Back pain in elite sports: A cross-sectional study on 1114 athletes

Factors associated with non-specific low back pain in field hockey: A cross-sectional study of Premier and Division One players

OBJECTIVE

To determine the extent to which various factors are associated with greater or lesser odds of reporting non-specific low back pain (NS-LBP) in field hockey.

METHODS

To meet the objective of the study, a cross-sectional study design was used with a purposive sampling strategy. A total of 194 responses (~18% of those accessible) from Premier and Division One players within the UK were received using a UK-based online survey. Data collected included information on NS-LBP, participant characteristics, injury history, training related factors, and work and personal factors. The overall and category-specific prevalence of NS-LBP was calculated. Univariable and multivariable logistic regression was used in conjunction with clinical value to identify associations.

RESULTS

The overall prevalence of NS-LBP was 44.0%, with this varying from 23.5 to 70.0% for categories with responses of "yes" and "no" to experiencing NS-LBP. A total of ten individual factors associated with a greater odds ratio (OR) of reporting NS-LBP (OR = 1.43-7.39) were identified in Premier and Division One players. Five individual factors were associated with reduced odds (OR = 0.11-0.60) of reporting NS-LBP. Seven factors (age, stature, playing position, playing internationally, performing a drag flick, low back stiffness/tightness and occupational factors) were deemed particularly pertinent to those working in field hockey given the magnitude of association and clinical value to clinicians.

CONCLUSIONS

Clinicians working in field hockey can consider the key risk factors identified in this study that are associated with NS-LBP when assessing injury risk, movement screening approaches, and overall athlete management.

Health problems among elite Dutch youth long track speed skaters: a one-season prospective study

OBJECTIVES

To describe the frequency, type, and severity of health problems in long-track speed skating to inform injury prevention strategies.

METHODS

We prospectively collected weekly health and sport exposure data on 84 highly trained Dutch athletes aged 15-21 years during the 2019/2020 season using the Oslo Sports Trauma Research Centre questionnaire on Health Problems and the trainers' documentation. We categorised health problems into acute or repetitive mechanisms of injury or illness and calculated incidences (per 1000 sports exposure hours), weekly prevalence and burden (days of time loss per 1000 sports exposure hours) related to the affected body region.

RESULTS

We registered 283 health problems (187 injuries, 96 illnesses), yielding an average weekly prevalence of health problems of 30.5% (95% CI 28.7% to 32.2%). Incidence rates were 2.0/1000 hours for acute mechanism injuries (95% CI 1.5 to 2.5) and 3.2/1000 hours for illnesses (95% CI 2.6 to 3.9). For acute mechanism injuries the head, shoulder and lumbosacral region had the highest injury burden of 5.6 (95% CI 4.8 to 6.5), 2.9 (95% CI 2.3 to 3.5) and 2.2 (95% CI 1.7 to 2.8) days of time loss/1000 hours, respectively. For repetitive mechanism injuries, the knee, thoracic spine, lower leg and lumbosacral region had the highest injury burden, with 11.0 (95% CI 9.8 to 12.2), 6.8 (95% CI 5.9 to 7.7), 3.9 (95% CI 3.2 to 4.6) and 2.5 (95% CI 1.9 to 3.1) days of time loss/1000 hours, respectively.

CONCLUSION

Our study demonstrated a high prevalence of acute and repetitive mechanism injuries in speed skating. These results can guide future research and priorities for injury prevention.

Potential neurophysiological and biomechanical risk factors for sport-related back problems: A scoping review

This scoping review aims (1) to map the literature dealing with neurophysiological and biomechanical aspects of back problems in athletes in order to identify valid risk-factors for their prevention, plus (2) to identify gaps in the existing research and propose suggestions for future studies. A literature search conducted with Scopus, Web of Science, MEDLINE and Cochrane Library was completed by Elsevier, SpringerLink and Google Scholar. The main neurophysiological risk factors identified leading to back problems in athletes are neuromuscular imbalance, increased muscle fatigability, muscle dysfunction and impaired motor control, whilst biomechanical risk factors include maladaptive spinal, spinopelvic and lower limb kinematics, side-to-side imbalances in axial strength and hip rotation range of motion, spinal overloading and deficits in movement pattern. However, most studies focused on back pain in the lumbar region, whereas less attention has been paid to thoracic and cervical spine problems. The range of sports where this topic has been studied is relatively small. There is a lack of research in sports in which the core muscles are highly involved in specific movements such as lifting weights or trunk rotations. A limited number of studies include female athletes and master athletes of both genders. In addition to chronic back pain patients, it is equally important to conduct research on healthy athletes with a predisposition to spine problems. Investigators should focus their empirical work on identifying modifiable risk factors, predict which athletes are at risk for back problems, and develop personalized sport-specific assessment tools and targeted prevention strategies for them. This review was registered using the Open Science Framework Registries (https://osf.io/ha5n7).

Effects of high-frequency hyperthermia on the elastic modulus of the lumbar muscle in female athletes with low back pain: A randomized crossover trial

OBJECTIVE

To investigate the effects of capacitive and resistive monopolar radiofrequency (CRMF) on the shear elastic modulus of the multifidus and erector spinae muscles in female athletes with low back pain (LBP) and a history of LBP.

DESIGN

Randomized crossover trial.

SETTING

Academic institution.

PARTICIPANTS

Twenty female university athletes with LBP or a history of LBP were included.

INTERVENTIONS

All participants received CRMF, hotpack, and sham (CRMF without power) in a random order on the right side of the lumbar region. More than 2 days were allocated between the experiments to eliminate any residual effects.

MAIN OUTCOME MEASURES

The shear elastic moduli of the right multifidus and erector spinae were evaluated in the prone (rest) position while sitting with 35° trunk flexion (stretched) using shear wave ultrasound imaging equipment. The moduli were measured before, immediately after, and 30 minutes after the intervention.

RESULTS

Repeated-measures 2-way analysis of variance and post hoc analysis showed that the moduli of the CRMF group were significantly lower than those of the sham group in the stretched position immediately after intervention (P = .045). This difference diminished 30 minutes after the intervention (P = .920).

CONCLUSIONS

CRMF can be used to reduce the shear elastic modulus of the multifidus muscle in the short term. Further studies are warranted to determine how to provide longer effects.

TRIAL REGISTRATION

None.

Evaluation of the Psychometric Properties of the Musculoskeletal Health Questionnaire (MSK-HQ) in a Population of Professional Basketball Players: A Cross-Sectional Study

Background and Objective: Musculoskeletal disorders affect a large portion of the population worldwide. The musculoskeletal health questionnaire is a helpful tool for assessing the health state of patients with these disorders. The primary goal of this study is to evaluate the psychometric properties of the MSK_HQ-IT in a population of professional basketball players. The secondary aim is to assess the prevalence of musculoskeletal disorders. Material and Methods: The study was performed from September to October 2022. The questionnaire was completed using an online or paper form, to which personal data were collected. Data were collected by submitting a translated version of the musculoskeletal health questionnaire directly to professional athletes. Results: A total of 63 basketball players were recruited. Regarding functional limitations, the body parts mentioned by the sample were the left ankle (23.8%) and the right ankle (17.5%), followed by the lumbar column and right hip (15.9%). Regarding pain, the data are more homogeneous, with a distribution in line with functional limitations. A peak of pain was perceived in the left foot, with a mean score of 4. Cronbach's alpha showed a value of 0.85. Conclusions: The musculoskeletal health questionnaire shows promising results in evaluating the health state of a population of professional athletes. Further studies are needed to enlarge the sample and possibly open it to more categories of professional sports.

Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review

Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports.

Injury and illness in short-course triathletes: A systematic review

BACKGROUND

Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies. This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting health problems (injury and illness) in triathletes (all sexes, ages, and experience levels) training and/or competing in short-course distances were included. Six electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, APA PsychINFO, Web of Science Core Collection, and SPORTDiscus) were searched. Risk of bias was independently assessed by 2 reviewers using the Newcastle-Ottawa Quality Assessment Scale. Two authors independently completed data extraction.

RESULTS

The search yielded 7998 studies, with 42 studies eligible for inclusion. Twenty-three studies investigated injuries, 24 studies investigated illnesses, and 5 studies investigated both injuries and illnesses. The injury incidence rate ranged 15.7-24.3 per 1000 athlete exposures, and the illness incidence rate ranged 1.8-13.1 per 1000 athlete days. Injury and illness prevalence ranged between 2%-15% and 6%-84%, respectively. Most injuries reported occurred during running (45%-92%), and the most frequently reported illnesses affected the gastrointestinal (7%-70%), cardiovascular (14%-59%), and respiratory systems (5%-60%).

CONCLUSION

The most frequently reported health problems in short-course triathletes were: overuse and lower limb injuries associated with running; gastrointestinal illnesses and altered cardiac function, primarily attributable to environmental factors; and respiratory illness mostly caused by infection.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Lower back pain in young climbers: a retrospective cross-sectional study

Objective

The popularity of sport climbing has been growing since its inclusion in the Olympic Games program, which led to more people practicing it on recreational, amateur, and professional levels. Strenuous climbing training sessions and competitions might lead to frequent and serious musculoskeletal injuries and complaints among competitive climbers. This study aimed to investigate the prevalence of low back pain (LBP) and to explore the influence of various risk factors on LBP in adolescent climbers.

Methods

The sample included 180 competitive climbers (46.6% males) aged 13-19 years competing in under-16 (48.3%) or under-20 categories. Data collection was carried out using the Nordic Musculoskeletal Questionnaire (NMQ) and the Graded Chronic Pain Scale (GCPS).

Results

A total of 74.4% of the entire sample of participants (male = 75%; female = 74%) reported lower back complaints throughout the past twelve months, and only 15.5% during the last seven days. A major part of complaints was classified as low intensity-low disability (Grade I, 62.8%; male = 72.6%; female = 54.2%). Under-20 competitors reported a small but significantly higher percentage of almost all NMQ measures compared to under-16 athletes.

Conclusions

This study found a relatively high prevalence of LBP, although complaints were of limited severity and did not affect climbers' regular training practice. Moreover, climbers did not differ in LBP prevalence according to sex, while climbers from the older age group reported higher complaints and seeking medical attention than younger climbers. Future studies should prospectively monitor the influence of climbing on LBP in youth climbers.

Injuries in Ballroom DanceSport: A Retrospective Study on Prevalence and Relation With Demographic Data

BACKGROUND

DanceSport is a variant of Ballroom dancing, a style that is performed as a couple dancing together. Although there are many participants worldwide, the amount of research on injuries done in this style of dancing is limited.

OBJECTIVE

The aim of this study was obtaining information about the DanceSport Athletes in the Netherlands including anthropometrics, level, frequency and duration of dance training per week. Our second objective was to investigate injury prevalence and type of injuries.

STUDY DESIGN

Retrospective questionnaire study.

METHODS

All 816 registered active dancers within the Dutch DanceSport Association received an online questionnaire with questions on anthropometrics, level of dancing, frequency and duration of dance training, and questions on injuries. The Chi-Square test was used to calculate differences between categorical variables.

RESULTS

A total of 218 dancers (33.7%) completed the questionnaire, 107 males (49.1%), and 111 females (50.9%). The mean age for men was 42 ± 15.9 and 36 ± 15.1 for women. 176 dancers (80.7%) reported 1 or more injuries. Foot, ankle, and lower leg injuries were reported most frequently, 49 males (45.8%), and 60 females (54.1%). No significant difference was found in the total number of injuries for the variables sex (P = .761) and discipline (P = .225). Significantly more head and neck injuries were identified in female Standard dancers (P < .001) compared to male dancers. Also, Standard dancers have more back injuries compared to dancers in both disciplines (P < .009).

CONCLUSION

With the described anthropometrics and an 80% lifetime prevalence of injuries, this group can be compared to other dance forms. Significant differences in injuries of the head and neck for female Standard dancers compared to male dancers and significantly more back injuries in Standard dancers compared to dancers in both disciplines were found. Future studies need to translate and validate existing questionnaires in Dutch for use in this population.

Biomechanical parameters of the golf swing associated with lower back pain: A systematic review

Low back pain (LBP) is the most common injury in golfers of all abilities. The primary aim of this review was to improve understanding of human golf swing biomechanics associated with LBP. A systematic review using the PRISMA guidelines was performed. Nine studies satisfying inclusion criteria and dually reporting golf swing biomechanics and LBP were identified. Human golf swing biomechanics potentially associated with LBP include: reduced lumbar flexion velocity; reduced transition phase length; reduced lumbar torsional load; earlier onset of erector spinae contraction; increased lumbar lateral flexion velocity; reduced or greater erector spinae activity; and earlier onset of external oblique contraction. These potential associations were undermined by a very limited and conflicting quality of evidence, study designs which introduced a severe potential for bias and a lack of prospective study design. There is no conclusive evidence to support the commonly held belief that LBP is associated with "poor" golf swing technique. The potential associations identified should be further investigated by prospective studies of robust design, recruiting participants of both sexes and dexterities. Once firm associations have been identified, further research is required to establish how this knowledge can be best integrated into injury prevention and rehabilitation.

Instruments for assessing back pain in athletes: A systematic review

Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.

The effect of gender, age and sports specialisation on isometric trunk strength in Greek high level young athletes

Aim of the study was to compare the isometric strength of flexors and extensors trunk muscles between male and female elite adolescent athletes of different age and training experience. Absolute and relative trunk muscle isometric peak extension (PTE) and flexion (PTF) torque, as well as flexion/extension (F/E) ratio were evaluated in 388 elite adolescent athletes 188 males (Age: 15.4±1.8 years, Body height: 175.5±11.2 cm, Body mass: 68.8±14.5 kg, BMI: 22.1±0.3 kg/m2) and 207 females (Age: 15.1±1.6 years, Body height: 166.8±7.8 cm, Body mass: 60.8±8.4 kg and BMI: 21.8±0.4 kg/m2). Participants were assigned into seven different groups according to their sport specialisation (oars-paddle, swimming, contact-combat, team, racket, winter and mixed other sports). Significant effect of age (η2: 0.077-0.112, p < 0.05), gender (η2: 0.020-0.077; p < 0.05) and sport category factors (η2: 0.057-0.154. p < 0.005) for absolute/relative PTE, PTF and F/E ratio was found. The highest values were observed in contact-combat and the lowest in mixed other sports groups. F/E ratio significantly differs between the age groups, especially in female athletes. The present data suggest that TMSs and F/E ratio are highly affected by age, gender and sports specialisation in high level trained adolescents.

What Factors Do Clinicians, Coaches, and Athletes Perceive Are Associated With Recovery From Low Back Pain in Elite Athletes? A Concept Mapping Study

OBJECTIVE: Identify factors that elite sport clinicians, coaches, and athletes perceive are associated with low back pain (LBP) recovery. DESIGN: Concept mapping methodology. METHOD: Participants brainstormed, sorted (thematically), and rated (5-point Likert scales: importance and feasibility) statements in response to the prompt, "What factors are associated with the recovery of an elite athlete from low back pain?" Data cleaning, analysis (multidimensional scaling, hierarchical cluster analysis, and descriptive statistics), and visual representation (cluster map and Go-Zone graph) were conducted following concept mapping guidelines. RESULTS: Participants (brainstorming, n = 56; sorting, n = 34; and rating, n = 33) comprised 75% clinicians, 15% coaches, and 10% athletes and represented 13 countries and 17 sports. Eighty-two unique and relevant statements were brainstormed. Sorting resulted in 6 LBP recovery-related themes: (1) coach and clinician relationships, (2) inter-disciplinary team factors, (3) athlete psychological factors, (4) athlete rehabilitation journey, (5) athlete non-modifiable risk factors, and (6) athlete physical factors. Participants rated important recovery factors as follows: athlete empowerment and psychology, coach-athlete and athlete-clinician relationships, care team communication, return-to-sport planning, and identifying red flags. CONCLUSION: Factors perceived as important to LBP recovery in elite athletes align with the biopsychosocial model of community LBP management. Clinicians should consider that an athlete's psychology, relationships, care team communication, and rehabilitation plan may be as important to their LBP recovery as the formulation of a diagnosis or the medications or exercises prescribed. J Orthop Sports Phys Ther 2023;53(10):1-16. Epub 10 August 2023. doi:10.2519/jospt.2023.11982.

Comparative Risk Analysis of Low Back Pain among Professional Football, Ice Hockey, and Floorball Athletes

BACKGROUND Low back pain (LBP) is a common concern among professional athletes, potentially hindering performance and career longevity. However, comparative assessments of LBP prevalence and severity across various sports remain scarce. This study aimed to evaluate the factors associated with LBP in 388 professional athletes, including football, ice hockey, and floorball players. MATERIAL AND METHODS Conducted from June 2021 to September 2022, this cross-sectional study incorporated 388 athletes from national elite clubs, including football (n=148), ice hockey (n=179), and floorball (n=61). The Oswestry Disability Index (ODI), comprising sections like pain intensity, self-care, lifting, walking, sitting, standing, sleeping, sexual life, social life, and traveling, was employed to evaluate spinal pain and disability. RESULTS The study found no significant disparities in the LBP assessment among the groups. The relative risk (OR) of LBP and disability varied among the sports: football players displayed a lower risk (OR=0.49; 95% CI 0.32-0.74, P≤0.001), while ice hockey players had a higher risk (OR=2.18; 95% CI 1.45-3.29, P≤0.001) compared to the others. In contrast, the risk for floorball players (OR=0.82; 95% CI 0.47-1.41) did not significantly deviate from that of the other two sports. CONCLUSIONS LBP prevalence stood at 42.6% for football players, 60.1% for ice hockey players, and 49.2% for floorball players. Among these, ice hockey players exhibited a 2.18-fold increased risk of developing LBP and associated disability when compared to their football and floorball counterparts.

Impact of Yoga as an Add-On Intervention on Neurocognitive Functions Among Adult Athletes: A Pilot Study

BACKGROUND

Athletes are vulnerable to musculoskeletal injuries and psychiatric conditions. Previous studies have reported the benefits of yoga on cognitive functions among healthy children, adults, and the elderly. This pilot study aimed to test the neurocognitive functions among athletes with/without yoga intervention.

METHODS

A non-randomized, two-armed parallel-group, single-blind comparative trial was used. The participants were grouped into (i) yoga with sports activity (YSA, n = 15) and (ii) sports activity alone (SA, n = 14). The subjects were assessed at the baseline and after a one-month intervention using digit span forward (DSF), digit span backward (DSB), Trail Making Test (TMT) A & B, and Rey Auditory Verbal Learning Test (RAVLT). A comprehensive one-hour yoga training three days a week for two months constitutes selected asanas (postures), pranayama (breathing techniques), relaxation techniques, and meditation techniques. The control group constitutes the routine sports activity for the same period.

RESULTS

A paired sample t-test showed a significant improvement in cognitive performance on TMT A & B duration and RAVLT total score in the YSA group compared with the SA group. However, a significant trend was observed for DSF, DSB, and RAVLT immediate recall. Independent sample t-test (pre-post change scores) showed no significant group difference in cognitive performance, except there was a significant trend observed related to DSF (p = 0.053) and RAVLT distraction (p = 0.09), where the yoga group showed better performance in cognitive functions.

CONCLUSION

The results suggest that yoga may be integrated with sports to enhance neurocognitive functions.

Low back pain in adolescent rowers: Association to muscle changes detected by magnetic resonance imaging

Adult elite rowers are at risk of developing low back pain (LBP). However, LBP data on adolescent elite rowers is currently insufficient. Therefore, the aim of this study was to assess LBP prevalence, LBP intensity and training characteristics in male adolescent elite rowers and a healthy control group. Twenty rowers (mean age 15.8 ± 1.2 years) and a non-athletic control group matched by age and gender (n = 13) were prospectively enrolled and underwent LBP assessment with a validated questionnaire and magnetic resonance imaging (MRI) of the lumbar spine muscles, which included a T2-mapping sequence. From the quantitative image data, T2 relaxation times were calculated. The prevalence of LBP in the last 24 hours and 3 months in the rowing group was 55.0% and 85.0%, respectively, compared to 23.1% and 30.8% in the control group (p < 0.001). Rowers had significantly longer T2 relaxation times of the paraspinal muscles compared to controls (p ≤ 0.041). LBP intensity was associated with longer T2 relaxation times (p < 0.001). Adolescent rowers had a higher prevalence of LBP compared to an age-matched control group. The observed increase in T2 relaxation might be explained by muscle soreness due to strenuous exercise, which is correlated with short-term pain intensity.

Epidemiology of Acute and Overuse Injuries in Underwater Rugby

Background

Underwater rugby (UWR) is a team sport. Athletes require a high degree of strength, endurance, speed, and coordination involving intense physical contact. Currently, a paucity of literature exists regarding injury occurrence in UWR.

Purpose

To examine the nature and prevalence of acute and overuse injuries in UWR.

Study Design

Descriptive epidemiology study.

Methods

Between November 2020 and March 2021, a total of 720 German UWR athletes were invited to take an online survey developed by orthopaedic specialists with UWR athletes. Data were recorded regarding general and health-related information, training habits, acute injuries that necessitated an interruption in training and/or doctor consultation, as well as overuse injuries. Overuse injuries were evaluated using the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire. Statistical analyses included t tests or rank sum tests depending on normality of distribution. A nonparametric Kruskal-Wallis 1-way analysis of variance on ranks was used for nonnormally distributed data among several groups.

Results

This study included 161 active athletes (mean ± SD, 36.1 ± 11.9 years old; 75.3% male) for analysis, of whom 90.1% were competing regularly. The performance-level distribution was as follows: first German national league (n = 73), second German national league (n = 46), state league (n = 17), district league (n = 1), and no league (n = 24). The mean ± SD sport-specific training workload was 5.6 ± 3.0 h/wk, including UWR training, additional swimming (n = 71; 44.1%), strength (n = 70; 43.5%), and/or endurance training (n = 102; 63.4%). Acute injuries were recorded in 78.9% of all athletes. The most typical locations for acute injuries were hand/finger (42.4%), head/face (concussion, ruptured eardrum; 18.1%), wrist (5.5%), or spine (5.0%). Overuse injuries were reported by 42.9% of the participants. The predominant locations for overuse injuries were hand/finger (18.8%), shoulder/clavicle (14.1%), spine and wrist (10.7% each), head/face (8.7%), and ankle joint and knee (6.7% each).

Conclusion

In the current study, 3 of 4 athletes reported at least 1 acute injury, and 2 of 5 athletes reported at least 1 overuse injury. Leading injury regions were the hand/finger, head/ear, wrist, and spine.

Prevalence and Risk Factors of Musculoskeletal Disorders in Basketball Players: Systematic Review and Meta-Analysis

Musculoskeletal disorders characteristically induce pain and limitations in mobility, ability, and overall functioning. In athletes, including basketball players, disorders such as back pain, postural changes, and spinal injuries are common. This systematic review aimed to evaluate the prevalence of back pain and musculoskeletal disorders in basketball players and ascertain the associated factors. Methods: The Embase, PubMed, and Scopus databases were searched for studies published in English without a time limit. Using STATA, meta-analyses were performed to estimate the prevalence of pain and musculoskeletal disorders of the back and spine. Results: Of the 4135 articles identified, 33 studies were included in this review, with 27 studies included in the meta-analysis. Of these, 21 were used for the meta-analysis of back pain, 6 articles were used for the meta-analysis of spinal injury, and 2 studies were used for the meta-analysis of postural changes. The overall prevalence of back pain was 43% [95% CI, -1% to 88%]; of these, the prevalence of neck pain was 36% [95% CI, 22-50%], the prevalence of back pain was 16% [95% CI, 4-28%], the prevalence of low back pain was 26% [95% CI, 16-37%], the prevalence of thoracic spine pain was 6% [95% CI, 3-9%]. The combined prevalence of spinal injury and spondylolysis was 10% [95% CI, 4-15%], with a prevalence of spondylolysis of 14% [95% CI, 0.1-27%]. The combined prevalence of hyperkyphosis and hyperlordosis was 30% [95% CI, 9-51%]. In conclusion, we found a high prevalence of neck pain, followed by low back pain and back pain, in basketball players. Thus, prevention programs are important to improve health and sports performance.

Differences in the elastic modulus of the lumbar muscles between female athletes with and without low back pain

BACKGROUND

Low back pain is the most prevalent musculoskeletal disorder affecting performance and sports participation among athletes and is more prevalent among female athletes. Evaluating the stiffness of the lumbar muscles is important for understanding the pathophysiology of low back pain. Therefore, this study examined the differences in stiffness of the lumbar multifidus and erector spinae muscles between female university athletes with and without low back pain.

METHODS

This was a cross-sectional study. The study was conducted at a single centre, the university research laboratory. Twenty female university athletes with low back pain or a history of low back pain and 20 without low back pain participated in this study. The shear elastic moduli of the multifidus and erector spinae muscles were evaluated in the prone (to relax the muscles) and sitting with 35° of trunk flexion (to stretch the muscles) positions using shear wave ultrasound imaging equipment.

FINDINGS

The low back pain group showed significantly greater shear elastic modulus in the multifidus in both prone and sitting positions than the non-low back pain group. There were no differences in the erector spinae muscle between the two groups at either position.

INTERPRETATION

These results provide new insights into the microscopic characteristics of low back pain pathophysiology in young female athletes. Stiffness assessment using shear wave elastography will help provide a specific treatment strategy for female athletes with low back pain or a history of low back pain.

Functional Movement Patterns, Spinal Posture and Prevalence of Musculoskeletal Symptoms among Elite Ice Hockey Players: A Cross Sectional Study

The aim of this study was to evaluate functional movement patterns and spinal posture of elite ice hockey players and to examine the association between spinal posture, prevalence of musculoskeletal symptoms and Functional Movement Screen (FMSTM) scores. The study included 86 elite male ice hockey players aged 18 to 38 years. Sagittal spinal curvatures were measured with a Saunders digital inclinometer, and functional movement patterns were assessed by the FMSTM. Spinal posture of the studied ice hockey players was characterized by normal kyphosis (46%) or hyperkyphosis (41%) and decreased lumbar lordosis (54%). The mean total FMSTM score was 14.8. Most of the hockey players (57%) achieved a total FMSTM score in the range of 14-17 points, whereas 28% had a total FMSTM score of <14. Seventy-two percent of the studied athletes had at least one asymmetry. Significant differences between performing the movements on the right and the left sides of the body were observed in in-line lunges (p = 0.019) and shoulder mobility sub-tests (p < 0.001). The FMSTM sub-tests performed with the lowest success rates were rotatory stability and the hurdle step. A lower score in the rotatory stability test is related to shoulder pain. It is highly important to develop appropriate exercise programs to reduce or prevent muscle imbalances in ice hockey players.

Integration of yoga within exercise and sports science as a preventive and management strategy for musculoskeletal injuries/disorders and mental disorders - A review of the literature

OBJECTIVES

Exercise-induced musculoskeletal injuries/disorders and associated mental disorders are prevalent among athletes. The main objective of this review is to analyze the prospects of Yoga practices as a preventive and management strategy for musculoskeletal injuries/disorders and associated mental disorders often encountered in exercise and sports activities.

METHODS

A review of the literature was performed using electronic databases such as MEDLINE/PubMed and google scholar published between January 1991 and December 2021 which yielded 88 research articles. The keywords used were yoga OR exercise AND musculoskeletal injuries OR disorders, yoga OR exercise AND mental disorders, yoga AND sports injuries, yoga AND stress, yoga OR exercise AND oxidative stress, yoga OR exercise AND inflammation, yoga OR exercise AND diet.

RESULTS

The moderate and regular exercises are beneficial to health. However, high intensity and overtraining physical activities lead to immune suppression, oxidative stress, muscle damage/fatigue, coronary risk, psychiatric disorders and so on due to enormous strain on various physiological functions. Yoga seems to undermine these adverse activities through up-regulating the functions of the parasympathetic nervous system (PNS) and down-regulating the activities of hypothalamohypophysial axis (HPA) which are conducive to healing, recovery, regeneration, reduction in stress, relaxation of mind, better cognitive functions, promotion of mental health, reduction in inflammation and oxidative stress, and so on.

CONCLUSION

Literature suggests that Yoga should be integrated within exercise and sports sciences mainly to prevent & manage musculoskeletal injuries/disorders and associated mental disorders.

Musculoskeletal pains among amateur and professional athletes of five disciplines in Senegal: a preliminary study

BACKGROUND

Musculoskeletal pains (MSPs) in sport are cause of poor performances and loss of competition in athletes. The present study aimed at determining the prevalence of MSPs with regard to sport disciplines and athletic status.

METHODS

A cross-sectional study was conducted among 320 Senegalese professional and amateur athletes practicing football, basketball, rugby, tennis, athletics, and wrestling. Rates of MSPs in the past year (MSPs-12) and week (MSPs-7d) were assessed using standard questionnaires.

RESULTS

Overall proportions of MSPs-12 and MSPs-7d were 70 and 74.2%, respectively. MSPs-12 were more frequently reported on shoulders (40.6%), neck (37.1%) and hips/thigh (34.4%), while MSPs-7d were predominant on hips/thigh (29.5%), shoulders (25.7%), and upper back (17.2%). Proportions of MSPs-12 and MSPs-7d varied significantly by sport disciplines, with highest values among basketball players. Again, highest MSPs-12 proportions on shoulders (29.7%, P = 0.02), wrists/hands (34.6%, P = 0.001), (40.2%, P = 0.0002), and knees (38.8%, P = 0.002) were seen among basketball players. High proportions of MSPs-7d were seen on shoulders (29.6%, P = 0.04) for tennis players, wrists/hands (29.4%, P = 0.03) for basketball and football players, and hips/thigh (38.8%, P < 0.00001) for basketball players. Football players had reduced risk of MSPs-12 by 75% on lower back (OR = 0.25; 95% CI. 0.10-0.63; P = 0.003) and by 72% on knees (OR = 0.28; 95% CI. 0.08-0. 95; P = 0.04). In contrast, tennis players were more at risk of MSPs-12 on shoulders (OR = 3.14; 95% CI. 1.14-8.68; P = 0.02), wrists/hands (OR = 5.18; 95% CI.1.40-11.13; P = 0.01), and hips/thigh (OR = 2.90; 95% CI. 1.1-8.38; P = 0.04). Professionals were protected from MSPs-12 on neck pain with a significant reduction of risk by 61% (OR = 0.39, 95% CI. 0.21-0.75, P = 0.03).

CONCLUSION

MSPs are a reality among athletes and their risk is modulated by sport disciplines, athletic status and gender.

Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review

BACKGROUND

Upper and lower limb (peripheral) pain is prevalent in athletes. Contemporary research prioritises multidimensional pain assessment and classification. This study aims to review comprehensive athlete pain assessment practices against the reference standard (International Olympic Committee, IOC Athlete Pain framework), identifying trends and highlighting gaps.

METHODS AND ANALYSIS

Six databases were searched using a comprehensive search strategy. This review followed the Joanna Briggs Institute standardised methodology for scoping reviews and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Title and abstract, full-text screening and data charting were completed by two independent reviewers.

INCLUSION CRITERIA

Original research, systematic reviews and clinical practice guidelines reporting assessment or classification of pain in athletes of any age with chronic or acute peripheral pain in English on human participants from database inception.

RESULTS

470 studies with 175 different pain assessment tools were mapped against the IOC Athlete Pain Framework. Papers included tools from neurophysiological (470/100%), biomechanical (425/90%), affective (103/22%), cognitive (59/13%) and socioenvironmental (182/39%) domains. Pain classification was included in 108 studies (23%). 4 studies (0.85%) defined pain. Athletes with physical disability were included in 13 (3%) studies and no studies included athletes with intellectual disabilities. Socioeconomic factors were addressed in 29 (6%) studies.

DISCUSSION

Neurophysiological and biomechanical domains are frequently addressed. Affective, socioenvironmental and cognitive tools are under-represented. Potential tools for use by researchers and clinicians are highlighted. Defining and classifying pain and determining predominant pain mechanisms is needed in both research and clinical practice. More work on underrepresented populations is needed.

CONCLUSION

This review informs researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and highlights future priorities.

Examining the Peer-Reviewed Published Literature Regarding Low Back Pain in Rowing: A Scoping Review

Background

Low back pain (LBP) is highly prevalent in the rowing population. The body of existing research variously investigates risk factors, prevention, and treatment methods.

Purpose

The purpose of this scoping review was to explore the breadth and depth of the LBP literature in rowing and to identify areas for future research.

Study Design

Scoping review.

Methods

PubMed, Ebsco and ScienceDirect were searched from inception to November 1, 2020. Only published, peer-reviewed, primary, and secondary data pertaining to LBP in rowing were included for this study. Arksey and O'Malley's framework for guided data synthesis was used. Reporting quality of a subsection of the data was assessed using the STROBE tool.

Results

Following the removal of duplicates and abstract screening, a set of 78 studies were included and divided into the following categories: epidemiology, biomechanics, biopsychosocial, and miscellaneous. The incidence and prevalence of LBP in rowers were well mapped. The biomechanical literature covered a wide range of investigations with limited cohesion. Significant risk factors for LBP in rowers included back pain history and prolonged ergometer use.

Conclusion

A lack of consistent definitions within the studies caused fragmentation of the literature. There was good evidence for prolonged ergometer use and history of LBP to constitute risk factors and this may assist future LBP preventative action. Methodological issues such as small sample size and barriers to injury reporting increased heterogeneity and decreased data quality. Further exploration is required to determine the mechanism of LBP in rowers through research with larger samples.

EEG-based sensory testing reveals altered nociceptive processing in elite endurance athletes

Increased exercise loads, as observed in elite athletes, seem to modulate the subjective pain perception in healthy subjects. The combination of electroencephalography (EEG) and standardized noxious stimulation can contribute to an objective assessment of the somatosensory stimulus processing. We assessed the subjective pain ratings and the electroencephalogram (EEG)-based response after standardized noxious mechanical and thermal stimuli as well as during conditioned pain modulation (CPM) in 26 elite endurance athletes and compared them to 26 recreationally active controls. Elite endurance athletes had consistently stronger somatosensory responses in the EEG to both mechanical and thermal noxious stimuli than the control group. We observed no significant group differences in the subjective pain ratings, which may have been influenced by our statistics and choice of stimuli. The CPM testing revealed that our conditioning stimulus modulated the subjective pain perception only in the control group, whereas the EEG indicated a modulatory effect of the conditioning stimulus on the spectral response only in the athletes group. We conclude that a higher activation in the cortical regions that process nociceptive information may either be an indicator for central sensitization or an altered stimulus salience in the elite endurance athletes' group. Our findings from our CPM testing were limited by our methodology. Further longitudinal studies are needed to examine if exercise-induced changes in the somatosensory system might have a critical impact on the long-term health of athletes.

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

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

Body Composition Asymmetries in University Ice Hockey Players and Their Implications for Lower Back Pain and Leg Injury

ABSTRACT

Resta, T, Frenette, S, Rizk, A, and Fortin, M. Body composition asymmetries in university ice hockey players and their implications for lower back pain and leg injury. J Strength Cond Res 36(10): 2830-2836, 2022-Right to left asymmetries in body composition have been examined across many sports, suggesting possible implications for lower back pain (LBP) and decreased level of performance. However, we are not aware of any study that has examined the presence and implications of morphological asymmetries in ice hockey players. The purpose of this study was to (a) investigate body composition asymmetries in female and male university-level ice hockey players and (b) examine whether the degree of body composition asymmetry is associated with the history of LBP and lower-limb injury (LLI). A total of 32 players (female = 18, male = 14) were included in this cross-sectional study (e.g., university research center setting). Dual-energy X-ray absorptiometry (DEXA) was used to acquire body composition measurements. The parameters of interest included bone mass, lean body mass, and fat mass, for the right and left sides and body segments (e.g., arm, leg, trunk, and total), separately. The history of LBP and LLI was obtained using a self-reported demographic questionnaire. The statistical significance for the study was set at p < 0.05. Our findings revealed significant side-to-side asymmetry in arm and total bone mass in females, with higher values on the right side. Both males and females also had significantly greater trunk lean body mass on the left side. With the exception of greater arm bone mass asymmetry being associated with LBP in the past 3 months, there was no other significant association between the degree of asymmetry with LBP and LLI. This study provides novel data regarding the presence of asymmetry in body composition in university-level ice hockey players. Monitoring body composition in athletes provides information that can be used by athletic trainers and strength and conditioning coaches to develop injury prevention, performance optimization, and targeted rehabilitation programs.

Prevalence and risk factors of chronic low back pain in university athletes: a cross-sectional study

AIM

This study aimed to establish the prevalence of chronic low back pain (CLBP) in university-level athletes and to examine the influence of age, sex, body mass index (BMI), sports discipline, sleep, anxiety, and depression on CLBP. The secondary purpose was to check the association of certain variables in athletes having CLBP with the sports discipline and chronicity of LBP.

METHODS

A total of 340 players (100% response rate) from different sports, aged 18-30 years with at least 1 year of participation in sports at the university level were screened for the present study. The subjects completed a detailed, semi-structured questionnaire that gathered data regarding their demographic variables, personal and pain-related factors. The study was registered on the clinical trials registry, India (CTRI/2021/09/036675).

RESULTS

The results revealed the sport-wise point prevalence as follows: cricket (18.5%), basketball (15.6%), volleyball (20.0%), football (11.4%), badminton (7.7%) and tennis (7.7%). A higher number of years at university-level participation (>4 years), smoking, anxiety and BMI (>25 kg/m²) are risk factors for CLBP. The type of LBP, the intensity of the pain (current and last week), variation of the pain intensity, disability, intake of oral medications, physiotherapy for CLBP, number of missed days of training and number of missed matches are not significantly related to the chronicity of LBP or the sports discipline. Only the number of missed days of training had a significant association with the chronicity of LBP.

CONCLUSIONS

CLBP is a common complaint in Indian university athletes, and our findings indicate the necessity for a specific prevention program.

Effectiveness of Ultrasonography Visual Biofeedback of the Diaphragm in Conjunction with Inspiratory Muscle Training on Muscle Thickness, Respiratory Pressures, Pain, Disability, Quality of Life and Pulmonary Function in Athletes with Non-Specific Low Back Pain: A Randomized Clinical Trial

Diaphragmatic weakness and thickness reduction have been detected in athletes with lumbopelvic pain (LPP). Strength training of inspiratory muscles may be necessary for athletes with LPP. Inspiratory muscle training (IMT) and visual biofeedback by rehabilitative ultrasound imaging (RUSI) have been proposed as possible interventions. Here, we determine the effectiveness of visual biofeedback by RUSI with a proposed novel thoracic orthotic device to facilitate diaphragmatic contraction in conjunction with high-intensity IMT in athletes with non-specific LPP. A single-blinded, parallel-group, randomized clinical trial was performed (NCT04097873). Of 86 participants assessed for eligibility, 64 athletes with non-specific LPP (39 males and 25 females; mean age, 33.15 ± 7.79 years) were recruited, randomized, analyzed and received diaphragm visual biofeedback by RUSI in conjunction with high-intensity IMT (RUSI+IMT; n = 32) or isolated high-intensity IMT (IMT; n = 32) interventions for 8 weeks. Diaphragmatic thickness during normal breathing, maximum respiratory pressures, pain intensity, pressure pain threshold on lumbar musculature, disability by the Roland−Morris questionnaire, quality of life by the SF-12 questionnaire and spirometry respiratory parameters were assessed at baseline and after the 8-week intervention. There were significant differences (p = 0.015), within a medium effect size (Cohen’s d = 0.62) for the forced expiratory volume in 1-s (FEV1), which was increased in the RUSI+IMT intervention group relative to the IMT alone group. Adverse effects were not observed. The rest of the outcomes did not show significant differences (p > 0.05). Diaphragm visual biofeedback by RUSI with the proposed novel thoracic orthotic device in conjunction with high-intensity IMT improved lung function by increasing FEV1 in athletes with non-specific LPP.

Perturbation-based trunk stabilization training in elite rowers: A pilot study

Introduction

Low back pain is a major health issue in elite rowers. High training volume, frequent flexion movements of the lower spine and rotational movement in sweep rowing contribute to increased spinal strain and neuropathological patterns. Perturbation-based trunk stabilization training (PTT) may be effective to treat neuromuscular deficits and low back pain.

Methods

All boat classes (8+, 4+/-, 2-) of the male German national sweep rowing team participated in this non-randomized parallel group study. We included 26 athletes (PTT: n = 12, control group: n = 14) in our analysis. Physical and Sports therapists conducted 16 individualized PTT sessions á 30–40 minutes in 10 weeks, while the control group kept the usual routines. We collected data before and after intervention on back pain intensity and disability, maximum isometric trunk extension and flexion, jump height and postural sway of single-leg stance.

Results

We found less disability (5.3 points, 95% CI [0.4, 10.1], g = 0.42) for PTT compared to control. Pain intensity decreased similar in both groups (-14.4 and -15.4 points), yielding an inconclusive between-group effect (95% CI [-16.3, 14.3]). Postural sway, strength and jump height tend to have no between- and within-group effects.

Conclusion

Perturbation-based trunk stabilization training is possibly effective to improve the physical function of the lower back in elite rowers.

A Scoping Review of Injuries in Amateur and Professional Men’s Ice Hockey

Background:

Orthopaedic injuries are common in ice hockey at all levels and can result in physical and psychological adverse effects on these athletes.

Purpose:

Primarily, to summarize published data on orthopaedic hockey injuries at the junior through professional level. Secondarily, to characterize the literature based on anatomic site injured, return-to-play rates, cause/mechanism of injury, time lost, and treatments used.

Study Design:

Scoping review; Level of evidence, 4.

Methods:

PubMed, EMBASE, Cochrane library, and SCOPUS were searched using the terms “hockey” and “injuries” using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and 4163 studies involving orthopaedic injuries were identified. Our inclusion criteria consisted of accessible full-text articles that evaluated orthopaedic injuries in men’s ice hockey athletes of all levels. We excluded case reports and articles evaluating women’s ice hockey injuries, as well as those evaluating nonorthopaedic injuries, such as concussions; traumatic brain injuries; and facial, dental, and vascular injuries, among others. Studies were divided based on level of play and anatomic site of injury. Level of evidence, year published, country of corresponding author, method of data collection, incidence of injury per athlete-exposure, and time lost were extracted from each article.

Results:

A total of 92 articles met the inclusion criteria and were performed between 1975 and 2020, with the majority published between 2015 and 2020. These were divided into 8 anatomic sites: nonanatomic-specific (37%), intra-articular hip (20.7%), shoulder (9.8%), knee (8.7%), trunk/pelvis (7.6%), spine (7.6%), foot/ankle (6.5%), and hand/wrist (2.2%). Of these studies, 71% were level 4 evidence. Data were obtained mostly via surveillance programs and searches of publicly available information (eg, injury reports, player profiles, and press releases).

Conclusion:

This scoping review provides men’s hockey players and physicians taking care of elite ice hockey athletes of all levels with a single source of the most current literature regarding orthopaedic injuries. Most research focused on nonanatomic-specific injuries, intra-articular hip injuries, knee injuries, and shoulder injuries, with the majority having level 4 evidence.

Chronic low back pain is associated with impaired bed turning ability: Evaluation by a mobility detection system

BACKGROUND

We aimed to assess and compare kinetics and kinematic variables of bed turning ability using a mobility detection system in patients with and without chronic low back pain and to observe the impacts of the disease on bed turning kinetics and kinematics.

METHODS

Thirty-five patients with chronic low back pain were enrolled and compared to healthy controls (n = 34). Pain scores and disability level were assessed by Numeric Pain Rating Scale and the function questionnaires including Oswestry Disability Index and Roland Morris Disability Questionnaire. Bed turning ability was tested using the Mobile Detection System. Univariate and multivariate regression analysis were applied to compare the differences between groups.

FINDINGS

Patients with chronic low back pain had significantly lower turning over and back force/weight ratio (p < 0.001) than those healthy controls. Turning over time was significantly longer in patients with Numeric Rating Scale score 3 than in those with Numeric Rating Scale score 2 (p = 0.015). Turning over and back force were significantly higher in male patients and patients with higher BMI after adjusting BMI and sex, respectively (all p < 0.001). When turning back, chronic low back pain patients with Numeric Rating Scale scores of 3 had lower turning back force/weight ratio than those with Numeric Rating Scale scores of 2 (p = 0.014). Male patients had higher turning back force/weight ratio after adjusting pain score (p = 0.001).

INTERPRETATION

The novel Mobility Detection System can provide more objective assessments of bed turning kinetics and kinematics in patients with chronic low back pain.

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

BACKGROUND

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

HYPOTHESIS

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

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL RELEVANCE

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

Assessment and classification of peripheral pain in athletes: a scoping review protocol

Pain is often presumed to be part of the sport injury experience. The time-loss definition of injury leads to under-reported athletic pain impacting performance and quality of life. Whilst research regarding the assessment and classification of back pain in athletes is emerging, little has been reported regarding how peripheral pain is assessed and classified in research and practice. Six databases will be searched for relevant articles. Title and abstract screening followed by full-text screening will be completed by two independent reviewers. Data charting will be carried out using a modified standardised form. Descriptive results and frequencies will be reported. Pain measures identified in the studies will be mapped against the IOC Athlete Pain Framework alongside a narrative summary. Published peer-reviewed primary research studies alongside systematic reviews and clinical practice guidelines reporting the assessment or classification of pain in athletes of any age with chronic or acute peripheral pain across all study contexts in the English language on human participants from inception of the databases will be included. The results of this study are part of a body of research which will be used to inform the development of a pain assessment framework. The scoping review will be submitted for peer-reviewed journal publication and presented at sports medicine conferences. This review will inform researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and positioned against the IOC Athlete Pain Framework.

Acute Effects of Aerobic Exercise on Muscle Strength and Power in Trained Male Individuals: A Systematic Review with Meta-analysis

BACKGROUND

Concurrent training can be an effective and time-efficient method to improve both muscle strength and aerobic capacity. A major challenge with concurrent training is how to adequately combine and sequence strength exercise and aerobic exercise to avoid interference effects. This is particularly relevant for athletes.

OBJECTIVE

We aimed to examine the acute effects of aerobic exercise on subsequent measures of muscle strength and power in trained male individuals.

DESIGN

We performed a systematic review with meta-analysis.

DATA SOURCES

Systematic literature searches in the electronic databases PubMed, Web of Science, and Google Scholar were conducted up to July 2021.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included that applied a within-group repeated-measures design and examined the acute effects of aerobic exercise (i.e., running, cycling exercise) on subsequent measures of lower limb muscle strength (e.g., maximal isometric force of the knee extensors) and/or proxies of lower limb muscle power (e.g., countermovement jump height) in trained individuals.

RESULTS

Fifteen studies met the inclusion criteria. Aerobic exercise resulted in moderate declines in muscle strength (standardized mean difference [SMD] = 0.79; p = 0.003). Low-intensity aerobic exercise did not moderate effects on muscle strength (SMD = 0.65; p = 0.157) while moderate-to-high intensity aerobic exercise resulted in moderate declines in muscle strength (SMD = 0.65; p = 0.020). However, the difference between subgroups was not statistically significant (p = 0.979). Regarding aerobic exercise duration, large declines in muscle strength were found after > 30 min (SMD = 1.02; p = 0.049) while ≤ 30 min of aerobic exercise induced moderate declines in muscle strength (SMD = 0.59; p = 0.013). The subgroup difference was not statistically significant (p = 0.204). Cycling exercise resulted in significantly larger decrements in muscle strength (SMD = 0.79; p = 0.002) compared with running (SMD = 0.28; p = 0.035). The difference between subgroups was statistically significant (p < 0.0001). For muscle power, aerobic exercise did not result in any statistically significant changes (SMD = 0.04; p = 0.846).

CONCLUSIONS

Aerobic exercise induced moderate declines in measures of muscle strength with no statistically significant effects on proxies of muscle power in trained male individuals. It appears that higher compared with lower intensity as well as longer compared with shorter aerobic exercise duration exacerbate acute declines in muscle strength. Our results provide evidence for acute interference effects when aerobic exercies is performed before strength exercises. These findings may help practitioners to better prescribe single training sessions, particularly if environmental and/or infrastructural reasons (e.g., availability of training facilities) do not allow the application of strength training before aerobic exercise.

Triathlon Considerations

Triathlon is an increasingly popular sport that includes swimming, cycling, followed by running. The triathlete should not be seen merely as a cyclist who also swims and runs. Notable differences are seen in the type of bike used, training patterns, lower extremity demands, and cumulative nature of the sport. Injury prevention and treatment strategies need to take into account the triathlon distance, the type of bike used, athletic experience, prior injuries, risk factors, and a thorough understanding of the demands placed on the body through all 3 disciplines (swim, bike, and run).

Prevalence and Incidence of Injury during Olympic-style Shooting Events: A Systematic Review

BACKGROUND

Shooting sports are included in collegiate and Olympic events. However, there is minimal evidence examining injury prevalence and incidence for these athletes.

HYPOTHESIS/PURPOSE

The purpose of this study was to systematically review the literature to examine the available evidence regarding the incidence, prevalence, and types of injuries that affect athletes in Olympic-style shooting events.

STUDY DESIGN

Systematic review.

METHODS

The electronic databases PubMed, Cochrane Library, Cinahl, MEDLINE, and SPORTDiscus were searched utilizing terms related to shooting and injuries. Studies were included if they reported prevalence or incidence of injury in collegiate or Olympic shooting events, and were excluded if inclusion criteria were not met, full text was unavailable, or not in English. Two reviewers independently screened articles in two phases: 1) screening of titles/abstracts 2) full text review. A third reviewer resolved conflicts.

RESULTS

Nineteen studies were ultimately included. The sports identified were biathlon, rifle, pistol, and shotgun. Shooting events in both winter and summer Olympics had low percentages of injuries compared to other sports. Winter shooting events had a higher percentage of injuries (6.9%) compared to summer (2.3%). In summer, females demonstrated a higher percentage of injuries (6.9%) compared to males (1.7%). In winter, males had a higher percentage of injuries (8.6%) versus females (5.1%).

CONCLUSION

Injury incidence and prevalence was low for athletes in shooting sports in the Olympics. Injury rate was higher in the winter Olympic shooting events likely from increased physiological demand. With injury surveillance focusing on acute injuries rather than chronic, the number of injuries may be underestimated. Females had higher injury rates than males in the summer Olympics while the opposite was observed in the winter Olympics, likely from sex differences and differences in physiological demand for each event.

LEVEL OF EVIDENCE

Level 3.

Low Back Pain in Young Sports Players: A Cross-sectional Study in Japan

STUDY DESIGN

A cross-sectional study.

OBJECTIVE

The purpose of this large cohort study was to assess the prevalence of low back pain (LBP) among young players participating in several types of sports.

SUMMARY OF BACKGROUND DATA

LBP is a significant problem among young sports players. Sport discipline among young players is thought to be associated with LBP. However, similar previous studies did not specifically analyze LBP by age and sex.

METHODS

A cross-sectional study was conducted with young sports players (ages 6-15 years, n = 7277) using a self-reported questionnaire. The prevalence of LBP was assessed using the variables of age, sex, and sport discipline.

RESULTS

The point prevalence of LBP among young sports players was 5.0%. The participants between 6 and 8 years' old had the lowest prevalence of LBP (0.4%-1.3%), which increased with aging and reached the highest proportion of 13.5% to 14.8% at 13 to 14 years. Furthermore, female players had significantly higher proportions of LBP than male players (8.1% vs. 3.7%). Regarding sport discipline, the prevalence of LBP was higher in basketball, handball, and volleyball.

CONCLUSION

The prevalence of LBP among young sports players was different for age, sex, and sport discipline. Further studies are needed to clarify the association of sport-specific movements to LBP in each sport discipline. This may assist in developing programs or strategies for preventing LBP among young sports players.Level of Evidence: 3.

Spinal and Pelvic Kinematics During Prolonged Rowing on an Ergometer vs. Indoor Tank Rowing

ABSTRACT

Trompeter, K, Weerts, J, Fett, D, Firouzabadi, A, Heinrich, K, Schmidt, H, Brüggemann, GP, and Platen, P. Spinal and pelvic kinematics during prolonged rowing on an ergometer vs. indoor tank rowing. J Strength Cond Res 35(9): 2622-2628, 2021-This investigation aimed to compare spinopelvic kinematics during rowing on an ergometer vs. in a rowing tank and to evaluate changes with progressing fatigue. Spinal and pelvic kinematics of 8 competitive scull rowers (19.0 ± 2.1 years, 179.9 ± 7.6 cm, and 74.8 ± 8.1 kg) were collected during 1 hour of rowing on an ergometer and in a rowing tank using a routine training protocol. Kinematics of the upper thoracic spine, lower thoracic spine, lumbar spine, and pelvis were determined using an infrared camera system (Vicon, Oxford, United Kingdom). There was a greater lumbar range of motion (ROM) and less posterior pelvic tilt at the catch during rowing on the ergometer compared with in the rowing tank (p = 0.001-0.048), but no differences in pelvic ROM. In the rowing tank, the pelvic ROM increased over time (p = 0.002) and the ROM of the lower thoracic spine decreased (p = 0.002). In addition, there was an extended drive phase (when the rower applies pressure to the oar levering the boat forward) and an abbreviated recovery phase (setting up the rower's body for the next stroke) in the rowing tank (p = 0.032). Different rowing training methods lead to differences in spinopelvic kinematics, which may lead to substantially different spinal loading situations. Greater pelvic rotation and lesser lumbar ROM are considered ideal; therefore, the present results indicate that rowing in the rowing tank might facilitate the maintenance of this targeted spinopelvic posture, which might help protect the lower back. Rowers, coaches, and researchers should consider the differences between rowing training methods, especially when giving training recommendations.

Concurrent Validity and Reliability of Manual Versus Specific Device Transcostal Measurements for Breathing Diaphragm Thickness by Ultrasonography in Lumbopelvic Pain Athletes

The use of rehabilitative ultrasound imaging (RUSI) to evaluate diaphragm thickness during breathing in athletes who suffer from non-specific lumbopelvic pain presents some measurement errors. The purpose of this study was to evaluate intra- and inter-sessions, intra- and inter-rater reliabilities, and concurrent validity of diaphragm thickness measurements during breathing using transcostal RUSI with a novel thoracic orthotic device that was used to fix the US probe versus those measurements obtained using manual fixation. A total of 37 athletes with non-specific lumbopelvic pain were recruited. Intra- (same examiner) and inter-rater (two examiners) and intra- (same day) and inter-session (alternate days) reliabilities were analyzed. All measurements were obtained after manual probe fixation and after positioning the thoracic orthotic device to fix the US probe in order to correctly correlate both measurement methods. Both left and right hemi-diaphragm thickness measurements were performed by transcostal RUSI at maximum inspiration, expiration, and the difference between the two parameters during relaxed breathing. Intra-class correlation coefficients (ICC), standard errors of measurement (SEM), minimum detectable changes (MCD), systematic errors, and correlations (r) were assessed. Orthotic device probe fixation showed excellent reliability (ICC = 0.852-0.996, SEM = 0.0002-0.054, and MDC = 0.002-0.072), and most measurements did not show significant systematic errors (p > 0.05). Despite manual probe fixation with a reliability ranging from good to excellent (ICC = 0.714-0.997, SEM = 0.003-0.023, and MDC = 0.008-0.064 cm), several significant systematic measurement errors (p < 0.05) were found. Most significant correlations between both orthotic device and manual probe fixation methods were moderate (r = 0.486-0.718; p < 0.05). Bland-Altman plots indicated adequate agreement between both measurement methods according to the agreement limits. The proposed novel thoracic orthotic device may allow ultrasound probe fixation to provide valid and reliable transcostal RUSI measurements of diaphragmatic thickness during relaxed breathing thus reducing some measurement errors and avoiding systematic measurement errors. It may be advisable to measure diaphragm thickness and facilitate visual biofeedback with respect to diaphragm re-education during normal breathing in athletes with non-specific lumbopelvic pain.

Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training

While competitive training is usually associated with the prevalence of back pain and injuries in athletes, little attention is being paid to the positive effects of sport-specific exercises on core musculature in the prevention of back problems. This scoping review aims (i) to map the literature that addresses the effects on reduction of back problems following athlete training with differing demands on the core musculature and (ii) to identify gaps in the existing literature and propose future research on this topic. The main literature search was conducted on the MEDLINE, PubMed, Web of Science, Scopus, and Cochrane Library databases and was completed on Elsevier, SpringerLink, and Google Scholar. A total of 21 research articles met the inclusion criteria. The findings of 17 studies identified that core strengthening and core stabilization exercises, alone or in combination with athlete training, contribute to the reduction of back pain in athletes, whereas only four studies revealed no significant association of core muscle strength and/or endurance with back problems. Nevertheless, more research is warranted to elucidate the pros and cons of purely sport-specific training with differing demands on the core musculature on back health in athletes. This could help us to design prevention strategies specifically tailored to individual athletes.

Rehabilitation and return to sport of a high-level track & field athlete with low back pain - a case report

INTRODUCTION: Low back pain is prevalent among elite athletes with initial high levels of physical activity. Currently, there is a lack of evidence describing the optimal management strategy of high-level track and field athletes presenting with low back pain. CASE DESCRIPTION: This case report describes the clinical management and return-to-sport strategies of a male high-level track and field athlete presenting with low back pain in an outpatient physiotherapy clinic. Mechanical diagnosis and therapy (MDT) served as an important tool in the clinical management of the athlete. Patient-Specific Function Scale (PSFS), an 11-point scale (0 = unable to perform activity to 10 = able to perform activity at preinjury level), was used during three activities: hammer throw, squats and getting socks and shoes on.OUTCOMES: Eight weeks after initial consultation (15 weeks after the index injury), the athlete returned to sport and competition at national championship-level. PFPS scores at final consultation: hammer throw - 10/10; squats - 10/10 and getting socks and shoes on - 10/10. CONCLUSION: In combination with modern rehabilitation strategies, MDT provided the opportunity to engage the athlete as an active collaborator, which is in accordance with current clinical guidelines and best practice.

Surgical Intervention for Femoroacetabular Impingement Can Lead to Improvements in Both Hip and Back Function in Patients With Coexisting Chronic Back Pain at 1-Year Follow-Up

PURPOSE

To determine whether patients with coexisting lumbar back pain experience back pain improvement after undergoing hip arthroscopy for femoroacetabular impingement (FAI).

METHODS

An institutional review board-approved retrospective chart review compared patients undergoing hip arthroscopy for FAI with lumbar spine back pain to patients solely reporting hip pain. The modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) were recorded preoperatively and at 1-year follow up. The Oswestry Disability Index score, which quantifies disability from lower back pain, and visual analog scale were recorded from the hip-spine cohort alone. Statistical analysis was performed using paired sample t tests with P ≤ .05 considered significant.

RESULTS

Sixty-eight patients who underwent hip arthroscopy between November 2016 and October 2018 were enrolled. Thirty-four patients with a mean age of 48.2 ± 14.0 years and body mass index of 26.6 ± 6.6 had a history of back pain and 34 patients were age- and sex-matched for the matched-control (MC) cohort. The MC cohort had lower mHHS and NAHS scores preoperatively. The MC cohort reported a larger increase in the mHHS (P = .01) and NAHS scores (P = .01) postoperatively. More patients in the MC cohort reached minimally clinically important difference with mHHS (P = .003) and NAHS (P = .06). Following surgery, the hip-spine cohort reported a lower Oswestry Disability Index score, indicating minimal disability (P = .01).

CONCLUSIONS

Surgical intervention for FAI can lead to improvements in hip and back pain in patients with coexisting lumbar pathology.

LEVEL OF EVIDENCE

III, retrospective comparative study.

Lumbosacral injuries in elite Paralympic athletes with limb deficiency: a retrospective analysis of patient records

Background

Compared to injury data in able-bodied athletes, relatively little literature exists for Paralympic athletes. Injury data underpins the design and evaluation of injury prevention strategies in elite sport. The aim of this study was to investigate frequency, characteristics and management of lumbosacral injuries in elite athletes with limb deficiency.

Methods

A retrospective analysis of injuries in elite athletes with limb deficiency (2008 to 2017) was conducted using available data extracted from The English Institute of Sport (EIS) clinical records. Eligibility criteria: funded athletes, eligible for EIS physiotherapy support with full or partial limb deficiency. Data were analysed descriptively using frequencies.

Results

A total of 107 injuries from 32 athletes were included. Participants comprised 18 men (59%), from 9 sports, with mean age for index injuries of 27 years (range 18 to 38 years) and 15 with congenital limb deficiency (47%). Average number of index injuries for congenital and traumatic limb deficient groups were 13 and 19, respectively. Where injury onset was recorded (n=79), half of injuries occurred during training (40%, n=43). Arthrogenic structures accounted for 32.7% of injuries, myogenic 26.2%, with neurogenic, discogenic and osteogenic each <5%. The number of treatments delivered in each injury episode ranged from 1 to 43, with symptom resolution taking 2 to 439 days.

Conclusion

Elite athletes with limb deficiency experience lumbosacral injuries predominantly involving muscles and joints. While consistency and accuracy of data recording limits definitive conclusions, findings highlight the importance of precision in recording injury data as part of surveillance to enable implementation of effective injury prevention strategies.

Low back pain among Italian runners: A cross-sectional survey

BACKGROUND

Low Back Pain (LBP) is commonly reported as a very frequent disorder in sports, but its prevalence in runners remains unclear.

OBJECTIVES

To determine the prevalence of LBP in a wide sample of Italian runners.

DESIGN

A cross-sectional online survey.

SETTING

A national survey, according to the CHERRIES and STROBE guidelines, was performed in 2019.

PARTICIPANTS

2539 Italian runners.

METHODS

A sample of Italian runners registered with national running associations was recruited. The survey was conducted using an online survey development platform. The questionnaire was self-reported and included 38 questions.

MAIN OUTCOME MEASURES

Descriptive statistics and frequencies were used to analyze results. Relationships between demographics, daily habits and running characteristics and the responses given was calculated with Cramer's V. Only correlation values higher >0.60 were deemed of interest.

RESULTS

2539 questionnaires (63.5%) were valid for analysis. In total, 22.6% of runners reported having experienced LBP in the past year. Most participants (77.0%) reporting episodes of LBP believed it was not caused by running. No significant correlations (Cramer's V < 0.60) were found between LBP and demographics, training characteristics or lifestyle habits.

CONCLUSION

The prevalence of LBP among Italian runners was 22,57%. LBP was not associated with training, equipment or lifestyle.