Ramadan intermittent fasting and its association with health-related indices and exercise test performance in athletes and physically active individuals: an overview of systematic reviews.

OBJECTIVE: To systematically review, summarise and appraise findings of published systematic reviews, with/without meta-analyses, examining associations between Ramadan fasting observance (RO), health-related indices and exercise test performances in athletes and physically active individuals. DESIGN: Overview of systematic reviews with assessment of reviews' methodological quality. DATA SOURCES: PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, SPORTDiscus, ProQuest, PsycINFO and SciELO. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews with/without meta-analyses examining associations of RO with health-related indices and exercise performances in athletes and physically active individuals. RESULTS: Fourteen systematic reviews (seven with meta-analyses) of observational studies, with low-to-critically-low methodological quality, were included. Two reviews found associations between RO and decreased sleep duration in athletes and physically active individuals. One review suggested athletes may experience more pronounced reductions in sleep duration than physically active individuals. One review found associations between RO and impaired sleep quality in athletes and physically active individuals. RO was associated with decreased energy, carbohydrate and water intake in adult-aged athletes, but not adolescents. One review suggests RO was associated with athletes' increased feelings of fatigue and decreased vigour. No association was found between RO and athletes' lean mass or haematological indices. RO was unfavourably associated with changes in athletes' performance during high-intensity exercise testing. CONCLUSION: Continuance of training during RO could be associated with athletes' mood state disturbances, decreased sleep duration and performance decline during high-intensity exercise testing, while preserving lean mass. However, careful interpretation is necessary due to the low-to-critically-low methodological quality of the included reviews.

The impact of interval training on adiponectin to leptin ratios and on blood pressures in severely obese adolescent girls: A randomized controlled trial.

Interval-training is widely implemented among populations with obesity to decrease metabolic-disorders; however, high-intensity-interval-training (HIIT) has rarely been studied in severely obese adolescent girls. Therefore, the aim of this study was to compare the effects of 8 weeks of (HIIT) or moderate-intensity interval-training (MIIT), on cardiometabolic risk factors and hormonal-ratios in severely-obese-girls. For this aim, 35 female-adolescents (14.4 ± 1.4 years) were assigned randomly into HIIT (n = 12) and MIIT (n = 12), groups and a control group (CG, n = 11). Both training groups significantly improved (p < 0.05): the body-mass, body-mass-index (BMIp95), body-fat (BF%), waist-circumference (WC), mean-arterial-pressure (MAP), with a slight increase in the HIIT group. However, HIIT induced greater improvements on the maximal oxygen uptake (VO2MAX) and the speed related (24.7 and 11.8%) compared to MIIT. Higher improvements occurred in HIIT group related to leptin and adiponectin concentrations and the A/L ratio at (p < 0.001). In conclusion, the findings indicate that both HIIT and MIIT can positively influence body composition and cardio-respiratory fitness. Given the significant correlation noted between the A/L ratio, BMIp95, BF%, and MAP post-HIIT, this training modality may be considered a more advantageous approach over MIIT for mitigating cardio-metabolic issues in severely obese adolescent girls.

Snus use in football: the threat of a new addiction?

The use of Snus, an oral nicotine pouch, is becoming increasingly common in English professional football. As a nicotine product, Snus raises important questions about health and performance for practitioners. The purpose of this short communication is to explain the current regulatory status of Snus, performance relatedeffects, and associated health outcomes. Further, based on player statements and evidence from the general public, we argue that Snus is used as a coping mechanism to deal with the stressors of professional football. Accordingly, the communication concludes with guidance for club-level multidisciplinary interventions to support player welfare, aimed at reducing Snus use as well as future research recommendations.

A new statistical approach to training load and injury risk: separating the acute from the chronic load.

The relationship between recent (acute) training load relative to long-term (chronic) training load may be associated with sports injury risk. We explored the potential for modelling acute and chronic loads separately to address current statistical methodology limitations. We also determined whether there was any evidence of an interaction in the association between acute and chronic training loads and injury risk in football. A men's Qatar Stars League football cohort (1 465 players, 1 977 injuries), where training load was defined as the number of minutes of activity, and a Norwegian elite U-19 football cohort (81 players, 60 injuries), where training load was defined as the session rating of perceived exertion (sRPE). Mixed logistic regression was run with training load on the current day (acute load) and cumulative past training load estimated by distributed lag non-linear models (chronic load) as independent variables. Injury was the outcome. An interaction between acute and chronic training load was modelled. In both football populations, we observed that the risk of injury on the current day for different values of acute training load was highest for players with low chronic load, followed by high and then medium chronic load. The slopes varied substantially between different levels of chronic training load, indicating an interaction. Modelling acute and chronic loads separately in regression models is a suitable statistical approach for analysing the association between relative training load and injury risk in injury prevention research. Sports scientists should also consider the potential for interactions between acute and chronic load.

Using artificial intelligence for exercise prescription in personalised health promotion: A critical evaluation of OpenAI's GPT-4 model.

The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.

Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies.

This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women's Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club's international players' lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player's injury resilience in professional women footballers.

Leptin Signaling Could Mediate Hippocampal Decumulation of Beta-Amyloid and Tau Induced by High-Intensity Interval Training in Rats with Type 2 Diabetes.

Leptin (LEP) can cross the blood-brain barrier and facilitate cross-talk between the adipose tissue and central nerve system (CNS). This study aimed to investigate the effect of 8-week high-intensity interval training (HIIT) on the LEP signaling in the hippocampus of rats with type 2 diabetes. 20 rats were randomly divided into four groups: (i) control (Con), (ii) type 2 diabetes (T2D), (iii) exercise (EX), and (iv) type 2 diabetes + exercise (T2D + EX). The rats in the T2D and T2D + EX were fed a high-fat diet for two months, then a single dose of STZ (35 mg/kg) was injected to induce diabetes. The EX and T2D + EX groups performed 4-10 intervals of treadmill running at 80-100% of Vmax. Serum and hippocampal levels of LEP as well as hippocampal levels of LEP receptors (LEP-R), Janus kinase 2 (JAK-2), signal transducer and activator of transcription 3 (STAT-3), activated protein kinase (AMP-K), proxy zoster receptor α (PGC-1α), beta-secretase 1 (BACE1), Beta-Amyloid (Aß), Phosphoinositide 3-kinases (PI3K), protein kinase B (AKT), mammalian target of rapamycin (mTOR), Glycogen Synthase Kinase 3 Beta (GSK3ß), and hyperphosphorylated tau proteins (TAU) were measured. One-way ONOVA and Tukey post-hoc tests were used to analyze the data. Serum and hippocampal levels of LEP as well as hippocampal levels of LEP-R, JAK-2, STAT-3, AMP-K, PGC1α, PI3K, AKT, and mTOR were increased while hippocampal levels of BACE1, GSK3B, TAU, and Aß were decreased in T2D + EX compared with T2D group. Serum LEP and hippocampal levels of LEP, LEP-R, JAK-2, STAT-3, AMP-K, PGC1α, PI3K, AKT, and mTOR were decreased. Conversely hippocampal levels of BACE1, GSK3B, TAU, and Aß were increased in T2D group compared with CON group. HIIT could improve LEP signaling in the hippocampus of rats with type 2 diabetes and decrease the accumulation of Tau and Aß, which may reduce the risk of memory impairments.

Karatekas educated on injury prevention and supported by fitness coaches are more likely to practise injury prevention.

To determine the current perceptions and practices of top-level karate athletes concerning risk factors and injury prevention programme (IPP) implementation in training and competition. Out of 90 eligible countries (933 athletes) participating in the karate World Senior Championships (WSC) in Madrid 2018, 50 countries (55.6%) represented by 137 athletes (14.7%; 52 females and 85 males) responded to a structured questionnaire. Of the athletes responding, 45% reported that their national team did not conduct any measures to reduce injury risk (43% among females and 47% among males; p = 0.68). Kumite athletes (51%) were more likely to practise injury prevention compared to kata athletes (25%; p = 0.016). Of the respondents, 69%, 60%, 60% and 34% reported having no team doctor, fitness coach, massage therapist and physiotherapist, respectively. A greater proportion of athletes who had access to a fitness coach (part-time or full-time) engaged in injury prevention strategies (67% and 51%, respectively) than those who did not (35%; p = 0.031). Athletes who had received previous advice about injury prevention were more likely to practise injury prevention (58%) compared to the rest (21%; p < 0.001). The current study revealed that: i) almost half of the karatekas already benefited from an injury prevention programme, ii) injury prevention programmes were practised more frequently when there was a fitness coach among their coaching staff, iii) karatekas who had received education about injury prevention were more likely to practise injury prevention programmes.

Fatigue score as a promising complementary training monitoring tool: a pilot study in elite rugby sevens players.

The aim of this study was to compare physical and hormonal responses of seventeen elite rugby sevens players over a 6-week intense training block (IT) and a consecutive 2-week tapering period (TAP), using a fatigue cut-off score of 20 as a potential moderating variable. Training was monitored by daily training load (TL) and strain (TS) (using the session rating of perceived exertion [sRPE]) and also the weekly total score of fatigue (TSF; 8-item questionnaire tool). Testing and 24 h urinary cortisol (CL), cortisone (CN), adrenaline (AD) and noradrenalin (NAD) concentrations were also analysed before (T0) and after IT (T1) and after the TAP (T2). Players were assigned to group 1 with a TSF above 20 (G1 > 20, n = 9) and group 2 with a TSF below 20 (G2 < 20, n = 8) according to the French Society for Sports Medicine guidelines. TSF (effect size [ES] from 1.17 to 1.75), TL (ES from 0.81 to 1.06) and TS (ES from 1.23 to 1.40) were higher in G1 > 20 than in G2 < 20 over IT. Likewise, performance standards (ES from 1.58 to 2.61) and AD levels were lower (ES = 3.20), whereas CL and CL/CN ratio (ES from 1.60 to 3.47) were higher in G1 > 20 than in G2 < 20. After the TAP, TSF, TL and TS returned to baseline values for both groups, with an increase in performance standards and normalization in hormone levels. We suggest that a TSF greater than or equal to 20 could be considered as a fatigue threshold generating hormone disturbance and performance decrement, making it a potentially useful preventive and complementary training monitoring tool.

From human writing to artificial intelligence generated text: examining the prospects and potential threats of ChatGPT in academic writing.

Natural language processing (NLP) has been studied in computing for decades. Recent technological advancements have led to the development of sophisticated artificial intelligence (AI) models, such as Chat Generative Pre-trained Transformer (ChatGPT). These models can perform a range of language tasks and generate human-like responses, which offers exciting prospects for academic efficiency. This manuscript aims at (i) exploring the potential benefits and threats of ChatGPT and other NLP technologies in academic writing and research publications; (ii) highlights the ethical considerations involved in using these tools, and (iii) consider the impact they may have on the authenticity and credibility of academic work. This study involved a literature review of relevant scholarly articles published in peer-reviewed journals indexed in Scopus as quartile 1. The search used keywords such as "ChatGPT," "AI-generated text," "academic writing," and "natural language processing." The analysis was carried out using a quasi-qualitative approach, which involved reading and critically evaluating the sources and identifying relevant data to support the research questions. The study found that ChatGPT and other NLP technologies have the potential to enhance academic writing and research efficiency. However, their use also raises concerns about the impact on the authenticity and credibility of academic work. The study highlights the need for comprehensive discussions on the potential use, threats, and limitations of these tools, emphasizing the importance of ethical and academic principles, with human intelligence and critical thinking at the forefront of the research process. This study highlights the need for comprehensive debates and ethical considerations involved in their use. The study also recommends that academics exercise caution when using these tools and ensure transparency in their use, emphasizing the importance of human intelligence and critical thinking in academic work.

Recovery time variation during sprint interval training impacts amateur soccer players adaptations - a pilot study.

The objective of the present study was to investigate the selected performance adaptations of amateur soccer players to 2 different running-based sprint interval training (SIT) protocols with different recovery intervals and work-rest ratios (1:5 & 1:1). Twenty-three subjects (age 21.4 ± 1.1 years; height 175.4 ± 4.7 cm; body mass 69 ± 6.4 kg) participated in the study. Before the 6-weeks training period, participants completed 3-weeks of low-intensity training preparation. Subsequently, the pre-tests (anthropometric measurements, repeated sprint test [12 × 20-m with 30-s recovery intervals], Yo-YoIRT1 & Yo-YoIRT2 and treadmill VO2max test) were conducted. Thereafter, participants were randomly divided into 3 sub-groups (1 - SIT with 150 s recovery intervals [SIT150, n = 8]; 2 - SIT with 30 s recovery intervals [SIT30, n = 7]; and 3 - control group [CG, n = 8]). SIT150 and SIT30 training groups completed sprint interval training (2-days/week; 30-s all-out running, 6-10 repetition with 150 s recovery intervals for SIT150 and 30 s for SIT30 groups, respectively), a soccer match (1-day) and routine soccer training (3-days) per week. The CG attended only routine training sessions and the soccer-match (4-days). The study experiments and the trainings were conducted during off-season. Yo-YoIRT1, Yo-YoIRT2, and VO2max were significantly improved both in SIT30 and SIT150 (p < 0.05) groups. Yo-YoIRT1 and VO2max were also significantly improved in CG (p < 0.05). Both the SIT150 and SIT30 training were shown to improve Yo-YoIRT1, Yo-YoIRT2 and VO2max performance compared to the control group, nevertheless, SIT150 was more efficient in improving the Yo-YoIRT1, Yo-YoIRT2 than SIT30. The authors of this study suggest using SIT150 to induce more effective performance outputs in amateur soccer players.

Mechanisms of ACL injuries in men's football: A systematic video analysis over six seasons in the Qatari professional league.

To assess the mechanisms of ACL injury in male professional football players in Qatar across multiple seasons using systematic video analysis. 15 ACL injuries occurred in competition among the professional football teams that participated in an injury Surveillance Programme during 6 seasons (2013/2014 to 2018/2019). High-definition broadcast videos of these injuries were analyzed (49 views; 34 slow motion) by five analysts who independently described the injury mechanisms (situation, behavior, biomechanical characteristics) using validated observational tools. A knee valgus mechanism was observed in two-thirds of the cases (1 with direct contact to the knee, 3 with indirect contact (other body parts) and 6 with no contact). No visible valgus was reported in 2 of the direct knee contact injuries, while 3 cases of non-contact and indirect contact injuries were unclear. We observed 4 main categories of injury situation among those (n = 12) classified as non-contact/ indirect contact (multiple combinations were possible): pressing (n = 6), tackling or being tackled (n = 4), blocking (n = 3) and screening (n = 2). Direct contact injuries (n = 3) were suffered by 2 players during tackling and 1 whilst being tackled. Contact injuries represented only 20% of ACL injuries occurring during competition in Qatari professional soccer players. Independent of the playing situation, knee valgus was frequently observed (10/15 cases). Pressing was the most common situation (6/15 cases) leading to injury. Landing after heading was not reported in any of these ACL injuries.

Fractures in professional footballers: 7-years data from 106 team seasons in the Middle East.

Epidemiological studies on fractures in European professional football (soccer) are in abundance. However, such data are lacking in Middle Eastern professional footballers and information on fracture treatment is scarce. The aim of this study is to describe the epidemiology of fractures across seven seasons in Qatar Stars League (QSL) footballers. A prospective study of fractures in professional male footballers over 7 consecutive seasons (2013 to 2020), involving 3255 players and 106 team' seasons. Time loss and injuries and illnesses were recorded using standardised digital tools in accordance with international consensus procedures. Fractures were recorded according to onset mechanism, location, diagnoses, treatment and return to play. A total of 108 players sustained fractures during 638,247 hours of player exposure (88.9% training and 11.1% matches), representing 2.7% of all time-loss injuries. The incidence was 0.17 fractures per 1000 h of exposure (match and training incidence of 0.9 and 0.07 fractures / 1000 h, respectively), equivalent to an average of one fracture per team per season. Fractures mostly occurred in the feet (28.2%), hands (21.1%), shoulders (11.3%) and head (i.e., face) (9.9%). Mean (median) absence was 71 (47 days), with 4.6% refractures. Only 34.3% of the fractures required surgery and nearly all players (98.1%) returned to play at the professional level. Almost all professional football players with fractures return to play at the same competitive level after an average of 10 weeks of absence (mean absence was 71 ± 81 (median: 47, Inter Quartile Range [14-93]) days). One in ten continue to play with symptoms and one in twenty may refracture. Long-term effects of fractures are still unknown.

Large-scale sporting events during the COVID-19 pandemic: insights from the FIFA World Cup 2022 in Qatar with an analysis of patterns of COVID-19 metrics.

The 2022 FIFA World Cup (FIFA-WC) held in Qatar presented unique challenges, given the potential for rapid transmission of coronavirus disease 2019 (COVID-19) among over 1.4 million international fans attending the event. This study aimed to investigate the impact of the FIFA-WC 2022 on COVID-19 cases, deaths, and reproduction rate (R0) in Qatar. Additionally, it sought to understand the implications of hosting large-scale events during a pandemic without COVID-19 restrictive measures, providing critical insights for future decision-making. Data from "Our World in Data" were analysed for three distinct periods: one week before the FIFA-WC (week-preWC), the four weeks of the event (week-1WC to week-4WC), and one week after (week-postWC). The results revealed a significant increase in COVID-19 cases during week-3WC and week-4WC (compared to week-preWC) in Qatar, followed by a subsequent decrease during the week-postWC. Notably, Qatar experienced a more pronounced surge in positive cases than the global trend. Regarding COVID-19-related deaths, Qatar's peak occurred during week-2WC, while globally deaths peaked from week-3WC to week-postWC. Nevertheless, Qatar's death toll remained relatively low compared to the global trend throughout the event. The findings highlight that the FIFA-WC 2022 in Qatar demonstrated the feasibility of organizing large-scale sporting events during a pandemic with appropriate measures in place. They emphasize the importance of high vaccination coverage, continuous monitoring, and effective collaboration between event organizers, healthcare authorities, and governments. As such, the event serves as a valuable model for future gatherings, underlining the significance of evidence-based decision-making and comprehensive public health preparedness.

Does observance of Ramadan affect sleep in athletes and physically active individuals? A systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis is to provide an accurate description of the effect of Ramadan observance on sleep duration, sleep quality, daily nap duration, and daytime sleepiness in athletes and physically active individuals. Five electronic databases (PubMed, Web of Science, Scopus, Wiley, and Taylor and Francis) were used to search for relevant studies conducted with athletes or physically active individuals during Ramadan, published in any language, and available before May 23, 2021. Studies that included assessments of sleep quantity and/or quality, and/or daytime sleepiness, and/or daily naps in athletes and physically active individuals were included. The methodological quality of the studies was assessed using "QualSyst". Of the 18 papers included in this study (298 participants in total), 14 were of strong quality, two were moderate, and the remaining two were rated as weak. Individuals who continued to train during Ramadan experienced a decrease in sleep duration (number of studies, K = 17, number of participants, N = 289, g = -0.766, 95% confidence interval [CI] -1.199 to -0.333, p = 0.001). Additionally, the global score of the Pittsburgh Sleep Quality Index increased from 4.053 (K = 5, N = 65, 95% CI 3.071-5.034) pre-Ramadan, to 5.346 (95% CI 4.362-6.333) during Ramadan, indicating a decrease in sleep quality. The duration of daytime naps increased during compared to pre-Ramadan (K = 2, N = 31, g = 1.020, 95% CI 0.595-1.445, p = 0.000), whereas Epworth Sleepiness Scale scores remained unchanged during versus pre-Ramadan (K = 3, N = 31, g = 0.190, 95% CI -0.139-0.519, p = 0.257). In conclusion, individuals who continued to train during Ramadan experienced a decrease in sleep duration, impairment of sleep quality, and increase in daytime nap duration, with no change in daytime sleepiness levels.

High-speed running during match-play before and after return from hamstring injury in professional footballers.

Hamstring injuries constitute the single largest cause of lost playing time in professional football. While restoring high-speed running ability is paramount for rehabilitation from these injuries, little evidence exists regarding the extent of return to sport running performance after hamstring injury in football. We examined medical and match performance data available from a sample of 38 professional soccer players competing in the Qatar Stars League (N = 1426 observations) to describe high-speed running performance during match-play prior and subsequent to a hamstring strain injury. Multivariable-adjusted random-effects generalized additive models estimated post- versus pre-hamstring injury differences in maximal speed (km/h), high-speed running (>20 km/h), and sprinting (>25 km/h) distance. Mean effects and uncertainty (95% confidence interval, CI) were interpreted against the estimated random match-to-match variability in maximal sprinting speed, high-speed running distance, and sprinting running distance of ±1.67 km/h (95% CI, 1.62-1.72 km/h), ±102 m (95% CI, 99-105 m), and ±60 m (95% CI, 58-61 m), respectively. The estimated post- versus pre-hamstring injury mean differences in maximal sprinting speed, high-speed running distance, and sprinting running distance primary outcomes were -0.25 km/h (95% CI, -0.38 to -0.12 km/h), -43 m (95% CI, -56 to -30 m), and -22 m (95% CI, -29 to -16 m). Players returning to football match-play after hamstring strain injury experienced reductions in high-speed match physical performance that were well within normal match-to-match variation in performance.

Shedding light on incidence and burden of physeal injuries in a youth elite football academy: A 4-season prospective study.

INTRODUCTION: Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. METHODS: In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad). RESULTS: There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12-30) days; II: 10 (95% CI: 7.3.1-13.4)]. Apophyseal injuries of the hip-pelvis resulted in the greatest burden [median: 13 (95% CI: 10-17); II: 2.5 (95% CI: 2.1-3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot-ankle (II: 2.4; 95% CI: 1.0-4.9), U-14 for knee (II: 4.5; 95% CI: 2.7-7.1), and U-17 for hip-pelvis (II: 6.4; 95% CI: 4.2-9.3). CONCLUSION: Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip-pelvic apophyseal injuries accounted for the largest injury burden.

Injury and illness epidemiology in professional Asian football: lower general incidence and burden but higher ACL and hamstring injury burden compared with Europe.

BACKGROUND: While football injury and illness epidemiology surveillance at professional club level in Europe is available, epidemiological data from other continents are lacking. PURPOSE: Investigating injury and illness epidemiology in professional Asian football. STUDY DESIGN: Descriptive prospective study. METHODS: Professional teams from the Asian Football Confederation (AFC) league were followed prospectively for three consecutive AFC seasons (2017 through 2019, 13 teams per season, 322 team months). Time-loss injuries and illnesses in addition to individual match and training exposure were recorded using standardised digital tools in accordance with international consensus procedures. RESULTS: In total, 232 665 hours of exposure (88.6% training and 11.4% matches) and 1159 injuries were recorded; 496 (42.8%) occurred during matches, 610 (52.6%) during training; 32 (2.8%) were reported as 'not applicable' and for 21 injuries (1.8%) information was missing. Injury incidence was significantly greater during match play (19.2±8.6 injuries per 1000 hours) than training (2.8±1.4, p<0.0001), resulting in a low overall incidence of 5.1±2.2.The injury burden for match injuries was greater than from training injuries (456±336 days per 1000 hours vs 54±34 days, p<0.0001). The two specific injuries causing the greatest burden were complete ACL ruptures (0.14 injuries (95% CI 0.9 to 0.19) and 29.8 days lost (29.1 to 30.5) per 1000 hours) and hamstring strains (0.86 injuries (0.74 to 0.99) and 17.5 days (17.0 to 18.1) lost per 1000 hours).Reinjuries constituted 9.9% of all injuries. Index injuries caused 22.6±40.8 days of absence compared with 25.1±39 for reinjuries (p=0.62). The 175 illnesses recorded resulted in 1.4±2.9 days of time loss per team per month. CONCLUSION: Professional Asian football is characterised by an overall injury incidence similar to that reported from Europe, but with a high rate of ACL ruptures and hamstring injury, warranting further investigations.

Hamstring Injury Prevention for Elite Soccer Players: A Real-World Prevention Program Showing the Effect of Players' Compliance on the Outcome.

ABSTRACT: Chebbi, S, Chamari, K, Van Dyk, N, Gabbett, T, and Tabben, M. Hamstring injury prevention for elite soccer players: A real-world prevention program showing the effect of players' compliance on the outcome. J Strength Cond Res 36(5): 1383-1388, 2022-The aim of this study was to determine the effect of implementing the Nordic hamstring exercise (NHE) to prevent hamstring injuries in soccer. A professional team was followed by the same medical team during 5 successive seasons (2012/2013 through 2016/2017). During the first and last seasons (2012/2013 and 2016/2017), no hamstring preventive action was implemented. For the seasons 2013/2014, 2014/2015, and 2015/2016, a noncompulsory (few players refusing to participate) NHE prevention program was implemented with accurate recording of the players' training and match exposure and attendance to the prevention sessions. The first 10 weeks of the season were used to progressively increase the volume and intensity of the NHE exercises, and at the end of the season, players were split in low-, moderate-, and high-attendance groups to the prevention sessions. Overall, 35 time-loss hamstring strain injuries were accounted for. The injury incidence was 0.30 per player per season, and the injury rate was 0.95 injury/1000 hour of exposure. A nonstatistically significant higher risk of hamstring injury was observed in the control, low, and moderate attendance groups compared with the high-attendance group. The greatest risk of hamstring injury was observed in the low-attendance group (odds ratio 1.77, confidence interval 0.57-5.47, p = 0.32). Implementing a NHE prevention program has a positive effect on the injury rate in a soccer team; however, the compliance of players with such interventions may be critical for its success.

Neuropathic pain in athletes: basics of diagnosis and monitoring of a hidden threat.

The aim was to increase awareness about neuropathic pain in athletes and the available diagnostic criteria and explore the relevance to athletes and sports. In the report of its consensus meeting of 2016, the International Olympic Committee (IOC) noted the critical need to raise the awareness about pain and its management amongst sports physicians. The adequate management of pain requires recognition of its type and pathophysiological mechanisms. This is paramount in applying the multi-modal management of pain as a symptom or approach it as a disease. In athletes, the assessment of pain in general, and of neuropathic pain in particular, is more complex due to the impact of physiological, psychological and motivational factors and specific pathophysiological mechanisms on the pain threshold and tolerance. Neuropathic pain is not uncommon to encounter in athletes although not always recognised. Examples of neuropathic pain as a disease include complex regional pain syndrome (CRPS), peripheral neuropathy and spinal cord injuries. The recognition and diagnosis of neuropathic pain could be facilitated by the application of screening tools such as DN4 (Douleur Neuropathique 4) and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs). Sports injuries may lead to neuropathic pain through different pathologies and mechanisms. Thus, neuropathic pain could be a real threat to athletes' career if not promptly recognised and treated. We therefore believe that early recognition and expert management are mandatory for the best outcome.