Sports Health-A Multidisciplinary Approach最新文献

Background: Young female athletes may have higher rates of overuse injuries and sport specialization than male athletes. The association of sports specialization and return to sport (RTS) timeframe is also unknown.

Hypothesis: Specialized female athletes will have more intense, year-round training patterns, more overuse injuries, and longer RTS times than male athletes.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: Injured athletes aged 10 to 23 years presenting to a sports medicine clinic reported their degree of sport specialization and training patterns. Skeletal maturity was estimated using the Khamis-Roche method. Injury type and RTS timeframes were categorized from electronic medical records. Chi-square tests and logistic regression analysis assessed associations between variables.

Results: A total of 485 athletes (40.2% female) were enrolled. Higher degrees of sport specialization were associated strongly with overuse injuries (P < 0.01). After adjusting for specialization, female athletes were more likely to sustain an overuse injury (adjusted odds ratio, 1.49; P = 0.04). Female athletes participated in fewer total physical activity hours per week (P < 0.01), fewer free play hours per week (P < 0.01), and participated in their main sport for more months of the year than their male counterparts (P = 0.02). Female athletes were more likely to be at a higher developmental stage than male athletes (P < 0.01). RTS timeframes were increased in athletes with serious overuse injury; however, no association was found between degree of specialization and RTS time regardless of sex.

Conclusion: Female athletes are more likely to sustain overuse injuries with more organized, year-round, training and less free play compared with their male counterparts.

Clinical relevance: Female sex may be an independent risk factor of overuse injury. Future strategies to mitigate these risks may include increased free play hours and limiting year-round training through seasonal rest.

Background: Monitoring training load has the potential to improve sport performance and reduce injuries in athletes. This study examined training load and its association with wellness in artistic gymnastics.

Hypotheses: Training load and changes in training load (acute:chronic workload ratio [ACWR]) vary throughout 1 season; wellness is inversely correlated with training load and ACWR.

Study design: Prospective case series.

Level of evidence: Level 3.

Methods: A total of 30 female collegiate gymnasts from 4 Division I National Collegiate Athletic Association teams participated (mean age, 20 ± 2 years). During 4 months, before daily training, wellness surveys assessed sleep, energy, soreness, and mood (1-10; higher = better). After daily training, training load surveys assessed training duration per event (warm-up, vault, bars, beam, floor, strength and conditioning) and session rating of perceived exertion (RPE; 1-10; 10 = hardest) per event. Coaches reported technical complexity of training per event (1-4; 4 = hardest). Training load was calculated as [duration] × [RPE] × [technical complexity]. ACWR represented a ratio between acute [1-week] and chronic [4-week rolling average] training loads.

Results: ACWR and weekly training load fluctuated throughout the season (ACWR mean weekly range: 0.68-1.11; training load mean weekly range: 2073-6193 arbitrary units). ACWR and weekly training loads were trichotomized into low, medium, and high groups; positive correlations were observed between each wellness variable and ACWR (P < 0.01) and between each wellness variable and weekly training load (P < 0.01).

Conclusion: Our novel training load monitoring framework for women's college gymnastics enabled us to characterize training load and its relationship with wellness throughout 1 season. This method should be explored in gymnasts across various ages and competitive levels.

Clinical relevance: This study proposes a framework and the initial findings of monitoring training load and wellness in collegiate women's gymnastics.

Context: Fastpitch softball is a popular women's sport in the United States, and participation rates are increasing. There is growing concern about the prevalence of overuse injuries in softball pitchers at all competitive levels. Pitching workload in softball may be a modifiable risk factor and will be discussed in this narrative review.

Evidence acquisition: A review of softball injury research related to workload available in electronic databases, including PubMed, Medline, and EBSCO.

Study design: Clinical review.

Level of evidence: Level 4.

Results: There is a paucity of research evaluating workload (inclusive of internal and external risk factors) including pitch counts in women's softball. In particular, research has shown that pitchers report increasing fatigue and pain over a game and weekend tournament, and that the number of pitches thrown by pitchers varies widely. One study showed that pitchers throwing >85 pitches per game had an increased risk of injury over the season. As of 2023, no established pitch count restrictions exist in the United States or Canada. Further research, particularly at high school and collegiate levels, is needed.

Conclusion: Softball pitchers are at an increased risk of overuse injury and further research is needed to recommend specific workload interventions such as pitch counts.Strength-of-Recommendation Taxonomy (SORT): B.

Context: Athletes often face the dual challenge of high training loads with insufficient time to recover. Equally, in any team, sports medicine and performance staff are required to progress training loads in healthy athletes and avoid prolonged reductions in training load in injured athletes. In both cases, the implementation of a well-established psychological technique known as motor imagery (MI) can be used to counteract adverse training adaptations such as excessive fatigue, reduced capacity, diminished performance, and heightened injury susceptibility.

Study design: Narrative overview.

Level of evidence: Level 5.

Results: MI has been shown to enhance performance outcomes in a range of contexts including rehabilitation, skill acquisition, return-to-sport protocols, and strength and conditioning. Specific performance outcomes include reduction of strength loss and muscular atrophy, improved training engagement of injured and/or rehabilitating athletes, promotion of recovery, and development of sport-specific skills/game tactics. To achieve improvements in such outcomes, it is recommended that practitioners consider the following factors when implementing MI: individual skill level (ie, more time may be required for novices to obtain benefits), MI ability (ie, athletes with greater capacity to create vivid and controllable mental images of their performance will likely benefit more from MI training), and the perspective employed (ie, an internal perspective may be more beneficial for increasing neurophysiological activity whereas an external perspective may be better for practicing technique-focused movements).

Conclusion: We provide practical recommendations grounded in established frameworks on how MI can be used to reduce strength loss and fear of reinjury in athletes with acute injury, improve physical qualities in rehabilitating athletes, reduce physical loads in overtrained athletes, and to develop tactical and technical skills in healthy athletes.

Context: The logistical efficiency and flexibility of small-sided games (SSG) to develop various soccer-specific attributes simultaneously make them a staple component of contemporary training programs in youth soccer. Their high ecological validity and consequential high utilization mean that if not considerately prescribed, players may be exposed to frequent repetitive mechanical stress that may induce maladaptation in skeletally and/or load-naïve or sensitive athletes. The purpose of this clinical review is to summarize mechanical load adaptations associated with the manipulation of area per player in SSG to outline the mechanistic pathway of load-related injuries in skeletally maturing athletes and to offer practical guidelines for coaches for the preservation of athlete health.

Evidence acquisition: A nonsystematic search of computerized databases of peer-reviewed articles in English between 2010 and the present was used, and a critical appraisal of existing literature was subsequently conducted.

Study design: Clinical review.

Level of evidence: Level 4.

Results: The temporary relative strength deficit and inefficiency of the musculotendinous system associated with accelerated growth increase the mechanical cost of activity. As a result, the load tolerance (ie, tolerant, naïve, or sensitive) of athletes is transiently reduced as the musculoskeletal system struggles to attenuate force absorption adequately. Repeated exposure to submaximal mechanical loads that stimulate the accumulation of "microdamage" in structural tissue may lead to aggravation and/or tissue failure at connective sites in skeletally fragile athletes.

Conclusion: Coaches and practitioners need to individualize exposure to mechanical load for load-tolerant, naïve, and sensitive athletes during adolescence. Subtle changes to SSG prescription including modifying the area per player, inclusion of goalkeepers, constrained floaters, and management of work; rest ratios can offer practical and efficient methods to mitigate risk without derailing the development process. This, in turn, should contribute to reducing injury burden in this population and enhance developmental opportunities for young players.

Strength of recommendations: A. Recommendation based on consistent and good-quality evidence published from 2010 onwards.

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.

Background: Youth sport specialization is a growing trend in youth sports and is associated with an increased risk of injuries and burnout. However, it is unknown how sport specialization is perceived to be affecting the working environment of secondary school athletic trainers (ATs). The purpose of this paper is to describe how ATs perceive youth sport specialization impacting their workload and whether they perceive it to impact patient safety.

Hypothesis: ATs will perceive that youth sport specialization impacts their workload and could impact patient safety.

Study design: A sequential, explanatory mixed methods design with 2 phases: (1) cross-sectional surveys and (2) individual interviews.

Level of evidence: Level 3.

Methods: A total of 487 secondary school ATs completed the online survey (access rate, 8.4%; completion rate, 85.4%). The survey consisted of Likert questions and included sections about aspects of workload impacted by specialization, impacts on patient safety, demographics. Ten participants were selected to complete a semi-structured interview via video conference.

Results: Approximately two-thirds of ATs perceive that sport specialization impacts their workload. (Somewhat, 38.6%; Quite a bit, 25.5%; A great deal, 5.5%) Attempts to reduce or modify patient activity and a patient's time for rehabilitation were the highest rated aspects of workload impacted by sport specialization. Approximately 30% ATs (29.9%) perceive that sport specialization impacts their workload to where it may influence patient safety (Somewhat, 21.6%; Quite a bit, 6.4%; A great deal, 1.9%). Three themes and subsequent subthemes were identified from the qualitative interviews: (1) current youth sport expectations, (2) conflict between school and club sports, and (3) AT job impacts.

Conclusion: Secondary school ATs perceive their workload to be negatively impacted by youth sport specialization and some believe it may impact patient safety.

Clinical relevance: Youth sport specialization is impacting youth sport stakeholders, including ATs, in a variety of ways.

Background: Upper extremity (UE) dynamic balance is a significant physical fitness ability, which includes high-level neuromuscular proprioception, joint mobility, force, and coordination. The evaluation methods of UE dynamic balance are insufficient and lack experimental support. The Star Excursion Balance Test (SEBT) is a reliable assessment of dynamic balance and injury risk of the lower extremity.

Hypothesis: The UE-SEBT is a reliable and reproducible approach for evaluating dynamic balance of UEs.

Study design: Observational study.

Level of evidence: Level 4.

Methods: This cross-sectional study recruited 65 healthy adults. All participants were required to complete UE-SEBT, UE Y-balance test (UE-YBT), maximal voluntary isometric contraction (MVIC) of UE, closed kinetic chain UE stability test (CKCUEST), trunk flexor endurance test (TFET), trunk extensor endurance test (TEET), and lateral trunk endurance test (LTET). Intra- and inter-rater reliability and the correlation of UE-SEBT with other outcomes were measured.

Results: Among the participants, the intra- and interoperator reliability of UE-SEBT in all directions and composite score achieved a moderate-to-excellent (intraclass correlation coefficients [ICC], 0.729-0.946) reliability. For validity, the UE-SEBT had a moderate to very strong correlation with UE-YBT (r = 0.315-0.755, P < 0.01) and a strong correlation with CKCUEST (r = 0.4-0.67, P < 0.01). Furthermore, the UE-SEBT performance showed weak-to-strong correlations with MVIC (r = 0.26-0.43, P < 0.05). UE-SEBT was also correlated with LTET, TEET, and TFET to varying degrees.

Conclusion: UE-SEBT has good reliability and validity to assess UE dynamic balance compared with other tests.

Clinical relevance: UE-SEBT can be used as a clinical assessment method to evaluate UE dynamic balance and injury prevention.