Pub Date : 2024-09-09DOI: 10.1136/bjsports-2024-108731
Aminah Amer
{"title":"Rehabilitation from the perspective of a hijabi: a tale of finding myself while navigating unchartered territory-Dr Aminah Amer.","authors":"Aminah Amer","doi":"10.1136/bjsports-2024-108731","DOIUrl":"10.1136/bjsports-2024-108731","url":null,"abstract":"","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/bjsports-2024-108127
Tong Zhao, Qize Yang, Joshua F Feuerbacher, Bizhu Yu, Christian Brinkmann, Sulin Cheng, Wilhelm Bloch, Moritz Schumann
Objective To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control. Design Systematic review and network meta-analysis. Data sources Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus. Eligibility criteria Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Results 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference −0.16%, 95% CI (−0.23 to −0.09) vs −0.10%, 95% CI (−0.21 to 0.02)), 2-hour glucose (−0.68 mmol/L, 95% CI (−0.97 to −0.39) vs 0.01 mmol/L, 95% CI (−0.38 to 0.41)) and HOMA-IR (−0.54, 95% CI (−0.71 to −0.36) vs −0.23, 95% CI (−0.55 to 0.10)), while the efficacy on fasting glucose was comparable (−0.26 mmol/L, 95% CI (−0.32 to −0.19) vs −0.33 mmol/L, 95% CI (−0.45 to −0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (−0.88%, 95% CI (−1.07 to −0.69) vs −0.48%, 95% CI (−0.58 to −0.38)), 2-hour glucose (−2.55 mmol/L, 95% CI (−3.24 to −1.86) vs −0.97 mmol/L, 95% CI (−1.52 to −0.42)) and fasting glucose (−1.52 mmol/L, 95% CI (−1.73 to −1.31) vs −0.85 mmol/L, 95% CI (−0.96 to −0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (−1.23%, 95% CI (−2.41 to –0.05)) and fasting glucose (−2.02 mmol/L, 95% CI (−3.31 to –0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage. Conclusion Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM. PROSPERO registration number CRD42023400622. Data are available upon reasonable request. Data are available on reasonable request by contacting the corresponding author.
目的 比较运动、二甲双胍及其联合用药对血糖控制异常者糖代谢的疗效。设计 系统综述和网络荟萃分析。数据来源：Embase、Web of Science、PubMed/MEDLINE 和 SPORTDiscus。资格标准 纳入对糖尿病前期或 2 型糖尿病 (T2DM) 患者进行运动、二甲双胍或其联合治疗的随机对照试验。结果包括血红蛋白 A1c (HbA1c)、口服葡萄糖耐量试验中的 2 小时血糖、空腹血糖、空腹胰岛素和胰岛素抵抗稳态模型评估 (HOMA-IR)。结果 共纳入 407 篇文章，410 项随机对照试验（n=33 802）。在糖尿病前期，运动对 HbA1c 水平（平均差 -0.16%，95% CI (-0.23 to -0.09)对 -0.10%，95% CI (-0.21 to 0.02)）、2 小时血糖（-0.68 mmol/L，95% CI (-0.97 to -0.39)对 0.01 mmol/L，95% CI (-0. 38 to 0.41)和胰岛素抵抗（HOMA-IR）的疗效高于二甲双胍。38至0.41））和HOMA-IR（-0.54，95% CI（-0.71至-0.36） vs -0.23，95% CI（-0.55至0.10）），而对空腹血糖的疗效相当（-0.26 mmol/L，95% CI（-0.32至-0.19） vs -0.33 mmol/L，95% CI（-0.45至-0.21））。在 T2DM 患者中，二甲双胍对 HbA1c（-0.88%，95% CI（-1.07 至 -0.69） vs -0.48%，95% CI（-0.58 至 -0.38））、2 小时血糖（-2.55 mmol/L，95% CI（-3.24 至 -1.86） vs -0.97 mmol/L，95% CI（-1.52 至 -0.42））和空腹血糖（-1.52 mmol/L，95% CI (-1.73 to -1.31) vs -0.85 mmol/L，95% CI (-0.96 to -0.74)）；运动+二甲双胍在改善 HbA1c（-1.23%，95% CI (-2.41 to -0.05)）和空腹血糖（-2.02 mmol/L，95% CI (-3.31 to -0.74)）方面的疗效也优于单独使用每种治疗方法。然而，运动方式和二甲双胍剂量会影响疗效。结论 运动、二甲双胍和它们的组合对改善糖尿病前期和 T2DM 患者的糖代谢都有疗效。对于糖尿病前期患者，运动的疗效似乎优于二甲双胍，但对于 T2DM 患者，二甲双胍的疗效似乎优于运动。PROSPERO 注册号为 CRD42023400622。如有合理要求，可提供数据。如需数据，请联系通讯作者。
{"title":"Effects of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control: a systematic review and network meta-analysis","authors":"Tong Zhao, Qize Yang, Joshua F Feuerbacher, Bizhu Yu, Christian Brinkmann, Sulin Cheng, Wilhelm Bloch, Moritz Schumann","doi":"10.1136/bjsports-2024-108127","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108127","url":null,"abstract":"Objective To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control. Design Systematic review and network meta-analysis. Data sources Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus. Eligibility criteria Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Results 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference −0.16%, 95% CI (−0.23 to −0.09) vs −0.10%, 95% CI (−0.21 to 0.02)), 2-hour glucose (−0.68 mmol/L, 95% CI (−0.97 to −0.39) vs 0.01 mmol/L, 95% CI (−0.38 to 0.41)) and HOMA-IR (−0.54, 95% CI (−0.71 to −0.36) vs −0.23, 95% CI (−0.55 to 0.10)), while the efficacy on fasting glucose was comparable (−0.26 mmol/L, 95% CI (−0.32 to −0.19) vs −0.33 mmol/L, 95% CI (−0.45 to −0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (−0.88%, 95% CI (−1.07 to −0.69) vs −0.48%, 95% CI (−0.58 to −0.38)), 2-hour glucose (−2.55 mmol/L, 95% CI (−3.24 to −1.86) vs −0.97 mmol/L, 95% CI (−1.52 to −0.42)) and fasting glucose (−1.52 mmol/L, 95% CI (−1.73 to −1.31) vs −0.85 mmol/L, 95% CI (−0.96 to −0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (−1.23%, 95% CI (−2.41 to –0.05)) and fasting glucose (−2.02 mmol/L, 95% CI (−3.31 to –0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage. Conclusion Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM. PROSPERO registration number CRD42023400622. Data are available upon reasonable request. Data are available on reasonable request by contacting the corresponding author.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/bjsports-2023-106722
Robin Vermeulen, Nicol van Dyk, Rod Whiteley, Karim Chamari, Warren Gregson, Lorenzo Lolli, Roald Bahr, Johannes L Tol, Andreas Serner
Objective To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis. Methods Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive. Results We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0–10 m (24% of all injuries) and in general at different running distances (0–50 m) and speeds (slow to fast). At 0–10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3). Conclusion The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Not applicable.
{"title":"Injury-inciting circumstances of sudden-onset hamstring injuries: video analyses of 63 match injuries in male professional football players in the Qatar Stars League (2013–2020)","authors":"Robin Vermeulen, Nicol van Dyk, Rod Whiteley, Karim Chamari, Warren Gregson, Lorenzo Lolli, Roald Bahr, Johannes L Tol, Andreas Serner","doi":"10.1136/bjsports-2023-106722","DOIUrl":"https://doi.org/10.1136/bjsports-2023-106722","url":null,"abstract":"Objective To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis. Methods Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive. Results We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0–10 m (24% of all injuries) and in general at different running distances (0–50 m) and speeds (slow to fast). At 0–10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3). Conclusion The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Not applicable.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1136/bjsports-2024-108260
Branimir Ivanic, Anna Cronström, Kajsa Johansson, Eva Ageberg
Objective To review the efficacy of exercise interventions on sport-related concussion (SRC) incidence, as well as on linear and rotational head accelerations, and isometric neck strength and to assess reporting completeness of exercise interventions using the Consensus on Exercise Reporting Template (CERT). Design Systematic review and meta-analysis, according to the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines. Data sources Six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science CC and SPORTDiscus) were searched up to 26 June 2023. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cluster RCTs or quasi-experimental studies, evaluating exercise interventions on SRC incidence, linear and rotational head accelerations, and/or isometric neck strength in male and/or female athletes of any age, and/or in a healthy general population. Results A total of 26 articles were included. A large effect size was observed for resistance training (RT) on isometric neck strength (standardised mean difference (SMD) 0.85; 95% CI 0.57 to 1.13; high-quality evidence). Non-significant effect sizes were observed for neuromuscular warm-up programmes on SRC incidence (risk ratio 0.69; 95% CI 0.39 to 1.23; low-quality evidence), or for RT on linear head acceleration (SMD −0.43; 95% CI −1.26 to 0.40; very low-quality evidence) or rotational head acceleration (SMD 0.08; 95% CI −0.61 to 0.77; low-quality evidence). No studies assessed the impact of RT on SRC incidence. CERT scores ranged from 4 to 16 (out of 19) with median score of 11.5 (IQR 9–13). Conclusion RT increases isometric neck strength, but the effect on SRC incidence is unknown. More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. Future studies should follow CERT guidelines, as the included interventions were generally not reported in sufficient detail for accurate replication. PROSPERO registration number CRD42023435033. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.
{"title":"Efficacy of exercise interventions on prevention of sport-related concussion and related outcomes: a systematic review and meta-analysis","authors":"Branimir Ivanic, Anna Cronström, Kajsa Johansson, Eva Ageberg","doi":"10.1136/bjsports-2024-108260","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108260","url":null,"abstract":"Objective To review the efficacy of exercise interventions on sport-related concussion (SRC) incidence, as well as on linear and rotational head accelerations, and isometric neck strength and to assess reporting completeness of exercise interventions using the Consensus on Exercise Reporting Template (CERT). Design Systematic review and meta-analysis, according to the Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science guidelines. Data sources Six databases (MEDLINE, Embase, CINAHL, Scopus, Web of Science CC and SPORTDiscus) were searched up to 26 June 2023. Eligibility criteria for selecting studies Randomised controlled trials (RCTs), cluster RCTs or quasi-experimental studies, evaluating exercise interventions on SRC incidence, linear and rotational head accelerations, and/or isometric neck strength in male and/or female athletes of any age, and/or in a healthy general population. Results A total of 26 articles were included. A large effect size was observed for resistance training (RT) on isometric neck strength (standardised mean difference (SMD) 0.85; 95% CI 0.57 to 1.13; high-quality evidence). Non-significant effect sizes were observed for neuromuscular warm-up programmes on SRC incidence (risk ratio 0.69; 95% CI 0.39 to 1.23; low-quality evidence), or for RT on linear head acceleration (SMD −0.43; 95% CI −1.26 to 0.40; very low-quality evidence) or rotational head acceleration (SMD 0.08; 95% CI −0.61 to 0.77; low-quality evidence). No studies assessed the impact of RT on SRC incidence. CERT scores ranged from 4 to 16 (out of 19) with median score of 11.5 (IQR 9–13). Conclusion RT increases isometric neck strength, but the effect on SRC incidence is unknown. More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. Future studies should follow CERT guidelines, as the included interventions were generally not reported in sufficient detail for accurate replication. PROSPERO registration number CRD42023435033. All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bjsports-2024-108089
Iain Robert Murray, Navnit S Makaram, Andrew G Geeslin, Jorge Chahla, Gilbert Moatshe, Kay Crossley, Michelle E Kew, Aileen Davis, Maria Tuca, Hollis Potter, Dina C Janse van Rensburg, Carolyn A Emery, SeungPyo Eun, Hege Grindem, Frank R Noyes, Robert G Marx, Chris Harner, Bruce A Levy, Enda King, James L Cook, Daniel B Whelan, George F Hatch, Christopher J Wahl, Kristian Thorborg, James J Irrgang, Nicolas Pujol, Michael J Medvecky, Michael J Stuart, Aaron J Krych, Lars Engebretsen, James P Stannard, Peter MacDonald, Romain Seil, Gregory C Fanelli, Travis G Maak, K Donald Shelbourne, Evert Verhagen, Volker Musahl, Michael T Hirschmann, Mark D Miller, Robert C Schenck, Robert F LaPrade
Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined ‘a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.
{"title":"Multiligament knee injury (MLKI): an expert consensus statement on nomenclature, diagnosis, treatment and rehabilitation","authors":"Iain Robert Murray, Navnit S Makaram, Andrew G Geeslin, Jorge Chahla, Gilbert Moatshe, Kay Crossley, Michelle E Kew, Aileen Davis, Maria Tuca, Hollis Potter, Dina C Janse van Rensburg, Carolyn A Emery, SeungPyo Eun, Hege Grindem, Frank R Noyes, Robert G Marx, Chris Harner, Bruce A Levy, Enda King, James L Cook, Daniel B Whelan, George F Hatch, Christopher J Wahl, Kristian Thorborg, James J Irrgang, Nicolas Pujol, Michael J Medvecky, Michael J Stuart, Aaron J Krych, Lars Engebretsen, James P Stannard, Peter MacDonald, Romain Seil, Gregory C Fanelli, Travis G Maak, K Donald Shelbourne, Evert Verhagen, Volker Musahl, Michael T Hirschmann, Mark D Miller, Robert C Schenck, Robert F LaPrade","doi":"10.1136/bjsports-2024-108089","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108089","url":null,"abstract":"Multiligament knee injuries (MLKIs) represent a broad spectrum of pathology with potentially devastating consequences. Currently, disagreement in the terminology, diagnosis and treatment of these injuries limits clinical care and research. This study aimed to develop consensus on the nomenclature, diagnosis, treatment and rehabilitation strategies for patients with MLKI, while identifying important research priorities for further study. An international consensus process was conducted using validated Delphi methodology in line with British Journal of Sports Medicine guidelines. A multidisciplinary panel of 39 members from 14 countries, completed 3 rounds of online surveys exploring aspects of nomenclature, diagnosis, treatment, rehabilitation and future research priorities. Levels of agreement (LoA) with each statement were rated anonymously on a 5-point Likert scale, with experts encouraged to suggest modifications or additional statements. LoA for consensus in the final round were defined ‘a priori’ if >75% of respondents agreed and fewer than 10% disagreed, and dissenting viewpoints were recorded and discussed. After three Delphi rounds, 50 items (92.6%) reached consensus. Key statements that reached consensus within nomenclature included a clear definition for MLKI (LoA 97.4%) and the need for an updated MLKI classification system that classifies injury mechanism, extent of non-ligamentous structures injured and the presence or absence of dislocation. Within diagnosis, consensus was reached that there should be a low threshold for assessment with CT angiography for MLKI within a high-energy context and for certain injury patterns including bicruciate and PLC injuries (LoA 89.7%). The value of stress radiography or intraoperative fluoroscopy also reached consensus (LoA 89.7%). Within treatment, it was generally agreed that existing literature generally favours operative management of MLKI, particularly for young patients (LoA 100%), and that single-stage surgery should be performed whenever possible (LoA 92.3%). This consensus statement will facilitate clinical communication in MLKI, the care of these patients and future research within MLKI.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bjsports-2024-108304
Sebastien Racinais, Valentin Dablainville, Yohan Rousse, Mohammed Ihsan, Marie-Elaine Grant, Wolfgang Schobersberger, Richard Budgett, Lars Engebretsen
Sports medicine physicians and physiotherapists commonly use cryotherapy (eg, ice application) postinjury to decrease tissue temperature with the objective of reducing pain, limiting secondary injury and inflammation, and supporting healing. However, besides the analgesic effect of cryotherapy, a literature search revealed no evidence from human studies that cryotherapy limits secondary injury or has positive effects on tissue regeneration. Thus, our current understanding of the potential mechanisms and applications of cryotherapy largely relies on the results from animal studies. Importantly, treatment should not aim at obliterating the inflammatory and regeneration processes but instead aim to restore an adapted/normal regulation of these processes to improve function and recovery. However, some animal studies suggest that cryotherapy may delay or impair tissue regeneration. With the translation of laboratory animal studies to human sport medicine being limited by different injury and muscle characteristics, the effect of cryotherapy in patients with musculoskeletal injuries is uncertain. Thus, pending the results of human studies, cryotherapy may be recommended in the first 6 hours following an injury to reduce pain (and possibly haematoma), but it should be used with caution beyond 12 hours postinjury as animal studies suggest it may interfere with tissue healing and regeneration.
{"title":"Cryotherapy for treating soft tissue injuries in sport medicine: a critical review","authors":"Sebastien Racinais, Valentin Dablainville, Yohan Rousse, Mohammed Ihsan, Marie-Elaine Grant, Wolfgang Schobersberger, Richard Budgett, Lars Engebretsen","doi":"10.1136/bjsports-2024-108304","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108304","url":null,"abstract":"Sports medicine physicians and physiotherapists commonly use cryotherapy (eg, ice application) postinjury to decrease tissue temperature with the objective of reducing pain, limiting secondary injury and inflammation, and supporting healing. However, besides the analgesic effect of cryotherapy, a literature search revealed no evidence from human studies that cryotherapy limits secondary injury or has positive effects on tissue regeneration. Thus, our current understanding of the potential mechanisms and applications of cryotherapy largely relies on the results from animal studies. Importantly, treatment should not aim at obliterating the inflammatory and regeneration processes but instead aim to restore an adapted/normal regulation of these processes to improve function and recovery. However, some animal studies suggest that cryotherapy may delay or impair tissue regeneration. With the translation of laboratory animal studies to human sport medicine being limited by different injury and muscle characteristics, the effect of cryotherapy in patients with musculoskeletal injuries is uncertain. Thus, pending the results of human studies, cryotherapy may be recommended in the first 6 hours following an injury to reduce pain (and possibly haematoma), but it should be used with caution beyond 12 hours postinjury as animal studies suggest it may interfere with tissue healing and regeneration.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bjsports-2024-108607
Ann Bernadette Gates, Fiona Moffatt, George S Metsios
In 2014, as part of the outcomes from the inaugural World Heart Federations Emerging Leaders’ work,1 a network of collaborators and change agents set about strengthening the capacity of healthcare professionals (HCPs) to support patients and communities to be more physically active. The intent was to influence the prevention, treatment and rehabilitation of noncommunicable diseases (NCDs) and poor health, in the context of research demonstrating that even brief physical activity advice during routine consultations can translate to significant clinical outcomes.2 The community of practice3 aim was simple: to upskill, through capacity building, key frontline professionals of any healthcare discipline to be more confident, capable and competent in implementing interventions to mitigate NCDs. This included enabling HCPs to promote greater physical activity by their patients and use their leadership influence to effect wide-scale change in society.4 Previous initiatives across UK medical and health schools to access free physical activity and health resources and implement them through curriculum change resulted in slow and inconsistent uptake. Similar suboptimal outcomes were reflected in other countries.5 However, in 2019, the European Union (EU) ERASMUS+Virtual Advice, Nurturing, Guidance on Universal Action, Research and Development for physical activity and sport engagement (VANGUARD) project enabled five European schools of medicine (and one UK-based physiotherapy school) to embed bespoke resources, secure academic support and empower future HCPs. The VANGUARD project objectives were to: 1. Embed physical activity in the EU undergraduate curricula of future frontline HCPs (medical doctors and subsequently allied health professions) in these six European countries to help promote and sustain health. 2. Foster meaningful collaborative partnerships in the implementation, methodology and evaluation of physical activity in the EU curricula of future frontline HCPs. 3. Develop an at-scale approach, led by future HCPs, in the critical role of physical activity/sport in the prevention and treatment …
{"title":"A decade on: successes and future directions for integrating physical activity into healthcare curricula in the UK and EU","authors":"Ann Bernadette Gates, Fiona Moffatt, George S Metsios","doi":"10.1136/bjsports-2024-108607","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108607","url":null,"abstract":"In 2014, as part of the outcomes from the inaugural World Heart Federations Emerging Leaders’ work,1 a network of collaborators and change agents set about strengthening the capacity of healthcare professionals (HCPs) to support patients and communities to be more physically active. The intent was to influence the prevention, treatment and rehabilitation of noncommunicable diseases (NCDs) and poor health, in the context of research demonstrating that even brief physical activity advice during routine consultations can translate to significant clinical outcomes.2 The community of practice3 aim was simple: to upskill, through capacity building, key frontline professionals of any healthcare discipline to be more confident, capable and competent in implementing interventions to mitigate NCDs. This included enabling HCPs to promote greater physical activity by their patients and use their leadership influence to effect wide-scale change in society.4 Previous initiatives across UK medical and health schools to access free physical activity and health resources and implement them through curriculum change resulted in slow and inconsistent uptake. Similar suboptimal outcomes were reflected in other countries.5 However, in 2019, the European Union (EU) ERASMUS+Virtual Advice, Nurturing, Guidance on Universal Action, Research and Development for physical activity and sport engagement (VANGUARD) project enabled five European schools of medicine (and one UK-based physiotherapy school) to embed bespoke resources, secure academic support and empower future HCPs. The VANGUARD project objectives were to: 1. Embed physical activity in the EU undergraduate curricula of future frontline HCPs (medical doctors and subsequently allied health professions) in these six European countries to help promote and sustain health. 2. Foster meaningful collaborative partnerships in the implementation, methodology and evaluation of physical activity in the EU curricula of future frontline HCPs. 3. Develop an at-scale approach, led by future HCPs, in the critical role of physical activity/sport in the prevention and treatment …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-05DOI: 10.1136/bjsports-2024-108232
Andreas Holtermann, Pieter Coenen, Matthew N. Ahmadi, Emmanuel Stamatakis, Leon Straker
Need to put the health effects of standing in the research spotlight. Since the turn of the century, the spotlight on the cardiometabolic risks of prolonged sitting has overshadowed the health effects of perhaps the greatest behavioural change in the transition from hunter-gatherers to modern humans: the remarkable increase in time spent standing.1 As an example, figure 1 makes a comparison in device-measured time spent in various postures between middle-aged British adults2 and Hadza adults in Tanzania1 who still live a typical hunter-gatherer lifestyle. These data illustrate that in modern western society adults spend more than twice as much time in standing postures while stepping less, than typical hunter-gatherers. There are many differences between the populations which might confound these differences, but they indicate that globally, adults might have different compositions of physical behaviours depending on whether they are living in agricultural, industrial or information-based communities. A large portion of present-day adults spend a considerable amount of their day standing, with recent data from international adult cohorts showing that daily standing accounts for a staggering 3.1–4.6 hours/day or approximately 19%–29% of total waking times.2 3 Figure 1 Comparison in device-measured posture and activity (sedentary, standing, stepping and sleeping) allocation between middle-aged British adults2 (representing modern lifestyle) and Hadza …
{"title":"Standing in the shadows: is standing a tonic or a toxin for cardiometabolic health?","authors":"Andreas Holtermann, Pieter Coenen, Matthew N. Ahmadi, Emmanuel Stamatakis, Leon Straker","doi":"10.1136/bjsports-2024-108232","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108232","url":null,"abstract":"Need to put the health effects of standing in the research spotlight. Since the turn of the century, the spotlight on the cardiometabolic risks of prolonged sitting has overshadowed the health effects of perhaps the greatest behavioural change in the transition from hunter-gatherers to modern humans: the remarkable increase in time spent standing.1 As an example, figure 1 makes a comparison in device-measured time spent in various postures between middle-aged British adults2 and Hadza adults in Tanzania1 who still live a typical hunter-gatherer lifestyle. These data illustrate that in modern western society adults spend more than twice as much time in standing postures while stepping less, than typical hunter-gatherers. There are many differences between the populations which might confound these differences, but they indicate that globally, adults might have different compositions of physical behaviours depending on whether they are living in agricultural, industrial or information-based communities. A large portion of present-day adults spend a considerable amount of their day standing, with recent data from international adult cohorts showing that daily standing accounts for a staggering 3.1–4.6 hours/day or approximately 19%–29% of total waking times.2 3 Figure 1 Comparison in device-measured posture and activity (sedentary, standing, stepping and sleeping) allocation between middle-aged British adults2 (representing modern lifestyle) and Hadza …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":18.4,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142138304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1136/bjsports-2024-108211
Thomas Romeas, Félix Croteau, Suzanne Leclerc
Objectives: This cohort study reported descriptive statistics in athletes engaged in Summer and Winter Olympic sports who sustained a sport-related concussion (SRC) and assessed the impact of access to multidisciplinary care and injury modifiers on recovery.
Methods: 133 athletes formed two subgroups treated in a Canadian sport institute medical clinic: earlier (≤7 days) and late (≥8 days) access. Descriptive sample characteristics were reported and unrestricted return to sport (RTS) was evaluated based on access groups as well as injury modifiers. Correlations were assessed between time to RTS, history of concussions, the number of specialist consults and initial symptoms.
Results: 160 SRC (median age 19.1 years; female=86 (54%); male=74 (46%)) were observed with a median (IQR) RTS duration of 34.0 (21.0-63.0) days. Median days to care access was different in the early (1; nSRC=77) and late (20; nSRC=83) groups, resulting in median (IQR) RTS duration of 26.0 (17.0-38.5) and 45.0 (27.5-84.5) days, respectively (p<0.001). Initial symptoms displayed a meaningful correlation with prognosis in this study (p<0.05), and female athletes (52 days (95% CI 42 to 101)) had longer recovery trajectories than male athletes (39 days (95% CI 31 to 65)) in the late access group (p<0.05).
Conclusions: Olympic athletes in this cohort experienced an RTS time frame of about a month, partly due to limited access to multidisciplinary care and resources. Earlier access to care shortened the RTS delay. Greater initial symptoms and female sex in the late access group were meaningful modifiers of a longer RTS.
{"title":"Where is the research on sport-related concussion in Olympic athletes? A descriptive report and assessment of the impact of access to multidisciplinary care on recovery.","authors":"Thomas Romeas, Félix Croteau, Suzanne Leclerc","doi":"10.1136/bjsports-2024-108211","DOIUrl":"10.1136/bjsports-2024-108211","url":null,"abstract":"<p><strong>Objectives: </strong>This cohort study reported descriptive statistics in athletes engaged in Summer and Winter Olympic sports who sustained a sport-related concussion (SRC) and assessed the impact of access to multidisciplinary care and injury modifiers on recovery.</p><p><strong>Methods: </strong>133 athletes formed two subgroups treated in a Canadian sport institute medical clinic: earlier (≤7 days) and late (≥8 days) access. Descriptive sample characteristics were reported and unrestricted return to sport (RTS) was evaluated based on access groups as well as injury modifiers. Correlations were assessed between time to RTS, history of concussions, the number of specialist consults and initial symptoms.</p><p><strong>Results: </strong>160 SRC (median age 19.1 years; female=86 (54%); male=74 (46%)) were observed with a median (IQR) RTS duration of 34.0 (21.0-63.0) days. Median days to care access was different in the early (1; n<sub>SRC</sub>=77) and late (20; n<sub>SRC</sub>=83) groups, resulting in median (IQR) RTS duration of 26.0 (17.0-38.5) and 45.0 (27.5-84.5) days, respectively (p<0.001). Initial symptoms displayed a meaningful correlation with prognosis in this study (p<0.05), and female athletes (52 days (95% CI 42 to 101)) had longer recovery trajectories than male athletes (39 days (95% CI 31 to 65)) in the late access group (p<0.05).</p><p><strong>Conclusions: </strong>Olympic athletes in this cohort experienced an RTS time frame of about a month, partly due to limited access to multidisciplinary care and resources. Earlier access to care shortened the RTS delay. Greater initial symptoms and female sex in the late access group were meaningful modifiers of a longer RTS.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1136/bjsports-2024-108384
Eric G Post, Travis Anderson, Olivia Samson, Ashley N Triplett, Alexis D Gidley, Steven S Isono, Jennifer Watters, Amber T Donaldson, Jonathan T Finnoff, William M Adams
Objective: To describe the incidence and characteristics of injuries and illnesses among Team USA athletes competing at the Santiago 2023 Pan American Games (PAG) and Parapan American Games (PPAG), with a particular focus on the incidence of respiratory illnesses and on injuries for sports new to the Olympic and Paralympic programmes.
Methods: Illnesses and injuries occurring among the 870 Team USA athletes competing in the Santiago 2023 PAG or PPAG were documented within Team USA's Injury and Illness Surveillance system. Illness and injury incidence per 1000 athlete-days (ADs) and incidence ratios (IR) were calculated, both with 95% CIs.
Results: Illness (IR 2.5, 95% CI 1.6, 3.9) and injury (IR 1.8, 95% CI 1.3, 2.5) rates were greater during PPAG compared with PAG. Illness rates were higher in the pre-opening ceremony period compared with the competition period for both PAG (IR 2.7, 95% CI 1.1, 5.9) and PPAG (IR 1.9, 95% CI 0.9, 3.8). Respiratory illness was the most common illness with 3.2% and 8.9% of all Team USA athletes reporting a respiratory illness during the PAG and PPAG, respectively. Sports that are relatively new to the Olympic/Paralympic programmes exhibited the highest injury rates during the Games: breaking (250.0 (91.7, 544.2) per 1000 ADs), Para taekwondo (93.8 (19.3, 274.0) per 1000 ADs) and surfing (88.9 (24.2, 227.6) per 1000 ADs).
Conclusion: Respiratory illness rates were the most common type of illness during both PAG and PPAG and were more likely to occur prior to competition starting. Our data have identified high injury risk populations (breaking, surfing, Para taekwondo) and timing (pre-opening ceremony period) for further risk factor analysis.
{"title":"High rates of respiratory illnesses upon arrival: lessons from Team USA at the Santiago 2023 Pan American and Parapan American Games.","authors":"Eric G Post, Travis Anderson, Olivia Samson, Ashley N Triplett, Alexis D Gidley, Steven S Isono, Jennifer Watters, Amber T Donaldson, Jonathan T Finnoff, William M Adams","doi":"10.1136/bjsports-2024-108384","DOIUrl":"10.1136/bjsports-2024-108384","url":null,"abstract":"<p><strong>Objective: </strong>To describe the incidence and characteristics of injuries and illnesses among Team USA athletes competing at the Santiago 2023 Pan American Games (PAG) and Parapan American Games (PPAG), with a particular focus on the incidence of respiratory illnesses and on injuries for sports new to the Olympic and Paralympic programmes.</p><p><strong>Methods: </strong>Illnesses and injuries occurring among the 870 Team USA athletes competing in the Santiago 2023 PAG or PPAG were documented within Team USA's Injury and Illness Surveillance system. Illness and injury incidence per 1000 athlete-days (ADs) and incidence ratios (IR) were calculated, both with 95% CIs.</p><p><strong>Results: </strong>Illness (IR 2.5, 95% CI 1.6, 3.9) and injury (IR 1.8, 95% CI 1.3, 2.5) rates were greater during PPAG compared with PAG. Illness rates were higher in the pre-opening ceremony period compared with the competition period for both PAG (IR 2.7, 95% CI 1.1, 5.9) and PPAG (IR 1.9, 95% CI 0.9, 3.8). Respiratory illness was the most common illness with 3.2% and 8.9% of all Team USA athletes reporting a respiratory illness during the PAG and PPAG, respectively. Sports that are relatively new to the Olympic/Paralympic programmes exhibited the highest injury rates during the Games: breaking (250.0 (91.7, 544.2) per 1000 ADs), Para taekwondo (93.8 (19.3, 274.0) per 1000 ADs) and surfing (88.9 (24.2, 227.6) per 1000 ADs).</p><p><strong>Conclusion: </strong>Respiratory illness rates were the most common type of illness during both PAG and PPAG and were more likely to occur prior to competition starting. Our data have identified high injury risk populations (breaking, surfing, Para taekwondo) and timing (pre-opening ceremony period) for further risk factor analysis.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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