Headgear safety attitudes: a national survey of collegiate women's lacrosse stakeholders

Controversy exists among collegiate lacrosse about the use of headgear and whether its use will facilitate greater risk compensation by players and thus contribute to unsafe gameplay. We aimed to characterize the attitudes of headgear among women's collegiate lacrosse stakeholders. A total of 190 women's lacrosse stakeholders (players: n = 87; coaches: n = 71; officials: n = 32) participated in this study. Participants completed a survey surrounding attitudes of headgear in women's lacrosse. Descriptives, multiple regressions, and Kruskal-Wallis analyses compared attitudes surrounding headgear among stakeholder groups. Scales of Headgear Affects Play (β = -0.38, p < 0.001) and Sports Development and Safety Practices (β = 0.26, p < 0.05) significantly predicted endorsement on Headgear Safety Attitudes Scale. Among players, Aesthetics (β = 0.51, p < 0.001) and Intention to Wear Headgear (β = 0.31, p < 0.05) predicted endorsement on Headgear Safety Attitudes Scale. Stakeholders did not agree if headgear should be worn in women's lacrosse. Items related to sports development, safety and potential changes in gameplay predicted attitudes to headgear safety among all participants.

Functional Limitations Persist After Mild Sports-Related Traumatic Brain Injury

According to this study.

Essential elements of physical fitness analysis in male adolescent athletes using machine learning

Physical fitness (PF) includes various factors that significantly impacts athletic performance. Analyzing PF is critical in developing customized training methods for athletes based on the sports in which they compete. Previous approaches to analyzing PF have relied on statistical or machine learning algorithms that focus on predicting athlete injury or performance. In this study, six machine learning algorithms were used to analyze the PF of 1,489 male adolescent athletes across five sports, including track & field, football, baseball, swimming, and badminton. Furthermore, the machine learning models were utilized to analyze the essential elements of PF using feature importance of XGBoost, and SHAP values. As a result, XGBoost represents the highest performance, with an average accuracy of 90.14, an area under the curve of 0.86, and F1-score of 0.87, demonstrating the similarity between the sports. Feature importance of XGBoost, and SHAP value provided a quantitative assessment of the relative importance of PF in sports by comparing two sports within each of the five sports. This analysis is expected to be useful in analyzing the essential PF elements of athletes in various sports and recommending personalized exercise methods accordingly.

Microfluidics devices for sports: A review on technology for biomedical application used in fields such as biomedicine, drug encapsulation, preparation of nanoparticles, cell targeting, analysis, diagnosis, and cell culture

Microfluidics is an interdisciplinary field that combines knowledge from various disciplines, including biology, chemistry, sports medicine, fluid dynamics, kinetic biomechanics, and microelectronics, to manipulate and control fluids and particles in micron-scale channels and chambers. These channels and chambers can be fabricated using different materials and methods to achieve various geometries and shapes. Microfluidics has numerous biomedical applications, such as drug encapsulation, nanoparticle preparation, cell targeting, analysis, diagnosis, and treatment of sports injuries in both professional and non-professional athletes. It can also be used in other fields, such as biological analysis, chemical synthesis, optics, and acceleration in the treatment of critical sports injuries. The objective of this review is to provide a comprehensive overview of microfluidic technology, including its fabrication methods, current platform materials, and its applications in sports medicine. Biocompatible, biodegradable, and semi-crystalline polymers with unique mechanical and thermal properties are one of the promising materials in microfluidic technology. Despite the numerous advantages of microfluidic technology, further research and development are necessary. Although the technology offers benefits such as ease of operation and cost efficiency, it is still in its early stages. In conclusion, this review emphasizes the potential of microfluidic technology and highlights the need for continued research to fully exploit its potential in the biomedical field and sport applications.

Collegiate student-athletes concussion knowledge and attitudes: what a difference a decade Makes

OBJECTIVE

The purpose of this study was to assess changes in concussion knowledge and attitudes amongst incoming intercollegiate student-athletes over the course of a decade (2010-2012 vs 2021-2023).

METHODS

There were 592 student-athletes from 2 cohorts (2010-2012, 2021-2023) who completed the Rosenbaum Concussion Knowledge and Attitudes Survey (ROCKaS) questionnaire which is comprised of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. A three factor ANOVA (Group, Sex, Concussion History) compared performance on the CKI and CAI. Individual questions were compared between groups with a Chi-Square analysis.

RESULTS

For the CKI, there was a significant main effect for Group (2010-2012: 18.5 ± 2.6, 2021-2023: 19.4 ± 2.5, p < 0.001, η 2 = 0.032 ) . For the CAI, there was also a significant main effect for group (2010-2012: 52.9 ± 6.0, 2021-2023: 62.2 ± 6.5, p < 0.001, η 2 = 0.359 ) .

CONCLUSIONS

The results of this study show a modest increase in concussion knowledge; however, large improvements in concussion attitudes were observed between groups. These results suggest a continued improvement in student-athlete concussion awareness and provide specific areas to continue addressing persistent misconceptions.

[Research progress of magnesium and magnesium alloy implants in sports medicine]

Objective

To review the research progress of magnesium and magnesium alloy implants in the repair and reconstruction of sports injury.

Methods

Relevant literature of magnesium and magnesium alloys for sports injury repair and reconstruction was extensively reviewed. The characteristics of magnesium and its alloys and their applications in the repair and reconstruction of sports injuries across various anatomical sites were thoroughly discussed and summarized.

Results

Magnesium and magnesium alloys have advantages in mechanical properties, biosafety, and promoting tendon-bone interface healing. Many preclinical studies on magnesium and magnesium alloy implants for repairing and reconstructing sports injuries have yielded promising results. However, successful clinical translation still requires addressing issues related to mechanical strength and degradation behavior, where alloying and surface treatments offer feasible solutions.

Conclusion

The clinical translation of magnesium and magnesium alloy implants for repairing and reconstructing sports injuries holds promise. Subsequent efforts should focus on optimizing the mechanical strength and degradation behavior of magnesium and magnesium alloy implants. Conducting larger-scale biocompatibility testing and developing novel magnesium-containing implants represent new directions for future research.

A international cross-sectional study examining knowledge and attitudes towards sport-related concussion in Touch

OBJECTIVE

To determine the current level of knowledge and attitudes towards sport-related concussion (SRC) amongst key stakeholders in touch rugby.

DESIGN

An international cross-sectional study. Participants n = 141 (male, n = 88; female, n = 53) from 15 Touch Associations.

MAIN OUTCOME MEASURE

Online questionnaire including non-validated sections captured participant characteristics, first aid training, previous concussion, awareness of SRC guidelines, combined with Rosenbaum Concussion Knowledge and Attitudes Survey. Distributed online to Touch athletes internationally. Concussion knowledge index (CKI) and attitude index (CAI) scores were calculated. A linear regression was performed to determine whether awareness of concussion, previous concussion and role affected CKI and CAI scores.

RESULTS

Median CKI and CAI scores were 21 ± 2.0 and 67 ± 6.3, respectively, across all key stakeholders. 39% of participants reported a previous SRC and 32% of respondents were aware of concussion guidelines form their Association. Regression analysis showed minimal influence of key contextual information on CKI and CAI.

CONCLUSIONS

Findings suggest that key stakeholders in Touch have high to very high knowledge and safe attitudes towards SRC. However, there were some areas where further improvement could be targeted by those involved in Touch such as individual associations at the direction of the sport's governing body.

A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players

BACKGROUND

There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes.

HYPOTHESIS

Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes.

STUDY DESIGN

Cross-sectional survey.

LEVEL OF EVIDENCE

Level 4.

METHODS

An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups.

RESULTS

A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01).

CONCLUSION

While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points).

CLINICAL RELEVANCE

This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.

"Run-and-jump failure": new injury patterns in indoor bouldering

In recent years, professional and non-professional bouldering have seen a fundamental change in movement patterns towards complex movement sequences. This is associated with increased demands on the musculoskeletal system, especially the lower extremities, which can lead to new injury patterns. In the course of our clinical work, we have already seen an increasing number of lower extremity injuries after run-and-jump sequences, with a severe one being highlighted in this case report.

Gender and socioecological level differences in stakeholders' perceptions of athlete attrition factors in an Australian high-performance pathway system

OBJECTIVES

This study aimed to build on previous work by the authors. It examines how socioecological level and gender influence high-performance sport system (HPSS) stakeholders' perspectives of the relative importance and feasibility to address athlete attrition factors within an Australian high-performance pathway system (HPPS).

DESIGN

Mixed methods.

METHODS

Sub-analysis was conducted of rating data from 30 participants who had contributed to identifying 83 statements in 13 clusters in a previous Concept Mapping study. The 13 clusters were statistically analysed in 'R' using cumulative link mixed models (CLMMs) to determine differences in perceived importance and feasibility between 1) socioecological levels, and 2) genders.

RESULTS

Mean ratings for 11 and three of the 13 clusters were statistically significantly different between at least two of the five socioecological levels, for importance and feasibility, respectively. Athletes had the largest variation in mean ratings from the most (athlete health 4.59), to least (performance potential 2.83) important cluster, when compared to the other four socioecological levels. There were statistically significant differences between the ratings between genders (Men/Women) for two clusters for each rating scale: Importance: 'athlete health' (M3.33:W3.84 [p 0.012]); 'performance potential' (M3.35:W2.57; [p 0.001]), Feasibility: 'abuse and mismanagement of health' (M2.97:W3.68; [p 0.000]) and 'athlete health' (M2.54:W3.33; [p 0.000]).

CONCLUSIONS

This study highlights the need to implement more robust athlete attrition monitoring protocols. It also highlights the importance of listening to youth athletes' voices, and enabling equal gender representation to ensure holistically tailored environments are created to retain talented athletes in high-performance pathway programmes.

One-dimension statistical parametric mapping in lower limb biomechanical analysis: A systematic scoping review

BACKGROUND

Biomechanics significantly impacts sports performance and injury prevention. Traditional methods like discrete point analysis simplify continuous kinetic and kinematic data, while one-dimensional Statistical Parametric Mapping (spm1d) evaluates entire movement curves. Nevertheless, spm1d's application in sports and injury research is limited. As no systematic review exists, we conducted a scoping systematic review, synthesizing the current applications of spm1d across various populations, activities, and injuries. This review concludes by identifying gaps in the literature and suggesting areas for future research.

RESEARCH QUESTION

What research exists using spm1d in sports biomechanics, focusing on the lower limbs, in what populations, and what are the current research gaps?

METHODS

We searched PubMed, Embase, Web of Science, and ProQuest databases for the following search string: "(((knee) OR (hip)) OR (ankle)) OR (foot) OR (feet) AND (statistical parametric mapping)". English peer-reviewed studies assessing lower limb kinetics or kinematics in different sports or sports-related injuries were included. Reviews, meta-analyses, conference abstracts, and grey literature were excluded.

RESULTS

Our search yielded 165 papers published since 2012. Among these, 112 examined healthy individuals (67 %), and 53 focused on injured populations (33 %). Running (n = 45), cutting (n = 25), and jumping/landing (n = 18) were the most common activities. The predominant injuries were anterior cruciate ligament rupture (n = 21), chronic ankle instability (n = 18), and hip-related pain (n = 9). The main research gaps included the unbalanced populations, underrepresentation of common sports and sport-related injuries, gender inequality, a lack of studies in non-laboratory settings, a lack of studies on varied sports gear, and a lack of reporting standardization.

SIGNIFICANCE

This review spotlights crucial gaps in spm1d research within sports biomechanics. Key issues include a lack of studies beyond laboratory settings, underrepresentation of various sports and injuries, and gender disparities in research populations. Addressing these gaps can significantly enhance the application of spm1d in sports performance, injury analysis, and rehabilitation.

Preseason Measures of Cervical Spine Function, Vestibulo-Ocular Reflex, Dynamic Balance, and Divided Attention in Youth Ice Hockey Players

OBJECTIVES: Report typical scores and examine preseason cervical spine, vestibulo-ocular reflex, dynamic balance, and divided attention measures in competitive youth ice hockey players aged 10 to 18 years with and without a previous concussion history. DESIGN: Cross-sectional secondary analysis. METHODS: The exposure of interest was self-reported history of concussion. The main outcomes were cervical spine measures (Cervical Flexor Endurance [CFE; seconds], Cervical Flexion-Rotation Test [normal/abnormal], Anterolateral Cervical Spine Strength [kilograms], Head Perturbation Test (/8), and Joint Position Error [JPE; centimeters]), vestibulo-ocular reflex (Dynamic Visual Acuity [logMAR], Head Thrust Test [Positive/Negative]), dynamic balance (Functional Gait Assessment [/30]) and divided attention (Walking While Talking Test [seconds]). Multivariable linear or logistic regression, adjusted for age-group, sex, level of play, and clustered by team, were used to assess potential differences by concussion history. RESULTS: We included data from 2311 participants in this study (87.2% male, 12.8% female, 39.0% reported a previous concussion). No differences by concussion history were found across any of the measures (P values range: 0.17-0.99). Measures of cervical spine function and divided attention differed by age group (eg, Median Left Anterolateral Cervical Spine Strength [kilograms] for males: U13 = 7.46, U15 = 9.10, U18 = 9.67). CONCLUSION: Clinical outcomes scores in youth ice hockey players did not differ by concussion history. Performance on cervical spine strength, CFE, and JPE test outcomes may improve with age, highlighting the importance of developmental considerations when interpreting test scores. J Orthop Sports Phys Ther 2024;54(3):1-11. Epub 30 November 2023. doi:10.2519/jospt.2023.11958.

Trends in Presentation and Management of Pediatric Renal Trauma

OBJECTIVE

We queried the Pediatric Health Information System (PHIS) to evaluate the presentation, management, and outcomes of renal trauma in children from birth to 18 years from 2007-2018.

METHODS

Patients were categorized as infants (0-1 year), toddlers (2-4 years), children (5-9 years), preteen (10-14 years), and teens (15-18 years), and patient demographics, grade of injury, and mechanism of injury including sports-related trauma (SRT) were collected. Each group was then evaluated for the level of management and patient outcome.

RESULTS

We identified 3720 patients with renal trauma. Our cohort was predominantly White (68.5%), male (68.6%), and required public insurance (38.5%). Most injuries were low grade (86.7%) and managed non-operatively (94.7%). The overall mortality was 51 (1.4%). Younger patients (infants, toddlers, children) were more likely to present with complex injuries and they were more likely to have been involved in a motor vehicle accident. They had higher blood transfusion rates, longer inpatient courses, higher levels of admission acuity, and higher mortality. Patients in the older age groups presented most after SRT. Across all age groups, the most common source of SRT was limited contact sports; however, when considering only teens, full contact sports were the primary offending activity. This review of the PHIS database provides insight to the rates and patterns of pediatric renal trauma in the United States.

CONCLUSION

Our data suggest an age-related differences in the presentation, management, and outcomes of pediatric renal trauma patients.

Name, Image, and Likeness and the Health of the Young Athlete: A Call to Action for Sports Medicine Providers and the Athletic Healthcare Network

CONTEXT

In June 2021, the National Collegiate Athletic Association (NCAA) adopted a new policy allowing NCAA athletes the opportunity to benefit and profit from their name, image, and likeness (NIL). Several state high-school associations have established policies to guide their members and students through the new era of NIL. While the potential benefits cannot be ignored, NIL presents novel responsibilities and stressors to athletes. This paper will review the paucity of literature on the effect of NIL on youth athletes and bring attention to mental health, well-being, or academic performance impacted by NIL.

EVIDENCE ACQUISITION

Articles were identified through Google and PubMed search starting from NIL policy approval (June 30, 2021). Search terms included "name, image and likeness" and "NIL."

STUDY DESIGN

Clinical commentary.

LEVEL OF EVIDENCE

Level 5.

RESULTS

Although 1 article was identified through PubMed search and numerous articles were identified through Google search, no articles directly evaluated the effects of NIL on the mental health, well-being, or academic performance of youth athletes.

CONCLUSION

It is critical for sports medicine providers and other members of the athletic healthcare network to familiarize themselves with these emerging topics to best serve their patients and communities. The athletic healthcare network must be prepared to address possible NIL-related health ramifications for our patients and their families and help them navigate a confusing and predatory landscape. We must provide resources to youth athletes to minimize the risks associated with NIL involvement and related activities, and to ensure that athletes with NIL contracts are able to balance their academic and athletic responsibilities. Fostering strong relationships between stakeholders and sports medicine staff is paramount to creating an environment that permits honest discussions about NIL and the health of athletes from youth to adulthood.

STRENGTH-OF-RECOMMENDATION TAXONOMY

N/A.

Strong Association Between Growth Hormone Therapy and Proximal Tibial Physeal Avulsion Fractures in Children and Adolescents: A Case-Control Study

BACKGROUND

Published literature describes slipped capital femoral epiphysis as a complication of recombinant human growth hormone (rhGH) therapy that may be related to decreased physeal strength. The purpose of the current investigation was to utilize a case-control study design to determine whether a greater proportion of pediatric patients sustaining physeal avulsion fractures of the proximal tibia were undergoing rhGH therapy at the time of injury compared with a cohort of matched controls.

METHODS

A case-control design study design was utilized. Patients 4 to 18 years of age with proximal tibial physeal avulsion fractures (cases) or midshaft tibial fractures (controls) at our institution from February 1, 2016, to May 4, 2023, were identified. Cases and controls were matched 1:1 on the basis of age (within 1 year), sex, and body mass index (within 3 kg/m 2 ). A total of 132 patients were included in the analysis (mean age, 13 ± 2 years). rhGH exposure was compared using conditional logistic regression with Firth correction.

RESULTS

We found that 11% of the patients with a proximal tibial physeal avulsion fracture were on rhGH therapy at the time of injury compared with 0% of patients with midshaft tibial fractures (odds ratio [OR], 15.0; 95% confidence interval [CI], 1.8 to 1,946.7; p = 0.007). There was no significant difference in the proportion of sports-related injuries between cases (70%) and controls (67%) (OR, 1.15; 95% CI, 0.55 to 2.39; p = 0.85). Among subjects with proximal tibial avulsion fractures, the proportion requiring surgery did not differ significantly between patients receiving and those not receiving rhGH therapy (43% versus 41%, respectively; p = 0.99).

CONCLUSIONS

This study demonstrates that the proportion of subjects who sustained proximal tibial physeal avulsion fractures and were receiving recombinant human growth hormone therapy at the time of injury was significantly greater than that of an age, sex, and body mass index-matched control group with midshaft tibial fractures (11% versus 0%, respectively, representing 15-times greater odds of exposure). This quantifies a previously unreported serious orthopaedic complication associated with rhGH therapy.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Analysis of potential hydration opportunities during future football tournaments based on data from the 2018 FIFA World Cup

The World Cup is traditionally held oppressive thermal conditions. Therefore, teams should follow heat strain mitigation strategies, including optimal fluid ingestion. The objective of this analysis was to assess and visually communicate match-based World Cup player hydration opportunities and behaviors. Broadcast recordings of the 2018 World Cup (June-July) were analyzed. Descriptive data were reported for match duration, the number, type, and duration of breaks, and player-initiated hydration moments, as well as environmental conditions categorized as 'no thermal stress' and 'thermal heat stress.' The median number and interquartile range of total match breaks were 7 [5-8] during official breaks, with a duration of 42 [23-72] seconds. There were 2 [1-3] player-initiated hydration moments per game, with a duration of 77 [55-100] seconds. On top of the 29% (#126) of breaks in which drinking occurred, an additional 26% (#33) of self-initiated drinking was registered with a duration of 7 [4-28] seconds without an official break. There was no significant difference (P = 0.22) in self-initiated hydration between thermal conditions. Relative percentages showed suboptimal use of substitution (14%) and VAR (38%) breaks vs. injury breaks (75%). In conclusion, football players did not sufficiently use available breaks to hydrate.

The current state of concussion knowledge and attitudes in British American Football

OBJECTIVES

To examine concussion knowledge and concussion attitudes of players, coaches, and support staff in British American Football (BAF).

METHODS

Data from players, coaches and support staff (n = 236) were collected from across all leagues in BAF. An online survey tool was used which included the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS), and questions examining concussion education and perceived risk of participating in football.

RESULTS

The mean score on the RoCKAS concussion knowledge was 21.0 ± 2.1 of a possible score of 25 reflecting good knowledge. Of a possible score of 65, the mean concussion attitude score was 55.6 ± 6.1 showing safe attitude. Whilst an overall safe attitude was seen, almost half of participants (45.3%) noted they would continue to play with a concussion. No relationship was found between CAI and prior concussion history. Fifty seven percent of participants agreed the benefits of playing football outweighed the risks. Forty eight percent reported that they had received no concussion-related education in the past 12 months.

CONCLUSION

BAF participants have good concussion knowledge and safe attitudes. However, risky behavior is demonstrated through unsafe likelihood to report and attitude to long-term health risks. Access to the British American Football Association (BAFA) concussion policy and education was poor raising questions over what sources of information stakeholders are drawing their knowledge from. These findings can help form the foundation of educational interventions (e.g. coaching workshops) to challenge current misconceptions and improve likelihood to report concussion in BAF.

Fat-Free Mass Index in a Large Sample of National Collegiate Athletic Association Men and Women Athletes From a Variety of Sports

ABSTRACT

Magee, MK, Fields, JB, Jagim, AR, and Jones, MT. Fat-free mass index in a large sample of National Collegiate Athletic Association men and women athletes from a variety of sports. J Strength Cond Res 38(2): 311-317, 2024-Fat-free mass index (FFMI) can be used to categorize fat-free mass (FFM) relative to height. Normative values have been established in a variety of sports, as has suggested lower and upper thresholds of FFMI. However, FFMI has not been reported in a large sample of athletes, representing both sexes and multiple sport types. The purpose of this study was to evaluate differences in FFMI and establish normative values across a large sample of collegiate sports. A total of 1,961 athletes (men: n = 596, 10 sports; women: n = 1,365, 8 sports) participated. Height and mass were measured using a stadiometer and calibrated digital scale, respectively. Fat-free mass was assessed with air displacement plethysmography and used to calculate FFMI. Kruskal-Wallis test and one-way analysis of variance evaluated differences in FFMI in women's and men's sports, respectively. When collapsed across sport type and stratified by sex, men had a higher FFMI (21.5 ± 1.9 kg·m -2 vs. 17.9 ± 1.8 kg·m -2 ; p < 0.001). Differences occurred in FFMI across sport. In women, basketball athletes had the highest FFMI (18.9 kg·m -2 ) and highest 99th percentile for FFMI, whereas rowers had the lowest (16.9 kg·m -2 ). In men, throwers had the highest FFMI (25.7 kg·m -2 ) and highest 99th percentile, whereas volleyball athletes had the lowest (19.9 kg·m -2 ). Differences in FFMI may be attributable to dietary habits and physiological demands of respective sports. These results can provide information relative to differences in FFMI values across sports. In addition, sport-specific normative values can be used as benchmarks and targets for training, nutrition, and goal setting.

Influences of Athletic Trainers' Return-to-Activity Assessments for Patients With an Ankle Sprain

CONTEXT

Athletic trainers (ATs) inconsistently apply rehabilitation-oriented assessments (ROASTs) when deciding return-to-activity readiness for patients with an ankle sprain. Facilitators and barriers that are most influential to ATs' assessment selection remain unknown.

OBJECTIVE

To examine facilitators of and barriers to ATs' selection of outcome assessments when determining return-to-activity readiness for patients with an ankle sprain.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

We sent an online survey to 10 000 clinically practicing ATs. The survey was accessed by 676 individuals, of whom 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria.

MAIN OUTCOME MEASURE(S)

The survey was designed to explore facilitators and barriers influencing ATs' selection of pain; ankle-joint swelling, range of motion, arthrokinematics, and strength; balance; gait; functional capacity; physical activity level; and patient-reported outcome assessments when making return-to-activity decisions for patients after an ankle sprain. The survey asked for reasons that participants chose to use or not use each measure (eg, previous education, personal comfort, most appropriate, available or feasible, perceived value, and other). The survey contained 12 demographic items that characterized the sample of respondents and were examined as potential influences on the facilitators and barriers. Chi-square analysis was used to identify relationships among participant demographics and facilitators of or barriers to assessment selection.

RESULTS

Selection of each ROAST and non-ROAST was most commonly facilitated by previous education, availability or feasibility, or perceived value. Avoidance of each ROAST was most often caused by the lack of previous education, availability or feasibility, or perceived value. The presence of facilitators and barriers was affected by various demographic variables.

CONCLUSIONS

A variety of facilitators and barriers affected ATs' implementation of expert-recommended assessments when determining return-to-activity readiness in patients with an ankle sprain. Some subpopulations of ATs experienced more favorable or prohibitive conditions for assessment use.

Assessments Used by Athletic Trainers to Decide Return-to-Activity Readiness in Patients With an Ankle Sprain

CONTEXT

Athletic trainers (ATs) often care for patients with ankle sprains. Expert consensus has been established for rehabilitation-oriented assessments (ROASTs) that should be included in ankle-sprain evaluations. However, the methods ATs use to determine return-to-activity readiness after an ankle sprain are unknown.

OBJECTIVES

To identify ATs' methods for determining patients' return-to-activity readiness after an ankle sprain and demographic characteristics of the ATs and their methods.

SETTING

Online survey.

DESIGN

Cross-sectional study.

PATIENTS OR OTHER PARTICIPANTS

We recruited 10 000 clinically practicing ATs. A total of 676 accessed the survey, 574 submitted responses (85% completion rate), and 541 respondents met the inclusion criteria.

MAIN OUTCOME MEASURE(S)

We distributed an online survey to ATs that asked about their assessment of pain, swelling, range of motion, arthrokinematics, strength, balance, gait, functional capacity, physical activity level, and patient-reported outcomes in deciding return to activity. Descriptive statistics were used to characterize participant demographics and frequencies of the assessment measures used by ATs. Chi-square analysis was conducted to identify relationships between the demographics and assessment selection.

RESULTS

Pain, swelling, range of motion, strength, balance, gait, and functional capacity were assessed by 76.2% to 96.7% of ATs. Arthrokinematics, physical activity level, and patient-reported outcomes were assessed by 25.3% to 35.1% of participants. When selecting specific assessment methods, ATs often did not use recommended ROASTs. Athletic trainers with higher degrees, completion of more advanced educational programs, employment in nontraditional settings, more clinical experience, and familiarity with expert consensus recommendations were more likely to use ROASTs.

CONCLUSIONS

Before approving return to activity for patients with ankle sprains, ATs did not use some recommended outcomes and assessment methods. Practice in nontraditional settings, more advanced degrees, more clinical experience, and familiarity with expert consensus guidelines appeared to facilitate the use of ROASTs.

Decrease in aerial challenges after revision of goal kick rules in Japan Professional Soccer League: explorative study of the possibility of a risk reduction for head injury, concussion, and brain damage by a rule revision

In 2019, FIFA revised the goal kick (GLK) rule such that a GLK could be performed even if the kicker had teammates in the penalty area. This study aimed to examine whether the rule revision reduced the frequency of aerial challenge (AC) and long GLKs (LGLKs), which are risk factors for head injury and concussion in soccer. We analyzed all official league matches (306 matches/season) of the Japan Professional Soccer League 1st Division before (2018 season) and after the rule revision (2020 season). The analysis categorized GLKs into short GLKs (SGLKs) and LGLKs, depending on the GLK distance, and included the frequency and causes of AC, in each match following a GLK, which were compared between the 2018 and 2020 seasons. The average number of LGLKs per match in the 2020 season (8.85) decreased compared to that in the 2018 season (14.20). Additionally, for ACs following a GLK, the frequency of ACs decreased from 6.08 to 3.92 per match. Meanwhile, the frequency of LGLKs tended to increase toward the end of the first and second halves in matches. The results of this study revealed that the 2019 GLK rule revision reduced the number of LGLKs and ACs.

Appraising the Methodological Quality of Sports Injury Video Analysis Studies: The QA-SIVAS Scale

BACKGROUND

Video analysis (VA) is commonly used in the assessment of sports injuries and has received considerable research interest. Until now, no tool has been available for the assessment of study quality. Therefore, the objective of this study was to develop and evaluate a valid instrument that reliably assesses the methodological quality of VA studies.

METHODS

The Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) scale was developed using a modified Delphi approach including expert consensus and pilot testing. Reliability was examined through intraclass correlation coefficient (ICC3,1) and free-marginal kappa statistics by three independent raters. Construct validity was investigated by comparing QA-SIVAS with expert ratings by using Kendall's tau analysis. Rating time was studied by applying the scale to 21 studies and computing the mean time for rating per study article.

RESULTS

The QA-SIVAS scale consists of an 18-item checklist addressing the study design, data source, conduct, report, and discussion of VA studies in sports injury research. Inter- and intra-rater reliability were excellent with ICCs > 0.97. Expert ratings revealed a high construct validity (0.71; p < 0.001). Mean rating time was 10 ± 2 min per article.

CONCLUSION

QA-SIVAS is a reliable and valid instrument that can be easily applied to sports injury research. Future studies in the field of VA should adhere to standardized methodological criteria and strict quality guidelines.

Pediatric Trauma During the COVID-19 Pandemic: A 3-year Retrospective Analysis

The Coronavirus 2019 (COVID-19) pandemic has significantly impacted the volume and types of trauma patients encountered. We performed a retrospective analysis of pediatric trauma patients <17 years old presenting within a large US health care system from 2019 to 2021. Demographics, trauma volume, injury severity, mechanism of injury, and outcomes were compared. A total of 16 966 patients, from 88 hospitals over 18 states, were included in our analysis. Pediatric traumas decreased from 2019 to 2020 and 2021. The injury severity scores (ISSs) increased from 2019 to 2020 and 2019 to 2021. Compared with 2019, more gun-related traumas occurred in both 2020 and 2021, whereas motor vehicle collisions decreased. There were additional changes in bicycle, assault, auto versus pedestrian (AVP), playground, and sports injuries. The COVID-19 pandemic has impacted the volume, injury severity, and mechanism of injury of the pediatric trauma population.

Youth intentions to provide social support to a peer with a concussion

OBJECTIVES

1) To describe demographic factors, concussion knowledge, attitudes, subjective norms, self-efficacy and intentions to provide social support to a peer with a concussion and 2) to examine if demographic factors and concussion knowledge are associated with components of the Theory of Planned Behavior.

METHODS

The survey was completed between October 2018 and February 2019 by 200 youth (M = 15.30 years, SD = 1.52). Questions were designed for athletes and non-athletes and inquired about various types of social support. Data analysis included descriptive statistics, Wilcoxon Rank Sum Tests and Spearman's Rank-Order Correlation Coefficients.

RESULTS

More favorable attitudes and intentions to provide social support were observed among females (W = 2576, p ≤ 0.001; W = 2411, p ≤ 0.001), older youth (rho = 0.32, p ≤ 0.001; rho = 0.41, p ≤ 0.001) and those with higher concussion knowledge (rho = 0.29, p ≤ 0.001; rho = 0.22; p ≤ 0.001). Participating in sports with a high-risk of concussion was associated with lower attitudes and intentions to provide social support (W = 6677; p ≤ 0.001; W = 6721; p ≤ 0.001). Self-reported concussion history or knowing someone with a concussion history was not significantly associated with social support intentions.

CONCLUSION

This study identified characteristics of youth who had positive intentions to provide social support. These findings identify individuals who may model providing social support to a peer, as well as opportunities for future concussion education.

Intersection of Race and Socioeconomic Status on Concussion Recovery among NCAA Student-Athletes: A CARE Consortium Study

PURPOSE

The objectives of this study are to 1) describe collegiate student-athlete (SA) race and household income and 2) evaluate time to normal academic performance (i.e., return to learn (RTL)), initiation of the return to play (iRTP) protocol, RTP protocol duration, and time to unrestricted RTP (URTP) after sustaining sport-related concussion (SRC).

METHODS

Data were collected between 2014 and 2020 by the Concussion Assessment, Research, and Education Consortium. Baseline data were used to characterize participant demographics ( N = 22,819) and post-SRC outcomes ( n = 5485 SRC) in time to RTL ( n = 1724) and RTP outcomes ( n = 2646) by race. Descriptive statistics and nonparametric tests examined differences across race by demographic and injury characteristics. Kaplan-Meier curves estimated median days to RTL, iRTP protocol, RTP protocol completion, and URTP by race and covariate measures. Multivariable Cox proportional hazards regression assessed the effect of race on risk of RTL and RTP recovery time points.

RESULTS

SA largely identified as White (75%) followed by Black (14%), multiracial (7%), and Asian (3%). More than half (53%) of all SA reported a household income of >$120,000, whereas 41% of Black SA reported a household income <$60,000. Race was not associated with relative risk of RTL or iRTP but was associated with RTP protocol completion and URTP. Non-Black/non-White SA were 17% less likely (adjusted hazard ratio = 0.83; 95% confidence interval = 0.71, 0.97) to complete the RTP protocol, and Black SA were 17% more likely (adjusted hazard ratio = 1.17; 95% confidence interval = 1.05, 1.31) to reach the URTP time point compared with White SA.

CONCLUSIONS

The present findings suggest collegiate SA enrolled in the Concussion Assessment, Research, and Education Consortium are primarily White and come from household incomes well above the US median. Race was not associated with RTL or iRTP but was associated with RTP protocol duration and total time to URTP. Clinicians should be conscientious of how their implicit or preconceived biases may influence SRC management among National Collegiate Athletic Association SA.

Balancing academics and athletics: School-level athletes' results are positively associated with their academic performance

BACKGROUND

Using data from a nationwide high-school sample, the present study aimed to examine whether school-level athletes' sporting results are positively or negatively associated with their academic performance.

METHODS

Athletic performance was assessed using the results of spring and summer regional qualifying interschool tennis tournaments in Japan among both male and female tournaments across all prefectures in Japan. Academic performance was assessed using the standardized rank scores for academic performance at the school level, with higher scores denoting superior academic levels; this is the most common measure of academic performance in Japanese high schools. Linear mixed models were conducted to compare the academic performance of high schools with winning and losing records, respectively, for all games together and for the spring and summer tournaments separately. The results of a total of 4,870 games were analyzed.

RESULTS

High schools with winning records showed a significantly higher academic-performance score than those with losing records, and this association was stronger among boys than girls. The observed difference in academic-performance scores between the schools with winning and losing records, respectively, was replicated in both tournament settings (i.e., spring and summer).

CONCLUSIONS

Athletic results are positively associated with academic performance at the school level. Given the cross-sectional nature of the present study, the present results do not necessarily imply that sports participation can improve academic performance; rather, the present study suggests that balancing academic and athletic commitments is feasible.

An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

Assessing Concussion Knowledge Among Recreational Surfers and Comparing Results to Concussion Knowledge Among Soccer Players: A Pilot Study

Concussions are caused by physical trauma to the head, face, or neck and can be sustained while surfing, increasing the risk of drowning. The purpose of this pilot study was to establish a preliminary assessment of concussion knowledge in a group of adult recreational surfers. Using the standardized Concussion Knowledge Index, an anonymous survey was conducted with 55 surfers. The Concussion Knowledge Index and similar statistical measures were used in a previous study of adult soccer players in England. Data from these 2 groups were compared. The preliminary data suggests that the group of adult surfers demonstrate more concussion knowledge than the group of adult soccer players. Further study into surfers' knowledge of concussion with a larger sample size could increase the clinical utility and generalizability of this study.

Driving characteristics of young adults prior to and following concussion

OBJECTIVES

This study sought to examine whether young adults who sustain concussions have different driving histories and pre-injury driving styles than uninjured peers. In addition, we assessed whether modifications were made to driving behavior in the acute period following concussion.

METHODS

Self-reported driving and demographic information was collected from 102 16- to 25-year-old drivers. Half of the sample had recently sustained concussions and the other half comprised a matched comparison group.

RESULTS

The groups reported similar pre-injury driving behaviors and styles. However, the recently injured group had more driving citations, higher rates of psychiatric disorders, and greater likelihood of having sustained a prior concussion. Self-reported driving habits postconcussion suggested that most drivers did not modify their driving behavior following concussion, though they were less likely to drive at night or with others in the car.

CONCLUSION

Results highlight the need for postconcussion driving guidelines and support for returning to driving safely.

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.

Individual-differences affecting emotion regulation behaviors of injured athletes: A retrospective quantitative study

Suppressing the expression of negative emotions caused by injuries prevents athletes from fully accepting their sports injuries. However, acceptance is maintained and promoted when positive reappraisal and suppression are synchronized. This study analyzes individual-differences affecting the use of these two emotion regulation behaviors. A questionnaire consisting of personal variables regarding athletic identity, commitment to sports ethics and emotion regulation behavior scale for suppression and positive reappraisal was conducted on athletes with previous injuries (N = 180). A model estimate using correlation analysis and multiple regression analysis was examined utilizing structural equation modeling. The results indicated that commitment to sports ethics and athletic identity promoted the suppression of expressiveness toward negative emotions and positive reappraisal. In contrast, difficulty describing feelings facilitated suppression and hindered positive reappraisal. These results seem to suggest that commitment to sports ethics and athletic identity might facilitate suppression and positive reappraisal, as well as function as variables maintaining and promoting accepting sports injuries. On the other hand, difficulties in describing feelings might lead to abnormal responses caused by accumulated negative emotions due to the suppression of expressing negative emotions and lack of positive reappraisal promotion.

Ankle Sprain History Does Not Significantly Alter Single- and Dual-Task Spatiotemporal Gait Mechanics

CONTEXT

Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures.

DESIGN

Cross-sectional study.

METHODS

We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance.

RESULTS

Athletes with and without a history of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = .19).

CONCLUSIONS

Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments.

Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA)

OBJECTIVES

Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation.

METHODS

NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively.

RESULTS

Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5).

CONCLUSION

Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury.

Are return-to-play times longer in lower-limb muscle injuries involving the intramuscular tendon? A systematic review

OBJECTIVES

To determine the influence of severity and direction (craniocaudal length vs cross-sectional area) of intramuscular tendon tears in the lower limb on return-to-play times, compared to muscle injuries without intramuscular tendon involvement.

DESIGN

Systematic review with meta-analysis.

METHODS

AMED, CINAHL, SPORTDiscus, ScienceDirect, PubMed (MEDLINE) and Web-of-Science were searched from inception to 31st July 2023, retrieving 666 records, of which nine were deemed eligible. A random-effects meta-analysis was performed on time to return-to-play for British Athletics Muscle Injury Classification 'b' vs 'c'.

RESULTS

On the Quality in Prognosis Studies tool, one study had low risk of bias and eight had high risk. Using a best-evidence synthesis, no strong evidence emerged for a difference in time to return-to-play between injuries with or without intramuscular tendon involvement. Moderate evidence was found for an association between increased return-to-play time and the presence of "waviness" on magnetic resonance imaging and loss of tendon tension, but no association with longitudinal extent of tendon involvement. Pooled analysis revealed a medium effect-size difference between British Athletics Muscle Injury Classification 'b' and 'c' injuries, favouring classification 'b' (Hedges g = 0.67; 95% confidence interval 0.20 to 1.15; P = 0.002).

CONCLUSIONS

It remains difficult to provide an accurate prognosis for muscle injuries involving the intramuscular tendon due to high risk of bias and moderate heterogeneity across studies. Moderate evidence favoured the prognosis for injuries at the musculotendinous junction (British Athletics Muscle Injury Classification 'b') over intratendinous injuries (British Athletics Muscle Injury Classification 'c').

The Trade Secret Taboo: Open Science Methods are Required to Improve Prediction Models in Sports Medicine and Performance

Clinical prediction models in sports medicine that utilize regression or machine learning techniques have become more widely published, used, and disseminated. However, these models are typically characterized by poor methodology and incomplete reporting, and an inadequate evaluation of performance, leading to unreliable predictions and weak clinical utility within their intended sport population. Before implementation in practice, models require a thorough evaluation. Strong replicable methods and transparency reporting allow practitioners and researchers to make independent judgments as to the model's validity, performance, clinical usefulness, and confidence it will do no harm. However, this is not reflected in the sports medicine literature. As shown in a recent systematic review of models for predicting sports injury models, most were typically characterized by poor methodology, incomplete reporting, and inadequate performance evaluation. Because of constraints imposed by data from individual teams, the development of accurate, reliable, and useful models is highly reliant on external validation. However, a barrier to collaboration is a desire to maintain a competitive advantage; a team's proprietary information is often perceived as high value, and so these 'trade secrets' are frequently guarded. These 'trade secrets' also apply to commercially available models, as developers are unwilling to share proprietary (and potentially profitable) development and validation information. In this Current Opinion, we: (1) argue that open science is essential for improving sport prediction models and (2) critically examine sport prediction models for open science practices.

Fighting in professional ice hockey: it's time for a change

Ice hockey has long been defined by a level of violence not seen in other sports. The rough-and-tough vigilante nature of the game was often employed as a method of enticing fans. Play in the National Hockey League (NHL) evolved throughout the 20th century as the rules governing it did. The nuances of what was allowed on the ice was slowly defined, but the league always fell short of an outright ban on fighting. Notably, the NHL allows fighting while international and Olympic leagues do not. Proponents of fighting's continued presence in the NHL argue that it can attract fans, facilitate momentum changes, help win games, and allows for social regulation on the ice. However, analyses of these theories have found little definitive evidence, calling the utility of fighting into question. The economics of fighting in hockey reveal high salary payouts, increased cost of injury, and a lack of correlation with ticket sales. Additionally, there is a concern for concussions sustained during fighting which has the potential for long term, detrimental mental health effects for athletes. In this analysis, we explore the history and evolution of fighting in the NHL, as well as the reasons behind its continued presence in the game, the risks associated with fighting, and the economics behind it all. Based upon these bodies of evidence, we make a proposal regarding the future of fighting in the NHL.

Monitoring Muscle Oxygen Asymmetry as a Strategy to Prevent Injuries in Footballers

Purpose: It has been hypothesized that sports injury risk is explained by muscle metabolism. The objective was to evaluate the muscle oxygen saturation slopes (ΔSmO2 slopes) and muscle oxygenation asymmetry (MO2Asy) at rest and to study their associations with injuries during the pre-season. Methods: A total of 16 male and 10 female footballers participated in this study. Injuries were diagnosed and classified by level of severity during the pre-season. The workload was also evaluated using the rate of perceived exertion × training time, from which the accumulated loads. The SmO2 was measured at rest in the gastrocnemius muscle using the arterial occlusion method in the dominant and non-dominant legs. The repeated measures ANOVA, relative risk, and binary logistic regression were applied to assess the probability of injury with SmO2 and workload. Results: Higher MO2Asy and ΔSmO2 Slope 2 were found among footballer who suffered high-severity injuries and those who presented no injuries. In addition, an MO2Asy greater than 15% and an increase in accumulated load were variables that explained a greater probability of injury. Conclusion: This study presents the new concept of muscle oxygenation asymmetry in sports science and its possible application in injury prevention through the measurement of SmO2 at rest.

Perceived social pressure and intention to play through injuries in junior ice hockey: The sporting environment matters

Playing when injured is a risky yet common business among ice hockey players. Conceptualized within the framework of the theory of planned behaviour, the current cross-sectional study aimed to test a multiple-mediator model linking players' perceived social pressure to their intention to play when injured. We tested whether social pressure is directly and indirectly (via attitudes, subjective norms, perceived behavioural control avoidance, and situational temptation) related to intention to play when injured. We recruited 186 junior players aged 16-20 years (mean age = 17.85; standard deviation = 1.35) from two Norwegian ice hockey leagues (under 18 and under 20 years of age). The data were analysed using a linear regression procedure and a bias-corrected bootstrapping technique to measure indirect effects. The results revealed a positive direct and indirect (via attitudes, subjective norms, and situational temptation) relationship between players' perceived social pressure and their intention to play when injured. In conclusion, players that perceived pressure to play despite being injured, who perceived positive consequences of doing so, who believed that people close or important to them approved of them doing so, and who perceived game-specific temptations, were more likely to report a stronger intent to play the game when injured.

Factors Affecting Anxiety-Related Symptoms, Diagnosis, and Treatment Among Collegiate Student-Athletes in the National College Health Assessment

CONTEXT

Increased attention continues to be placed on best practices for assisting student-athletes who show symptoms of a mental health illness. One of the most common mental health concerns for student-athletes is feeling overwhelmed or anxious. Early recognition of these symptoms can help student-athletes find early intervention.

OBJECTIVE

To elucidate specific attributes associated with an increased likelihood of anxiety symptoms and treatment avoidance to help athletic trainers and other practitioners better identify and assist high-risk individuals.

DESIGN

Cross-sectional study.

SETTING

Colleges and universities in the United States.

PATIENTS OR OTHER PARTICIPANTS

A total of 51 882 varsity athletes who completed the National College Health Assessment between 2011 and 2019.

MAIN OUTCOME MEASURE(S)

Survey responses (self-report) to questions related to anxiety symptoms and disorders cross-sectioned into 9 predictors: year in school, gender, sexual orientation, race and ethnicity, international student status, school type, received information on stress reduction or depression or anxiety, anxiety about impeding academic performance, and history of mental health treatment in the last year.

RESULTS

More than three-fourths (82.9%, n = 43 016) of student-athletes reported feeling overwhelmed because of all that they had to do in their daily activities, whereas only half (47.5%, n = 24 645) of student-athletes described overwhelming anxiety as a symptom. Gender, sexual orientation, race and ethnicity, school type, and previous mental health treatment had large effects on these 2 symptoms. However, of the student-athletes who reported overwhelming anxiety as a symptom, only one-fourth (22.9%, n = 5649) indicated they received a diagnosis of anxiety with or without treatment.

CONCLUSIONS

Factors such as the year in school and availability of mental health information appeared to have little effect on the experience of anxiety-related symptoms and the propensity to seek treatment. However, other factors, including gender, sexual orientation, race and ethnicity, school type, and previous mental health treatment, did have important effects. Our study provides additional evidence that the stresses placed on collegiate student-athletes frequently led to feelings of being overwhelmed and, eventually, anxiety disorder diagnoses. However, most student-athletes experiencing anxiety-related symptoms still did not seek a diagnosis with or without treatment.