Musculoskeletal injuries in sports

Principles of musculoskeletal sport injuries for epidemiologists: a review

BACKGROUND

Musculoskeletal injuries are a common occurrence in sport. The goal of sport injury epidemiology is to study these injuries at a population level to inform their prevention and treatment.

MAIN BODY

This review provides an overview of musculoskeletal sport injuries and the musculoskeletal system from a biological and epidemiologic perspective, including injury mechanism, categorizations and types of sport injuries, healing, and subsequent injuries. It is meant to provide a concise introductory substantive background of musculoskeletal sport injuries for epidemiologists who may not have formal training in the underlying anatomy and pathophysiology.

CONCLUSION

An understanding of sport injuries is important for researchers in sport injury epidemiology when determining how to best define and assess their research questions and measures.

Musculoskeletal Injuries in Table Tennis during Competition: A Systematic Review

The study aimed to investigate the incidence of musculoskeletal injuries among table tennis players and identify their associated risk factors. We conducted a literature search in online databases using relevant search terms related to "table tennis" and "injury". To compare the rate of injuries according to player-related variables, we extracted information on sex, level of games, circumstances of injury, and duration of sport absence after injury. Furthermore, we calculated the odds ratios based on the number of injuries according to variables. Eight articles included 873 professional table tennis players, revealing an overall musculoskeletal injury rate of 3.6% (31 musculoskeletal injuries). The incidence was 10.0 injuries per 1,000 playing hours (range, 0-27.0). The rate of musculoskeletal injuries for female and male players were 3.2% and 3.8%, respectively, and those for Summer Olympic Games, Asian Games, and domestic national games was 4.8%, 15.4%, and 0%, respectively. More than half (52%) of injuries occurred during training, and most injuries (64%) were of a nature that did not cause time loss. This review provides valuable information about the incidence of musculoskeletal injuries in table tennis competitions. However, owing to the limitations of this study in identifying injury-related risk factors, future studies analyzing comprehensive variables are required.

Challenges and Solutions for Musculoskeletal Disorders in Athletes

The etymology of the word "athlete" derives from the ancient Greek ἀθλητής (athletés, from âthlos that is, fight, competition) [...].

Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review

Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes.

A Random Forest Machine Learning Framework to Reduce Running Injuries in Young Triathletes

Background: The running segment of a triathlon produces 70% of the lower limb injuries. Previous research has shown a clear association between kinematic patterns and specific injuries during running. Methods: After completing a seven-month gait retraining program, a questionnaire was used to assess 19 triathletes for the incidence of injuries. They were also biomechanically analyzed at the beginning and end of the program while running at a speed of 90% of their maximum aerobic speed (MAS) using surface sensor dynamic electromyography and kinematic analysis. We used classification tree (random forest) techniques from the field of artificial intelligence to identify linear and non-linear relationships between different biomechanical patterns and injuries to identify which styles best prevent injuries. Results: Fewer injuries occurred after completing the program, with athletes showing less pelvic fall and greater activation in gluteus medius during the first phase of the float phase, with increased trunk extension, knee flexion, and decreased ankle dorsiflexion during the initial contact with the ground. Conclusions: The triathletes who had suffered the most injuries ran with increased pelvic drop and less activation in gluteus medius during the first phase of the float phase. Contralateral pelvic drop seems to be an important variable in the incidence of injuries in young triathletes.

Use of Acupuncture for the Treatment of Sports-Related Injuries in Athletes: A Systematic Review of Case Reports

Acupuncture is one of the representative complementary and alternative medicine treatments used for various types of pain. This systematic review summarized and analyzed clinical case reports/series utilizing acupuncture for treating sports injuries in athletes, thereby providing the basis for further research to establish clinical evidence on acupuncture treatment in sports medicine. A comprehensive literature search was conducted in Embase including MEDLINE up to 21 August 2019 without language and publication date restrictions. Due to the heterogeneity of each study, explanatory and descriptive analyses were performed. As a result, in each case report/series, it was confirmed that acupuncture was applied for treating various types of sports injuries experienced by athletes. Acupuncture can help relieve short-term pain and recover from dysfunction and has been used as a useful, noninvasive, and conservative modality for managing sports injuries such as lateral meniscus rupture, femoral acetabular impingement, ganglion cysts, and sports hernia. In addition, acupuncture has been suggested as a treatment worth trying for diseases such as yips and delayed onset muscle soreness. The included cases showed some potential of acupuncture in the treatment of various types of sports injuries, beyond pain control in musculoskeletal disorders. However, considering that this review was based on case reports/series, a limited understanding of the clinical value of acupuncture in athletes is required. In the future, more specific research questions and hypotheses should be addressed to generate evidence based on experimental research.

Ankle Brachial Index in Different Types of Popliteal Artery Entrapment Syndrome: A Systematic Review of Case Reports

Similar to other peripheral artery diseases, vessel narrowing in popliteal artery entrapment syndrome (PAES) reduces the ankle brachial index (ABI). Since the PAES is related to several anatomical or functional variations, we sought to determine if the ABI was correlated with the type of syndrome. Through a systematic review of literature, we identified case reports and series in which the diagnosis of PAES was accompanied by ABI measurement. Twenty-seven studies included in the qualitative synthesis described 87 limbs. The most common types of the syndrome were those caused by an abnormal medial head of the gastrocnemius (type II, n = 35, 40.23%) and aberrant course of the popliteal artery (type I, n = 20, 22.99%). The variation of plantaris muscle (n = 7, 8.05%) is currently not included in the classification system. The median value of ABI was 0.87 (interquartile range (IQR) = 0.6–1.0). There were no differences among types of syndrome (F = 0.13, p = 0.72). In conclusion, despite clinical recommendations, the ABI remains underused in PAES diagnosis. No correlation was detected between the index score and type of syndrome. The cases of PAES involving structures other than the gastrocnemius or popliteus muscle suggest the need to revisit the current clinical classification system.

Epidemiology of sports-related musculoskeletal injuries in young athletes in United States

Over the past several decades there has been increased participation in sports by children and adolescents at earlier ages in the United States, as well as more intense participation and specialization in sports at very early ages. This trend has also partly contributed to the patterns of injuries seen in young athletes, and especially in recent years, injuries previously seen in mature athletes are being seen in young athletes. Overall, the vast majority of sport-related musculoskeletal injuries in children and adolescents are due to repetitive overuse and acute macrotrauma is less frequently seen in young athletes. Epidemiological data on sports injuries are provided by several national surveys. Investigators have used different methods to define sports injuries and the most widely used definition is based on athlete-exposure time. Certain aspects related to adolescent growth and development modulate the pattern of injuries. This article provides an overview of the epidemiology of sports-related musculoskeletal injuries seen in children and adolescents.

Evaluation of Knee Pain in Athletes: A Radiologist's Perspective

Lower limb injuries account for most of all injuries suffered by athletes and the knee joint accounts for over half of these. The etiology of knee pain is multifactorial; a good history focusing on the mechanism of injury and the chronicity of pain is extremely useful in correlating with radiologic findings and establishing a clinically meaningful diagnosis. This review article will discuss several important and common causes of acute and chronic knee pain in athletes, focusing on their mechanism of injury and site of pain as well as their salient imaging findings.

Common injuries in athletes' knee: experience of a specialized center

OBJECTIVE:

The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics.

METHOD:

Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury.

RESULTS:

Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patient's age/gender.

CONCLUSION:

The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners.

Level of Evidence IV, Study Transversal.

Trends in concussion return-to-play timelines among high school athletes from 2007 through 2009

CONTEXT

Whereas guidelines about return-to-play (RTP) after concussion have been published, actual prognoses remain elusive.

OBJECTIVE

To develop probability estimates for time until RTP after sport-related concussion.

DESIGN

Descriptive epidemiology study.

SETTING

High school.

PATIENTS OR OTHER PARTICIPANTS

Injured high school varsity, junior varsity, or freshman athletes who participated in 1 of 13 interscholastic sports at 7 area high schools during the 2007-2009 academic years.

INTERVENTION(S)

Athletic trainers employed at each school collected concussion data. The athletic trainer or physician on site determined the presence of a concussion. Athlete-exposures for practices and games also were captured.

MAIN OUTCOME MEASURE(S)

Documented concussions were categorized by time missed from participation using severity outcome intervals (same-day return, 1- to 2-day return, 3- to 6-day return, 7- to 9-day return, 10- to 21-day return, >21-day return, no return [censored data]). We calculated Kaplan-Meier time-to-event probabilities that included censored data to determine the probability of RTP at each of these time intervals.

RESULTS

A total of 81 new concussions were documented in 478 775 athlete-exposures during the study period. After a new concussion, the probability of RTP (95% confidence interval) was 2.5% (95% confidence interval = 0.3, 6.9) for a 1- to 2-day return, 71.3% (95% confidence interval = 59.0, 82.9) for a 7- to 9-day return, and 88.8% (95% confidence interval = 72.0, 97.2) for a 10- to 21-day return.

CONCLUSIONS

For high school athletes, RTP within the first 2 days after concussion was unlikely. After 1 week, the probability of return rose substantially (approximately 71%). Prognostic indicators are used to educate patients about the likely course of disease. Whereas individual symptoms and recovery times vary, prognostic time-to-event probabilities allow clinicians to provide coaches, parents, and athletes with a prediction of the likelihood of RTP within certain timeframes after a concussion.

Recovery from injury in sport: considerations in the transition from medical care to performance care

Return from athletic injury can be a lengthy and difficult process. The injured athlete commonly receives care from several providers during rehabilitation. As their condition improves, injured athletes resume strength and conditioning programs and sport-specific activities in preparation for return to play. Until full medical clearance is provided to return to sport and the athlete is psychologically ready to return to play, the injured athlete remains a patient regardless of who is developing and supervising each component of the recovery process. An understanding of and commitment to the plan of care for each athlete, as well as communication among health care providers, strength and conditioning specialists, coaches, and the athletes, are essential to the safest and most efficient recovery from injury.

Terapia gênica, doping genético e esporte: fundamentação e implicações para o futuro

A busca pelo desempenho ótimo tem sido uma constante no esporte de alto rendimento. Para tanto, muitos atletas acabam utilizando drogas e métodos ilícitos, os quais podem ter importantes efeitos adversos. A terapia gênica é uma modalidade terapêutica bastante recente na medicina, cujos resultados têm, até o momento, indicado sua eficácia no tratamento de diversas doenças graves. O princípio da terapia gênica consiste na transferência vetorial de materiais genéticos para células-alvo, com o objetivo de suprir os produtos de um gene estruturalmente anormal no genoma do paciente. Recentemente, o potencial para uso indevido da terapia gênica entre atletas tem despertado a atenção de cientistas e de órgãos reguladores de esporte. A transferência de genes que poderiam melhorar o desempenho esportivo por atletas saudáveis, método proibido em 2003, foi denominado de doping genético. Os genes candidatos mais importantes para doping genético são os que codificam para GH, IGF-1, bloqueadores da miostatina, VEGF, endorfinas e encefalinas, eritropoetina, leptina e PPAR-delta. Uma vez inserido no genoma do atleta, o gene se expressaria gerando um produto endógeno capaz de melhorar o desempenho atlético. Assim, os métodos atuais de detecção de doping não são sensíveis a esse tipo de manipulação, o que poderia estimular seu uso indevido entre atletas. Além disso, a terapia gênica ainda apresenta problemas conhecidos de aplicação, como resposta inflamatória e falta de controle da ativação do gene. Em pessoas saudáveis, é provável que tais problemas sejam ainda mais importantes, já que haveria excesso do produto do gene transferido. Há também outros riscos ainda não conhecidos, específicos para cada tipo de gene. Em vista disso, debates sobre o doping genético devem ser iniciados no meio acadêmico e esportivo, para que sejam estudadas medidas de prevenção, controle e detecção do doping genético, evitando assim futuros problemas de uso indevido dessa promissora modalidade terapêutica.