Sports Health-A Multidisciplinary Approach最新文献

Background: Basketball-related fractures involving the lower extremities frequently present to emergency departments (ED) in the United States (US). This study aimed to identify the primary mechanisms, distribution, and trends of these injuries.

Hypothesis: We hypothesize that (1) lower extremity fracture frequency will decrease from 2013 to 2022, (2) the ankle will be the most common fracture site, and (3) noncontact twisting will 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 for lower extremity fractures from basketball presenting to US EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury location, and disposition were recorded. The injury mechanism was characterized using the provided narrative. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression.

Results: There were 6259 cases (NE: 185,836) of basketball-related lower extremity fractures. Linear regression analysis of annual trends demonstrated a significant decrease in lower extremity fractures over the study period (2013-2022: P = 0.01; R² = 0.64). The most common injury mechanism was a noncontact twisting motion (NE: 49,897, 26.9%) followed by jumping (NE: 39,613, 21.3%). The ankle was the most common fracture site (NE: 69,936, 37.6%) followed by the foot (NE: 49,229, 26.49%). While ankle and foot fractures decreased significantly (P < 0.05), fractures of the lower leg, knee, toe, and upper leg showed no significant trends (P = 0.09, 0.75, 0.07, and 0.85, respectively).

Conclusion: Basketball-related lower extremity fractures decreased from 2013 to 2022, with the ankle being the most common fracture site and most fractures arising from a noncontact twist. Increasing utilization of outpatient clinics may have contributed to the decline, particularly for ankle and foot fractures. The prevalence of ankle fractures and twisting-related injuries reinforces the importance of protective footwear and targeted strengthening protocols.

Background: The health benefits associated with recreational running are challenged by the occurrence of running-related injuries (RRIs). Effective preventive measures require knowledge of sport injury etiology. Psychological factors such as perfectionism, mental toughness, and passion are believed to predispose to sports injury by influencing training behaviors, motivation to run, and suppression of feelings of fatigue and pain. Yet their association with RRIs are understudied.

Hypothesis: Perfectionism, mental toughness, and passion predict an increased risk of RRIs in recreational runners.

Study design: Prospective cohort study.

Level of evidence: Level 3.

Methods: A total of 143 recreational runners (age 34.9 ± 13.9 years, 37% women) with a response rate of 76.5% answered an online questionnaire about their characteristics, running behaviors, and psychological variables (perfectionism, mental toughness, and running passion) as well as a sports injury survey. Then, as a primary outcome, RRIs were recorded biweekly for 6 months. The incidence of injuries was expressed as RRI per 1000 hours of running. The association between predictive factors and RRIs was estimated using logistic regression.

Results: The incidence of RRIs during follow-up was 5.16 per 1000 hours of running. The knee was the location injured most often (26.4%), followed by the foot (18.9%) and lower leg (13.2%). Higher obsessive passion (OP) for running (odds ratio [OR], 1.11; 95% CI, 1.04-1.20) and perfectionistic concerns (OR, 1.22; CI,1.05-1.41) were associated with a greater risk of RRIs, as were previous injury (OR, 2.49; CI,1.10-5.70), weekly running distance (OR,1.10; CI, 1.03-1.16), and both supinated (OR, 4.51; CI, 1.11-18.30) and pronated (OR, 3.55; CI, 1.29-9.80) foot type. Following a running schedule (OR, 0.24; CI, 0.09-0.66) was associated with a lower risk of RRIs.

Conclusion: History of previous RRI, pronated and supinated foot type, weekly running distance, perfectionistic concerns, and OP increased RRI risk in recreational runners. Following a running schedule was a protective factor.

Clinical relevance: Multiple factors, including runners' psychological characteristics, predict RRIs. These findings can inform the development of injury risk management strategies.

Background: Core musculature is important for efficiency during activities including running. Both abdominal muscle strength and endurance contribute to this efficiency. The purpose of this study is to determine what differences and relationships exist in abdominal muscle thickness, strength, and endurance among persons who are runners, active, and inactive.

Hypothesis: Persons in the running group would show significantly greater abdominal muscle thickness, muscle strength, and muscle endurance compared with those in the nonrunning groups.

Study design: Quantitative cohort design.

Level of evidence: Level 2b.

Methods: A total of 78 subjects aged 18 to 27 years were divided into 3 groups: runners, active, and inactive. Assessment included abdominal muscle thickness via diagnostic ultrasound (Mindray North America), strength using a static Isotrack dynamometer (JTech Medical), and abdominal muscle endurance using a side plank. Statistical analysis using analysis of variance, t tests, and Pearson's correlation coefficients and partial correlations was performed using SPSS Version 26 with a significance level of P < 0.05.

Results: Significantly greater muscle thickness of internal obliques (IOs) at rest and during contraction was found in the running group compared with the active group, the active group compared with the inactive group, and the running group compared with the inactive group. There were no statistically significant differences in overall strength measured by dynamometry among the 3 groups. Plank time was significantly greater for the running group compared with the other 2 groups. Male participants were greater in all areas: strength, plank time as a measure of muscle endurance, and muscle thickness. Body mass index was significantly correlated with resting thickness, muscle endurance, and muscle strength.

Conclusion: Persons who run, are active, and are inactive use their abdominal muscles differently. Runners have thicker IOs and better abdominal muscle endurance than the other 2 groups. Focusing on endurance training of the obliques may be beneficial for persons who run.

Clinical relevance: This research could contribute to developing core training programs to ensure runners target the correct abdominal muscles with the best type of training.

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.

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: 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.