Sports Health-A Multidisciplinary Approach最新文献

Background: The improvement of physical fitness parameters is beneficial for child gymnasts to maximize functionality. Core stability exercises (CSEs) help maintain spinal stabilization during athletic performance. Thus, they contribute to enhancing gymnasts' performance on various movements and planes. This study aimed to investigate the effect of 8-week CSEs training on the physical fitness parameters of child gymnasts.

Hypothesis: An 8-week CSEs intervention could be beneficial for improving the various physical parameters in child gymnasts.

Study design: Randomized trial.

Level of evidence: Level 2.

Methods: Thirty-six child gymnasts (aged 7-12 years) were allocated randomly into a training group (TG) and control group (CG). Participants in the TG received CSEs in addition to the traditional program for 8 weeks. The physical fitness parameters of all participants were assessed twice before and after training.

Results: The results showed that all participants' scores of balance, endurance, sprint, and jumping parameters improved after exercise programs (P < 0.05). The muscle strength and flexibility scores of the TG showed a statistically significant difference compared with the CG (P < 0.05). However, compared with other parameters, there were no significant changes seen in the scores between groups (P > 0.05).

Conclusion: The CSEs training contributed to the improvement of all physical fitness parameters in child gymnasts.

Clinical relevance: The addition of CSEs to traditional training could help improve athletic performance in child gymnasts.

Context: Tennis-specific musculoskeletal (MSK) screening can assess range of motion (ROM) and muscular imbalances. Identifying normative values before implementing a MSK screen is essential in contributing to athlete performance and injury risk profiles.

Objective: To review upper extremity MSK data in healthy tennis players across age, sex, and level of play.

Data source: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. A search was conducted in MEDLINE, SPORTDiscus, Embase, and CINAHL.

Study selection: This review included shoulder, elbow, and wrist ROM, isometric strength, or isokinetic strength in a tennis population. Each article was critically appraised to help identify the internal and external validity of each study.

Study design: Systematic review.

Level of evidence: Level 3.

Data extraction: A total of 41 studies met the search criteria. Each contributor organized the data elements of interest into data tables, with a second contributor assigned for review. Data elements of interest included player and study characteristics: ROM, isometric dynamometry, and isokinetic strength.

Results: A total of 3174 players were included in the final studies. Most of the players included were competitive adolescents and young adults; 15 studies included ROM data. Male tennis players consistently had more external rotation (ER) gain (range, 1.8º to 8.8º) and internal rotation (IR) loss (range, -15.3º to -3.0º) when compared with their female counterparts (ER range, -2.5º to 5.8º; IR range, -10.4º to -3º). Shoulder IR and ER strength were measured in the majority of all the strength studies, with the external rotators generating at least two-thirds the strength of the internal rotators.

Conclusion: Overall MSK data of tennis players indicate that shoulder strength values are often larger than nontennis players, but equal to or slightly lower than comparable athletes in other overhead sports. Adaptive changes of the glenohumeral joint and subsequent rotational motion are similar to those of other overhead athletes.

Context: In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today.

Evidence acquisition: Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used.

Study design: Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed.

Level of evidence: Level 2.

Results: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome.

Conclusion: Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost.

Strength-of-recommendation taxonomy (sort): Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B).

Context: Bicycle motocross (BMX) has become increasingly popular since its inclusion in the 2008 Olympics, but it has some of the highest injury rates (IRs) in multisport studies. To support planning for tailored primary prevention, understanding gaps in BMX injury prevention is crucial.

Objective: To examine the evidence on injury incidence, prevalence, risk factors, prevention strategies, and prevention implementation in BMX.

Data sources: Ovid MEDLINE, Embase, APA PsycInfo, CINAHL, and SPORTDiscus were searched systematically in June 2023.

Study selection: Articles including BMX and any injury as the main topic or subtopic were searched across multiple databases.

Study design: A scoping review was designed following the PRISMA Extension for Scoping Reviews (PRISMA-ScR).

Level of evidence: Level 4.

Data extraction: BMX injury incidences, prevalence, risk factors, prevention strategies, and prevention implementation were extracted. Two reviewers screened all studies and extracted data independently.

Results: Of the 1856 articles screened, 37 met inclusion criteria. Most studies used injury surveillance at elite competitions or emergency departments, and common injuries were contusions, lacerations, and fractures. IRs provided were based primarily on elite competition and were heterogeneous (eg, 2016 Olympics: 37.5 per 100 athletes; 2007 BMX World Championship: 11.7 per 100 athletes; 1989 BMX Euro Championship: 6.6 per 100 athletes). Only 1 study stratified IRs by BMX discipline (BMX freestyle: IR, 22.2 injuries per 100 athletes; BMX racing: IR, 27.1 per 100 athletes). Few prevention strategies have been evaluated, but reducing the number of riders per race could be helpful.

Conclusion: Most BMX studies do not use recommended injury surveillance methodology. Studies based on emergency department data may underestimate minor injuries and do not adequately measure BMX exposures. Rigorous community-based prospective studies examining IRs for both BMX racing and freestyle, risk factors, and prevention strategies are needed to inform widespread evidence-based prevention strategies.

Background: Legal performance enhancing substance (PES) use is increasing in young athletes and may lead to banned PES use. This study examines legal PES use and consideration of banned PES use in young athletes with a season-ending injury (SEI) compared to young athletes with non-SEI/no previous injury.

Hypothesis: Young athletes sustaining SEI or concussions have increased odds of reporting legal PES use and consideration of banned PES use compared with non-SEI or no injury.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: Cross-sectional study from 2013 to 2020 of athletes aged 6 to 25 years.

Results: No association was found between reporting legal PES use or consideration of banned PES use and young athletes with SEI or concussion compared with no injury/non-SEI. 14% of athletes reported legal PES use and 3% reported consideration of banned PES use. In adjusted analysis, athletes who were male (odds ratio [OR], 1.38; 95% CI, 1.16-1.73; P = 0.03), have history of depression (OR, 3.01; 95% CI, 1.26-7.18; P = 0.01), weight train (OR, 1.66; 95% CI, 1.04-2.65; P = 0.03), and believe that athletic ability is influenced by weight (OR, 1.75; 95% CI, 1.08-2.83; P = 0.02) had increased odds of reporting legal PES use. Older (OR, 1.18; 95% CI, 1.03-1.36; P = 0.02) and male (OR, 1.57; 95% CI, 1.02-1.81; P < 0.04) athletes had increased odds of consideration of banned PES use.

Conclusion: This study found no increased odds of reported PES use in young athletes with sports-related injury or concussion regardless of injury type or severity. Factors associated with PES use were male sex, age, history of depression, weight training, and belief that weight affects athletic performance.

Clinical relevance: Risk factors associated with PES use in young athletes are essentially unknown. This study can inform pertinent clinical care, education, and policy implementation.

Background: The regional hypertrophy response of elbow flexor muscles was compared after unilateral elbow flexion training in extended versus flexed shoulder position under vascular occlusion, which can induce muscle hypertrophy in the absence of muscle damage-induced edema/swelling.

Hypothesis: Hypertrophy of elbow flexor muscles would be greater in extended compared with flexed shoulder position.

Study design: Randomized within-subject trial.

Level of evidence: Level 2.

Methods: A total of 21 resistance-trained men (age, 25 ± 5 years; height, 1.78 ± 0.07 m; weight, 79.3 ± 13.1 kg) performed unilateral elbow flexions with one shoulder extended/elbow flexor muscles lengthened/long muscle length (LONG) and the other flexed/elbow flexor muscles shortened/short muscle length (SHORT) under a low-load (30% 1-repetition maximum) vascular occlusion training regimen (15 repetitions per set, 4 sets per session, 4 sessions per week for 3 weeks, using 80% of vascular occlusion pressure). Magnetic resonance imaging measured elbow flexor muscles cross-sectional area (EFCSA) pre- and post-training at 45%, 65%, and 85% of humerus length.

Results: EFCSA significantly increased in both SHORT (P = 0.04) and LONG (P = 0.05) at 45% and 85% lengths (P < 0.01 for both). Changes in EFCSA between SHORT and LONG were statistically similar at the 45% (+6.20% vs +5.08%; Cohen d = 0.006; P = 0.98), 65% (+5.91% vs +3.83%, Cohen d = 0.28, P = 0.30), and 85% lengths (+8.51% vs +7.38%, Cohen d = 0.18,P = 0.56).

Conclusion: Muscle hypertrophy of the elbow flexor muscles displayed a similar behavior after low-load elbow flexion training with vascular occlusion performed in the extended versus flexed shoulder position.

Clinical relevance: Therapists, clinicians, and coaches may choose elbow flexion exercises expecting to achieve similar results for hypertrophy in this muscle group, such that exercise selection may rely on availability of equipment in the training room or personal preference.

Background: This study explored concussion assessment and management self-efficacy and practices of allied healthcare professionals in Ireland.

Hypotheses: (1) Self-efficacy levels and practices vary across different concussion assessment and management skills, (2) the ability to practice skills impacts self-efficacy most.

Study design: Cross-sectional.

Level of evidence: Level 3.

Methods: Survey of allied healthcare professionals (285 responders), investigating (1) demographics, (2) concussion assessment (immediate and office) and management (postconcussion advice and management/rehabilitation) self-efficacy levels and practices, and (3) factors affecting self-efficacy.

Results: Levels of self-efficacy among clinicians were 64.5 ± 26.6 (immediate assessment) and 56.6 ± 25.4 (postconcussion advice) (highest scores: concussion symptom checklist [80 ± 28.4], physical rest advice [80.1 ± 27.8]; lowest: Child Sport Concussion Assessment Tool [44.6 ± 41.2] and nutrition advice [34.1 ± 33.7]). Overall levels of self-efficacy among Certified Athletic Therapists and Chartered Physiotherapists were 51.5 ± 20.1 (assessment) and 62.1 ± 20.9 (management) (highest scores: history/clinical evaluation nonspecific to concussion [86.6 ± 16.2], physical rest advice [86.3 ± 20]; lowest: paper/pencil neuropsychological test [16.7 ± 28.6], advice on medication use [39.2 ± 35]). A strong positive correlation was observed between clinician self-efficacy and frequency of use of overall (r = 0.795; P < 0.01) and immediate (r = 0.728; P < 0.01) assessment, advice (r = 0.805; P < 0.01), and management (r = 0.812; P < 0.01) skills. Factors with greatest positive impact on clinician self-efficacy were the ability to practice skills during clinical placement (3.3 ± 0.9) and remaining emotionally (3.3 ± 0.8) and physically (3.3 ± 0.8) calm while practicing.

Conclusion: Clinicians in Ireland had moderate self-efficacy in concussion care. Those who used concussion-relevant skills frequently in practice displayed higher self-efficacy for those skills.

Clinical relevance: Concussion-related self-efficacy can be enhanced through practice in a clinical environment and through experiencing composure while practicing.

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: 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.