and core endurance were found in players with a previous shoulder injury compared with players without a previous shoulder injury (P < 0.05).

Conclusion: At baseline, a significant difference was present in proposed risk factors (shoulder and core endurance parameters) between players with and without a previous shoulder injury. Shoulder IR ROM and years of experience were significant predictors of shoulder injury. Early detection of modifiable proposed risk factors may help prevent reinjury in young athletes.

Clinical relevance: Screening at an early age can help identify and address pre-existing injuries, support youth athletes' return to sport after a shoulder injury, prevent new injuries, and improve performance.

Background: Unplanned sidestep cutting and forward single-leg jump-landing contribute to non-contact anterior cruciate ligament (ACL) injuries in netball. Neuromuscular training programs (NMTPs) have shown promising results in reducing injury risk in certain populations when compliance is high. Compliance is easier to achieve when NMTPs are effective yet require minimal time for completion.

Hypothesis: Once- and thrice-weekly intervention groups would be equally effective in reducing knee abduction and internal rotation moments during forward single-leg jump landing and unplanned sidestep cutting.

Study design: Randomized controlled trial.

Level of evidence: Level 3.

Methods: External peak knee abduction and peak knee internal rotation moments during unplanned sidestep cutting and forward single-leg jump-landing were assessed pre- and post-intervention for 17 elite-level female netballers assigned randomly to either a once-weekly or thrice-weekly group. Regular netball training continued throughout the intervention, which lasted 6 weeks (30 minutes/session). One-way analysis of covariance (α = 0.05) was utilized to compare post-intervention peak knee abduction and peak knee internal rotation moments between groups, controlling for pre-intervention knee moments during the forward single-leg jump-landing and unplanned sidestep cut. Paired t tests were used to examine within-group changes in knee moments pre- versus post-intervention.

Results: For unplanned sidestep cuts on the right leg, both groups differed significantly, with the once-weekly group displaying a decrease in peak knee internal rotation moments [F(1,14) = 5.23; P = 0.04] whereas the thrice-weekly group did not. No other significant group interactions were found.

Conclusion: A condensed NMTP with targeted exercises, performed once-weekly as part of regular training, shows potential to reduce peak knee internal rotation moments that are injurious to the ACL during unplanned sidestep cutting in adult female netballers.

Clinical relevance: A once-weekly targeted NMTP would pose minimal disruption to a high-performing athlete's training schedule and likely increase compliance to ensure the success of the NMTP.

Background: Estimating repetitions in reserve (RIR) has been established as a valid and practical method for monitoring set configuration concerning proximity to failure in resistance training. However, factors such as sex and exercise equipment could interfere with the estimation process. Therefore, this study aimed to determine the influence of sex (female vs male) and exercise equipment (free-weight vs Smith machine) on the RIR estimation at different relative loads during the bench press exercise.

Hypothesis: Men would be more accurate than women in the RIR estimation, and participants would better perceive their actual effort at the Smith machine compared with the free-weight bench press exercise.

Study design: Repeated measures design.

Level of evidence: Level 3.

Methods: In a counterbalanced order, recreationally trained participants (12 female, 14 male) performed 2 identical sessions with the free-weight bench press exercise in 1 week and 2 identical sessions with the Smith machine bench press exercise in another week (first session for familiarization and second session for validity analysis). In each session, participants performed single sets of repetitions to failure against 3 relative loads (65%, 75%, and 85% of the 1-repetition maximum [1RM]).

Results: Results revealed a significant interaction between RIR and sex at 65% 1RM (P < 0.01; women: -1.2 [-1.7 to -0.6] repetitions; men: -0.1 [-0.6 to 0.3] repetitions), and between RIR and exercise equipment at 65% 1RM (P < 0.01; free-weight: -1.1 [-1.5 to -0.6] repetitions; Smith machine: -0.2 [-0.6 to 0.2] repetitions), but not at 75% and 85% 1RM.

Conclusions: RIR estimation is a valid method for monitoring set configuration. However, this method tends to underestimate RIR at 65%1RM with female athletes and in the free-weight exercise for both sexes.

Clinical relevance: Strength and conditioning coaches should help their athletes understand effort awareness in the aforementioned context.

Background: Rates of emergency action plan (EAP) implementation and compliance with EAP guidelines vary in United States secondary schools. There are limited data on emergency preparedness in schools without athletic trainers (ATs).

Hypothesis: Rural and high poverty schools have poor emergency preparedness for high school athletic events due to financial barriers and lack of ATs.

Study design: Cross-sectional study.

Level of evidence: Level 5.

Methods: A web-based questionnaire was emailed by each State High School Athletics Association to ATs, athletic directors, and coaches of recipient schools to assess emergency preparedness.

Results: A total of 686 responses were received (response rate ~3.5%). Schools with an AT on staff were more likely to have an EAP (P < 0.01). Schools with a higher enrollment were more likely to have an EAP (P < 0.01), an AT on staff (P < 0.01), require additional training for coaches (P < 0.01), and have an automated external defibrillator (AED) onsite for all events (P < 0.01). Urban (odds ratio [OR], 3.514; 95% CI [2.242, 5.507]; P < 0.01) and suburban (OR, 4.950; 95% CI [3.287, 7.454]; P < 0.01) districts were more likely than rural districts to have an AT on staff. High poverty districts were less likely to have an AED (OR, 0.660; 95% CI [0.452, 0.964]; P = 0.03) or EAP (OR, 0.511; 95% CI [0.306, 0.853]; P < 0.01) at athletic venues.

Conclusion: Lower enrollment, high poverty, and rural schools are less prepared for athletic emergencies than their higher enrollment, low poverty, and suburban counterparts as these schools are generally less likely to have an AT on staff, AEDs, and EAPs and less likely to provide additional training to coaches and other staff.

Clinical relevance: This study assesses athletic emergency preparedness-a critical component of ensuring athlete safety and recovery after injury.