The elite young athlete: strategies to ensure physical and emotional health

Athlete Mental Health and Wellbeing During the Transition into Elite Sport: Strategies to Prepare the System

The transition into elite-level sport can expose young athletes to risk factors for mental ill-health, including increased performance expectations, stressors associated with becoming increasingly public figures, and changes in lifestyle demands, such as diet, training loads and sleep. Successful integration into elite-level sport requires athletes to quickly adapt to these newfound challenges and the norms and culture of the new sport setting, while developing relationships with teammates, coaches, and support staff. Despite these demands, the mental health experiences of athletes transitioning into elite-level sport have been largely neglected in sport psychology literature. This is reflected in the dearth of programs for supporting mental health during this career phase, particularly relative to retirement transition programs. In this article, we offer a preliminary framework for supporting athletes' mental health during the transition into elite-level sport. This framework is based on holistic, developmental, and ecological perspectives. Our framework outlines a range of recommendations for promoting mental health and preventing mental ill-health, including individual-level, relational, sport-level, and sociocultural-level strategies. Key recommendations include preparing athletes for the challenges they are likely to face throughout their athletic careers, highlighting athletes' competence earlier in their careers, developing supportive relationships in the sport setting, and fostering psychologically safe sporting cultures. Supporting mental health from earlier in the athletic career is likely to promote athletes' overall wellbeing, support enjoyment and retention in sport, and encourage help-seeking.

Changes in Sports Participation, Specialization, and Burnout From 7th to 12th Grade: Final Results From a 6-Year Longitudinal Study

BACKGROUND

Previous studies show alarming rates of burnout and dropout from sports participation and physical activity in the youth population. Early sports specialization may increase the risk of injury, burnout, and eventual dropout from sports.

HYPOTHESIS

Sports participation will decrease, specialization will increase, and burnout will increase from junior high to high school.

STUDY DESIGN

Prospective longitudinal study.

LEVEL OF EVIDENCE

Level 2b.

METHODS

The graduating class of 2023 was surveyed longitudinally in the fall of each school year from 7th to 12th grade (n = 35-77 from middle to high school based on new enrollment participants and attrition). Survey questions asked about sports participation, specialization, and burnout. Responses were analyzed by grade level using mixed effects linear and logistic regression accounting for repeated measures.

RESULTS

The number of days per week in which students engaged in at least 60 minutes of strenuous exercise progressively decreased from 7th through 12th grade from 4.0 to 2.3 days per week (P < 0.01). The percentage of students participating in sports also decreased from 7th to 12th grade from 82% to 39% (P < 0.01). More students stopped participating in a sport (38% vs 22% to 29%, P = 0.04), quit a sport to focus on a single sport (60% vs 46% to 49%, P = 0.01), or reported that 1 sport was most important to them (71% vs 54% to 67%, P = 0.06) in 9th grade. Burnout in sports did not differ significantly by grade level (19% to 23%, P > 0.99). In contrast, burnout in school was significantly more common in high school (54% to 69%) compared with middle school (36%, P < 0.01). Burnout in school was higher in female students compared with male students (68% vs 38%, P < 0.01).

CONCLUSION

Organized sports participation and general physical activity decreased from middle to high school, with the entry into high school at 9th grade being a time at which a significant number of students dropped other sports to specialize in a single sport or stopped participating. Burnout in sports did not appear to increase with age; however, there was an increase in school-related burnout as students transitioned from middle to high school.

CLINICAL RELEVANCE

Our results highlight the need for continued research into sports participation, specialization, and burnout in adolescents. In addition, health professionals and the community (parents, coaches, teachers) supporting youth athletes may consider positive interventions during the periods of transition from middle to high school to include facilitating different tracks of sports participation (including a developmental or recreational model of play) to reduce dropout from sport and supportive measures to lessen burnout from sports and from school.

Mental Health in Elite Coaches

CONTEXT

Coaches play an important role in promoting mental health in elite sports. However, they themselves are exposed to risks affecting their mental health, and their fears and worries are often overlooked. Moreover, it remains unclear how coaches' mental health affects their athletes' mental health.

OBJECTIVE

To create a compilation of the literature on (1) elite coaches' mental health and (2) how coaches' mental health influences elite athletes' mental health. Building on this, recommendations for improving coaches' psychological well-being should be elaborated upon and discussed.

DATA SOURCES

A literature search was conducted up to November 30, 2021, using the following databases: PubMed, PsycINFO, Scopus, Web of Science, and SportDiscus.

STUDY SELECTION

Studies reporting elite coaches' mental health symptoms and disorders and the influence of elite coaches' mental health on elite athletes' mental health were included.

STUDY DESIGN

Scoping review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data regarding elite coaches' mental health, as well as their influence on athletes' mental health and performance, were included in a descriptive analysis. The PRISMA guidelines were used to guide this review.

RESULTS

Little research has been done on elite coaches' mental health disorders, although studies confirm that they do experience, for example, symptoms of burnout, anxiety, and depression. The influence of coaches' mental health on their athletes is underinvestigated, with research focused mainly on the influence of coaches' stress.

CONCLUSION

Knowledge about coaches' mental health is still limited. Coaches' poor mental health diminishes coaching performance and might impair athletes' mental health. Coaches should receive more support, including sports psychiatric care and education on the importance of mental health. This could improve the mental health of both coaches and athletes, and positively affect athlete performance.

What is it like to be a sport school student-athlete? A mixed method evaluation of holistic impacts and experiences

Assessing the holistic impact of student-athletes within sport schools is important due to the increasing popularity of sport school programmes, the likelihood that most youth athletes do not ultimately succeed in their sport and the multiple and wide ranging positive and negative impacts associated with intensified youth sport. Therefore, this study, using a mixed method design, aimed to evaluate the 'in-time' holistic impacts and experiences of being a sport school student-athlete. Five data collection methods (i.e., online questionnaire, physical fitness testing battery, academic assessments grades, injury data and log diaries) were used to assess athletic, academic, psychological and psychosocial holistic impacts and experiences of 83 student-athletes from one sport school in the United Kingdom (UK). Due to the mixed method approach, a triangulation design was used whereby quantitative and qualitative data were firstly analysed separately and then integrated and presented together. Overall, the findings demonstrated there were a multitude of positive impacts and experiences associated with being a sport school student-athlete. These included: high average academic attainment, satisfaction with academic support, sport competence, all-round sport development, higher general and sport specific recovery than stress, inter- and intra-personal development, social support, positive peer and parent relationships and dual career motivation. However, impacts and experiences of concern were also apparent including: participation in sport external to the school context, difficulty balancing education and sport, academic lessons missed, injury, fatigue, lack of free time, extra-curricular and social sacrifice, social intensity and body image concerns. Large inter-individual variability was demonstrated across all data analyses highlighting the variable nature of the impacts and experiences of being a sports school student-athlete. Overall, sport schools have the potential to promote many positive holistic impacts, however stakeholders need to be aware, monitor and mitigate the potential negative impacts. Flexible development programmes, individualised support and student-athlete monitoring are essential features required of sport schools to ensure healthy and holistic development for all sport school student-athletes.

Coaches' experiences of injury prevention in youth elite athletes: An interview study of 10 coaches

INTRODUCTION

Injury prevention is important to reduce the high injury risk in youth elite athletes studying at sports high schools. Coaches are considered important in youth elite sports and injury prevention.

OBJECTIVES

The aim was to investigate perceptions and experiences of injury prevention among coaches at sports high schools.

METHODS

A manifest qualitative content analysis with an inductive approach was used based on ten semi-structured interviews with coaches who work at sports high schools.

RESULTS

An overarching theme "Coaches of youth athletes value injury prevention but have limited knowledge and support" was identified and five main categories were formed. Coaches perceived themselves to play an important role in injury prevention, yet they described limited time for knowledge acquisition and highlighted the close collaboration with other professions as a key in injury prevention.

CONCLUSION

A coach's knowledge and support are critical factors in injury prevention of youth elite athletes. Evidence-based as well as non-evidence-based approaches are used, and the biopsychosocial perspective was not always taken into consideration. A need for more interprofessional collaboration and knowledge acquisition regarding injury prevention is warranted.

Athletic Burnout and Its Association with Diet in Children and Adolescents

Children today are constantly exposed to several risk factors and high levels of stress that can impact their mental, emotional, and physical health, which can trigger burnout. The objective of this study was to determine the prevalence and frequency of burnout in young amateur athletes and to study the role of the Mediterranean diet on burnout risk. An observational, cross-sectional, and descriptive study of 183 basketball players between 8 and 15 years old was carried out. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire and the risk of burnout was assessed with the Athlete Burnout Questionnaire. Medians, minimums and maximum values for quantitative variables and absolute frequencies and percentages for qualitative variables were obtained. The results show a higher percentage of burnout among girls. The children who meet the established threshold for burnout spend more time watching television. Participants with better adherence to the Mediterranean diet have lower burnout values in both genders and those with a higher risk of burnout have a worse adherence to the Mediterranean diet. Therefore, it is important to implement a balanced diet appropriate to the individual needs of the athlete.

Macronutrient intake as a prospective predictor of depressive symptom severity: An exploratory study with adolescent elite athletes

BACKGROUND

Appropriate availability of macro- and micronutrients has an important impact on cognitive performance, mood and mental health. Although the critical role of nutrition for elite athletes' performance was recognized early on, little is known about whether consumption of specific macronutrients (carbohydrates, proteins, fat) predict the development of future depressive symptoms in adolescent elite athletes.

METHODS

Participants were recruited from three Swiss Olympic Partner Schools (SOPS) in the Northwestern German speaking part of Switzerland. A total of 97 adolescent elite athletes (38% girls, Mage = 16.35 ± 1.19) participated in the study. Depressive symptoms (PHQ9) were assessed at baseline and after 10 months follow-up. A 3-day food recall was completed three months after the baseline assessment. Linear regression analyses were used to examine whether macronutrients predict depression symptom severity after controlling for covariates and baseline depressive symptoms.

RESULTS

Higher protein consumption in athletes was a prospective predictor of lower depressive symptom severity at follow-up (β = -35, p < .05). Several deviations from recommended nutritional standards were observed in elite athletes.

CONCLUSIONS

The findings of this exploratory study support the notion that dietary behaviour may be prospectively associated with athletes' mental health. However, more research is required with larger samples and more in-depth assessment techniques. Future research should also examine whether nutrition education and dietary modification can be used to prevent depressive symptoms among adolescent elite athletes.

Psychological readiness to return to sports practice and risk of recurrence: Case studies

Returning to sport after the sports injury is a difficult decision because it's multicausal and the fact that a rash decision can result in numerous negative consequences. Given the importance of psychological variables for the correct rehabilitation of the injured athlete and his or her optimal return to sports practice, there seems to be little information on this subject. In this sense, the objective is to determine the relationship between the subjective psychological disposition of the athlete in the process of Return to Play (RTP) with the type of mood profile and his mental health. This is based on the fact that each athlete evaluates his or her recovery differently and has different levels of anxiety, depression, and stress. For this purpose, four athletes participated in the study. Two males and two females from the sports of indoor soccer and soccer, who had just returned to sports after a moderate or severe injury. The average age was 24.25 years. Various measurements were taken after practices and after matches, to assess mood, psychological readiness, anxiety, stress, and depression. The results confirm Morgan's iceberg profile and the influence that subjective psychological perceptions and assessed emotional states have on athletes' incorporation into their sports practice with a guarantee of success.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Development and test–retest reliability of the Combat Sports Post-Career Health Questionnaire (CSPCHQ)

The long-term impact of weight cycling on health status, eating habits, physical activity and the lifestyle of former combat sports athletes is still insufficiently explored. Therefore, a novel questionnaire in English, Portuguese, Spanish and Croatian language was constructed. To determine the reliability and the content/face validity, a total of 110 participants filled the questionnaire on two occasions. With the majority of intra-class correlation coefficient values above 0·75, the questionnaire items were shown to be very stable. Additionally, according to κ values, the questionnaire has fair test–retest reliability, with only one coefficient being labelled as poor (Q40 in ESP). All questionnaire sub-scales showed moderate to very good internal consistency when the overall sample was observed (α ranging from 0·605 to 0·802). Poor α values were found only in Godin-Shephard Leisure-Time Physical Activity Questionnaire for CRO and ESP samples. Wilcoxon’s signed rank test showed significant differences only in the Mindful Eating Questionnaire sub-scale scores (overall: P = 0·002, effect size = −0·208 [moderate]; CRO: P = 0·005, effect size = 0·303 [moderate]). It can be concluded that the newly developed questionnaire had strong test–retest reliability. Further validity research in a larger sample of former combat sports athletes should be considered.

Cardiac Structure and Function in Junior Athletes: A Systematic Review of Echocardiographic Studies

Background

In young athletes, the level of competitiveness in sports is increasing, as well as frequency and intensity of exercise training. Adaptations of the cardiac system to this increased workload imposed by exercise has not yet been studied sufficiently. In adults, studies point towards a shift from the functional athlete's heart towards pathological cardiac remodelling, with ventricular arrythmia and impaired cardiac function, that is exercise-related. This systematic review investigates cardiac adaptations to exercise in junior athletes compared to inactive controls.

Methods

Three electronic databases (PubMed/Medline, ScienceDirect and Web of Science) were searched for studies assessing 2-dimensional transthoracic echocardiography (2D TTE) and 2-dimensional speckle tracking echocardiography (2D STE) parameters in junior athletes, aged 7-19 years, compared to inactive controls. Data was screened and extracted by two reviewers; study quality and risk of bias was assessed by three reviewers.

Results

Eight out of 1460 studies met all inclusion criteria, with all studies reporting results on 2D TTE and six studies reporting results on 2D STE parameters in 540 (51 girls) junior athletes and 270 (18 girls) controls. There is evidence for structural cardiac adaptations of the left ventricle and both atria in junior athletes. Results regarding left ventricular function are controversial with a tendency to improved function in dynamic exercising athletes. Left ventricular mass and relative wall thickness point towards higher values in static exercising athletes.

Conclusions

Cardiac adaptations to exercise occur in children and adolescents. These adaptations are more pronounced in structural left ventricular parameters. Functional parameters are preserved or slightly improved in junior athletes but not impaired by exercise.

I. Shalfawi S. Progression in training volume and perceived psychological and physiological training distress in Norwegian student athletes: A cross-sectional study

This cross-sectional study examined self-reported weekly training volume and perceived training distress in Norwegian student athletes according to gender, type of sport, school program, and school year. The Norwegian version of the Multicomponent Training Distress Scale (MTDS-N) was completed by 608 student athletes (M age = 17.29 ± .94). Univariate and multivariate techniques were used in data analyses. Results revealed significant differences in weekly training volume between sport types. No significant differences in weekly training volume were found for gender, school year, or school program. However, a multivariate effect was found for gender, with females perceiving higher levels of training distress than males. A multivariate interaction effect between school year and training volume was also observed. We recommend that practitioners use a conceptual framework to periodize training and monitor training distress in student athletes, particularly in females, to preserve physiological and psychological well-being and ensure a progressive training overload leading to positive performance development.

Incidence of injuries in professional snow sports: A systematic review and meta-analysis

PURPOSE

The study aimed to conduct a comprehensive systematic review and meta-analysis of injury incidence in professional skiers and snowboarders.

METHODS

We systematically searched PubMed, Web of Science, and MEDLINE for studies on injury incidence published from inception to April 2020. Injury data were extracted, alongside information on injury location, severity, type, cause, and sport discipline. Incidence of injuries was presented per 1000 athlete-days, with 95% confidence intervals (95%CIs).

RESULTS

The search identified 462 articles, and 22 were included in our review. The overall incidence of injuries among professional skiers and snowboarders was 3.49 per 1000 athlete-days (95%CI: 2.97-4.01). Lower extremity had the highest injury incidence (1.54 per 1000 athlete-days, 95%CI: 1.24-1.84). Incidence rates of slight, mild, moderate, and severe injuries were 0.26, 0.31, 0.57, and 0.59 per 1000 athlete-days, respectively. Contusion had the highest incidence rate (1.82 per 1000 athlete-days, 95%CI: 1.01-2.63). The most common cause of injury was contact trauma (3.20 per 1000 athlete-days, 95%CI: 1.32-5.08). Freestyle skiing had the highest incidence rate (6.83 per 1000 athlete-days, 95%CI: 4.00-9.66), and Nordic skiing had the lowest rate (2.70 per 1000 athlete-days, 95%CI: 1.94-3.46).

CONCLUSION

Professional skiers and snowboarders have a substantial risk of sustaining injuries. Our findings can be used to inform the planning and provision of healthcare for elite participants in different snow sports.

Effect of workshops for coaches on the motor ability of balance in children practicing sports in late childhood

BACKGROUND

The coach attitude impacts the whole mind and body system of a child athlete from emotional and motivational aspects to motor skills like motor coordination. It translates into the ability to control and stabilize posture. The vestibular system plays an important role in this regulation. This system, next to the visual system and mechanoreceptors, is responsible for balance and control during posture transition. Moreover, the vestibular system is influenced by emotional factors. Therefore the authors of this study focused on the changes in the balance stability of children practicing sport after the implementation of the psychological workshops for coaches.

METHODS

Fifty-nine children at the age of 9-12 practicing soccer, art gymnastic and sport gymnastic were divided into two groups. The experimental group consisted of 31 participants and 28 in the control group. Experimental group children were under the influence of the 3 coaches who attended three workshops over 12 weeks period. Control group children were coached by 5 coaches who attended no workshops. Postural stability tests were performed on children before and after the workshops.

RESULTS

The statistically significant changes were observed in selected parameters of children's balance stability after the experiment. The significant difference between the experimental and control group in Overall Stability Index (OSI) (p < 0.0002), Anterior-Posterior Stability Index (AP) (p < 0.01), Medial-Lateral Stability Index (ML) (p < 0.01) with eyes open were observed after the experiment. The results show a significant deterioration in control group contrary to the experimental group where the improvement trend was observed. Moreover, the difference between the groups was observed in OSI parameter (p < 0.005) with eyes closed after the experiment.

CONCLUSION

The results obtained by the authors of the current study may support the thesis that educating coaches allows for better results in postural stability of child's athletes. Nevertheless, this thesis requires further research, with particular emphasis on the age and gender of young athletes.

Sport Psychiatry and Its Research Agenda

Athletes commonly experience mental health symptoms. However, prevalence estimates require refinement so that symptoms are interpreted in context and diagnostic labels are accurately applied. Further prevalence studies are also needed in subgroups within sport, in particular female athletes, athletes with disabilities, and coaches. Existing consensus-based and evidence-based therapies must be adapted not only to the individual athlete but also to the ecology of sports. Filling the gaps in our knowledge on what treatment modifications may be required for the individual athlete and how services should be designed to deliver treatment most effectively will require well-designed studies that use standardized terminology and defined outcome measures.

Dietary Intake and Daily Distribution of Carbohydrate, Protein and Fat in Youth Tennis Players over a 7-Day Training and Competition Period

During a 7-day training and/or competition period, macronutrient intake and distribution was assessed using food diaries, supported by remote food photography and 24-hr multiple pass recalls of youth tennis players categorised by under 12s, under 14s and under 16+ age groups (n = 27). Total energy did not differ between age groups nor type of day (training [TD], competition day [CD]), irrespective of a significant increase in body mass reported in the older players (U16+; p < 0.05). Average intakes were consistently below 2250 kcal·day-1 (range 1965 ± 317-2232 ± 612 kcal·day-1). Carbohydrate consumption was below guidelines for all groups (≤6g·kg-1). Conversely, protein intake met or exceeded guidelines throughout, with intakes ≥2 g·kg-1 for both the U12 and U14 age groups on both days. Protein intake was ~17% higher on TDs than CDs (p < 0.05), with protein intake at lunch significantly higher on TDs than CDs (p < 0.05). No further differences were observed between breakfast, lunch or dinner between group or day. Inconsistent snacking was reported, with players consuming snacks on less than half of the days reported (46 ± 12% of TDs and 43 ± 30% of CDs). In conclusion, youth tennis players present sub-optimal nutrition practices, appearing to under fuel and under consume carbohydrate for performance, adaptation, recovery and health.

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.

A Systematic Review on Markers of Functional Overreaching in Endurance Athletes

PURPOSE

The aim of this brief review was to present an overview of noninvasive markers in trained to professional endurance athletes that can reflect a state of functional overreaching.

METHODS

A systematic literature search was conducted in the PubMed, Scopus, and PsycINFO databases. After screening 380 articles, 12 research papers were included for the systematic review.

RESULTS

Good consensus was found between the different papers in which noninvasive parameters were able to reflect a state of functional overreaching. Changes in power output (PO), heart rate (HR; [sub]maximal and HR recovery), rating of perceived exertion, and scores in the Daily Analysis of Life Demands for Athletes (DALDA) and/or Profile of Mood States (POMS) were shown to be able to reflect functional overreaching, whereas changes in maximal oxygen uptake and HR-variability parameters were not.

CONCLUSION

Functional overreaching within a maximal performance test was characterized by a decrease in peak PO and a lower maximum HR, whereas a lower mean PO and a lower HR were observed during time trials. Changes in parameters during a standardized submaximal test when functionally overreached were characterized by a higher PO at a fixed HR or a lower HR at a fixed intensity, higher rating of perceived exertion, and a faster HR recovery. Although both the DALDA and POMS were able to reflect functional overreaching, the POMS was not able to differentiate this response from acute fatigue, which makes it unsuitable for accurately monitoring functional overreaching.

Troubleshooting a Nonresponder: Guidance for the Strength and Conditioning Coach

Ideally an athlete would continue to improve performance indefinitely over time, however improvement slows as the athlete approaches their genetic limits. Measuring performance is complex—performance may be temporarily depressed following aggressive training for multiple reasons, physiological and psychosocial. This reality may be vexing to the strength and conditioning coach, who, as a service provider, must answer to sport coaches about an athlete’s progress. Recently an evaluation mechanism for strength and conditioning coaches was proposed, in part to help coaches establish their effectiveness within the organization. Without formal guidance and realistic expectations, if an athlete is not bigger, leaner, stronger, etc. as a result of training within a specified timeframe, blame is often placed upon the strength and conditioning coach. The purpose of this article is to explore possible causes of what may be perceived as athlete non-responses to training and to provide guidance for the coach on how to handle those issues within their domain. A process of investigation is recommended, along with resources to assist coaches as they consider a broad range of issues, including enhancing existing testing methods, improving athlete behaviors, and adjusting processes designed to bring about performance improvement.

Off-training physical activity and training responses as determinants of sleep quality in young soccer players

This study aimed to quantify and assess the relationship of young soccer players' off-training physical activity (PA) and training responses on sleep quality. Eleven adolescent soccer players (13 ± 0.5 years old) were monitored during weekdays for four consecutive weeks, throughout soccer practice days. Off-training PA and sleep quality were assessed using 100 Hz tri-axial accelerometers and training responses analyzed using 20 Hz global positioning measurement units. A cluster analysis classified all cases into three different dimensions, (1) off-training PA, (2) training responses and (3) sleep quality. For each dimension, the most important variables for classifying the cases into clusters were sedentary PA and moderate-to-vigorous PA; total distance covered and impacts; and sleep onset latency and sleep fragmentation index, respectively. Afterwards, a correspondence analysis was used to identify whether off-training PA and training responses affected sleep quality. Results exposed that high to medium off-training PA combined with medium to high training responses may have decreased sleep quality. Conversely, no correspondence was observed between off-training PA and training responses, with higher sleep quality. This study emphasizes the importance of sports organizations adopting a holistic approach to youth soccer players' development, that appropriately considers the inter-relationship between lifestyle, performance and health-related information.

Caracterización psicosocial de deportistas y reconocimiento de la importancia del psicólogo deportivo

Objetivo. Desarrollar la caracterización psicosocial de un grupo de deportistas del departamento del Huila (Colombia), e identificar su percepción acerca de la labor del psicólogo deportivo. Método. Investigación descriptiva, transversal, en la que participaron 817 deportistas (72.3% hombres, edad promedio 17.26 años [DE = 4.28]). La información fue obtenida mediante un instrumento ad hoc de autorreporte, validado por expertos, guardando las consideraciones éticas del caso. Resultados. Se evidenciaron asociaciones significativas (p < 0.05) entre los factores psicológicos emocionales (principalmente ansiedad y estrés) y cognitivos (atención, concentración, cohesión, motivación, autoconfianza y cohesión), con las variables sexo, sometimiento a cirugías, trabajo actual, asociación a club deportivo, participación en competencias y acompañamiento con psicólogo deportivo. Muchos de los encuestados no tenían acceso a los profesionales en psicología deportiva, pero resaltaron su importancia para el mejoramiento del rendimiento deportivo. Conclusión. El estudio permitió tener una panorámica general de las condiciones sociodemográficas de los deportistas y de sus necesidades psicosociales. No obstante, se deben llevar a cabo ejercicios más rigurosos que permitan no solo establecer relaciones estadísticas entre las variables reportadas, sino también realizar intervenciones efectivas.

Youth Football Players' Psychological Well-Being: The Key Role of Relationships

Well-being in youth sport is a growing topic in literature. Practicing sports at a youth level is recognized as an important opportunity for growth and development but also an experience that conversely can prove to be tiring and cause discomfort. Sometimes expectations and pressures make it a risky experience. This is emphasized even more when looking at very popular and spectacular sports, such as football in some European Countries; practicing football often solicits the hope of becoming champions one day and thus being able living thanks to the beloved sport. How do young Italian football practitioners feel? What role do relationships with significant others belonging to the world of sport and extra-sport play on the well-being of young athletes? On which specific aspects of psychological well-being (PWB) are these relationships based? Are there any differences between elite and amateurs levels? These are the questions upon which this paper focuses, considering a sample of young Italian football practitioners. Analysis reveals a strong and positive influence of some dimensions of the relationships with significant others on PWB, specifically team effort, coach closeness, and parental learning climate. Moreover, elite players perceive significantly better relationships than sub-elite and amateurs and have significantly higher levels of PWB. Those results provide a first evidence for the importance of good relationships within and outside sport for an effective development of youth football players since they positively influence players' PWB, which is higher in elite players. It emerges the necessity to further investigate different aspects of PWB and to deepen the knowledge about the meaning of relationship in developmental athletes according to a psychosocial approach.

Stress, Professional Lifestyle, and Telomere Biology in Elite Athletes: A Growing Trend in Psychophysiology of Sport

Professional lifestyle and championship period often put a great deal of pressure on athletes, who usually experience highly stressful periods during training for competitions. Recently, biomarkers of cellular aging, telomere length (TL) and telomerase activity (TA), have been considered to investigate the effects of stress and lifestyle factors. Studies in non-athletic populations have shown that stress and poor lifestyle decrease TL and TA. On the other hand, it has been shown that in general, exercise increases TL and its activity, although the underlying mechanisms remained largely unexplored. TL and TA outcomes in elite athletes remain inconclusive and mainly affected by confounding factors, such as age. Elite athletes, therefore, might offer a unique target group for studying exercise-telomere hypothesis for further investigation of the roles of stressors on telomere-related biomarkers. In this perspective, we highlight the potentials for studying these psychophysiological markers in elite athletes in order to understand stress-aging relationship and potential underlying mechanisms. Moreover, we present important methodological aspects that could help in the development of future experimental designs.

The Association of Finger Growth Plate Injury History and Speed Climbing in Youth Competition Climbers

INTRODUCTION

Finger growth plate injuries are the most common injury among youth climbers, and the association between these injuries and speed climbing, a mandatory discipline in the 2021 Olympics, has not been examined previously. Our primary purpose was to examine the demographic and training characteristics of adolescent competition climbers who reported a history of a finger growth plate injury compared to those who did not report a history of a finger growth plate injury. Our secondary purpose was to determine whether training characteristics differed between adolescent competition climbers who did and did not report speed climbing.

METHODS

Our study was a cross-sectional study design. We surveyed adolescent climbers who competed in the 2017 USA Climbing Sport and Speed Youth National Championships. Questions assessed climbing injury history and current rock-climbing training characteristics.

RESULTS

Two-hundred sixty-seven adolescent competition climbers, 14±3 (9-18) y of age (mean±SD with range), completed the survey. Those with a history of a finger growth plate injury reported greater approximate time spent speed climbing throughout the year (β=1.28, 95% CI 0.11-2.46, P=0.032) and training regularly on the International Federation of Sport Climbing speed wall (adjusted odds ratio=3.95, 95% CI 1.14-13.7, P=0.031).

CONCLUSIONS

Training regularly at practices on the speed wall was associated with a self-reported history of finger growth plate injuries among elite youth competition climbers. Speed climbing should be limited, especially during periods of rapid growth.

Risk of Injuries Associated With Sport Specialization and Intense Training Patterns in Young Athletes: A Longitudinal Clinical Case-Control Study

BACKGROUND

There are no clinical longitudinal studies exploring the associations between sport specialization and intense training patterns and injuries in young athletes.

PURPOSE

To prospectively determine the relationship between young athletes' degree of sport specialization and their risk of injuries and reinjuries.

STUDY DESIGN

Case-control study; Level of evidence, 2.

METHODS

Young athletes aged between 7 and 18 years presenting for sports-related injuries or sports physical examinations were recruited from either sports medicine clinics or pediatric/family medicine offices. Each participant completed a baseline survey at enrollment and an identical follow-up survey every 6 months for 3 years. Surveys assessed training patterns and injuries. Injury type (acute, overuse, or serious overuse) and clinical diagnosis were also recorded from electronic medical records.

RESULTS

Of the 1208 participants who provided consent, 579 (48%) completed the baseline survey and first follow-up survey at 6 months (mean age, 14.1 ± 2.3 years; 53% female). Of this sample, 27% (158/579) of participants were uninjured, and 73% (421/579) were injured, with 29% (121/421) of injuries classified as reinjuries. Consistent with previous studies, over the 3-year study period, the degree of sport specialization had an effect such that more specialized athletes were significantly more likely to be injured (P = .03) or have an overuse injury (P = .02) compared with less specialized athletes after adjusting for potential confounders. Additionally, female athletes were more at risk for all injuries (P = .01) and overuse injuries (P = .02) after adjusting for covariates. Finally, young athletes who trained in weekly hours in excess of their age or who trained twice as many hours as their free play were significantly more likely to be injured on univariate analysis (both P < .001).

CONCLUSION

Our study confirms that over time, young athletes, and in particular young female athletes, were more likely to be injured and sustain an overuse injury if they had a higher degree of sport specialization. Similarly, those athletes whose training hours exceeded thair age or whose sports hours exceeded their free play by a factor of greater than 2 were also more likely to develop injuries and overuse injuries.

Use of PROMIS and Functional Movement System (FMS) Testing to Evaluate the Effects of Athletic Performance and Injury Prevention Training in Female High School Athletes

Two major health concerns with female high school athletes are: 1) psychosocial wellness, and 2) sports-related injuries. It is also known that these health concerns are much greater for minority students who attend high school in economically depressed cities. While it has been well-established that exercise is an effective intervention for these health concerns, there are no established outcome measures to quantitatively assess athletic performance and injury prevention training interventions in this population. Previously, we have demonstrated the utility of Patient-Reported Outcomes Measurement Information System (PROMIS) as a robust outcome measure following ACL reconstruction. Functional Movement Screening (FMS) has been used as a tool to determine injury risk in female collegiate athletes. Since these tools are broadly available, we completed a research study of urban underrepresented minority and suburban female high school athletes, to assess the feasibility and utility of these tools to measure changes in this population during 10-weeks of athletic training. No adverse events of the training or study were reported. A Kaplan-Meier assessment of the data revealed that there was high student retention throughout the 10 weeks. In addition, we found no difference in weekly attendance between the students that completed the intervention vs. the dropouts (while they were in the program), indicating that the students were highly motivated to attend when possible. While no significant differences were found for fatigue and physical function, the intervention significantly improved anxiety, peer relationships, pain interference, and trended towards significance for depression (p<0.05). In terms of physical performance, bench press, combined Pro Agility, and total FMS were all significantly improved (p<0.05). Surprisingly, there were 10 students (67%) in peril of sports- related injury (FM˂14) at the start of the intervention, and all but 1 (90%) eliminated this serious risk factor. Collectively, these results demonstrate the feasibility of PROMIS and FMS outcomes to assess the efficacy of physical training interventions, in underrepresented minority female high school students, which warrants investigation in a formal prospective study.

Identification of Potential Performance-Related Predictors in Young Competitive Athletes

Introduction

Systematic training is an essential demand for the individual success of an athlete. However, similar training modalities cause individual responses, and finally, decide on athletes’ success or failure. To predict performance development, potential influencing parameters should be known. Therefore, the purpose of this study was to identify performance-related parameters in young competitive athletes.

Methods

Individual performance developments of 146 young athletes (m: n = 96, f: n = 50, age V1: 14.7 ± 1.7 years) of four different sports (soccer: n = 45, cycling: n = 48, swimming: n = 18, cross-country skiing: n = 35) were evaluated by analysis of 356 visits in total (exercise intervention periods, 289 ± 112 d). At V1 and V2 several performance parameters were determined. Based on the relative performance progress (Δ), potential influencing predictors were analyzed: training load, health sense, stress level, clinical complaints, hemoglobin, vitamin D, hs-CRP and EBV serostatus. Data were collected within a controlled, prospective study on young athletes, which was conducted between 2010 and 2014.

Results

Athletes improved their performance by 4.7 ± 10.7%. In total, 66.3% of all athletes represented a positive performance progress. This group demonstrated, despite similar training loads (p = 0.207), enhanced health senses (p = 0.001) and lower stress levels (p = 0.002). In contrast, compared to athletes with an impaired performance progress, no differences in hemoglobin values (m: p = 0.926, f: p = 0.578), vitamin D levels (0.787) and EBV serostatus (p = 0.842) were found. Performance progress was dependent on extents of health senses (p = 0.040) and stress levels (p = 0.045). Furthermore, the combination of declined health senses and rised stress levels was associated with an impaired performance development (p = 0.018) and higher prevalences of clinical complaints (p < 0.001) above all, in contrast to hs-CRP (p = 0.168).

Discussion

Athletes with an improved performance progress reported less pronounced subjective sensations and complaints. In contrast, objective known performance-related indicators, offered no differences. Therefore, subjective self-reported data, reflecting health and stress status, should be additionally considered to regulate training, modify intensities, and finally, predict and ensure an optimal performance advance.

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

The current 'state of play' in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete's mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete's overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete's mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Influence of Vigorous Physical Activity on Structure and Function of the Cardiovascular System in Young Athletes-The MuCAYA-Study

Objective: Moderate physical activity (PA) is associated with a reduced risk to develop cardiovascular disease. However, junior athletes exercise between 10 and 20 h a week with intensities exceeding moderate levels by far. In this regard, the cardiovascular system has to increase its work five to six times compared to moderate intensities. This may result in potentially pathological adaptations of the cardiovascular system. The underlying process of vascular adaptations to exercise is yet not fully understood and hardly investigated in junior athletes. An increased blood pressure and pulse wave velocity, ventricular hypertrophy, arrhythmia, and even sudden cardiac death (SCD) has been reported in adult athletes. Studies, examining the cardiovascular system in children, its association to intensity and type of exercise, are rare. Therefore, we present the study protocol of a prospective cross-sectional study that investigates the influence of PA on the cardiovascular system in young athletes.

Methods and Design: Children and adolescents, 7–18 years, presenting for their annual pre-participation screening at the Institute of Preventive Pediatrics, Faculty of Sports and Health Sciences, Technical University of Munich (TUM), are examined in this prospective cross-sectional study. Vascular parameters measured by ultrasound are carotid intima-media thickness (cIMT), vascular stiffness (AC, Ep, β, PWV β), and the vascular diameter (D) to calculate the IMT:Diameter-Ratio (IDR). Cardiac function is evaluated by a 12-lead ECG, and echocardiographic parameters (end-diastolic left ventricular diameter, left ventricular diastolic posterior wall thickness, diastolic septal thickness, left ventricular mass and relative wall thickness, ejection fraction, and shortening fraction). A cardiopulmonary exercise test is performed on a bicycle ergometer, muscular strength is assessed with the handgrip test, and physical activity with the MoMo questionnaire.

Discussion: It is essential to follow young athletes over the course of their career in order to detect pathophysiological changes in the myocardium as soon as possible. If these changes are preceded or followed by changes in vascular structure and function is not known yet. Therefore, we present the study protocol of the Munich Cardiovascular adaptations in young athletes study (MuCAYA-Study) which investigates the association between vascular and cardiac adaptation to intensive exercise in junior athletes.

The Psychosocial Implications of Sport Specialization in Pediatric Athletes

Data on the psychosocial implications of sport specialization in pediatric athletes are lacking. Sport specialization often requires increased training hours and may predispose young athletes to social isolation, poor academic performance, increased anxiety, greater stress, inadequate sleep, decreased family time, and burnout. Sport specialization frequently introduces multiple stressors that could be expected to adversely affect mental health and function in young athletes and may increase the risk for burnout. This may be confounded by altered sleep duration and quality, increased drive for elite status, and perfectionistic personality types. The signs and symptoms of burnout in young athletes can be difficult to detect. It is important to be aware of the possible diagnosis of burnout in young athletes who display vague symptoms and a decrease in academic performance. The purpose of this review was to survey the available literature on sport specialization in young athletes and its association with mental health, sleep, the drive for success in sport, and burnout.

Effects and Dose-Response Relationship of Balance Training on Balance Performance in Youth: A Systematic Review and Meta-Analysis

BACKGROUND

Effects and dose-response relationships of balance training on measures of balance are well-documented for healthy young and old adults. However, this has not been systematically studied in youth.

OBJECTIVES

The objectives of this systematic review and meta-analysis were to quantify effects of balance training (BT) on measures of static and dynamic balance in healthy children and adolescents. Additionally, dose-response relations for BT modalities (e.g. training period, frequency, volume) were quantified through the analysis of controlled trials.

DATA SOURCES

A computerized systematic literature search was conducted in the electronic databases PubMed and Web of Science from January 1986 until June 2017 to identify articles related to BT in healthy trained and untrained children and adolescents.

STUDY ELIGIBILITY CRITERIA

A systematic approach was used to evaluate articles that examined the effects of BT on balance outcomes in youth. Controlled trials with pre- and post-measures were included if they examined healthy youth with a mean age of 6-19 years and assessed at least one measure of balance (i.e. static/dynamic steady-state balance, reactive balance, proactive balance) with behavioural (e.g. time during single-leg stance) or biomechanical (e.g. centre of pressure displacements during single-leg stance) test methods.

STUDY APPRAISAL AND SYNTHESIS METHODS

The included studies were coded for the following criteria: training modalities (i.e. training period, frequency, volume), balance outcomes (i.e. static and dynamic balance) as well as chronological age, sex (male vs. female), training status (trained vs. untrained), setting (school vs. club), and testing method (biomechanical vs. physical fitness test). Weighted mean standardized mean differences (SMD_wm) were calculated using a random-effects model to compute overall intervention effects relative to active and passive control groups. Between-study heterogeneity was assessed using I² and χ² statistics. A multivariate random effects meta-regression was computed to explain the influence of key training modalities (i.e. training period, training frequency, total number of training sessions, duration of training sessions, and total duration of training per week) on the effectiveness of BT on measures of balance performance. Further, subgroup univariate analyses were computed for each training modality. Additionally, dose-response relationships were characterized independently by interpreting the modality specific magnitude of effect sizes. Methodological quality of the included studies was rated with the help of the Physiotherapy Evidence Database (PEDro) Scale.

RESULTS

Overall, our literature search revealed 198 hits of which 17 studies were eligible for inclusion in this systematic review and meta-analysis. Irrespective of age, sex, training status, sport discipline and training method, moderate to large BT-related effects were found for measures of static (SMD_wm = 0.71) and dynamic (SMD_wm = 1.03) balance in youth. However, our subgroup analyses did not reveal any statistically significant effects of the moderator variables age, sex, training status, setting and testing method on overall balance (i.e. aggregation of static and dynamic balance). BT-related effects in adolescents were moderate to large for measures of static (SMD_wm = 0.61) and dynamic (SMD_wm = 0.86) balance. With regard to the dose-response relationships, findings from the multivariate random effects meta-regression revealed that none of the examined training modalities predicted the effects of BT on balance performance in adolescents (R² = 0.00). In addition, results from univariate analysis have to be interpreted with caution because training modalities were computed as single factors irrespective of potential between-modality interactions. For training period, 12 weeks of training achieved the largest effect (SMDwm = 1.40). For training frequency, the largest effect was found for two sessions per week (SMDwm = 1.29). For total number of training sessions, the largest effect was observed for 24-36 sessions (SMDwm = 1.58). For the modality duration of a single training session, 4-15 min reached the largest effect (SMDwm = 1.03). Finally, for the modality training per week, a total duration of 31-60 min per week (SMDwm = 1.33) provided the largest effects on overall balance in adolescents. Methodological quality of the studies was rated as moderate with a median PEDro score of 6.0.

LIMITATIONS

Dose-response relationships were calculated independently for training modalities (i.e. modality specific) and not interdependently. Training intensity was not considered for the calculation of dose-response relationships because the included studies did not report this training modality. Further, the number of included studies allowed the characterization of dose-response relationships in adolescents for overall balance only. In addition, our analyses revealed a considerable between-study heterogeneity (I² = 66-83%). The results of this meta-analysis have to be interpreted with caution due to their preliminary status.

CONCLUSIONS

BT is a highly effective means to improve balance performance with moderate to large effects on static and dynamic balance in healthy youth irrespective of age, sex, training status, setting and testing method. The examined training modalities did not have a moderating effect on balance performance in healthy adolescents. Thus, we conclude that an additional but so far unidentified training modality may have a major effect on balance performance that was not assessed in our analysis. Training intensity could be a promising candidate. However, future studies are needed to find appropriate methods to assess BT intensity.

Identifying Unique Contributions of the Coach-Athlete Working Alliance, Psychological Resilience and Perceived Stress on Athlete Burnout among Norwegian Junior Athletes

The main purpose of the current study was to examine how the coach-athlete working alliance, psychological resilience and perceived stress are uniquely associated with burnout among junior athletes in sport. A sample of 670 Norwegian junior athletes practicing a variety of sports participated in the study. A hierarchical multiple regression analysis showed that the bond dimension of the working alliance, the protective factors 'planned future' and 'structured style', as well as perceived stress, all contributed uniquely to the explanation of athlete burnout. A dominance analysis identified perceived stress to have the strongest relative influence on athlete burnout among the set of variables investigated in this study. The findings are discussed in terms of applied implications and possible future research.

The Power of Faith: The Influence of Athletes' Coping Self-Efficacy on the Cognitive Processing of Psychological Stress

Coping self-efficacy (CSE) has a positive mental health effect on athletes’ ability to cope with stress. To understand the mechanism underlying the potential impact of CSE, event-related potentials (ERPs) were used to explore the neural activity of the cerebral cortex under acute psychological stress in athletes with different CSE levels. Among 106 high-level athletes, 21 high-CSE athletes and 20 low-CSE athletes were selected to participate in the experiment. A mental arithmetic task was used to induce acute psychological stress. The results showed that high-CSE athletes responded more quickly than low-CSE athletes. In the stress response stage, the N1 peak latency of low-CSE athletes was longer than that of high-CSE athletes, and the N1 amplitude was significantly larger than that of high-CSE athletes. In the feedback stage, the FRN amplitude with error feedback of high-CSE athletes was larger than that of low-CSE athletes, and the P300 amplitude with correct feedback was larger than that with error feedback. The results indicate that high-CSE athletes can better cope with stressful events, adjust their behaviors in a timely manner according to the results of their coping, and focus more on processing positive information.

Intrinsic modifiable risk factors in ballet dancers: Applying evidence based practice principles to enhance clinical applications

INTRODUCTION

The risk of musculoskeletal injury is multifactorial (Bahr 2005). Injury risk is a composite of intrinsic and extrinsic risk factors that can be modifiable or non-modifiable. Ballet dancers have unique risk factors, due to the nature of their art and sport. The purpose of this literature review is to identify intrinsic modifiable risk factors for injury in ballet dancers. The secondary purpose is to investigate potential screening tools which can be used to identify these risk factors.

METHODS

The authors performed a review of the literature in October 2017 within the databases of MEDLINE Complete, SPORTDiscus, and PubMed Central following a list of inclusion and exclusion criteria.

RESULTS

A review of the available literature identified seven intrinsic modifiable factors specifically for ballet dancers and seven appropriate screening tools.

DISCUSSION

The literature identified the most common intrinsic modifiable risk factors associated with ballet dancers to be: hypermobility, fatigue, overuse, neuromuscular dysfunction, degree of turnout, weakness of core and lower extremity musculature, and lower extremity range of motion (ROM) discrepancies.

CONCLUSION

Sports medicine professionals who manage these performing artists can use this literature review to help develop injury prevention programs and enhance return to sport decision.

Unique Predictors of Sleep Quality in Junior Athletes: The Protective Function of Mental Resilience, and the Detrimental Impact of Sex, Worry and Perceived Stress

Since athletic development and functioning are heavily dependent on sufficient recuperation, sleep in athletes is becoming a topic of increasing interest. Still, existing scientific evidence points to inadequate sleep in athletes, especially in females. This may be due to the fact that sleep is vulnerable to disturbances caused by stress and cognitive and emotional reactions to stress, such as worry and negative affect, which may exacerbate and prolong the stress response. Such disturbing factors are frequently experienced by junior athletes aiming for performance development and rise in the rankings, but may be damaging to athletic progression. Based on limited research in non-athletic samples, mental resilience may protect individuals against the detrimental effects of stress on sleep. Therefore, the present study aimed to investigate the extent to which sex, mental resilience, emotional (negative affect) and cognitive (worry) reactions to stress, and perceived stress, uniquely contributed to sleep quality in a cross-sectional study including 632 junior athletes. A multiple hierarchical linear regression showed that females had poorer sleep quality than males, while the mental resilience sub-components Social Resources and Structured Style were positively associated with sleep quality, providing a protective function and thus preventing sleep quality from deteriorating. Simultaneously, worry, as well as perceived stress, were negatively associated with sleep quality. Together, the independent variables explained 28% of the variance in sleep quality. A dominance analysis showed that perceived stress had the largest relative relationship with sleep quality. Based on these results, close attention should be paid to athletes' abilities to manage worry and perceived stress, and the potential of mental resilience as a protective factor that could prevent sleep from deteriorating. The latter might be especially relevant for female athletes. Since performance margins are progressively becoming smaller and smaller, every improvement that adequate sleep can provide will be beneficial in terms of improved functioning and athletic performance.

Effects of stress and mental toughness on burnout and depressive symptoms: A prospective study with young elite athletes

OBJECTIVES

To examine in a sample of young elite athletes (a) the presence of clinically relevant symptoms of burnout and depression, and (b) a possible interaction of perceived stress and mental toughness in the prediction of burnout and depressive symptoms.

DESIGN

6-month prospective study.

METHODS

A representative sample of 257 young elite athletes (M=16.82years, SD=1.44, 36% females) was recruited in North-Western Switzerland. 197 athletes were followed-up across a 6-month period. Burnout was assessed with the Shirom-Melamed Burnout Measure (SMBM), and depression with the 9-item depression module of the Patient Health Questionnaire (PHQ). Values of ≥4.40 (SMBM) and >14 (PHQ-9) were considered indicative of clinically relevant burnout or depression. Stress perceptions were assessed with the Perceived Stress Scale (PSS), and mental toughness with the Mental Toughness Questionnaire (MTQ). Hierarchical regression analyses were used to test stress-buffering effects.

RESULTS

The percentage of athletes with clinically relevant levels of burnout and depressive symptoms was 12% and 9%, respectively. Both cross-sectional and prospective analyses showed that compared to participants with low mental toughness, those with higher mental toughness scores reported significantly fewer mental health issues, when exposed to high stress. By contrast, when stress levels were low, mental toughness was unrelated to psychological health complaints.

CONCLUSIONS

About every tenth young elite athlete reported burnout or depressive symptoms of potential clinical relevance. While high perceived stress was associated with increased psychological health complaints, mental toughness was able to off-set some of the negative consequences resulting from high stress exposure.

Training Load, Immune Status, and Clinical Outcomes in Young Athletes: A Controlled, Prospective, Longitudinal Study

Introduction: Beside positive effects on athlete's health, competitive sport can be linked with an increased risk of illness and injury. Because of high relative increases in training, additional physical and psychological strains, and an earlier specialization and professionalization, adolescent athletes needs an increased attention. Training can alter the immune system by inducing a temporary immunosuppression, finally developing infection symptoms. Previous studies identified Epstein Barr Virus (EBV) as potential indicator for the immune status. In addition to the identification of triggering risk factors for recurrent infections, the aim was to determine the interaction between training load, stress sense, immunological parameters, and clinical symptoms.

Methods: A controlled, prospective, longitudinal study on young athletes (n = 274, mean age: 13.8 ± 1.5 yrs) was conducted between 2010 and 2014. Also 285 controls (students, who did not perform competitive sports, mean age: 14.5 ± 1.9 yrs) were recruited. Athletes were examined 3 times each year to determine the effects of stress factors (training load: training hours per week [Th/w]) on selected outcome parameters (clinical [susceptibility to infection, WURSS-21: 21-item Wisconsin Upper Respiratory Symptom Survey], immunological, psychological end points). As part of each visit, EBV serostatus and EBV-specific IgG tiers were studied longitudinally as potential immune markers.

Results: Athletes (A) trained 14.9 ± 5.6 h weekly. Controls (C) showed no lower stress levels compared to athletes (p = 0.387). Twelve percent of athletes reported recurrent infections (C: 8.5%, p = 0.153), the presence of an upper respiratory tract infection (URTI) was achieved in 30.7%. EBV seroprevalence of athletes was 60.3% (C: 56.6%, p = 0.339). Mean EBV-specific IgG titer of athletes was 166 ± 115 U/ml (C: 137 ± 112 U/ml, p = 0.030). With increasing Th/w, higher stress levels were observed (p < 0.001). Analyzes of WURSS-21 data revealed no relationship to training load (p = 0.323). Also, training load had no relation to EBV serostatus (p = 0.057) or the level of EBV-specific IgG titers (p = 0.364).

Discussion: Young elite athletes showed no increased sense of stress, no higher prevalence of recurrent infections, and no different EBV-specific serological parameters compared to controls. Also, no direct relationship between training loads, clinical complaints, and EBV-specific immune responses was found. With increasing training loads athletes felt more stressed, but significant associations to EBV-specific serological parameters were absent. In summary, EBV serostatus and EBV-specific IgG titers do not allow risk stratification for impaired health. Further investigations are needed to identify additional risk factors and immune markers, with the aim to avoid inappropriate strains by early detection and following intervention.

Safety in Mixed Martial Arts: a 7-Year Review of Cancelled MMA Bouts in Calgary, Alberta, During the Pre-bout Medical Examination Period

BACKGROUND

Presently, there is no literature that examines the reasons for the cancellation of amateur or professional mixed martial arts (MMA) bouts. The purpose of this study was to review the circumstances that lead to the cancellation of MMA bouts by Calgary ringside physicians during the pre-bout examination period and to identify any emerging patterns that may guide the regulatoin of this sport.

METHODS

The case-series  was constructed from the Calgary Combative Sports Commission pre-bout examination records and the medical records submitted by each athlete from January 2010 to December 2016.

RESULTS

Cancelled bouts in the pre-bout examination periods represented 5.4% of all MMA bouts in Calgary. A total of 25 reasons lead to bout cancellation and included the following: failure to obtain required neuroimaging (28.0%), neuroimaging abnormalities (24.0%), incomplete routine screening investigations (16.0%), exceeding maximum weight differential between the two athletes (16.0%), injury in the pre-competition period (8.0%), dehydration (4.0%), and ECG abnormalities (4.0%). The abnormalities on neuroimaging (n of 6) included the following: post traumatic gliosis on MRI (n = 1, 16.7%), flares diffusely and findings consistent with microhemorrhage on MRI (n = 1, 16.7%), chronic orbital fracture with fat pad extrusion on CT (n = 2, 33.3%), lacunar infarct on MRI (1), and unspecified MRI abnormality (n = 1, 16.7%). Twenty-two athletes had bouts cancelled and of these three athletes had their bouts stopped for two reasons.

CONCLUSIONS

The following recommendations are presented and include: the creation of guidelines regarding pre- and post-bout neuroimaging, the implementation of industry-wide minimum medical screening standards, the adoption of a longitudinal approach to weight monitoring, the development of competent ringside physician groups, and active oversight by the Combative Sports Commission during the matchmaking process.

Specialization patterns across various youth sports and relationship to injury risk

OBJECTIVES

Current trends among young athletes towards earlier specialization age and year-round training on multiple teams has raised concern for increased injury risk. Our previous analyses showed higher risk for injury in highly specialized young athletes. The goal of this research was to determine whether sports specialization and injury patterns vary by sports type.

METHODS

In this clinical case-control study, injured athletes (aged 7-18 years) were recruited from sports medicine clinics and compared to similarly aged uninjured athletes recruited from primary care clinics. Participants completed a survey reporting age, gender, sport type, specialization patterns, and details regarding sports-related injuries in the previous 6 months. Clinical diagnoses were collected from patients' medical records. Injuries were classified as acute, overuse, or serious overuse.

RESULTS

Of 1,190 athletes enrolled, 26% (313) were single-sport specialized (reported participation in one sport and trained >8 months/year). Sports with the highest proportion of single-sport specialized athletes were tennis (46.7%), gymnastics (30.1%), and dance (26.3%). Single-sport specialized athletes in individual sports started specializing at a younger age (11.2 ± 2.4 vs. 12.0 ± 2.7, p = 0.05) and reported higher training volumes (11.8 vs. 10.3 h/week, p = 0.04) than those in team sports. Sports with the youngest specialization age were gymnastics (8.9 ± 1.7), dance (10.8 ± 3.0), and soccer (10.9 ± 2.4). Single-sport specialized athletes in individual sports accounted for a higher proportion of overuse injuries (44.3% vs 32.2%, OR = 1.67, p = 0.037) and serious overuse injuries (23.4% vs 11.6%, OR = 2.38, p = 0.011), but a lower proportion of acute injuries (28.8% vs 13.8%, OR = 0.37, p = 0.001) compared to single-sport specialized athletes involved in team sports.

CONCLUSIONS

Athletes in individual sports may be more likely to specialize in a single sport than team sport athletes. Single-sport specialized athletes in individual sports also reported higher training volumes and greater rates of overuse injuries than single-sport specialized athletes in team sports.