Pediatric and adolescent injury in adventure and extreme sports

Overuse Injury of the Epiphyseal Primary Physis

Year-round participation in youth sport that involves high levels of repetitive movement fosters an environment in which overuse injuries are likely to occur. Epiphyseal primary physeal stress injuries (PSIs), unique to skeletally immature athletes, are a particular concern, given their potential for growth disturbance. Initially observed in Little League baseball players, these injuries are now known to affect the long bones around the shoulder, elbow, wrist, hand, knee, ankle, and foot of skeletally immature athletes involved in a variety of sport activities.This article offers an epidemiological and radiologic perspective on the extent and distribution of epiphyseal PSIs in youth sport. We also review a novel framework for understanding the pathophysiologic mechanisms causing these injuries. This information is essential for the early identification of epiphyseal PSIs and devising preventive measures that can reduce a delayed diagnosis and long-term morbidity. Preventing and reducing injury to the epiphyseal growth plates is essential because impairment and dysfunction can result in lifelong morbidity and a risk of premature osteoarthritis.

Augmented reality advertising and college students' interest in the extreme sports: Moderating role of innovation resistance and health consciousness

Advertising and promotions are the most utilized types of augmented reality (AR) activations for marketers across all industries. The same is true for the sports industry. This form of augmented reality is meant to bring attention to the organization through a novel technology such as AR. Recently, a lack of interest among students in extreme sports has been attributed to a lack of professional advertising and marketing innovation. This situation requires the attention of researchers, and this study investigates the impact of augmented reality advertising on college students' interest in extreme sports, specifically in China. The article also investigates the moderating role of innovation resistance and health consciousness in the relationship between augmented reality advertising and college students' interest in extreme sports in China. Students actively participating in sports were selected using the purposive sampling technique, and AMOS was used for data analysis. According to the findings, augmented reality advertising positively correlates with interest in extreme sports. The findings also revealed that innovation resistance and health consciousness significantly moderated college students' interest in extreme sports and augmented reality advertising. This research assists regulators in developing regulations to increase interest in extreme sports through augmented reality advertising and innovation adoption.

What Is an Extreme Sports Healthcare Provider: An Auto-Ethnographic Study of the Development of an Extreme Sports Medicine Training Program

“I remember when sex was safe and skydiving was dangerous” read a popular bumper sticker during the HIV crisis. Popular perceptions of extreme sport (ES) often include the descriptor ‘dangerous’. Therefore, why is the popularity of ES increasing exponentially with “dedicated TV channels, internet sites, high-rating competitions, and high-profile sponsors drawing more participants”? More importantly, how should health practitioners respond to the influx of ES athletes with novel injuries, enquiries and attitudes. This paper describes the results of a collaborative auto-ethnographic approach to answering “what is an extreme sports medicine health care provider and what are the components of an effective Extreme Sports Medicine (ESM) training program?” The study was conducted following the first ESM university course offered in Australia with the intention of assessing the learning design and reflecting on the development and practice of ES health practitioners. We explicated three overarching themes common to both the ES health practitioner and for the effective training of healthcare providers in the support of ES endeavors and athletes. These themes were individual, task and environmental factors. The impacts of these findings confirm that ESM courses are vital and should be designed specifically to ensure that practitioners are effectively supported to develop the unique skills necessary for practice in real world extreme sports events.

Early Sport Specialization and Past Injury in Competitive Youth Rock Climbers

INTRODUCTION

Sport specialization has been shown to have negative effects on athletes but has not been studied within rock climbing. This study seeks to evaluate the proportion and impact of specialization in pediatric climbers.

METHODS

Climbers (ages 8-18 y) were recruited from throughout the United States to complete a 1-time survey regarding climbing experience, training patterns, and injury history. The main outcome of proportion of climbers suffering an injury was assessed within the last 12 mo and within their entire climbing experience (defined as "lifetime" injury). Early specialization was defined as exclusive participation in climbing, with training for >8 mo‧y^-1, prior to age 12 y (late specialization if after age 12 y).

RESULTS

Participants (n=111, 14±3 y [mean±SD], 69 females) were high-level climbers. Fifty-five percent of participants specialized in climbing, and 69% of those specialized early. Hand and ankle injuries occurred most commonly. Seventy-eight percent of late specialized climbers had a lifetime injury. Late specialized climbers were 1.6 times (95% CI: 1.1-2.3) more likely than early specialized climbers to have had a lifetime injury and 1.8 times (95% CI: 1.1-2.8) more likely to have had an injury in the last 12 mo. No difference in overuse injuries was found between specialization groups.

CONCLUSIONS

Early specialization is common among youth climbers but was not associated with an increase in injuries. Late specialization was associated with a higher likelihood of having had a climbing injury in the last 12 mo and during an entire climbing career.

The Imaging Diagnosis of Patients with Shoulder Pain Caused by Sports Injury

The shoulder joint is the most complex and movable joint of the human body. A variety of diseases can affect the shoulder joint and cause shoulder pain. Sports injuries are an important and common cause of shoulder pain. In the clinical diagnosis of shoulder joint injury, the most commonly used diagnostic methods are X-ray photography and CT imaging, but X-ray photography has poor ability to distinguish shoulder joints and other tiny tissue structures and has a sense of inspiration for shoulder joint injuries. In addition, CT arthrography has a certain risk to the lesion and is easy to form trauma, and it cannot clearly show the shoulder joint structures such as the rotator cuff and the labrum. Therefore, this article conducts MR imaging diagnostic research on patients with shoulder pain caused by sports injuries and plays an important role in imaging. This article deeply studied the clinical manifestations of shoulder joint pain and image processing technology, designed a research experiment on imaging diagnosis results of patients with shoulder joint pain caused by sports injuries, selected 87 patients with shoulder joint pain in a hospital, and analyzed X-ray photography, CT imaging, and MR imaging diagnosis, three methods to compare the diagnostic accuracy and inspection results and conduct an in-depth analysis of the causes of shoulder joint injury. The experimental results showed that there were 87 patients with shoulder joint pain, 65 patients with rotator cuff tear were diagnosed using arthroscopy, and 63 patients with rotator cuff tear were diagnosed by MR imaging. The accuracy rate was as high as 95.6%. Among them, the proportion caused by sports injuries is the highest, reaching 56%.

Primary Periphyseal Stress Injuries in Young Athletes: A Systematic Review

BACKGROUND

Overuse injuries are common in sporting children and adolescents. These injuries are a particular concern when they involve the epiphyseal-physeal-metaphyseal (EPM) complex given their potential to disturb skeletal growth. Specifically, the limits of mechanical tolerance of the EPM complex to repetitive stress may be exceeded by the intense and continuous training characteristic of many youth sports today.

OBJECTIVE

This article describes the present status of knowledge on the occurrence and outcome of primary periphyseal stress injuries (PPSIs) affecting the EPM complex in the extremities of children and adolescents involved in youth sports.

METHODS

A comprehensive review of the sports medicine literature was conducted to determine the nature and extent of PPSIs affecting the EPM complex of the extremities among youth sports participants and the potential for consequent skeletal growth disturbance and resultant limb deformity associated with these injuries.

RESULTS

Our initial search uncovered 128 original published scientific articles reporting relevant data on PPSIs. There were 101 case reports/series, 19 cross-sectional, 1 case-control, and 7 cohort studies with relevant data. The case reports/series studies reported 448 patients with PPSIs involving the extremities. Children and adolescents representing a variety of high impact repetitive youth sports activities-including baseball, badminton, climbing, cricket, dance, gymnastics, rugby, soccer, swimming, tennis, and volleyball-may sustain PPSIs involving the shoulder, elbow, hand and wrist, knee, and ankle and foot. Although incidence data from prospective cohort studies are lacking, data arising from cross-sectional studies suggest that PPSIs may be common in select groups of youth athletes-including the shoulder in baseball players (0-36.6%), wrist in gymnasts (10-83%) and platform divers (52.6%), and fingers in rock climbers (5-58%). Notably, not all stress-related skeletal changes detected on imaging were symptomatic in these studies. When diagnosed and treated with an appropriate period of rest and rehabilitation, most patients studied were able to return to their sport activities. However, our data also show that 57/448 PPSIs (12.7%) produced growth disturbance, and that 28/448 patients (6.2%) underwent surgery for their injuries. Absence of treatment, delayed presentation and diagnosis, and non-compliance with a rest regimen were common in cases that produced growth disturbance.

CONCLUSIONS

PPSIs may affect the extremities of children and adolescents engaged in a variety of youth sports, especially at advanced levels of training and competition. Most skeletally immature patients with PPSIs respond well to timely treatment; however, in extreme cases, PPSIs can progress to produce skeletal growth disruption which may necessitate surgical intervention. Clearly, establishing the early diagnosis of PPSIs and providing timely treatment of these injuries are needed to ensure the skeletal health of youth sports participants. Rigorous prospective longitudinal epidemiological and imaging studies designed to provide incidence rates of PPSIs and to determine the effect of PPSIs on long-term skeletal health are also necessary.

The Incidence of Pediatric and Adolescent Concussion in Action Sports: A Systematic Review and Meta-Analysis

BACKGROUND

This was a systematic review and meta-analysis of the incidence of concussion risk in youth athletes involved in action sports (AS).

METHODS

A search of PubMed and Web of Science (from January 1980 to August 2020). Titles, abstracts, and full text were screened according to predefined inclusion criteria to find relevant studies. Moreover, the methodological quality of the studies selected was assessed.

RESULTS

Nineteen of 1.619 studies were included in the systematic review and 14 in the meta-analysis. Motocross, sailing and snowboarding presented the highest incidence rates per 1000 athlete exposure at 39.22, 3.73 and 2.77 respectively, whereas alpine skiing had the lowest incidence rates resulting in 0.30. Overall risk of concussion was estimated at 0.33 (CI: 0.22, 0.45). Regarding the methodological quality, we have to report that 26.3% of the studies reported the definition of concussion while 36.8% presented age and gender-specific incidence rates. The mechanism of injury and follow up were reported only in one study.

CONCLUSIONS

There are significant differences in the rates of incident youth concussion across AS. Despite some limitations, the data from this research can serve as the current sport-specific baseline risk of concussion among youth athletes who practice action sports.

Approaching community priorities in youth sports injury prevention research

BACKGROUND

Research in youth sports is often complex. As interest in youth sports injury prevention grows, scientists should consider community priorities beyond a specific research study.

MAIN TEXT

This commentary discusses the authors' personal experiences researching concussion prevention in middle school sports, as the overarching community faced multiple challenges. These challenges included a series of weather-related emergencies that resulted in a shift in the community's priorities, multi-day school closures, and cancellations of sports activities and meetings. We discuss the importance of considering community priorities and providing support as scientists, colleagues, and members of the communities in which we conduct research.

CONCLUSION

Scientists should consider the changing circumstances and dynamics surrounding community priorities in order to help drive their research-based decisions and ensure successful and respectful applications of research based on community values and priorities.

[Risk-taking Behaviour and Aspects on Adolescents' Participation in High-risk Sports]

Risk-taking Behaviour and Aspects on Adolescents' Participation in High-risk Sports The age of adolescence represents an enhanced reward sensitivity which is often linked to increased risk-taking behaviour. Peers enhance risk-taking behaviour which is shown through delinquency and substance use. Whereas most research on adolescent risk-taking has been directed towards negative risk-taking, this narrative review tries to highlight adventure and high-risk sport participation as a prosocial form of risk-taking and its potential influence on adolescents' behaviour. Adventure/high-risk sports such as mountainbiking, freeride ski and snowboarding and climbing have grown exponentially in the last years with a high popularity among adolescents. Besides the inherent risk of severe injury in case of a mismanaged accident, which should be minimized by preventive steps such as educative risk-management and protective gear, those sports bear the potential for multiple psychological benefits such as enhanced mood, autonomy, resilience and self-efficacy. Adventure/high-risk sports seem to have the possibility to satisfy the need for rewards, prestige and risk-taking in a socially accepted way. Few research projects have already successfully integrated adventure sport interventions in clinical settings in mental health treatment. The idea of testing adventure/high-risk sport interventions as an addition to the treatment in child and adolescent psychiatry and psychotherapy could be promising and an impulse for future research projects.

To Analyze Thrill, Define Extreme Sports

Emotions are a signaling system, evolved by providing selective advantage through enhanced survival and reproduction. The selective advantage conferred by thrill or exhilaration, however, remains unknown. Hypotheses, as yet untested, include overcoming phobias or honing physical skills as juveniles, or exhibiting desirability during mate selection. Extreme sports can provide an ethically and experimentally feasible tool to analyze thrill. To use this tool, extreme sports must first be defined in a non-circular way, independent of participant psychology. Existing concepts, from different disciplines, focus, respectively, on drama, activity types, or consequences of error. Here, I draw upon academic and popular literature, and autoethnographic experience, to distinguish extreme from adventurous levels for a range of different outdoor sports. I conclude that extreme outdoor adventure sports can be defined objectively as those activities, conditions, and levels, where participant survival relies on moment-by-moment skill, and any error is likely to prove fatal. This allows us to examine the motivations, experiences, and transformations of individuals who undertake these activities. In particular, it will allow us to examine the emotional experience of thrill, previously studied principally as an aspect of personality, from new neurophysiological and evolutionary perspectives.