Sports Health-A Multidisciplinary Approach最新文献

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.

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.

Context: Exercise immunology is aimed at understanding how exercise sessions can affect the immune system in athletic subjects of different age groups. The objective of the current study was to discuss in which stage of biological maturation (BM) young athletes may be more vulnerable in relation to the immune system, and whether there is a BM range in which it is safer to perform sports training with strenuous exercise loads.

Evidence acquisition: Evidence from scientific research from several scientific disciplines (eg, immunology, sport immunology, pediatrics, sports medicine, human development) was gathered to holistically examine the main particularities of exercise immunology as applied to pediatric sport.

Study design: Narrative review.

Level of evidence: Level 5.

Results: In pediatric patients, lymphoid tissue expands during puberty and involutes after puberty until it returns to pre-expansion values. This suggests that there is a specific period in which the immune system may be stronger, which may provide opportunities for strenuous exercise in pediatric athletes. However, the chronological period when puberty occurs will be determined by BM, which is the rate at which the biological systems of the human body improves. This may affect the period of lymphoid tissue expansion and, consequently, the behavior of the immune system in pediatric subjects of the same age category.

Conclusion: During puberty, there is a significant increase in the proinflammatory profile; to compensate for this, there is an expansion of lymphoid tissue that may favor the efficiency of the immune system. The period in which puberty is reached may vary according to the stages of BM. Therefore, in exercise immunology applied to pediatric sports, in addition to external and internal training loads, it is necessary to consider BM and puberty, which have been shown to be safer biomarkers than chronological age for determining immune system behavior in pediatric athletes.

Strength-of-recommendation taxonomy (sort): Evidence B level 3.

Context: Volleyball is a complex sport involving multifaceted movements and high-velocity actions, leading to diverse external training loads (ETLs) that have profound implications for player performance and injury risk.

Objective: To provide a comprehensive overview of the measurement of ETL in volleyball, identify gaps in current understanding, and offer valuable insights for stakeholders in the field.

Data sources: The literature search was conducted across the following electronic databases: PubMed/Medline, Scopus, Web of Science, and SPORTDiscus.

Study selection: Studies were selected based on their relevance to the measurement of ETL in volleyball.

Study design: A scoping review methodology was chosen to map and summarize the broad body of literature related to ETL measurement in volleyball.

Level of evidence: Level 4.

Data extraction: Data related to ETL measurements in volleyball were extracted and analyzed from the selected studies, focusing on metrics utilized, player positions examined, and technologies employed.

Results: A total of 18 studies related to ETL in volleyball were identified and examined for this review. Despite the importance of sagittal plane movements in volleyball, the review identified a substantial research gap regarding ETL measurements beyond this plane, as well as a lack of focus on the unique demands of different player positions like the liberos. The use of technologies such as inertial measurement units was prevalent, but more comprehensive measurement methods are needed.

Conclusion: There is a critical need for diversified ETL metrics in volleyball, extending beyond the conventional sagittal plane measurements. The findings highlight a substantial research gap in addressing the unique demands of different player positions, notably the liberos. This study underscores the importance of incorporating multiplanar movement data, player-specific roles, and advanced measurement technologies to develop more tailored training programs and injury prevention strategies.

Background: Load management is a sports science concept describing the execution of well-established training principles to measure athletic workloads and enhance performance. The term 'load management' has become common in sports media to refer to a much wider range of scenarios, including the idea that by limiting regular season workload for athletes, their health and playoff performance will improve. Varying links between load and performance have been demonstrated in baseball and soccer. The purpose of this study was to objectively assess the impact of regular season workload on postseason performance among National Hockey League (NHL) goalies.

Hypothesis: NHL goalies with lighter regular season workloads will perform better in postseason appearances.

Study design: Retrospective cohort.

Level of evidence: Level 3.

Methods: NHL goalies with a minimum of 20 regular season games played and 3 playoff game appearances in the same season since 2013-2014 were eligible for inclusion. All regular season and postseason workload and performance metrics were collected from publicly available statistical databases. Workload outcomes included games started, minutes played, and shots faced. Performance outcomes included goals against average, save percentage, goals saved above average, and quality start percentage. Multivariable linear regression was used to determine whether regular season workload predicted postseason performance, when controlling for age and injury status.

Results: A total of 51 goalies contributed 111 goalie-seasons to the analysis. The results of the primary model indicated that regular season workload explained only 6.8% of the variance in postseason performance, and that this relationship was not significant (R² = 0.068; F(5,92) = 1.335; P = 0.26).

Conclusion: Based on data from 6 full seasons, there is no evidence to support a specific regular season game limit among NHL goalies with the aim of improved performance.

Clinical relevance: Individualized workload plans may be more appropriate than a single league-wide standard.

Background: Shoulder pain is one of the most common musculoskeletal complaints in overhead athletes. This study investigated the prevalence of the main risk factors and sex differences related to the development of shoulder pain in a cohort of amateur overhead athletes.

Hypothesis: The external rotation/internal rotation (ER/IR) isometric strength ratio <0.75% is the most prevalent risk factor associated to overuse shoulder injuries in both sexes.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: A total of 296 (147 male and 149 female) amateur overhead athletes from handball, volleyball, and water polo participated in this cross-sectional study. Isometric strength, rotational range of motion, and scapular control were analyzed bilaterally. The measurements and motions were randomized between sides.

Results: The ER/IR isometric strength ratio deficit among the disciplines was presented in 264 and 229 out of 296 athletes in the dominant and nondominant sides, respectively. Normalized isometric strength showed significant differences for dominant (P < 0.01; ε² = 0.47) and nondominant IR (P < 0.01; ε² = 0.60). No significant differences were observed between dominant (P = 0.44; ε² = 0.05) and nondominant ER (P = -0.24; ε² = 0.07). The prevalence of glenohumeral IR deficit (GIRD) (P = 0.81) and total arc of motion differences (TAMD) (P = 0.39) was low, with no difference between sexes. Male (16.3%) and female (12.1%) athletes had low rate of obvious scapular dyskinesis in their dominant shoulders.

Conclusion: Muscle strength was the most prevalent risk factor. The ER/IR ratio imbalance was present in both sides, without sex differences. Risk factors such as scapular dyskinesis, GIRD, and TAMD were present in low percentages, without sex differences.

Clinical relevance: It is advisable to implement shoulder exercises to strengthen ER muscles to decrease differences between internal and external rotators and prevent injuries in overhead athletes.

Background: Baseball pitching injuries can be related to fatigue. Changes in grip and pinch strength over the course of professional baseball games are unknown.

Hypothesis: Grip and pinch strength will decrease as the number of innings pitched increases; injured pitchers will have a lower grip strength than uninjured pitchers.

Study design: Prospective cohort study.

Level of evidence: Level 3.

Methods: Minor league pitchers for 1 affiliate of a single organization were included. Changes in dominant and nondominant grip, and middle and index finger pincer strength were recorded pregame and after each inning, and compared between players who sustained a shoulder/elbow injury and those who did not.

Results: Of 41 pitchers included, 6 sustained a shoulder (n = 2) or elbow (n = 4) injury during the study period. Average grip strength for all pitchers was 124.5 ± 17 lb pregame and increased slightly after the first inning (125.2 ± 17 lb), then declined slowly after the second (120.7 ± 18.5 lb), third (119.2 ± 24 lb), and fourth (113.1 ± 19.6 lb) innings. There was a slight uptick in grip strength in the fifth (118.5 ± 23.6 lb) and sixth (121.3 ± 21.8 lb) innings, but pregame levels were not reached. Evaluating uninjured and injured pitchers, the grip strength of injured pitchers was lower at all timepoints. As a percentage of uninjured pitchers grip strength, injured pitcher grip strength was 94.8% pregame, and 97.9%, 95.4%, 81.8%, 87.7%, 82.3%, and 74.5% after the first to sixth innings, respectively.

Conclusion: Dominant arm grip strength generally declined over the course of a game in professional baseball pitchers. Injured pitchers generally had weaker grip strength and a steeper decline in grip strength during games compared with uninjured pitchers.

Clinical relevance: Incremental loss of grip strength may increase injury risk in professional baseball pitchers.

Background: Factors associated with performance outside of a normative range on dynamic exertion test (EXiT) after sport-related concussion (SRC) remain unknown. This study examined the role of demographic and medical history factors on performance using minimal detectable change (MDC) cutoff scores in athletes being cleared to return to sport (RTS) from SRC.

Hypothesis: Older age, being female, and body mass index (BMI) ≥50th percentile would be associated with worse EXiT performance and with increased likelihood of falling outside the normative MDC score range.

Study design: Cross-sectional.

Level of evidence: Level 3.

Methods: Demographic factors, physiological metrics, performance metrics, symptoms, and ratings of perceived exertion were collected from 55 participants (age, 16.5 ± 2.3 years, 31.5% female) initially evaluated within 14 days of SRC who completed EXiT at medical clearance for RTS. Chi-square analyses, logistic and ordinal regressions, and 1-way analyses of variance examined factors associated with EXiT performance.

Results: Most participants fell within the MDC score range on aerobic (71.2-100%), dynamic (75.8-100%), and change-of-direction (36.5-98.0%) tasks, and symptoms (96.2-100%). Older age was associated with better performance on Box Drill Shuffle (P < 0.01) and lower heart rate (HR) outcomes after Ball Toss (P = 0.04), Box Drill Shuffle (P < 0.01), Box Drill Carioca (P = 0.04), and Pro Agility (P < 0.01). Greater BMI was associated with higher HR_%max after Ball Toss (P < 0.01) and worse posttreadmill aerobic performance (P < 0.01). Motion sickness history was associated with longer Zig Zag completion time (P = 0.036).

Conclusion: Most athletes presenting for clearance from concussion performed within MDC score ranges on EXiT metrics.

Clinical relevance: EXiT is accurate and effective in assessing response to dynamic exertion after SRC, and MDC scores can inform RTS decisions. Clinicians should consider age, BMI, and history of motion sickness when assessing EXiT performance.

Background: The contribution of vastus medialis oblique muscle (VMO) weakness or dysfunction to patellofemoral pain syndrome is well recognized, yet its role in lateral patellar instability and recurrent patellar dislocations remains unclear. This study investigates the association between VMO characteristics and patellar instability.

Hypothesis: Altered VMO structure, characterized by differences in muscle elevation and cross-sectional area (CSA), is associated with patellar instability.

Study design: A case-control study.

Level of evidence: Level 3.

Methods: The study included 204 participants, matched on a 1:1 ratio by age and sex, from a local hospital registry from 2005 to 2020. VMO measurements were taken via magnetic resonance imaging, and included muscle elevation, CSA, fiber angulation, and CSA-to-thigh circumference ratio. Univariate analysis, and multivariable regression model with adjustment for potential confounders were constructed. In addition, a secondary analysis was performed to evaluate the variations in VMO characteristics and mass across primary and recurrent patellar instability groups.

Results: Patients with patellar instability demonstrated significant differences in VMO characteristics compared with controls, including increased muscle elevation (13 mm vs 5.9 mm; P < 0.01), increased muscle fiber angulation (42.5° vs 35.3°; P < 0.01), reduced CSA (716 mm² vs 902 mm²; P < 0.01), and a lower CSA-to-thigh circumference ratio (0.05 vs 0.07; P < 0.01). These findings remained significant in the multivariable adjusted model. Moreover, the secondary analysis revealed that both primary and recurrent instability patients had similar VMO characteristics alterations compared with controls, with slightly more pronounced reductions in VMO CSA in those sustaining recurrent instability episodes.

Conclusion: This study confirms a statistically significant association between altered VMO characteristics and patellar instability, emphasizing the importance of considering VMO characteristics in the evaluation and management of patients with patellar instability.

Background: Risk factors for anterior cruciate ligament reconstruction (ACLR) construct failure have been studied extensively. However, while some studies account for variables such as activity level, construct types, preoperative physical therapy, or patient demographics individually, comprehensive studies that control for all these factors simultaneously are scarce.

Hypothesis: By utilizing a robust multivariable analysis, the factors associated with an increased risk of ACLR construct failure can be determined.

Study design: A single-center, retrospective cohort study was conducted, encompassing patients who underwent primary ACLR between January 2015 and December 2021.

Level of evidence: Level 3.

Methods: Eligible patients were identified using the current procedural terminology code 29888. Datapoints collected included demographics, body mass index, injury setting, graft type, graft size, fixation type, concomitant ligamentous injuries, notchplasty, operating surgeon, preoperative physical therapy, and instances of construct failure. The prevalence of construct failure was analyzed using chi-square tests, comparing across all graft and fixation type combinations in ACLR procedures. A mixed-effects logistic regression model was utilized to account for the potential influence of all relevant variables on construct failure.

Results: Out of 1245 patients, the construct failure rate was 5.62% (n = 70), with >95% of patients having >2 years of retrospective follow-up (95% CI [4.34-6.90]), with a median failure time of 502.5 days (interquartile range [265.5-1033.8]). The mixed-effect logistic model identified preoperative physical therapy (odds ratio, 0.404, 95% CI [0.193-0.844]) as the only significant factor in possibly preventing construct failure.

Conclusion: Contrary to conventional focus on graft and fixation types, this study emphasizes the protective role of preoperative physical therapy in reducing ACLR construct failure.

Clinical relevance: Our findings suggest the integration of preoperative physical therapy in clinical practices to mitigate ACLR construct failure risk, warranting further exploration in future studies.