Sports Health-A Multidisciplinary Approach最新文献

Background: The force-velocity profile (FVP) is essential for understanding sprint performance, capturing parameters such as maximum theoretical force (F₀), maximum theoretical velocity (V₀), and power (P_max). Effective horizontal force application, especially during acceleration, enhances sprinting outcomes. Resisted sprint training (RST) using varied loads (light, moderate, heavy) can improve neuromuscular adaptations, sprint mechanics, and sport-specific performance. This study explores the effects of RST with different load magnitudes.

Hypothesis: Heavy loads (HL) in athletes with no previous experience in RST are expected to promote better results on sprint performance than light loads (LL) and no loads (CON).

Study design: Randomized clinical trial.

Level of evidence: Level 3.

Methods: Professional male and female football players and referees without experience in sled sprint, allocated into HL (80% of body mass [BM]), LL (20% of BM), and CON (0% of BM) groups, performed RST twice weekly over 6weeks, with pre- and postintervention assessments of sprint performance.

Results: RST with HL significantly improves acceleration, maximum velocity, and horizontal force application. The HL group demonstrated reduced sprint times, enhanced force production during the acceleration phase, and improvements in maximum velocity metrics such as V₀ and maximum velocity (V_max). The LL group showed small benefits in V₀ and decreased times in the 10 meter to 20 meter and 20 meter to 30 meter splits. Intergroup comparisons revealed that the HL group obtained better results compared with the LL and CON groups.

Conclusion: Both LL and HL improved the right spectrum of the FVP. However, the HL group also improved the acceleration phase variables and force production at low velocity.

Clinical relevance: These findings suggest that HL provides superior neuromuscular adaptations and mechanical outputs compared with lighter loads in athletes without previous experience in RST. The inclusion of professional female football players expands the applicability of these results.

Context: Small-sided soccer games (SSSG) have been proposed as a strategy to promote the health of children and adolescents. Understanding training loads has a strong influence on program effectiveness.

Objective: This systematic review aimed to describe the training load and perception of enjoyment during SSSG in untrained children and adolescents.

Data sources: A systematic search on PubMed, Web of Science, Scopus, and Scielo databases was performed.

Study selection: Experimental or observational studies conducted in untrained children or adolescents (6 to 18 years) that analyzed internal loads, external loads, or perceived enjoyment during 1 or more SSSG were included.

Study design: Systematic review following PRISMA guidelines.

Level of evidence: Level 3.

Data extraction: Information on publication type, participants, SSSG characteristics, and main results of the internal and external load and perceived enjoyment was extracted.

Results: A total of 15 articles (n = 539 participants, aged 8-18 years) were included. Twenty-one SSSG designs were identified, and the format used most was 3v3. Heartrate (HR) (range 71%-88% of maximum HR) and rate of perceived exertion (range 3-7 of 10 or 12-15 of 20) were the primary measures of internal load, while distance traveled, average speed, and number of accelerations were used to assess external load. Perceived enjoyment was reported using mainly the 16-item PACES or 18-item PACES scale (59.14 or 88.67, respectively). The structural aspects of the game were evaluated in 6 studies, suggesting that the number of players, pitch size, man-marking, and restricting the type of locomotion may affect workload. Contextual factors, such as verbal motivation or sex, can also influence workload.

Conclusion: SSSG is associated with moderate-to-vigorous intensity exercise and high enjoyment perception. Workload can be affected by structural (number of players, pitch size, man-marking) and contextual factors (verbal encouragement, sex composition), although evidence is still limited.

Background: There is little available information on the reduction of injury incidence and injury burden after strength training programs. This study aimed to analyze the effects of a 12-week high-load strength training program on injury incidence, injury burden, and fitness in young, highly trained, soccer players.

Hypothesis: It was hypothesized that well-targeted high-load training focused on the gluteal and hamstring musculature could aid in injury prevention and increase physical fitness.

Study design: A randomized controlled trial design was applied, which followed the CONSORT Statement.

Level of evidence: Level 2.

Methods: Twenty players were assigned randomly to the experimental group (EG, n = 10 players), who performed a high-load strength training program, or to the control group (CG, n = 10 players), who performed only their usual soccer training. Injury incidence (injuries per 1000 hours exposure) and injury burden (days of absence per 1000 hours exposure) were recorded during the intervention, as well as the physical fitness attributes before and after the training program.

Results: A significant (P < 0.05) lower injury incidence was observed in the EG (CG, 11.34 vs EG, 1.31 injuries per 1000 hours of exposure) and a significant (P < 0.001) lower injury burden in the EG (CG, 304.66 versus EG, 19.72 days of absence per 1000 h of exposure). The analysis of covariance model revealed significant between-group differences favoring the EG, showing significantly greater improvements in jumping, change of direction ability, sprinting, and imbalance strength tests (P < 0.001; effect size, 3.02 to -7.23).

Conclusion: This study demonstrated the beneficial effects of a 12-week high-load strength training program on injury incidence, injury burden and physical fitness, in highly trained soccer players.

Clinical relevance: This study provides positive information for implementing this type of strength training in the daily training sessions of young soccer players for both performance enhancement and injury prevention.

Background: Adolescent sport culture is moving away from multisport participation, emphasizing sport specialization for improved skill development despite concern of injury. This study examined biomechanical differences among low-, moderate-, and high-level specialized pitchers.

Hypothesis: Kinetics, kinematics, and peak velocities will vary with specialization level.

Study design: Descriptive laboratory study.

Level of evidence: Level 3.

Methods: Adolescent male baseball pitchers' (N = 46) pain, injury, baseball exposure history, and pitching biomechanics were measured during a single pitching session. Means and standard deviations were calculated for all metrics (significance, P ≤ 0.05) and compared among low-, moderate-, and high-level specialization groups.

Results: Stride length increased significantly (P = 0.03) from low- (mean, 74% height; SD, 13.6; 95% CI, 64.3-83.8) to high-level (mean, 92.9% height; SD, 6.3; 95% CI, 79.7-86.1) specialization. Hip-shoulder separation at foot contact increased significantly (P = 0.01), with low-, moderate-, and high-level specialization demonstrating means of 21.9° (SD, 12.1; 95% CI, 13.3-30.6), 31.1° (SD, 7.0; 95% CI, 27.7-34.4) and 30.0° (SD, 5.3; 95% CI, 27.3-32.8), respectively. Maximum torso rotation velocity and maximum shoulder internal rotation (IR) velocity increased significantly (P = 0.03) from low- to high-level specialization rising from 930.5 deg/s (SD, 68.4) to 1020.0 deg/s (SD, 75.7), and from 4284.2 deg/s (SD, 311.6) to 4827 deg/s (SD, 512.2), respectively. Peak shoulder distraction force also increased significantly from low- to high-level specialization (P = 0.03), rising from 0.81 N (% bodyweight) (SD, 0.13; 95% CI, 0.72-0.91) to 0.96 N (% bodyweight) (SD, 0.12; 95% CI, 0.89-1.02). There were no significant differences among age, height, weight, or pitch speed across pitching specialization level.

Conclusion: Differences in pitching biomechanics were observed among low-, moderate-, and high-level specialized high school baseball pitchers.

Clinical relevance: Recognizing the impact of sport specialization and negative influences on pitching biomechanics will contribute positively to performance training and injury prevention strategies.

Background: Arm injuries in baseball continue to rise. Previous studies have confirmed relationships between shoulder strength, injury risk, and performance in baseball athletes. Shoulder strength measures vary considerably within and among baseball players and are influenced heavily by anthropometric measures. Presently, the normalization of shoulder strength measures has not been tested adequately to meet necessary statistical assumptions.

Hypothesis: At least 1 shoulder strength normalization method would meet 2 statistical assumptions: the intercept assumption and correlation assumption.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: Isometric shoulder strength was tested in a cohort of uninjured baseball athletes on the dominant limb via handheld dynamometry: external rotation (ER), internal rotation (IR), and scapular plane abduction (SCAP). Five normalization methods were assessed using 2 statistical assumptions to determine the most appropriate normalization method for each shoulder strength measure: first, the regression line between a participant characteristic (body mass, height, ulnar length, and their respective combinations) and the unnormalized strength measure passes through the origin; second, normalizing shoulder strength eliminates its correlation with the participant characteristics. Statistical significance was set a priori at α < 0.05.

Results: Body mass normalization was the only normalization method that satisfied the intercept and correlation assumptions for ER, IR, and SCAP strength (P > .05).

Conclusion: Normalizing shoulder ER, IR, and SCAP strength in uninjured baseball athletes using body mass satisfied both statistical assumptions. When clinicians seek to compare shoulder strength in baseball athletes of differing anthropometric make-up, using body mass as the denominator is the most appropriate method for normalization.

Clinical relevance: The utilization of a statistically supported shoulder strength normalization method is warranted to account for anthropometric differences when comparing strength between athletes. This study adds a clinically relevant and reproducible method for normalizing isometric shoulder strength in uninjured baseball players.

Background: Sports concussion receives heavy attention from researchers. Conversely, research devoted to performing arts concussion is scant, despite a variety of head injury opportunities in artistic endeavors and environments. Circus is a high-energy, high-velocity performing art for which minimal concussion research is available.

Purpose: Assess via medical records the 10-year concussion incidence in Cirque du Soleil (CdS) performers and the variables surrounding their concussions.

Study design: Descriptive epidemiology.

Level of evidence: Level 5.

Methods: Data were extracted from CdS performers' medical records for 2010 to 2019: sex, age at injury, performance type, artistic discipline, mechanism of injury, performance context, and time-loss from full participation. Yearly artist-exposures for all CdS artists were identified. Data were analyzed for both resident and touring shows.

Results: Over 10 years there were 2,733,073 exposures, with 354 concussions sustained among 296 performers. Acrobats were the most commonly concussed (82.8% of all concussions). There were 1.30 concussions per 10,000 artist-exposures. Repeat concussions accounted for 58 concussions (16.4%). Full return to performance occurred at a mean of 35.5 ± 100.3 days. The highest rate of concussions was in 2019 (1.93 per 10,000 artist-exposures); 2010 had the lowest (0.86 per 10,000 artist-exposures). More concussions occurred during performances than training sessions; nearly half (170 of 354) occurred during the first of 2 shows presented nightly. There was no significant difference in overall incidence between resident and touring performers. The most frequent concussion mechanisms were impact with apparatus/equipment (113 of 354) or with another artist (106 of 354).

Conclusion: The concussion incidence of CdS artists is noteworthy compared with sports concussions. Acrobats sustained the most concussions. Concussions occurred more frequently during performances than during training.

Clinical relevance: These new data on performing arts concussions highlight the prevalence and incidence of concussions in circus performers for healthcare professionals who care for them.

Background: Assess the association between changes in injured leg knee extension and flexion strength (peak torque) and self-reported and performance-based measures of leg function after a variety of youth sport-related, time-loss knee injuries.

Hypothesis: There will be a relationship between changes in knee muscle strength and changes in measures of leg function in youth after a sport-related knee injury.

Study design: Prospective cohort study.

Level of evidence: Level 2.

Methods: This was a secondary analysis of the Alberta Youth Prevention of Early Osteoarthritis (PrEOA) Cohort study (Edmonton) that included youth (11-19 years old) who had experienced a medical attention, time-loss, sport-related knee injury in the previous 4 months. Injured leg knee extensor and flexor concentric peak torque (isokinetic; 90 deg/s), triple hop distance, modified Y-balance test (YBT), and Knee injury and Osteoarthritis Outcome Score Sport subscale (KOOS_sport) were assessed at baseline (≤4 months postinjury) and 6 and 12 months later. Adjusted associations between 6- and 12-month change in strength and functional measures were assessed using multivariable regression (95% CI).

Results: Based on data from 106 participants (16.2 ± 1.8 years old), a 1 Nm increase in knee extensor strength (6-12 months) was associated with a 0.9 cm (95% CI, -0.5, 2.3) increase in hop distance. Similarly, every 1 Nm increase in knee flexor strength (6-12 months) was associated with a 0.3 cm (95% CI, -1.1, 1.7) increase in hop distance. Across other models, a 1 Nm increase in extensor or flexor strength was associated with a 0- to 0.3-point increase in KOOS_sport score.

Conclusion: There was minimal-to-no longitudinal relationship between changes in knee extensor or flexor strength and changes in triple hop or YBT performance, or self-reported function within the first year after a youth sport-related knee injury.

Background: The King-Devick (KD) test is a timed rapid number naming test used for the acute diagnosis of concussion.

Hypothesis: The KD test will be more sensitive, but less specific, than other commonly used objective tests for concussion.

Study design: Case-control study.

Level of evidence: Level 4.

Methods: National Collegiate Athletic Association Division I college athletes completed baseline testing for the KD. When an athlete presented acutely with suspected concussion from July 1, 2020 to December 31, 2022 (sideline/within 48 hours) the test was repeated. If a concussion was diagnosed, a control matched on comorbid conditions, sex/gender, team, season, and baseline test time was identified to test.

Results: Baseline and postinjury data were collected for 97 concussed and 97 matched control athletes. In total, 44% of concussions occurred in female athletes, with most concussion occurring in football 37 (38%), women's volleyball 14 (14%), and softball 6 (6%). The KD test had fair test-retest reliability at 0.72 (95% CI, 0.61-0.80). The sensitivity and specificity of the test for any increase in time compared with baseline was 81% and 56%, with a positive predictive value of 65% and negative predictive value of 75%. The AUC was also fair at 0.75 (0.68-0.82). There was no significant difference in accuracy of the KD taken at different times points (immediate, 2-8 hours, 8-24 hours, 24-48 hours).

Conclusion: The KD is more sensitive, but less specific, than other commonly used objective tests for concussion. Understanding the psychometric properties of the KD can help with the diagnosis of concussion.

Clinical relevance: The KD may be a good initial screening tool to prompt further evaluation or allow return to play without further evaluation. Further study in other populations is needed.

Context: Reverse shoulder arthroplasties (RSAs) have become significantly more common in recent decades, and shoulder arthroplasties are increasingly performed on younger, active patient populations. However, the body of evidence evaluating return to sport after RSA is limited.

Objective: To evaluate the rates of return to sport after RSA as well as patient-reported outcomes for pain and function.

Data sources: A comprehensive search of MEDLINE, EMBASE, and CENTRAL identified studies from inception through October 10, 2023.

Study selection: Studies evaluating return to sport after RSA in adult patients (>18 years) were included. Reviews, meta-analyses, non-English language, and studies that did not report return to sport data were excluded. Outcomes included rates of return to sport at any level, and at the same level or higher, as well as patient-reported outcomes.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: A descriptive analysis of the included studies was performed.

Results: A total of 19 studies (3092 patients) were included. Mean patient age was 72.5 years, and most (58.8%) were female. The mean rate of return to sport at any level was 85.1% (95% CI, 84.6-85.6). The mean rate of return to the same level or higher was 69.5% (95% CI, 67.6-71.4). The mean decrease in visual analog scale pain score was 1.97, whereas ASES and CMS scores increased 64.0 and 35.5 points, respectively. All changes in patient-reported outcomes exceeded the minimal clinically important difference.

Conclusion: This review demonstrates a high rate of return to sport after RSA, with a substantial portion of patients maintaining or exceeding their preoperative activity level. Clinically meaningful improvements in pain and function were also observed. Limitations include the predominantly retrospective study design and the high mean patient age, necessitating further research on generalizability and long-term outcomes, particularly in younger populations.