Clinical and Imaging Outcomes Over 12 Weeks in Elite Athletes With Early-Stage Tendinopathy.

Knowledge of how to treat chronic tendinopathy has advanced in recent years, but the treatment of early tendinopathy is not well understood. The main purpose of this prospective observational study was to investigate if changes occur in clinical and imaging outcomes over 12 weeks in elite athletes with recent debut of tendinopathy. Sixty-five elite adult athletes (24 ± 5 years) with early Achilles or patellar tendinopathy (symptoms < 3 months) were examined at baseline and after 12 weeks. Patients were divided into groups based on the duration of symptoms at the time of inclusion: (T1): 0-1 month, (T2): 1-2 months, or (T3): 2-3 months. Pain-guided activity modification was the only intervention. We assessed the following clinical outcomes: Questionnaires (Victorian Institute of Sports Assessment (VISA)) and pain scores (0-10 numeric rating scale, NRS), structural outcomes from ultrasonography: Thickness, echogenicity, and Doppler flow, and from magnetic resonance imaging: Cross-sectional area (CSA), thickness and length. Tendinopathic Achilles and patellar tendons displayed no significant differences on imaging tendon structural outcomes between T1 (n = 19), T2 (n = 23), and T3 (n = 20) at baseline or after 12 weeks, with one exception: Patellar tendons in T1 were thicker than T2 and T3 at baseline. Although athletes improved clinically on VISA and most NRS scores after 12 weeks, affected tendons with greater thickness, CSA and Doppler flow than contralateral tendons at baseline remained unchanged after 12 weeks. In conclusion, these data suggest that early tendinopathy in elite athletes can improve clinically after 12 weeks while morphology remains unchanged.

Medial sleeve fractures in elite-athletes: A heterogeneous group, anatomical and case-based considerations.

PURPOSE: The purpose of this study is to provide a detailed description of the anatomy and radiology of the medial sleeve and present an approach in its management among elite athletes. METHODS: Five cases of elite athletes who underwent treatment for a medial sleeve injury of which the diagnosis was confirmed through physical examination and additional magnetic resonance imaging scan are described in this study. RESULTS: Two patients presented with isolated medial sleeve injuries, while the other three patients suffered from concomitant ankle injuries. Non-operative treatment consisted of relative rest, soft cast immobilization and mobilization in a walking boot or kinesiotape which was successful in four of the cases with regard to the medial sleeve. One patient underwent surgery due to syndesmotic instability. Another patient presented with combined medial and lateral ankle instability which was treated surgically with an open medial and lateral ligament repair. All patients were able to return to their pre-injury sports and at the time of the last follow-up were still playing in their pre-injury level of competition. CONCLUSION: Medial sleeve injuries of the ankle in elite athletes should be considered in the differential diagnosis for athletes presenting with medial ankle pain. Inherent knowledge regarding anatomy is essential when guiding the management of these injuries which can be treated successfully with a non-operative approach consisting of relative rest, immobilization, kinesiotape and physical therapy. In case of persistent medial instability or rotational instability, surgical repair is a viable treatment option. Both modalities allow athletes to return to the pre-injury level of competition. However, early diagnosis is crucial to minimize the delay of appropriate treatment and avoid potential residual symptoms. LEVEL OF EVIDENCE: Level IV.

The Race Within a Race: Starting Together, Finishing Apart.

Every four years the world's best athletes come together to compete in the Olympic games, electrifying audiences with incredible feats of speed, strength, endurance and skill as personal best performances and new records are set. However, the exceptional talent that underpin such performances is incomprehensible to most casual observers who often cannot appreciate how unique these athletes are. In this regard, endurance running, specifically the marathon, a 42.195 km foot race, provides one of the few occasions in sport outside of Olympic, world and national competitions, that permits sport scientists and fans alike to directly compare differences in the physiology between recreational and elite competitors. While these individuals may all cover the same distance, on the same course, on the same day - their experience and the physiological and psychological demands placed upon them are vastly different. There is, in effect, a "race within a race". In the current review we highlight the superior physiology of the elite endurance athlete, emphasizing the gap between elite competitors and well-trained, but less genetically endowed athletes. We draw attention to a range of inconsistencies in how current sports science practices are understood, implemented, and communicated in terms of the elite and not-so-elite endurance athlete.

Comparative Analysis of Heart Rate Variability and Arterial Stiffness in Elite Male Athletes after COVID-19.

This study investigated the long-term cardiovascular effects of coronavirus disease (COVID-19) in elite male athletes by comparing the heart rate variability (HRV), arterial stiffness, and other cardiovascular parameters between those with and without prior COVID-19 infection. Methods: This cross-sectional study evaluated 120 elite male athletes (60 post COVID-19, 60 controls) using anthropometric measurements, body composition analysis, pulmonary function tests, HRV analysis, arterial stiffness assessments, hemodynamic monitoring, and microcirculatory function tests. Results: Athletes post COVID-19 showed significantly higher lean mass (p = 0.007), forced vital capacity (p = 0.001), and forced expiratory volume in 1 s (p = 0.007) than controls. HRV parameters did not significantly differ between the groups. Post-COVID-19 athletes exhibited peripheral vascular resistance (p = 0.048) and reflection index (p = 0.038). No significant differences were observed in the blood pressure, cardiac output, oxygen saturation, or microcirculatory oxygen absorption. Conclusions: Elite male athletes showed notable cardiovascular resilience after COVID-19, with only minor differences in vascular function. The maintained cardiac autonomic function and improved lung parameters in post-COVID-19 athletes suggests an adaptive response. These findings support the cardiovascular health of elite athletes following COVID-19 but emphasize the importance of continued monitoring.

'Goalkeepers are players too': key attributes coaches' look for in talented youth soccer goalkeepers.

OBJECTIVE: Currently, there is a gap in knowledge on what the key goalkeeper attributes are during talent identification and selection in soccer. Hence, the objective was to investigate South African coaches' perceptions regarding key attributes of talented youth soccer goalkeepers. DESIGN: Cross-sectional survey. METHODS: A total of 173 soccer coaches (130 men and 43 women; Mage = 36.6 ± 10.4 years; Mcoaching experience = 8.4 ± 7.3 years) were purposively recruited to participate in the study. All of the participants completed the Talent Identification Questionnaire in Soccer - Goalkeepers (TIDQS-GK). RESULTS: The six-component solution identified by the principal component analysis accounted for 68.96% of the total variance. Coaches deemed psychological (e.g. concentration, bravery, self-discipline), physical (e.g. speed, flexibility), social (e.g. coachability, communication), technical (e.g. catching the ball, first touch), tactical (e.g. defensive organisation against set plays) and perceptual-cognitive skills (e.g. decision-making) as important factors in identifying talented goalkeepers. CONCLUSIONS: The study offers new insights into the key attributes that soccer coaches look for in talented goalkeepers such as concentration, bravery, speed, coachability and decision-making and could direct coaches towards more objective evaluation strategies for informing their decisions.

Geriatric medicine and Olympic elite sports-parallels and philosophies.

The 30th Olympiad took place in July 2024. At first glance, sports science and training of elite athletes may appear to be of little relevance to geriatric medicine. However, there are important parallels between the practice of geriatric medicine and elite sports and lessons that we can learn from our sports science colleagues. Elite athletes and older people are operating at the margins of physiological capacity. Both benefit from tailored, scientifically informed training programmes delivered and monitored by a multidisciplinary team. There are parallels between the comprehensive geriatric assessment and the philosophy of marginal gains pioneered by British Cycling. Insights into the biology of skeletal muscle function are beginning to translate into the development of clinical interventions and substances that offer an unfair advantage in sport by improving muscle strength and physical performance may be of therapeutic benefit in sarcopenia. The 2024 Olympics provide an opportunity for us to learn lessons for excellence in our research and provide an opportunity to promote exercise across the life course-important for healthy ageing.

Finding a way in and making it stick: an exploration of chiropractor experiences working in team-oriented elite sport practice settings.

Interprofessional healthcare teams have become the benchmark for optimising athlete health and performance in high-stakes sports. Despite a history of utility as provider partners, chiropractors are currently a relatively underutilised human resource in this rapidly developing and challenging field. Consequently, our study explored the global experiences and distinct perspectives of elite-level career sports chiropractors. Through a qualitative explorative single case study, we purposively sampled and interviewed 15 chiropractors active in elite-level athletic contexts. 'Professional characteristics and competencies', 'Running the gamut of professional career development' and 'Navigating team development in a small organisational structure' emerged as the three key themes from the data. Our data indicate that chiropractors gain provider as members of the elite athletic health and performance management team as multirole manual medicine practitioners. However, thriving in a team-oriented practice, this context appears to be reliant on their capacity for development as part of a small organisational group.

Implementation of a mixed-methods heat acclimation programme in a professional soccer referee before the 2022 FIFA world cup in Qatar: a case study.

Objectives: This case study reports the real-world practicalities of implementing a mixed-methods heat acclimation (HA) programme before the 2022 FIFA World Cup. Methods: One male English soccer referee (age: 44 years; height: 1.82 m; body mass: 76.0 kg) who had officiated professionally for over 17 years and had over 10 years' experience officiating in European and international matches undertook an 11-session HA programme over 22 days. On days 1 and 22, a 30 min fixed-intensity heat tolerance test (9 km.h-1, 2% gradient, 40°C, 40% relative humidity) was performed, and physiological and perceptual responses were measured. A mixed-methods HA approach was used, including environmental chamber isothermic training, post-temperate training saunas and hot water immersion. Results: Compared with the pre-test, peak core temperature reduced by 0.40°C (38.4 vs 38.0°C; minimal detectable change (MDC) = 0.34°C), peak skin temperature reduced by 0.5°C (36.7 vs 36.2°C; MDC=0.28°C) and peak heart rate reduced by 5 b·min-1 (167 vs. 162 b·min-1; MDC=4 b·min-1) in the post-test. In the post-test, the sweat rate increased by 17% (1.94 vs 2.27 L.h-1; MDC=0.42 L.h-1). Peak thermal sensation (7 = 'hot') and the rating of perceived exertion (3 = 'moderate') were unchanged between the tests. However, peak thermal comfort (3 = 'slightly uncomfortable' vs 2 = 'uncomfortable') was rated lower in the post-test. Conclusion: The HA programme elicited positive physiological but indifferent perceptual responses, highlighting that mixed-methods HA can be implemented when a referee still has officiating, travel and training responsibilities during the HA window.

Sprint training in hypoxia and with blood flow restriction: Controversies and perspectives.

This narrative review assesses the effects of repeated sprint training (RST) in hypoxia (RSH) and blood flow restriction (BFR) methods on skeletal muscle adaptations and performance. Current literature suggests that RSH promotes metabolic modifications in muscle cells, especially driven by reactive oxygen species production, HIF-1α stabilization, and changes in metabolism. Training with BFR promotes metabolite accumulation in working muscles due to limited blood flow, however, cellular mechanisms affected by BFR during RST are less explored. Data highlight that RSH improves repeated sprint ability (RSA) in several sport disciplines (e.g. rugby, tennis, soccer, cross-country skiing). However, recent studies showed that addition of hypoxia or BFR during RST did not promote supplementary benefits on aerobic performance, force-velocity power profile, and V˙O2max. Nonetheless, gains in V˙O2max were observed during sprint interval training protocols when BFR was applied during recovery between sets. Finally, recent studies highlighted that RSH can improve RSA in a short period. Thus, RSH and sprint training with BFR may be useful for sports disciplines requiring high glycolytic demand and can promote gains in RSA in a short window. Further studies must be encouraged to better understand the biological consequences of adding such stimuli to exercise, especially BFR, on long-term adaptation.

Resting muscle tension and trigger points in elite junior short-track athletes and healthy non-athletes: a cross-sectional examination.

Introduction: Short-track speed skating (short track) is an Olympic sport characterized by a specific body position and counterclockwise movement on the track. Based on previous studies, we hypothesized that athlete body positions employed in this sport could lead to asymmetric overuse disorders of the left lower limb muscles. An increased number of latent trigger points (LTrPs) was confirmed in individual muscles of the overloaded left limb of short-track athletes. This study aimed to compare the number of LTrPs and the level of resting muscle tone between elite junior short-track athletes and healthy non-athletes. Methods: The experimental (EXP) group comprised 15 elite short-track junior athletes from the Polish national team and the control (CON) group comprised 15 healthy young volunteers. In both groups, the left leg was tested for (i) the presence of LTrPs and (ii) resting muscle tone (RMT), assessed using surface electromyography in six muscles. Results: The EXP group showed a higher number of LTrPs in the left lower limb, compared with the CON group. The muscle that was most significantly affected in the athletes was the vastus lateralis obliquus [χ 2 (1, N = 30), p < 0.001, V Cramer = 0.71]. This muscle also differed significantly between the groups in terms of the RMT (p = 0.033, Cohen's d = 0.87). Conclusions: Elite short-track junior athletes presented with increased RMT and an increased number of LTrPs in the vastus lateralis oblique muscle, compared with healthy non-athletes.

Relationship Between Force-Velocity Characteristics and Sprint Performance in Elite Sprinters: A Pilot Study.

BACKGROUND: Sprinting is a type of running that consists of producing a short and intense effort in order to perform maximal speed in a short period of time. Sprinting is widely investigated because of the multiple and complex mechanisms involved. Sprint studies are now focusing on how to improve performance by focusing their analyses on the mechanic variables. The hamstrings are part of the most important muscle groups during sprinting because of their role of stabilization and propulsion, but they must be able to produce the maximum strength during a short moment, this ability is characterized by rate of torque development (RTD). The main of this study was to investigate the association between hamstring RTD (Nm.s-1.kg-1) and mechanical variables composed of maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m.s-1), and maximal horizontal force production (F0) (N.kg-1) on short sprints in elite sprinters. METHODS: For this clinical trial, we used a research method based on data collection. A single group composed of four male and one female elite sprinters (age: 17.2 ± 1.79 years) has been included in this study. The sprinters performed a hamstring strength test, which included five trials of four seconds for each leg. This test required a portable dynamometer, the Kforce®, to collect 100 and 200 milliseconds RTD. Then the subjects were submitted to a sprint test. My Sprint® application has been used to collect the sprint mechanical variables. The sprint test included two trials; a starting block has been used for this test. A linear regression analysis was used between the rates of torque development and mechanical variables composed of maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m. s-1), and maximal horizontal force production (F0) (N.kg-1). RESULTS: No significant correlation was observed between 100 and 200 ms hamstring RTD and sprint biomechanical variables: maximal power output (Pmax) (W.kg-1), maximal theoretical velocity (V0) (m. s-1), and horizontal force production (F0) (N.kg-1). However, 100 and 200 ms RTD collected on the dominant leg tends to be more correlated with maximal theoretical velocity (spearman's rho = 0.80; p-value = 0.13) and Pmax output (spearman's rho = 0.70; p-value = 0.23) while for non-dominant leg, RTD tends to be more correlated with maximal power output (spearman's rho = 0.60; p-value = 0.35) and horizontal force production (spearman's rho = 0.70; p-value = 0.23). CONCLUSIONS: Hamstring RTD is not correlated with sprint biomechanical variables in elite sprinters. Further investigations must be made to study the observed trends in this study.

Brain endurance training improves soccer-specific technical skills and cognitive performance in fatigued professional soccer players.

OBJECTIVES: Brain Endurance Training (BET) - the addition of mentally fatiguing cognitive tasks to standard physical training - could improve performance in soccer. We tested whether BET, with cognitive tasks intermixed with physical training activities, improved players' cognitive and soccer-specific technical performance compared to physical training alone when fresh and fatigued. DESIGN: The study employed a pre/training/midtest/training/posttest design. METHODS: 31 professional male soccer players were randomly assigned to BET or control groups and completed 18 physical training sessions over 6 weeks. In between the physical training activities, the BET group completed demanding cognitive tasks, whereas the control group rested. Players completed the Loughborough soccer passing (LSPT) and shooting test (LSST) before and after completing a 30-min Stroop task. A brief psychomotor vigilance test (PVT-B), a visual analog rating of mental fatigue (MF-VAS), and rating of perceived exertion (RPE) were measured during testing and training. RESULTS: During testing, the 30-min Stroop task elicited a state of MF, confirmed by higher subjective ratings (P < .01). Compared to pre-testing, at mid- and post-testing, the BET group improved passing (all P < .01), shooting (all P < .01), and PVT-B performance (all P < .01) when tested after (fatigued) but not before (fresh) the Stroop task, whereas the control group did not change performance either way. During training the BET group reported higher MF (P < .01) and exhibited slower PVT-B responses (P < .01) compared to control. CONCLUSIONS: Intermixed BET was more effective than physical training alone at improving cognitive and soccer-specific technical performance of professional soccer players when fatigued.

Elevated plasma levels of IP-10 and MIG are early predictors of loss of control among elite HIV controllers.

Plasma cytokine levels were quantified among 30 persons with HIV (PWH) identified as elite controllers (15 transient controllers [studied a median of 1.38 years before losing viral control] and 15 persistent controllers). Thirty antiretroviral therapy (ART)-naive PWH, 30 ART-treated PWH with undetectable viremia, and 30 HIV-uninfected controls also were studied. Higher levels of cytokines were recognized among PWH than among controls, with EC displaying the highest levels. Elevated levels of IP-10 and MIG were identified among transient controllers as predictors of the loss of viral control. These findings offer feasible biomarkers for predicting virologic outcome and loss of control in EC.

Return to Play Assessment After Lateral Ankle Sprains - German Male Elite Youth Football (Soccer) Academy Baseline Data.

Background: Lateral ankle sprain (LAS) is one of the most common types of injury in football (soccer). Normative baseline data of performance tests for Return to Play (RTP) decision are still lacking. Purpose: The primary aim of this study was to generate baseline values for uninjured elite youth football players for a multifactorial RTP assessment and compare with previously published data. A secondary aim was to investigate the use of the Limb Symmetry Index (LSI) as a method to determine whether an athlete passes a performance test or not. Study Design: Observational Cohort study. Methods: Baseline data of performance tests (Y-Balance [YBT-LQ], Heel Rise [HRT]; Singe Leg Squat [SLST]; Single Leg Drop Jump [SLDJ]; Side Hop [SHT]; Figure of 8 Hop [F-8]; Modified Agility T-Test [MAT]) were assessed in 20 elite youth football players, aged 16-21 years. Additionally, the traditional LSI (dividing the result of the non-dominant leg by the result of the dominant leg and multiplying by 100) and directionally corrected LSI (the worst value is divided by the better value and multiplied by 100) were calculated. The test values were compared to previously reported study results. LSI and side-to-side comparisons between dominant and non-dominant leg sides were analyzed using the Wilcoxon test. Results: Male elite youth football players achieved better results in the dynamic performance tests (SHT, F-8, and MAT) compared to reference values of the cohorts previously described in the literature: YBT-LQ total score (cm) dominant (dom) 99.3±8.3, non-dominant (ND) 99.5±10.4; HRT (average number) dom. 27.1±5.4, ND 25.2±5.1); SLDJ height (cm) dom 15±5, ND 15±5 and contact time (sec) dom 0.29±0.08, ND 0.29±0.07, Reactive Strength Index (RSI) dom 0.52±0.12, ND 0.50±0.13); SHT (sec) dom 7.12±0.73, ND 7.39±0.93; F-8 (sec) dom 10.52±1.02, ND 10.37±1.04; and MAT (sec) 5.82±0.22. Directionally corrected LSI differed significantly from the traditional calculated LSI (p<0.05). Conclusion: The findings of this study highlight the need to determine specific baseline data for RTP testing in male elite youth football players after LAS. The traditional LSI should not be used as a "stand alone method" for determining RTP. LSI calculations should consider the direction of asymmetry to determine passing a performance test or not. Level of evidence: 3b.

An examination of relationships between transdiagnostic psychological processes and mental health disorders in athletes.

INTRODUCTION: The aims of this study were (a) to identify links between transdiagnostic psychological processes and mental health disorder (MHD) symptoms, and (b) to examine differences in MHD and transdiagnostic psychological processes as a function of demographic variables, including, gender, status as an athlete (elite vs. non-elite), number of training sessions per week, previous severe injuries, and use of medical care following severe injuries. METHODS: A total of 159 competitive athletes aged between 18 and 40 years old (44 % female; mean age = 24.20 ± 4.88 years) participated in this cross-sectional study. Participants completed a demographic questionnaire along with validated questionnaires evaluating MHD symptoms and transdiagnostic processes including: motivation to practice sport, emotional competencies, self-efficacy, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionist behaviors. RESULTS: MHD symptoms were positively correlated with controlled forms of motivation, repetitive negative thinking, meta-cognitive beliefs, and impulsive and perfectionistic behaviors; and negatively correlated with emotional competencies and self-efficacy. Gender differences showed that women were more likely to experience MHD, higher levels of repetitive negative thinking, meta-cognitive beliefs, and lower levels of emotional competencies and self-efficacy than men. Finally, elite athletes showed higher personal standards than their non-elite counterparts and those training more than four times per week showed significantly higher perfectionistic behaviors. DISCUSSION: These results are in line with previous findings in clinical psychology and shed light on the role of transdiagnostic processes and the risk of MHD in a sample of French athletes. Further research on the identification of key risk factors for MHD in competitive athletes is needed.

Female Athlete Sport Science Versus Applied Practice: Bridging the Gap.

BACKGROUND: Female-specific science, medicine, and innovation have grown steadily since the turn of the decade as the focus on female sport continues to advance. While this growth is welcome, and despite the best of intentions, it is not always coupled with valuable application. PURPOSE: This commentary discusses barriers faced when developing and applying sport-science research and innovation activities in female sport. We offer several practical solutions to help safeguard the progress of female athlete health and performance support. We make 3 suggestions: (1) multicenter studies to increase the number of elite athletes participating in research and enhance statistical power, which is often lacking in sport-science research; (2) further acceptance of case studies in elite sport research, as they can include context alongside athlete data that more traditional research designs perhaps do not; and (3) collaborative, codesigned approaches to research and innovation, wherein researchers, practitioners, and athletes all contribute to balancing scientific rigor with applied "real-world" understanding, which may result in the generation of richer, more meaningful knowledge for the benefit of female athletes and their environments.

Metabolomic profiling of elite female soccer players: urinary biomarkers over a championship season.

INTRODUCTION: In soccer, most studies evaluate metabolic profile changes in male athletes, often using data from a single match. Given the current landscape of women's soccer and the effects of biological sex on the physiological response and adaptation to exercise, more studies targeting female athletes and analyzing pre- and post-game moments throughout the season are necessary. OBJECTIVES: To describe the metabolomics profile of female soccer athletes from an elite team in Brazil. The study observed the separation of groups in three pre- and post-game moments and identified the discriminating metabolites. METHODS: The study included 14 female soccer athletes. Urine samples were collected and analyzed using Nuclear Magnetic Resonance in pre-game and immediate post-game moments over three national championship games. The metabolomics data were then used to generate OPLS-DA and VIP plots. RESULTS: Forty-three metabolites were identified in the samples. OPLS-DA analyses demonstrated a progressive separation between pre-post conditions, as supported by an increasing Q2 value (0.534, 0.625, and 0.899 for games 1, 2 and 3, respectively) and the first component value (20.2% and 19.1% in games 1 and 2 vs. 29.9% in game 3). Eight out of the fifteen most discriminating metabolites appeared consistently across the three games: glycine, formate, citrate, 3-hydroxyvalerate, glycolic acid, trimethylamine, urea, and dimethylglycine. CONCLUSION: The main difference between the three games was the increasing separation between groups throughout the championship. Since the higher VIP-scores metabolites are linked to energy and protein metabolism, this separation may be attributed several factors, one being the accumulation of fatigue.