Sport-Specific Biomechanics of Spinal Injuries in the Athlete (Throwing Athletes, Rotational Sports, and Contact-Collision Sports)

The Impact of Spine Injuries on Amateur Athletes: An Exploratory Analysis of Sport-Related Patient-Reported Outcomes

INTRODUCTION

There is a lack of information on return to sport and patient-reported outcome measures (PROMs) in amateur athletes after isolated spine injuries.

METHODS

A single-center cohort study in amateur athletes aged 18 to 60 with isolated spine injuries; clinical data collection and follow-up via telephone interview and standardized PROMs (Short-Form 36, Oswestry and Neck Disability Index, Tampa Scale of Kinesiophobia, Hospital Anxiety and Depression Scale, Pain Visual Analog Scale). Bivariate analyses of potential influencing factors on PROMs were conducted using the Wilcoxon Signed-Rank Test. p-values < 0.05 were considered statistically significant.

RESULTS

Out of the 80 included participants, 78% (n = 62) were active in sport at follow-up. PROMs were slightly worse than those described for the age-adjusted general population. There were consistent associations of better PROMs with having reached the subjective preinjury level of performance in sport, while injury severity and surgical or conservative therapy did not show consistent associations with PROMs.

CONCLUSION

Most amateur athletes resume their sports activity after a spine injury. Better outcomes are associated with individuals' resumption of sport and subjective level of performance, while injury severity and surgical or conservative therapy do not show consistent associations with PROMs, highlighting the importance of patient education, rehabilitation, and encouragement.

Influence of trunk rotator strength on rotational medicine ball throwing performance

BACKGROUND

The strength of the trunk musculature plays an essential role in performance. The aims of this study were to analyze the relationship between the strength of the trunk rotation muscles with rotational medicine ball throwing velocity and distance, to study differences between sex in rotational medicine ball throwing and to compare the asymmetries of trunk rotational strength and rotational medicine ball throwing.

METHODS

Thirty physically active college students participated on the study. Horizontal and low cable woodchop exercises were assessed with a functional electromechanical dynamometer and throwing was measured with a radar and a measuring tape. A Pearson's correlation coefficient was calculated for the relation between trunk rotational strength and rotational medicine ball throwing. Independent samples t-test was performed to determine the differences between sex in rotational medicine ball throwing and a paired samples t-test was performed to study the asymmetries.

RESULTS

Large and very large correlations were obtained between trunk rotational strength and rotational medicine ball throwing (r=0.68-0.79). Significant differences and a large effect size were found between males and females for all throwing velocity and throwing distance variables (P<0.05; ES>0.90) and asymmetries in performance of mean velocity throwing (P=0.003; ES=-0.60) and peak velocity throwing (P=0.025; ES=-0.43). No significant differences were found between dominant and non-dominant side in any of the trunk rotator strength assessment conditions (P>0.05).

CONCLUSIONS

There is a large or very large correlation between the STRM and the RMBT in all its modalities. Differences in strength were found between sexes, with no significant differences between dominant and non-dominant sides.

Management of Spine-Related Problems Following Sport Injuries: A Review Article

Context: Athletes have routine activity programs, and better physical health is expected among them. There is limited information about the connection between athletes' injuries during sports activity and their future health status. Objectives: The prevalence of spine changes related to sports activities and what risk factors were associated with these events in athletes. Method: SCOPUS, EMBASE, and Web of Science were used for article searching. Results: Sports injuries in sports happen frequently. Our data is limited to introducing sports with the highest risk of injury. A history of sports injury, an intense training program, and years of sports activities are factors predicting injury. It has been seen that former top male athletes have more activity than age-matched control individuals. Conclusions: Spinal injury management in athletes needs a proper diagnosis, work-up, and complex rehabilitation plans; otherwise, it can lead to spinal complaints in the future. Rest, appropriate analgesia, and rehabilitation are the three main primary treatments. The usage of orthoses is not recommended for these injuries in general.

Whole and segmental body composition changes during mid-follicular and mid-luteal phases of the menstrual cycle in recreationally active young women

BACKGROUND

Changes in oestradiol and progesterone hormones and associated fluid retention during the menstrual cycle phases might affect body composition (BC) in women.

AIM

The main objectives of this study were to determine the changes in whole and segmental BC by dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance (BIA) during the mid-follicular (MFP) and mid-luteal (MLP) phases.

SUBJECTS AND METHODS

Thirty recreationally active young women participated in this study. BC was measured by DXA and BIA during MFP and MLP. A mixed linear model for repeated measures analysis was used to determine the differences between the two phases.

RESULTS

Body mass was higher during MLP than MFP, while total body water, total and segmental fat mass and fat percentages measured by both BIA and DXA were similar during the two phases. DXA-derived fat-free mass and soft lean mass in the android region were higher during MLP than MFP. Large variability in individual responses was evident.

CONCLUSION

On average, whole and segmental BC variables do not change significantly between MFP and MLP. However, given the large variability among the individual responses, it is suggested to perform repeated BC measurements during the same phase of the menstrual cycle.

EU health co-design policies to counteract the covid-19 pandemic effect promoting physical activity

BACKGROUND

The research is placed in the context of interdisciplinary medical-legal studies on the importance of promoting physical activity as a public health tool.

OBJECTIVE

The aim was to highlight the tools that can be used by EU members for planning interventions aimed at overcoming the consequences of the COVID-19 pandemic and for responding to a future crisis.

METHODS

First, the medical resources relating to the indirect and direct effects of the COVID-19 pandemic are analysed. Then, the results are compared with the measures of the EU bodies to verify the correspondence of the scientific arrests, with the political-regulatory interventions.

RESULTS

It was found that the prolonged closure of sports centres and the contagion from COVID-19 produce affects the body in a way that can only be recovered by motor activity. However, in the EU, there does not exist a regulatory harmonization about health issues that can directly impose the Members to implement their legislation to promote motor activity.

CONCLUSIONS

The signing of the Rome Declaration at the Global Health Summit on 21 May 2021 constitutes an important and concrete commitment for the exchange in the medical-scientific field, and for an effective co-design of intervention strategies for the relaunch of physical activity within projects such as EU4Health and the two-year HealthyLifestyle4All campaign.

Age and Gender Differences in Injuries and Risk Factors in Elite Junior and Professional Tennis Players

BACKGROUND

Elite tennis athletes experience injuries throughout the entire body. Impairments in trunk stability, lower limb flexibility, and hip range of motion (ROM) are modifiable risk factors that can impact injuries and performance. Information on nonmodifiable risk factors such as age and gender is limited. The purpose of this investigation was to provide information on risk factors to direct clinical decision-making and injury prevention and rehab programming in this population.

HYPOTHESIS

Prevalence and location of injuries will differ by age group and gender. Trunk stability, lower limb flexibility, and hip ROM will differ by age group and gender.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A de-identified database (n = 237; females = 126) from the United States Tennis Association High Performance Profile (HPP) 2014-2015 was used for the analysis. Subjects were elite junior and professional tennis players (mean age 14.6 [range, 9-27] years). The HPP is a tennis-specific assessment and questionnaire that includes retrospective information on injury history. Subjects were categorized by injury, gender, and age. Injury locations were classified by region. Trunk stability measures included drop vertical jump (DVJ), single-leg squat, and prone and side planks. Lower limb measures included hamstring, quadriceps and hip flexor flexibility, and hip rotation ROM.

RESULTS

A total of 46% of athletes reported an injury. Significant differences were found for injury prevalence and location by age group. Adolescent athletes (age 13-17 years) had more trunk injuries, while adult athletes (age ≥18 years) had more lower limb injuries. Adolescent athletes performed worse on DVJ, dominant side plank, and hamstring flexibility compared with young (age ≤12 years) and adult athletes. Significant gender differences in hip ROM included internal rotation on both the dominant and nondominant sides.

CONCLUSION

Impairments in trunk stability, lower limb flexibility, and hip rotation ROM may affect both health and performance outcomes in this population. Elite tennis athletes may benefit from additional off court programming to address trunk and lower limb impairments.

CLINICAL RELEVANCE

Adolescent elite tennis athletes may be at higher risk of trunk injuries. Age, gender, injury history, and impairments should be considered with all assessments and programming.

Low back pain and golf: A review of biomechanical risk factors

Golf is an international sport played by a variety of age groups and fitness levels, and although golf has a low to moderate aerobic intensity level, injuries are common among professional and amateur golfers. High amounts of force experienced during the golf swing can lead to injury when golfers lack appropriate strength or technique with the lower back most commonly injured. Research has indicated that trunk muscle activation, hip strength and mobility, and pelvis and trunk rotation are associated with low back pain (LBP). Based on anecdotal evidence, golf practitioners specifically address issues in weight shift, lumbar positioning, and pelvis sequencing for golfers with LBP. This review aims to elucidate the effects of proper and improper golf swing technique on LBP and to help golf practitioners understand how to approach the alleviation of LBP in their clientele.

The Thoracic Spine in the Overhead Athlete

Overhead athletes are susceptible to many injuries, particularly in the shoulder and lumbar spine. Due to the heterogeneity of these two regional injuries, it is difficult to pinpoint the exact origin. A potential contributing factor that should be thoroughly evaluated is the thoracic spine. It can be challenging to quantify exactly how much thoracic spine mobility or lack thereof plays a role toward injury. Despite this, when examining mechanics of an overhead athlete, if neuromuscular control of the thorax is impaired, adjacent motion segments often take the brunt of the required movements. This article addresses the need to incorporate the thoracic spine when analyzing the entire kinetic chain. Clinical pearls regarding thoracic neuromuscular control and rehabilitation were explored, as well as a review of recent literature. Further investigation of thoracic spine therapeutic interventions should be considered when treating overhead athletes.

Neck and Cervical Spine Injuries in National College Athletic Association Athletes: A 5-Year Epidemiologic Study

STUDY DESIGN

Descriptive epidemiology study.

OBJECTIVE

The purpose of this study was to describe the epidemiology of neck and cervical spine injuries in collegiate athletes over a 5-year period.

SUMMARY OF BACKGROUND DATA

The incidence and etiology of neck and cervical spine injuries in National Collegiate Athletic Association (NCAA) athletes has not been well defined in recent years.

METHODS

The incidence and characteristics of neck and cervical spine injuries were identified utilizing the NCAA Injury Surveillance Program database. Rates of injury were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in one NCAA-sanctioned practice or competition.

RESULTS

Nationally, there were an estimated 11,510 neck and cervical spine injuries over the 5-year period. These occurred at a rate of 7.05 per 100,000 athlete-exposures (AEs). The rate of neck and cervical spine injuries in men was 2.66 per 100,000 AEs, while women suffered injuries at a rate of 1.95 per 100,000 AEs. In sex-comparable sports, men were 1.36 times more likely to suffer a neck or cervical spine injury compared with women. Men's football (29.09 per 100,000 AEs) and women's field hockey (11.51 per 100,000 AEs) were the sports with the highest rates of injuries. These injuries were 3.94 times more likely to occur during competition compared with practice. In-season injury rates were the highest, at 8.18 per 100,000 AEs.

CONCLUSION

The vast majority of neck and cervical spine injuries in NCAA athletes are minor and uncommon. Across all sports in both sexes, the majority of injuries were new, and occurred during in-season competitions. Most athletes returned to play within 24 hours of injury. These data can inform players, parents, coaches, athletic trainers, and physicians regarding the prevalence and rates of these injuries and potentially inform decision-making regarding injury prevention, treatment, and rehabilitation.

LEVEL OF EVIDENCE

4.

Lumbar Spine Injuries in National Collegiate Athletic Association Athletes: A 6-Season Epidemiological Study

Background:

Lumbar spine injuries in National Collegiate Athletic Association (NCAA) athletes have not been well studied.

Purpose:

To describe the epidemiology of lumbar spine injuries in NCAA athletes during the 2009/2010 through 2014/2015 academic years utilizing the NCAA Injury Surveillance Program (ISP).

Study Design:

Descriptive epidemiology study.

Methods:

A voluntary convenience sample of NCAA varsity teams from 25 sports was examined. Mechanism of injury, injury recurrence, and time lost from sport were recorded. Injury rates were calculated as the number of injuries divided by the total number of athlete-exposures (AEs). AEs were defined as any student participation in 1 NCAA-sanctioned practice or competition. Injury rate ratios and injury proportion ratios were calculated to compare the rates within and between sports by event type, season, patient sex, mechanism, injury recurrence, and time lost from sport. Comparisons between sexes were made utilizing data that had both male and female samples.

Results:

An estimated 37,435 lumbar spine injuries were identified. The overall rate of injuries was 6.01 per 1000 AEs. The rate of injuries was 4.94 per 1000 AEs in men compared with 3.94 per 1000 AEs in women for sex-comparable sports. Men were 1.25 times more likely than women to suffer a lumbar spine injury. Men’s football (24.62 injuries/1000 AEs) and women’s gymnastics (11.46 injuries/1000 AEs) had the highest rates of lumbar spine injuries. Athletes were 1.83 and 3.71 times more likely to sustain a lumbar spine injury during the preseason than the regular season or postseason, respectively. Noncontact was the most common mechanism of injury (38%). Injury recurrence was most common in men’s outdoor track (58%). Most injuries resulted in less than 24 hours of time loss from event participation (61%).

Conclusion:

The rate of lumbar spine injuries was high in NCAA athletes, and injuries commonly recurred (20%). In general, men were more likely to sustain a lumbar spine injury compared with women. Higher injury rates occurred during competition and via a noncontact mechanism of injury. In addition to prevention programs, reconditioning programs should be considered to prevent these injuries.

Coordination of lower extremity multi-joint control strategies during the golf swing

This study aimed to understand how players coordinate the multi-joint control strategies of the rear and target legs to satisfy the lower extremity and whole-body mechanical objectives during the golf swing when hitting shots with different clubs. Highly skilled golf players (n = 10) performed golf swings with a 6-iron and a driver. Joint kinetics were calculated using ground reaction forces and segment kinematics to determine net joint moments (NJMs) during the interval of interest within the downswing. Between club difference in NJMs and 3D support moments were compared across the group and within a player. Although player-specific multi-joint control strategies arose, players generally increased target leg ankle, knee, and hip NJMs when hitting with the driver while maintaining the relative contribution to the 3D support moment. Multi-joint control strategies used to control the target and rear legs were found to be different, yet the majority of the 3D support moment was produced by NJMs about an axis perpendicular to the leg planes. These results emphasize the importance of recognizing how an individual player coordinates multi-joint control from each leg, and highlights the need to design interventions that are player and leg specific to aid in improving player performance.

The role of pelvis-thorax coupling in controlling within-golf club swing speed

Pelvis-thorax coordination has been recognised to be associated with swing speed. Increasing angular separation between the pelvis and thorax has been thought to initiate the stretch shortening cycle and lead to increased clubhead speed. The purpose of this study was to determine whether pelvis-thorax coupling played a significant role in regulating clubhead speed, in a group of low-handicap golfers (mean handicap = 4.1). Sixteen participants played shots to target distances determined based on their typical 5- and 6-iron shot distances. Half the difference between median 5- and 6-iron distance for each participant was used to create three swing effort conditions: "minus", "norm", and "plus". Ten shots were played under each swing effort condition using both the 5-iron and 6-iron, resulting in six shot categories and 60 shots per participant. No significant differences were found for X-factor for club or swing effort. X-factor stretch showed significant differences for club and swing effort. Continuous relative phase (CRP) results mainly showed evidence of the stretch shortening cycle in the downswing and that it was more pronounced late in the downswing as swing effort increased. Substantial inter-individual CRP variability demonstrated the need for individual analyses when investigating coordination in the golf swing.

Body composition and bone mineral density of collegiate American football players

The aim of this study was to compare whole and segmental body composition and bone mineral density of collegiate American football players by playing positions. Forty collegiate American football players voluntarily participated in this study. Participants were categorized by playing positions into one of five categories i.e., defensive linemen, offensive linemen, defensive secondary players, offensive secondary players and receivers. Whole body composition and bone mineral density were measured by dual x-ray absorptiometry. Offensive and defensive linemen had higher body mass, a body mass index, lean mass and a fat mass index compared to the remaining three positions and a higher lean mass index compared to offensive secondary players and receivers. Offensive linemen had a higher body fat percentage and lower values of upper to lower lean mass than offensive and defensive secondary players and receivers, and higher total mass to the lean mass ratio and fat mass to the lean mass ratio compared to the other players. Offensive linemen had a higher fat mass index and fat mass to the lean mass ratio than defensive linemen. However, in all other measures they were similar. Offensive and defensive secondary players and receivers were similar with respect to the measured variables. Bone mineral density of the players was within the normal range and no difference in lean mass was observed between the legs. In conclusion, findings of this study showed that the total and segmental body composition profile of collegiate American football players reflected the demands of particular playing positions.

The effect of exercise training on lower trunk muscle morphology

BACKGROUND

Skeletal muscle plays an important role in maintaining the stability of the lumbar region. However, there is conflicting evidence regarding the effects of exercise on trunk muscle morphology.

OBJECTIVE

To systematically review the literature on the effects of exercise training on lower trunk muscle morphology to determine the comparative effectiveness of different exercise interventions.

DATA SOURCE AND STUDY SELECTION

A systematic search strategy was conducted in the following databases: PubMed, SportDiscus, CINAHL, the Cochrane Library and PEDro. We included full, peer-reviewed, prospective longitudinal studies, including randomized controlled trials and single-group designs, such as pre- to post-intervention and crossover studies, reporting on the effect of exercise training on trunk muscle morphology.

STUDY APPRAISAL AND SYNTHESIS

Study quality was assessed with the Cochrane risk-of-bias tool. We classified each exercise intervention into four categories, based on the primary exercise approach: motor control, machine-based resistance, non-machine-based resistance or cardiovascular. Treatment effects were estimated using within-group standardized mean differences (SMDs).

RESULTS

The systematic search identified 1,911 studies; of which 29 met our selection criteria: motor control (n = 12), machine-based resistance (n = 10), non-machine-based resistance (n = 5) and cardiovascular (n = 2). Fourteen studies (48 %) reported an increase in trunk muscle size following exercise training. Among positive trials, the largest effects were reported by studies testing combined motor control and non-machine-based resistance exercise (SMD [95 % CI] = 0.66 [0.06 to 1.27] to 3.39 [2.80 to 3.98]) and machine-based resistance exercise programmes (SMD [95 % CI] = 0.52 [0.01 to 1.03] to 1.79 [0.87 to 2.72]). Most studies investigating the effects of non-machine-based resistance exercise reported no change in trunk muscle morphology, with one study reporting a medium effect on trunk muscle size (SMD [95 % CI] = 0.60 [0.03 to 1.16]). Cardiovascular exercise interventions demonstrated no effect on trunk muscle morphology (SMD [95 % CI] = -0.16 [-1.14 to 0.81] to 0.09 [-0.83 to 1.01]).

LIMITATIONS

We excluded studies published in languages other than English, and therefore it is possible that the results of relevant studies are not represented in this review. There was large clinical heterogeneity between the included studies, which prevented data synthesis. Among the studies included in this review, common sources of potential bias were random sequence generation, allocation concealment and blinding. Finally, the details of the exercise parameters were poorly reported in most studies.

CONCLUSION

Approximately half of the included studies reported an increase in lower trunk muscle size following participation in an exercise programme. Among positive trials, studies involving motor control exercises combined with non-machine-based resistance exercise, as well as machine-based resistance exercises, demonstrated medium to large effects on trunk muscle size. Most studies examining the effect of non-machine-based resistance exercise and all studies investigating cardiovascular exercise reported no effect on trunk muscle morphology. However, these results should be interpreted with caution because of the substantial risk of bias and suboptimal reporting of exercise details in the included studies. Additional research, using methods ensuring a low risk of bias, are required to further elucidate the effects of exercise on trunk muscle morphology.