Sports Health-A Multidisciplinary Approach最新文献

Context: Muscle injury classification and grading systems have been reported for >100 years; yet it offer limited evidence relating the clinical or radiological qualities of a muscle injury to the pathology or clinical outcome. The British Athletics Muscle Injury Classification (BAMIC) incorporates recent predictive features of muscle injuries and provides a precise radiographic framework for clinical prediction and management.

Objective: To investigate clinical outcomes, particularly time to return to play (RTP), reinjury rate (RIR), and prognostic value of specific magnetic resonance imaging (MRI) findings, of activity-related muscle injuries (tears) in athletes after application of the BAMIC.

Data sources: A search of PubMed (NLM), EMBASE (Ovid), Web of Science (Clarivate), Cochrane Library (Wiley), and ClinicalTrials.gov from the inception date of each database through August 31, 2022, was conducted. Keywords included the BAMIC.

Study selection: All English language studies evaluating clinical outcomes of RTP and RIR after activity-related muscle injuries and where BAMIC was applied were included. A total of 136 articles were identified, and 11 studies met inclusion criteria.

Study design: Systematic review (PROSPERO: CRD42022353801).

Level of evidence: Level 2.

Data extraction: Two reviewers independently screened studies for eligibility and extracted data. Methodological quality of included study was assessed independently by 2 reviewers with the Newcastle-Ottawa Quality Scale (NOS); 11 good quality studies (4 prospective cohort studies, 7 retrospective cohort studies) with 468 athletes (57 female) and 574 muscle injuries were included.

Results: All studies reported a statistically significant relationship between BAMIC grade, BAMIC injury site, and/or combined BAMIC grade and injury site with RTP. A statistically significant increased RIR was reported by BAMIC grade and BAMIC injury site in 2 of 4 and 3 of 4 studies, respectively. The prognostic value of individual MRI criteria was limited.

Conclusion: Consistent evidence suggests that BAMIC offers prognostic and therapeutic guidance for clinical outcomes, particularly RTP and RIR, after activity-related muscle injuries in athletes that may be superior to previous muscle injury classification and grading systems.

Context: Muscle atrophy and loss of knee function are common findings after anterior cruciate ligament (ACL) reconstruction. Rehabilitation through blood flow restriction (BFR) has gained clinical relevance when combined with low loads to improve these disorders in recent years.

Objective: To evaluate the rehabilitation effectiveness of ACL reconstruction with the use of BFR on pain, functionality, strength, and muscle mass in physically active people.

Data sources: A search of PubMed, Web of Science, and MEDLINE was performed on March 31, 2023, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

Study selection: Randomized clinical trials with active adults who underwent ACL surgery were included. They had to compare conventional treatments with the use of BFR, reporting values of pain, functionality, strength, or cross-sectional area (CSA). Articles whose participants presented concomitant injuries and whose intervention combined the use of BFR with treatments other than resistance training were excluded.

Study design: Systematic review.

Level of evidence: Level 2.

Data extraction: Study design, population, cuff pressure, and main outcomes including strength, quadriceps CSA, pain, and functionality.

Results: Six studies out of a total of 389 were included (152 participants; 90 men and 62 women). These included studies showed no differences on CSA or strength when comparing BFR training with high loads exercise. BFR has demonstrated improvements in knee functionality and pain compared with other interventions such as immobilization or high loads training.

Conclusion: The use of low loads combined with BFR improves pain, strength, functionality, and CSA. In addition, knee pain reduction and functionality are greater with BFR compared with the use of high loads or immobilization.

Context: Ammonia inhalants, also known as smelling salts, are preparations of ammonia designed to treat fainting but more commonly used by athletes to boost awareness and arousal during competition. Despite their widespread use, the physiological and performance-enhancing effects of ammonia inhalants remain poorly understood. The aim of the present study was to review the current literature surrounding the benefits, risks, and physiological effects of ammonia inhalants.

Evidence acquisition: An extensive literature review of articles pertaining to ammonia inhalants was performed through MEDLINE and Google Scholar. The search terms "smelling salts," "ammonia inhalants," "strength," "performance," "head injury," and "concussion" were used.

Study design: Clinical review.

Level of evidence: Level 4.

Results: The physiological response to acute ammonia inhalation includes cerebral vasodilation and heart rate elevation without change in blood pressure. The existing evidence demonstrates an ergogenic benefit to ammonia inhalant use only during repeated bouts of high-intensity exercise; in these subjects, ammonia inhalation was associated with increased power as measured by the Wingate anaerobic test. In contrast, there is no performance benefit to ammonia inhalants in a short burst of maximal effort despite elevated arousal and an associated perception of performance enhancement. Importantly, ammonia inhalants have no role in medical management of head injuries, as they have the potential to exacerbate an underlying brain injury due to the involuntary withdrawal reflex associated with ammonia inhalation. Furthermore, the signs and symptoms of a concussion or more threatening head injury may be masked by ammonia inhalation and lead to continued participation in competition, causing additional harm.

Conclusion: Ammonia inhalants have no role in medical management of head injuries and have limited benefit with regards to sports performance.

Strength of recommendation: B.

Background: Taurine (TAU) and caffeine (CAF), as common ergogenic aids, are known to affect exercise performance; however, the effects of their combined supplementation, particularly in high temperature and humidity environments, have not been studied.

Hypothesis: The combination of TAU and CAF will have a greater effect on endurance cycle performance and improve changes in physiological indicators during exercise compared with TAU or CAF supplementation alone and placebo.

Study design: Single-blind crossover randomized controlled study.

Level of evidence: Level 1.

Methods: Twelve university students majoring in physical education volunteered to receive 4 different supplement ingestions: (1) placebo (maltodextrin), (2) TAU, (3) CAF, (4) TAU + CAF. After a 7-day washout period, participants completed a time to exhaustion (TTE) test in the heat (35°C, 65% relative humidity).

Results: All experimental groups improved TTE compared with the placebo group. Peak and mean power of countermovement jump were significantly higher in the CAF group compared with the placebo group before the exhaustion exercise (P = 0.02, d = 1.2 and P = 0.04, d = 1.1, respectively). Blood lactate was significantly lower after the exhaustion test in the TAU group compared with the CAF (P < 0.01, d = 0.8) and TAU + CAF (P < 0.01, d = 0.7) groups. Core temperature in the TAU group was significantly reduced in the placebo group later in the exhaustion test (P < 0.01, d = 1.9).

Conclusion: In high temperature and humidity environments, acute TAU, CAF, and combined supplementation all improved TTE and did not affect recovery from lower limb neuromuscular fatigue compared with placebo, with TAU having the best effect. Combined supplementation failed to exhibit superimposed performance.

Clinical relevance: The results provide suggestions for the effects of TAU, CAF, and their combined intake on exercise performance in high temperature and humidity environments.

Context: The limb symmetry index (LSI) is recommended as a milestone of return to play (RTP), and relying on the LSI value of a single-leg hop for distance (SLHD) test may overestimate rehabilitation status. Identifying a more reliable functional test can help to carefully make decisions for RTP.

Objective: The aim was to compare the LSI value of the SLHD test with that of a single-leg vertical jump (SLVJ) test after anterior cruciate ligament reconstruction (ACLR) and determine which test provides lower LSI values.

Data sources: The PubMed, Web of Science, Embase, and Cochrane Library databases were searched from inception to July 2022.

Study selection: Observational studies with participants who had both SLHD and SLVJ tests after ACLR and LSI values of an SLHD and SLVJ were included. Disagreements were resolved after discussion between the 2 researchers.

Study design: Systematic review and meta-analysis.

Level of evidence: Level 4.

Data extraction: Data on the primary outcomes (LSI values of the SLVJ and SLHD tests) were collected. Means and standard deviations (SDs) for each variable of interest were used to calculate standardized mean differences (SMDs).

Results: A total of 12 studies met the inclusion criteria for the meta-analysis. A total of 587 patients underwent SLHD and SLVJ tests at different time points after ACLR. Compared with the SLHD test, the SLVJ test provided lower LSI values (SMD -0.42; 95% confidence interval (CI) -0.67 to -0.17). Subgroup analysis found that the SLVJ test provided a lower LSI value than the SLHD test in a specific period (approximately 7-18 months after ACLR, SMD -0.53; 95% CI -0.91 to -0.14) and a similar LSI value at other times.

Conclusion: The SLVJ test provided lower LSI values in a specific period (7-18 months after ACLR).

Background: Musculoskeletal injuries are prevalent in the NBA and are associated with a significant number of games missed. There is a lack of reference data for clinical measures in NBA players, making it difficult for sports medicine professionals to set goals and develop programs.

Hypothesis: Values for clinical measures in NBA players will differ from those of the general population but will not differ between dominant (D) and nondominant (ND) limbs.

Study design: Descriptive laboratory study.

Level of evidence: Level 3.

Methods: Clinical measures were taken on 325 players invited to NBA training camp (2008-2022). Measures included range of motion for great toe extension, hip rotation, weightbearing ankle dorsiflexion, flexibility, arch height (AH) indices, and tibial varum.

Results: Clinical values for NBA players differ from reference norms of the general population. Results for NBA players include great toe extension (D, 40.4°; ND, 39.3°), 90/90 hamstring (D, 41.5°; ND, 40.9°), hip internal rotation (D, 29.0°; ND, 28.8°), hip external rotation (D, 29.7°; ND, 30.9°), total hip rotation (D, 60.2°; ND, 60.4°), Ely (D, 109.9°; ND, 108.8°), AH difference (D, 0.5 mm; ND, 0.5 mm), AH index (D, 0.310; ND, 0.307), arch stiffness (D, 0.024; ND, 0.024), arch rigidity (D, 0.924; ND, 0.925), tibial varum (D, 4.6°; ND, 4.5°), and weightbearing ankle dorsiflexion (D, 35.4°; ND, 35.6°). Descriptive statistics are presented; 2-tailed paired t tests show that, whereas most measures demonstrated differences between sides, the results were not statistically significant.

Conclusion: Clinical measures of NBA players differ from those reported for the general population and athletes of other sports although there were no statistically significant differences between D and ND limbs.

Clinical relevance: Establishing a reference database may help clinicians develop more sensitive and more effective preseason and return-to-play screening processes, aiding the management of player orthopaedic care and reducing injury risk.

Context: Equestrian sports continue to gain popularity in the United States and are associated with a high injury rate, especially involving the central nervous system and thorax. Due to this high rate of injury and the potential for long-term consequences associated with participation, an understanding of the unique risks of this sport is needed.

Objective: To describe severe injury in equestrian sports and review the role that protective gear plays in injury mitigation.

Data sources: The PubMed Database was searched using the search terms "equestrian" and "horse" combined with "spinal cord injury," "head injury," "traumatic brain injury," "experience levels," and "demographics."

Study selection: A total of 53 papers were selected based on their relevance of epidemiology, risk factors, and management of injuries sustained during equestrian activities. Case studies, randomized controlled trials, prospective studies, and retrospective studies were all included for further review.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: None.

Results: Injuries to the thorax, including fractures, pneumothoraces, internal organ contusions, and crush injuries, have been cited in multiple national and international trauma registries as the most prevalent injury location in equestrians; however, head and neck injuries, high cervical spine fractures, and closed head injuries are reported to be associated with the highest rates of mortality. Helmets provide protection against skull fracture and traumatic brain injury. Vests were not associated with diminished rates of spinal cord injuries; however, they may provide protection to the thorax. Riding experience also plays a role in reducing the prevalence of injury.

Conclusion: Equestrian-related activities are associated with a high risk of injury despite protective measures. Protective gear can mitigate some injury risk but does not protect against spinal injury. Continued investigation into improving protective equipment, rider education, and preventative strategies to mitigate this risk is needed.

Background: Although the lower extremities are essential for movement function and human gait, no normalized isometric maximum strength values, which include the factors gender, age, weight, height, and body mass index (BMI), have been defined to date for orthopaedic patients.

Objective: To systematically analyze the isometric maximal muscle strength of a cohort in an orthopaedic outpatient clinic and to evaluate its relation to gender, age, weight, height, BMI, and the differences between diseases.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: Isometric maximal muscle strength of knee extension, knee flexion, hip abduction, and hip adduction was measured in orthopaedic patients of an outpatient clinic using a specific muscle strength measurement device. Correlation analysis was performed for age, gender, height, weight, and BMI. Patients were grouped by disease characteristics.

Results: The cohort consisted of 311 subjects (sex: 164 male, 147 female; age: 48.63 years, SD = 16.595; BMI: 26.56 kg/m², SD = 4.9). Age correlated significantly with maximal isometric muscle strength. At the age of 54 years onward, based on 133 patients, a decline in maximum isometric muscle strength was detected. Gender showed a strong influence on maximal isometric muscle strength, with significantly higher values for male patients. Furthermore, weight and height, but not BMI, correlated significantly with muscle strength.

Conclusion: For clinical studies comparing different evidence-based training interventions for rehabilitation, it is important to consider determinants such as gender, age, weight, and height for isometric maximum strength measurement. For further validation, follow-up examinations taking into account the performance level, other target groups, and other muscle groups are required to avoid the wide dispersion of isometric maximum strength values. These results and associated determinants are highly clinically relevant and can be used as a reference for further studies in the field of musculoskeletal regeneration.

Background: Traumatic shoulder instability is a common injury in the general population and the military. Surgical stabilization surgery reduces recurrence rates compared with nonsurgical management. Time since surgery is generally the primary measure of return to sport. There is a gap in knowledge on psychological variables and time since surgery and their relationship to rotator cuff strength and functional performance.

Hypothesis: It was hypothesized that, after shoulder stabilization surgery, psychological factors and time since surgery will be associated positively with objective physical performance tests, that physical performance will differ significantly between postsurgery cadets and healthy controls, and that surgical stabilization of the nondominant arm will demonstrate greater range of motion deficits than surgical intervention on the dominant arm.

Study design: Case-control study.

Level of evidence: Level 4.

Methods: The 52 participants (26 postsurgical [6-24 months after surgery] and 26 healthy controls) were all military cadets. Outcome measures were patient-reported outcomes, range of motion, isometric strength, and functional performance.

Results: No significant relationships existed between time since surgery and psychological factors to rotator cuff strength or functional performance. Significant differences were found between groups in self-reported outcomes, including the Shoulder Instability Return to Sport After Injury scale, Single Assessment Numeric Evaluation, Numeric Pain Rating Scale, quickDASH, flexion and external rotation (ER), and ER limb symmetry. Those who received dominant-sided shoulder surgery demonstrated a greater mean active range of motion deficit than those who received nondominant-sided surgery. Both groups demonstrated a significant loss in ER, but dominant-sided surgical participants also demonstrated significant flexion loss.

Conclusion: Time since surgery and psychological variables did not demonstrate a relationship to rotator cuff strength and functional performance. Significant differences existed between the stabilization surgical participants and healthy controls in all patient-reported outcomes. Surgical participants with dominant-sided shoulder surgery demonstrated a greater mean motion deficit when compared with those who received nondominant-sided surgery.

Background: Monitoring training load and competition load is crucial for evaluating and improving athlete performance. This study proposes an applied approach to characterize and classify the training task specificity in relation to competition in a top-level rink hockey team, considering external and internal load from training tasks and competition.

Hypothesis: Training tasks and game demands have significant dose-response differences, and exercises can be classified successfully based on their physiological and biomechanical demands.

Study design: Cross-sectional study.

Level of evidence: Level 5.

Methods: Ten elite-level male rink hockey players participated in this study. Players were monitored on 6 different task categories during 8 training sessions and 2 official games. A linear mixed model with random intercepts was used to compare training tasks and competition load, accounting for individual repeated measures. A 2-step cluster analysis was performed to classify the training tasks and games based on physiological and biomechanical load, employing log-likelihood as the distance measure and Schwartz's Bayesian criterion.

Results: Average heartrate , maximum heartrate, and high-speed skating (18.1-30 km/h) were the best physiological load predictors, while the most effective biomechanical load predictors were impacts [8-10] g(n), decelerations [-10 to -3]m/s²(n), and accelerations [3-10]m/s²(n). Different physiological and biomechanical responses were verified between training tasks and match demands. A 4-quadrant efforts assessment for each task category revealed that training tasks used by the team in the analysis presented lower biomechanical and physiological load demands than competition.

Conclusion: Training tasks failed to adequately replicate the specific demands of competition, especially regarding high mechanical stress, such as the absence of high-intensity impacts and decelerations.

Clinical relevance: This method of classification of training tasks may allow coaches to understand further the specificity and contribution of each task to competition demands, consequently improving the capacity of load management and the preparedness and readiness of players for competition.