Sports Health-A Multidisciplinary Approach最新文献

Background: Hockey is an immensely popular sport in Canada, especially among youth participants. Despite evidence on the rates and risk of head injuries, especially in bodychecking contexts, little research has explored how and why injury occurs in gameplay through video observational methods.

Objective: To understand whether head contact (HC) events occur in youth bodychecking hockey as a result of play execution according to the rules, or result from violent and/or aggressive play.

Study design: Descriptive observational video analysis.

Methods: Verified head impact data from bodychecking minor hockey in Eastern Ontario at AA/AAA levels were used. In total, 249 verified head impacts were available for analysis across 48 under-15 (U15) and under-18 (U18) games. A comprehensive video analysis of head impacts was conducted to identify whether play was: (1) penalty vs no penalty; and (2) aggressive vs nonaggressive. Penalties were evaluated based on rule definition through video analysis, rather than the referee's call on the ice. Similarly, 4 contextual definitions for aggressive/nonaggressive gameplay behaviors were established for analysis.

Results: Amongst the highest levels in U15 and U18 bodychecking hockey, our results demonstrate that most HC events (~68%) were the outcome of nonaggressive play and within the rules of the sport (~67%).

Conclusion: Key findings from this study identify that HC events are mainly a result of legal and nonaggressive hockey gameplay. While the rules do penalize aggressive play, these same rules do not prevent HC from occurring in bodychecking hockey.

Relevance: This study adds to existing knowledge by identifying contextual factors related to potential injury events (HC) through video analysis in youth bodychecking hockey. This explains why injuries may happen, and assists in shifting research efforts towards injury prevention rather than simply documenting rates.

Context: Achilles tendon (AT) rupture is a devastating and potentially career-ending injury. Compared with other severe lower extremity injuries, such as anterior cruciate ligament reconstruction, it is associated with lower return to sport (RTS) rates, longer absence from training and competition, reduced sport-specific performance in the 2 years after rupture, shorter career length, and persistent long-term functional deficits. Therefore, better knowledge of the RTS criteria after AT rupture may support the optimization of rehabilitation outcomes and improve long-term RTS success.

Objective: The purposes of this scoping review were to (1) map the scientific evidence regarding criteria used to clear patients to RTS after surgical AT repair, and (2) describe the predominant outcome measurements reported in the literature.

Data sources: Web of Science, Scopus, and MEDLINE databases.

Study selection: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework, including English-language studies published from 1995 to 2022 on "athletes" or "sportive patients" who underwent surgical AT repair.

Study design: Scoping review.

Level of evidence: Level 3.

Results: Of 589 studies identified, 34 met the inclusion criteria: 3% were randomized controlled trials, 50% were case series, and 47% were cohort studies. None defined an outcome measurement as a criterion to RTS. The main outcomes were timeframe from surgery to RTS (53%), ankle range of motion (47%), Achilles Tendon Rupture Score (47%), calf circumference (44%), and heel-rise test (44%).

Conclusion: None of the 34 studies defined an outcome measurements as criteria for RTS. The main measurements focused on the early rehabilitation stage, with limited standardization and a lack of assessment for the mid- and late stages of rehabilitation. Defining RTS criteria after AT repair may help optimize rehabilitation and the RTS process.

Background: Velocity-based training (VBT) is a resistance training approach that uses lifting velocity to determine training load and track strength progress. This study determined the impact of a VBT versus a tempo-based training (TBT) approach on volume load and time under tension during a single set of submaximal bench press performed to failure.

Hypothesis: VBT would result in larger volume load and similar time under tension as TBT.

Study design: Randomized-crossover design.

Level of evidence: Level 3.

Methods: A total of 14 healthy men (24.1 ± 5.8 years) performed free-weight bench-press exercise at low intensities (12%, 16%, 20%, and 24% of 1-repetition maximum [1RM]) with oxygen uptake ($\stackrel{.}{V}$O₂) measurements. $\stackrel{.}{V}$O₂ was then extrapolated to a set performed at 70% 1RM to failure and the accumulated O₂ deficit was calculated together with the relative energy contribution of aerobic and anaerobic metabolism. Mechanical data were collected with a linear encoder.

Results: Despite the lack of differences between conditions for total time under tension (P > 0.05), VBT achieved a higher volume load at set failure (P < 0.05). Moreover, the VBT condition resulted in a larger total $\stackrel{.}{V}$O₂ from set initiation to termination (P < 0.01). Conversely, the accumulated O₂ deficit did not differ between conditions (P > 0.05). Compared with TBT, VBT elicited a higher relative contribution of aerobic energy (VBT, ~41%; TBT, 33%) and a lower relative contribution of anaerobic energy (VBT, ~59; TBT, 67%) during exercise (P < 0.01).

Conclusion: VBT is an effective strategy to enhance volume load during bench-press performed to failure at 70% 1RM. This effect occurs without compromising time under tension. These findings are associated with a higher contribution of aerobic energy supply to exercise.

Clinical relevance: VBT may be beneficial for athletes aiming to maximize volume load in response to resistance exercise.

Background: Fear of pain and reinjury significantly hinders return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). However, the neural basis of this psychological barrier remains unclear.

Hypothesis: ACLR patients will exhibit structural and functional brain changes in regions related to pain and emotion, influencing their psychological readiness to RTS.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: We recruited 36 ACLR patients and 36 healthy controls, collecting visual analog scale (VAS) scores for knee pain, Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scores, and structural and functional magnetic resonance imaging data.

Results: Significant smaller gray matter (GM) volume was observed in the thalamus (effect size, -0.813), periaqueductal gray (PAG) (effect size, -0.737), and prefrontal cortex (PFC) (effect size, -0.690) in ACLR patients. We also found weakened functional connectivity between the PAG and the anterior cingulate cortex (ACC). GM volume in the thalamus was correlated positively with ACL-RSI scores (r = 0.362). Notably, the effect of VAS scores on ACL-RSI was mediated by the reduced FC between PAG and ACC (direct effect, -2.071, indirect effect, -0.826).

Conclusion: This study reveals that the psychological readiness to RTS after ACLR may be due to peripheral nociceptive input causing changes in pain-related brain structures and functions.

Clinical relevance: Recognizing these neuropsychological changes may guide comprehensive rehabilitation strategies post-ACLR, emphasizing the need for interventions targeting central neural mechanisms alongside physical recovery.

Tenosynovial giant cell tumor (TGCT), formerly pigmented villonodular synovitis (PVNS), may extend into the popliteal fossa and mimic a Baker cyst, complicating diagnosis and operative planning. A 53-year-old former endurance runner presented with posterior knee pain, swelling, intermittent locking, and a palpable popliteal mass. Examination demonstrated effusion and limited range of motion; weightbearing radiographs showed mild osteoarthritic change with effusion, and magnetic resonance imaging (MRI) revealed synovial hypertrophy with low T2 signal suggestive of hemosiderin deposition. Arthroscopic synovectomy via 4 anterior and 2 posterior portals was performed; histology confirmed diffuse, nonmalignant TGCT. Given persistent posterior disease, a staged posterior open approach (lazy-S incision) enabled en bloc excision of the extra-articular component. Adjuvant radiosynoviorthesis (intra-articular yttrium-90) was administered. At 8-year follow-up, there was no clinical or radiographic evidence of disease. This case emphasizes MRI recognition of hemosiderin-related low T2 signal, the value of combining arthroscopic synovectomy with posterior open excision in diffuse disease with popliteal extension, and selective use of adjuvant radiosynoviorthesis for durability.

Background: Researchers have examined associations between sport specialization and injury. However, no studies have investigated associations between sport specialization and health-related quality of life (HRQoL) after injury.

Hypothesis: Among injured youth athletes, level of sport specialization is not associated with differences in HRQoL approximately 1 month after sport-related injury.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: A multicenter, cross-sectional study was performed at 3 primary care sports medicine clinics. Eligible 8- to 18-year-old athletes who presented for musculoskeletal injury or concussion were enrolled. At the initial clinic visit, patients completed the Player Development Survey (PDS) to determine sport specialization level. Approximately 1 month after enrollment, patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) to determine HRQoL measures.

Results: Of 720 athletes invited to participate, 336 (age, 14.2 ± 2.4 years) completed the PDS and PROMIS surveys; 22% were highly specialized, 39% were moderately specialized, and 39% were low specialized athletes. Overall, there were no differences in HRQoL scores across the 3 levels of sport specialization. In subgroup analysis based on sex, female HRQoL scores were worse than male HRQoL scores irrespective of sport specialization level in 3 categories: pain interference (mean difference between female and male scores [± SEM] = 2.3 ± 1.1; P = 0.04), depression/sadness (2.9 ± 1.1; P = 0.01), and anxiety/fear (2.8 ± 1.2; P = 0.02).

Conclusion: Higher level of sport specialization is not associated with worse HRQoL approximately 1 month after sport-related injury. Female athletes have worse short-term HRQoL after an injury irrespective of sport specialization level. While sex differences were statistically significant, the magnitude of differences was small.

Clinical relevance: Sport specialization is not associated with differences in HRQoL after injury. Injured female athletes may need closer monitoring due to possibly worse short-term HRQoL, but further investigation is needed.

Context: Testosterone is a steroid hormone produced primarily in the testes in men and ovaries in women, playing crucial roles in androgenic, anabolic, and psychological functions, including muscle growth, bone formation, erythropoiesis, risk-taking, and aggression, making it important for athletes. Sports performance is linked closely to testosterone level, prompting athletes to explore legal and illegal ways to boost testosterone. This review examines testosterone physiology and legal strategies for optimizing testosterone levels in athletes, as well as their practical applications.

Evidence acquisition: Database search.

Study design: Narrative review.

Level of evidence: Level 5.

Results: Maintaining healthy testosterone levels requires energy balance and optimal nutrition with adequate macronutrients and micronutrients, especially for athletes prone to dieting and food restriction. Testosterone boosters are marketed widely but lack strong evidence for efficacy and may pose risks. While some substances show promise, further research is needed. Sleep is critical as testosterone secretion is linked to the rapid eye movement phase, highlighting the need for proper sleep hygiene and addressing sleep disorders. Moderate-to-high intensity free-weight resistance exercises are most effective for increasing testosterone, while the effects of sexual activity remain unclear. Endocrine-disrupting chemicals can lower testosterone levels and should be avoided. While cold-water immersion may decrease testosterone, sauna bathing appears to be neutral. Radiofrequency electromagnetic radiation from modern electronic devices may harm the hypothalamic-pituitary-gonadal axis, warranting limited use. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, may decrease testosterone levels, suggesting cautious use. Seasonal changes in testosterone levels require further study. Testosterone-optimizing strategies excluding banned substances may aid in treating functional low testosterone or reducing harm in anabolic-androgenic steroid users.

Conclusion: Educating athletes on safe and effective strategies to increase testosterone is crucial, with ongoing research needed to explore additional methods.Strength-of-Recommendation Taxonomy:B.

Context: Ankle injuries are common in athletes and can significantly impair postural stability. Balance deficits may vary with the type of injury and the specific biomechanical demands of the sport.

Objective: To evaluate systematically how different types of ankle injuries affect postural stability in athletes by classifying and comparing findings across distinct sport archetypes (eg, multidirectional, linear, balance-focused) to identify sport-specific impairments.

Data sources: A search was conducted in PubMed, Scopus, Embase, and Web of Science from inception up to August 31, 2025, for observational studies assessing postural stability in athletes with ankle injuries.

Study selection: Studies published in any language were included if they assessed postural stability in athletes with ankle injuries. Data were extracted independently by 2 authors, and any disagreements were resolved through discussion. Study quality was assessed using Joanna Briggs Institute checklists (cross-sectional: 8-item; cohort: 11-item; case-control: 10-item). Reporting quality was evaluated using the STROBE checklist.

Study design: Systematic review.

Level of evidence: Level 1.

Data extraction: Data were extracted on static and dynamic balance (DB), including postural sway, center of pressure, stabilization times, and reach distances in the Star Excursion Balance Test (SEBT) and Y Balance Test (YBT).

Results: A total of 59 studies involving 4848 participants were included. Most participants were youth (61%, aged 19-29 years) and adolescent (32%, aged 12-18 years) athletes, with a limited focus on female-only cohorts (6.7% of studies). Athletes with ankle injuries showed deficits in static and DB, with chronic ankle instability (CAI) causing persistent impairments in stabilization times and reduced reach in the SEBT/YBT. Pivoting sports (eg, soccer, basketball) exhibited greater balance deficits than endurance or balance-focused sports.

Conclusion: Ankle injuries, particularly CAI, result in significant balance impairments, necessitating sport-specific rehabilitation addressing both distal and proximal neuromuscular control. Static tests may underestimate functional deficits.

This infographic summarizes the first prospective injury and illness surveillance study in Sail Grand Prix (SailGP) during Season 4 (2023-2024). Monitoring 100 professional athletes across 4919.84 sailing hours, the study found an overall injury rate of 9.96 per 1000 hours-higher during racing (11.89) and particularly during foiling activities (26.52). Lower limb injuries, especially to the ankle and knee, were most common, with grinders showing the highest positional injury incidence. Illness, mainly respiratory in nature, occurred at 5.14 per 1000 hours. These findings highlight the physical demands and health risks of elite foiling, informing targeted prevention, conditioning, and safety strategies in SailGP.

Background: Structural abnormalities assessed with conventional ultrasound (US) or magnetic resonance imaging (MRI) are associated with the risk of developing patellar tendinopathy (PT). However, their prognostic value for athletes with PT performing exercise therapy remains unclear.

Hypothesis: Baseline imaging features could be associated with changes in pain and disability over 24 weeks in athletes with PT after exercise treatment.

Study design: Cohort study.

Level of evidence: Level II.

Methods: Athletes with PT were randomly allocated to 2 different programs of exercise therapy for 24 weeks. Imaging features at baseline included patellar tendon thickness, intratendinous calcifications, patellar erosions, and Doppler flow on US, as well as tendon fiber disruption, infrapatellar fat pad (IFP) edema, bone marrow edema, and deep infrapatellar bursitis on MRI scan. Clinical outcomes were measured at baseline, and at 12- and 24-week follow-up, using the visual analog scale after single-leg squat (VAS-SLDS) for pain on loading, and Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire for disability. Linear mixed-effects models, incorporating interaction terms tested using likelihood ratio tests, evaluated the prognostic value of baseline imaging features.

Results: Of 76 included athletes (58 male, 18 female; average age, 24 ± 4 years), abnormal US features were identified in 26% to 78% of cases. Among 72 MRI scans analyzed, abnormal features were demonstrated in 43% to 81% of cases. No significant associations were identified between individual imaging features and 24-week changes in VAS-SLDS or VISA-P scores (all P_interaction > 0.10), or between the total number of imaging abnormalities and clinical outcomes (all P_interaction > 0.50).

Conclusion: There was no evidence of an association between baseline abnormalities assessed using conventional US or MRI and 24-week changes in pain or disability among athletes with PT undergoing exercise therapy.

Clinical relevance: Healthcare professionals should avoid relying on conventional imaging findings to predict prognosis.