The training-injury prevention paradox: should athletes be training smarter and harder?

Risk Factors of Sports-Related Injury in School-Aged Children and Adolescents: A Retrospective Questionnaire Survey

Studies conducting quantitative surveys in school-aged children and adolescents help identify sports-related risk factors for acute and overuse injuries are scarce. This study aimed to quantify the risk factors for sports-related injury in school-aged children and adolescents by school categories. University students (n = 484) retrospectively recalled their sports experiences and related injuries in a questionnaire according to the following school categories: lower elementary school (LE), upper elementary school (UE), junior high school (JH), and high school (H). Both sports-related acute and overuse injuries were recorded. After adjusting various covariates, weekly hours in sports were identified as a significant risk factor in LE and UE. The interaction of weekly hours in sports and sports specialization was significant in LE and UE, suggesting that early specialization would be a risk factor in lower school categories. In JH and H, female sex, high-level competition, and injury experienced in a previous school category were significantly related to sports-related injuries. In conclusion, weekly hours in sports, high-level competitions, previous injury experience, and sex were confirmed as risk factors in specific school categories. Most identified risk factors are modifiable, suggesting that sports-related injuries can be prevented in school-aged children and adolescents.

Monitorización y periodización del rendimiento desde la fisioterapia deportiva ¿Hacia dónde vamos?

RESUMEN Introducción El concepto de monitorización y periodización es un visión que se ha desarrollado en la última década, donde se busca que se pueda tener un control de la carga interna y externa en los deportistas de distintas disciplinas deportivas producidas por el proceso de interacción con variables de prescripción de ejercicio que causan modificaciones a nivel fisiológico, bioquímico, biomecanico, muscular, neuromuscular  ocasionando la tensión en los subsistemas del movimiento corporal humano generando adaptaciones especificas ante una carga determinada la cual puede ser medida mediante el uso de tecnología especifica o test indirectos Metodología Revisión de la literatura con la combinación de palabras clave como Monitoring, Performance, sports training load, Periodization en bases de datos como Pubmed, Ebsco, Medline, Scopus, Science Direct Resultados se pudo identificar 65 artículos que referencian la existencia  de herramientas tecnológicas para realizar un proceso de monitorización y periodización desde la rehabilitación , prevención, control de carga, recuperación y readaptación deportiva que permiten la generación de datos estadísticos y crear perfiles desde cada área de actuación del fisioterapeuta deportivo. Conclusión la fisioterapia es una profesión encargada de muchos procesos deportivos que deben ser monitorizados y generen datos que permitan estandarizar procesos, crear perfiles de seguimiento específicos para facilitar la toma de decisiones desde el equipo biomédico e investigaciones en el deporte de alto rendimiento fusionando la practica con la evidencia científica.

The Athlete’s Paradox: Adaptable Depression

We proposed that an athlete’s depressive symptoms may be different from the general population in etiology if considered from the context of a depressive disorder. By shifting focus from a limited notion of symptoms onto a comprehensive model of depression, the full scope of the phenomenon becomes clearer. This paper investigated the relationship between neurotransmitters and allostatic load to explain the incidence of depression among elite athletes. This literature review extensively analyzed exercise-induced neurohormonal imbalance resulting in depressive states among athletes. The research revealed that 5-HTTLPR polymorphism, brain-derived neurotrophic factor (BDNF), extensive psychological demands, social stigma, and overtraining syndrome (OTS) may all contribute to a unique version of depression. The research revealed that the biological standards of athletes differ from those of non-athletes, to the point that the new model may be useful, thereby introducing the new term “Adaptable Depression (AD)” to the literature. This framework suggests a new direction for future research to precisely measure the neurotransmitter-related brain changes that result in “Adaptable Depression” in athletes and to establish a better understanding of the depressive tipping point.

The Impact of Statewide Limitations of Practice on High School Injury Incidence During the COVID-19 Season: An Ecological Study

BACKGROUND

Abrupt training stoppage can increase injury incidence and risk following return to sport. The rate of coronavirus disease 2019 (COVID-19) infections in the general population has resulted in the abrupt stoppage of high school education and sport. The objective of this study was to (1) compare injury incidence proportion (IP) and excess injury in high school athletes before and during the COVID-19 pandemic; and (2) stratify by identified gender.

HYPOTHESIS

The COVID-19 academic year will demonstrate increased injury incidence, and injury incidence will be similar between genders.

STUDY DESIGN

Ecological.

LEVEL OF EVIDENCE

Level 2.

METHODS

High schools (6 states; 176 high schools) were matched between prepandemic and pandemic years. Injury IP with 95% confidence interval (CI) was calculated. Interrupted time series models with robust errors were performed to assess the IP ratio and excess injury incidence between prepandemic and pandemic academic calendar years.

RESULTS

A total of 98,487 athletes participated in high school sport in the prepandemic year and 72,521 athletes in the pandemic year; 15,477 injuries were reported in the prepandemic year compared with 14,057 injuries during the pandemic year. Injury IP (CI) was 15.7 (15.5-15.9) and 19.4 (19.1-19.7) for the prepandemic and pandemic years, respectively. Injury incidence ratio increased by 1.3 (1.2-1.5) between the prepandemic and pandemic years. Excess injuries were 1812 greater in the pandemic year compared with the prepandemic year. Female and male athlete incidence ratios were similar.

CONCLUSION

Prolonged sport stoppage due to the COVID-19 pandemic resulted in increased injury incidence compared with the previous high school academic year.

CLINICAL RELEVANCE

High school sports stakeholders should consider longer periods of ramp up for training in lieu of future sport stoppages compared with usual preseason training. These data may also have more generalizable implications to other abrupt sport and physical activity stoppage scenarios such as earthquakes and hurricanes.

Forecasting football injuries by combining screening, monitoring and machine learning

Identifying players or circumstances associated with an increased risk of injury is fundamental for successful risk management in football. So far, time-constant and volatile risk factors are generally considered separately in either a screening (constant) or a monitoring (volatile) approach each resulting in a restricted set of explanatory variables. Consequently, improvements in predictive accuracy may be expected when screening and monitoring data are combined, especially when analysed with current machine learning (ML) techniques. This trial was designed as a prospective observational cohort study aiming to forecast non-contact time-loss injuries in male professional football (soccer). Injuries were registered according to the Fuller consensus. Gradient boosting with ROSE upsampling within a leave-one-out cross-validation was used for data analysis. The hierarchical data structure was considered throughout. Different splits of the original dataset were used to probe the robustness of results. Data of 88 players from 4 teams and 51 injuries could be analysed. The cross-validated performance of the gradient boosted model (ROC area under the curve 0.61) was promising and higher compared to models without integration of screening data. Importantly, holdout test set performance was similar (ROC area under the curve 0.62) indicating prospect of generalizability to new cases. However, the variation of predictive accuracy and feature importance with different splits of the original dataset reflects the relatively low number of events. It is concluded that ML-based injury forecasting based on the integration of screening and monitoring data is promising. However, external prospective verification and continued model development are required.

Assessing the cumulative effect of long-term training load on the risk of injury in team sports

Objectives

Determine how to assess the cumulative effect of training load on the risk of injury or health problems in team sports.

Methods

First, we performed a simulation based on a Norwegian Premier League male football dataset (n players=36). Training load was sampled from daily session rating of perceived exertion (sRPE). Different scenarios of the effect of sRPE on injury risk and the effect of relative sRPE on injury risk were simulated. These scenarios assumed that the probability of injury was the result of training load exposures over the previous 4 weeks. We compared seven different methods of modelling training load in their ability to model the simulated relationship. We then used the most accurate method, the distributed lag non-linear model (DLNM), to analyse data from Norwegian youth elite handball players (no. of players=205, no. of health problems=471) to illustrate how assessing the cumulative effect of training load can be done in practice.

Results

DLNM was the only method that accurately modelled the simulated relationships between training load and injury risk. In the handball example, DLNM could show the cumulative effect of training load and how much training load affected health problem risk depending on the distance in time since the training load exposure.

Conclusion

DLNM can be used to assess the cumulative effect of training load on injury risk.

Comparison of Measurements of External Load between Professional Soccer Players

Background: The excessive and rapid increases in training load (TL) may be responsible for most non-contact injuries in soccer. This study’s aims were to describe, week(w)-by-week, the acute (AW), chronic (CW), acute:chronic workload ratio (wACWR), total distance (wTD), duration training (wDT), sprint total distance (wSTD), repeat sprint (wRS), and maximum speed (wMS) between starter and non-starter professional soccer players based on different periods (i.e., pre-, early-, mid-, and end-season) of a full-season (Persian Gulf Pro League, 2019−2020). Methods: Nineteen players were divided according to their starting status: starters (n = 10) or non-starters (n = 9). External workload was monitored for 43 weeks: pre- from w1−w4; early- from w5−w17; mid- from w18−w30, and end-season from w31−w43. Results: In starters, AW, CW, and wACWR were greater than non-starters (p < 0.05) throughout the periods of early- (CW, p ≤ 0.0001), mid- (AW, p = 0.008; CW, p ≤ 0.0001; wACWR, p = 0.043), or end-season (AW, p = 0.035; CW, p = 0.017; wACWR, p = 0.010). Starters had a greater wTD (p ≤ 0.0001), wSTD (p ≤ 0.0001 to 0.003), wDT (p ≤ 0.0001 to 0.023), wRS (p ≤ 0.0001 to 0.018), and wMS (p ≤ 0.0001) than non-starters during early-, mid-, and end-season. Conclusion: Starters experienced more CW and AW during the season than non-starters, which underlines the need to design tailored training programs accounting for the differences between playing status.

A description of veterinary eliminations within British National Endurance rides in the competitive season of 2019

Veterinary eliminations within the equestrian sport of endurance have predominantly been evaluated based on data from international competitions. However, in order to take part in international competition, each horse and rider must qualify by completing rides under their national federation. The aim of this study was to analyse the competitive data and veterinary eliminations, specifically lameness, from competitions run by the British governing body of endurance: Endurance GB, during the 2019 competitive season. Competitive results for 765 ride starts from seven different ride venues were evaluated; 81.6% (n=624) horses successfully completed the rides, with the remaining 18.4% (n=141) failing to complete the ride. The majority of horses that were unsuccessful were eliminated for lameness at veterinary inspections (n=83; 58.9%). Horses competing in single loop rides (up to 55 km rides) had a success rate of 88.6% (n=624), in contrast, horses competing in rides of three loops or more (>80 km rides) reported a decreased success rate of 61.8% (n=81). Hindlimb lameness was identified more frequently (n=50; 60.2%) compared with forelimb lameness (n=33; 39.8%). Further consideration should be given to the differences between single loop rides, where a higher percentage are presented to the veterinary panel as lame prior to the start, and multi loop rides, where a higher percentage of horses are eliminated lame during the ride and potential risk factors for the increased prevalence of hindlimb lameness observed.

Injury risk factors and barriers to their mitigation for women playing rugby league: a Delphi study

This study aimed to 1) develop a consensus (≥70% agreement between experts) on injury risk factors specific to women playing rugby league, 2) establish the importance of the identified injury risk factors and the feasibility of mitigating these risk factors and 3) establish context specific barriers to injury risk management. Aim 1: A Delphi panel, consisting of 12 experts in rugby league and injury (e.g., physiotherapists, research scientists) were asked to identify injury risk factors specific to women playing rugby league. Aim 2: seven coaches of women's rugby league teams were asked to rate each risk factor that achieved consensus by their importance and feasibility to manage. Aim 3: Coaches reported barriers which restrict injury risk factor mitigation. Of the 53 injury risk factors which achieved consensus, the five injury risk factors with the highest combination of importance and feasibility ratings were: "poor tackle technique", "a lack of pre-season intensity", "training session are too short", "the current medical standards", and "limited access to physiotherapists". Following the identification of injury risk factors, their feasibility to manage and context specific barriers, this study proposes three constraint driven, integrated solutions which may reduce the barriers which limit injury risk factor management.

Machine Learning for Understanding and Predicting Injuries in Football

Attempts to better understand the relationship between training and competition load and injury in football are essential for helping to understand adaptation to training programmes, assessing fatigue and recovery, and minimising the risk of injury and illness. To this end, technological advancements have enabled the collection of multiple points of data for use in analysis and injury prediction. The full breadth of available data has, however, only recently begun to be explored using suitable statistical methods. Advances in automatic and interactive data analysis with the help of machine learning are now being used to better establish the intricacies of the player load and injury relationship. In this article, we examine this recent research, describing the analyses and algorithms used, reporting the key findings, and comparing model fit. To date, the vast array of variables used in analysis as proxy indicators of player load, alongside differences in approach to key aspects of data treatment—such as response to data imbalance, model fitting, and a lack of multi-season data—limit a systematic evaluation of findings and the drawing of a unified conclusion. If, however, the limitations of current studies can be addressed, machine learning has much to offer the field and could in future provide solutions to the training load and injury paradox through enhanced and systematic analysis of athlete data.

The Role of Workload Management in Injury Prevention, Athletic, and Academic Performance in the Student-Athlete

ABSTRACT

Workload plays important roles in sports-related injury and athletic performance by influencing exposure to external injury risk factors and potential events, promoting changes in fitness level, which involves positive adaptations to training that may lead to improved performance, and/or stimulating fatigue which leads to negative effects in the body that may increase the risk of injury and negatively affect performance. In addition to the physical stress and significant time required for practice and training, student athletes also face subjective stressors. The total workload affects injury risk, but acute changes or spikes in external and/or internal loads seem to affect injury risk the most. These also may lead to poor recovery practices that may affect physical and academic performance. It is important for the medical team, coaches, parents, and the student athlete to understand the vulnerability of this population to increased amounts of workload and its positive and negative effects.

Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

Background

Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts.

Objective

To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports.

Methods

Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

Results

Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48–62, I² = 82%; females: 63%, 95% CI 53–71, I² = 84%; males: 50%, 95% CI 42–58, I² = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05–0.10, I² = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03–0.07, I² = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10–0.19, I² = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03–0.07, I² = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32–0.72, I² = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15–0.70, I² = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02–0.07, I² = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01–0.05, I² = 86%) and these differences were significant. Heterogeneity across studies was generally high.

Conclusion

This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01697-w.

Movement quantity and quality: How do they relate to pain and disability in dancers?

Objective

This field-based study aimed to determine the association between pre-professional student dancers’ movement quantity and quality with (i) pain severity and (ii) pain related disability.

Methods

Pre-professional female ballet and contemporary dance students (n = 52) participated in 4 time points of data collection over a 12-week university semester. At each time point dancers provided self-reported pain outcomes (Numerical Rating Scale as a measure of pain severity and Patient Specific Functional Scale as a measure of pain related disability) and wore a wearable sensor system. This system combined wearable sensors with previously developed machine learning models capable of capturing movement quantity and quality outcomes. A series of linear mixed models were applied to determine if there was an association between dancers’ movement quantity and quality over the 4 time points with pain severity and pain related disability.

Results

Almost all dancers (n = 50) experienced pain, and half of the dancers experienced disabling pain (n = 26). Significant associations were evident for pain related disability and movement quantity and quality variables. Specifically, greater pain related disability was associated with more light activity, fewer leg lifts to the front, a shorter average duration of leg lifts to the front and fewer total leg lifts. Greater pain related disability was also associated with higher thigh elevation angles to the side. There was no evidence for associations between movement quantity and quality variables and pain severity.

Discussion

Despite a high prevalence of musculoskeletal pain, dancers’ levels of pain severity and disability were generally low. Between-person level associations were identified between dancers’ movement quantity and quality, and pain related disability. These findings may reflect dancers’ adaptations to pain related disability, while they continue to dance. This proof-of-concept research provides a compelling model for future work exploring dancers’ pain using field-based, serial data collection.

Physical Demands during the Game and Compensatory Training Session (MD + 1) in Elite Football Players Using Global Positioning System Device

The aims of this study were to analyze the differences of physical demands of non-starter players regarding the playing time during the competition and to evaluate the physical demands of the compensatory training (MD + 1C) for substitute players in elite football. The match statistics and MD + 1C of substitute players from a professional Spanish LaLiga football club were analyzed using a 10-Hz global positioning system (GPS) Apex GPS system device, which has been validated as a reliable and valid method to analyze performance in team sports, during all games of the 2016/2017, 2017/2018 and 2018/2019 seasons. The starting players showed both lower total distances covered and high-intensity actions compared to the substitutes. Regarding the minutes played by the substitutes, greater physical performance was found for the players with fewer minutes (5−15 min). Furthermore, no differences were found between first and second divisions regarding physical performance of substitutes (p > 0.05). This study highlights the importance of individualizing the workload of training sessions for substitutes and starters. Furthermore, the complementary session should be individualized according to the minutes played by the substitutes. These players are potentially under-loaded compared to starters, especially in terms of high-intensity actions, therefore additional session-specific training for each substitute would be useful to reach the optimal training load according to the minutes played during the game.

Validation of Instrumented Football Shoes to Measure On-Field Ground Reaction Forces

Ground reaction forces (GRF) have been widely studied in football to prevent injury. However, ambulatory tools are missing, posing methodological limitations. The purpose of this study was to assess the validity of an innovative football shoe measuring normal GRF (nGRF) directly on the field through instrumented studs. A laboratory-based experiment was first conducted to compare nGRF obtained with the instrumented shoe (IS) to vertical GRF (vGRF) obtained with force platform (FP) data, the gold standard to measure vGRF. To this aim, three subjects performed 50 steps and 18 counter-movement jumps (CMJs). Secondly, eleven subjects completed running sprints at different velocities on a football field, as well as CMJs, while wearing the IS. Good to excellent agreement was found between the vGRF parameters measured with the FP and the nGRF measured by the IS (ICC > 0.75 for 9 out of 11 parameters). Moreover, on-field nGRF patterns demonstrated a progressive and significant increase in relation with the running velocity (p < 0.001). This study demonstrated that the IS is a highly valid tool to assess vGRF patterns on a football field. This innovative way to measure vGRF in situ could give new insights to quantify training load and detect neuromuscular fatigue.

How training loads in the preparation and competitive period affect the biochemical indicators of training stress in youth soccer players?

Background

Physical fitness optimization and injury risk-reducing require extensive monitoring of training loads and athletes' fatigue status. This study aimed to investigate the effect of a 6-month training program on the training-related stress indicators (creatine kinase - CK; cortisol - COR; serotonin - SER; brain-derived neurotrophic factor - BDNF) in youth soccer players.

Methods

Eighteen players (17.8 ± 0.9 years old, body height 181.6 ± 6.9 cm, training experience 9.7 ± 1.7 years) were blood-tested four times: at the start of the preparation period (T0), immediately following the preparation period (T1), mid-competitive period (T2), and at the end of the competitive period (T3). CK activity as well as concentrations of serum COR, SER and BDNF were determined. Training loads were recorded using a session rating of perceived exertion (sRPE).

Results

Statistical analyzes revealed significant effects for all biochemical parameters in relation to their time measurements (T0, T1, T2, T3). The statistical analyzes of sRPE and differences of biochemical parameters in their subsequent measurements (T0-T1, T1-T2, T2-T3) also demonstrated significant effects observed for all variables: sRPE (H^KW = 13.189 (df = 2); p = 0.00), COR (H^KW = 9.261 (df = 2); p = 0.01), CK (H^KW = 12.492 (df = 2); p = 0.00), SER (H^KW = 7.781 (df = 2); p = 0.02) and BDNF (H^KW = 15.160 (df = 2); p < 0.001).

Discussion

In conclusion, it should be stated that the most demanding training loads applied in the preparation period (highest sRPE values) resulted in a significant increase in all analyzed biochemical training stress indicators. The reduction in the training loads during a competitive period and the addition of recovery training sessions resulted in a systematic decrease in the values of the measured biochemical indicators. The results of the study showed that both subjective and objective markers, including training loads, are useful in monitoring training stress in youth soccer players.

Injuries in Judo Athletes With Disabilities: Prevalence, Magnitude, and Sport-Related Mechanisms

CONTEXT

The participation of judo athletes with disabilities in competitions has increased over the years as well as the burden of sports-related injuries and illnesses in this population. However, there is limited knowledge about sports-related injuries in judo athletes with different disabilities.

OBJECTIVE

To investigate the prevalence of injuries in judo athletes with disabilities, considering the different impairment groups, magnitude of injury (ie, mechanism, nature, and severity of injury), and specific body parts.

DESIGN

Cross-sectional study (level of evidence, 3).

SETTING

Brazilian Judo athletes with disabilities.

PATIENTS

Fifty-one judo athletes with disabilities (15 men and 36 women) participated in this study.

MAIN OUTCOME MEASURES

Data were obtained from an adapted injury report form. The prevalence of injuries was assessed, considering type of impairment, body parts, mechanisms, and severity as well as differences between male and female athletes, with the significance level set at P < .05.

RESULTS

The results demonstrated a high prevalence of injuries in female athletes with visual impairment (n = 11, 73.3%) and male athletes with amputations (n = 14, 38.8%). A high prevalence was found in the national group, especially for male athletes (n = 29, 80.5%). Among athletes who had injuries, 69.4% (n = 12) of male and 80.0% (n = 25) of female athletes' injuries occurred due to direct contact with other athletes, and 72.2% (n = 26) of male and 86.6% (n = 13) of female athletes' injuries were in the training environment. The magnitude of injuries ranged from moderate to severe for male and female athletes. The knee (n = 25, 49.0%) and shoulder (n = 12, 23.5%) were the body parts most affected by injuries in both male and female athletes.

CONCLUSION

A large percentage of judo athletes with disabilities reported experiencing an injury during the previous 2 years; percentages were greater in athletes with visual and physical impairment. Moreover, most injuries occurred in the knee or shoulder, during training, and in direct contact with other athletes and were of severe magnitude.

Disabled Throwing Shoulder: 2021 Update: Part 2-Pathomechanics and Treatment

The purpose of this paper is to provide updated information for sports healthcare specialists regarding the disabled throwing shoulder (DTS). A panel of experts, recognized for their experience and expertise in this field, was assembled to address and provide updated information on several topics that have been identified as key areas in creating the DTS spectrum. Each panel member submitted a concise presentation on one of the topics within these areas, each of which were then edited and sent back to the group for their comments and consensus agreement in each area. Part two presents the following consensus conclusions and summary findings regarding pathomechanics and treatment, including (1) internal impingement results from a combination of scapular protraction and humeral head translation; (2) the clinically significant labral injury that represents pathoanatomy can occur at any position around the glenoid, with posterior injuries most common; (3) meticulous history and physical examination, with a thorough kinetic chain assessment, is necessary to comprehensively identify all the factors in the DTS and clinically significant labral injury; (4) surgical treatment should be carefully performed, with specific indications and techniques incorporating low profile implants posterior to the biceps that avoid capsular constraint; (5) rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwing-specific motor patterns and proper distribution of loads and forces across all joints during throwing; and (6) injury risk modification must focus on individualized athlete workload to avoid overuse. LEVEL OF EVIDENCE: V, expert opinion.

Hamstring Injury Prevention for Elite Soccer Players: A Real-World Prevention Program Showing the Effect of Players' Compliance on the Outcome

ABSTRACT

Chebbi, S, Chamari, K, Van Dyk, N, Gabbett, T, and Tabben, M. Hamstring injury prevention for elite soccer players: A real-world prevention program showing the effect of players' compliance on the outcome. J Strength Cond Res 36(5): 1383-1388, 2022-The aim of this study was to determine the effect of implementing the Nordic hamstring exercise (NHE) to prevent hamstring injuries in soccer. A professional team was followed by the same medical team during 5 successive seasons (2012/2013 through 2016/2017). During the first and last seasons (2012/2013 and 2016/2017), no hamstring preventive action was implemented. For the seasons 2013/2014, 2014/2015, and 2015/2016, a noncompulsory (few players refusing to participate) NHE prevention program was implemented with accurate recording of the players' training and match exposure and attendance to the prevention sessions. The first 10 weeks of the season were used to progressively increase the volume and intensity of the NHE exercises, and at the end of the season, players were split in low-, moderate-, and high-attendance groups to the prevention sessions. Overall, 35 time-loss hamstring strain injuries were accounted for. The injury incidence was 0.30 per player per season, and the injury rate was 0.95 injury/1000 hour of exposure. A nonstatistically significant higher risk of hamstring injury was observed in the control, low, and moderate attendance groups compared with the high-attendance group. The greatest risk of hamstring injury was observed in the low-attendance group (odds ratio 1.77, confidence interval 0.57-5.47, p = 0.32). Implementing a NHE prevention program has a positive effect on the injury rate in a soccer team; however, the compliance of players with such interventions may be critical for its success.

Increased Regular Season Soft Tissue Injury Rates in National Football League (NFL) Players May Be Associated With the Canceled 2020 NFL Preseason Due to COVID-19

Introduction The purpose of this study is to evaluate the rates of regular season soft tissue injuries in National Football League (NFL) players during the 2020 season, which had a canceled preseason due to the COVID-19 pandemic. Methods This study retrospectively reviewed the injury rates of the 2020-2021 NFL regular season in comparison to the 2018-2019 NFL regular season using publicly available injury data. The focus of our analysis was comparing the following soft tissue injuries: hamstring, groin, calf, quadriceps, thigh, knee - anterior cruciate ligament (ACL), pectoral, and Achilles. The week of injury occurrence, duration of injury in weeks, position of the injured player, and age of the NFL player at injury were obtained. Injury rates were calculated per 1000 athletic exposures with 95% confidence intervals (CIs). A chi-square test and Student's t-test were utilized as appropriate. Results There were 1370 total injuries in the 2018-2019 regular NFL season and 2086 total injuries reported in the 2020-2021 regular NFL season. The total number of injuries per 1000 athletic exposures was significantly higher in the 2020-2021 NFL season compared to the 2018-2019 NFL season (88.57 versus 58.17, p < 0.001). The rates of injuries per 1000 athletic exposures for hamstring (9.98 versus 5.31, p = 0.043), groin (5.56 versus 2.46, p = 0.007), calf (4.08 versus 1.61, p = 0.006), quadriceps (2.00 versus 0.72, p = 0.030), and thigh (1.23 versus 0.30, p = 0.012) injuries were significantly higher in the 2020-2021 regular NFL season compared to the 2018-2019 NFL regular season. Conclusions The 2020-2021 NFL season had a significantly higher incidence of soft tissue injuries compared to the 2018-2019 regular NFL season, which may have been associated with the absent preseason due to the COVID-19 pandemic and an abrupt increase in the athletic workload of players.

Association between SARS-COV-2 infection and muscle strain injury occurrence in elite male football players: a prospective study of 29 weeks including three teams from the Belgian professional football league

OBJECTIVES

The aim of this study was to investigate the association between SARS-CoV-2 infection and muscle strain injury in elite athletes.

METHODS

A prospective cohort study in three Belgian professional male football teams was performed during the first half of the 2020-2021 season (June 2020-January 2021). Injury data were collected using established surveillance methods. Assessment of SARS-CoV-2 infection was performed by a PCR test before each official game.

RESULTS

Of the 84 included participants, 22 were infected with SARS-CoV-2 and 14 players developed a muscle strain during the follow-up period. Cox's proportional hazards regression analyses demonstrated a significant association between SARS-CoV-2 infection and the development of muscle strain (HR 5.1; 95% CI 1.1 to 23.1; p=0.037), indicating an increased risk of developing muscle strains following SARS-CoV-2 infection. All athletes who sustained a muscle strain after infection were injured within the first month (15.71±11.74 days) after sports resumption and completed a longer time in quarantine (14.57±6.50 days) compared with the infected players who did not develop a muscle strain (11.18±5.25 days).

CONCLUSION

This study reported a five times higher risk of developing a muscle strain after a SARS-CoV-2 infection in elite male football players. Although this association should be examined further, it is possible that short-term detraining effects due to quarantine, and potentially pathological effects of the SARS-CoV-2 infection are associated with a higher risk of muscle strain injury.

Bone stress injuries

Bone stress injuries, including stress fractures, are overuse injuries that lead to substantial morbidity in active individuals. These injuries occur when excessive repetitive loads are introduced to a generally normal skeleton. Although the precise mechanisms for bone stress injuries are not completely understood, the prevailing theory is that an imbalance in bone metabolism favours microdamage accumulation over its removal and replacement with new bone via targeted remodelling. Diagnosis is achieved by a combination of patient history and physical examination, with imaging used for confirmation. Management of bone stress injuries is guided by their location and consequent risk of healing complications. Bone stress injuries at low-risk sites typically heal with activity modification followed by progressive loading and return to activity. Additional treatment approaches include non-weight-bearing immobilization, medications or surgery, but these approaches are usually limited to managing bone stress injuries that occur at high-risk sites. A comprehensive strategy that integrates anatomical, biomechanical and biological risk factors has the potential to improve the understanding of these injuries and aid in their prevention and management.

Feasibility and usability of GPS data in exploring associations between training load and running-related knee injuries in recreational runners

BACKGROUND

The purpose of the present study was to explore the feasibility of collecting GPS data and the usability of GPS data to evaluate associations between the training load and onset of running-related knee injuries (RRKIs).

METHODS

Participants of the INSPIRE-trial, a randomized-controlled trial on running injury prevention, were asked to participate in this study. At baseline, demographic variables were collected. Follow-up questionnaires assessed information on RRKIs. Participants with a new reported RRKI and uninjured participants were sent a GPS export request. Weekly GPS-based training distances were used to calculate Acute:Chronic Workload Ratios (ACWRs).

RESULTS

A total of 240 participants (62.7%) tracked their running training sessions with the use of a GPS-enabled device or platform and were willing to share their GPS data. From the participants (N = 144) who received a GPS export request, 50.0% successfully shared their data. The majority (69.4%) of the shared GPS data were usable for analyses (N = 50). GPS data were used to present weekly ACWRs of participants with and without an RRKI eight weeks prior to RRKI onset or running event.

CONCLUSIONS

It seems feasible to collect GPS data from GPS-enabled devices and platforms used by recreational runners. The results indicate that GPS data is usable to calculate weekly ACWRs to evaluate associations between training load and onset of RRKIs in recreational runners. Therefore, GPS-based ACWR measures can be used for future studies to evaluate associations between training load and onset of RRIs.

Inter- and intra-microcycle external load analysis in female professional soccer players: A playing position approach

This study analyzes the inter- and intra-differences in external load across the microcycle in professional female soccer players. External load during four consecutive microcycles (i.e., M1, M2, M3, and M4) and training sessions (i.e., MD-4, MD-3, MD-2, and MD-1) and a match day (i.e., MD) were registered in seventeen female professional soccer players (age: 26.3 ± 4.6 years; height: 166.3 ± 6.1 cm; body mass: 59.8 ± 6.8 kg; and body mass index: 21.6 ± 1.7 kg·m^-2) who belonged to the same team in Spanish first division. A 10-Hz GPS that integrated a 100-Hz triaxial accelerometer was used to register external load. The results showed lower decelerations in M2 compared to M1 and M3 (p < 0.05), lower high-intensity distance (>16.0 km·h^-1) in M3 vs. M2, and greater relative sprint distance (>21.0 km·min^-1) in M4 vs. M1 and M3 (p < 0.05). MD-3 registered the highest load for all variables (p < 0.05). Forwards (FWs) performed (p < 0.05) significantly more sprints (meters and number > 21.0 km·h^-1) than central midfielders (CMs) and central defenders (CDs) in MD-2 and MD. Both, fitness and conditioning staff should pay special attention to the external loads for each playing position in training sessions to optimize the training process.

Evidence‐Based Recovery in Soccer – Low‐Effort Approaches for Practitioners

Strategies to improve recovery are widely used among soccer players at both amateur and professional levels. Sometimes, however, recovery strategies are ineffective, improperly timed or even harmful to players. This highlights the need to educate practitioners and athletes about the scientific evidence of recovery strategies as well as to provide practical approaches to address this issue. Therefore, recent surveys among soccer athletes and practitioners were reviewed to identify the recovery modalities currently in use. Each strategy was then outlined with its rationale, its physiological mechanisms and the scientific evidence followed by practical approaches to implement the modality. For each intervention, practical and particularly low-effort strategies are provided to ensure that practitioners at all levels are able to implement them. We identified numerous interventions regularly used in soccer, i.e., sleep, rehydration, nutrition, psychological recovery, active recovery, foam-rolling/massage, stretching, cold-water immersion, and compression garments. Nutrition and rehydration were classified with the best evidence, while cold-water immersion, compression garments, foam-rolling/massage and sleep were rated with moderate evidence to enhance recovery. The remaining strategies (active recovery, psychological recovery, stretching) should be applied on an individual basis due to weak evidence observed. Finally, a guide is provided, helping practitioners to decide which intervention to implement. Here, practitioners should rely on the evidence, but also on their own experience and preference of the players.

A machine learning approach to identify risk factors for running-related injuries: study protocol for a prospective longitudinal cohort trial

BACKGROUND

Running is a very popular sport among both recreational and competitive athletes. However, participating in running is associated with a comparably high risk of sustaining an exercise-related injury. Due to the often multifactorial and individual reasons for running injuries, a shift in thinking is required to account for the dynamic process of the various risk factors. Therefore, a machine learning approach will be used to comprehensively analyze biomechanical, biological, and loading parameters in order to identify risk factors and to detect risk patterns in runners.

METHODS

The prospective longitudinal cohort study will include competitive adult athletes, running at least 20 km per week and being free of injuries three months before the start of the study. At baseline and the end of the study period, subjective questionnaires (demographics, injury history, sports participation, menstruation, medication, psychology), biomechanical measures (e.g., stride length, cadence, kinematics, kinetics, tibial shock, and tibial acceleration) and a medical examination (BMI, laboratory: blood count, creatinine, calcium, phosphate, parathyroid hormone, vitamin D, osteocalcin, bone-specific alkaline phosphatase, DPD cross-links) will be performed. During the study period (one season), continuous data collection will be performed for biomechanical parameters, injuries, internal and external load. Statistical analysis of the data is performed using machine learning (ML) methods. For this purpose, the correlation of the collected data to possible injuries is automatically learned by an ML model and from this, a ranking of the risk factors can be determined with the help of sensitivity analysis methods.

DISCUSSION

To achieve a comprehensive risk reduction of injuries in runners, a multifactorial and individual approach and analysis is necessary. Recently, the use of ML processes for the analysis of risk factors in sports was discussed and positive results have been published. This study will be the first prospective longitudinal cohort study in runners to investigate the association of biomechanical, bone health, and loading parameters as well as injuries via ML models. The results may help to predict the risk of sustaining an injury and give way for new analysis methods that may also be transferred to other sports.

TRIAL REGISTRATION

DRKS00026904 (German Clinical Trial Register DKRS), date of registration 18.10.2021.

Analysis of professional soccer players in competitive match play based on submaximum intensity periods

The main objective of this study is to analyse sub-maximum intensity periods (SubMIP's) manifested by professional soccer players during official matches (number of events and time spent in each event), according to the player position, match halve and match, and also to group the players according to their SubMip values during the competition.

Methods

We collected a total of 247 individual records of 14 players using Global Positioning System (GPS) during 15 official league matches (Azerbaijan Premier League 2019-2020). We calculated both the number of SubMIPs events and the time each player spent in the SubMIPs zone (threshold of 85% MIP). We analysed the possible independence of the variables with the Kruskal-Wallis test and the possible specific relationships between the groups using a post-hoc analysis with Dunn's test. In order to explore the possible distribution of physical demands in homogeneous groups, a cluster analysis was performed.

Results

The statistical analysis showed significant differences between the individual variables in the number of events and in the time spent by the player above the threshold in distance covered at speed >19.8 km/h (HSR), distance covered at speed >25.2 km/h (Sprint), acceleration density (AccDens), mean metabolic power (MetPow), metres per minute (Mmin) and high metabolic load distance >25.5 W/kg (HMLD). Differences were also found according to the playing position in MetPow, Mmin and between halves in AccDens, MetPow, Mmin. In the clustering based on the time spent by the player in SubMIPs, three main groups were described: (1) the centroid was located in lower values in each of the variables; (2) there were an accentuation of the AccDens variable; (3) all the variables, except AccDens, were accentuated.

Conclusions

The main differences with regard to SubMIPs were related to the player's individual physical performance and not to position. However, the player's position could act as an attractor and show significant differences during matches.

Risk of surgery and epidemiological profile of athletes presenting to a single sports injury clinic in Hong Kong

Background

Although participation in sports and exercise is promoted widely due to its health benefits, sports-related injuries can also be a detriment to an individual's health and a burden for the healthcare system. Herein, the aim of this study is to provide a comprehensive review on the epidemiological profile and the risk for surgery of athletes presented to a sports injuries clinic in Hong Kong.

Methods

A total of 566 patients attending the sports injuries clinic at a local hospital between October 2017 and September 2018 were reviewed. Only 271 patients sustaining injuries from sports activities were included. These patients attended a survey-based data collection session, which recorded their demographic, injury site, events leading to injury, exercise details (type, level-of-play, frequency, experience), and functional score according to the injury site.

Results

The highest proportion of injuries was observed in amateur athletes (45.4%) than in recreational (28.8%) and professional (25.8%). Those patients aged between 18–29 years old (50.2%) had the most injuries. Both soccer (25.1%) and basketball (25.1%) were the two most common sports to incurred injuries. Whereas, the lower extremities being the most common injured sites. Based on our logistic model, athletes with less experience were more prone to required surgeries with injuries in the lower extremities.

Conclusion

Preventive measures should be targeted at less experience athletes, focusing on strengthening the knee region, to reduce sports-related injuries and surgeries. Importantly, this study demonstrates the need to further identify factors to develop effective sports injury prevention programmes for tailoring athletes at different levels-of-play.

Platelet Activation Favours NOX2-Mediated Muscle Damage in Elite Athletes: The Role of Cocoa-Derived Polyphenols

Mechanisms of exercise-induced muscle injury with etiopathogenesis and its consequences have been described; however, the impact of different intensities of exercise on the mechanisms of muscular injury development is not well understood. The aim of this study was to exploit the relationship between platelet activation, oxidative stress and muscular injuries induced by physical exercise in elite football players compared to amateur athletes. Oxidant/antioxidant status, platelet activation and markers of muscle damage were evaluated in 23 elite football players and 23 amateur athletes. Compared to amateurs, elite football players showed lower antioxidant capacity and higher oxidative stress paralleled by increased platelet activation and muscle damage markers. Simple linear regression analysis showed that sNOX2-dp and H₂O₂, sCD40L and PDGF-bb were associated with a significant increase in muscle damage biomarkers. In vitro studies also showed that plasma obtained from elite athletes increased oxidative stress and muscle damage in human skeletal muscle myoblasts cell line compared to amateurs’ plasma, an effect blunted by the NOX2 inhibitor or by the cell treatment with cocoa-derived polyphenols. These results indicate that platelet activation increased muscular injuries induced by oxidative stress. Moreover, NOX2 inhibition and polyphenol extracts treatment positively modulates redox status and reduce exercise-induced muscular injury.

Injury and Illness in Elite Athletics: A Prospective Cohort Study Over Three Seasons

Background

Athletics (also known as track and field) is one of the most popular sports in the world and is the centrepiece of the Summer Olympic Games. Participation in athletics training and competition involves a risk of illness and injury.

Purpose

To describe injury and illness in British Olympic track and field athletes over three full training and competition seasons.

Study Design

Descriptive Epidemiology Study.

Methods

A total of 111 athletes on the British national program were followed prospectively for three consecutive seasons between 2015-2018. Team medical personnel recorded all injuries and illnesses during this time, following current consensus-based methods. All data pertaining to these records were reviewed and analyzed for sports injury and illness epidemiological descriptive statistics.

Results

The average age of the athletes was 24 years for both males and females (24 years, +/- 4). Total exposure for the three seasons was 79 205 athlete days (217 athlete years). Overuse injuries (56.4%) were more frequent than acute injuries (43.6%). The thigh was the most common injury location (0.6 per athlete year), followed by the lower leg (0.4 per athlete year) and foot (0.3 per athlete year). Muscle and tendon were the most commonly injured tissues, while strains and tears were the most common pathology type. Hamstring muscle strain was the most common diagnosis causing time loss, followed by Achilles tendinopathy and soleus muscle strain. Respiratory illness was the most common illness type (0.3 per athlete year).

Conclusion

Hamstring strains, Achilles tendinopathy, and soleus strains are the most common injuries in athletics and have highest burden. Respiratory illness is the most common illness and has the highest burden. Knowledge of this injury and illness profile within athletics could be utilised for the development of targeted prevention measures within the sport at the elite level.

Level of Evidence

3.

Are acute:chronic workload ratios of perceived exertion and running based variables sensible to detect variations between player positions over the season? A soccer team study

Background

The aim of this study was to describe and compare the in-season variations of acute: chronic workload ratio (ACWR) coupled, uncoupled, and exponentially weighted moving average (EWMA) through session rating of perceived exertion (s-RPE), total distance (TD), high-speed running distance (HSRD) and sprint distance (SPRINT) in three different periods of an elite soccer season according to player positions.

Methods

Twenty male elite players (age: 29.4 ± 4.4) from an Asian First League team were daily monitored for twenty consecutive weeks during the 2017–2018 in-season. Forty-seven trainings and twenty matches were monitored using global positioning system units (GPS) to collect TD, HSRD and SPRINT. Through the collection of s-RPE, TD, HSRD, and SPRINT by ACWR and EWMA were calculated for each training session.

Results

The results revealed that according to different periods of the season, workload measures observed in mid-season were meaningfully higher compared with early-season (g = ranging from 0.53 to 4.98) except for EWMA_SPRINT. In general, wingers and strikers tended to have greater scores in workload measures compared to the defenders and midfielders (g = ranging from 0.41 to 5.42).

Conclusions

These findings may provide detailed information for coaches and sports scientists regarding the variations of acute and chronic workload ratio and external loading in-season and between player positions in an elite soccer team.

Local Positioning System-Derived External Load of Female and Male Varsity Ice Hockey Players During Regular Season Games

Purpose

The purposes of this study were to quantify the external load for female and male varsity ice hockey players during regular season games using a local positioning system (LPS), compare LPS-derived external load between sexes and positions, and compare skating distances in absolute and relative speed zones.

Methods

Data were collected for 21 female (7 defense, 14 forwards; 20.0 ± 1.4 yrs., 69.1 ± 6.7 kg, 167.1 ± 5.4 cm) and 25 male (8 defense, 17 forwards; 21.9 ± 1.1 yrs., 85.9 ± 5.4 kg, 181.1 ± 5.2 cm) varsity ice hockey players. Measures included skating distance (total, and in absolute and relative speed zones), peak skating speed, peak acceleration and deceleration, accumulative acceleration load, and number of accelerations, decelerations, turns, skating transitions, direction changes, and impacts.

Results

Female and male players had a high external load during games, with average peak skating speeds >28 km/h and average skating distances >4.4 km. Most LPS-derived measures showed greater external load in males than females (p < 0.05). Forwards skated further at higher speeds compared to defense in both sexes (p < 0.001). Skating distances were significantly different when comparing absolute and relative speed zones (p < 0.001), with absolute speed zones potentially overestimating skating at very slow, very fast, and sprint speeds and underestimating skating at slow and moderate speeds.

Conclusion

This was the first study to measure external load in female ice hockey players with a LPS. Both female and male varsity players had high external loads during games, with forwards having greater external load at higher intensities and defense having greater external load at lower intensities. Sex and positional differences outline the importance of individualized athlete monitoring.

Are Subjective Intensities Indicators of Player Load and Heart Rate in Physical Education?

Physical education teachers need valid, low-cost, subjective techniques as an alternative to high-cost new technologies to monitor students’ intensity monitoring. This study aimed to investigate the correlations between both objective and subjective external (eTL) and internal (iTL) intensities. A total of 95 primary education students participated in this study. In this regard, 40 played soccer, and 55 performed basketball tasks, recording a total of 3956 units of analysis. The intensities caused by the different soccer and basketball tasks were measured using objective techniques (inertial devices and heart rate monitors) and subjective techniques (a sheet of task analysis and ratings of perceived exertion). Matrix scatter plots were made to show the values of two variables for a dataset. In this regard, adjustment lines were plotted to determine the trend of the correlations. Then, Spearman’s correlation was calculated to measure the association between two variables. Despite the low correlation levels obtained, the main results showed significant positive correlations between the intensities. This means that the high intensity values recorded by objective techniques also implied high intensity values recorded by subjective techniques, and vice versa. Negative correlations (r Rho = −0.19; p = 0.00) were only found between the following eTL variables: task eTL per minute (subjective technique) and player load per minute (objective technique). This negative correlation occurred when students played in the same 3 vs. 3 game situation without variability in subjective eTL (M ± SD, 28.00 ± 0.00). Therefore, subjective eTL and iTL techniques could be proposed as a suitable alternative for planning and monitoring the intensities supported by students in physical education classes. Moreover, these subjective techniques are easy to use in schools.

Association Between Preseason Fitness Level and Risk of Injury or Illness in Male Elite Ice Hockey Players: A Prospective Cohort Study

Background:

Little is known about the association between physical fitness and the risk of injury or illness in ice hockey. The least-fit players may be more prone to injury and illness.

Purpose:

To examine the association between preseason fitness level and injury or illness risk among elite ice hockey players during the regular season.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

A total of 133 male ice hockey players in the GET League (the premier professional league in Norway) completed 8 different exercises (40-m sprint, countermovement jump, 3000-m run, squat, bench press, chin-ups, brutal bench, and box jump) at the annual 1-day preseason testing combine. During the 2017-2018 competitive season, the players reported all health problems (acute injuries, overuse injuries, and illnesses) weekly (31 weeks) using the Oslo Sports Trauma Research Center Questionnaire on Health Problems.

Results:

Overall, the players reported 191 acute injuries, 82 overuse injuries, and 132 illnesses. The least-fit tercile of players did not report more health problems (mean, 3.0; 95% CI, 2.2-3.8) compared with the most-fit (mean, 3.4; 95% CI, 2.6-4.2) or the medium-fit (mean, 2.7; 95% CI, 1.9-3.5) players. The most-fit players reported more substantial health problems (mean, 2.0; 95% CI, 1.6-2.5) compared with the medium-fit (mean, 1.3; 95% CI, 0.8 -1.8) and least-fit (mean, 1.8; 95% CI, 1.3-2.3) (P = .02) players. There was no association between low physical fitness and number of health problems when comparing the least-fit tercile of the players with the rest of the cohort (P > .05); however, there was an association between low physical fitness and greater severity of all health problems when comparing the least-fit tercile of players to the rest of the cohort after adjusting for time on ice per game, playing position, and age (P = .02).

Conclusion:

Low physical fitness was not associated with increased rate of injury or illness but was associated with greater severity of all health problems after adjusting for time on ice per game, playing position, and age.

Influence of the Weekly and Match-play Load on Muscle Injury in Professional Football Players

The aim of this investigation was to examine the impact of the weekly training load and the match running patterns prior to a muscle injury as potential risk factors of muscle injury in professional football players. Forty male professional football players participated in the investigation. Running distances at different intensities 5 min and 15 min prior to the injury were compared to the same time-points in official matches of the same player with no injury events. Furthermore, the cummulative session rating of perceived exertion (sRPE) and training load of the week prior to the injury were compared to a control week (mean value of training weeks without injury). Nineteen players suffered 31 non-contact muscle injuries during matches. The distance covered at 21-24 km/h (p<0.001; effect size (ES)=0.62) and at>24 km/h (p=0.004; ES=0.51) over the 5-min period prior to the injury was greater than in matches without injury. The cumulative sRPE (p=0.014; ES=1.33) and training volume (p=0.002; ES=2.45) in the week prior to the injury was higher than in a control week. The current data suggest that the combination of a training week with a high load and a short period of high intensity running during the match might increase the risk of muscle injury in professional footballers.

Impact of match-related contextual variables on weekly training load in a professional soccer team: a full season study

The purpose of this study was to analyse the impact of match-related contextual variables (match location, match outcome and level of the opponent) on the weekly training load in a professional soccer team throughout a full competitive season. Total distance, high-speed running distance (HSRD, > 18 km·h^-1), highmetabolic load distance (HMLD, > 25.5 W·kg^-1), player load and total number of impacts (above 3 G) were collected from training and match sessions in professional soccer players (n = 25) competing in LaLiga123. Comparisons of external load parameters by each match-related contextual variable were examined using a mixed-effect model. Differences between playing positions were found for total distance (p < 0.05; r = 0.11–0.15), HSRD (p < 0.05; r = 0.13–0.19), HMLD (p < 0.05; r = 0.12–0.19), player load (p < 0.05; r = 0.11–0.19) and impacts (p < 0.05; r = 0.15–0.26). However, no significant interaction was observed between match-related contextual variables and playing position for any variable (p > 0.05). In addition, a significant impact of match outcome (p < 0.05; r = 0.11–0.15), opponent level (p < 0.05; r = 0.11–0.17) and match location (p < 0.05; r = 0.14–0.20) on the weekly training load (before and after the match) was observed. In conclusion, match-related contextual variables seem to slightly affect weekly external training load. Thus, coaching and medical departments could consider the influence of these contextual variables when prescribing the training load relative to the match demands.

Position-Specific Physical Workload Intensities in American Collegiate Football Training

ABSTRACT

MamonJr, MA, Olthof, SBH, Burns, GT, Lepley, AS, Kozloff, KM, and Zernicke, RF. Position-specific physical workload intensities in American collegiate football training. J Strength Cond Res 36(2): 420-426, 2022-Quantifying player training loads allows football coaching staff to make informed adjustments to the volume and intensity of training. Physical workload intensity in American football practices have not been extensively quantified. The current study examined physical workload intensities across positions in American collegiate football during training. Data from player tracking technology (Catapult Vector) were collected from 72 American football players (National Collegiate Athletic Association Division I) during in-season practices. Players were involved in individualized skill (indy), team playbook (team), and special team (ST) drills during practice and analyzed for their specialist offensive or defensive role (e.g., linebacker or wide receiver). Player running (i.e., high-speed running and sprint) and accelerations (i.e., high-intensity PlayerLoad and high-intensity inertial movement analysis) per minute were of interest. Drill type and practice day had significant effects on all workload intensity metrics (p < 0.01), but not position. Greater running intensities were seen in ST drills compared with other drill types. Tuesday practice sessions had greater overall intensities compared with other days. Interaction effect of position and drill type was significant (p < 0.001) for all intensity metrics, indicating that position groups exhibited unique workload responses to the drill types. Drill type and practice day interaction effect was significant for all intensity metrics (p < 0.01). The findings may be informative for coaches to tailor physical workloads of practice drills for positional roles in preparation for games and practices. Player tracking technology can add value for strength and conditioning coaches to adjust training programs based on position-specific on-field demands of players.

Influence of Strength Programs on the Injury Rate and Team Performance of a Professional Basketball Team: A Six-Season Follow-Up Study

This study aims to determine possible associations between strength parameters, injury rates, and performance outcomes over six seasons in professional basketball settings. Thirty-six male professional basketball players [mean ± standard deviation (SD): age, 30.5 ± 4.7 years; height, 199.5 ± 9.5 cm; body mass, 97.9 ± 12.9 kg; BMI 24.6 ± 2.5 kg/m2] participated in this retrospective observational study, conducted from the 2008-09 to the 2013-14 season. According to their epidemiological records, each player followed an individual plan designed within different strength training programs: Functional (n = 16), Eccentric (n = 8), or Resistance (n = 12). Seven hundred and fourteen valid records were obtained from 170 individual strength tests during 31 sessions. Tests performed were leg press, squat, and jerk. Parameters recorded were force, power, velocity, peak velocity, and time to peak velocity for strength; time loss injury and muscle injury for injury rate; and games won, games lost, and championships for performance outcomes. All the strength variables and injuries are independent of the strength programs (p < 0.01). The correlation analysis showed very significant relationships between muscular injuries and time to peak velocity (r = 0.94; p < 0.01), significant relationships between force and games lost (r = 0.85; p < 0.05), and muscular injuries with games lost (r = -0.81; p < 0.05) per season. Mean values per season described a possible association of force, time to peak velocity, and muscular injuries with performance outcomes (R 2 = 0.96; p < 0.05). In this specific context, strength variables and injury rate data show no association with a single type of strength training program in this cohort of high-performance basketball players.

Considerations for the Medical Management of the Circus Performance Artist and Acrobat

Medical management of the circus performer encompasses a wide variety of multicultural, transdisciplinary and multifaceted decision-making considerations. There is a paucity of research evidence investigating both the unique diversity of skill sets and cultural considerations in addition to injury patterns of performers within the circus environment. Since a previously established framework for supporting the health and well-being of the circus performer across various aspects of medical management does not exist in the literature, most recommendations in this regard must come from practical experience working with this highly specialized performance athlete population. The purpose of this clinical commentary is to provide the reader with a greater understanding of the unique challenges associated with the medical management of performance artists and acrobats as well as recommendations for developing an integrated approach for mitigating injury risk within a highly specialized, diverse athlete population.

LEVEL OF EVIDENCE

5.

Masterclass: Hypermobility and hypermobility related disorders

INTRODUCTION

Hypermobile joints display a range of movement that is considered excessive, taking into consideration the age, gender and ethnic background of the individual. Joint hypermobility may present in a single joint, a few joints or in multiple joints and may be congenital or acquired with training, disease or injury. Hypermobile joints may be asymptomatic or may be associated with pain, fatigue, multisystemic complaints and significant disability. Furthermore, joint hypermobility may be a sign of an underlying hereditary disorder of connective tissue.

PURPOSE

This masterclass aims to provides a state-of-the-art review of the aetiology, epidemiology, clinical presentation, assessment and management of joint hypermobility and hypermobility related disorders using an evidence based and biopsychosocial approach. The new framework for classifying the spectrum of joint hypermobility disorders along with new diagnostic criteria for the hypermobile Ehlers Danlos syndrome, published by an international consortium of clinical experts and researchers in 2017 is integrated into the paper.

IMPLICATIONS FOR PRACTICE

People with joint hypermobility related disorders present to healthcare professionals with a wide range of symptoms which extend beyond the musculoskeletal system. Early recognition and treatment are key to effective management. A biopsychosocial and patient empowerment approach to functional restoration is recommended.

Physiological characteristics and acute fatigue associated with position-specific speed endurance soccer drills: production vs maintenance training

Objective: The study aimed to compare the physiological characteristics and acute fatigue associated with position-specific speed endurance production (SEP) and maintenance (SEM) soccer drills.Methods: Twenty male soccer players performed a position specific drill consisting of 8 exercise bouts each lasting ~30 s interspersed by 150 s (SEP) and 60 s (SEM) of passive recovery. A selection of players (n = 10) completed neuromuscular assessments pre and post drill.Results: Players covered greater high speed (12%), very high speed (49%) and sprint (218%) running distances in SEP (P < 0.05, ES: 0.51-0.80). SEP resulted in greater peak (7%) and average (10%) running speeds (P < 0.01, ES: 0.70-0.93). Mean and peak heart rate responses were greater in SEM (4-10%, P < 0.01, ES: 0.97-1.84) whilst blood lactate concentrations were higher following SEP (6%, P < 0.05, ES: 0.42). Reductions in vertical countermovement jump height were more pronounced immediately after SEP (2%, P < 0.05, ES: 0.36) but 24 h post SEM (4%, P < 0.05, ES: 0.52). Horizontal countermovement jump performance was reduced immediately post SEP and SEM (3-5%, P < 0.01, ES: 0.22-0.38) and 24 h post SEM (4%, ES: 0.32).Conclusion: The data demonstrate that position-specific SEP and SEM drills overload different physiological indices and induce small impairments in some neuromuscular measures.

Racing-associated fatalities in Norwegian and Swedish harness racehorses: Incidence rates, risk factors, and principal postmortem findings

Background

There are no reports on the number of fatalities or causes of death in the Norwegian and Swedish harness racehorses.

Objectives

The incidence rates (IRs), risk factors, and postmortem findings in horses that died or were euthanized associated with racing between 2014 and 2019 were investigated.

Animals

Thirty‐eight Standardbreds and 10 Norwegian‐Swedish Coldblooded Trotters died or were euthanized associated with racing. A total of 816 085 race‐starts were recorded.

Methods

Incidence rates were calculated for both countries and horse breeds. Risk factors for sudden death were identified using a case‐control logistic model. Postmortem examinations were performed in 43 horses.

Results

The overall fatality IR was 0.059/1000 race‐starts. Traumatic injuries accounted for 14.5%, while sudden death for 85.5% of fatalities. Only minor differences between countries and breeds were recorded. The number of starts within the last 30 days increased the risk of sudden death (5 starts odds ratio (OR) 228.80, confidence interval (CI) 10.9‐4793). An opposite non‐linear effect was observed in number of starts the last 180 days (>10 starts OR 0.12, CI 0.02‐0.68). Seven horses were euthanized because of catastrophic injury. Acute circulatory collapse because of suspected cardiac or pulmonary failure or both was recorded in 30 horses, while major hemorrhage after vessel rupture was the primary cause of death in 10 cases. One horse collapsed and died but was not submitted for autopsy.

Conclusions and Clinical Importance

Comparatively low rates of catastrophic orthopedic fatalities were reported, while causes and IR of sudden death were similar to previous studies.

Wearable Inertial Measurement Unit to Measure External Load: A Full-Season Study in Professional Soccer Players

The aim of this study was to describe weekly acute workload (wAW), chronic workload (wCW), acute: chronic workload ratio (wACWR), training monotony (wTM), and training strain (wTS) variations over a full season across playing positions. Twenty-one professional soccer players were daily monitored during 48 consecutive weeks. Total distance, sprint total distance (STD), high-speed running distance (HSRd), maximum speed, number of the repeated sprints, and body load (BL) were obtained during training and matches using a Wearable Inertial Measurement Unit. The wAW was determined for each external load measure. The wCW, wACWR, and wTM were calculated based on BL metric. Higher values of weekly STD were observed in lateral defenders/wingers (LDW) compared to central defenders/forwards (CDF) (p = 0.009; ES = Large) and midfielders (MDF) (p = 0.034; ES = Large). Additionally, weekly HSRd was higher in LDW vs. CDF (p = 0.016; ES = Large) and MDF (p = 0.011; ES = Large). The CDF presented a lower weekly number of repeated sprints than LDW (p = 0.021; ES = Large). In conclusion, weekly external load metrics were position-dependent over the season. Moreover, LDW a presented greater weekly STD, HSRd, and number of repeated sprints compared to other positions.

Characteristics of Plantar Pressure with Foot Postures and Lower Limb Pain Profiles in Taiwanese College Elite Rugby League Athletes

Background: This study aimed to explore the differences in the distributions of plantar pressure in static and dynamic states and assess the possible pain profiles in the lower limb between elite rugby league athletes and recreational rugby players. Methods: A cross-sectional study of 51 college elite rugby athletes and 57 recreational rugby players was undertaken. The arch index (AI) and plantar pressure distributions (PPDs) with footprint characteristics were evaluated via the JC Mat. Rearfoot alignment was examined to evaluate the static foot posture. The elite group’s lower-limb pain profiles were examined for evaluating the common musculoskeletal pain areas. Results: The recreational group’s AI values fell into the normal range, whereas the elite group’s arch type fell into the category of the low arch. Results from the elite group were: (1) the PPDs mainly exerted on the entire forefoot and lateral midfoot regions in static standing, and transferred to the forefoot region during the midstance phase of walking; (2) the static rearfoot alignment matched the varus posture pattern; (3) the footprint characteristics illustrated the features of low-arched, supinated, dropped metatarsal heads and dropped cuboid feet; and (4) the phalanx and metatarsophalangeal joints, and the abductor hallucis and abductor digiti minimi of the plantar plate were common musculoskeletal pain areas. Conclusions: Characteristics of higher plantar loads beneath forefoot and midfoot associated with low-arched supinated feet in bipedal static stance could be the traceable features for the foot diagram of elite rugby league athletes. The limb pain profiles of the elite rugby league athletes within this study echoed the literature on rugby injuries, and reflected the features of metatarsophalangeal joint pains and dropped cuboids. The relationships among the low-arched supinated feet, metatarsophalangeal joint pains and cuboid syndrome are worth further studies.

Accumulative weekly load in a professional football team: with special reference to match playing time and game position

The aim of this study was to compare weekly accumulative load during the in-season competitive period by professional soccer players according to the amount of time played in official matches (90-min, >60-min, <60-min, and 0-min) regarding the players' position. Twenty-four professional outfield football players were monitored by GPS devices during training sessions and official matches and the accumulative weekly load were calculated for the following external load variables: total distance (TD; m), high speed running (HSR; >19.8 km·h-1), sprint meters (SPR; >25.2 km·h-1), high metabolic load distance (HMLD; >25.5 W·kg-1), number of accelerations (ACC; >3 m·s-2) and decelerations (DEC; <-3 m·s-2). This study revealed that players (as a whole o per demarcation) with more match playing time had a higher accumulative weekly load for most of the variables, but particularly at TD and HMLD (90-min and >60-min vs. <60-min and 0-min), HSR (90-min vs. <60-min and 0-min) and SPR (90-min vs. <60-min and 0-min). In addition, less positional variation was observed in relation to the competition requirements. This information would allow coaches to refine the required load with the objective of optimizing performance to soccer players.

Variability of Competition-Based Caloric Expenditure and Relative Heart Rates in National Collegiate Athletic Association Division I Women's Basketball

ABSTRACT

Sanders, GJ, Boos, B, Rhodes, J, Peacock, CA, Kollock, RO, and Scheadler, CM. Variability of competition-based caloric expenditure and relative heart rates in National Collegiate Athletic Association Division I women's basketball. J Strength Cond Res 36(1): 162-166, 2022-Basketball athletes frequently engage in high intensities (≥85% HRpeak) throughout competition, and it is unknown how high-intensity play coincides with caloric expenditure and average and peak relative heart rates. The purpose of the study was to assess caloric expenditure throughout 31 games (4- to 10-minute quarters) in National Collegiate Athletic Association Division I women's basketball. A total of 11 female athletes were tested for peak heart rate (HRpeak) and peak oxygen uptake (V̇o2peak) before the season, then monitored in-season with heart rate-based wearable devices. Estimated caloric expenditure, average (% HRavg) and peak (% HRpeak) relative heart rates, time played at intensities ≥85% HRpeak, and live time (i.e., game minutes not including stoppages in play) were recorded each game. Data were assessed as a team and compared across 4 quarters, and then, interathlete comparisons were made based on full game data. There were significant main effects of 10-minute quarters on calories (p < 0.001) and % HRavg (p = 0.015) but not playing intensity ≥85% HRpeak (p = 0.125) and % HRpeak (p = 0.629). Caloric expenditure was the only variable to increase from the first to the fourth quarter. There were main effects of individual athletes on calories, % HRavg, % HRpeak, live time, and playing intensity ≥85% HRpeak (p < 0.001 for all). Assessing individual athletes, relative to a team assessment across quarters, can provide practitioners with more accurate caloric expenditure, heart rate, and playing intensity data per athlete to improve training and fueling protocols.