Sports Health-A Multidisciplinary Approach最新文献

Context: Preoperative and postoperative strength training is beneficial for outcomes of total knee arthroplasty (TKA). However, the effect of high-intensity strength training is not well understood.

Objective: This systematic review and meta-analysis aimed to determine the effects of preoperative high-intensity strength training on TKA outcomes.

Data sources: PubMed, EMBASE, and Cochrane CENTRAL were searched up to December 18, 2023.

Study selection: Randomized controlled trials and cohort studies evaluating the effect of preoperative high-intensity strength training after TKA were eligible.

Study design: Systematic review and meta-analysis.

Level of evidence: Level II, systematic review and meta-analysis of randomized controlled trials and cohort studies.

Data extraction: Evaluated outcomes consisted of Timed Up and Go (TUG) test, the 6-minute walk test (6MWT), stair test, range of motion (ROM) flexion, Short Form Health Survey (SF-36) scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and the Knee Injury and Osteoarthritis Outcome Score for Activities of Daily Living (KOOS-ADL). These were compared between the intervention and control groups using pooled standardized mean differences. The quality of the studies was appraised using the Risk of Bias in Nonrandomized Studies by Interventions (ROBINS-I) and the Cochrane Collaboration tool.

Results: Seven studies, comprising 419 patients in total, were included. The meta-analysis showed that the preoperative high-intensity strength training group (intervention group) exhibited statistically significant improvements compared with the control group in 6MWT (pooled standardized mean difference [pSMD] = 0.73; 95% CI, 0.04 to 1.41), ROM flexion (pSMD = 0.40; 95% CI, 0.08 to 0.72), SF-36 (pSMD = 1.54; 95% CI, 0.32 to 2.75), and WOMAC (pSMD = -0.78, 95% CI, -1.22 to -0.34).

Conclusion: Preoperative high-intensity strength training as the prehabilitation programs for patients scheduled for TKA lead to better postoperative recovery, enhanced physical function, and improved quality of life.

Background: The level of interlimb asymmetry varies significantly across outcome measures, resulting in poor agreement in categorizing participants as (a)symmetric. Several researchers have discussed the need for an individual approach to data analysis and the need to perform multiple tests.

Hypothesis: Limb dominance does not consistently influence muscle function, and the direction of asymmetry may show low consistency across different muscle groups and across the various metrics applied to the same muscles.

Study design: Cross-sectional.

Level of evidence: Level 4.

Methods: A total of 71 subjects visited the laboratory once to undergo assessments for knee extensors (KEs) and knee flexors (KFs) separately for the dominant and nondominant limbs. Maximal voluntary force (MVF), rate of force development (RFD) at various time intervals (50, 100, 150 ms) and at its peak (RFD_peak), and RFD-scaling factor (RFD-SF) were obtained. Approximate entropy (ApEn), coefficient of variation, and detrended fluctuation analysis (DFAα) of force signal were also calculated during sustained submaximal contractions. Analyses of variance or Wilcoxon signed-rank test assessed differences in each metric between muscle groups and limbs. Kappa coefficients (κ) were calculated to determine the level of agreement for the direction of asymmetry.

Results: Except for RFD₁₅₀ (d = 0.305) and RFD-SF (r_rb = 0.280) for KF, no differences between dominant and nondominant limb were observed. All κ values were null, slight or fair (all κ ≤ 0.23).

Conclusion: The dominant limb is not necessarily stronger than the nondominant limb. The direction of asymmetry varies depending on the metric and muscle considered. Our findings corroborate that asymmetries are ubiquitous in physical performance with neuromuscular asymmetries observed in 75% of subjects.

Clinical relevance: These findings highlight the necessity of comprehensive assessment across a multimetrics approach, identifying imbalances and tailoring personalized programs to address performance asymmetries effectively.

Background: Women are typically more prone to knee injuries than men, possibly due to poorer hamstrings-to-quadriceps ratio (HTQ), particularly during fast velocity movements.

Hypothesis: Men would have greater HTQ across velocity than women.

Study design: Cross-sectional study.

Level of evidence: 2.

Methods: Ultrasound images quantified quadriceps and hamstrings muscle cross-sectional area (CSA) in 27 study participants (14 women, age, 24 ± 4 years; 13 men, age, 25 ± 6 years). Peak torque (PT) was taken from maximal voluntary isometric contractions (MVICs) and isokinetic leg extension and flexion contractions from 60° to 300° s^-1. Independent samples t-tests examined differences in CSA and HTQ from CSA. Mixed-factorial ANOVAs examined differences in PT and HTQ from PT.

Results: Men had larger CSA and PT than women for leg extension and flexion across velocity (P < .01). There were no sex-based differences in the HTQ from CSA or PT across velocity (P ≥ .11). For both groups, leg extension PT decreased from MVIC to 300° s^-1 (P ≤ .04). For women, leg flexion PT was the same from MVIC to 60° s^-1 (P > .98), decreased from 60° to 180° s^-1 (P < .01), and plateaued from 180° to 300° s^-1 (P ≥ .07). For men, leg flexion PT decreased from MVIC to 300° s^-1 (P ≤ .03). For both groups, HTQ increased from MVIC to 60° s^-1 (P < .01), then plateaued from 60° to 300° s^-1 (P > .98).

Conclusion: Both groups had similar patterns of response for leg extension PT and HTQ across velocity, with no sex-based differences for HTQ. Factors other than HTQ may account for the potential sex-based difference in knee injury risk.

Clinical relevance: Increased knee injury predisposition for women compared with men may be due to neuromuscular control or anatomy rather than HTQ.

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 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: Radiographic evaluations are commonly used to determine calcaneal ossification staging throughout pediatric development. Sonographic imaging may offer a less expensive, noninvasive, clinically feasible option for calcaneal developmental assessments. Here, we assessed (1) inter-rater agreement of radiographic and sonographic calcaneal ossification staging of children and adolescent patients with Sever's disease and (2) agreement between radiographic and sonographic calcaneal ossification staging scores.

Hypothesis: There would be substantial agreement of radiographic and sonographic calcaneal ossification staging across raters, and between imaging measures.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: Adolescent patients (<18 years of age) with physician-diagnosed Sever's disease who had complete calcaneal sonographic and radiographic imaging available on a retrospective chart review were included. Three independent reviewers with advanced training in musculoskeletal ultrasound each separately assessed radiographic and sonographic imaging data and assigned calcaneal calcification stages (0-5) to blinded images based on established criteria. Fleiss' Kappa analyses were used to determine inter-rater staging agreement for both imaging approaches. Cohen's Kappa analyses were used to determine the agreement between radiographic and sonographic staging. Absolute agreement, and relative agreement within each stage were assessed for both analyses.

Results: Data from 19 patients (13 female, 6 male; 12.2 ± 2.3 years) were included. Absolute inter-rater agreement for radiographic and sonographic calcaneal ossification staging was comparable across the 3 raters (radiographs, κ = 0.692, z = 9.02; P < .01; sonographs, κ = 0.713, z = 7.95; P < .01), and perfect relative agreement (κ = 1.0, z = 10.6; P < .01). Consensus scores for radiographic and sonographic staging had moderate (κ = 0.535, z = 4.2; P < .01, and perfect relative (100% relative agreement, z = 6.22; P < .01) agreement.

Conclusion: Sonographic evaluations of calcaneal ossification staging was comparable across assessors, and similar to radiographic staging.

Clinical relevance: Clinicians may consider incorporating ultrasound imaging for calcaneal ossification staging for young patients.

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: 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: Diminished corticospinal excitability is theorized to contribute to poor quadriceps function after anterior cruciate ligament (ACL) reconstruction. Operant conditioning of the motor evoked torque (MEP_TORQUE) is a promising approach capable of improving corticospinal excitability. However, it is unknown whether increasing corticospinal excitability can improve quadriceps function after a short-term operant conditioning intervention in patients with reconstructed ACL.

Hypothesis: After ACL reconstruction, patients would demonstrate increases in quadriceps strength, voluntary activation, and corticospinal excitability after a 2-week operant conditioning intervention.

Study design: Randomized controlled clinical trial.

Level of evidence: Level 1.

Methods: A total of 22 patients with reconstructed ACL were randomized into 1 of 2 groups: group 1 received 2 weeks of operant conditioning training on the reconstructed leg to improve their transcranial magnetic stimulation (TMS)-elicited MEP_TORQUE responses (COND); group 2 received 2 weeks of TMS only (SHAM-COND). Quadriceps strength, voluntary activation, and corticospinal excitability on the reconstructed leg were evaluated before and after the 2-week intervention. Within-session changes in corticospinal excitability were also evaluated during the training sessions.

Results: The COND group demonstrated a significantly higher within-session percent increase in MEP_TORQUE during training compared with the SHAM-COND group, paralleled by a significant increase in corticospinal excitability after the 2-week intervention. In addition, quadriceps strength and voluntary activation improved on the reconstructed leg after the 2-week intervention, regardless of group.

Conclusion: Operant conditioning training can elicit improvements in corticospinal excitability after ACL reconstruction; however, improvements in quadriceps strength and voluntary activation seem not to be attributed solely to operant upconditioning training.

Clinical relevance: Operant conditioning is a promising approach to improve corticospinal excitability after ACL reconstruction. However, optimizing the delivery of operant conditioning protocols by potentially increasing the dosage of operant conditioning and intervening earlier after surgery may be needed to translate these changes to improvements in quadriceps function.