Sports Health-A Multidisciplinary Approach最新文献

Context: Physical activity (PA) interventions improve well-being and positive mental health in children and adolescents, but the results of previous systematic reviews included participants with chronic medical conditions and did not accurately assess the multidimensional nature of health-related quality of life (HRQoL).

Objective: The aims of this meta-analysis were to (1) evaluate the effects of PA interventions on several domains of HRQoL in healthy <18-year-olds and (2) examine the effectiveness of interventions on HRQoL according to whether they were successful in increasing PA, the type of intervention delivered, and the duration of the intervention.

Data sources: PubMed (Medline), EMBASE, the Cochrane Library, SCIELO, SPORTDiscus, and PEDro databases were systematically searched from inception to September 30, 2022.

Study selection: Experimental studies that examined the effectiveness of PA interventions on HRQoL participants aged <18 years.

Study design: Systematic review with meta-analysis and meta-regression.

Level of evidence: Level 1.

Methods: Random-effects models were used to calculate pooled effect size (ES) for total HRQoL score and its dimensions. Subgroup analyses were conducted to examine the effect of PA program characteristics.

Results: A total of 17 studies were included. Pooled ES (95% CI) estimations were as follows: 0.179 (0.045, 0.002) for total HRQoL score, 0.192 (0.077, 0.306) for physical well-being, 0.158 (0.080, 0.237) for psychological well-being, 0.118 (0.044, 0.192) for autonomy and parent relation, 0.135 (0.043, 0.227) for social support and peers, and 0.129 (-0.013, 0.270) for school environment. Subgroup analyses suggested there were no differences in the effectiveness of the interventions by category of PA increase or by type and duration of intervention.

Conclusion: Exercise interventions are an effective strategy for improving overall HRQoL and its most significant domains in children and adolescents.

Context: Competitive swimmers are at high risk of overuse musculoskeletal injuries due to their high training volumes. Spine injuries are the second most common musculoskeletal injury in swimmers and are often a result of the combination of improper technique, high loads on the spine in strokes that require hyperextension, and repetitive overuse leading to fatigue of the supporting trunk muscles. The purpose of this review is to summarize the current evidence regarding swimming biomechanics, stroke techniques, and common injuries in the lumbar spine to promote a discussion on the prevention and rehabilitation of lower back injuries in competitive swimmers.

Evidence acquisition: From a PUBMED/MEDLINE search, 16 articles were identified for inclusion using the search terms "swimming," "low back" or "lumbar," and "injury" or "injuries."

Study design: Narrative review.

Level of evidence: Levels 4 and 5.

Results: The trunk muscles are integral to swimming stroke biomechanics. In freestyle and backstroke, the body roll generated by the paraspinal and abdominal muscles is integral to efficient stroke mechanics by allowing synergistic movements of the upper and lower extremities. In butterfly and breaststroke, the undulating wave like motion of the dolphin kick requires dynamic engagement of the core to generate repetitive flexion and extension of the spine and is a common mechanism for hyperextension injuries. The most common lower back injuries in swimming were determined to be lumbar strain, spondylolysis and spondylolisthesis, facet joint pain, and disc disease. Most overuse swimming injuries can be treated conservatively with physical therapy and training adjustments.

Conclusion: Managing swimmers with low back pain requires a basic knowledge of swimming technique and a focus on prevention-based care. Since most swimming injuries are secondary to overuse, it is important for providers to understand the mechanisms underlying the swimming injury, including an understanding of the biomechanics involved in swimming and the role of spine involvement in the 4 strokes that assist in stabilization and force generation in the water. Knowledge of the biomechanics involved in swimming and the significant demands placed on the spinal musculoskeletal system will aid the clinician in the diagnosis and management of injuries and assist in the development of a proper rehabilitation program aimed at correction of any abnormal swimming mechanics, treatment of pain, and future injury prevention.

Strength of recommendations: B. Recommendation based on limited quality or inconsistent patient-oriented evidence.

Background: Delayed-onset muscle soreness (DOMS) has been widely examined in the peripheral muscles; however, studies showing the potential effects of DOMS on respiratory function are limited.

Hypothesis: DOMS in trunk muscles has a negative effect on respiratory function parameters, respiratory muscle strength, respiratory muscle endurance, and exercise capacity.

Study design: Prospective cohort study.

Level of evidence: Level 2.

Methods: In 24 healthy participants with a mean age of 21 ± 2 years, DOMS was induced for the trunk muscles with a load equal to 80% of the maximum repetitive voluntary contraction. Pulmonary function parameters, respiratory muscle strength and endurance, exercise capacity, pain, fatigue, and dyspnea perception severity were recorded before DOMS and at 24 and 48 hours after DOMS.

Results: After DOMS, decreases were observed in respiratory function parameters, namely, forced vital capacity, forced expiratory volume in the first second, vital capacity, and 25% to 75% flow rate value of forced expiratory volume (25% to 75%) (P = 0.02, P = 0.02, P < 0.01, P = 0.01, respectively). Maximal inspiratory pressure and exercise capacity also decreased (P = 0.02, P < 0.01, respectively). No difference was observed between all 3 measurements of maximal expiratory pressure (MEP) and MEP% values (P₁ = P₂ = P₃ ≥ 0.99). The results of the respiratory muscle endurance tests did not reveal a significant difference in terms of load and time in all 3 conditions (P > 0.05).

Conclusion: After DOMS, there was a 4% to 7.5% decrease in respiratory function parameters, and a 6.6% decrease in respiratory muscle strength.

Clinical relevance: The occurrence of DOMS before a competition can have a detrimental impact on pulmonary performance. Hence, it is imperative to consider this factor when devising training and exercise programs. In addition, the development of treatment protocols becomes crucial if DOMS arises.

Context: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain in young adults. Flexibility athletes represent an interesting subset due to the extreme range of motion requirements of their sport.

Objective: The objective of this review was to provide a summary of the outcomes of hip arthroscopy for FAIS in patients who participate in flexibility sports.

Data sources: Three online databases (Medline, Embase, and PubMed) were searched from database inception (1946, 1974, and 1966, respectively) to January 10, 2023.

Study selection: Studies were screened for literature addressing surgical outcomes for flexibility athletes undergoing hip arthroscopy for FAIS.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: Various patient-reported outcomes that evaluated the efficacy of hip arthroscopy in this patient population were abstracted and presented in descriptive and analytical format. Abstraction was performed by 2 reviewers.

Results: Overall, a total of 8 Level 3 or 4 studies and 295 patients (312 hips) were included in this review. The pooled standardized mean differences for the Visual Analog Scale for pain score, Modified Harris Hip Score, Hip Outcome Score - Activity of Daily Living scale, and Hip Outcome Score - Sport-Specific Subscale all demonstrated significant improvement after undergoing arthroscopy for FAIS between 12 and 116 months (N = 175, -1.97, 95% CI -2.5 to -1.4, P < 0.01, I² = 76%; N = 211, 1.82, 95% CI 1.49 to 2.16, P < 0.01, I² = 52%; N = 164, 1.75, 95% CI 1.42 to 2.05, P < 0.01, I² = 28%; N = 211, 1.71, 95% CI 1.38 to 2.04, P < 0.01, I² = 52%, respectively). Across 289 patients, 75.6% to 98% returned to sport at a similar or higher level than presurgery.

Conclusion: This review demonstrates a trend of improvement in patient-reported pain, function, quality of life, and return to sport at a minimum of 12 months among flexibility athletes after hip arthroscopy to treat FAIS.

Background: The relationship of running biomechanics, footwear, and injury has been studied extensively in adults. There has been little research on the effects of footwear on running biomechanics in youth.

Hypothesis: Running biomechanics of youth will be significantly affected by changes in footwear. Minimal shoe running will demonstrate similarities to barefoot.

Study design: Crossover study design: randomized trial.

Level of evidence: Level 2.

Methods: A total of 14 active male youth (8-12 years old) participants with no previous exposure to minimalist shoes or barefoot running had running biomechanics (lower extremity sagittal plane kinematics and vertical ground reaction forces [vGRFs]) collected and analyzed in 3 footwear conditions (barefoot, traditional, and minimal shoe).

Results: The average vertical loading rate (AVLR) was significantly greater running barefoot (173.86 bodyweights per second [BW/s]) and in the minimal shoe (138.71 BW/s) compared with the traditional shoe (78.06 BW/s), (P < 0.01). There were significant differences between shoe conditions for knee flexion at initial contact (P < 0.01), knee sagittal plane excursion (P < 0.01), peak dorsiflexion (P < 0.01), and dorsiflexion at initial contact (P = 0.03). No participants displayed a forefoot-strike during this study.

Conclusion: The introduction of barefoot and minimalist running in habitually shod youth significantly affected the running biomechanics of youth and caused immediate alterations in both lower extremity kinematics and vGRFs. Running barefoot or in minimal shoes dramatically increased the AVLR, which has been associated with injury, compared with a traditional shoe.

Clinical relevance: This study evaluated the effects of footwear on overground running biomechanics, including AVLR, in pre- and early-adolescent youth males. Based on our findings, clinicians should exercise caution in barefoot or minimal shoe transition among young, habitually shod, runners due to the immediate and dramatic increases in AVLRs.