Sports Health-A Multidisciplinary Approach最新文献

Background: For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few studies have investigated the association between shoulder strength, range of motion (ROM), and injury.

Hypothesis: Eccentric and isometric shoulder muscle strength and/or shoulder ROM are associated with new shoulder complaints and/or injuries.

Study design: Cohort study.

Level of evidence: Level 3.

Methods: At baseline 301 adolescent competitive tennis players aged 13 to 19 years completed a questionnaire, were assessed with a shoulder protocol for strength and ROM and followed weekly (for shoulder complaint/injury) for 52 consecutive weeks. Outcomes were a first incidence of a tennis-related shoulder complaint or injury in the dominant arm, defined as a sum score of ≥20 or ≥40, respectively, on the Oslo Overuse Injury Questionnaire. Two cohorts were created for Cox regression analyses, adjusted for age, sex, and playing level: (1) shoulder complaints (n = 204), and (2) shoulder injuries (n = 252).

Results: The most definitive adjusted associations were a hazard rate ratio (HRR) of 1.3 (95% CI 1.0-1.8) for a shoulder complaint in eccentric external rotation (eccER) strength, and a HRR for shoulder injuries of 1.4 (95% CI 1.0-1.9) in isometric internal rotation (IIR) strength in the 90-90 position, and 1.5 (95% CI 1.1-2.0) in eccER normalized to body mass.

Conclusion: Higher values of eccER shoulder strength, IIR strength at the 90-90 position, and eccER shoulder strength normalized to body mass, were associated with shoulder complaints/injuries in adolescent competitive tennis players.

Clinical relevance: Incorporating a training program that takes volume and intensity into account in the daily oncourt sessions, to build resilience through a well-planned, long-term training and competition plan to minimize shoulder injury risk may be of importance.

Background: Anterior cruciate ligament (ACL) reconstruction guidelines recommend delaying return to sport until 9 months postsurgery and using functional testing to inform clinical decision-making.

Hypothesis: Regular rehabilitation visits would continue up to 9 months postsurgery, and most patients would receive functional testing.

Study design: Retrospective study.

Level of evidence: Level 4.

Methods: Electronic medical records were reviewed for 338 patients, aged 14 to 21 years, who participated in sports preinjury and had primary ACL reconstruction between January 2017 and December 2018. Of these, 124 patients had all rehabilitation in-system. Rehabilitation visits and time to end of rehabilitation were examined through 12 months postsurgery. The proportion of patients who participated in return-to-sport training, received functional testing, and remained active in rehabilitation up to 9 months postsurgery was calculated.

Results: Of the total rehabilitation visits, 58.9% occurred in the first 3 months postsurgery. The mean time to end of rehabilitation was 7 months postsurgery. One-third of the patients participated in return-to-sport training, and 72.6% received at least 1 functional test. About 40% of patients were active in rehabilitation up to 9 months postsurgery but visit frequency (<2 times per month) was lower than in return-to-sport training (2 sessions per week).

Conclusion: Over half of the rehabilitation visits were received in the early phase, and more than half of patients completed rehabilitation before 9 months postsurgery. Return-to-sport training facilitated regular visits in the late phase. About one-quarter of patients had rehabilitation progression without functional testing.

Clinical relevance: Study findings illuminate late phase rehabilitation visits and functional testing as potential areas of care delivery to improve for better return-to-sport outcomes after ACL reconstruction.

Context: Dynamic postural control deficits are prevalent in people with anterior cruciate ligament injury (ACLI) or reconstruction (ACLR). Time to stabilization (TTS) and the dynamic postural stability index (DPSI) are used to assess dynamic postural stability during a jump-landing task. However, results vary on whether landing stability can adequately demonstrate dynamic postural deficits in patients with ACLI and ACLR.

Objective: To (1) describe common methods and parameters for determining TTS and DPSI, and (2) identify the differences in TTS and DPSI across different jump-landing tasks and directions between the ACLI or ACLR and control groups.

Data sources: PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus were searched for articles from conception until March 2024.

Study selection: Clinical studies assessing dynamic postural stability between patients with ACLI and ACLR and controls were included. Eleven articles were included in the analysis.

Study design: Systematic review and meta-analysis.

Level of evidence: Level 4.

Data extraction: The following information was extracted from included articles: demographic data, sample size, methodology, landing stability test outcomes, and calculation methods of outcomes. Different jump tasks were explored, and meta-analyses were conducted on the landing stability test outcomes.

Results: In forward jump-landing tasks, knees affected by ACLI or ACLR needed more time than controls to achieve stabilization, showing a moderate effect in the anteroposterior direction (based on 2 studies, 47 affected knees versus 44 healthy knees; standardized mean difference [SMD] = 0.438), and a large effect in the vertical direction (based on 3 studies, 77 affected knees versus 74 healthy knees; SMD = 0.656).

Conclusion: These findings demonstrate impaired dynamic stability in ACLI/ACLR patients, highlighting the importance of TTS as an effective measure for assessing landing stability.

Background: Upper extremity physical-performance-tests are gaining interest for screening overhead athletes in view of injury prevention, individual performance, and return to play after injury. However, at present, no reference data are available for these tests in a junior tennis population. In addition, the construct validity of these tests with respect to shoulder strength is still unclear.

Hypothesis: Junior tennis players will exhibit differences in test performance based on age, sex, and side. Shoulder strength will be moderately to highly correlated with the seated medicine ball throw (SMBT) and the modified-closed-kinetic-chain-upper-extremity test (M-CKCUEST), but not with shoulder endurance test (SET) and the Y-balance-test-upper-quadrant (YBT-UQ).

Study design: Descriptive study, cross-sectional design.

Level of evidence: Level 3.

Methods: Four commonly used physical performance tests (PPTs) (YBT-UQ, M-CKCUEST, SMBT, and SET) were executed by 99 junior tennis players aged 9 to 18 years. In addition, isometric external and internal rotation strength was measured, using a hand-held dynamometer. Descriptive reference values were reported, and correlations between the PPTs and strength values were calculated.

Results: A linear regression model with backwards stepwise regression was used to identify possible age, sex, and side differences regarding PPTs and strength. Some, but not all reached statistical significance. Moderate-to-high correlations (Pearson correlation coefficients) were found between the M-CKCUEST, SMBT, and SET and strength measurements, establishing acceptable construct validity with respect to strength. No significant correlation was found between the YBT-UQ and strength.

Conclusion: Junior tennis players exhibit differences in test performance based on age, sex, and side. The MCKCUEST, SMBT, and SET may be valuable alternatives for strength testing in the clinical setting.

Clinical relevance: These tests may provide a valuable, user-friendly alternative for strength measurements in junior tennis players.

Background: After anterior cruciate ligament reconstruction (ACLR), chronic changes in knee joint biomechanics during higher level tasks, such as running, may negatively impact long-term knee joint health. Among the factors that contribute to these chronic changes, the influence of quadriceps strength on knee joint biomechanics during running is not well understood.

Hypothesis: Higher involved limb quadriceps strength (peak torque and rate of torque development [RTD]) and limb symmetry index (LSI) will be positively associated with greater peak knee flexion angle and peak knee extensor moment during running.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: Peak knee extensor moment and peak knee flexion angle were analyzed during the stance phase of running, 6 months following ACLR (n = 26; 18 female participants; age, 19 ± 5.0 years). Involved limb quadriceps strength and LSI were calculated for peak torque and RTD. Linear regression models were used to analyze the relationship between involved limb and LSI values of quadriceps peak torque and RTD to peak knee flexion angle and peak knee extensor moment.

Results: Quadriceps peak torque (R² = 0.37; P < .01) and RTD (R² = 0.31, P < .01) each had a positive relationship to peak knee extensor moment, but not peak knee flexion angle. Quadriceps peak torque and RTD LSI were not associated with peak knee flexion angle or peak knee extensor moment (P > .20).

Conclusion: Quadriceps peak torque and RTD are positively associated with running kinetics 6 months after ACLR. Peak torque and RTD LSI were not associated with running mechanics after ACLR.

Clinical relevance: Quadriceps peak torque and rate of torque development are positively associated with running mechanics after ACLR. Clinicians should consider objective assessments of quadriceps strength before initiating running after ACLR.

Background: Biomechanical asymmetries after anterior cruciate ligament reconstruction (ACLR) may be amplified and perpetuated by progressing athletes to higher-demand tasks despite impairments in lower-demand tasks.

Hypotheses: (1) Between-limb asymmetries in limb loading and joint kinetics will be greater during the higher-demand drop jump compared with squatting. (2) Asymmetries in limb loading and joint kinetics during squatting will be associated with asymmetries during drop jump.

Study design: Descriptive laboratory study.

Level of evidence: Level 4.

Methods: A total of 22 (11 female) participants after primary ACLR (6.4 ± 0.5 months) performed bilateral squat and drop jump tasks. Vertical ground-reaction force (vGRF), knee and hip extensor net joint moments (NJMs), hip/knee mean NJM ratio, and limb symmetry index (LSI) were calculated during the eccentric phase. Comparisons between limbs and across tasks were analyzed using 2-way repeated measures analyses of variance. Pearson's correlations assessed associations between vGRF and NJM LSIs, and hip/knee NJM ratios across tasks.

Results: Mean vGRF LSI and knee NJM LSI were significantly more asymmetric during drop jump compared with squatting (79.7 ± 14.9 vs 90.0 ± 11.0%, P < 0.001 and 55.8 ± 17.6 vs 66.4 ± 25.6%, P = 0.02, respectively). Mean vGRF LSI (r = 0.58; P = 0.004) and knee NJM LSI (r = 0.61; P = 0.002) were moderately correlated between tasks. The hip/knee ratio for the ACLR limb correlated strongly between tasks (r = 0.69; P < 0.001); nonsurgical limb: r = 0.39; P = 0.07).

Conclusion: Underloading and reduced functional use of the ACLR knee were amplified during the drop jump compared with squatting. Limb mechanics during lower-demand squatting are informative of performance during drop jump.

Clinical relevance: Criterion-based rehabilitation guidelines may benefit from requiring symmetry in lower-demand tasks before progressing to higher-level activities to optimize recovery and reduce risk of reinjury.

Context: Early sports participation can provide significant physical, psychosocial, and mental benefits for young athletes. Sports engagement can be via sport sampling or sport specialization. Sport specialization is often encouraged by parents and coaches as it is perceived as a mechanism for achieving elite level play, particularly in tennis.

Evidence acquisition: A search on PubMed, Google Scholar, and Science Direct was conducted for pertinent peer-reviewed studies on sport specialization and overuse injuries in youth athletics and junior tennis using key terms including "junior tennis," "youth sports," "sport specialization," and "overuse injury."

Study design: Clinical review.

Level of evidence: Level 5.

Results: Early sport specialization leads to increased injury risk, decreased athletic career longevity, and higher incidence of burnout without demonstrating significant benefits in terms of improving peak sports performance or the likelihood of reaching elite play.

Conclusion: Youth athletes should avoid specializing in a single sport before age 12, avoid training more hours per week than their age in years, and limit training to 16 hours per week maximum. Specific to tennis, junior players should be at least 12 years old for tournament play, compete in no more than 2 tournaments per month or 12 per year, engage in a maximum of 12 hours per week of organized tennis, a minimum of 2 hours per week of injury prevention training, and consider another off-season sport. Injury may be more likely with early sport specialization, early intense training (before middle or late adolescence) and annual match volume (>40 matches annually). Finally, we provide novel recommendations for safe volumes of training, matches, and tournaments for junior tennis players based on their age and level of play.Strength-of-Recommendation Taxonomy (SORT):B - recommendations based on inconsistent or limited-quality patient-oriented evidence.

Background: Injury prevalence among adult recreational tennis players may be >50%, involving injuries to upper extremity, lower extremity, and trunk. No standardized on-court warm-up/cool-down program has demonstrated improved compliance and injury reduction in this population.

Hypothesis: Compliance with the Tennis 10+ warm-up/cool-down program in adult recreational tennis players will improve over time. High compliance with Tennis 10+ will show reduced injury rates versus low compliance over the 1-year study period.

Study design: Longitudinal cohort study.

Level of evidence: Level 3.

Methods: Adult recreational tennis players actively participating in a tennis league and/or competitive tennis were included. Level of compliance by time, injury rate, injury type, sex, and age were assessed at baseline, and at 3, 6, 9, and 12 months. Association between variables was assessed by a 2-sample t test or chi-squared statistical test.

Results: A total of 317 adult recreational tennis players (age, 18-75 years [mean, 48]) completed enrollment. Compliance levels improved significantly over time (P = 0.01). Men (P = 0.02) and players aged 39 to 50 years (P < 0.01) showed a significantly higher level of compliance over time. There were no differences in injury rates between low and high compliance groups, except at 12 months, when high compliance was associated with a significant decrease in injury frequency and overuse injuries (P = 0.01).

Conclusion: Compliance with the Tennis 10+ warm-up/cool-down program improved from baseline, especially with men and people aged 39 to 50 years. High compliance with Tennis 10+ was not associated with lower overall injury rates, except lower overuse injury rates at 12 months.

Clinical relevance: Tennis 10+ can be implemented as an on-court method before and after tennis play to effectively reduce barriers to warm-up/cool-down in adult recreational tennis players. Further study is necessary to identify the significance of injury reduction with program compliance.

Background: A thickened posterior shoulder capsule may increase injury risk in baseball pitchers due to maladaptive shoulder biomechanics such as altered arthrokinematics, decreased internal rotation range of motion (ROM) and increased scapular upward rotation. While diagnostic ultrasound offers a reliable method of measuring posterior capsule thickness (PCT), it is currently unclear whether PCT thus measured is valid.

Hypothesis: Diagnostic ultrasound is a valid method for measuring PCT compared with magnetic resonance imaging (MRI).

Study design: Cross-sectional.

Level of evidence: Level 4.

Methods: Asymptomatic baseball pitchers recently drafted into professional baseball from a single organization were enrolled during the 2021 to 2024 seasons. Pitchers underwent both diagnostic ultrasound and shoulder MRI on the same day to minimize any acute changes in PCT. All shoulder ultrasounds were performed with a 15-MHz linear transducer. Posterior capsule was identified as the tissue immediately lateral to the tip of the labrum between the humeral head and rotator cuff. PCT was measured on axial MRI scans by a musculoskeletal radiologist blinded to the ultrasound measurements. Agreement between modalities was evaluated through Pearson correlations and Bland-Altman analysis.

Results: Overall, 25 drafted pitchers were included. PCT obtained via diagnostic ultrasound had a mean of 2.4 ± 0.6 mm while PCT obtained via MRI scan had a mean of 2.4 ± 0.8 mm. Ultrasound PCT and MRI PCT were strongly positively correlated (R = 0.945, R² = 0.892, P < 0.001). The Bland-Altman plot demonstrated 95% limits of agreement of 0.55 mm between diagnostic ultrasound and MRI measurements of PCT.

Conclusion: Measuring PCT with diagnostic ultrasound is a valid technique compared with the gold standard of MRI.

Clinical relevance: Clinicians who wish to evaluate PCT in baseball pitchers may use this validated technique to quantify PCT and evaluate for potential contributors to glenohumeral internal rotation deficit.