Examining the incentive effects of athlete compensation: a combined analysis using SEM and fsQCA.

In the context of competitive sports, the evaluation of compensation incentive effectiveness is key to the optimization of compensation systems for athletes. This study creates a model of the athlete compensation incentive effect from single and multinomial grouping perspectives, combining empirical research (SEM) with fuzzy-set qualitative comparative analysis (fsQCA) based on a sample of 352 validated data. The results lead to two findings. First, athletes' direct economic compensation, direct non-economic compensation, and indirect non-economic compensation have a significant positive effect on the incentive effect of compensation. Second, that the incentive effect of high compensation has two configurations, namely "economic value" and "economic environmental value." It seems that the effective combination of compensation factors can enhance the motivation effect in a "different way."

The masters athlete and use of antihypertensive medications.

Hypertension is the most common cardiovascular condition in recreational athletes, especially older (masters) athletes. The interacting effects of hypertension, cardiac adaptation to endurance training, and antihypertensive medications on exercise performance are complex and of relevance to athletes, trainers, and health care providers. Cardiac adaptations occur in response to aging and endurance training, and findings may overlap with pathologic cardiac remodeling. This review summarizes the influence of antihypertensive medications on exercise performance, which can include both hemodynamic and metabolic effects, and includes practical considerations in choice of antihypertensive agent for the masters endurance athlete. Whereas the overriding priority for choice of antihypertensive is control of hypertension and improving clinical outcomes, other considerations regarding effects on exercise performance may also influence the choice of agent.

Cardiac Structure and Function of Elite Australian Jockeys Compared to the General Population: An Observational Cross-Sectional Study.

BACKGROUND: Research highlights the intense physiological demands of thoroughbred racing on jockeys, with elevated heart rates and substantial oxygen uptake, confirming the rigorous physical nature of the sport, however, the cardiovascular changes resulting from the physical demands of thoroughbred racing remain unexplored in Australian jockeys. Therefore, the objective of this study was to compare measures of cardiac structure and function of professional Australian jockeys to that of the general population and to determine if there are differences in heart structure and function detected using echocardiography. METHODS: Forty-six jockeys and thirty-three participants from the general population underwent two-dimensional echocardiography, which included all standard views and measurements. Each measurement was compared between groups using a Mann-Whitney U test. RESULTS: Groups were matched for age (jockeys (35 ± 12 years) and controls (36 ± 13 years)). Jockeys were shorter (1.64 ± 0.07 m vs. 1.75 ± 0.09 m, p < 0.001), lighter (56.5 ± 6.0 kg vs. 74.2 ± 12.9 kg, p < 0.001) and had a lower body surface area (BSA) (1.55 ± 0.17 m2 vs.1.9 ± 0.2 m2, p < 0.001). Jockeys had a larger absolute left ventricular (LV) end diastolic volume than the control group (120 ± 18.2 ml vs. 109.3 ± 29.0 ml, p = 0.05) which had a larger variation when indexed for BSA (78.0 ± 12.2 ml/m2 vs. 57.5 ± 13.3 ml/m2, p < 0.001). Jockeys demonstrated a higher LV mass index (79.4 ± 18.1 g/m2 vs. 64.2 ± 15.4 g/m2, p < 0.001). Left atrial volume index was larger in jockeys (33.4 ± 6.5 mL/m2 vs. 26.3 ± 7.0 mL/m2, p < 0.001). There were no differences in global longitudinal strain (GLS) for either group overall (-19.3 ± 3.0% vs. -19.8 ± 1.6%, p = 0.52), but 17% of the jockey group demonstrated an abnormal GLS. CONCLUSIONS: Jockeys have adaptations to their cardiac structure and function compared to the general population. Differences could be attributed to chronic physiological demands of racing and should be considered in future research involving jockeys.

Ventricular arrhythmias in association with athletic cardiac remodelling.

Athletes are predisposed to atrial arrhythmias but the association between intense endurance exercise training, ventricular arrhythmias (VAs) and sudden cardiac death is less well established. Thus, it is unclear whether the 'athlete's heart' promotes specific arrhythmias or whether it represents a more general pro-arrhythmogenic phenotype. Whilst direct causality has not been established, it appears possible that repeated exposure to high-intensity endurance exercise in some athletes contributes to formation of pro-arrhythmic cardiac phenotypes that underlie VAs. Theories regarding potential mechanisms for exercise-induced VAs include repeated bouts of myocardial inflammation and stretch-induced cellular remodelling. Small animal models provide some insights, but larger animal and human data are sparse. The current clinical approach to VAs in athletes is to differentiate those with and without structural or electrical heart disease. However, if the athlete's heart involves a degree of pro-arrhythmogenic remodelling, then this may not be such a simple dichotomy. Questions are posed by athletes with VAs in combination with extreme remodelling. Some markers, such as scar on magnetic resonance imaging, may point toward a less benign phenotype but are also quite common in ostensibly healthy athletes. Other clinical and invasive electrophysiology features may be helpful in identifying the at-risk athlete. This review seeks to discuss the association between athletic training and VAs. We will discuss the potential mechanisms, clinical significance and approach to the management of athletes with VAs.

The Enhanced Games: a timely injection for the International Olympic Committee.

The Enhanced Games, a privately funded sporting megaevent aspiring to rival the Olympic Games, have garnered significant media attention since its public inception in 2023. This attention has primarily been driven by the Enhanced Games' embrace of performance-enhancing drugs. Lost in the public fixation on the event's green-lit drug-use, however, is the fact that the Enhanced Games distance themselves from current Olympic standards in numerous ways beyond drug-policies alone. More precisely, the Enhanced Games promote themselves as a more economically and ecologically sustainable alternative to the Olympics, as well as a megaevent that aims to put athletes and their safety front-and-center. With an eye towards current Olympic standards, we suggest that closer examination of the Enhanced Games offers novel perspectives on the future of the Olympics and global sporting events more broadly.

Differential Resting-State Brain Characteristics of Skeleton Athletes and Non-Athletes: A Preliminary Resting-State fMRI Study.

(1) Background: This study investigates the resting-state brain characteristics of skeleton athletes compared to healthy age-matched non-athletes, using resting-state fMRI to investigate long-term skeleton-training-related changes in the brain. (2) Methods: Eleven skeleton athletes and twenty-three matched novices with no prior experience with skeleton were recruited. Amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity analyses were explored to investigate resting-state functional magnetic resonance imaging (rs-fMRI) data, aiming to elucidate differences in resting-state brain function between the two groups. (3) Results: Compared to the control group, skeleton athletes exhibited significantly higher ALFF in the left fusiform, left inferior temporal gyrus, right inferior frontal gyrus, left middle temporal gyrus, left and right insula, left Rolandic operculum, left inferior frontal gyrus, and left superior temporal gyrus. Skeleton athletes exhibit stronger functional connectivity in brain regions associated with cognitive and motor control (superior frontal gyrus, insula), as well as those related to reward learning (putamen), visual processing (precuneus), spatial cognition (inferior parietal), and emotional processing (amygdala), during resting-state brain function. (4) Conclusions: The study contributes to understanding how motor training history shapes skeleton athletes' brains, which have distinct neural characteristics compared to the control population, indicating potential adaptations in brain function related to their specialized training and expertise in the sport.

Athlete's ECG Made Easy: A Practical Guide to Surviving Everyday Clinical Practice.

Electrocardiogram modifications in athletes are common and usually reflect structural and electrical heart adaptations to regular physical training, known as the athlete's heart. However, these electrical modifications sometimes overlap with electrocardiogram findings that are characteristic of various heart diseases. A missed or incorrect diagnosis can significantly impact a young athlete's life and potentially have fatal consequences during exercise, such as sudden cardiac death, which is the leading cause of death in athletes. Therefore, it is crucial to correctly distinguish between expected exercise-related electrocardiogram changes in an athlete and several electrocardiogram abnormalities that may indicate underlying heart disease. This review aims to serve as a practical guide for cardiologists and sports clinicians, helping to define normal and physiology-induced electrocardiogram findings from those borderlines or pathological, and indicating when further investigations are necessary. Therefore, the possible athlete's electrocardiogram findings, including rhythm or myocardial adaptation, will be analyzed here, focusing mainly on the differentiation from pathological findings.

Electrocardiographic Clues for Early Diagnosis of Ventricular Pre-Excitation and Non-Invasive Risk Stratification in Athletes: A Practical Guide for Sports Cardiologists.

Ventricular pre-excitation (VP) is a cardiac disorder characterized by the presence of an accessory pathway (AP) that bypasses the atrioventricular node (AVN), which, although often asymptomatic, exposes individuals to an increased risk of re-entrant supraventricular tachycardias and sudden cardiac death (SCD) due to rapid atrial fibrillation (AF) conduction. This condition is particularly significant in sports cardiology, where preparticipation ECG screening is routinely performed on athletes. Professional athletes, given their elevated risk of developing malignant arrhythmias, require careful assessment. Early identification of VP and proper risk stratification are crucial for determining the most appropriate management strategy and ensuring the safety of these individuals during competitive sports. Non-invasive tools, such as resting electrocardiograms (ECGs), ambulatory ECG monitoring, and exercise stress tests, are commonly employed, although their interpretation can sometimes be challenging. This review aims to provide practical tips and electrocardiographic clues for detecting VP beyond the classical triad (short PR interval, delta wave, and prolonged QRS interval) and offers guidance on non-invasive risk stratification. Although the diagnostic gold standard remains invasive electrophysiological study, appropriate interpretation of the ECG can help limit unnecessary referrals for young, often asymptomatic, athletes.

Low Energy Availability Risk Is Associated with Anxiety in Female Collegiate Athletes.

This study investigated the association between the risk of low energy availability, disordered eating, and anxiety in collegiate female athletes. Female athletes (n = 115) completed questionnaires that assessed disordered eating (Disordered Eating Screen for Athletes, DESA-6; and the Eating Disorder Examination Questionnaire Short, EDE-QS), anxiety (Generalized Anxiety Disorder-7) and the risk of low energy availability (Low Energy Availability in Females Questionnaire; LEAF-Q). The athletes were 19.9 ± 0.1 years old and presented with no anxiety (14.8%), mild (33.0%), moderate (24.3%), and severe (27.8%) anxiety. The EDE-QS scores revealed that 22.6% of the participants had a high risk of an eating disorder, while the DESA-6 scores revealed that 31.3% of the participants scored positive for a risk of disordered eating. The LEAF-Q total scores revealed that 68.7% of the participants were at risk of low energy availability. Increased GAD-7 scores were associated (p < 0.001) with measures of disordered eating (EDE-QS and DESA-6) and the risk of low energy availability (LEAF-Q total score). Non-parametric partial correlations demonstrated that anxiety (increased GAD-7 scores) correlated with the risk of low energy availability (increased LEAF-Q total scores) while controlling for eating disorder scores (EDE-QS) (r (112) = 0.353, p < 0.001), or while controlling for the risk of disordered eating (DESA-6 scores) (r (112) = 0.349, p < 0.001). In female collegiate athletes, both disordered eating and the risk of low energy availability were positively associated with increased anxiety.

Specializing When It Counts: Comparing the Dose-Time Effect of Distance Variety between Swimming and Track Running.

OBJECTIVE: To conduct a longitudinal retrospective analysis, explore the relationship between success at peak performance age and the number of different race distances athletes competed in each year (within-sport distance variety), and compare the dose-time effect of this distance variety throughout the development process between male swimmers and track runners. METHODOLOGY: Male swimmers (n = 6033) and track runners (n = 19,278) still competing at peak performance age were ranked, and the number of different race distances was extracted retrospectively for each year until early junior age (13-14-year-old category) from the databases of the European Aquatics and World Athletics federations. Firstly, correlation analysis determined the relationship between ranking at peak performance age and distance variety. Secondly, Poisson distribution provided the probability and dose-time effect of distance variety for becoming an international-class athlete at peak performance age. RESULTS: Generally, correlation analysis revealed low coefficients (r ≤ 0.22) but significant effects (p < 0.001) for larger distance variety and success at peak performance age. Poisson distribution revealed the highest probability of becoming an international-class swimmer when competing in 2-4 race distances at junior age, depending on the primary race distance. The dose-time effect indicated a gradual reduction in the number of race distances as athletes approached peak performance age, narrowing down to 1-2, 2-3, and 3-4 distances for sprint, middle-, and long-distance races, respectively. Track runners exhibited a lower distance variety than swimmers, with a consistent optimum of 1-2 race distances across the age groups. CONCLUSIONS: The present findings including data of the most combined race distances for each primary race distance and a comparison between swimming and track running provide new background information to challenge traditional training regimes and help establish new strategies for long-term athlete development.

Physical Therapy in Neurorehabilitation with an Emphasis on Sports: A Bibliometric Analysis and Narrative Review.

The increasing interest in physical therapy in sports neurorehabilitation stems from the high incidence of neurological injuries among athletes and the crucial role of rehabilitation in facilitating their safe return to sports. This study aims to provide a comprehensive analysis of research trends in physical therapy and neurorehabilitation in athletes. This study presents a bibliometric analysis of 103 documents from the Scopus database, followed by a narrative review of the identified thematic areas. Together, these approaches offer a comprehensive overview of the international literature on the application of physical therapy in sports neurorehabilitation, highlighting key trends and contributors. The software VOSviewer and Power BI (2.136.1202.0) were used for the bibliometric analysis and the visualization of the results. Techniques such as performance analysis (documents per year, top sources and countries in documents, and top authors in citations) and science mapping (co-authorship, bibliographic coupling, co-citation, and co-occurrence) were conducted. The results revealed the journals and the authors with the greatest impact in the field and collaborations between various countries. From the co-occurrence analysis of the keywords, three key thematic clusters were identified, Clinical Approaches and Outcomes in Neurorehabilitation, Athlete-Centered Neurorehabilitation Techniques, and Specialized Interventions in Sports Medicine and Neurorehabilitation, which were used to conduct the narrative review. These findings provide a solid foundation for future research and clinical practice aimed at enhancing recovery times and overall performance in athletes with neurological injuries.

Impact Absorption Power of Polyolefin Fused Filament Fabrication 3D-Printed Sports Mouthguards: In Vitro Study.

BACKGROUND/AIM: This study aims to evaluate and compare the impact absorption capacities of thermoformed ethylene vinyl acetate (EVA) mouthguards and 3D-printed polyolefin mouthguards used in sports dentistry applications. The objective is to determine whether 3D-printed polyolefin mouthguards offer superior impact toughness compared to traditional EVA mouthguards commonly used in sports settings. MATERIALS AND METHODS: Six material samples were assessed: five pressure-formed EVA mouthguards (PolyShok, Buffalo Dental, Erkoflex, Proform, and Drufosoft) and one 3D-printed synthetic polymer (polyolefin). The materials were evaluated using a modified American Society for Testing and Materials (ASTM) D256 Test Method A for Izod pendulum impact resistance of plastics. Polyolefin samples were 3D-printed using fused filament fabrication (FFF) technology. Notably, the FFF process included samples printed with notches placed either parallel or perpendicular to the build direction. This orientation served as a study factor, allowing for comparison of material behavior under different printing conditions. Impact testing was conducted using an Izod impact tester to assess the materials' performance under controlled impact conditions. RESULTS: The study achieved a high power (1.0) in power analysis, indicating strong sensitivity to detect significant differences. Among molded materials, PolyShok showed significantly lower impact toughness compared to others (p = 0.06). The mean impact absorption of EVA materials was 5.4 ± 0.3 kJ/m2, significantly lower than polyolefin materials, which demonstrated 12.9 ± 0.7 kJ/m2 and superior performance (p = 0.0). Horizontal-notched polyolefin samples exhibited higher impact strength compared to vertical-notched samples (p = 0.009). CONCLUSIONS: 3D-printed polyolefin mouthguards exhibited significantly higher impact toughness than thermoformed EVA mouthguards. While EVA materials demonstrated structural robustness, their lower impact resistance and observed tearing in other test specimens suggest the need for alternative testing standards to better reflect real-world conditions. 3D-printed mouthguards fabricated with build orientations perpendicular to the direction of impact demonstrate significantly enhanced impact absorption. Further research into manufacturing methods and testing protocols is recommended to optimize mouthguard performance under impact scenarios.

A Severe Case of Arthrofibrosis After Anterior Cruciate Ligament (ACL) Reconstruction in a 25-Year-Old Female Hispanic Patient: A Case Report.

Arthrofibrosis is the most common postoperative complication of anterior cruciate ligament (ACL) reconstruction. It is caused by an exaggerated immune reaction to a pro-inflammatory trigger that causes abnormal periarticular fibrosis and joint stiffness. The shoulder, elbow, and knee are especially prone to this condition, often following trauma, surgery, or adhesive capsulitis. We describe the case of a 25-year-old Hispanic female who presented to the clinic with knee instability after experiencing a twisting and popping sensation in her left knee while playing tennis. Physical examination revealed increased anterior tibial translation, and imaging confirmed a torn ACL. She subsequently underwent ACL reconstruction using the bone-patellar tendon-bone graft technique. However, during her follow-up appointments, she reported persistent difficulties with active and passive range of motion in both flexion and extension despite undergoing appropriate physical therapy. Now, three months post-operation, she continues to experience limited knee range of motion. To our knowledge, there are only a few reports of arthrofibrosis in this particular age group and demographic undergoing this procedure. Our objective is to contribute this case to the scientific community, aiming to encourage future studies and gather epidemiological data on this topic.

Unravelling the threat of contamination in elite sports: Exploring diverse sources impacting adverse analytical findings and the risk of inadvertent exposure to prohibited substances.

In recent years, increasing concerns have emerged regarding athletes being exposed to various sources of contamination that could result in an adverse analytical finding (AAF), which is considered a positive doping test and may lead to the athlete's sanction. This review aims to examine the potential sources of contamination. Firstly, exogenous sources such as food, water, supplements, and medications will be described, along with endogenous sources, primarily arising from the athlete's physiological condition via the biotransformation of Medications. Finally, other hypothetical contaminations arising from sample collection procedures, poor transport or storage, and laboratory conditions will be discussed. Despite some legislative efforts to regulate the production of food and supplements, contamination remains a significant concern in the context of anti-doping, necessitating athletes to stay vigilant against the risks of inadvertent uptake of illicit products. Increased knowledge of the potential sources of contamination is essential for all parties involved in the fight against doping, including athletes, support personnel, legitimate supplement product manufacturers, and the anti-doping and scientific community. Such insights can contribute to developing the most effective strategy for preventing contamination and, most importantly, reducing the risk of inadvertent AAFs.

Pickleball Injuries in the Aging Athlete: A Critical Analysis Review.

The popularity of pickleball has rapidly increased in the United States, with over 48 million adult participants in recent years, leading to a growing need to better understand injuries exclusive to pickleball. Pickleball-related injuries are predominantly musculoskeletal, most commonly sprains and strains to the upper and lower extremities. Sport-specific variables, including sporting equipment, playing conditions, and proper technique may be utilized to guide clinicians in injury management and preventative treatment. Future research is warranted to better direct care for pickleball athletes with a focus on the aging population.

Sport-Related Injury and Performance Enhancing Substance Use by Young Athletes.

BACKGROUND: Legal performance enhancing substance (PES) use is increasing in young athletes and may lead to banned PES use. This study examines legal PES use and consideration of banned PES use in young athletes with a season-ending injury (SEI) compared to young athletes with non-SEI/no previous injury. HYPOTHESIS: Young athletes sustaining SEI or concussions have increased odds of reporting legal PES use and consideration of banned PES use compared with non-SEI or no injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: Cross-sectional study from 2013 to 2020 of athletes aged 6 to 25 years. RESULTS: No association was found between reporting legal PES use or consideration of banned PES use and young athletes with SEI or concussion compared with no injury/non-SEI. 14% of athletes reported legal PES use and 3% reported consideration of banned PES use. In adjusted analysis, athletes who were male (odds ratio [OR], 1.38; 95% CI, 1.16-1.73; P = 0.03), have history of depression (OR, 3.01; 95% CI, 1.26-7.18; P = 0.01), weight train (OR, 1.66; 95% CI, 1.04-2.65; P = 0.03), and believe that athletic ability is influenced by weight (OR, 1.75; 95% CI, 1.08-2.83; P = 0.02) had increased odds of reporting legal PES use. Older (OR, 1.18; 95% CI, 1.03-1.36; P = 0.02) and male (OR, 1.57; 95% CI, 1.02-1.81; P < 0.04) athletes had increased odds of consideration of banned PES use. CONCLUSION: This study found no increased odds of reported PES use in young athletes with sports-related injury or concussion regardless of injury type or severity. Factors associated with PES use were male sex, age, history of depression, weight training, and belief that weight affects athletic performance. CLINICAL RELEVANCE: Risk factors associated with PES use in young athletes are essentially unknown. This study can inform pertinent clinical care, education, and policy implementation.

Preparticipation Sports Physical Evaluation in Adolescents.

The purpose of the preparticipation physical evaluation (PPE) is to promote safe participation in sport and to restrict participation only when necessary for the safety of the athlete. Based on expert opinion, this tool is considered standard of care. Six stakeholder professional societies collaboratively published the Preparticipation Physical Evaluation Monograph to guide a more useful experience for both examiners and athletes. The PPE uses systems-based history-taking and physical examinations to determine medical eligibility for participation in sport.

Psychiatric risk factors in Formula One and the importance of integrating mental health into driver science.

Formula One (F1) racing has recently grown in popularity, extending well beyond its traditional European roots. However, there has been a paucity of scholarly research dedicated to the health of drivers and even less discussion of the prevalence of psychiatric symptoms, risk factors, and types of psychopathology in F1. This is notable given advancements in sports psychiatry and evidence of psychiatric disorders emerging across other sports. Accordingly, this perspective paper details the physiological conditions in F1 and the socioenvironmental pressures that a driver may encounter during their career, including heat stress, weight restrictions, harassment, and other factors. These extreme physiological and psychological stressors, both in racing and non-racing environments, alongside sport-specific psychosocial pressures, may cause HPA axis dysregulation and other issues in drivers, heightening vulnerabilities for mental health concerns. Additionally, F1 is still affected by stigmatizing attitudes and regressive sociocultural norms, which could inhibit progress toward promoting sustainable wellbeing. Consequently, drivers may be at risk for mental disorder and a decrease in overall health and wellbeing. Against this background, we thereby recommend mental health programs and regulatory actions that could better address these challenges and promote mental wellbeing across F1.

Preliminary Evaluation of Self-Reported Training Volume as an Adjunct Measure of Female Athlete Triad Risk in Division 1 Collegiate Female Runners.

Background/Objectives: This study tested whether self-reported training volume is predictive of female athlete triad risk collected using an established twelve-question triad screening tool in National Collegiate Athletic Association (NCAA) Division I (DI) collegiate female runners. Methods: A total of 319 institutions were initially contacted, seven of which agreed to distribute surveys to their female cross-country and track and field athletes. A total of 41 of 149 respondents completed the survey and met all inclusion criteria. Linear and binomial logistic regressions examined the relationships between self-reported training volumes and estimated triad risk. Independent samples t-tests were also used to compare training volumes across the high (> 50th percentile for risk factor counts) vs. low-risk groups. Results: Total weekly competition and conditioning resistance training hours were associated with the total number of triad risk factors (p = 0.044) and were also predictive of the triad risk group (p = 0.037). Likewise, both competition and conditioning resistance training hours (p = 0.034) were higher in the high-risk group versus the low-risk group. Conclusions: These findings suggest that self-reported resistance training volume is predictive of triad risk, but additional research is required to determine if monitoring training volume can provide valuable, real-time assessments of triad risk in DI collegiate female runners.

Carpal Tunnel Syndrome in Elite Female Tug-of-War Athletes: Prevalence and Risk Factor Analysis.

Background: Tug-of-War (TOW) games involve repetitive hand movements and vigorous force, raising the risk of peripheral neuropathy in the upper extremities. The prevalence of carpal tunnel syndrome (CTS) in TOW athletes remains unclear. We hypothesize that elite female TOW athletes have a higher prevalence of CTS than the general population. Methods: Twenty-nine female TOW athletes were recruited from a national team and participated in the study. CTS was clinically diagnosed by history taking and physical examination. Nerve conduction studies (NCS) were additionally performed to confirm CTS. Results: Twelve athletes were clinically diagnosed with CTS; however, only nine were confirmed by NCS. Ten athletes were diagnosed with subclinical CTS by NCS, while seven were classified as truly-non-CTS by both clinical assessment and NCS. The prevalence of CTS and subclinical CTS among the athletes was found to be 33.3% and 37.0%, respectively, significantly higher than 2.7% in the general population by electrodiagnosis. The body weight (p = 0.025) of the athletes with CTS and subclinical CTS was significantly different from those of the athletes without CTS. Conclusions: Our observations revealed a higher prevalence of CTS among elite female TOW athletes, with body weight being a risk factor. The forceful grasping and pulling of the rope may contribute to the development of CTS.