An examination of changes in psychological status across four phases of injury recovery and return to sport: A prospective weekly study of competitive athletes from acute care to return to sport

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post-injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self-efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self-efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status.

Exploring attributional and coping strategies in competitive injured athletes: a qualitative approach

Introduction

This study explores the attributions and coping strategies of athletes who experienced psychological impact from sport injuries or illness from a qualitative methodology.

Purpose

To understand athletes' unique perspectives on injury and recovery, framed in the Global Model of Sport Injuries, and contribute to the development of effective interventions and support programs for athletes.

Methods

A qualitative research approach was employed, conducting semi-structured interviews with an ad hoc sample of 16 athletes, representing diverse backgrounds and competitive levels. Interviews were transcribed and analyzed using NVivo software, identifying themes and codes related to attributions and coping strategies.

Results

Athletes attributed their sport injury mostly to bad luck, routine deviations, and negative mental states, while coping strategies used included cognitive restructuring, emotional calming, seeking social support, mental withdrawal, and behavioral risk. Factors such as training deviations, social support, psychological responses, and injury diagnosis seems to have influenced the coping strategies employed.

Conclusions

Sport injuries and illnesses significantly impact athletes' careers and wellbeing. Support and effective communication from coaching staff and healthcare professionals were identified as crucial for athletes' wellbeing. These findings contribute to understanding the psychological processes and experiences involved in sport injury recovery and highlight key elements for prevention and intervention protocols. Future research should explore communication patterns in sports contexts and assess attributions and coping strategies at different stages of injury recovery.

Suspensory Device Fixation of Lisfranc Injuries in a Southeast Asian Urban Population: Patient-Reported Functional Outcomes

Introduction Open reduction internal fixation (ORIF) and primary arthrodesis are two conventional options for the treatment of Lisfranc injuries. However, they are associated with implant-related complications. An alternative suspensory device construct using interosseous nonabsorbable sutures with endobuttons has been described with satisfactory results. This study aims to explore functional outcomes after suture button fixation of Lisfranc injuries in a Southeast Asian population. Methods This was a single-surgeon retrospective study of patients with Lisfranc injuries treated surgically using a suture button fixation technique between 2017 and 2019. Data collected included demographic information, pre-injury levels of activity, nature of injury, and type of surgery performed. The minimum postoperative follow-up was one year. The Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) were used to evaluate patient-reported outcomes. Scores were reported in percentage (%) with median and interquartile range. Results Twenty-nine patients with a mean age of 29 years (21-76) were recruited. Sixteen underwent suture button fixation only (SB), and 13 underwent suture button fixation with intercuneiform screw fixation and plating (SBM). The median scores for the FAOS and FAAM questionnaires were at least 80% in all domains. Twenty-eight patients (97%) were able to return to pre-injury activity level, 27 patients (93%) were able to return to sports. Only one patient was not satisfied with the outcomes of surgery. No patients had post-traumatic arthritis or hardware failure necessitating implant removal at the final follow-up. Conclusion This study has demonstrated that treatment of Lisfranc injuries with a suspensory device construct resulted in good outcomes with 97% of patients being able to return to pre-injury activity levels, and 93% of patients being able to return to sports. It may not be necessary to perform primary arthrodesis in uncomplicated Lisfranc injuries. This technique is also advantageous as implant removal is not routinely required due to the design and biomechanical properties of suspensory devices.

Isolated free intraperitoneal fluid in young male after blunt abdominal sport trauma: two case reports from the World Cup 2022

The presence of isolated intraperitoneal free fluid (IFIPF) indicates the presence of mesenteric, organ, or bowel injury, which necessitates surgical exploration. The advances in computerized tomographic scanning (CT scan) allow even smaller amounts of IFIPF being detected. However, the clinical significance of IFIPF following blunt abdominal trauma remains not well-studied. Moreover, IFIPF is an unexpected condition in healthy male in the absence of mesenteric or organ injury on abdominal imaging. Herein, we presented two cases with IFIPF detected by CT scan in two healthy football male players during the World Cup 2022. The two players were managed conservatively and rejoined safely their football team during the same competition.

Current Clinical Concepts: Integration of Psychologically Informed Practice for Management of Patients With Sport-Related Injuries

Psychologically informed practice is an approach to patient management that encourages clinicians to treat patients from a biopsychosocial perspective and can be adopted by athletic trainers to manage sport-related injuries. As described in the domains of athletic training clinical practice, athletic trainers are expected to identify, address, and make appropriate referrals regarding psychosocial responses to injuries and mental health symptoms. Psychologically informed practice suggests addressing physical impairments in addition to screening and intervening for psychosocial responses with patients. In this Current Clinical Concepts paper, we discuss appropriate patient-reported outcome measures used to screen for mental health symptoms and psychosocial responses, provide recommendations on psychological interventions that can be integrated to enhance patient outcomes, and describe how to effectively refer a patient to an appropriate mental health professional.

Associations of Pain Vigilance and Past and Current Pain with Kinesiophobia after Sport Injury in Current and Former Athletes from Iran and the United States

High levels of kinesiophobia (fear of movement/reinjury) have been related to reinjury and adverse injury rehabilitation outcomes in athletes. To examine the extent to which pain vigilance, memory of injury-related pain, and current injury-related pain were associated with kinesiophobia, a cross-sectional study was conducted with 172 current and former athletes from Iran (n = 113) and the United States (n = 59) who reported having experienced a serious injury that affected their participation or performance in sport. Questionnaires were administered to participants via an online survey platform. Hierarchical multiple regression analysis revealed that pain vigilance and memory of pain were positively associated with kinesiophobia, with the full model accounting for 31% of the variance in kinesiophobia scores. The findings suggest that excessive attention to pain-related stimuli and memory of pain for an injury that occurred an average of four years earlier may contribute to the experience of fear of movement and reinjury in current and former athletes.

Predicting the Risk of Injuries Through Assessments of Asymmetric Lower Limb Functional Performance: A Prospective Study of 415 Youth Taekwondo Athletes

Background

The impact of interlimb asymmetries on sport injuries is unclear because of inconsistent findings, and there is a lack of research on youth athletes and the sport of taekwondo.

Purpose

To examine the effects of functional interlimb asymmetries on noncontact lower limb injuries in youth athletes.

Study Design

Cohort study; Level of evidence, 2.

Methods

A total of 415 taekwondo athletes (318 boys and 97 girls) aged 6 to 17 years underwent baseline testing to determine interlimb asymmetries through the single-leg countermovement jump (CMJ), hop, and triple hop tests as well as the Star Excursion Balance Test. The athletes were then evaluated for 12 months to observe the occurrence of noncontact lower limb injuries.

Results

During the study, 98 athletes (70 boys and 28 girls) sustained at least 1 noncontact lower limb injury. Athletes with higher interlimb asymmetries in single-leg CMJ height showed a significantly increased risk of noncontact lower limb injuries (boys: odds ratio [OR], 1.053 [95% CI, 1.027-1.080], P < .001; girls: OR, 1.070 [95% CI, 1.016-1.128], P = .011). Asymmetry in single-leg CMJ height of ≥15.28% was found to be the cutoff point for predicting noncontact lower limb injuries in boys (OR, 4.652 [95% CI, 2.577-8.398]; P < .001).

Conclusion

This study highlights the utility of interlimb asymmetries in unilateral jump performance as a tool for assessing the risk of noncontact lower limb injuries in youth taekwondo athletes of both sexes. A proper evaluation of interlimb asymmetries may improve prevention strategies for youth athletes.

Calisthenics: Epidemiology of Injury Patterns and Their Risk Factors

Objective

To quantify the prevalence and nature of injuries and their risk factors in calisthenics to, therefore, inform the practitioner what to expect from these athletes.

Methods

This study was an online cross-sectional survey of calisthenics athletes. Data were collected online and the survey was distributed via social media over six months in 2020. The purpose-built survey consisted of demographic, training and loading questions. Participants were provided with an injury definition and reported their total number of injuries sustained during calisthenics including detailed information on three most significant injuries, along with mechanism of injury and risk factors. Multivariate regression analyses were used to determine objective factors associated with the number of injuries.

Results

There were 543 participants describing 1104 injuries. Mean (standard deviation (SD)) injury prevalence was 4.5 (3.3) per person. Of these injuries, 820 (74.3%) required training modification or treatment. Participants missed a mean (SD) 3.4 (5.1) weeks of training and engaged in a mean (SD) 10.9 (9.1) health professional consultations. The most common injuries were upper leg (24.5%), ankle/foot (22.8%) and lumbar spine (19.3%), with the majority being sprains/strains in nature (56.3%). Mechanism of injury included elevated work (27.6%), overuse (38.0%) and specific calisthenics skills (38.9%) - such as lumbar (40.6%) and lower limb (40.3%) extension-based movements. Subjective risk factors included load (66.8%), preparation (55.9%) and environmental factors (21.0%). Objective risk factors associated with higher numbers of injuries included increased years of participation, left leg dominance, increased training hours (regardless of training type) and state team participation (p<0.05).

Conclusion

Practitioners need to be aware that calisthenics athletes demonstrate a high proportion of strain/sprain injuries involving the lower limb and lumbar spine with causative movements being extension-based. Addressing risk factors such as loading, preparation, asymmetry, and the environment related to these movements are important for the treating practitioner.

Clinical Mental Health Measures and Prediction of Postconcussion Musculoskeletal Injury

CONTEXT

The rate of lower extremity musculoskeletal injury (LE MSK) is elevated after concussion; however, the underlying mechanism has not been elucidated. Physical characteristics have been investigated despite poorer mental health being a common postconcussion complaint and linked to MSKs.

OBJECTIVE

To evaluate the role of mental health as a predictor of postconcussion LE MSK.

DESIGN

Case-control study.

SETTING

Intercollegiate athletic training facility.

PATIENTS OR OTHER PARTICIPANTS

A total of 67 National Collegiate Athletic Association Division I student-athletes (n = 39 females) who had been diagnosed with a sport-related concussion.

MAIN OUTCOME MEASURE(S)

The Brief Symptom Inventory-18, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale (SWLS) measures were completed at baseline (preseason) and on the day participants were cleared for unrestricted return to play (RTP) after a concussion. Two binary logistic regressions were used to predict postconcussion LE MSK within a year, one for the baseline time point and the second for the RTP time point. A 2 (group: LE MSK, no LE MSK)-by-2 (time: baseline, RTP) repeated-measures analysis of variance compared performance between baseline and RTP.

RESULTS

Subsequent LE MSKs were sustained by 44 participants (65.7%). The only significant predictor of postconcussion LE MSK was the SWLS score at RTP, with Exp(B) = 0.64, indicating that an increased (improved) SWLS score was associated with a lower LE MSK rate. No significant interactions were present between mental health measures and subsequent MSK (P values = .105-.885).

CONCLUSIONS

Limited associations were evident between postconcussion LE MSK and scores on commonly used measures of anxiety, depression, and satisfaction with life. Reported increased satisfaction with life was associated with a decreased injury risk, which warrants further attention. Our results suggest that these measures of anxiety, depression, and satisfaction with life have limited value in assisting sports medicine clinicians with determining which student-athletes are at elevated risk of postconcussion LE MSK.

Peroneal Tendon Dislocation: A Report of Two Cases

Ankle injuries are a very common cause of patient visits to the primary care units and emergency departments. Although the most frequent ones are lateral ligament sprains, peroneal tendon subluxations have the same inversion mechanism and are described as one of the main causes of lateral ankle pain and instability. They are often missed during the acute phases as they are misdiagnosed as ankle sprains since both injuries share similar mechanisms and often occur in athletes and patients with high sports activity. We present two different cases of peroneal tendon dislocation that illustrate how this pathological condition may be present under different circumstances. We aim, through these cases, to provide clinical awareness and help improve earlier diagnosis of this condition; we also demonstrate the effectiveness of surgical reattachment of the upper retinaculum that two of our patients underwent.

Risk of anterior cruciate ligament injury in population with elevated body mass index

Aim Anterior cruciate ligament (ACL) injury is among the most common orthopaedic injuries. The elevated body mass index (BMI) can contribute to non-contact ACL injury. This study aims to assess the risk of ACL injury among elevated BMI population people (BMI ≥25 Kg\m2 ). Methods This is a cross sectional study that was conducted in a tertiary care centre in the Kingdom of Saudi Arabia. A total of 302 patients, who had an ACL reconstruction surgery in a ten-year-period (January 2008 to December 2018) were included. Results Sport related injury is significantly higher among the overweight and obese groups (p=0.002). Moreover, the combined ACL tear was higher among the overweight and obese groups (p=0.001). In univariate regression analysis for the selected baseline characteristics, it was found that individuals with higher BMI have chance to develop combined (ACL) injury 2 times higher when compared to those with isolated ACL injury (p=0.003). Also, the ACL type, mode of injury, types of injury and type of sports were statistically significant in univariate regression analysis. However, only the mode of injury was statistically significant after controlling the confounding factors. Other selected variables like type of sport, type of injury and ACL type were not significant. Conclusion Elevated BMI was associated with a higher risk of developing combined ACL tear as well as reinjured individuals.

Spontaneous Rupture of the Extensor Pollicis Longus in a Semi-professional Bodybuilder

Spontaneous rupture of the extensor pollicis longus is a rare injury. Distal radius fractures and rheumatisms are the principal causes, but there is an increase in cases related to some professional or sports activities. We report a case of a semi-professional bodybuilder who presented with a full loss of interphalangeal thumb extension and retropulsion following trivial trauma of the left wrist. Ultrasound confirmed the diagnosis of spontaneous rupture of extensor pollicis longus, and MRI revealed a very rare and aggressive anatomical variant of Lister's tubercle. The patient underwent a transfer of the extensor indicis propius, which is the most popular technique used for hyperextension and retropulsion restitution. Aggressive anatomical forms of Lister's tubercle can explain the frequent occurrence of spontaneous rupture of extensor pollicis longus in patients who practice sports or professions with a repetitive movement of the wrist.

Current concepts in the treatment of first-time patella dislocation in children and adolescents

Background

Lateral dislocation of the patella is a common injury in children. It can occur in previously healthy and anatomically normal knees, but there are several abnormalities that predispose to patellar instability. Magnetic resonance imaging is an essential part of assessing for associated injuries and risk of further instability. Treatment aims to prevent redislocation, residual instability, osteoarthritis, and allow return to previous activities. The purpose of this review was to assess evidence for management of first-time patella dislocation in children and adolescents.

Methods

Literature review was performed, accompanied by the current best practice by the authors.

Results

Non-operative treatment is preferred, except where there are associated injuries such as osteochondral fractures that would benefit from surgery. The exact method of ideal non-operative management is not clearly defined but should focus on restoration of range of movement and strength with bracing as indicated. There seems to be a trend toward operative intervention that may well be inappropriate.

Conclusion

Further prospective studies are required with focus on the younger patient to fully understand if there is an at-risk group that would benefit from early surgery.

Level of evidence

level III.

Knee Joint Contact Forces during High-Risk Dynamic Tasks: 90° Change of Direction and Deceleration Movements

Pivoting sports expose athletes to a high risk of knee injuries, mainly due to mechanical overloading of the joint which shatters overall tissue integrity. The present study explored the magnitude of tibiofemoral contact forces (TFCF) in high-risk dynamic tasks. A novel musculoskeletal model with modifiable frontal plane knee alignment was developed to estimate the total, medial, and lateral TFCF developed during vigorous activities. Thirty-one competitive soccer players performing deceleration and 90° sidestepping tasks were assessed via 3D motion analysis by using a marker-based optoelectronic system and TFCF were assessed via OpenSim software. Statistical parametric mapping was used to investigate the effect of frontal plane alignment, compartment laterality, and varus-valgus genu on TFCF. Further, in consideration of specific risk factors, sex influence was also assessed. A strong correlation (R = 0.71 ÷ 0.98, p < 0.001) was found between modification of compartmental forces and changes in frontal plane alignment. Medial and lateral TFCF were similar throughout most of the tasks with the exception of the initial phase, where the lateral compartment had to withstand to higher loadings (1.5 ÷ 3 BW higher, p = 0.010). Significant sex differences emerged in the late phase of the deceleration task. A comprehensive view of factors influencing the mediolateral distribution of TFCF would benefit knee injury prevention and rehabilitation in sport activities.

Serum microRNAs associated with concussion in football players

Mild Traumatic Brain Injury (mild TBI)/concussion is a common sports injury, especially common in football players. Repeated concussions are thought to lead to long-term brain damage including chronic traumatic encephalopathy (CTE). With the worldwide growing interest in studying sport-related concussion the search for biomarkers for early diagnosis and progression of neuronal injury has also became priority. MicroRNAs are short, non-coding RNAs that regulate gene expression post-transcriptionally. Due to their high stability in biological fluids, microRNAs can serve as biomarkers in a variety of diseases including pathologies of the nervous system. In this exploratory study, we have evaluated changes in the expression of selected serum miRNAs in collegiate football players obtained during a full practice and game season. We found a miRNA signature that can distinguish with good specificity and sensitivity players with concussions from non-concussed players. Furthermore, we found miRNAs associated with the acute phase (let-7c-5p, miR-16-5p, miR-181c-5p, miR-146a-5p, miR-154-5p, miR-431-5p, miR-151a-5p, miR-181d-5p, miR-487b-3p, miR-377-3p, miR-17-5p, miR-22-3p, and miR-126-5p) and those whose changes persist up to 4 months after concussion (miR-17-5p and miR-22-3p).

Forecasting neuromuscular recovery after anterior cruciate ligament injury: Athlete recovery profiles with generalized additive modeling

A retrospective analysis of longitudinally collected athlete monitoring data was conducted to generate a model of neuromuscular recovery after anterior cruciate ligament (ACL) injury and reconstruction (ACLR). Neuromuscular testing data including countermovement jump (CMJ) force-time asymmetries and knee extensor strength (maximum voluntary contraction_ext ) asymmetries (between-limb asymmetry index-AI) were obtained from athletes with ACLR using semitendinosus (ST) autograft (n = 29; AI measurements: n = 494), bone patellar tendon bone autograft (n = 5; AI measurements: n = 88) and noninjured controls (n = 178; AI measurements: n = 3188). Explosive strength measured as the rate of torque development was also calculated. CMJ force-time asymmetries were measured over discrete movement phases (eccentric deceleration phase, concentric phase). Separate additive mixed effects models (additive mixed effects model [AMM]) were fit for each AI with a main effect for the surgical technique and a smooth term for the time since surgery (days). The models explained between 43% and 91% of the deviance in neuromuscular recovery after ACLR. The mean time course was generated from the AMM. Comparative neuromuscular recovery profiles of an athlete with an accelerated progression and an athlete with a delayed progression after a serious multiligament injury were generated. Clinical Significance: This paper provides a new perspective on the utility of longitudinal athlete monitoring including routine testing to develop models of neuromuscular recovery after ACLR that can be used to characterize individual progression throughout rehabilitation.

Bilateral Medial Epicondyle Fracture Without Elbow Dislocation in a High-Level Adolescent Gymnast Athlete: A Rare Case

Isolated medial epicondyle fracture constitutes a common fracture in children's and adolescent's elbow and is highly associated with an elbow dislocation. Cases with bilateral medial epicondyle fracture with concomitant elbow dislocation have been previously described in literature, while cases without an associated elbow dislocation are lacking. In this article, a bilateral medial epicondyle fracture without elbow dislocation in an adolescent high-level gymnast athlete is reported. To the best of the authors' knowledge, this is the first case report in literature regarding such an extremely rare traumatic elbow injury.

Player Sex and Playing Surface Are Individual Predictors of Injuries in Professional Soccer Players

Background: The factors contributing to soccer injuries and their influence on the occurrence of injury are controversial and inconclusive. This study aimed to determine the association between player characteristics and playing factors with injuries in professional soccer players. Methods: One hundred and fifty-two professional soccer players completed a self-administered questionnaire that asked about demographic information and injury profile, the type of playing surface on which they sustained their injury, medical treatment, and the time lost due to soccer injury at the end of the soccer season. Results: The injury rate was 44.74% (n = 68; males: 61.50% (n = 56), females: 19.70% (n = 12)). Players’ age (OR: 1.15, 95%CI: 1.05−1.25, p < 0.002) and BMI (OR: 1.21, 95%CI: 1.06−1.38, p < 0.003) were significantly associated with soccer injuries. After adjusting for age and BMI, players’ sex (OR: 5.39, 95%CI: 2.11−13.75, p < 0.001), previous soccer injury (OR: 3.308, 95%CI: 2.307−29.920, p < 0.001), and playing surfaces (OR: 11.07, 95%CI: 4.53−27.03, p < 0.001) were the significant predictors of soccer injuries. Conclusion: Players’ age, BMI, sex, previous soccer injury, and playing surface were associated with injuries among professional soccer players. Old male athletes with high BMI, previous soccer injuries, and playing on natural grass were more likely to sustain soccer injuries than young female players with low BMI who had no previous injuries and played on synthetic surfaces.

Mapping Research Trends of Adapted Sport from 2001 to 2020: A Bibliometric Analysis

OBJECTIVES

To identify the research landscape in terms of keywords, annual outputs, journals, countries, and institutions and explore the hot topics and prospects regarding adapted sport research.

MATERIALS AND METHODS

Publications designated as "article" on adapted sport retrieved from the Web of Science Core Collection. VOSviewer 1.6.11, Citespace, and Bibliometrix in R Studio were applied for the bibliometric analyses.

RESULTS

A total of 1887 articles were identified. Over the past two decades, athletic performance, sociology/psychology, and rehabilitation were extensively investigated. Basketball, soccer, and swimming were the three most focused adapted sports. Researchers showed a growing interest in submitting their studies to sport science, rehabilitation, and sociological journals. Adapted sport research was more common in developed countries and regions. The UK contributed most publications accounting for about 20% of the total publications.

CONCLUSIONS

With the growth of publications concerning adapted sport, the bibliometric analysis presented an overview of collaboration, trends, and hotspots in the field.

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.

Spine Posture, Mobility, and Stability of Top Mobile Esports Athletes: A Case Series

Professional esports athletes spend a long time in the same sitting posture during training and competition. Mobile esports may exacerbate potential postural problems because of the closer and unsupported arms and because athletes spend more time in a forward-/flexed-head posture. Prolonged sitting in these postures carries significant health risks and may lead to musculoskeletal problems and injuries. The objective of this retrospective study is to assess the posture, mobility, and stability of the spine for professional mobile esports athletes. We collected spine-assessment data from 48 athletes participating in a top-tier league on a real-time-strategy battle-arena online game. The spinal assessment was conducted using the SpinalMouse® under upright standing and trunk flexion in addition to the Matthiass test. Measurements were converted into Idiag Scores by the SpinalMouse® software. The Idiag Posture, Idiag Mobility, and Idiag Stability scores were 62.50 (IQR: 21), 63.50 (IQR: 19.5), and 54.50 (IQR: 14.5), respectively, and were significantly lower (p < 0.001) than the reference normative value (100). Age was found to have a weak positive correlation with the posture score (ρ = 0.29, p = 0.048). Although career duration appeared to lower the scores, the association was insignificant (p > 0.05). The scores also had no significant association with body height, body mass, body mass index, and esports team (p > 0.05). It was anticipated that mobile-based esports would attenuate the biomechanics of the spine and increase the likelihood of musculoskeletal problems, such as neck and back pain.

Prevalence of Rotator Cuff Tears Among Older Tennis Players and Its Impact on Clinical Findings and Shoulder Function

CONTEXT

Tennis is a noncontact sport playable at an individual's own pace. Thus, it is popular among the older adults. It is known that older adults often suffer from rotator cuff tears (RCTs), which may affect tennis activity. However, the prevalence and influence of RCTs on tennis play among older players are not well-known. This study aimed to evaluate the prevalence of RCTs in older tennis players and its impact on physical findings and shoulder function.

DESIGN

A cross-sectional study.

METHODS

Fifty-three tennis players (mean age: 70.7 y; range: 60-83 y) participating in a recreational-level tennis tournament were examined in this study. An ultrasonographic examination of both shoulders was performed to detect RCTs. Relationships between RCTs of the dominant shoulder and clinical findings, shoulder pain, and shoulder function including range of motion, shoulder strength, and Single Assessment Numeric Evaluation score, and Disability of the Arm, Shoulder and Hand-Sports Module score were assessed.

RESULTS

RCTs were detected in 19 (36%) dominant shoulders and 6 (11%) nondominant shoulders. Asymptomatic RCTs were detected in 11 (58%) dominant shoulders and 5 (83%) nondominant shoulders. Increased crepitus and more positive results in the empty can test, and infraspinatus test were observed in the dominant shoulders with RCTs than in those without; however, there was no difference in shoulder pain, range of motion; strength; Single Assessment Numeric Evaluation score; and Disability of the Arm, Shoulder and Hand-Sports Module score between the players with and without RCTs.

CONCLUSIONS

One-third of the older tennis players in this study had RCTs in the dominant shoulder with some positive physical sign of an RCT. However, shoulder pain and shoulder function did not differ between the players with and without RCTs, suggesting that RCTs had a minor impact on the tennis performance in the participants of this study.

Investigating Turf Burn-Related Videos on TikTok: Cross-sectional Study

BACKGROUND

Due to the increased use of artificial turf, turf burn has become a common sports injury. Turf burn is caused by exposed skin sliding on artificial turf. Health complications, such as methicillin-resistant Staphylococcus aureus outbreaks, sepsis, and pneumonia, have been linked to untreated turf burns, and many athletes have been turning to social media for advice and companionship regarding their sports injuries.

OBJECTIVE

The goal of this study is to categorize and quantitatively assess the percentage of turf burn-related posts on TikTok based on creator type, content, athletes' experiences, and treatment and prevention methods. With these data, we not only investigate if there is room for health care professionals to assist in the distribution of evidence-based health education to athletes to counteract misinformation but also investigate if there is a potential audience of athletes on TikTok who have the potential to develop problematic responses to injuries.

METHODS

By using the Discover page on TikTok, we searched for the term turf burn on October 17, 2021. In total, 100 videos were analyzed. Videos were categorized and analyzed based on creator type, content, experiences of the athletes, and treatment and prevention methods. The number of likes and comments was recorded.

RESULTS

Most videos (98/100, 98%) were created by athletes. A small number of videos (2/100, 2%) were created by health care professionals. In terms of content, most videos (67/100, 67%) displayed turf burns. A small amount of videos (15/100, 15%) showed the incidents when turf burns were acquired, while around one-quarter of the videos (23/100, 23%) demonstrated the treatment and prevention of turf burns. Of the 23 treatment and prevention videos, a minority (4/23, 17%) showed the preferred treatment of turf burns, while most videos (19/23, 83%) showed nonpreferred treatments. The smallest amount of videos (2/100, 2%) were about turf burn education. Most of the videos created by athletes (56/98, 57%) depicted the negative experiences that patients had with turf burns. Some videos (37/98, 38%) depicted neutral experiences, while the smallest amount of videos (5/98, 5%) depicted positive experiences.

CONCLUSIONS

Our study suggests that there is a potential audience of athletes on TikTok who could develop problematic responses to sports injuries, such as turf burns, as most of the people who post videos are athletes, and many of the posts demonstrate negative experiences associated with turf burns. TikTok is a growing social media platform that should be studied to determine if it can be used to create a social support group for injured athletes to prevent the progression of negative emotional responses into problematic responses. Physicians should also have a role in establishing their social media presence on TikTok and offering evidence-based advice to athletes while disproving misinformation on TikTok.

National Athletic Trainers' Association Position Statement: Reducing Intentional Head-First Contact Behavior in American Football Players

OBJECTIVE

To provide evidence-based recommendations for reducing the prevalence of head-first contact behavior in American football players with the aim of reducing the risk of head and neck injuries.

BACKGROUND

In American football, using the head as the point of contact is a persistent, well-documented, and direct cause of catastrophic head and cervical spine injury. Equally concerning is that repeated head-impact exposures are likely to result from head-first contact behavior and may be associated with long-term neurocognitive conditions such as dementia, depression, and chronic traumatic encephalopathy.

CONCLUSIONS

The National Athletic Trainers' Association proposes 14 recommendations to help the certified athletic trainer, allied health care provider, coach, player, parent, and broader community implement strategies for reducing the prevalence of head-first contact in American football.

Injury History and Perceived Knee Function as Risk Factors for Knee Injury in Youth Team-Sports Athletes

BACKGROUND

The identification of risk factors for sports injuries is essential before injury prevention strategies can be planned.

HYPOTHESIS

Previous acute knee injury and lower perceived knee function measured by Knee injury and Osteoarthritis Outcome Score (KOOS) will increase the risk of acute knee injury in youth team-sports athletes.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

At baseline, youth (≤21 years old) male and female basketball and floorball athletes completed a questionnaire on previous acute knee injuries and perceived knee function (KOOS). A total of 211 male and 183 female athletes were followed for an acute knee injury up to 3 years. Unadjusted and adjusted Cox regression models were used in risk factor analyses.

RESULTS

In male athletes, previous acute knee injury and lower KOOS Pain, Activities of Daily Living, Sport and Recreation, and knee-related Quality of Life subscale scores increased the risk of acute knee injury in the unadjusted analyses. Adjusted analyses for male injuries were not performed because of low number of acute knee injuries (n = 18). In female athletes, previous acute knee injury increased the risk of acute knee injury when adjusted for athletes' age and body mass index (hazard ratio, 2.6 [95% CI, 1.3-5.2]). In female athletes, none of the KOOS subscale scores were associated with the increased risk of acute knee injury in the adjusted analyses.

CONCLUSION

Previous acute knee injury was associated with the risk of new acute knee injury in youth male and female athletes. In youth male athletes, additionally, lower perceived knee function in 4 out of 5 KOOS subscale scores were associated with the increased risk of new acute knee injury.

CLINICAL RELEVANCE

The treatment and rehabilitation of the present acute knee injury and secondary prevention of reinjury should be emphasized in youth team-sports athletes.

Association between Inter-Limb Asymmetries in Lower-Limb Functional Performance and Sport Injury: A Systematic Review of Prospective Cohort Studies

Background: Inter-limb asymmetry in lower-limb functional performance has been associated with increased risk of sport injury; however, findings are not always consistent. Purpose: To conduct a systematic review on whether inter-limb asymmetry in lower-limb functional performance can predict sport injury. Methods: Four electronic databases (MEDLINE, EMBASE, Web of Science, and SportDiscus) were systematically searched for prospective cohort studies reporting the association between inter-limb asymmetry in lower-limb functional performance and sport injury. Results: A total of 28 prospective cohort studies were included in the analyses. Collectively, the findings were highly inconsistent, and a clear statement on the association between each asymmetry and sport injury was difficult. Conclusions: Highly inconsistent findings make it difficult to create clear recommendations on the relationship between the inter-limb asymmetry in lower-limb functional performance (power, muscle flexibility, and dynamic balance) and sport injury. The influence of potential factors (selection of tests/parameters, participant characteristics, definition of injury, and ways of calculating asymmetry) should be considered when using previous findings.

Knee function after a mean of 19 years Post-retirement in 65 Italian semi-professional rugby veterans

Background and aim sport activity has been largely correlated to the development of knee osteoarthritis, but only few papers have investigated the long-term impact of a rugby career on the knee joint. The aim of this retrospective study was to evaluate the incidence and epidemiology of knee osteoarthritis and general health in a population of 65 retired semi-professional rugby players. Methods demographic and anamnestic analysis was recorded and Oxford Knee score, SF-12 and VAS were submitted to all veterans in order to assess current knee function, general health condition and level of pain. Parametric analysis of Spearman was used to evaluate the statistical significance on these results and the Kruskal-Wallis test was used to assess the significant differences between the questionnaire results and the demographic and anamnestic records. Results we found that players who sustained a knee injury during their career have a current reduction of the knee function compared to veterans who did not suffer any injury and who showed values comparable with those of the health population. In terms of general and mental health, athletes who retired later have now a better condition than those who retired from the sport  earlier. Conclusions: we concluded that knee injury prevention should be an unequivocal priority because although rugby is a high energy sport, it does not increase the risk of knee osteoarthritis in absence of serious knee injuries.

Profiles of psychosocial factors: Can they be used to predict injury risk?

The creation of risk profiles using the model of stress and athletic injury (J Appl Sport Psychol. 1998;10(1):5) represents a proposed shift from the reductionism paradigm to the complex sport approach in an attempt to formulate prevention strategies to combat the increasing number of injuries being reported in sporting populations. As a result, the primary purpose of this study was to: (a) identify different risk profiles based on psychosocial factors associated with the Williams and Andersen's model of stress and athletic injury model; and (b) examine potential differences in the frequency of injuries across these risk profiles. A prospective research design was utilized with a sample of 117 competitive soccer players (81 males and 36 females) from Sweden and the United States of America. Data was collected at two time points over the course of three months. At time 1 (beginning of the season) - a demographic information sheet, the Life Event Survey for Collegiate Athletes (LESCA), Sport Competitive Anxiety Test (SCAT), and Brief Cope were administered. At time two (T2), three months after the initial data collection, participants' traumatic injuries were recorded. Latent profile analysis (LPA) showed that 3 profiles solution showed best fit to data. Players in profile 1 and 2 reported fewer injuries compared to players in profile 3. However, whereas individuals in profile 1 had a lower predictive risk of sustaining an injury when compared to those in profile 3, both profiles had similar anxiety levels and use of coping strategies with differing stress levels. These findings suggest that the interaction between different proposed risk factors might influence injury risk.

Lived Experiences of an Elite Performance Management Team Through Injury Rehabilitation: An Interpretative Phenomenological Analysis

OBJECTIVES

Injury is a common and challenging experience for many athletes, and return-to-sport outcomes have been persistently poor despite advancements in research and practice. To ameliorate this challenge and to bridge a gap that exists in the sport injury literature between theoretical conceptualization and intervention design, research is needed to explore team-based approaches to professional practice. The current study aimed to begin this work through exploration of a single performance management team (PMT) through 2 injury and rehabilitation cases leading into and across the 2014 Olympic Winter Games.

DESIGN

Qualitative, interpretative phenomenological analysis.

METHOD

Interviews were conducted with the 5 members of the PMT (coach, physiotherapist, sport psychology consultant, case manager, and athlete) involved in both injury cases. Lower-order and higher order themes were identified and interpreted through the extent literature.

RESULTS

Results indicate that 3 higher order themes interacted to impact the lived experiences of the PMT members across the 2 injury cases. Participants described the sociocultural context that surrounded the team, the individual struggles they faced, and the functioning of the team as the primary contributors to their lived experiences as well as observed rehabilitation outcomes.

CONCLUSIONS

Findings of this study mirror previous research in team science within the general health care domain, and prompt ongoing exploration of how to improve the experiences for PMT members as well as rehabilitation and return-to-sport outcomes for athletes.

Effect of 8-week treadmill running with peroneal muscle functional electrical stimulation on laterally deviated centre of plantar pressure position and star excursion balance test performance

Introduction

Ankle sprain is a common injury that can have long-term sequelae resulting in pain, swelling and a reduction of physical activity participation. Previous research has shown a laterally deviated centre of pressure (COP) during running gait increases the risk of lateral ankle sprain. As a method of altering COP, electrical stimulation has been considered.

Method

A group of 14 healthy males were randomly allocated to case control groups which were single blinded. The intervention involved an 8-week training programme of functional electrical stimulation to the peroneal muscles during treadmill running, with a sham control group. Outcomes were COP position and star excursion balance test. Statistical analysis was through SPSS using a combination of MANOVA, T-tests and Wilcoxon signed rank.

Results

There was a significant difference in the results post intervention at max pressure for intervention M = 0.7(±0.7) and control M = -6.0 (±4.6) conditions; t(6) = -2.9, p < 0.05.

Conclusion

It has been demonstrated that FES can alter COP during max pressure in running gait after an 8-week training programme, although carry over effect appears limited and further testing is required.

Applying the trans-contextual model to promote sport injury prevention behaviors among secondary school students

The current study tested the effects of an intervention based on the trans‐contextual model (TCM) on secondary school PE students’ sport injury prevention behavior and on theory‐based motivational and social cognition mediators. Participants were PE students (N = 1168; M_age = 13.322 ± 1.045, range = 12–16; female = 51.721%) who participated in a 3‐month cluster‐randomized controlled trial. Schools were randomly assigned to a treatment group, in which PE teachers received training to be more supportive of psychological needs in teaching sport injury prevention, or a control group, in which PE teachers received no training. Participants completed survey measures of TCM variables and self‐reported sport injury prevention behavior at baseline and at 3‐month post‐intervention follow‐up. The proposed TCM model exhibited adequate fit with the data, χ² = 143.080 (df = 19), CFI = 0.956, TLI = 0.916, RMSEA = 0.078 (90% CI = 0.066–0.090), and SRMR = 0.058. We found positive, statistically significant direct intervention effects on changes in perceived psychological need support (β = 0.064, p = 0.020). We also found positive, significant direct (β = 0.086–0.599, p < 0.001) and indirect (β = 0.002–0.027, p = 0.020–0.032) intervention effects on changes in TCM variables and behaviors to prevent sport injuries. Our findings support the TCM as a useful framework for building an intervention for promoting sport injury prevention behaviors among secondary school students.

An Interactive Cognitive-Behavioural Multimedia Program Favourably Affects Pain and Kinesiophobia During Rehabilitation After Anterior Cruciate Ligament Surgery: An Effectiveness Trial

Psychological interventions have been found effective in helping athletes cope with the challenges associated with knee surgery. In this investigation, an interactive cognitive-behavioural multimedia program was evaluated as a means of delivering psychological interventions to individuals experiencing anterior cruciate ligament (ACL) surgery in a field trial with 69 ACL surgery patients (30 women and 39 men; 24 competitive athletes, 41 recreational athletes, and 4 nonathletes; M _age = 35.01, SD = 11.98 years). Results indicated that compared to participants who received standard care, participants who received the multimedia program reported greater preoperative confidence in ability to cope, lower postoperative pain and kinesiophobia, and greater use and perceived utility of patient education materials. The findings suggest that the multimedia program has promise as an economical and effective means of educating and delivering psychological interventions to people experiencing ACL surgery and rehabilitation.

Preliminary Report: Localized Cerebral Blood Flow Mediates the Relationship between Progesterone and Perceived Stress Symptoms among Female Collegiate Club Athletes after Mild Traumatic Brain Injury

Female athletes are under-studied in the field of concussion research, despite evidence of higher injury prevalence and longer recovery time. Hormonal fluctuations caused by the natural menstrual cycle (MC) or hormonal contraceptive (HC) use impact both post-injury symptoms and neuroimaging findings, but the relationships among hormone, symptoms, and brain-based measures have not been jointly considered in concussion studies. In this preliminary study, we compared cerebral blood flow (CBF) measured with arterial spin labeling between concussed female club athletes 3-10 days after mild traumatic brain injury (mTBI) and demographic, HC/MC matched controls (CON). We tested whether CBF statistically mediates the relationship between progesterone serum levels and post-injury symptoms, which may support a hypothesis for progesterone's role in neuroprotection. We found a significant three-way relationship among progesterone, CBF, and perceived stress score (PSS) in the left middle temporal gyrus for the mTBI group. Higher progesterone was associated with lower (more normative) PSS, as well as higher (more normative) CBF. CBF mediates 100% of the relationship between progesterone and PSS (Sobel p value = 0.017). These findings support a hypothesis for progesterone having a neuroprotective role after concussion and highlight the importance of controlling for the effects of sex hormones in future concussion studies.

Neuroplasticity in Corticolimbic Brain Regions in Patients After Anterior Cruciate Ligament Reconstruction

CONTEXT

Fear has been cited as the primary barrier to return to sport (RTS) by athletes after anterior cruciate ligament reconstruction (ACLR). Understanding the neural factors that contribute to fear after ACLR may help us to identify interventions for this population.

OBJECTIVE

To characterize the underlying neural substrate of injury-related fear in patients after ACLR versus healthy matched control individuals during a picture imagination task (PIT) consisting of sport-specific images and images of activities of daily living (ADL).

DESIGN

Case-control study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 24 right-hand-dominant participants (12 with left-sided ACLR and 12 control individuals) were enrolled. Participants underwent full-brain functional magnetic resonance imaging.

MAIN OUTCOME MEASURE(S)

Functional data were acquired using blood oxygen level-dependent (BOLD) echoplanar imaging. Independent t tests were conducted to identify between-groups differences in BOLD signal changes during all images of the PIT. Paired t tests were computed to examine differences in BOLD signal change between sport-specific and ADL images in the ACLR group.

RESULTS

Increased activation in the inferior parietal lobule and the mediodorsal thalamus was observed during PIT in the ACLR group. An inability to suppress the default mode network in the ACLR group was noted. The ACLR group exhibited increased activation in the cerebellum and inferior occipital regions during the sport-specific images versus the ADL images, but no other regions of interest demonstrated differences.

CONCLUSION

After ACLR, patients may be more predisposed to fear, anxiety, and pain during sport-specific activities and ADLs. Psychosocial interventions may be warranted after ACLR to reduce injury-related fear and mitigate potentially maladaptive neuroplasticity.

Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

Pediatric blunt abdominal trauma with horizontal duodenal injury in school baseball: A case report

RATIONALE

Pediatric sports injuries, including those from baseball, most often are musculoskeletal injuries and rarely include blunt abdominal injuries. Duodenal injury is rare and often associated with other organ injuries. Because it has a relatively high mortality, early recognition and timely treatment are needed. Here, we report a case of successful treatment of a pediatric patient with duodenal injury incurred in the context of school baseball.

PATIENT CONCERNS

A 13-year-old boy suffered blunt abdominal trauma and a right-hand injury caused by beating his abdomen strongly with his own right knuckle after he performed a diving catch during a baseball game. On the following day, the abdominal pain had worsened.

DIAGNOSES

Computed tomography led to a suspicion of injury to the horizontal part of the duodenum.

INTERVENTIONS

The duodenal injuries were repaired by simple closure. On the 10th post-operative day, an abscess formed in the retroperitoneal cavity because of an occult pancreatic injury. Ultrasound-guided percutaneous drainage of the cavity was performed.

OUTCOMES

The post-operative course of the abscess drainage was uneventful. The patient was discharged from our hospital on day 72 after admission and was in good health at the 9-month follow-up.

LESSONS

Regardless of the type of injury, we must assess the life-threatening conditions that can be expected based on the mechanism of the injury. In duodenal injuries, it is critical to perform surgical procedures and post-operative management based on the assumption of injuries to other organs.

Can the Functional Movement Screen Method Identify Previously Injured Wushu Athletes?

The functional movement screen (FMS) is commonly used to evaluate sports injury risks, but no study has been reported for Wushu athletes. The aim of this study was to identify optimal FMS cut-off points for previously injured Wushu athletes and to examine the associations with other possible factors. In this study, a total of 84 Chinese Wushu athletes (15.1 ± 4.5 years old, 51% male) with a minimum of two years of professional training background in either Taiji, Changquan, or Nanquan were assessed by the FMS. Video recordings were used to confirm the scoring criteria, and previous injuries were assessed based on face-to-face interviews. An optimal cut-off of the FMS score was investigated by receiver operating characteristic curves with sensitivity and specificity. We found that FMS score of less than 16 (sensitivity = 80%, specificity = 56%) was related to an increased occurrence of injuries (odds ratio = 5.096, 95%CI: 1.679-15.465) for the current study sample. The training type and training levels were related with FMS scores. More than half of the athletes (58%) had FMS asymmetry and 21% of athletes reported pain while performing the FMS protocol. Future prospective studies are recommended to use FMS with cut-off of 16 points in Wushu athletes.

NeuroHeal Improves Muscle Regeneration after Injury

Musculoskeletal injuries represent a challenging medical problem. Although the skeletal muscle is able to regenerate and recover after injury, the process engaged with conservative therapy can be inefficient, leading to a high re-injury rate. In addition, the formation of scar tissue implies an alteration of mechanical properties in muscle. There is still a need for new treatments of the injured muscle. NeuroHeal may be one option. Published studies demonstrated that it reduces muscle atrophy due to denervation and disuse. The main objective of the present work was to assess the potential of NeuroHeal to improve muscle regeneration after traumatic injury. Secondary objectives included characterizing the effect of NeuroHeal treatment on satellite cell biology. We used a rat model of sport-induced injury in the gastrocnemius and analyzed the effects of NeuroHeal on functional recovery by means of electrophysiology and tetanic force analysis. These studies were accompanied by immunohistochemistry of the injured muscle to analyze fibrosis, satellite cell state, and fiber type. In addition, we used an in vitro model to determine the effect of NeuroHeal on myoblast biology and partially decipher its mechanism of action. The results showed that NeuroHeal treatment advanced muscle fiber recovery after injury in a preclinical model of muscle injury, and significantly reduced the formation of scar tissue. In vitro, we observed that NeuroHeal accelerated the formation of myotubes. The results pave the way for novel therapeutic avenues for muscle/tendinous disorders.

Anxiety and Motivation to Return to Sport During the French COVID-19 Lockdown

Feeling anxious and presenting self-determined motivations about returning to sport after a break may impair sport performance and increase the risk of sustaining an injury. Hence, the aim of this study is to explore differences in anxiety and motivation to return to sport according to gender, expertise, training status before and during the lockdown, and athletes' availability (i.e., injury status) at the time of the lockdown. A total of 759 competitive athletes (49% female; mean age: 27 ± 10 years old) completed the cross-sectional study. Participants were invited to state their expertise, training status before and during the lockdown (did they have a training program), and whether they were injured at the start of the lockdown. Additionally, participants filled out psychometric self-report measures of anxiety (TFAI-return) and motivation (SMS-return) to return to sport. Due to non-normal distributions in the TFAI and SMS scores, non-parametric group comparisons were performed to compare participants for each categorical variable: non-parametric correlation tests were also performed to test the associations between continuous variables. Group comparisons showed higher scores of anxiety for females, younger athletes, athletes practicing and competing at the highest level, and athletes without a training program during the lockdown. Moreover, results suggested lower motivation scores (i.e., autonomous and controlled) for older athletes, experts (practicing for more than 10 years), athletes practicing and competing at a lower level, and athletes without a training program during the lockdown. Additionally, participants who were injured at the start of the lockdown reported higher scores of cognitive anxiety to return to sport than non-injured participants. The results of this study suggest that elite athletes may have suffered from external pressures to return to sport during the lockdown. Additionally, participants with a training program during the lockdown seemed to be less anxious and more self-determined to return to sport after the lockdown. Future studies may focus on the impact of cognitive behavioral interventions on anxiety and motivation to return to sport.

Clinically Historical and Prospective Associations Between Learning Disorders and Concussion in Young Adult Athletes

Background. Athletes with specific learning disorder (LD) tend to score lower on neuropsychological tests and are at increased risk of personal injury than their counterparts without such disorders. Using a retrospective historical and prospective design, we examined whether adult athletes with LD, the most prevalent of neurodevelopmental disorders, experience greater chances of past and future concussions than their counterparts without LD. We expected to find that young athletes with LD would show greater risk of past (historical) and future (prospective) cerebral concussions. Methods. Participants (95 men and 53 women aged 18 to 25 years) were recruited from university sports teams and followed during an entire season. Of these, 38 participants had a history of LD and 101 had a history of at least 1 concussion (72 males, 29 females) at the preseason baseline. One-third experienced a new concussion. Data analytic procedures include inferential cross-tabulations. Results. Athletes with LD were twice more likely to have a concussion history at baseline and to have a history of multiple concussions than athletes without LD; 95% CI = [0.86, 4.92] and [0.77, 3.40], respectively. Athletes with LD were twice more likely to incur a new concussion than those without LD; 95% CI = [0.86, 4.92]. Conclusions. Adult athletes with LD experience greater chances of previous and future concussions compared with counterparts without LD. Preventive practices regarding individuals with neurodevelopmental disorders may not only prevent the biopsychosocial consequences of brain trauma for the individual, but also represent a cost-effective public health measure.

Is the Landing Error Scoring System Reliable and Valid? A Systematic Review

CONTEXT

The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task.

OBJECTIVE

To systematically review the literature addressing the psychometric properties of the LESS.

DATA SOURCES

Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term "Landing Error Scoring System."

STUDY SELECTION

All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded.

STUDY DESIGN

Systematic literature review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template.

RESULTS

Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence.

CONCLUSION

The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.

Differential Effect of Recurrent Concussions on Symptom Clusters in Sport Concussion Assessment Tool

CONTEXT

Symptom checklist in Sport Concussion Assessment Tool has been widely used in preseason assessment and in concussion diagnosis, but the impact of prior concussions on the graded symptoms after a new concussion has not been evaluated.

OBJECTIVE

This study was undertaken to examine reported symptoms associated with recurrent concussions using data of a comprehensive survey among athletes.

DESIGN

Retrospective survey and cross-sectional study.

SETTING

College athletes.

PARTICIPANTS

Student athletes who sustained one or more concussions.

MAIN OUTCOME MEASURES

Concussion history and graded symptoms of the most recent concussion at time of the survey were surveyed. The impact of prior concussions was examined over symptoms and aggregated symptoms.

RESULTS

Multiple concussions were associated with greater reporting of individual symptoms related to emotion and physical symptoms of sensitivity to light and noise: more emotional (z = 2.3, P = .02); sadness (z = 2.4, P = .02); nervousness (z = 2.4, P = .02); irritability (z = 3.6, P = .01); sensitivity to light (z = 2.6, P = .01); and sensitivity to noise (z = 2.4, P = .04). The composite scores of emotional symptom and sensitivity symptom clusters were significantly higher: t = 2.68 (P < .01) and t = 3.35 (P < .01), respectively.

CONCLUSIONS

The significant rises in emotional and sensitivity symptoms may be an important additive effect of concussive injury. Closer attention should be given to these symptom clusters when evaluating concussion injury and recovery.

Impact of Insurance Status on Time to Evaluation and Treatment of Meniscal Tears in Children, Adolescents, and College-Aged Patients in the United States

Background:

The meniscus is vital for load bearing, knee stabilization, and shock absorption, making a meniscal tear a well-recognized sport-related injury in children and young adults. An inverse relationship between the quality and value of orthopaedic care provided and the overall treatment cycle exists in which delayed meniscal tear treatment increases the likelihood of unfavorable outcomes. Although a majority of children and young adults have health insurance, many athletes within this demographic still face significant barriers in accessing orthopaedic services because of insurance type and household income.

Purpose:

To determine the impact of insurance status and socioeconomic markers on the time to orthopaedic evaluation and treatment as well as the rate of surgical interventions for meniscal tears in children and young adult athletes in the United States.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We conducted a retrospective review of all patients ≤22 years of age who presented to our institution between 2008 and 2016 and who were diagnosed with meniscal tears. Patients were categorized based on insurance and socioeconomic status. Dates of injury, referral, evaluation by an orthopaedic surgeon, and surgery were also recorded. Chi-square and regression analyses were utilized to determine the significance and correlation between the influencing factors and time to referral, evaluation, and surgery.

Results:

Publicly insured, commercially insured, and uninsured patients comprised 49.4%, 26.6%, and 24.1%, respectively, of the 237 patients included in this study. Insurance status was predictive of time to orthopaedic referral, initial evaluation, and surgery (P < .01). Uninsured and publicly insured patients experienced significant delays during their orthopaedic care compared with commercially insured patients. However, no correlation was found between insurance status or household income and the rate of surgical interventions.

Conclusion:

Publicly insured and uninsured pediatric and college-aged patients faced significant barriers in accessing orthopaedic services, as demonstrated by substantially longer times between the initial injury and referral to an orthopaedic evaluation and surgery; however, these socioeconomic factors did not affect the rate of surgical management. Clinical competency regarding the effects of socioeconomic factors on the time to orthopaedic care and efforts to expedite care among underinsured and underserved children are vital for improving patient outcomes.

Importance of Sock Type in the Development of Foot Lesions on Low-Difficulty, Short Hikes

Background and objectives: Foot lesions can be developed during hiking because of external factors. This makes it important to study the effect of hiking equipment on lesion development. Materials and Methods: Technical and non-technical socks were given to 109 hikers to wear during a short hike. Participants were examined at three stages of the hike to determine the development of dermal, muscle and nail lesions, temperature and perimeter in various areas of each foot. Results: The percentage of hikers without injuries was significantly higher among those wearing technical socks (p-value < 0.001). Differences were also observed in mean foot temperature, which was higher in participants wearing technical socks (p-value < 0.001). Conclusion: The results indicate that even on a low-difficulty, short-term sport activity, it is advisable to wear technical socks to prevent lesion development and keep the foot temperature more stable. Sock type was identified as an external conditioning factor in lesion development.

'Active & Safe Central': development of an online resource for the prevention of injury in sport and recreational activity

BACKGROUND

Sport and recreation related injuries exert a significant cost on the healthcare system. As prevention researchers and practitioners, we have a responsibility to provide guidance towards prevention to those who participate in sport and recreation, and those that coach, treat and parent children that participate. The objective of this project was to use an integrated knowledge translation approach to develop an end user-driven digital platform that provides injury prevention information and resources across 51 sport and recreational activities.

DESIGN

We used an integrated knowledge translation approach to scope and develop an online sport and recreational injury prevention resource. A project team was formed that included end users-coaches, parents and athletes, injury researchers and practitioners, as well as members of a digital design team. All members of the project team informed the development process, including a review of literature and existing resources, the translation of evidence and development of the platform. At all stages of development, members of the project team cocreated knowledge for the tool, including forming the research questions, the approach, feasibility and development of outcomes.

CONCLUSION

The 'Active & Safe Central' (https://activesafe.ca/) platform provides web-based sport injury and prevention information. This user-friendly, web and mobile accessible platform can increase the reach, awareness and implementation of prevention programming in sport and recreational activity.

Nutritional Knowledge and Dietary Practice in Elite 24-Hour Ultramarathon Runners: A Brief Report

Several factors contribute to athletes’ sporting performance and diet is a key component. Higher levels of nutritional knowledge seem to correlate with a higher quality of diet, but this remains poorly explored and findings are still not conclusive. The aim of our study was to assess nutritional knowledge and dietary adequacy, detecting any potential association between these two factors in elite 24-hour ultramarathon runners, a sport which seems to have been increasing in popularity over the last decade. Nutritional knowledge and Mediterranean dietary adequacy scores were assessed by means of validated questionnaires given to 10 elite ultramarathon runners (six males and four females) from the Italian Ultramarathon and Trail Association (IUTA). The overall nutritional knowledge in the entire sample of athletes seemed to be good, especially in terms of “dietary recommendations” and “nutrient sources” knowledge. However, females had higher total nutritional knowledge scores when compared to males. Finally, linear regression analysis showed that greater nutritional knowledge was positively associated with an increase in Mediterranean dietary adequacy scores (β = 1.27; 95% CI = 0.039–2.494; p = 0.045) after adjusting for level of education. Our findings provide evidence that higher nutritional knowledge is associated with better dietary practice in elite 24-hour ultramarathon runners. Future studies are needed to assess the usefulness of educational programs as a strategy to improve the adequacy of dietary intake in this specific population.

Well-Come Back! Professional Basketball Players Perceptions of Psychosocial and Behavioral Factors Influencing a Return to Pre-injury Levels

The psychological factors influencing a return to sport has gained increased research attention. In the current investigation, we explored professional basketball players’ perceptions of the psychosocial and behavioral factors facilitating a return to performance equal to or exceeding previous performance standards. We also sought to describe athletes’ experiences – both positive and negative – of returning to sport following injury recovery. Ten Italian professional male basketball players (age range 22–36 years), were retrospectively interviewed in relation to three time-periods: (1) from the commencement of rehabilitation to their first official competition, (2) the first official competition, and (3) the 6-months following the initial competition. Qualitative content analysis of the data revealed numerous themes across the three time periods. In regards to Period 1, participants indicated that social support, investment in rehabilitation and training programs, coping skills and motivation were fundamental in reaching pre-injury performance levels. During their first official game (i.e., Period 2), athletes reported that realistic performance expectations, focusing on the performance, positive emotions, motivation, arousal and social support facilitated their return to sport. Athletes, however, also described a predominance of factors that hindered their return to pre- injury levels (i.e., low confidence in personal abilities, decrements in skill execution and dysfunctional physical sensations). Moreover, participants typically described a substandard level of performance during their first competition back following injury. In recounting experiences during the 6 months following their first official game, basketballers reported improvements in skill execution and highlighted the importance of coping skills, motivation and social support. The process of restoring self-confidence in one’s ability to successfully perform was perceived as crucial in enabling participants to move beyond a mere return to sport to a return to high performance – that is, to reach a level of proficiency equal to or exceeding previous performance standards. Findings support the relevance of cognitive, emotional and behavioral responses highlighted in the Integrated Model and suggest the importance of addressing psychological factors throughout the return-to-sport process. Finally, results from the present study hold a number of practical implications for athletes’ aiming to achieve a return to pre-injury levels.