Sports Health-A Multidisciplinary Approach最新文献

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.

Background: Kinesio tape (KT) is being applied increasingly in physical therapy and rehabilitation. This trial aimed to examine the effect of KT in terms of functional outcomes in people undergoing arthroscopic rotator cuff repair (ARCR).

Hypothesis: KT after ARCR will reduce pain and edema.

Study design: A double-blind, randomized controlled trial.

Level of evidence: Level 1b.

Methods: A total of 45 patients who underwent ARCR were assigned randomly to 1 of 3 groups: KT (n = 15), sham taping (ST, n = 15), and control (n = 15). Participants received a conservative physiotherapy program. The physiotherapy program, which was conservative in nature, covered the first 7 weeks after surgery. In addition to the program, patients in the KT group were also treated with KT, while those in the ST group received ST. Pain levels (visual analog scale), edema, and functional scores (Western-Ontario Rotator Cuff Index, Modified Constant-Murley Shoulder Score, Revised Oxford Shoulder Score, and Shoulder Pain and Disability Index) were evaluated at regular intervals throughout the treatment.

Results: Baseline characteristics of the groups were similar (P > 0.05). All evaluation parameters showed significant improvement over time in all 3 groups (P < 0.05). There were no differences between the groups in any of the parameters when analyzed for group × time interactions (P > 0.05).

Conclusion: This study found no efficacy of KT after ARCR in reducing pain and edema and improving shoulder function in the short- or medium-term.

Clinical relevance: Clinicians should not expect additional short- or medium-term benefits from KT in reducing pain and edema or improving shoulder function after ARCR.

Background: Quantitative electroencephalography (qEEG) offers sports medicine clinicians insight into the neurophysiological connection between the brain and musculoskeletal system. Dysregulation in the brain's neural state has been linked with altered biomechanical and/or musculoskeletal performance associated injury; however, comparative benchmark data among uninjured athletes without brain and/or musculoskeletal injury remain limited.

Hypothesis: Evaluating real-time qEEG neurophysiological and physiometric neurological brain responses while performing physical and cognitive functional tasks will offer clinicians performance insight to the neuromuscular preparedness in healthy Division I athletes.

Study design: Descriptive prospective case series.

Level of evidence: Level IV.

Methods: A total of 24 healthy female (n = 11) and male (n = 13) National Collegiate Athletic Association (NCAA) Division I athletes from multiple sports volunteered to participate in a qEEG neurophysiological and functional task assessment. A 21-channel Dry headset collected neurophysiological brain wave activity representing participants' level of attention, workload and sensorimotor rhythm (SMR) pre- and post-physical and cognitive tasks. Physiometric dependent variables included heartrate, respiration rate, heartrate variability, galvanic skin response, trapezius electromyography and peripheral temperature. Participants had no diagnosed attention deficits, learning impairments, and/or orthopaedic injuries.

Results: Healthy Division I athletes had balanced/regulated neurophysiological levels of change in neurophysiological activity. Brain connectivity, attention, and workload metrics were significantly higher in men (P ≤ 0.05). There were no sex or hemisphere differences at baseline for SMR; however, there were significant SMR differences pre- to post- for motor imagery tasks (P ≤ 0.05). There were relatively strong positive correlations between brain activity and physiometric performance (0.81-0.85), as well as, brain symmetry, workload, and attention (0.65-0.85).

Conclusion: Real-time qEEG brain mapping of neurophysiological and physiometric responses during functional and cognitive tasks provide standard performance benchmarks for healthy, Division I athletes.

Clinical relevance: Monitoring qEEG neurophysiological and physiometric benchmarks of healthy athletes can offer clinicians performance insight into neuromuscular preparedness.

Rationale: The International Ice Hockey Federation and USA Hockey are ice hockey governing bodies that have made neck guards mandatory beginning August 2024.^1,2 These mandates do not include National Hockey league (NHL) or National Collegiate Athletic Association (NCAA) level players.

Purpose: To describe life-threatening laceration injuries in ice hockey and identify prevention strategies.

Methods: Case summaries for catastrophic ice hockey laceration injuries from the National Center for Catastrophic Sport Injury Research (NCCSIR) were reviewed to describe the mechanism of injury, use of neck protection, and outcome. A Haddon Matrix informed preventative strategies across pre-event, event, and post-event phases as they relate to the athlete, source (skate, puck, stick), and environment.³Results:NCCSIR captured 26 catastrophic ice hockey laceration injuries from 1982 to 2025 (13 professional/semi-professional, 6 high school, 2 select/junior/adult league, 1 college; ages 13-34). Of these 26 injuries, 24 (92%) were caused by skates, and 1 each by puck and stick. The neck was the body part lacerated most commonly (15, 58%), followed by the arm (6), wrist (2,) leg (1), and eye (1). Of 15 athletes with neck lacerations, 7 were reportedly not wearing neck protection; 8 were unknown/unreported. A total of 5 (19%) injuries resulted in death (ages 13-29 years), and 3 of those 5 athletes were reportedly not wearing neck protection. A Haddon Matrix identified prevention strategies by phase and included pre-event: cardiopulmonary resuscitation (CPR) and first-aid training, stop-the-bleed kits, mandated neck protection; during event: equipment inspection, player training; and post-event: secure a safe space for medical personnel to enter/exit ice and provide quick emergency response.

Discussion: Ice hockey is an inherently dangerous sport, and lacerations are a common injury type that can result in serious injury or death. This study highlights the Haddon Matrix as a valuable tool for identifying preventive measures for life-threatening lacerations in ice hockey. Further research should investigate the effectiveness of the strategies proposed.

Background: Ulnar nerve dislocation is an under-reported cause of medial elbow mechanical symptoms in baseball players. It is often accompanied by a "pop" during the throwing motion. This mechanical symptom is often confused with ulnar collateral ligament (UCL) injury. This study evaluated associations of asymptomatic ulnar nerve subluxation with UCL laxity in collegiate baseball players.

Hypothesis: Asymptomatic ulnar nerve dislocation is prevalent among collegiate baseball players, and associated with years of playing baseball, playing as a pitcher, and having medial UCL laxity.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: Healthy, asymptomatic, National Collegiate Athletic Association Division I, male, collegiate baseball athletes were evaluated with dynamic stress ultrasound imaging for ulnar nerve dislocation and UCL laxity, and associations with demographic and athletic variables were evaluated.

Results: A total of 50 male athletes were evaluated (mean age, 20.5 years; 40% pitchers; mean playing experience, 15.7 years). Ulnar nerve dislocation was found in 16% of players (8 of 50 players) and in 11% of elbows evaluated (11 of 100 elbows; bilateral dislocations were identified in 3 players). None of the players reported ulnar nerve symptoms. No demographic or athletic variables, including years of playing or position, were associated with dislocation (P > 0.05). Players with ulnar nerve dislocation demonstrated higher values for all sonographic UCL laxity measurements than those who did not dislocate, including 0.6 mm greater valgus stress ulnohumeral joint space and 0.4 mm greater joint space gap. However, these group differences did not reach statistical significance (P > 0.05).

Conclusion: Ulnar nerve dislocation can be an asymptomatic finding in baseball athletes. Ulnar nerves may be more prone to dislocate in the presence of medial elbow valgus laxity.

Clinical relevance: Ulnar nerve dislocation should be considered a cause of medial elbow mechanical symptoms, even if the athlete is asymptomatic.

Context: Wrestling is a physically demanding sport that places athletes at a high risk of musculoskeletal injuries, particularly to shoulder and elbow joints.

Objective: This study summarizes published data on shoulder and elbow injuries in wrestling, determines their burden, and reports weighted average injury rates (wIRs).

Data sources: Databases searched included PubMed, Embase, Medline, Cochrane Library, and SPORTDiscus.

Study selection: Full-text studies in English evaluating shoulder or elbow injuries in competitive wrestlers with reported injury data specific to wrestlers, as well as to the shoulder or elbow were included. Exclusions were case reports, reviews, and studies not reporting orthopaedic injury data.

Study design: Systematic review.

Level of evidence: Level 4.

Data extraction: Extracted data included the first author, publication year, journal, country of the corresponding author, level of competition, method of data collection, duration of data collection, incidence of injury (injury rate [IR]) per athlete-exposure (AE), number of shoulder or elbow injuries, total number of injuries, total AEs, specific injury types, mechanism of injury, and time lost due to injury.

Results: Shoulder and elbow injuries together accounted for 21.2% of all wrestling injuries, with a wIR of 14.1 per 10,000 AEs. Shoulder injuries accounted for 14.1% of all injuries (wIR = 6.2 per 10,000 AEs), while elbow injuries accounted for 7.2% (wIR = 4.1 per 10,000 AEs). The most frequent injuries were shoulder strains/sprains (wIR = 4.2), including rotator cuff (wIR = 3.4) and acromioclavicular joint injuries (wIR = 1.5), shoulder instability (wIR = 2.5), and elbow instability, including ulnar collateral ligament injury (wIR = 1.8).

Conclusion: Shoulder and elbow injuries are common in wrestling, with shoulder injuries being more prevalent due to the joint's mobility and relative instability. This review identifies the most common injuries and serves as a valuable resource for physicians managing the care of wrestlers.

Background: Trail running has increased in popularity due to the benefits of physical activity in nature. However, trail running has an inherent risk of running-related injuries (RRI). It is known that athletes with certain psychological traits have a greater tendency to suffer injuries; however, this is unknown in trail runners. The main objective of this study was to identify trail runners' psychological profiles and to compare the proportion of RRI across these profiles.

Hypothesis: Trail runners with psychological profiles of high stress, precompetitive anxiety, mental fatigue, competitiveness, and poor sleep quality are at increased risk of RRI.

Study design: Prospective cohort study.

Level of evidence: Level 2.

Methods: A Gaussian mixture model cluster analysis was performed on 202 trail runners (55.5% male; aged 38.7 [33.4-46.2] years) with psychological stress, cognitive and somatic anxiety, self-confidence, mental fatigue, sleep quality, and competitiveness measured 4 weeks before participating in a race. The proportion of RRI during the race was recorded and compared across clusters.

Results: Overall RRI proportion during competition was 11.3% (n = 24). The most common RRI were muscle (41.7%) and tendon/bursa (16.7%) injuries, affecting primarily the knee (33.3%) and lower leg (20.8%). Five psychological profiles were identified. Cluster 1 (competitive runners with moderate psychological stress and mental fatigue, low sleep quality and anxiety, and high self-confidence) had a higher RRI proportion than Cluster 3 (similar traits but lower psychological stress, mental fatigue, and higher self-confidence; 21.2% vs 3.2%; P = 0.02).

Conclusion: Certain psychological profiles in trail runners were associated with higher RRI risk.

Clinical relevance: The medical team or trail running coaches should monitor runners with psychological profiles with higher psychological stress, mental fatigue, and cognitive anxiety, as well as lower self-confidence and sleep quality, to design strategies to reduce their risk of RRI.

Background: Quadriceps neuromuscular impairments are common after anterior cruciate ligament reconstruction (ACLR). Quadriceps function is typically characterized by peak torque (PT) assessment, and reported as limb symmetry index (LSI). Even when PT LSI is restored, high reinjury rates and abnormal biomechanics persist. Quadriceps rate of torque development (RTD) may have significant functional relevance, but direct comparisons of PT and RTD recovery post-ACLR are lacking.

Hypothesis: Quadriceps RTD LSI will recover more slowly than PT LSI post-ACLR.

Study design: Longitudinal cohort study.

Level of evidence: Level 3.

Methods: 42 athletes 4, 8, and 12 months post-ACLR completed maximal and rapid voluntary isometric knee extension contractions with both limbs. RTD was calculated as torque-time curve slopes from onset to 100 ms (RTD_0-100), 100 ms to 200 ms (RTD_100-200), onset to 200 ms (RTD_0-200), and 20% to 80% of PT (RTD_20-80). Between-limb differences were assessed with paired t tests (Bonferroni adjusted P < 0.003). Linear mixed models assessed the effect of time and variable on differences in PT and RTD LSIs and variable-by-time interactions. Least square mean differences and 95% CIs between PT and RTD LSIs are reported.

Results: Significant between-limb asymmetries were observed at all timepoints (P < 0.001) for all PT and RTD variables. No variable-by-time interactions were detected. There was a main effect of both time (P < 0.001) and variable (P < 0.001). RTD_0-100 LSI was not significantly different than PT LSI (P = 0.36). RTD_100-200, RTD_0-200, and RTD_20-80 LSIs were less than PT LSI by 10.4% (6.0, 14.9), 7.3% (2.8, 11.7), and 15.7% (11.2, 20.1), respectively (P < 0.002).

Conclusion: In collegiate athletes, RTD impairments are greater than PT impairments from 4 to 12 months post-ACLR, but the specific RTD metric is important.

Clinical relevance: Increased focus on the development and implementation of interventions to improve quadriceps RTD, beginning earlier post-ACLR, is warranted.

Background: The gold standard for measuring hip and knee strength is isokinetic dynamometry. This study evaluated the reliability and concurrent validity of a handheld dynamometer (HHD) and a externally fixated dynamometer (ForceFrame [FF]) against isokinetic dynamometry, considering their practicality, cost-effectiveness, and ease of use in clinical practice.

Hypothesis: The FF and HHD are reliable and valid for assessing hip and knee strength.

Study design: Controlled laboratory study.

Level of evidence: Level 4.

Methods: Maximal isometric hip strength (extension, flexion, abduction, adduction, internal and external rotation) and knee strength (extension and flexion) of 14 healthy persons (7 men; age, 24.4 ± 3.1 years; height, 176.3 ± 9.7 cm; weight, 68.5 ± 10.8 kg) was assessed with an isokinetic dynamometer, HHD, and FF. Measurements were repeated on 2 different days for test-retest reliability and by 2 different investigators on 1 day for interrater reliability. Intraclass correlations (ICC) were calculated, and Pearson correlation coefficients assessed concurrent validity.

Results: Moderate to good test-retest reliability was found for both the HHD (ICC, 0.62-0.88; MDC, 10-21%) and FF (ICC, 0.61-0.82; MDC, 15-38%). Interrater reliability was poor to good (HHD ICC, 0.15-0.80; FF ICC, 0.14-0.77). Concurrent validity was better for the HHD than FF.

Conclusion: Both the HHD and FF provide stable measurements of hip and knee strength over a 1-week interval. The calculated MDCs (HHD, 10-21%; FF, 15-38%) suggest that only differences exceeding these thresholds can be interpreted as true changes, rather than measurement errors. Inter-rater reliability was rather low, indicating that repeated evaluations are best performed by the same tester. Poor concurrent validity cautions against substituting the HHD and FF for isokinetic dynamometry.

Clinical relevance: HHD and FF offer practical and cost-effective alternatives for a single tester to evaluate strength changes over time.

Background: The latissimus dorsi (LD) comprises 2 neuromuscular regions-the thoracic and lumbar-pelvic-costal (LPC)-that may exhibit distinct activation patterns during shoulder and trunk exercises. A detailed understanding of these regional differences is crucial for optimizing therapeutic interventions due to their potential impact on muscle imbalances and rehabilitation outcomes in people with musculoskeletal conditions.

Hypothesis: Increasing contraction levels are expected to amplify differences between the thoracic and LPC regions, with the thoracic region demonstrating greater activation, particularly during shoulder extension and internal rotation tasks.

Study design: Descriptive laboratory study.

Level of evidence: Level 5.

Methods: A total of 20 healthy participants (15 men and 5 women) were recruited. High-density surface electromyography (HD-sEMG) electrode grids were positioned over the LD. Participants performed isometric contractions for shoulder extension, adduction, internal rotation, and lateral trunk bending at 10%, 30%, 50%, 70%, and 100% of their maximum voluntary contraction (MVC). The variables assessed included sEMG amplitude for each region and the spatial distribution of muscle activation (x- and y-axis barycenter).

Results: During shoulder extension, the thoracic region showed greater sEMG amplitudes than the LPC region at 50% (P = 0.02), 70% (P = 0.01), and 100% MVC (P < 0.01). Furthermore, shoulder extension generated greater amplitudes than all other exercises across both regions (P < 0.05). Barycenter analysis revealed a significant cephalomedial shift in the x-axis during both shoulder extension and internal rotation.

Conclusion: The thoracic region is preferentially recruited during isometric shoulder extension and internal rotation. This spatial redistribution of muscle activity suggests a functional specialization within the LD, which has important implications for the development of targeted shoulder rehabilitation strategies.

Clinical relevance: Exercises emphasizing shoulder extension may preferentially activate the thoracic region of the LD, thereby enhancing scapular stability while reducing strain on the rotator cuff tendons.