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Wang M, Chee J, Tanaka MJ, Dave Lee YH. Relative Energy Deficiency in Sport (RED-S) and Knee Injuries: Current Concepts for Female Athletes. J ISAKOS 2024:S2059-7754(24)00099-3. [PMID: 38795863 DOI: 10.1016/j.jisako.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 05/19/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
In athletes, a mismatch between caloric intake and energy expended in exercise can result in Low Energy Availability (LEA). LEA can lead to Relative Energy Deficiency in Sport (RED-S), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of RED-S is higher in females than males. RED-S more comprehensively describes the syndrome originally known as "Female Athlete Triad" (FAT). FAT encompasses the triad of LEA (with or without disordered eating), menstrual dysfunction and low bone mineral density. RED-S includes other physiological derangements such as poor cardiovascular health, abnormalities of metabolic rate, immunity, and protein synthesis. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of RED-S. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendon and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for RED-S if present, for holistic patient care.
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Affiliation(s)
- Mingchang Wang
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288.
| | - Jade Chee
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288.
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge Street, Suite 400, Boston, MA 02114 USA.
| | - Yee Han Dave Lee
- Division of Sports, Shoulder and Elbow Surgery, Department of Orthopaedic Surgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119288.
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Bibby K, Kenny IC, Cahalan R, Purtill H, Comyns TM. Contact Breast Injuries Among Female Athletes: A Systematic Review. Sports Med 2024:10.1007/s40279-024-02027-y. [PMID: 38693460 DOI: 10.1007/s40279-024-02027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Robust surveillance of injury aetiology and epidemiology is recognised as fundamental for effective injury reduction and management programmes. However, while sex-specific differences in injury type and nature are noted in the literature, it is unclear if these are reflected in surveillance practices, and how the athlete is affected. OBJECTIVE Therefore, this study aimed to systematically review contact breast injuries (CBIs) among adult female athletes. METHODS The following databases were searched: PubMed, EMBASE, SPORTDiscus including MEDLINE, Web of Science and Scopus. The literature search was conducted in May 2023 and the search was limited to articles in the English and German language. Studies including female athletes, aged 18 years and above, in any sports (team or individual) at any level (amateur, semi-professional and professional), where an occurrence of CBI was documented were included. Studies were included irrespective of their investigated timeframes (e.g. the whole career, one or multiple seasons). Findings were categorised (e.g. sport, level of competition and investigated timeframe of the study) to enable possible comparisons. Case studies were excluded due to the non-generalisability of findings. RESULTS Of the six studies included, rugby codes (rugby union, rugby league and rugby sevens) had the highest occurrence rate (62.0%) of CBIs among eight different investigated sports (rugby codes 62.0%, softball 59.5%, Australian Football League (AFL) 51.0%, water polo 50.0%, soccer 46.7%, basketball 27.6-48.8%, volleyball 34.6%, boxing 0.0%). Between 25.6% and 62.0% of participants reported incurring a CBI and between 0.0% and 42.9% of CBIs were reported to a medical professional or support staff. The reported treatment rate for CBIs ranged between 0.0% and 2.1%, The main mechanisms for CBIs (where reported) were contact with another athlete (AFL 37.6%, rugby codes 56%) the ball (AFL 31.6%, rugby codes 25.5%) and the ground (AFL 6.6%, rugby codes 22%). Between 18.2% and 48% of the participants reported that CBIs negatively affected their performance. Risk factors increasing CBIs were positional differences, larger breast size and higher body mass index (BMI). In-season injury data collection and surveillance supported through education of both players and medical staff were identified to be of relevance for future CBI prevention. None of the studies reported incidence rate. CONCLUSION Despite the frequent occurrence of CBIs among female athletes, reporting and treatment remains low. Awareness and education of all stakeholders are fundamental to ensuring better breast safety in female sport. Identifying the mechanics, severity and risk factors of CBIs through thorough injury surveillance must be a focus of further research. REGISTRATION The study was preregistered on Open Science Framework (OSF).
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Affiliation(s)
- Kilian Bibby
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Ian C Kenny
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Lero, The Science Foundation Ireland Centre for Software Research, University of Limerick, Limerick, Ireland
| | - Róisín Cahalan
- Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Tom M Comyns
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Mekoulou Ndongo J, Bika Lele EC, Malam Moussa Ahmet H, Guessogo WR, Wiliam MB, Guyot J, Rozand V, Ahmadou, Ayina Ayina CN, Kojom Foko LP, Barth N, Bongue B, Ba A, Samb A, Roche F, Mandengue SH, Assomo-Ndemba PB. Poor quality of sleep and musculoskeletal pains among highly trained and elite athletes in Senegal. BMC Sports Sci Med Rehabil 2024; 16:54. [PMID: 38389100 PMCID: PMC10882835 DOI: 10.1186/s13102-023-00705-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/21/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Previous studies reported that poor sleep quality (PSQ) was associated with musculoskeletal pains (MSP) and poor physical performance in athletes. OBJECTIVE The current study aimed at determining PSQ and its associations with MSP in some sub-Saharan athletes. METHODS A cross sectional study was conducted among 205 highly trained and 115 elite athletes (aged: 25 ± 2 years, Body mass index: 22.8 ± 0.9 kg/m2) in Dakar, Senegal, during a competitive season in a variety of sport disciplines including athletics, basketball, football, rugby, wrestling, tennis. Quality of sleep and MSP were assessed using the French version Pittsburgh Sleep Quality Index (PSQI) and French version of Nordic questionnaire respectively. Pain on body joints during a week was defined as seven-day MSP (MSP-7d) and PSQ for a PSQI > 5. RESULTS 27.8% (95%CI: 23.2-32.9) of the overall sample suffered PSQ, with 33.7% (95%CI: 24.7-44.0) in basketball and 24.7% (95%CI: 16.9-34.6) in football. According to athletic status and gender, PSQ was more prevalent among highly trained (66.3; 95%CI: 55.9-75.3) and men (69.7%; 95%CI: 59.5-78.7). Among athletes with PSQ 43.8% (95%CI: 33.9-54.2) suffered MSP-7d, with 36.6%; highly trained (95%CI: 23.7-42.9) and 28.1% female. Considering body region, hips/thigh (14.6%; 95% CI: 8.74-23.4) and upper back (13.5%; 95%CI: 7.88 -21, 1) were more affected. Basketball players were more affected from MSP (MSP-7d = 38.5%; 95%CI: 24. 9-54.1) on high on wrists/hands (MSP-7d = 44.4%; 95%CI: 18.9 -73.3; P = 0.04). Based on athletic status, MSP-7d were higher on highly trained necks (100%; 95%CI: 56.1-100; p = 0.04). PSQ was associated with basketball (OR: 3.062, 95%CI: 1.130-8.300, p = 0.02) compared to Athletic. PSQ and MSP-7d were associated on Wrist/hands (OR: 3.352, 95%CI: 1.235-9.099, p = 0.01), and at the upper back (OR: 5.820, 95%CI: 2.096-16.161, p = 0.0007). CONCLUSION These results indicate that PSQ is considerable among Senegalese athletes and is associated with MSP during a week. Hence, we recommend to look for strategies optimizing good quality of sleep in order to reduce pains, to improve health.
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Affiliation(s)
- Jerson Mekoulou Ndongo
- Physical Activities and Sport Physiology & Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Elysée Claude Bika Lele
- Physical Activities and Sport Physiology & Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | | | | | - Mbang Biang Wiliam
- National Institute of Youth and Sports Yaoundé, University of Yaounde I, Yaounde, Cameroon
| | - Jessica Guyot
- Mines Saint-Etienne, INSERM, U1059 Sainbiose, Université Jean Monnet, Saint-Étienne, 42023, France
| | - Vianey Rozand
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Inter-universitaire de Biologie de la Motricité, F-42023, Saint-Étienne, France
| | - Ahmadou
- Physical Activities and Sport Physiology & Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Clarisse Noel Ayina Ayina
- Physical Activities and Sport Physiology & Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Loick Pradel Kojom Foko
- Physical Activities and Sport Physiology & Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Nathalie Barth
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Inter-universitaire de Biologie de la Motricité, F-42023, Saint-Étienne, France
| | - Bienvenu Bongue
- Mines Saint-Etienne, INSERM, U1059 Sainbiose, Université Jean Monnet, Saint-Étienne, 42023, France
- Support and Education Technical Centre of Health Examination Centres (CETAF), Saint-Etienne, France
| | - Abdoulaye Ba
- Faculty of Medicine, Pharmacy and Dentistry, University of Cheikh Anta Diop, Dakar, Sénégal
| | - Abdoulaye Samb
- Faculty of Medicine, Pharmacy and Dentistry, University of Cheikh Anta Diop, Dakar, Sénégal
| | - Fréderic Roche
- Mines Saint-Etienne, INSERM, U1059 Sainbiose, Université Jean Monnet, Saint-Étienne, 42023, France
| | - Samuel Honoré Mandengue
- Physical Activities and Sport Physiology & Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
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Santos-Rocha R, Szumilewicz A. Fostering the social and physical challenges of female recreational or professional athletes in pregnancy and postpartum. BMC Pregnancy Childbirth 2024; 24:128. [PMID: 38350891 PMCID: PMC10863130 DOI: 10.1186/s12884-024-06312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
Combining pregnancy and parenthood with sporting activities or a professional athletic career can be challenging. The objective of this Collection is to gain a deeper understanding of the effects of pregnancy and postpartum on female athletes, both recreational and professional, in order to improve their health and fitness outcomes and support their continued success in sports.
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Affiliation(s)
- Rita Santos-Rocha
- ESDRM-Sport Sciences School of Rio Maior-Santarem Polytechnic University, Rio Maior, Portugal.
- SPRINT-Sport Physical Activity and Health Research & Innovation Center , Santarem Polytechnic University, Rio Maior, Portugal.
| | - Anna Szumilewicz
- Gdansk University of Physical Education and Sport, Gdansk, Poland
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Joachim MR, Kuik ML, Krabak BJ, Kraus EM, Rauh MJ, Heiderscheit BC. Risk Factors for Running-Related Injury in High School and Collegiate Cross-country Runners: A Systematic Review. J Orthop Sports Phys Ther 2024; 54:1-13. [PMID: 37970801 DOI: 10.2519/jospt.2023.11550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE: To summarize and describe risk factors for running-related injuries (RRIs) among high school and collegiate cross-country runners. DESIGN: Descriptive systematic review. LITERATURE SEARCH: Four databases (Scopus, SPORTDiscus, CINAHL, Cochrane) were searched from inception to August 2023. STUDY SELECTION CRITERIA: Studies assessing RRI risk factors in high school or collegiate runners using a prospective design with at least 1 season of follow-up were included. DATA SYNTHESIS: Results across each study for a given risk factor were summarized and described. The NOS and GRADE frameworks were used to evaluate quality of each study and certainty of evidence for each risk factor. RESULTS: Twenty-four studies were included. Overall, study quality and certainty of evidence were low to moderate. Females or runners with prior RRI or increased RED-S (relative energy deficiency in sport) risk factors were most at risk for RRI, as were runners with a quadriceps angle of >20° and lower step rates. Runners with weaker thigh muscle groups had increased risk of anterior knee pain. Certainty of evidence regarding training, sleep, and specialization was low, but suggests that changes in training volume, poorer sleep, and increased specialization may increase RRI risk. CONCLUSION: The strongest predictors of RRI in high school and collegiate cross-country runners were sex and RRI history, which are nonmodifiable. There was moderate certainty that increased RED-S risk factors increased RRI risk, particularly bone stress injuries. There was limited evidence that changes in training and sleep quality influenced RRI risk, but these are modifiable factors that should be studied further in this population. J Orthop Sports Phys Ther 2024;54(2):1-13. Epub 16 November 2023. doi:10.2519/jospt.2023.11550.
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Bascharon R, Sethi NK, Estevez R, Gordon M, Guevara C, Twohey E, deWeber K. Transgender competition in combat sports: Position statement of the Association of ringside physicians. PHYSICIAN SPORTSMED 2023:1-8. [PMID: 38038979 DOI: 10.1080/00913847.2023.2286943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
The Association of Ringside Physicians (ARP) is committed to the concept of fair competition. It advocates for two equally skilled and matched athletes to keep bouts fair, competitive, entertaining, and, most importantly, safe for all combatants. Numerous studies have proven that transgender women may have a competitive athletic advantage against otherwise matched cis-gender women. Likewise, transgender men may suffer a competitive disadvantage against cis-gender men. These differences - both anatomic and physiologic - persist despite normalization of sex hormone levels and create disparities in competitive abilities that are not compatible with the spirit of fair competition. More importantly, allowing transgender athletes to compete against cisgender athletes in combat sports, which already involve significant risk of serious injury, unnecessarily raises the risk of injury due to these differences. Hence the ARP does not support transgender athlete competition against cisgender athletes in combat sports.
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Affiliation(s)
- Randa Bascharon
- Orthopedic and Sports Medicine Institute of Las Vegas, Las Vegas, NV, US
| | - Nitin K Sethi
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Ryan Estevez
- Lakeland Regional Health Medical Center, Lakeland, FL, US
| | - Mark Gordon
- Memorial Hospital Pembroke, Pembroke Pines, FL, US
| | - Carlo Guevara
- Oral and Maxillofacial Surgery, Broward Health , Lauderdale, FL, USA
| | - Eric Twohey
- Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, MN, US
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Dupuit M, Meignié A, Chassard T, Blanquet L, LeHeran J, Delaunay T, Bernardeau E, Toussaint JF, Duclos M, Antero J. On-Field Methodological Approach to Monitor the Menstrual Cycle and Hormonal Phases in Elite Female Athletes. Int J Sports Physiol Perform 2023; 18:1169-1178. [PMID: 37666497 DOI: 10.1123/ijspp.2022-0287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 05/17/2023] [Accepted: 06/15/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Currently, there are no guidelines for implementing the monitoring of menstrual status, including the natural menstrual cycle (NC) or oral contraception (OC), in a sport setting. We aimed to provide a feasible, on-field methodological approach for monitoring NC and OC in female athletes. METHODS We developed a smartphone app with daily questionnaires to monitor both NC and OC phases in 19 elite female soccer players (23.7 [4.4] y) over 7 months. Adherence and compliance were evaluated. The NC and OC phases were based on calendar data to establish an individual menstrual profile for each athlete. RESULTS The initial questionnaire revealed that the vast majority of female players (80%) were interested in monitoring their menstrual status. The online monitoring yielded high athlete adherence (87.0% [14.2%]) with a slight decrease over the winter break and at the end of the championship, which necessitated adaptations to promote compliance. Monitoring identified the specific menstrual pattern of each athlete and highlighted large interindividual variability. CONCLUSION This study assesses, for the first time, the interest of female players in monitoring their menstrual status. It provides a new methodological approach, as well as guidelines for optimizing on-field monitoring. It also anticipates some obstacles sport staff may encounter when trying to implement such follow-up. It is essential to better understand the menstrual profile of athletes and determine its potential impacts on well-being and performance.
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Affiliation(s)
- Marine Dupuit
- Laboratory of Metabolic Adaptations to Exercise Under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne (UCA), Clermont-Ferrand, France
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Alice Meignié
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Tom Chassard
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Ludivine Blanquet
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | | | | | | | - Jean-François Toussaint
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
- CIMS, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Martine Duclos
- Sport Medicine and Functional Explorations, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France
- Unité de Nutrition Humaine (UNH), Université Clermont Auvergne (UCA), INRA, Clermont-Ferrand, France
| | - Juliana Antero
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
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Musko PA, Demetriades AK. Are Sex Differences in Collegiate and High School Sports-Related Concussion Reflected in the Guidelines? A Scoping Review. Brain Sci 2023; 13:1310. [PMID: 37759911 PMCID: PMC10526868 DOI: 10.3390/brainsci13091310] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Sport-related concussion (SRC) is a common sport injury. Females are participating in sports at increasing rates, and there is growing awareness that female athletes may be more vulnerable to SRC. Objectives: We aimed to identify sex differences in epidemiology, clinical manifestation and assessment of SRC and examine how these relate to the 6th International Conference on Concussion in Sport (ICCS). Methods: We conducted a scoping review of the Medline database and identified 58 studies examining the effects of sex on SRC in collegiate and high school athletes that were written in English and published in a peer-reviewed journal between March 2012 and March 2022. Results: We found that female athletes suffer higher rates of concussion in sex-comparable sports, in particular soccer. Female athletes experience more somatic symptoms-headache/migraine/sleep disturbance-and may take longer to recover from concussion. Sex differences were also identified regarding some aspects of sideline concussion assessment with the Sport Concussion Assessment Tool. Conclusions: Females are at greater risk and experience SRC differently than males; this is mostly likely due to a combination of biomechanical factors, differences in neck musculature and hormonal and social factors. Sex differences are not widely addressed by the 6th ICSS, which informs many sports' concussion protocols.
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Affiliation(s)
- Patryk A. Musko
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH16 4SB, UK;
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Pechlivanidou E, Antonopoulos I, Margariti RE. Gender equality challenges in orthopaedic surgery: a systematic review. INTERNATIONAL ORTHOPAEDICS 2023; 47:2143-2171. [PMID: 37433883 DOI: 10.1007/s00264-023-05876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Several studies have examined gender-equality challenges and ways to improve women's representation and management. Orthopaedic surgeons and patients are less gender equitable than them of other surgical disciplines. This systematic review summarizes these findings and highlights orthopaedic surgery gender inequality. METHODS Search of the PubMed, Embase, and Cochrane databases was carried out to extract human studies investigating the gender gap in orthopaedics, trying to highlight the equality challenges orthopaedic surgery faces. Studies incorporating patients with comorbidities in which gender is a proven risk factor, and pregnant women were excluded. RESULTS This systematic review included 59 studies involving 692,435 people (mean females/males ratio: 4.44), spanning the years 1987-2023. Regarding the targeted population, 35 (59.32%) studies focused on patients, while 24 (40.68%) on physicians. Orthopaedic surgery is described as an unfriendly career field for women as surgeons or sports leading physicians while women are generally under represented in the academic field of orthopaedics. Regarding patients, female gender consists both a risk and prognostic factor influencing the prevalence of degenerative disease and the outcome of the operative treatment in reconstructive orthopaedics. Female gender is a risk factor for multiple sports injuries and influences the pathogenetic mechanisms resulting in ACL reconstruction. Regarding spine surgery, women are less likely to have surgery suggested, and such suggestion underlines severe disease's progression. CONCLUSIONS Gender differences affect orthopaedic patient-physician-healthcare system interactions. Recognizing biases and their patterns is useful to improve the actual situation. By preventing those an unbiased, tolerant, and egalitarian workplace for physicians and a healthcare system that provides the best treatment to patients could be created.
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Affiliation(s)
- Evmorfia Pechlivanidou
- 1st Department of Orthopaedics, P. & A. Kyriakou Children's Hospital, Athens, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ioannis Antonopoulos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rodanthi E Margariti
- 1st Department of Orthopaedics, P. & A. Kyriakou Children's Hospital, Athens, Greece
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Antero J, Golovkine S, Niffoi L, Meignié A, Chassard T, Delarochelambert Q, Duclos M, Maitre C, Maciejewski H, Diry A, Toussaint JF. Menstrual cycle and hormonal contraceptive phases' effect on elite rowers' training, performance and wellness. Front Physiol 2023; 14:1110526. [PMID: 36875020 PMCID: PMC9981658 DOI: 10.3389/fphys.2023.1110526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023] Open
Abstract
Objectives: To investigate the effect of menstrual cycle (MC) and hormonal contraception (HC) phases in elite rowers training, performance and wellness monitoring. Methods: Twelve French elite rowers were follow-up for 4,2 cycles on average in their final preparation for the Olympics and Paralympics Games in Tokyo 2021 through an on-site longitudinal study based on repeated measures. Daily self-reported evaluation using Likert rating scales of wellness (sleep quality, fitness, mood, injuries' pain), menstrual symptoms and training parameters (perceived exertion and self-assessment of performance) were collected (n = 1,281) in parallel to a coach evaluation of rowers' performance (n = 136), blinded to theirs MC and HC phases. Salivary samples of estradiol and progesterone were collected in each cycle to help to classify the MC into 6 phases and HC into 2-3 phases depending on the pills' hormone concentration. A chi-square test normalized by each rower was used to compare the upper quintile scores of each studied variable across phases. A Bayesian ordinal logistic regression was applied to model the rowers' self-reported performance. Results: Rowers with a natural cycle, n = 6 ( + 1 amenorrhea) evaluate their performance and wellness with significant higher score indices at the middle of their cycle. Top assessments are rarer at the premenstrual and menses phases, when they more frequently experience menstrual symptoms which are negatively correlated with their performance. The HC rowers, n = 5, also better evaluate their performance when taking the pills and more frequently experience menstrual symptoms during the pill withdrawal. The athletes self-reported performance is correlated with their coach's evaluation. Conclusion: It seems important to integrate MC and HC data in the wellness and training monitoring of female athletes since these parameters vary across hormonal phases affecting training perception of both athlete and coach.
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Affiliation(s)
- Juliana Antero
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Steven Golovkine
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Louis Niffoi
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Alice Meignié
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Tom Chassard
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Quentin Delarochelambert
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Exploration, University Hospital CHU G. Montpied, INRAE, UNH, CRNH Auvergne, Clermont Auvergne University, Clermont-Ferrand, France
| | - Carole Maitre
- Medical Department at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France
| | | | - Allison Diry
- French Rowing Federation, Nogent-sur-Marne, France
| | - Jean-François Toussaint
- Institute for Research in BioMedicine and Epidemiology of Sport, IRMES at INSEP (Institut National du Sport, de l'Expertise et de la Performance), Paris, France.,URP 7329, Université Paris Cité, Paris, France.,Center for Investigation in Sport Medicine, CIMS Hôtel-Dieu, Assistance Publique-Hopitaux de Paris, Paris, France
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