Vitamin D Deficiency in Professional Football Players during Competitive Season of Italian First Division (Serie A).

BACKGROUND: Data in the literature have demonstrated the crucial role that vitamin D plays in the human organism, and recent studies also emphasize this essential role of vitamin D in athletes. Indeed, vitamin D acts on the skeletal muscles and plays a fundamental role in numerous physiological processes involved in immune function. Many factors such as sun exposure, skin tone, body mass index and chronic illness affect vitamin D levels. The aim of the study is to evaluate vitamin D levels in professional football players in Italy and investigate the variations in vitamin D values in footballers who train at different latitudes. METHODS: The study performed is a retrospective observational study analyzing 25-OH vitamin D values in professional football players of the Italian First Division (Serie A). Two teams during the competitive season were selected: team A (latitude of 41° N in southern Italy) and team B (latitude of 45° N in northern Italy). Three time periods were identified and were classified as follows: the first quarter (May, June, July, and August), the second quarter (September, October, November, and December) and the third quarter (January, February, March, and April). The purpose of this was to study the average values of vitamin D during the year corresponding to different levels of sunlight exposure. Each athlete was subjected to at least one sampling during the three quarters of the competitive season. RESULTS: Both vitamin D insufficiency (10.1%) and overt deficiency (1.93%) were found in Italian Serie A players. Insufficient vitamin D values are between 20 ng/mL and 29 ng/mL and overt deficiency values <20 ng/mL. At the same time, the data demonstrated a significant variation in vitamin D values depending on the period of the competitive season and the latitude of the cities of the two teams. In detail, there was no significant difference in the first quarter, while there was a significant increase in vitamin D values in team B in the second and third quarter, at p < 0.01 and p < 0.05, respectively. CONCLUSIONS: Latitude and seasons have a significant impact on vitamin D levels. Therefore, it is essential to measure vitamin D in professional football players, especially during the spring and winter months, so as to monitor changes in levels in relation to the season and latitude and evaluate any supplements. Further studies should be performed to evaluate the relationship between vitamin D deficiency and football players' athletic performance.

Prevalence of hip femoroacetabular impingement deformities in high-level (La Liga) male professional football players.

BACKGROUND: Femoroacetabular impingement (FAI) is considered one of the main causes of hip osteoarthritis in young adults, especially in athletes. In recent years, morphological changes in FAI in the hip have been linked to early and intense sports participation, but studying top-level athlete samples is not easy. This paper presents the prevalence of FAI radiological markers in 120 active white male professional football players in the Spanish First Division League (La Liga) and compares the morphological changes with those of a control group of healthy individuals without significant sport activity. METHODS: The precontract medical evaluation hip X-rays of 120 white male professional football players from four different First Division Spanish football teams were prospectively filed and retrospectively reviewed by a dedicated skeletal radiologist. The footballers' hip X-rays were compared with those of a control group of 80 healthy individuals (age-sex matched) without significant sport activity (obtained from routine work medical checks). RESULTS: The femoral head-neck deformity associated with the Cam type of femoroacetabular impingement was observed in 61.6% of professional football players and only in 11.6% of the control group (p <0.01). The presence of "herniation pit" (11.6%) and os acetabuli (13.3%) also reached statistical significance in the professional football players group. In the other analyzed parameters, no statistically significant differences between the groups were observed. CONCLUSIONS: White professional top-level football players have an increased incidence of abnormal lateral epiphyseal extension ("pistol grip deformity"), os acetabuli and herniation pits.

Development of novel calibration model(s) to predict whole-body density in professional football players.

INTRODUCTION: Questions continue to be raised about the validity that is in existence to estimate Db, in professional male footballer players. METHODS: Phase 1: n = 28 anthropometric variables were used on n = 206 footballers, using regression analyses to determine standard error of estimate and R2. A cut-off correlation coefficient set at r = 0.950 and 90% R2. Phase 2: all variables (z-scores, x- = 0.0, SD = ±1.0) to help reduce heteroscedasticity, ß, r, t, significance of t and P-values were calculated. Phase 3: a forced stepwise-backwards regression analysis approach with nine predictors which met the acceptance criteria (r = 0.950, R2 = 90% and ß weights) was used to develop a 'best fit' and a 'practical' calibration model. Phase 4: cross-validation of the two newly developed calibration method using LoA. RESULTS: The 'best fit' model SEM (0.115 g ml-1), the highest R2 (6.6%) (P ≤ 0.005), whereas the 'practical' calibration model SEM (0.115 g ml-1), R2 (4.7%) (P ≤ 0.005) with r values = 0.271 and 0.596 and R2 (%) coefficients = 0.3526 for the 'best fit' and 'practical' calibration models, respectively (P = 0.01). CONCLUSIONS: The two calibration models supported an ecologically and statistically valid contribution and can provide sound judgements about professional footballers' body composition.

Differentiation Between Tendinous, Myotendinous and Myofascial Injuries by L-BIA in Professional Football Players.

PURPOSE: To differentiate by localized bioimpedance (L-BIA) measurements 24 h after injury, between tendinous, myotendinous junction (MTJ), and myofascial junction (MFJ) injuries, previously diagnosed by MRI exam. To evaluate by L-BIA, the severity of MTJ injuries graded from 1 to 3, and to determine the relationship between days to return to play (RTP) and L-BIA measurements. METHODS: 3T MRI and tetra polar L-BIA was used to analyzed 37 muscle injuries 24 h after injury in 32 male professional football players, (23.5 ± 1.5 kg m-2; 1.8 ± 0.1 m; 20-30 year.) between the 2016-2017 and 2017-2018 seasons. Muscle injuries were classified by The British Athletics Muscle Injury Classification (BAMIC). Percentage difference of L-BIA parameters [resistance (R), reactance (Xc), and phase angle (PA)] of the injured side were calculated considering contralateral non-injured side as the reference value. RESULTS: According to BAMIC classification and by MRI exam, we found tendinous (n = 4), MTJ (n = 26), and MFJ (n = 7) muscle injuries. In addition, MTJ injuries were grouped according to the severity of injury in grade 1 (n = 11), grade 2 (n = 8), and grade 3 (n = 7). Significant decrease (P < 0.01) was found in the L-BIA parameters R, Xc, and PA, in both MTJ and MFJ as well as in the different grades of MTJ injuries. In particular, in Xc (P < 0.001), which is related to muscle cell disruption. Regarding days to RTP, there was statistical significance among the three different grades of MTJ injuries (P < 0.001), especially when grade 1 was compared to grade 3 and grade 2 compared to 3. CONCLUSION: L-BIA is a complementary method to imaging diagnostic techniques, such as MRI and US, to quantify MTJ and MFJ injuries. In addition, the increase in the severity of the MTJ injury resulted in higher changes of the Xc parameter and longer time to RTP.

FDDNP-PET Tau Brain Protein Binding Patterns in Military Personnel with Suspected Chronic Traumatic Encephalopathy1.

BACKGROUND: Our group has shown that in vivo tau brain binding patterns from FDDNP-PET scans in retired professional football players with suspected chronic traumatic encephalopathy differ from those of tau and amyloid aggregate binding observed in Alzheimer's disease (AD) patients and cognitively-intact controls. OBJECTIVE: To compare these findings with those from military personnel with histories of mild traumatic brain injury(mTBI). METHODS: FDDNP-PET brain scans were compared among 7 military personnel and 15 retired players with mTBI histories and cognitive and/or mood symptoms, 24 AD patients, and 28 cognitively-intact controls. Nonparametric ANCOVAs with Tukey-Kramer adjusted post-hoc comparisons were used to test for significant differences in regional FDDNP binding among subject groups. RESULTS: FDDNP brain binding was higher in military personnel compared to controls in the amygdala, midbrain, thalamus, pons, frontal and anterior and posterior cingulate regions (p < 0.01-0.0001). Binding patterns in the military personnel were similar to those of the players except for the amygdala and striatum (binding higher in players; p = 0.02-0.003). Compared with the AD group, the military personnel showed higher binding in the midbrain (p = 0.0008) and pons (p = 0.002) and lower binding in the medial temporal, lateral temporal, and parietal regions (all p = 0.02). CONCLUSION: This first study of in vivo tau and amyloid brain signals in military personnel with histories of mTBI shows binding patterns similar to those of retired football players and distinct from the binding patterns in AD and normal aging, suggesting the potential value of FDDNP-PET for early detection and treatment monitoring in varied at-risk populations.

MRI detection of soleus muscle injuries in professional football players.

OBJECTIVES: To describe magnetic resonance imaging (MRI) characteristics of soleus muscle injuries in symptomatic professional football players stratified according to both the Munich consensus statement and the British Athletics Muscle Injury Classification (BAMIC), and to investigate the association between specific MRI features and the "return to play" (RTP). MATERIALS AND METHODS: Professional football players with an episode of acute posterior calf pain and impaired function, subsequent to sports activity, underwent ultrasound followed by MRI examination reviewed by two different radiologists with more than 10 years of experience in the musculoskeletal system. MRI features and RTP outcome were evaluated for all types of injuries. RESULTS: During a 36-month period, a total of 20 professional football players were evaluated. According to the Munich consensus, 11 were type 3A, 8 were type 3B, and 1 was type 4, whereas according to the BAMIC, 11 lesions were considered grade 1, 4 grade 2, 4 grade 3, and 1 grade 4. RTP data were available for all patients (mean 3.3 ± 1.6 weeks). Both the Munich consensus and the BAMIC correlated with RTP (Spearman correlation = 0.982 and p < 0.0001 and 0.886 and p < 0.0001 respectively). Extension of edema was an independent prognostic factor for RTP in two different models of multivariate regression analysis (p = 0.044 model A; p = 0.031 model B). CONCLUSIONS: The Munich consensus and BAMIC grading systems are useful tools for defining the patient's prognosis and proper rehabilitation time after injury. The MRI feature that we should carefully look for is the extension of edema, as it seems to significantly affect the RTP.

Comparison of T2* relaxation times of articular cartilage of the knee in elite professional football players and age-and BMI-matched amateur athletes.

OBJECTIVE: Recent investigation has underlined the potential of quantitative MR imaging to be used as a complementary tool for the diagnosis of cartilage degeneration at an early state. The presented study analyses T2* relaxation times of articular cartilage of the knee in professional athletes and compares the results to age- and BMI (Body Mass Index)-matched healthy amateur athletes. MATERIALS AND METHODS: 22 professional football players and 22 age- and BMI-matched individuals were underwent knee Magnetic Resonance Imaging (MRI) at 3T including qualitative and quantitative analysis. Qualitative analysis included e.g. meniscal tears, joint effusion and bone edema. For quantitative analysis T2* (22 ET: 4.6-53.6ms) measurements in 3D data acquisition were performed. Deep and superficial layers of 22 predefined cartilage segments were analysed. All data sets were postprocessed using a dedicated software tool. Statistical analysis included Student t-test, confidence intervals and a random effects model. RESULTS: In both groups, T2* relaxation times were significantly higher in the superficial compared to the deep layers (p<0.001). Professional athletes had significantly higher relaxation times in eight superficial and three deep cartilage layers in the predefined cartilage segments (p<0.05). Highly significant differences were found in the weight-bearing segments of the lateral superficial femoral condyle (p<0.001). CONCLUSION: Elevated T2* values in cartilage layers of professional football players compared to amateur athletes were noted. The effects seem to predominate in superficial cartilage layers.

A survey of "mental hardiness" and "mental toughness" in professional male football players.

BACKGROUND: It is not uncommon for chiropractors to be associated with sports teams for injury prevention, treatment, or performance enhancement. There is increasing acceptance of the importance of sports psychology in the overall management of athletes. Recent findings indicate mental hardiness can be determined reliably using specific self-assessment questionnaires. This study set out to investigate the hardiness scores of professional footballers and examine the correlation between two questionnaires. It also included a mental hardiness rating of players by two coaches, and examined differences in hardiness and mental toughness between national and international players. METHODS: Two self-assessment questionnaires (modified Sports Mental Toughness Questionnaire [SMTQ-M] and Psychological Performance Inventory [PPI-A]) were completed by 20 male professional footballers. Two coaches, independently rated each player. A percentage score from each questionnaire was awarded each player and an average score was calculated ({SMTQ-M % + PPI-A %} ÷ 2). The PPI-A and SMTQ-M scores obtained for each player were analysed for correlation with Pearson's correlation coefficient. Cohen's kappa inter-reliability coefficient was used to determine agreement between coaches, and between the players' hardiness scores and coaches' ratings. The independent t-test was used to examine differences between national and international players. RESULTS: The players' scores obtained from PPI-A and SMTQ-M correlated well (r = 0.709, p < 0.001). The coaches ratings showed significant, weak to moderate agreement (Cohen's kappa = 0.33). No significant agreement was found between player self-assessments and coaches' ratings. The average ({SMTQ-M % + PPI-A %} ÷ 2) mean score was 77% (SD = 7.98) with international players scoring 7.4% (p = 0.04) higher than non-international players. CONCLUSIONS: The questionnaires (SMTQ-M and PPI-A) correlated well in their outcome scores. These findings suggest that coaches moderately agree when assessing the level of mental hardiness of football players. There was no agreement between player self-assessment and ratings by coaches. Footballers who play or had played for national teams achieved slightly higher mental hardiness scores. Either questionnaire can offer the clinician a cost-effective, valuable measure of an individual's psychological attributes, which could be relevant within the wider context of bio-psycho-social model of care.