Sports Health-A Multidisciplinary Approach最新文献

Background: Despite advancements in preparticipation physical examinations and cardiovascular evaluations, sport-related mortality persists. This study assesses athlete mortality over 25 years, stratifying data by sport, state, cause of death, socioeconomic factors, and age.

Hypothesis: Most athlete mortality would be due to sudden cardiac death (SCD) and occurred in contact sports in low-resource communities.

Study design: Descriptive epidemiology study.

Level of evidence: Level 3.

Methods: A retrospective search of athlete deaths occurring during games or practice from 1999 to 2024 was conducted using an online search engine (https://www.google.com/). Inclusion criteria required deaths to be related directly to athletic activity. Unrelated cases were excluded. The socioeconomic status of athletes was determined through the area deprivation index (ADI). Poisson regression was used to compare mortality rates with respect to sport type and region.

Results: A total of 593 athlete deaths were recorded, with a mean age of 16.2 years (range, 5-43). Most deaths occurred in male athletes (92%), at the high school level (70%), and during football participation (65%). Cardiovascular events were the leading cause of death (51%), followed by neurological causes (18%), and exertional heat stroke (11%). Mortality was highest during practice (69%) and was significantly more frequent in rural areas (P < 0.001). States with the highest mortality rates had an average national ADI of 67.8, indicating moderate socioeconomic deprivation, while states with the lowest mortality rates had an average ADI of 43.8. Exertional heat stroke accounted for 87.5% of deaths in football and was most prevalent in the South Atlantic region (P < 0.001).

Conclusion: Football had the highest rate of all-cause athlete mortality, driven by cardiovascular events, traumatic brain injuries, and exertional heat stroke. Mortality was disproportionately higher in rural areas during practice.

Clinical relevance: Higher mortality rates correlated positively with greater socioeconomic deprivation, as indicated by ADI values.

Context: The efficacy of orthobiologic therapies, such as platelet-rich plasma (PRP) and concentrated bone marrow aspirate (cBMA), is influenced by not only the biologic product but also the patient's systemic biological milieu. Emerging preclinical and clinical evidence suggests that modifiable metabolic factors, including obesity, insulin resistance, chronic low-grade inflammation, inflammaging, sarcopenia, dysbiosis, poor sleep, and lifestyle behaviors such as smoking and alcohol use, can impair tissue regeneration and reduce the effectiveness of orthobiologics.

Evidence acquisition: A structured approach guided article selection. Searches in PubMed, Embase, and Scopus through July 2025 were supplemented by reference checking. Terms included "metabolic optimization," "obesity," "insulin resistance," "inflammation," "sarcopenia," "dysbiosis," "sleep," "orthobiologics," "PRP," and "bone marrow aspirate." Preclinical and clinical studies, mechanistic reviews, and meta-analyses assessing the impact of metabolic factors on musculoskeletal regeneration and orthobiologic outcomes were included. Only English-language articles relevant to mechanisms, clinical implications, or patient optimization were considered.

Study design: Narrative review.

Level of evidence: Level 5.

Results: Evidence-based strategies to optimize metabolic health include targeted exercise, nutritional optimization, pharmacologic interventions, sleep regulation, microbiome support, and behavioral counseling for tobacco and alcohol cessation. While clinical evidence remains limited and of low methodological rigor, preclinical and available clinical studies support the plausibility, safety, and potential efficacy of these interventions. Optimizing metabolic factors can enhance tissue responsiveness, reduce interpatient variability, and improve orthobiologic therapy outcomes.

Conclusion: Optimizing metabolic health before orthobiologic therapy improves the biological environment and regenerative outcomes. Screening and managing factors such as insulin resistance, chronic inflammation, and poor sleep are essential. Further randomized controlled trials and biomarker-guided studies are needed to validate strategies and personalize interventions.Strength-of-Recommendation Taxonomy (SORT):C: Supported mostly by preclinical and indirect clinical evidence.

Background: Deficits in passive range of motion (ROM) and strength of the lead hip during the pitch among professional baseball pitchers are associated with increased injury risk to the core, groin, and throwing shoulder.

Hypothesis: A positive, linear relationship will link lead hip flexion at maximum shoulder external rotation (MER) with pitch velocity.

Study design: Descriptive laboratory study.

Level of evidence: Level 3.

Methods: Professional pitchers were divided into Low (<85°, n = 122), Moderate (85-95°, n = 137), and High (>95°, n = 80) groups based on lead hip flexion at MER, and pitched fastballs while using 3-dimensional motion capture (480 Hz).

Results: Pitchers in the Low, Moderate, and High groups did not significantly differ in age (P = 0.16), weight (P = 0.08), height (P = 0.36), or throwing hand (P = 0.54). Low pitchers had significantly less MER compared with High pitchers (P = 0.04); shorter stride length than Moderate and High pitchers (P < 0.001); greater lead knee extension velocity than High pitchers (P = 0.007); and less lead knee flexion at ball release than Moderate and High pitchers (P < 0.001). Low pitchers had greater shoulder anterior force, elbow anterior force, and elbow flexion torque compared with Moderate pitchers. Lead hip flexion at MER was not predictive in group (P = 0.89) or univariate analysis (P = 0.43) for ball velocity.

Conclusion: This study provides normative values for lead hip flexion angles throughout the pitch. Pitchers with moderate lead hip flexion at MER demonstrated significantly less shoulder anterior force, elbow anterior force, and elbow flexion torque compared with other groups, with no significant relationship with biomechanical efficiency or ball velocity.

Clinical relevance: Pitchers appear to benefit from maintaining lead hip flexion within an appropriate range at MER, near 90°, as either too much or too little can be disadventagous.

Background: The "heel hook" is a debilitating, high-percentage submission move in Brazilian jiu jitsu. While evidence suggests that the heel hook can result in severe ligamentous damage to the knee and/or ankle, definitive data on injuries from this technique are lacking. The purpose of this study was to assess the safety of the heel hook by comparing the incidence of knee and ankle injuries in International Brazilian Jiu Jitsu Federation (IBJJF) competitions where the move was permitted versus banned.

Hypothesis: Knee and ankle injury incidence will be higher in those exposed to the heel hook relative to those not exposed to the heel hook during competition.

Study design: Cross-sectional.

Level of evidence: Level 4.

Methods: Using data from 303 adult (<30 years old) and 455 masters (≥30 years old) division brown and black belt IBJJF competitors from 2021, and 164 adult brown and black belt competitors from 2009, we calculated injury frequencies, incidence rates per 1000 matches, and incidence rate ratios resulting from submission holds, emphasizing the heel hook.

Results: In 2021 (heel-hook-legal), knee injury incidence rate in exposed competitors was 26.5 per 1000 matches, while knee injury incidence rate in unexposed competitors was 2.2 per 1000 matches (relative risk [RR], 12.0; 95% CI, 1.5, 96.1; P < 0.001). There was no significant difference in ankle injury incidence in exposed (19.8 injuries per 1000 matches) versus unexposed (8.8 injuries per 1000 matches) competitors. There were no significant differences in ankle or knee injury incidence when comparing injury rates between athletes in 2009 and 2021.

Conclusion: Our findings indicate the heel hook significantly increased risk of knee injury.

Clinical relevance: Competitive BJJ athletes should engage in skill training to mitigate knee injury risk.

Context: This review synthesizes current literature regarding metabolic aspects of athlete bone health and incorporates evidence-based recommendations into a clinician-friendly algorithm.

Evidence acquisition: Published manuscripts listed in PubMed between 1993 and 2024 were reviewed. Relevant terms including keywords and section titles of manuscripts were searched, and relevant studies identified.

Study design: Clinical review.

Level of evidence: Level 1-3.

Results: A metabolic workup is often appropriate in the context of an athlete with bone stress injury (BSI) but varies based on clinical scenario. Evidence supports that all athletes with BSI be considered for a minimum workup including 25-hydroxyvitamin D (SORT A), complete blood count (CBC) (SORT B), and an iron panel with ferritin (SORT B). Athletes with features of low energy availability, including ≥2 Triad risk factors (low body mass index, abnormal uterine bleeding), or with multiple features of relative energy deficiency in sport require an initial strategy to correct energy availability (increased energy intake and/or decreased training load) and should be considered for dual-energy x-ray absorptiometry (DXA) (SORT A) and additional laboratory testing. If there is persistent clinical concern, a comprehensive laboratory evaluation should be considered, and varies based on athlete sex and clinical context. People with recurrent or multiple BSI or requiring surgical fixation also warrant detailed, stepwise testing for underlying causes (SORT C). A reasonable strategy starts with a focused workup for more common conditions (eg, CBC, complete metabolic panel, iron panel, 25-OH vitamin D, DXA) and may expand based on initial findings and clinical suspicion.

Conclusion: Existing evidence supports optimizing nutrition and further evaluation for factors influencing bone health for all athletes with BSI. More extensive workup is required in athletes with multiple features of low energy availability, multiple/recurrent BSI, BSI requiring surgical fixation, and signs/symptoms of an underlying medical disorder.Strength-of-Recommendation Taxonomy (SORT):A, B, C.

Background: This study aimed to develop an objective, repetition-based method for inter-set rest adjustment in resistance training (RT), addressing limitations of fixed and self-selected intervals.

Hypothesis: The adjustable protocol would yield greater repetition volume, higher velocity, and lower fatigue than the fixed protocol, with reduced time cost compared with the self-selected protocol.

Study design: Crossover randomized trial.

Level of evidence: Level 2.

Methods: A total of 20 young adults completed 3 RT protocols in randomized order: fixed, self-selected, and adjustable. Each protocol involved 5 sets of bench press and bench pull at approximately 75% 1 repetition maximal, performed close to failure. The protocols differed in inter-set rest strategy: fixed (3-minute rest), self-selected (participant-determined), and adjustable (based on previous set repetition count).

Results: Our findings indicated that the self-selected and adjustable protocols resulted in significantly greater repetition volume compared with the fixed protocol (F = 7.0; P = 0.003). Although the self-selected and adjustable protocols exhibited significantly higher fastest set velocity than the fixed protocol (F = 3.5, P = 0.04), the practical difference was only 0.01 m/s. In addition, no significant main effects of protocol were observed in mean set velocity, blood lactate concentration, or perceived exertion (F = 1.1-2.4; P = 0.10-0.58). In terms of time efficiency, the fixed protocol was the most efficient, followed by the adjustable protocol, with the self-selected protocol being the least efficient.

Conclusion: People using the adjustable protocol achieved greater repetition volume without increased metabolic stress or perceived exertion compared with the fixed 3-minute rest. Although the adjustable protocol sacrifices some time efficiency compared with the fixed protocol, it remains more efficient than the self-selected approach.

Clinical relevance: The repetition-based inter-set rest adjustment approach can serve as a feasible alternative to both fixed and self-selected inter-set rest approaches in RT.

Background: The ability to identify patients with long-term poor outcomes using clinical and functional information is limited. Identifying prognostic factors to improve long-term outcomes after anterior cruciate ligament (ACL) injury can influence and inform targeted interventions for this population.

Hypothesis: Preoperative functional tests and patient-reported outcome measures are predictive of postoperative functional recovery and satisfaction in patients undergoing first-time ACL repair, second-time ACL repair on the same knee, and bilateral ACL repair.

Study design: Quasi-experimental prospective study.

Level of evidence: Level 3.

Methods: A total of 88 patients with ACL reconstruction were included. Subjective knee scoring systems and functional performance tests were used for evaluation and analyzed for correlation with results.

Results: The first time ACL injury group had lower scores in the various self-report scales: Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Rating Scale, International Knee Documentation Committee (IKDC), and Lower Extremity Functional Scale (LEFS).

Conclusion: Reduction in self-reported knee function and Y balance test performance after ACL injury are predictive factors for recovery. Estimates exceeded clinically important thresholds. Those who had already undergone surgery had clinically better thresholds, highlighting the assessing these measures when designing presurgical rehabilitation programs.

Background: Undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) does not normalize the asymmetric knee biomechanics during gait that are related to the later development of post-traumatic osteoarthritis. ACL rupture and reconstruction have negative neuromuscular implications, disrupting knee joint afferent inputs that may be essential for central nervous system adaptability and motor learning. Here, we examined the ability of patients after ACLR to adapt knee joint biomechanics using a split-belt treadmill locomotor learning paradigm compared with uninjured controls.

Hypothesis: Patients after ACLR will be able to adapt and retain their knee joint mechanics, but to a lesser extent than controls.

Study design: Cross-sectional study.

Level of evidence: Level III.

Methods: We examined neuromuscular adaptations (ie, motor learning) using an evidence-based split-belt treadmill adaptation paradigm in 15 patients (20.8 ± 3.5 years old, 9 female), 3 to 9 months after ACLR and 15 control patients. During adaptation, the 2 treadmill belts were split (ie, moving at different speeds) to induce motor learning of new knee joint kinematic patterns. Three-dimensional motion capture was used to record joint kinematics and assess adaptation of knee flexion and extension angles. We also measured quadriceps strength, knee joint proprioception, and other markers of ACLR recovery.

Results: After ACLR, patients showed flexibility in motor patterns for peak knee flexion and extension angles. Our data showed no difference between patients after ACLR and uninjured controls in the extent of adaptation of either kinematic variable.

Conclusion: These data suggest that knee kinematics are malleable during rehabilitation, and demonstrate adaptability in the nervous system for knee joint angles during gait.

Clinical relevance: Current clinical interventions and evidence-based rehabilitation programs have not been successful in restoring gait mechanics. The current work indicates motor learning-based approaches can modify knee joint kinematics and therefore may be worthy of consideration in future interventions to address poor gait mechanics after ACLR.

Background: Kinetic and kinematic side-to-side limb asymmetries can increase after anterior cruciate ligament reconstruction (ACLR). Limb stiffness asymmetry has not been previously explored.

Hypothesis: Athletes with ACLR will exhibit greater asymmetry in limb stiffness, peak eccentric joint power, and eccentric joint work compared with asymptomatic controls during landing.

Study design: Case-control study.

Level of evidence: Level 4.

Methods: Forty athletes with 5.9 ± 1.4 months removed from ACLR and 40 asymptomatic athletes completed 7 stop-jumps (SJs) during a single session. Three-dimensional motion capture and ground-reaction force data were collected during landing. Normalized symmetry index values for limb stiffness, peak eccentric joint power, and eccentric joint work of athletes with bone-patellar tendon-bone (BPTB) grafts, athletes with hamstring grafts, and control athletes were compared.

Results: Athletes with ACLR had greater knee power Athletes with ACLR had greater knee power (BPTB, 29.1 ± 17.6; hamstring, 27.3 ± 14.1; Control, 14.2 ± 10.7; P < 0.01) and knee work (BPTB, 35.2 ± 21.5; hamstring, 32.1 ± 18.4; Control, 14.9 ± 10.1; P < 0.01) asymmetries than control athletes. Athletes with BPTB grafts and hamstring grafts both displayed larger knee power and work asymmetries compared with control athletes (P < 0.01 for each comparison), with no differences between graft types (P = 0.90 and P = 0.80, respectively). No between-group differences were found in limb stiffness (BPTB, 16.2 ± 10.8; hamstring, 13.5 ± 9.83; Control, 13.9 ± 9.33; P = 0.63), ankle power (BPTB, 16.5 ± 11.4; hamstring, 14.4 ± 13.0; Control, 18.3 ± 14.0; P = 0.55), ankle work (BPTB, 20.9 ± 13.0; hamstring, 17.4 ± 14.9; Control, 18.4 ± 12.8; P = 0.69), hip power (BPTB, 17.6 ± 12.8; hamstring, 19.5 ± 11.3; Control, 13.3 ± 9.08; P = 0.09), or hip work (BPTB, 17.2 ± 13.9; hamstring, 24.6 ± 14.1; Control, 16.2 ± 11.7; P = 0.06) asymmetries.

Conclusion: Athletes with ACLR use asymmetric landing strategies that favor their nonsurgical limb, resulting in greater knee power and knee work asymmetries compared with controls. No between-group asymmetry differences in limb stiffness, ankle power and work, and hip power and work were found.

Clinical relevance: After 5.9 ± 1.4 months removed from ACLR surgery, athletes favor their nonsurgical limb at the knee, risking further injury. While limb stiffness asymmetry was not different between groups, the groups appeared to modulate limb stiffness differently between limbs to produce similar asymmetry values.