Sex Differences in Common Sports Injuries

Between-Session Reliability of Athletic Performance and Injury Mitigation Measures in Female Adolescent Athletes in the United States

Adolescence is a fundamental period for female athletes to develop athletic performance, mitigate injury risk, and gain collegiate sport scholarships, but there is also a high incidence of sport-related injuries. Physical profiling and athlete screening can support the individualisation of training programmes; however, there is a lack of data pertaining to the reliability of athletic performance and injury surrogate measures in adolescent female athletes. The aim of this study was to quantify the between-session reliability of an athletic performance and injury mitigation testing battery in female adolescent athletes. A total of 31 post-peak height velocity (PHV) (3.00 ± 0.82 years) female athletes (age: 16.20 ± 1.20 years; standing height: 166.00 ± 6.00 cm; mass: 65.5 ± 10.70 kg) from various sports (track and field = 1; lacrosse = 2; basketball = 2; soccer = 3; softball = 11; volleyball = 12) completed two sessions of a multicomponent testing battery 48 h to 1 week apart including the assessment of 33 measures addressing lower-limb isometric strength, eccentric strength, reactive strength, linear sprint and change of direction speed, and lower limb control. Of the 33 measures, between sessions, 29 had a high to nearly perfect intraclass correlation coefficient (ICC) (0.508-0.979), and 26 measures were not statistically significantly different between sessions (p ≤ 0.05). All measures demonstrated low to acceptable coefficient variation (CV%) (0.61-14.70%). The testing battery used can be utilised for recruitment and longitudinal monitoring within sports organisations for female adolescent athletes.

Intraoperative and Postoperative Outcomes of Patients Undergoing Total Knee Arthroplasty With Prior Anterior Cruciate Ligament Reconstruction: A Matched Cohort Analysis

Background

Previous anterior cruciate ligament (ACL) injury is a risk factor for the development of knee osteoarthritis. Despite advances in ACL reconstruction (ACLR) techniques, many patients with history of ACLR develop end-stage osteoarthritis necessitating total knee arthroplasty (TKA). The purpose of this study was to investigate the impact of prior ACLR on intraoperative and postoperative outcomes of TKA.

Methods

This was a single-centre matched cohort study of all patients with prior ACLR undergoing primary TKA from January 2000 to May 2022. Patients were matched 1:1 to patients undergoing TKA with no prior ACL injury based on age, sex, and body mass index. Outcomes investigated included TKA procedure duration, soft-tissue releases, implant design, and complications requiring reoperation.

Results

Forty-two ACLR patients were identified and matched to controls. Mean follow-up was 6.8 years and 5.0 years in the ACLR and control cohorts, respectively (P = .115). ACLR patients demonstrated longer procedure durations (122.8 minutes vs 87.0 minutes, P < .001) and more frequently required soft-tissue releases (40.5% vs 14.3%, P = .007), stemmed implants (23.8% vs 4.8%, P = .013), and patellar resurfacing (59.5% vs 26.2%, P = .002). There were no significant differences in postoperative clinical or surgical outcomes between groups. Ten-year implant survivorship was 92% and 95% in the ACLR and control cohorts, respectively (P = .777).

Conclusions

TKA is an effective procedure for the management of end-stage osteoarthritis with prior ACLR. The care team should be prepared for longer operative times and the utilization of advanced techniques to achieve satisfactory soft-tissue balance and implant stability.

Injury Incidence, Severity, and Type Across the Menstrual Cycle in Female Footballers: A Prospective Three Season Cohort Study

PURPOSE

The aim of the study was to assess the influence of menstrual cycle phase on injury incidence, severity, and type in elite female professional footballers over three seasons.

METHODS

Time-loss injuries and menstrual cycle data were prospectively recorded for 26 elite female football players across three seasons. The menstrual cycle was categorized into four phases using a standardized model: menstruation (phase 1; P1), remainder of follicular phase (phase 2; P2), early luteal (phase 3; P3), and premenstrual phase (phase 4; P4). Injury incidence rates (IIR) and ratios (IIRR) were calculated for overall injuries, injury severity, type, contact vs noncontact, and game/training.

RESULTS

A total of 593 cycles across 13,390 d were tracked during the study, and 74 injuries from 26 players were eligible for analysis. When comparing IIR between phases (reference: P1), overall injury rates were highest in P4 (IIRR, 2.30 (95% confidence interval, 0.99-5.34; P = 0.05)). When examining rates by injury severity and type, IIR values were also highest in P4 for ≤7 d' time-loss (4.40 (0.93-20.76; P = 0.06)), muscle-specific (6.07 (1.34-27.43; P = 0.02)), and noncontact (3.05 (1.10-8.50; P = 0.03)) injuries. Muscle-specific (IIRR P3/P1, 5.07 (1.16-22.07; P = 0.03)) and ≤7 d' time-loss (4.47 (1.01-19.68; P = 0.05)) injury risk was also significantly higher in P3. Muscle injuries were the most prevalent subtype ( n = 41). No anterior cruciate ligament injuries were recorded across the monitoring period.

CONCLUSIONS

Injury risk was significantly elevated during the luteal phase of the menstrual cycle (P3 and P4) among elite female professional footballers. Further research is urgently needed to better understand the influence of the menstrual cycle on injury risk and to develop interventions to mitigate risk.

Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study

OBJECTIVES

The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data.

METHODS

National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24-48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King-Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale.

RESULTS

Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24-48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5-70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6-49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1-2.9; male athletes, mean = 4.1, 95% CI 1.5-10.9).

CONCLUSIONS

Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.

Use of the concussion check protocol for concussion assessment in a female soccer team over two consecutive seasons in New Zealand

AIM

Address deficiencies in access to sports sideline medical care by using a Concussion Check Protocol (CCP) for non-medically-trained people.

METHOD

A prospective observational cohort study was undertaken on a single amateur female club-based soccer team over two consecutive years in New Zealand utilising a non-medically trained support person termed a Safety officer. CCP is an extension of the King-Devick test with features such as warning signs and symptoms of concussion built into the application. All players suspected of having a potential concussive injury were tested on the match sideline.

RESULTS

The study overall incidence of match-related concussions was 20.8 (95% CI: 11.8 to 36.6) per 1000 match-hrs, with mean missed-match duration of 31 (95% CI: 27.9 to 34.1) days. Twelve players over the study had a significantly slower post-injury KD (49.9 [44.3 to 64.1]s; χ2(1) = 11.0; p = 0.0009; z = -2.9; p = 0.0033; d = 0.30) and/or reported symptoms, compared with their own baseline (47.2 [44.3 to 64.1]s). CCP had an overall sensitivity of 100% (95% CI: 73.5% to 100.0%), specificity of 100% (95% CI: 69.2% to 100.0%) and positive predictive value (PPV) of 100% (84.6% to 100.0%).

CONCLUSION

Sideline use of CCP was undertaken successfully by non-medically trained people and provided a reliable platform for concussion identification.

Relationships between physical fitness characteristics, technical skill attributes, and sports injury in female Australian football players

OBJECTIVES

To explore the relationships between physical fitness and i) technical skills and ii) time-loss from Australian football injury in female players across the talent and participation pathways.

METHODS

This study uses a subset of data from two cross-sectional and one prospective cohort studies. A total of 223 female Australian football players across five competition levels (elite/non-elite senior, high-level junior, and non-elite junior (14-17 years)/(10-13 years)) were included in this study. Comprehensive physical fitness assessments and modified Australian football kicking and handballing tests were conducted in the 2018/19 pre-seasons. During the respective competitive in-season, time-loss injuries were recorded by team personnel. Stepwise multiple linear regressions were performed to determine the relationship between physical fitness and kicking and handballing scores. Cox proportional regressions were conducted to identify physical fitness factors associated with injury.

RESULTS

Increased running vertical jump height, greater hip abduction strength, and faster timed 6 m hop speed demonstrated a relationship with kicking accuracy when adjusted for years of Australian football playing experience (adjusted R2 = 0.522, p < 0.001). Faster agility time and increased lean mass were associated with better handballing accuracy (adjusted R2 = 0.221, p < 0.001). Multivariate Cox regression revealed an increased risk for sustaining a time-loss injury in less agile players (adjusted HR 2.41, 95% CI 1.23, 4.73, p = 0.010). However, this relationship no longer remained when adjusted for age and years of Australian football experience (adjusted HR 1.68, 95% CI 0.81, 3.50, p = 0.166).

CONCLUSIONS

Physical fitness may be a significant factor contributing to development of Australian football technical skills in female players. However, its role is unclear in protecting against injury risk in this athlete population. Further research is needed to explore the multifactorial and complex phenomenon of talent development and injury risk reduction in female Australian football players.

Sex does not influence the long-term outcome of matrix-assisted autologous chondrocyte transplantation

PURPOSE

Regenerative techniques for articular cartilage lesions demonstrated heterogeneous clinical results. Several factors may influence the outcome, with sex being one of the most debated. This study aimed at quantifying the long-term influence of sex on the clinical outcome obtained with a regenerative procedure for knee chondral lesions.

METHODS

Matrix-assisted autologous chondrocyte transplantation (MACT) was used to treat 235 knees which were prospectively evaluated with the International Knee Documentation Committee (IKDC), EuroQol visual analogue scale, and Tegner scores at 14-year mean follow-up. A multilevel analysis was performed with the IKDC subjective scores standardised according to the age/sex category of each patient and/or the selection of a match-paired subgroup to compare homogeneous men and women patients.

RESULTS

At 14 years, men and women showed a failure rate of 10.7% and 28.8%, respectively (p < 0.0005). An overall improvement was observed in both sexes. Women had more patellar lesions and men more condylar lesions (p = 0.001), and the latter also presented a higher preinjury activity level (p < 0.0005). Men had significantly higher IKDC subjective scores at all follow-ups (at 14 years: 77.2 ± 18.9 vs. 62.8 ± 23.1; p < 0.0005). However, the analysis of homogeneous match-paired populations of men and women, with standardised IKDC subjective scores, showed no differences between men and women (at 14 years: -1.6 ± 1.7 vs. -1.9 ± 1.6).

CONCLUSION

Men and women treated with MACT for knee chondral lesions presented a significant improvement and stable long-term results. When both sexes are compared with homogeneous match-paired groups, they have similar results over time. However, women present more often unfavourable lesion patterns, which proved more challenging in terms of long-term outcome after MACT.

LEVEL OF EVIDENCE

Level II.

Sex and gender differences in lower limb chronic exertional compartment syndrome: a systematic review

OBJECTIVES

Chronic exertional compartment syndrome (CECS) is a cause of exertional leg pain and has been reported in varying frequencies in males and females. Currently, it is unclear whether there are significant sex and gender differences in lower-limb CECS. Delineating sex and gender differences is vital in determining the causes of CECS and best treatments. This systematic review aimed to determine the sex/gender distribution of CECS and to assess for sex and gender differences in CECS diagnosis and outcomes.

METHODS

PubMed (Medline), Cochrane Library, and EMBASE databases were searched for studies that were published from January 2000-March 2022 and reported lower-limb CECS data in males and/or females. Data on CECS diagnosis (intracompartmental pressures) and outcomes (e.g. post-surgical return-to-sport, need for re-operation) with sex/gender breakdowns were extracted. The sex/gender distribution of CECS and prevalence of CECS by sex/gender were calculated.

RESULTS

Forty-one studies were included in the systematic review; there were 27 retrospective reviews, 8 prospective studies, and 6 retrospective studies with prospective follow-ups. Thirty studies involved surgical populations. Sex/gender distribution of CECS was calculated using data from 24 studies; 51% were female. Prevalence of CECS was available in five studies and ranged widely for males (54%-73%) and females (43%-65%). Intracompartmental pressure data varied by sex/gender. Male athletes were more likely than female athletes to return to sport following surgery for CECS, but variations in all other post-surgical outcomes were observed between sexes and genders in the general population.

CONCLUSION

Females represented 51% of the patients who were diagnosed with CECS among studies. Most CECS diagnosis and outcomes data varied by sex/gender, except for post-surgical outcomes data in athletes, which demonstrated that males had higher rates of return to sport than females. Future studies are needed to examine factors contributing to sex and gender differences in CECS diagnosis and outcomes.

Risk Factors Associated With Poor Outcomes After Quadriceps Tendon Repair

Background

Ruptures of the quadriceps tendon present most frequently in older adults and individuals with underlying medical conditions.

Purpose

To examine the relationship between patient-specific factors and tear characteristics with outcomes after quadriceps tendon repair.

Study Design

Case-control study; Level of evidence, 3.

Methods

A retrospective review was conducted on all patients who underwent quadriceps tendon repair between January 1, 2016, and January 1, 2021, at a single institution. Patients <18 years and those with chronic quadriceps tendon tears (>6 weeks to surgery) were excluded. Information was collected regarding patient characteristics, presenting symptoms, tear characteristics, physical examination findings, and postoperative outcomes. Poor outcome was defined as a need for revision surgery, complications, postoperative range of motion of (ROM) <110° of knee flexion, and extensor lag of >5°.

Results

A total of 191 patients met the inclusion criteria. Patients were aged 58.5 ± 13.2 years at the time of surgery, were predominantly men (90.6%), and had a mean body mass index (BMI) of 32.2 ± 6.3 kg/m2. Patients underwent repair with either suture anchors (15.2%) or transosseous tunnels (84.8%). Postoperatively, 18.5% of patients experienced knee flexion ROM of <110°, 11.3% experienced extensor lag of >5°, 8.5% had complications, and 3.2% underwent revision. Increasing age (odds ratio [OR], 1.03 [95% CI, 1.004-1.07]) and female sex (OR, 3.82 [95% CI, 1.25-11.28]) were significantly associated with postoperative knee flexion of <110°, and increasing age (OR, 1.08 [95% CI, 1.04-1.14]) and greater BMI (OR, 1.14 [95% CI, 1.05-1.23]) were significantly associated with postoperative extensor lag of >5°. Current smoking status (OR, 15.44 [95% CI, 3.97-65.90]) and concomitant retinacular tears (OR, 9.62 (95% CI, 1.67-184.14]) were associated with postoperative complications, and increasing age (OR, 1.05 [95% CI, 1.02-1.08]) and greater BMI (OR, 1.08 [95% CI, 1.02-1.14]) were associated with risk of acquiring any poor outcome criteria.

Conclusion

Patient-specific characteristics-such as increasing age, greater BMI, female sex, retinacular involvement, and current smoking status-were found to be risk factors for poor outcomes after quadriceps tendon repair. Further studies are needed to identify potentially modifiable risk factors that can be used to set patient expectations and improve outcomes.

Cognition and post-concussive symptom status after pediatric mild traumatic brain injury

Cognitive impairment and post-concussive symptoms (PCS) represent hallmark sequelae of pediatric mild traumatic brain injury (pmTBI). Few studies have directly compared cognition as a function of PCS status longitudinally. Cognitive outcomes were therefore compared for asymptomatic pmTBI, symptomatic pmTBI, and healthy controls (HC) during sub-acute (SA; 1-11 days) and early chronic (EC; approximately 4 months) post-injury phases. We predicted worse cognitive performance for both pmTBI groups relative to HC at the SA visit. At the EC visit, we predicted continued impairment from the symptomatic group, but no difference between asymptomatic pmTBI and HCs. A battery of clinical (semi-structured interviews and self-report questionnaires) and neuropsychological measures were administered to 203 pmTBI and 139 HC participants, with greater than 80% retention at the EC visit. A standardized change method classified pmTBI into binary categories of asymptomatic or symptomatic based on PCS scores. Symptomatic pmTBI performed significantly worse than HCs on processing speed, attention, and verbal memory at SA visit, whereas lower performance was only present for verbal memory for asymptomatic pmTBI. Lower performance in verbal memory persisted for both pmTBI groups at the EC visit. Surprisingly, a minority (16%) of pmTBI switched from asymptomatic to symptomatic status at the EC visit. Current findings suggest that PCS and cognition are more closely coupled during the first week of injury but become decoupled several months post-injury. Evidence of lower performance in verbal memory for both asymptomatic and symptomatic pmTBI suggests that cognitive recovery may be a process separate from the resolution of subjective symptomology.

Prevalence of and Factors Associated with Sports Injuries in 11,000 Japanese Collegiate Athletes

BACKGROUND

To establish the 1-year prevalence of sports injuries and explore associations of various factors with a sports injury in Japanese collegiate athletes.

METHODS

The data were collected through a web-based survey of Japanese collegiate athletes associated with UNIVAS (Japan Association for University Athletics and Sport). The survey questions asked about athletes' personal characteristics, sports participation, and injuries sustained within the previous year. Follow-up questions on the details regarding the three most serious injuries were asked. Differences in proportions of athlete characteristics between males and females and between injured and uninjured were explored with the chi-square test. Factors associated with sustaining an injury were determined with regression analysis.

RESULTS

The prevalence of injuries among Japanese collegiate athletes is high, and most of the sustained injuries require athletes to take a considerable time off training and competition indicating their severity. Athletes from year two and higher at the university, overweight or obese, training more often per week, and with longer sports experience were more likely to sustain an injury within the previous year.

CONCLUSIONS

There is compelling evidence to suggest that excessive training and insufficient recovery may be contributing to their increased risk of injury. These findings underscore the importance of implementing evidence-based training programs and recovery strategies to mitigate injury risk and optimize performance outcomes among this population.

The development and test-retest reliability of the periodic health evaluation for female athletes (PHE FA) survey

OBJECTIVES

To develop and assess the test-retest reliability of a survey exploring Australian high-performance female athlete's perspectives toward the periodic health evaluation and their perceived health needs.

METHODS

A structured three-phase method for survey development was used to develop the periodic health evaluation for female athletes (PHE FA) survey. Initially, a literature review and gap analysis was performed to identify themes and questions (Phase 1). Survey questions were developed covering demographic information (n = 9); sports-related medical screening (n = 19) and health needs and information (n = 7) (Phase 2). Test-retest reliability of the survey was then assessed (Phase 3). The survey was administered to a purposeful sample of seven high-performance level female athletes who completed the survey, on two separate occasions, 3 weeks apart via Checkbox© survey software (Checkbox Technology Inc., San Francisco, CA). Test-retest reliability was assessed using the intraclass correlation coefficient (ICC).

RESULTS

The mean age of the athletes was 29 years (SD 4 years, range 24-34 years). All were able-bodied athletes and 71% participated in team sports. Eighty-six percent of athletes have competed in world championships and 71% were Olympians. The average ICC of all items was 0.998 (95% CI 0.997-0.998, p = 0.000) demonstrating excellent consistency of measures between the two time points.All the athletes preferred a Sport and Exercise Medicine Physician to conduct their PHE and 86% preferred a female doctor. The key topics of interest were pelvic floor health including incontinence (100%); fertility (86%); pregnancy (71%); and mental and emotional wellbeing (71%). Face-to-face education was the preferred option to receive health information.

CONCLUSIONS

The PHE FA survey was co-created with an athlete and other key stakeholders. Excellent consistency of measures between the two time points was indicated by the high test-retest reliability of the PHE FA survey. Data collected using the PHE FA survey can contribute to informed evidence-based policies, and processes to support the health and wellbeing of female athletes.

Predicting Risk Factors of Lower Extremity Injuries in Elite Women's Football: Systematic Review and Meta-Analysis

This study identified and analyzed the risk factors of lower extremity injuries (LEI) in elite women football players to improve career and health outcomes. To address this aim, a systematic review and meta-analysis methodology was used. In total, four relevant research articles were identified through database searching and screening using the PRISMA flow diagram. From these articles, eight predictors were identified that influence the risk of LEI among elite women football players: higher body mass index (OR 1.51, 95% CI); previous knee injury (OR 3.57, 95% CI); low normalized knee separation (≤10th percentile) (RR 1.92, 95% CI); all previous injury (previous ACL tear: OR 5.24, 95% CI; ankle sprain: 1.39, 95% CI; knee sprain: 1.50, 95% CI); and previous injury in the lower body (OR 2.97, 95% CI). Meanwhile, lower knee valgus angle in a drop-jump landing (OR 0.64, 95% CI) was found to decrease the risk of LEI among elite women football players.

Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review

The surgical intervention rate and the subsequent rehabilitation plan for anterior cruciate ligament (ACL) injury was crucially affected by the COVID-19 pandemic due to the necessity in the face of the emergency. This review aimed to evaluate potential persistent and residual symptoms after COVID-19 disease, including fatigue and neuromuscular disorders. A scoping review design and methodology were used due to the exploratory nature of the research question, according to literature searches on PubMed/Medline, Scopus, Web of Science (WoS), and Physiotherapy Evidence Database (PEDro) electronic databases using the following keywords: "Anterior Cruciate Ligament", "ACL", "SARS-CoV-2", and "COVID-19". Undertraining and muscular knee imbalance might cause inefficient movement strategies, lack of knee stability, and increasing load with negative implications in ACL injuries. In the post-surgery period, during COVID-19, telerehabilitation approaches appeared to be successfully applied to maintain strength and range of motion in this condition. However, no definitive data are available regarding the most effective interventions. This scoping review showed the influence of the COVID-19 pandemic and associated restrictions on postoperative and rehabilitative care of ACL injuries.

Psychological Aspects of Return to Sport for the Female Athlete

Female athletes represent a unique population of competitors who face distinct stressors when compared with male athletes. These include sport inequities, violence, abuse, body image concerns, disordered eating, relative energy deficiency, family planning challenges, hormonal challenges, and mental distress. When combined with sports injuries, these stressors can negatively impact the mental health of female athletes as well as their injury recovery and return to sports. It is essential for orthopaedic surgeons to be familiar with the unique aspects inherent to being a female athlete, along with the psychological aspects of sports injuries. By integrating questions about female athletes' psychological well-being into their routine practice and collaborating with a multidisciplinary team, orthopaedic surgeons can better address these unique stressors, support female athletes in achieving optimal outcomes, and enhance return to sport rates.

Level of Evidence

V, expert opinion.

Genetic Determinants of the Anterior Cruciate Ligament Rupture in Sport: An Up-to-Date Systematic Review

Anterior cruciate ligament injuries (ACLIs) are one of the most common knee injuries in sports. Although numerous factors have been related to the risk of ACLIs, it is still unclear why some individuals are more susceptible than others due to the intricate etiology of ACLIs. Several genetic factors have been identified as contributing to ACLIs. This systematic review summarizes the current evidence regarding the genetic causes of ACLIs based on the available literature. Five electronic databases were searched from 2017 to 2022. All titles, abstracts, and full texts were reviewed in detail to determine the inclusions and exclusions. The Newcastle-Ottawa Scale was used to evaluate the risk of bias. The studies' characteristics and results are presented in both narrative and tabular formats. A total of 24 studies examined 31 genes and 62 variants associated with ACLIs in the global population. Ten studies investigated seven collagens and ten SNPs for the ACL injury. The majority of studies found no significant difference in the association of the COL1A1 rs1800012, COL5A1 rs12722, VEGFA rs1570360, IL6R rs2228145, IL6 rs1800795, IL1B rs16944 and rs1143627, however, contrary results were found when nationality and gender were considered together. Conflicting evidence was found for polymorphisms rs2010963, rs699947 of the VEGFA gene in different studies. Due to a lack of data, it was impossible to determine the relationship between the anterior cruciate ligament rupture (ACLR) and the other polymorphisms. More research is required to establish a clear relationship between the ACLR and genetic variants, particularly when gender and nationality are taken into account separately.

Darkness stopping play? An update on cricket and mental health

Mental health within elite cricket continues to be an area of focus for researchers and practitioners working within the game. Support structures for psychological issues within differing administrations and franchises vary. This may lead to inconsistent practice and levels of resource allocation. Elite level cricketers are exposed to stressors as a result of the congested international and domestic calendar, contract insecurity, injury and pressure to perform. Within the following commentary, the authors consider the existing medical literature, franchise and women-specific challenges and suggest ways to build on existing structures in order to optimise mental health within elite-level cricket.

Demographic characteristics of patients who underwent anterior cruciate ligament reconstruction at a tertiary care hospital in India

BACKGROUND

Anterior cruciate ligament (ACL) tears are common sports-related injuries. Their incidence is not the same either for all the sports or for the same sport across various nations. This information is maintained by many sports leagues in their registries. However, very few nationwide registries exist for such injuries. This study is carried out to know the demographic characteristics of patients who underwent ACL reconstruction at our hospital in India.

AIM

To know the demographic characteristics of patients who underwent ACL reconstruction at a tertiary care hospital in India.

METHODS

All the patients who underwent ACL reconstruction from January 2020 to December 2021 were retrospectively studied. Patients with multi-ligament injuries or a history of previous knee surgery were excluded. The patients’ history was obtained from the hospital records, they were interviewed telephonically, and online questionnaires were given. Their demographic data was analyzed and compared to the existing literature.

RESULTS

A total of 124 patients were operated on for ACL reconstruction during this period. The mean age of the patients was 27.97 years. One hundred and thirteen patients (91.1%) were male and 11 (8.9%) were female. The majority of the patients (47.6%) sustained this injury by road traffic accidents (RTA) followed by sports-related injuries (39.5%). The commonest presenting complaint was giving way of the knee in 118 patients (95.2%). The mean duration from the injury to the first hospital visit among the patients was 290.1 d. The mean duration from the injury to surgery was 421.8 d.

CONCLUSION

ACL patients’ demography is different in developing nations as compared to the developed world. RTA are the leading cause of ACL injuries and are followed by recreational sports as a cause. There is delayed access to healthcare leading to delayed diagnosis as well as even greater time to surgery. This, in turn, leads to poorer prognosis and longer rehabilitation. National registries for developing nations are the need of the hour due to the different demographics of ACL injuries in developing countries.

Risk of Upper Extremity Musculoskeletal Injury Within the First Year After a Concussion

Background

Emerging evidence suggests that athletes and military personnel are at increased risk for lower extremity musculoskeletal injury after a concussion; however, the association between concussion and subsequent upper extremity (UE) musculoskeletal injury is unknown.

Purpose

To prospectively examine the association between concussion and UE musculoskeletal injury risk within the first year after returning to unrestricted activity.

Study Design

Cohort study; Level of evidence, 3.

Methods

A total of 316 cases of concussion 42% (132/316 women) were observed among 5660 Concussion Assessment, Research and Education Consortium participants at the United States Military Academy from May 2015 to June 2018. Active injury surveillance within the cohort was conducted for 12 months after unrestricted return to activity to identify any incident cases of acute UE musculoskeletal injury. Injury surveillance during the follow-up period was also conducted for nonconcussed controls who were matched by sex and competitive sport level. Univariate and multivariable Cox proportional hazards regression models were used to estimate hazard ratios between concussed cases and nonconcussed controls for time to UE musculoskeletal injury.

Results

During the surveillance period, 19.3% of concussed cases and 9.2% of nonconcussed controls sustained a UE injury. In the univariate model, concussed cases were 2.25 times (95% CI, 1.45-3.51) more likely to sustain a UE injury during the 12-month follow-up period when compared with the nonconcussed controls. In the multivariable model, adjusted for history of concussion, sport level, somatization, and history of UE injury, concussed cases were 1.84 times (95% CI, 1.10-3.07) more likely to sustain a UE injury during the surveillance period compared with nonconcussed controls. Sport level remained an independent risk factor for UE musculoskeletal injury; however, concussion history, somatization, and history of UE injury were not independent risk factors.

Conclusion

Concussed cases were more than twice as likely to sustain an acute UE musculoskeletal injury within the first 12 months after unrestricted return to activity when compared with nonconcussed controls. The higher hazard of injury remained in the concussed group after adjusting for other potential risk factors.

[Stress reactions and stress fractures]

Bone stress injuries is an umbrella term that encompasses repetitive microtraumatic events that accumulate to surpass the threshold of bone failure, which can range from bone marrow edema to frank stress fracture as the end point. Due to nonspecific clinical complaints and physical findings, imaging plays a central role in the diagnostic workup of these entities. Magnetic resonance imaging (MRI) is the most important imaging modality with a high sensitivity and specificity and allows for differential diagnosis of other diseases. Edema-sensitive with fat suppression and T1-weighted sequences are the core sequence types, and contrast-enhanced imaging-albeit displaying subtle fractures much more easily-is rarely necessary. Furthermore, MRI enables differentiation of injury severity, which has an impact on length of rehabilitation, therapeutic regimen, and the time to return to sports in athletes.

Multinomial Estimations of Predictive Risk Factors for Traumatic Brain Injuries

Introduction Traumatic brain injuries (TBIs) affect millions of patients each year, with more than 220,000 hospitalizations in 2019 and 64,000 deaths in 2020 alone. TBIs span a plethora of injuries including cerebral contusions and lacerations, axonal injuries, optic pathway disruptions, and skull fractures. Previous research has established that characteristics such as sex, mechanism of injury (MOI), and blood-thinning agents have some causal connections to a variety of cranial traumas. Methods This paper sought to analyze aggravating risk factors for various TBIs in the New York City borough of Staten Island. Data on eight predictive risk variables were collected at a level 1 trauma center from January 1, 2022, to December 31, 2022: MOI, seizure history, anticoagulant/antiplatelet therapy, alcoholism, age, biological sex, tested alcohol level, and body mass index (BMI). A multinomial logistic regression was estimated to generate risk ratios (RRs), and chi-squared tests were carried out to determine univariate associations. Results It was found that blood thinner use and sex were both significant predictors of various types of TBIs. Additionally, those not tested for alcohol, including pediatric patients, were less likely to suffer most forms of TBI, while BMI had a negligible relationship with any TBI class. The use of blood-thinning agents put patients at an increased risk of concussions (relative risk ratio [RRR]: 1.82; 95% confidence interval [CI]: 1.10-3.02) and undiagnosed intracranial injuries (RRR: 1.90; 95% CI: 1.08-3.34). Men were at higher risk of multiple cranial injuries than women (RRR: 3.62; 95% CI: 1.38-9.48), as well as physical traumas such as brain lacerations and hemorrhages (RRR: 2.81, 95% CI: 1.28-6.18). BMI was weakly correlated with undiagnosed cranial injuries (RRR: 1.04; 95% CI: 1.00-1.08) and slightly uncorrelated with physical traumas (RRR: 0.94; 95% CI: 0.88-1.00). Those not tested for alcohol were at far less risk of multiple TBIs (RRR: 0.08; 95% CI: 0.01-0.66), concussions (RRR: 0.27; 95% CI: 0.11-0.71), and physical brain traumas (RRR: 0.33; 95% CI: 0.13-0.84). No parameter exhibited any statistical significance with skull fractures. Conclusion Particular risk factors for TBIs include biological sex and blood thinner use. Injury prevention efforts should be based on the category of TBI, with a particular focus on blood thinner users becoming concussive post-trauma. Attention should also be paid to men who engage in risky behavior such as binge drinking and crime sustaining more than one brain trauma or isolated brain bleeds. Therefore, improved hospital outreach for fall precautions in nursing homes and targeted interventions for at-risk men are vital for future projects.

Occupational and Environmental Challenges for Women

ABSTRACT

The prevalence of women in the global workforce is increasing. Women increasingly participate in nontraditional employment settings in previously male-dominated industries and manually intensive professions, such as military service, emergency response, health care, aviation, space, agriculture, and technical trades. Limited occupational and environmental hazard data specific to women exist for these work environments. Physiologic and biomechanical differences between sexes create unique workplace challenges specific to women. This article will summarize challenges confronting women working in nontraditional employment and identify strategies to mitigate risk within these populations.

Editorial Commentary: Early Anterior Cruciate Ligament Reconstruction Decreases the Risk of Developing Irreparable Meniscus Tears in Female Athletes

There has been a substantial increase in the participation of women in sports since the passage of Title IX in 1972. With increased participation has come a rise in athletic injuries, including anterior cruciate ligament (ACL) tears. Numerous factors (modifiable and nonmodifiable) contribute to the 2 to 8 times increased risk of ACL tears in female compared with male athletes. The sports with the greatest risk of ACL injury include cutting sports such as soccer (1.1% per season), basketball (0.9% per season), volleyball, and lacrosse. In addition, female patients have a 33.7% greater risk of a subsequent contralateral ACL tear. Approximately 70% of ACL tears are the result of noncontact injuries. Numerous factors contribute to the increased risk of ACL tears in female athletes, including nonmodifiable (hormonal fluctuations, sex differences in knee geometry) and modifiable risk factors (neuromuscular control). Injury-prevention programs focus on modifiable risk factors and have been shown to be incredibly effective, decreasing the risk of ACL tears up to 50%. ACL tears commonly are associated with meniscus tears, including medial meniscus ramp and lateral posterior root lesions; therefore, thorough assessment is critical to identify this pathology. Early ACL reconstruction (i.e., <12 months following injury) increases the likelihood of being able to repair meniscus tears. Given the much greater risk of ACL tears and lower rate of return to sport in female athletes, this group warrants special attention to identify and treat these injuries earlier and subsequently improve overall outcomes.

Knee Joint Contact Forces during High-Risk Dynamic Tasks: 90° Change of Direction and Deceleration Movements

Pivoting sports expose athletes to a high risk of knee injuries, mainly due to mechanical overloading of the joint which shatters overall tissue integrity. The present study explored the magnitude of tibiofemoral contact forces (TFCF) in high-risk dynamic tasks. A novel musculoskeletal model with modifiable frontal plane knee alignment was developed to estimate the total, medial, and lateral TFCF developed during vigorous activities. Thirty-one competitive soccer players performing deceleration and 90° sidestepping tasks were assessed via 3D motion analysis by using a marker-based optoelectronic system and TFCF were assessed via OpenSim software. Statistical parametric mapping was used to investigate the effect of frontal plane alignment, compartment laterality, and varus-valgus genu on TFCF. Further, in consideration of specific risk factors, sex influence was also assessed. A strong correlation (R = 0.71 ÷ 0.98, p < 0.001) was found between modification of compartmental forces and changes in frontal plane alignment. Medial and lateral TFCF were similar throughout most of the tasks with the exception of the initial phase, where the lateral compartment had to withstand to higher loadings (1.5 ÷ 3 BW higher, p = 0.010). Significant sex differences emerged in the late phase of the deceleration task. A comprehensive view of factors influencing the mediolateral distribution of TFCF would benefit knee injury prevention and rehabilitation in sport activities.

Litigation involving sports-related spinal injuries: a comprehensive review of reported legal claims in the United States in the past 70 years

BACKGROUND CONTEXT

Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (eg, football) may be particularly prone to injury given the high-impact nature of these activities. Due to the oftentimes profound impact of sports-related spinal injuries on health and quality-of-life, they are also associated with a substantial risk of litigation. However, no study to date has assessed litigation risks associated with sports-related spinal injuries. A better understanding of the risk factors surrounding these legal claims may provide insights into injury prevention and other strategies to minimize litigation risks. In addition, it may allow the spine surgeon to better recognize the health, socioeconomic, and legal challenges faced by this patient population.

PURPOSE

To provide a comprehensive assessment of reported legal claims involving sports-related spinal injuries, including a comparative analysis of legal outcomes between collision and non-collision sports. To discuss strategies to prevent sports-related spinal injuries and minimize litigation risks.

STUDY DESIGN/SETTING

Retrospective review.

PATIENT SAMPLE

Athletes experiencing spinal injuries during sports.

OUTCOME MEASURES

Outcomes included verdict outcome (defendant vs. plaintiff), legal claims, injuries sustained, clinical symptoms, and award payouts.

METHODS

The legal research database Westlaw Edge (Thomson Reuters) was queried for legal claims brought in the United States from 1950 to 2021 involving sports-related spinal injuries. Verdict or settlement outcomes were collected as well as award payouts, time to case closure, case year, and case location. Demographic data, including type of sport (ie collision vs. non-collision sport) and level of play were obtained. Legal claims, spinal injuries sustained, and clinical symptoms were also extracted. Furthermore, the nature of injury, injured spinal region, and treatment pursued were collected. Descriptive statistics were reported for all cases and independent-samples t-tests and chi-square tests were used to compare differences between collision and non-collision sports.

RESULTS

Of the 840 cases identified on initial search, 78 met our criteria for in-depth analysis. This yielded 62% (n=48) defendant verdicts, 32% (n=25) plaintiff verdicts, and 6% (n=5) settlements, with a median inflation-adjusted award of $780,000 (range: $5,480-$21,585,000) for all cases. The most common legal claim was negligent supervision (n=38, 46%), followed by premises liability (n=23, 28%), and workers' compensation/no fault litigation (n=10, 12%). The most common injuries sustained were vertebral fractures (n=34, 44%) followed by disc herniation (n=14, 18%). Most cases resulted in catastrophic neurological injury (n=37, 49%), either paraplegia (n=6, 8%) or quadriplegia (n=31, 41%), followed by chronic/refractory pain (n=32, 43%). Non-collision sport cases had a higher percentage of premises liability claims (41% vs. 11%, p=.006) and alleged chronic/refractory pain (53% vs. 28%, p=.04). Conversely, collision sport cases had a higher proportion of workers' compensation/no fault litigation (23% vs. 4%, p=.03) and cases involving disc herniation (29% vs. 9%, respectively; p=.04).

CONCLUSION

Sports-related spinal injuries are associated with multiple and complex health, socioeconomic, and legal consequences, with median inflation-adjusted award payouts nearing $800,000 per case. In our cohort, the most commonly cited legal claims were negligent supervision and premises liability, emphasizing the need for prevention guidelines for safe sports practice, especially in non-professional settings. Cases involving athletes participating in non-collision sports were significantly associated with claims citing chronic/refractory pain, highlighting the importance of long-term care in severely injured athletes.

Sex differences in musculoskeletal injury and disease risks across the lifespan: Are there unique subsets of females at higher risk than males for these conditions at distinct stages of the life cycle?

Sex differences have been reported for diseases of the musculoskeletal system (MSK) as well as the risk for injuries to tissues of the MSK system. For females, some of these occur prior to the onset of puberty, following the onset of puberty, and following the onset of menopause. Therefore, they can occur across the lifespan. While some conditions are related to immune dysfunction, others are associated with specific tissues of the MSK more directly. Based on this life spectrum of sex differences in both risk for injury and onset of diseases, a role for sex hormones in the initiation and progression of this risk is somewhat variable. Sex hormone receptor expression and functioning can also vary with life events such as the menstrual cycle in females, with different tissues being affected. Furthermore, some sex hormone receptors can affect gene expression independent of sex hormones and some transitional events such as puberty are accompanied by epigenetic alterations that can further lead to sex differences in MSK gene regulation. Some of the sex differences in injury risk and the post-menopausal disease risk may be "imprinted" in the genomes of females and males during development and sex hormones and their consequences only modulators of such risks later in life as the sex hormone milieu changes. The purpose of this review is to discuss some of the relevant conditions associated with sex differences in risks for loss of MSK tissue integrity across the lifespan, and further discuss several of the implications of their variable relationship with sex hormones, their receptors and life events.

Risk Factors for Musculoskeletal Injury in CrossFit: A Systematic Review

The objective of this systematic review was to identify potential risk factors for injury in CrossFit participants. Embase, Medline, Web of Science, Cochrane, CINAHL, Google Scholar, and SportDiscuss databases were all searched up to June 2021. Cohort studies that investigated risk factors for CrossFit injuries requiring medical attention or leading to time loss in sports were included. A best-evidence synthesis was performed combining all the outcomes from prospective cohort studies. From 9,452 publications identified, we included three prospective cohort studies from which two had a low risk of bias and one a high risk of bias. The studies examined 691 participants of whom 172 sustained an injury. There was limited evidence that switching between prescribed and scaled loads during training is associated with increased injury risk and that increased duration of participation is a protective factor for injury. This could mean that novice CrossFit athletes and those increasing their training load should have closer supervision by CrossFit coaches. These risk factors should be considered when developing preventive interventions.

Food cravings during the first week of concussion

The brain utilizes glucose as its main source of energy. Traumatic brain injuries may alter the brain's ability to shuttle glucose effectively; therefore, the symptoms experienced may be a signal of the dysregulation. The objective of this cross-sectional study was to investigate the presence of any specific food cravings during the first week post-concussion and if the consumption of such a food decreased the symptoms of concussion. The link to the survey was posted on 4 Canadian organization websites from November 2020 to February 2021. Any individual over 18 years old who had suffered one of more concussions in the past 12 months was included. 73 females and 24 males, the majority aged 18-40 years, completed the survey. Participants with combined carbohydrate and sweet cravings reported significantly more symptoms of increased emotions (p=0.04), irritability (p=0.03), sadness (p=0.04), nervousness (p=0.03), and sleep disturbances (p=0.05) than those without these cravings. Consumption of the craved food did not change the concussion symptoms.

Dizziness Is Associated With Neck/Shoulder Pain Following Pediatric Concussion

OBJECTIVE

To examine the association between dizziness and neck/shoulder pain after concussion and if differences in postural stability and oculomotor function exist among patients reporting dizziness with or without concurrent neck/shoulder pain.

DESIGN

Cross sectional.

SETTING

Sports medicine clinic.

PATIENTS

Pediatric patients ≤14 days post concussion.

INTERVENTIONS

N/A.

OUTCOME MEASURES

Patients completed the Health and Behavior Inventory (HBI) symptom rating and separately rated neck/shoulder pain (scale 0-3; 0 = no pain). We grouped patients by HBI dizziness rating (0 = not-dizzy; 1-3 = dizzy) and compared neck/shoulder pain ratings between the groups. We then compared oculomotor and postural stability outcomes between dizzy patients with and without neck/shoulder pain.

RESULTS

We included 153 patients: dizzy (n = 100; age = 14.6 ± 2.2 years; 48% female) and not-dizzy (n = 53, age = 14.4 ± 3.1 years; 38% female). The dizzy group reported significantly higher neck/shoulder pain (1.4 ± 1.1 vs 0.5 ± 0.9 points, P < 0.001) and total symptom score (25.7 ± 11.2 vs 11.7 ± 9.3 points, P < 0.001) than the not-dizzy group. After adjusting for total symptom score and preinjury anxiety, depression, and migraines, dizziness was associated with higher odds of neck/shoulder pain (odds ratio = 1.9, 95% CI, 1.2-3.0; P = 0.004). No differences were observed between dizzy patients with and without neck/shoulder pain for near point of convergence (10.0 ± 7.5 vs 8.5 ± 6.7 cm, P = 0.43), modified Balance Error Scoring System (8.9 ± 5.5 vs 6.8 ± 4.7 errors, P = 0.09), or tandem gait (single-task: 26.0 ± 12.3 vs 24.2 ± 11.9 seconds, P = 0.56; dual-task: 35.1 ± 14.3 vs 35.6 ± 18.6 seconds, P = 0.90).

CONCLUSIONS

In concussion patients experiencing dizziness, evaluating neck/shoulder pain may help identify individuals who would benefit from cervical spine rehabilitation. However, other potential causes of dizziness should also be evaluated to facilitate timely recovery.

Athleticism and sex impact neural processing of sound

Biology and experience both influence the auditory brain. Sex is one biological factor with pervasive effects on auditory processing. Females process sounds faster and more robustly than males. These differences are linked to hormone differences between the sexes. Athleticism is an experiential factor known to reduce ongoing neural noise, but whether it influences how sounds are processed by the brain is unknown. Furthermore, it is unknown whether sports participation influences auditory processing differently in males and females, given the well-documented sex differences in auditory processing seen in the general population. We hypothesized that athleticism enhances auditory processing and that these enhancements are greater in females. To test these hypotheses, we measured auditory processing in collegiate Division I male and female student-athletes and their non-athlete peers (total n = 1012) using the frequency-following response (FFR). The FFR is a neurophysiological response to sound that reflects the processing of discrete sound features. We measured across-trial consistency of the response in addition to fundamental frequency (F0) and harmonic encoding. We found that athletes had enhanced encoding of the harmonics, which was greatest in the female athletes, and that athletes had more consistent responses than non-athletes. In contrast, F0 encoding was reduced in athletes. The harmonic-encoding advantage in female athletes aligns with previous work linking harmonic encoding strength to female hormone levels and studies showing estrogen as mediating athlete sex differences in other sensory domains. Lastly, persistent deficits in auditory processing from previous concussive and repetitive subconcussive head trauma may underlie the reduced F0 encoding in athletes, as poor F0 encoding is a hallmark of concussion injury.

Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction

BACKGROUND

The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment.

HYPOTHESIS

Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations.

RESULTS

A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P < .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P < .05). There were no associations detected between income bracket and the outcomes in this study.

CONCLUSION

This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.

Occupational Therapy and Prevention of Common Sports Injuries for Special Physical Training

This paper provides an in-depth study of occupational therapy and the prevention of common sports injuries in special physical training. The issue of sports injuries and rehabilitation has always been a hot topic in special training. With the continuous development of sports, the increasing intensity of competition, and more stringent requirements for special techniques, the increase in difficulty and intensity of training has led to the increasing frequency of sports injuries, so how to prevent injuries in special physical training and rehabilitation and recovery of athletes after the injury is particularly important. Since the most common musculoskeletal injuries occur in the lower quadrant, this paper proposes a lower extremity functional test (LEFT) model as a means of identifying injury risk and guiding the implementation of training programs to prevent sports injuries. In this paper, a knee injury is used as an example, and an occupational therapy program of TCM physical therapy + aquatic rehabilitation is adopted for the already occurred sports injuries. Through interviews and clinical examinations of athletes, coaches, and medical personnel, this paper summarizes the sites, types, characteristics, and probability of occurrence of common sports injuries in special physical training. Experiments were conducted through clinical rehabilitation of common sports injuries with the addition of TCM manual massage. A series of effects of this modality on the rehabilitation of sports injuries were examined by monitoring physiological and biochemical indexes and by comparative analysis before and after testing physical function indexes using the Omega Wave system. Sports injuries are diverse. Traditional Chinese medicine physical therapy + water rehabilitation therapy is an effective physical therapy method. According to the relevant theories of traditional Chinese medicine treatment, diagnosis and treatment through meridians and related acupuncture points have significant curative effects. Traditional Chinese medicine, massage, and acupuncture have irreplaceable roles in the rehabilitation and treatment of sports injuries and can effectively improve and cure sports injuries.

Considerations for Sex-Cognizant Research in Exercise Biology and Medicine

As the fields of kinesiology, exercise science, and human movement developed, the majority of the research focused on male physiology and extrapolated findings to females. In the medical sphere, basing practice on data developed in only males resulted in the removal of drugs from the market in the late 1990s due to severe side effects (some life-threatening) in females that were not observed in males. In response to substantial evidence demonstrating exercise-induced health benefits, exercise is often promoted as a key modality in disease prevention, management, and rehabilitation. However, much like the early days of drug development, a historical literature knowledge base of predominantly male studies may leave the exercise field vulnerable to overlooking potentially key biological differences in males and females that may be important to consider in prescribing exercise (e.g., how exercise responses may differ between sexes and whether there are optimal approaches to consider for females that differ from conventional approaches that are based on male physiology). Thus, this review will discuss anatomical, physiological, and skeletal muscle molecular differences that may contribute to sex differences in exercise responses, as well as clinical considerations based on this knowledge in athletic and general populations over the continuum of age. Finally, this review summarizes the current gaps in knowledge, highlights the areas ripe for future research, and considerations for sex-cognizant research in exercise fields.

Prevalence and Characteristics of Muscle Tightness in Young Adults

In young adults, muscle sprains and strains leading to muscle tightness are considered short-term and believed to have no ill effects on quality of life. However, recent advances in the science indicate that muscle tightness is an invisible condition that can limit life activities. The objective of this study was to identify the prevalence and characteristics of muscle tightness in young adults. The study used descriptive quantitative design. One hundred individuals aged between 18 and 27 years completed a survey based upon a validated muscle tightness measurement tool. Seventy-two percent of participants reported experiencing muscle tightness that limited their daily living and recreational activities. Fifty-six percent reported experiencing pain with muscle tightness. Women were more likely than men to experience muscle tightness. Awareness, prompt evaluation, and treatment of this condition are key to preventing negative consequences associated with chronic muscle tightness.

Insall-Salvati index is associated with anterior cruciate ligament tears in men: A Case-controlled study

PURPOSE

Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall-Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears.

METHODS

The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed.

RESULTS

The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 ± 8.2 years and 31.8 ± 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values (p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears (p = 0.009). The ATT was 8.61 ± 4.68 mm in the study group and 3.80 ± 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group (p = 0.001).

CONCLUSIONS

As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.

Systematic review and meta-analysis of sex-based differences for concussion incidence in soccer

OBJECTIVE

To compare concussion incidence in male and female soccer players due to the specific concussion-causing activity.

METHODS/DATA SOURCES

PubMed, EMBASE, and Cochrane Library were searched for studies published between January 2000 and February 2020. Search terms included 'sex,' 'gender,' 'sex differences,' 'brain injury,' 'sports,' 'athletes,' 'incidence,' 'epidemiology,' 'symptoms,' and 'injury rate.' Studies that contained data on concussion incidence in soccer and featured comparisons by sex and soccer activity were included. Studies that were not written in English, contained data on non-sports-related concussions, or were conference abstracts were excluded.

RESULTS

Six studies were included in this meta-analysis, each of which contributed the number of concussions in males and females for a specific soccer activity. Concussion incidence rates were calculated using athlete-exposures as the denominator and a rate ratio was measured by dividing the concussion rate among female soccer players by the rate among male soccer players. Female soccer players were shown to have a greater rate of concussions from heading [1.65 (95% CI: 1.35, 2.03, p < 0.001)] and goalkeeping [1.63 (95% CI: 1.22, 2.17, p = 0.001)]. There were 3 studies comparing sex differences for general play. While the pooled rate ratio was statistically significant [1.51 (95% CI: 1.12, 2.04), p = 0.007], this result was largely driven by 1 study.

CONCLUSION

Concussion incidence rates were significantly higher in female soccer players compared to male players while heading. There is also some evidence to suggest that the incidence is higher for female goalkeepers. Soccer coaches and health care providers need to recognize this sex difference when coaching or treating players.

Anterior cruciate ligament injury prevention

Anterior cruciate ligament injuries are a prominent issue in the field of sports medicine, especially for the female athlete. Extensive research has been performed that acknowledges the disparity in anterior cruciate ligament injury rates between male and female athletes and the high prevalence of risk factors specific to females. The underlying causes of anterior cruciate ligament injuries are widespread and are important to consider when approaching injury prevention. For example, prevention techniques aim to correct neuromuscular imbalances and improve biomechanical deficits, which are some of the most significant risk factors leading to these injuries. While there is a lack of opportunity for intervention related to anatomical and hormonal risks, awareness of their influence on injury mechanisms remains an important factor in clinical decision-making. In pursuit of addressing the risks of this injury, several prevention programs have been established that have been shown to successfully reduce anterior cruciate ligament injury rates when properly executed. The most effective programs include early intervention with continuous training and are multicomponent programs including various targeted exercises to modify associated risk factors. Unfortunately, despite the development of these readily available programs, anterior cruciate ligament injury rates remain high due to insufficient implementation of these methods. Recognizing the efficacy and feasibility of utilizing prevention strategies and continuing to develop effective techniques remain of utmost importance to reduce the incidence of this substantial injury among athletes.

Functional Movement Screen™ in High School Basketball Players: Pre- and Post-Season

Pre-participation screening and tracking of an athlete's functional status during a competitive season is essential to maintaining optimal performance. The sport of basketball had the third highest number of boys and girls participating during the 2018-2019 season (23), which typically occurs October to March each year. The Functional Movement Screen™ (FMS; 10) has been administered to some youth athletes from various sports, however, both males and females from basketball have not been studied extensively. The purposes of this study were: 1) to assess functional movements before and after the natural progression of a high school competitive basketball season; 2) to determine if there were functional movement differences between male and female youth basketball players. Eighteen male (n = 10) and female (n = 8) high school basketball players completed the FMS pre- and post-season. Scores were analyzed using a mixed-model ANOVA. No significant differences were found for Time or Sex for composite FMS scores (Mean ± SD, Pre-season: 16.2 ± 2.1, Post-season: 17.1 ± 1.4; Males: 16.8 ± 1.8, Females: 16.5 ± 2.0). Specific FMS tests were compared pre- to post-season using Wilcoxon signed-rank tests and were not significantly different after the competitive season or between the sexes. Sex differences relating to overall FMS composite scores or specific test scores were not apparent in this age group or sport. In this small group of high school basketball players, participation in a competitive, high school basketball season did not limit nor enhance functional movement ability.

Prevalence and incidence of injuries among female cricket players: a systematic review and meta-analyses

OBJECTIVE

The objective of the review was to describe the incidence and prevalence of injuries among female cricket players of all ages, participating in all levels of play.

INTRODUCTION

Cricket, a bat-and-ball sport, is becoming popular among women of all ages and abilities worldwide. However, cricket participation carries a risk of injury. Injuries negatively affect sport participation, performance, and short- and long-term health and well-being. Injury prevention, therefore, is the key to safe, long-term cricket participation as a physical activity goal. Epidemiological data are needed to underpin evidence-based injury-prevention strategies.

INCLUSION CRITERIA

Studies reporting incidence and prevalence of injuries in female cricket players of all ages, participating in all levels of play, were included in this review, including studies that report data by sex or by sport. Studies without enough data to calculate prevalence or incidence, that do not distinguish female injury data from males', that focus on athletes participating in other sports, or that focus on case studies were excluded.

METHODS

A systematic review and meta-analyses were conducted according to the JBI and PRISMA 2020 guidelines. MEDLINE, SPORTDiscus, Physiotherapy Evidence Database (PEDro), EBSCO MasterFILE Premier, EBSCO CINAHL Complete, ProQuest Health and Medical Complete, Scopus, and Science Direct were systematically searched from inception to August 2021. Additionally, Cochrane Controlled Trials Register and ClincalTrail.gov were searched. EBSCO MegaFile Premier (EBSCO), OpenGrey (SIGLE), WorldCat, Grey Matters, Grey Literature, and Google Scholar databases were searched for gray literature. Full-text articles that met the inclusion criteria were critically appraised using JBI-tools, and were extracted and synthesized in narrative summary and tabular forms. Three meta-analyses were conducted: injury incidence rate, injury prevalence proportions, and injury incidence proportions. Heterogeneity was assessed using the I2 statistic and the random-effects model.

RESULTS

Of the 7057 studies were identified and only 4256 screened after duplicates removed, 23 studies met the inclusion criteria. Risk of bias was low for 21 studies. The injury incidence rate for elite cricket was 71.9 (SE 21.3, 95% CI 30.2-113.6) injuries per 1000 player hours, time-loss injury incidence rate was 13.3 (SE 4.4, 95% CI 4.6-22.0) injuries per 1000 player hours, and non-time-loss injury incidence rate was 58.5 (SE 16.9, 95% CI 25.6-91.7) injuries per 1000 player hours. The injury prevalence proportions for community to elite cricket was 65.2% (SE 9.3, 95% CI 45.7-82.3) and injury prevalence proportions for community cricket was 60% (SE 4.5, 95% CI 51.1-68.6). The injury incidence proportions for community cricket was 5.6 (SE 4.4, 95% CI 0.1-18.3) injuries per 10,000 participants. Elite cricket players were more frequently injured than community cricket players. The most prevalent body regions injured were the shoulder and knee, and most were sustained by fast bowlers. Injuries to the hand, wrist, and fingers had the highest incidence and were most sustained by fielders.

CONCLUSIONS

The study's findings can help stakeholders (including players, coaches, clinicians, and policymakers) make informed decisions about cricket participation by informing and implementing strategies to promote cricket as a vehicle for positive public health outcomes. This review also identified gaps in the available evidence base and addressing these through future research would enhance women's cricket as a professional sport.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020166052.

Validity and reliability study of the Turkish version of the 'A Sport Fitness Index'

BACKGROUND

The aim of this study was to adapt the 'Sport Fitness Index' into Turkish and to ensure its validity and reliability.

METHODS

After obtaining the necessary permissions, the Sports Fitness Index was independently translated from its English original to Turkish by four different physicians specialising in sports medicine. The content validity of index v.1 was calculated using the Davis technique in sample 1 of 20 people regularly participating in sports. In sample 2 consisting of 104 athletes who had a sports-related ligament/muscle injury or applied to the sports medicine clinic for general medical examination; the validity and reliability of index v.2 were examined. ROC analysis was applied to determine the cut-off point value of the score obtained from the Turkish version of the index.

RESULTS

The calculated I-CVI (lowest: 0.80, highest: 0.95) and S-CVI/Ave values (0.87) showed that the index provided content validity. Item 1 and item 10 were removed from the Turkish version of the index, as it caused a decrease in the Cronbach's alpha coefficient of the index v.2. Thus, the Cronbach's alpha coefficient of the index was calculated as 0.925. In the Turkish version of index v.2, the single-factor structure (explained variance rate 66.22%; eigenvalue 5.29) was preserved. The index provided confirmatory factor analysis model fit indices. The index provided a high level of negative correlation (r ˃ -.60; P = .0001) with the total score of the Physical Activity Inadequacy Scale Short Form-10 and the sub-scores of all summary components (r ˃ -.60; P = .0001). According to the ROC curve, the best cut-off point was 70 points with 96.6% sensitivity and 75% specificity in the Turkish version of the index.

CONCLUSION

The Sports Fitness Index-TR provided its Turkish validity and reliability with its 8-item and single-factor structure. The cut-off point is accepted as 70 points.

Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes

Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.

Changes in U.S. girls' participation in high school sports: implications for injury awareness

CONTEXT

The number of female athletes has grown exponentially since Title IX. However, little data exists on the proportion of women and girls who play each sport.

OBJECTIVE

To quantify changes in female sports participation in high school sports from 1973 to 2018.

DESIGN

Retrospective analysis of data from the National Federation of State High School Associations Participation Survey.

SETTING

US high schools.

PARTICIPANTS

US high school athletes from 1973 to 2018.

MAIN OUTCOME MEASURES

Percentage of female participation for each high school sport in 5-year intervals; and changes in rates of participation by player gender and sport at designated intervals.

RESULTS

From 1973 to 2018, the percentage of high school sports played by girls increased from 24.2% to 42.9% ([95%CI, 18.6,18.8], p < 0.0001). In the 14 sports included in our study, all had an increase in the percentage of female participation between 1973 and 2018. >80% of the increases occurred between 1973 and 1998 for all sports except lacrosse, ice hockey, football, and wrestling. Between 1998 and 2018, the percentage of girls playing each sport increased by less than 5% in all sports, except for ice hockey (11.5%, 95% CI 11.0, 12.0, p < 0.001) and wrestling (7.1%, 95% CI 6.9, 7.1, p < 0.001).

CONCLUSIONS

Girls' participation in high school sports continues to grow not only in numbers but in the types of sports played. Between 1998 and 2018, the greatest increases were noted in ice hockey and wrestling, which had fewer than 1% female participation before 1998. Physicians providing care for female athletes should be aware of these changes and understand the potential injuries associated with these sports.

The Effect of a Novel Training Program to Improve Trunk Stability Push Up Performance in Active Females: A Pilot Study

BACKGROUND

Trunk stability is a risk factor commonly associated with lower extremity injuries, particularly in females. Performance on trunk stability tasks, such as the Trunk Stability Push Up (TSPU), is less than optimal in females. Current corrective programs include few females, and clinically, improvements for females have been minimal.

PURPOSE/HYPOTHESIS

The purpose of this pilot study was to determine the effectiveness of a novel trunk stability intervention program in improving TSPU performance in a cohort of active female participants. It was hypothesized that ≥60% of participants would improve their TSPU scores to ≥2 via Functional Movement Screen™ (FMS™) criteria following a novel six-week intervention program.

STUDY DESIGN

Pilot Cohort Study.

METHODS

Participants were screened for pain with lumbar and shoulder clearing tests and hypermobility was assessed using Beighton scores. Additional testing included a breathing screen, the FMS™, Y-Balance Test-Lower Quarter and Y-Balance Test-Upper Quarter. Participants who scored a 1 on the TSPU received a home exercise program instructed by student physical therapists. Exercises focused on improving awareness of lumbar spine position and thoracic spine mobility. Participants returned for follow-ups after two and four weeks for instruction in exercise progression, which increased postural demand on the lumbar spine and upper extremities, and utilized closed-chain, multiplanar stability strategies.

RESULTS

Nine of 20 participants (45%) scored ≥2 on the TSPU at posttest. Due to the COVID-19 pandemic, only 12 participants were able to complete all posttest outcome measures. No significant differences were noted in the remaining outcome measures. Conclusion: The results of this study indicate that a multiplanar exercise approach, combining anti-extension and anti-rotation training, was beneficial for inducing trunk stability improvements in some active females.

LEVEL OF EVIDENCE

2b.

Return to play protocols for musculoskeletal upper and lower limb injuries in tackle-collision team sports: A systematic review

Athletes in tackle-collision teams are at high risk of musculoskeletal injuries resulting in absence from play due to the high impact nature of the sport. There is a paucity of research to guide the management and assessment methods needed to facilitate the return to play (RTP) process. This review aimed to describe, synthesise and evaluate RTP protocols implemented for musculoskeletal injuries in tackle-collision teams. A systematic search of Scopus, PubMed, Web of Science and Ebsco Host was conducted for RTP management protocols and assessment modalities following upper and lower limb musculoskeletal injuries in tackle-collision team athletes. Prospective and retrospective quantitative controlled trials, cohort, case-control, case-series and cross-sectional observation studies published between January 2000 and March 2020 were considered. The main outcome measures were the proportion of athletes to RTP, associated time-loss and reinjury risk. 5265 articles were screened. 34 studies met the eligibility criteria of which 23 involved management and 11 assessment modalities. Management involved surgical or conservative strategies along with exercise-based rehabilitation. Assessment modalities included radiographic assessment, clinical evaluation and subjective ratings. Promising RTP management included progressive weight-bearing and exercised-based rehabilitation for ankle sprains as well as surgery, the use of a sling and exercise-based rehabilitation for shoulder instability. MRI scans showed promise in predicting time-loss following hamstring and calf strains in tackle-collision athletes. There are currently no clear guidelines for RTP after musculoskeletal injuries in tackle-collision sports. Future research should investigate efficient management strategies evaluated through valid and reliable assessment methods to better guide clinicians.

Sex-based differences in outcomes for adult patients presenting to the emergency department with a concussion

OBJECTIVE

Patients with concussion frequently present to the emergency department (ED). Studies of athletes and children indicate that concussion symptoms are often more severe and prolonged in females compared with males. Given infrequent study of concussion symptoms in the general adult population, the authors conducted a sex-based comparison of patients with concussion.

METHODS

Adults (≥ 17 years of age) presenting with concussion to one of three urban Canadian EDs were recruited. Discharged patients were contacted by telephone 30 and 90 days later to capture the extent of persistent postconcussion symptoms using the Rivermead Post Concussion Symptoms Questionnaire (RPQ). A multivariate logistic regression model for persistent symptoms that included biological sex was developed.

RESULTS

Overall, 250 patients were included; 131 (52%) were women, and the median age of women was significantly higher than that of men (40 vs 32 years). Women had higher RPQ scores at baseline (p < 0.001) and the 30-day follow-up (p = 0.001); this difference resolved by 90 days. The multivariate logistic regression identified that women, patients having a history of sleep disorder, and those presenting to the ED with concussions after a motor vehicle collision were more likely to experience persistent symptoms.

CONCLUSIONS

In a community concussion sample, inconsequential demographic differences existed between adult women and men on ED presentation. Based on self-reported and objective outcomes, work and daily activities may be more affected by concussion and persistent postconcussion symptoms for women than men. Further analysis of these differences is required to identify different treatment options and ensure adequate care and management of injury.

The instrumented sheep knee to elucidate insights into osteoarthritis development and progression: A sensitive and reproducible platform for integrated research efforts

BACKGROUND

Osteoarthritis of the knee is a very common condition that has been difficult to treat. The majority of cases are considered idiopathic. Much research effort remains focused on biology rather than the biomechanics of such joints. Some new methods were developed and validated to better appreciate the subtleties of the biomechanical integrity of joints, and how changes in biomechanics can contribute to osteoarthritis.

METHODS

Over the past 15 years our lab has enhanced the sensitivity of the assessment of knee biomechanics of an instrumented, trained large animal model (sheep) of osteoarthritis and integrated the findings with biological and histological assessments. These new methods include gait analysis before and after injury followed by robotic validation post-sacrifice, and more recently using Fibre Bragg Grating sensors to detect alterations in cartilage stresses.

RESULTS

A review of the findings obtained with this model are presented. The findings indicate that sheep, like humans, exhibit individual characteristics. They also indicate that joint kinetics, rather than kinematics may better define the alterations induced by injury. With the addition of Fibre Bragg Grating sensors, it has been possible to measure with good accuracy, alterations to cartilage stresses following a controlled knee injury.

INTERPRETATION

Using this model as Proof of Concept, this sheep system can now be viewed as a sensitive platform to address many questions related to risk for development of idiopathic osteoarthritis of the human knee, the efficacy of potential interventions to correct biomechanical disruptions, and how joint biomechanics and biology are integrated during aging.

Physiological Characteristics of Female Soccer Players and Health and Performance Considerations: A Narrative Review

Female soccer has seen a substantial rise in participation, as well as increased financial support from governing bodies over the last decade. Thus, there is an onus on researchers and medical departments to develop a better understanding of the physical characteristics and demands, and the health and performance needs of female soccer players. In this review, we discuss the current research, as well as the knowledge gaps, of six major topics: physical demands, talent identification, body composition, injury risk and prevention, health and nutrition. Data on female talent identification are scarce, and future studies need to elucidate the influence of relative age and maturation selection across age groups. Regarding the physical demands, more research is needed on the pattern of high-intensity sprinting during matches and the contribution of soccer-specific movements. Injuries are not uncommon in female soccer players, but targeting intrinsically modifiable factors with injury prevention programmes can reduce injury rates. The anthropometric and physical characteristics of female players are heterogeneous and setting specific targets should be discouraged in youth and sub-elite players. Menstrual cycle phase may influence performance and injury risk; however, there are few studies in soccer players. Nutrition plays a critical role in health and performance and ensuring adequate energy intake remains a priority. Despite recent progress, there is considerably less research in female than male soccer players. Many gaps in our understanding of how best to develop and manage the health and performance of female soccer players remain.

The Functional Movement Screen as an injury prediction tool for German physical education and exercise science students: a prospective cohort-study

Background Several studies have evaluated the applicability of the Functional Movement Screen (FMS) as a screening tool for injury prediction. However, only few studies investigate gender differences for FMS as a screening tool for female and male college students.

Objective To evaluate gender differences in FMS single items and the overall score. In addition, the applicability of FMS as a diagnostic tool for injury prevention of German exercise students will be investigated.

Method N = 99 college students performed an FMS at the beginning of the semester. Injuries were recorded for the entire term. Gender differences of FMS single items were assessed using the Mann-Whitney-U-Test. Differences in injury prediction were calculated using logistic regression. If the model was statistically significant, diagnostic accuracy was calculated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The Youden index was used to identify a cut-off score. 2 × 2 contingency tables, sensitivity and specifity, positive/negative predictive values, and likelihood ratios were assessed.

Results There were significant gender differences for Deep Squat, Shoulder Mobility, Trunk Stability Push Up, and Active Straight Leg Raise. The logistic regression showed that the composite score was statistically significant in clarifying the model for females (p = 0.005, RN 2 = 0.14), but not for males (p = 0.18, RN 2 = 0.04). The ROC curve indicated acceptable injury prediction in females (AUC: 0.66, p = 0.02) and poor injury prediction in males (AUC: 0.40, p = 0.19). The cut-off score of ≤ 16 for females resulted in a sensitivity of 63 % and specificity of 54 %. No cut-off score was calculated for males.

Conclusion Females performed better on flexibility items, while males scored higher on strength exercises. Results of the study indicate low predictive accuracy. Therefore, no solid recommendation can be made for the use of the FMS as an injury screening tool for either female or male German exercise science students.

Multi-Location External Workload Profile in Women's Basketball Players. A Case Study at the Semiprofessional-Level

The external workload measured in one anatomical location does not determine the total load supported by the human body. Therefore, the purpose of the present study was to characterize the multi-location external workload through PlayerLoad_RT of 13 semi-professional women’s basketball players, as well as to analyze differences among anatomical locations (inter-scapulae line, lumbar region, 2× knee, 2× ankle) and laterality (left vs. right) during five tests that represent the most common movements in basketball—(a) linear locomotion, 30-15 IFT; (b) acceleration and deceleration, 16.25-m RSA (c) curvilinear locomotion, 6.75-m arc (d) jump, Abalakov test (e) small-sided game, 10’ 3 vs. 3 10 × 15-m. Statistical analysis was composed of a repeated-measures t-test and eta partial squared effect size. Regarding laterality, differences were found only in curvilinear locomotion, with a higher workload in the outer leg (p < 0.01; η_p² = 0.33–0.63). In the vertical profile, differences among anatomical locations were found in all tests (p < 0.01; η_p² = 0.56–0.98). The nearer location to ground contact showed higher values except between the scapulae and lumbar region during jumps (p = 0.83; η_p² = 0.00). In conclusion, the multi-location assessment of external workload through a previously validated test battery will make it possible to understand the individual effect of external workload in each anatomical location that depends on the type of locomotion. These results should be considered when designing specific strategies for training and injury prevention.