Sports Health-A Multidisciplinary Approach最新文献

Background: The volume and frequency of throwing activity are among the most significant risk factors for developing overuse injuries in youth athletes. Despite introducing systematic guidelines for 'pitch counts,' throwing injuries continue to rise. Using technology to create enhanced measures of workload exposure in this unique population of athletes may help generate more effective and personalized injury prevention strategies.

Hypothesis: The wrist-worn sensor system (PhySens) will: 1) accurately detect and differentiate throwing activity from other baseball movements, and 2) accurately predict ball velocity, arm slot angle, and elbow valgus torque.

Study design: Descriptive laboratory study.

Level of evidence: Level 5.

Methods: Youth pitchers (n = 10) performed a standardized protocol of pitching, field-throwing, and batting. Pitching velocity and biomechanical data were simultaneously captured by the PhySens and traditional 3-dimensional motion capture. The accuracy of the pitching detection algorithm (throw vs batting) was analyzed by comparing truth data with throwing events cataloged by the device. Ball velocity, elbow valgus torque, and arm slot angle predictions were assessed with Pearson correlation coefficients and Bland-Altman plots.

Results: A total of 230 events (pitches and bat swings) were analyzed. Pitch detection was excellent, with a sensitivity of 99.4% and specificity 97.9%. Pearson correlations were significant and excellent across all predicted variables, with ball velocity r = 0.96, elbow valgus torque r = 0.95, and arm slot angle r = 0.87. The system demonstrated excellent estimations of ball velocity, elbow valgus torque, and arm slot angle.

Conclusion: This novel single-sensor wrist worn device was highly accurate in detecting pitching events, predicting ball velocity, and estimating arm slot angle and elbow valgus torque.

Clinical relevance: Throwing volume is highly associated with overuse injuries in youth baseball players. Sensor-based measures of workload monitoring can address inherent limitations related to human error and underestimation of true throwing exposure.

Background: Radiographic evaluations are commonly used to determine calcaneal ossification staging throughout pediatric development. Sonographic imaging may offer a less expensive, noninvasive, clinically feasible option for calcaneal developmental assessments. Here, we assessed (1) inter-rater agreement of radiographic and sonographic calcaneal ossification staging of children and adolescent patients with Sever's disease and (2) agreement between radiographic and sonographic calcaneal ossification staging scores.

Hypothesis: There would be substantial agreement of radiographic and sonographic calcaneal ossification staging across raters, and between imaging measures.

Study design: Retrospective cohort study.

Level of evidence: Level 3.

Methods: Adolescent patients (<18 years of age) with physician-diagnosed Sever's disease who had complete calcaneal sonographic and radiographic imaging available on a retrospective chart review were included. Three independent reviewers with advanced training in musculoskeletal ultrasound each separately assessed radiographic and sonographic imaging data and assigned calcaneal calcification stages (0-5) to blinded images based on established criteria. Fleiss' Kappa analyses were used to determine inter-rater staging agreement for both imaging approaches. Cohen's Kappa analyses were used to determine the agreement between radiographic and sonographic staging. Absolute agreement, and relative agreement within each stage were assessed for both analyses.

Results: Data from 19 patients (13 female, 6 male; 12.2 ± 2.3 years) were included. Absolute inter-rater agreement for radiographic and sonographic calcaneal ossification staging was comparable across the 3 raters (radiographs, κ = 0.692, z = 9.02; P < .01; sonographs, κ = 0.713, z = 7.95; P < .01), and perfect relative agreement (κ = 1.0, z = 10.6; P < .01). Consensus scores for radiographic and sonographic staging had moderate (κ = 0.535, z = 4.2; P < .01, and perfect relative (100% relative agreement, z = 6.22; P < .01) agreement.

Conclusion: Sonographic evaluations of calcaneal ossification staging was comparable across assessors, and similar to radiographic staging.

Clinical relevance: Clinicians may consider incorporating ultrasound imaging for calcaneal ossification staging for young patients.

Context: Despite fastpitch softball's growing popularity, there is limited evidence-based guidance to aid practitioners in developing pitching-specific injury prevention and performance enhancement strategies. This commentary describes the biomechanics across each phase of the softball pitch and provides explanation of common biomechanical errors during the pitch as well as training strategies and exercise recommendations to foster optimal pitcher development.

Evidence acquisition: A review of softball pitching biomechanics research available in electronic databases including PubMed, Medline, and EBSCO.

Study design: Clinical review.

Level of evidence: Level 4.

Results: The 4 primary phases of the windmill softball pitch include the wind-up, stride, acceleration, and follow-through.

Conclusion: Specific training strategies are recommended to combat the various flaws associated with each phase of the softball pitch. Evaluating body composition, functional characteristics like strength and range of motion of the shoulders, trunk, and hips, as well as assessing energy flow may result in improved performance and minimize risk of injury.

Background: Recent research indicates a potential link between effusion-synovitis and knee pain in athletes. This study investigates the association of knee effusion-synovitis with self-reported knee pain in elite female athletes, leveraging ultrasound imaging for effusion-synovitis assessment.

Hypothesis: Presence of knee effusion-synovitis is associated with increased self-reported knee pain in Division I female athletes.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: A total of 53 NCAA Division I female athletes underwent bilateral knee ultrasound to identify effusion-synovitis. The Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain subscale assessed knee pain. A 1-way analysis of variance compared KOOS pain, symptoms, activities during daily living (ADL), and quality of life (QoL) scores across groups with no, unilateral, and bilateral effusion-synovitis.

Results: Among the athletes, 49.1% showed no effusion-synovitis, 26.4% had unilateral, and 24.5% had bilateral effusion-synovitis. There were no differences in self-reported pain scores (F = 0.027; P = 0.97), ADL (F = 0.256; P = 0.78), or QoL (F = 0.120; P = 0.88) between any groups. In addition, the frequency of effusion-synovitis was as follows: for the right limb, Grade 0 = 35 (66%), Grade 1 = 15 (28%), Grade 2 = 1 (2%), and Grade 3 = 2 (4%); for the left limb, Grade 0 = 31 (58%), Grade 1 = 19 (36%), Grade 2 = 3 (6%), and Grade 3 = 0 (0%).

Conclusion: The presence of effusion-synovitis, irrespective of being unilateral or bilateral, was not associated with self-reported knee pain in elite female athletes. This suggests that lower grades of effusion-synovitis may not significantly impact knee pain.

Clinical relevance: The findings of this study challenge existing assumptions about the impact of effusion-synovitis on knee pain in athletes, contributing to the nuanced understanding of knee joint health in sports medicine.

Context: Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population.

Evidence acquisition: Nonsystematic review with critical appraisal of existing literature.

Study design: Clinical review.

Level of evidence: Level 4.

Results: Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy.

Conclusion: With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.

Background: Diminished corticospinal excitability is theorized to contribute to poor quadriceps function after anterior cruciate ligament (ACL) reconstruction. Operant conditioning of the motor evoked torque (MEP_TORQUE) is a promising approach capable of improving corticospinal excitability. However, it is unknown whether increasing corticospinal excitability can improve quadriceps function after a short-term operant conditioning intervention in patients with reconstructed ACL.

Hypothesis: After ACL reconstruction, patients would demonstrate increases in quadriceps strength, voluntary activation, and corticospinal excitability after a 2-week operant conditioning intervention.

Study design: Randomized controlled clinical trial.

Level of evidence: Level 1.

Methods: A total of 22 patients with reconstructed ACL were randomized into 1 of 2 groups: group 1 received 2 weeks of operant conditioning training on the reconstructed leg to improve their transcranial magnetic stimulation (TMS)-elicited MEP_TORQUE responses (COND); group 2 received 2 weeks of TMS only (SHAM-COND). Quadriceps strength, voluntary activation, and corticospinal excitability on the reconstructed leg were evaluated before and after the 2-week intervention. Within-session changes in corticospinal excitability were also evaluated during the training sessions.

Results: The COND group demonstrated a significantly higher within-session percent increase in MEP_TORQUE during training compared with the SHAM-COND group, paralleled by a significant increase in corticospinal excitability after the 2-week intervention. In addition, quadriceps strength and voluntary activation improved on the reconstructed leg after the 2-week intervention, regardless of group.

Conclusion: Operant conditioning training can elicit improvements in corticospinal excitability after ACL reconstruction; however, improvements in quadriceps strength and voluntary activation seem not to be attributed solely to operant upconditioning training.

Clinical relevance: Operant conditioning is a promising approach to improve corticospinal excitability after ACL reconstruction. However, optimizing the delivery of operant conditioning protocols by potentially increasing the dosage of operant conditioning and intervening earlier after surgery may be needed to translate these changes to improvements in quadriceps function.

Background: Isometric and dynamic tasks of low-to-moderate intensities have been used to study sex differences in fatigability; however, maximal exertions with flywheel devices (FDs) have not been used. This study aimed to (1) detect sex differences in fatigue-related performance in a maximal intermittent fatiguing protocol on a FD, and (2) investigate the most sensitive dynamometric and mechanical variables for assessing fatigue in both sexes.

Hypothesis: No sex differences should exist when performing this protocol on a FD.

Study design: Cohort observational study.

Level of evidence: Level 3.

Methods: A total of 34 young adults (17 female/17 male) performed 10 sets of 10 repetitions with 3 minutes of passive recovery of a half-squat exercise on a FD. Inter- and intraset analysis of force, power, velocity, work, and impulse, together with their relative change and slope, were calculated during concentric and eccentric phases. Raw data were also normalized to body mass in the interset analysis. The relative changes in each variable were compared.

Results: Men showed greater and earlier decreases in performance throughout sets (P < .05; η_p² ≥ 0.08), but these differences were not consistent after normalization for body mass (P > .05; η_p² ≤ 0.05). Irrespective of sex and phase, the intraset analysis revealed that relative change was higher in the last set (P ≤ .03; η_p² ≥ 0.14), with power being the most sensitive variable for detecting performance decline (P ≤ .04; η_p² = 0.49).

Conclusion: Women experienced slower and delayed fatigue kinetics than men during a maximal intermittent fatiguing protocol with FD if body dimensionality is not considered. For training purposes, power seems to be the most sensitive and discriminative variable for detecting decreases in performance.

Clinical relevance: Body dimensionality is a key factor that must be considered when comparing both sexes in FDs.

Background: Research on catastrophic injuries and medical conditions among majority girls' and women's sports are underrepresented. In this study, we describe the incidence, characteristics, and mechanisms of severe softball injuries/medical conditions between 2014 and 2021.

Hypothesis: Catastrophic injury and illness patterns will be observed with a higher incidence rate at the collegiate level.

Study design: Descriptive epidemiologic study.

Level of evidence: Level 3.

Methods: Events from the National Center for Catastrophic Sport Injury Research (NCCSIR) and National Electronic Injury Surveillance System (NEISS) were included. NCCSIR included catastrophic injuries during participation in high school (HS) or college sponsored girls'/women's softball resulting in death, temporary or permanent disability, or life-threatening injury. NEISS included severe girls'/women's softball injuries (product code 5034) among 13- to 17- and 18- to 24-year-olds among severe dispositions. National estimates were derived using a weighted sample for NEISS. Counts (%) and incidence rates (IR) per 100,000 participants overall and by age level, injury/medical event, and outcome were reported.

Results: NCCSIR captured 0.3 events per 100,000 participants (95% confidence interval, 0.1-0.5), and incidence was higher in college (IR, 2.5; 0.9-6.6) compared with HS (IR, 0.1; 0.1-0.4). Sudden cardiac arrest was the most common event (5, 63%), and 2 (25%) fatalities were reported. NEISS captured 10.2 events per 100,000 participants (9.7-10.8). Incidence was higher in 18- to 24-year-olds (IR, 8.9; 8.3-9.6) compared with 13- to 17-year-olds (IR, 4.2; 3.8-4.6), and no fatalities were captured.

Conclusion: Collegiate and 18- to 24-year-old athletes demonstrated a higher incidence of severe injuries than HS and 13- to 17-year-old athletes across both surveillance systems. NEISS captured a higher incidence of catastrophic events than NCCSIR. NCCSIR observed more cardiac events, whereas NEISS observed more head/face injuries.

Clinical relevance: Continued monitoring of severe injuries and medical events in softball is necessary to support response and prevention measures.

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: Adipose tissue is an endocrine organ that produces various bioactive molecules known as adipokines, including resistin, which is be highly expressed in people with obesity and cardiovascular disease (CVD). The effects of supramaximal high intensity interval training (HIIT) and moderate-intensity interval training (MIIT) on serum levels of resistin and various cardiometabolic health indices, were investigated.

Hypothesis: Supramaximal and moderate interval training induce comparable effects on serum resistin levels and cardiometabolic health indices.

Study design: Cohort study.

Methods: Thirty overweight adult women were assigned to 1 of 3 groups: HIIT (2 sets of 8 intervals, each with 30 seconds exercise at 100%-110% maximal aerobic speed [MAS] followed by 30 seconds rest at 50% MAS; for 6 weeks with 3 sessions per week), MIIT (2 sets of 8 intervals, each with 30 seconds exercise at 70%-80% MAS followed by 30 seconds rest at 50% MAS; for 6 weeks with 3 sessions per week), or a control group.

Results: Triglyceride levels were significantly higher in the control group compared with both the HIIT and MIIT groups (P = .02 and .01, respectively). High-density lipoprotein levels were also elevated significantly in the experimental groups compared with the control group (P = .04 and .03, respectively). Serum resistin increased significantly from pretest levels in the control group (P < .01). Between-group comparisons showed that resistin levels were significantly higher in the control group than in the experimental groups (P < .01 and .01, respectively).

Conclusion: Six weeks of HIIT can reduce resistin levels and improve cardiometabolic health indicators in nonpostmenopausal women. Although 6 weeks of MIIT does not reduce resistin, it does decrease systolic blood pressure and obesity-related factors in nonmenopausal women.

Clinical relevance: Supramaximal interval training may be recommended to control bioactive molecules produced from adipose tissue that are linked to CVD.