Most elite athletes return to preinjury competitive activity after surgical treatment for medial malleolus stress fractures.

PURPOSE: To provide return-to-performance outcomes after surgical treatment for medial malleolus stress fractures in the elite athlete. Additionally, to describe an individualised surgical approach in the management of medial malleolus stress fractures. METHODS: Five athletes (six ankles) underwent surgical treatment for a medial malleolus stress fracture. The surgical technique was based on the extent of the fracture line in steps with first arthroscopic debridement of bony spurs, microfracturing of the fracture line and screw fixation. Return-to-performance data included time to return to sport-specific training, normal training, first competitive activity, performance and the return-to-performance rate. RESULTS: Patients returned to sport-specific training at a median of 10 weeks. They started normal training at 16 weeks postoperatively and returned to their first competitive activity after 19 weeks. All patients had bony spurs on the distal tibia which were arthroscopically debrided. One patient received arthroscopic debridement of bony spurs alone. Four patients received additional microfracturing of the fracture line and three patients received screw fixation. All patients achieved clinical and radiographic union on follow-up computed tomography scan at 3 months postsurgery. At latest follow-up, no refractures nor hardware complications, nor any other complications were observed. CONCLUSION: Arthroscopic debridement of bony spurs, debridement and microfracturing of the fracture line and screw fixation are all viable surgical tools in the management of medial malleolus stress fractures in elite athletes. The surgical approach containing these options should be tailored to the individual athlete based on the fracture line in the sagittal plane. While most athletes return to full competitive activity in 3-4 months, time to self-reported return to full performance is often much longer. LEVEL OF EVIDENCE: Level IV.

Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes.

PURPOSE: This study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra-articular knee ligament reconstructions in elite athletes by reporting return-to-play (RTP) rates and levels, career longevity and complications. METHODS: A consecutive series of all extra-articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy-six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTP was defined as competing at professional level or national/international level in amateur sport. RESULTS: There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty-two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty-six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP. CONCLUSION: Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications. LEVEL OF EVIDENCE: Level IV.

Gambling Habits and Attitudes among Athlete and Non-Athlete High School Students in Skåne Region, Sweden.

Previous literature has reported increased rates of gambling problems in athletes compared to non-athletes. More liberal gambling-related attitudes have been suggested as a reason, although this rarely has been researched. The present study aimed to examine gambling experience, gambling problems, and gambling-related attitudes and parental gambling experience in high school students, comparing student-athletes to students at conventional schools. This is a cross-sectional web survey study in high school students (N = 473, 53% at sports high schools, 57% male) at eleven schools in the Skåne region, Sweden, who answered a web survey addressed gambling experiences, parental gambling and gambling-related attitudes, and included validated screening instruments for gambling problems and psychological distress. A history of any gambling was common and increased with age. Problem gambling was detected in 10% (13% of males and 5% of females, p < .001), and was associated with paternal and maternal gambling but not with psychological distress. Sports high school students were not more likely (9%) than other students (10%) to endorse gambling problems and history of each gambling type. However, paternal (but not maternal) gambling was more commonly reported in athletes, who also had more positive attitudes to gambling's effects on society and gambling availability. In contrast to other studies, this study did not demonstrate higher prevalence of gambling or gambling problems among young athletes than among other students, but liberal attitudes towards gambling, and experience of parental gambling on the father's side, were more common among athletes than among non-athletes. Gambling attitudes in adolescents may need to be targeted in future preventive efforts in young athletes and others.

Technical and tactical evolution of the offensive team sequences in LaLiga between 2008 and 2021. Is Spanish football now a more associative game?

The aim of this investigation was to study the technical and tactical evolution of the offensive team sequences in the Spanish football teams from 2008/09 to 2020/21. A comparative analysis including twelve variables related to the development of offensive sequences in 4940 matches was performed from 2008/09 to 2020/21 seasons of the Spanish professional football league (LaLiga). All match observations were recorded using a validated video tracking system. Multilevel linear mixed models were used to examine the differences across seasons, considering the effects of contextual variables. The number of passes per sequence (2.4 [CI: 2.2-2.5] vs 3.2 [CI: 3.0-3.4]; +33.3%), the passing accuracy (72.1 [CI: 70.6-73.5] vs 76.9 [CI: 75.4-78.3]%; +6.8%) and the average duration of the team sequences (6.4 [CI: 5.9-6.8] vs 8.3 [CI: 7.8-8.7] seconds; +25.76%) showed a small increasing trend over the seasons (P < 0.05). In contrast, variables such as the direct speed of progression (2.2 [CI: 2.1-2.3] vs 1.6 [CI: 1.5-1.7] metres/second; -24.5%), key passes (8.1 [CI: 7.6-8.5] vs 6.8 [CI: 6.3-7.2]; -15.8%), and the sequences that ended in the attacking third (64.8 [CI: 62,7-66.8] vs 57.1 [CI: 55.1-59.2]; -11.7%) or in a shot (13.0 [CI: 12.4-13.6] vs 10.2 [CI: 9.6-10.8]; -21.6%) showed a small decreasing trend from 2008/09 to 2020/21 (P < 0.05). Spanish professional football teams slightly evolved technically and tactically towards a more associative style of play that includes longer passing sequences. This evolution also involved a decreasing speed of progression and fewer technical actions such as through balls, key passes and shots.

Effects of acute caffeine intake on combat sports performance: A systematic review and meta-analysis.

The interest in the benefits of caffeine in combat sports has grown exponentially in the last few years, evidenced by the significant rise of post-competition urine caffeine concentration. We conduct a systematic review and meta-analysis on the effects of caffeine on different performance variables in combat sports athletes. In total, we included 25 studies. All studies included had blinded, and cross-over experimental designs, and we conducted a risk of bias analysis. For nonspecific outcomes, there was an ergogenic effect of caffeine on vertical jump height (SMD: 0.38; 95% CI: 0.04, 0.71) and reaction time (SMD: -0.98, 95% CI: -1.46,-0.50). For outcomes specific to combat sports, there was an increase in the number of throws with caffeine in the Special Judo Fitness Test (SMD: 0.62; 95% CI: 0.14, 1.09). Caffeine ingestion increased the number of offensive actions during combats (SMD: 0.40; 95% CI: 0.06, 0.74). Caffeine ingestion increased the duration of offensive actions during combat (SMD: 0.58; 95% CI: 0.21, 0.96). Finally, caffeine ingestion increased blood lactate concentration after bout 1 (SMD: 1.35) bout 2 (SMD: 1.43) and bout 3 (SMD: 1.98). Overall, athletes competing in combat sports may consider supplementing with caffeine for an acute increase in exercise performance.

Augmented stress weightbearing CT for evaluation of subtle tibiofibular syndesmotic injuries in the elite athlete.

OBJECTIVE: We aim to present a novel imaging technique utilizing weight-bearing CT with syndesmotic stress to identify subtle, unstable syndesmotic injuries. We illustrate this with a case presentation of such an injury in an elite athlete that ultimately required operative fixation. MATERIALS AND METHODS: In order to perform an augmented stress weightbearing CT, the patient is in the standing position, feet facing forward, and with weight distributed equally. The patient is then coached to internally rotate the shin and knee. This places an external rotational moment on the TFS due to the planted foot and ankle. The augmented stress images undergo 3D reconstruction and post-processing to render coronal and sagittal images. These are subsequently compared to standard, conventional weightbearing CT images performed without the external rotation stress. RESULTS: We illustrate this technique by presenting a case in which a 21-year-old collegiate athlete sustained a Grade II syndesmotic injury, diagnosed by MRI and clinical exam without evidence of instability by standard weightbearing CT or weightbearing radiographs. After undergoing the augmented stress weightbearing CT, the instability was noted. This prompted subsequent operative fixation and ultimately return to sport. CONCLUSION: We propose this technique for diagnosing unrecognized, subtle dynamically unstable syndesmosis injuries where clinical suspicion persists despite negative imaging, particularly in the elite athlete.

Where in a time constrained throwing task is the speed-accuracy trade-off?

Previous research on fielding in cricket and baseball has focused on the technique and speed-accuracy trade-off of the throw in isolation from a typical sequence of fielding actions; approach, gather and throw. The present study aimed to determine whether a speed-accuracy trade-off existed in fielding and where within the above sequence the trade-off occurs. Participants, who were elite cricketers, were required to run to a stationary ball and throw to the centre of a target in order to run-out a virtual batter. High-speed video was used to record the time of approach, time in contact with, and time of flight of the ball. Two-way ANOVAs were used to determine differences in group (gender) and condition (instructions to prioritise speed or accuracy). A speed-accuracy trade-off was found, with both groups being quicker in the approach and spending less time in contact with the ball in the speed condition; however, the horizontal velocity of the throw remained the same in both conditions. It was proposed the drop in accuracy in the speed condition may be associated with less time spent aiming. It was found that instructions triggered a change in throwing technique for 31% of the participants, which requires further investigation.

The Potential of Heart Rate Variability Monitoring for Mental Health Assessment in Top Wheel Gymnastics Athletes: A Single Case Design.

The assessment of heart rate variability (HRV) upon waking has been proposed as a method to evaluate mental health; however, owing to large individual differences among athletes, it is unclear whether HRV is adequate to predict mental health decline. In this study, we sought to establish this by evaluating HRV upon awakening in one athlete over 20 months. We assessed mental health once a month by calculating the depression index. In addition, self-reported training load and psychological fatigue index were assessed as psychological indices for athletes. Heart rate and HRV were each measured three days per week in both resting (supine) and standing (upright) positions. The results showed that orthostatic HRV upon waking had moderate linear relationships with the scores on the depression index and psychological fatigue index. By contrast, self-reported training load, a measure of physical stressor, was not associated with HRV. The findings suggest that the repeated assessment of HRV upon waking and mental health indicators may be useful in preventing mental health decline in athletes.

Triple careers of athletes: exploring the challenges of planning a pregnancy among female elite athletes using semi-structured interviews.

BACKGROUND: The challenging factors that elite athletes perceive for combining their sportive career with planning a pregnancy and motherhood need to be identified in order to develop supportive measures. Therefore, this phenomenological qualitative study aimed to explore challenges associated with planning a pregnancy among female, non-pregnant elite athletes. METHODS: Semi-structured skype-interviews were performed among female elite athletes (athletes competing on national or international level) aged 28 years or older. Using Mayring's qualitative content analysis approach, anchor examples served to identify potential challenges of planning a pregnancy which were categorized independently by two researchers. RESULTS: Interviews of 16 elite athletes (mean age 30.7 years) entered analysis. Eleven challenges of planning a pregnancy were identified, categorized into organizational / environmental, financial, personal, and physical factors. CONCLUSIONS: With regard to financial challenges, we propose mandatory maternity leave and continuation of the contracts and salary. Furthermore, mentoring programs may help to provide support and advice to new generations of female elite athletes and help to reduce concerns regarding the wish of becoming pregnant during a sportive career. In order to reduce physical concerns regarding pregnancy and exercise, we see a need for scientific studies investigating the association of sport discipline specific characteristics on sportive performance and the mother´s, fetus' and child´s health. Finally, the results of the current study may be used in future quantitative studies to test specific hypotheses.

Association between offensive and defensive playing style variables and ranking position in a national football league.

The aim of this study was to determine the association of playing style and efficacy variables with football success in a professional football league. Match statistics were obtained from 23 football teams competing in the 2017-2018 and 2018-2019 seasons of the Spanish national league(LaLiga). Offensive and defensive playing style and efficacy variables were calculated. Pearson's correlation coefficient tests and principal component analysis (PCA) were applied to establish the influence of these variables on the number of points obtained at the end of the season and on the ranking position. In isolation, the efficacy of completion showed the highest association with ranking points and position. A two-dimension PCA explained 77.8% of the variance in the ranking position. In dimension-1 (58.5%), game initiative and attack building, and in dimension-2 (19.3%), efficacy of defensive containment and a lower rate of long passes were within the variables that explained more variance in the ranking position. Success in football, measured by ranking position at the end of the Spanish national league, was associated with several playing style and efficacy variables. Overall, a dominant game style with high efficacy to finish attacking plays, and an offensive game initiative, are most associated with successful football.

High return to play rate following treatment of multiple-ligament knee injuries in 136 elite athletes.

PURPOSE: The purpose of the study is to assess return to play rate and timing of elite athletes treated for multi-ligament knee injuries with modern surgical techniques. METHODS: A retrospective review was performed of all professional or national/international level athletes treated for a multi-ligament knee injury by the senior author in the period from February 2001 to October 2019, with a minimum of 2-year follow-up. The study cohort consisted of 136 elite athletes who underwent surgery of two or more knee ligaments. Outcomes measures were return to play (RTP), defined as return to elite level sport, return to play time, and further surgical procedures. RESULTS: One hundred and twenty (88.2%) athletes returned to elite level sport at an average of 12.8 months from operation. In unicruciate injuries, ACL and PCL-based injuries had similar return to play rates (89.1% vs. 87.5% respectfully, n.s.) although mean RTP time was longer in those with PCL-based injuries (15.2 vs. 11.9 months, p < 0.01). Bicruciate injuries had longer RTP times compared to unicruciate injuries (mean RTP 16.0vs. 12.4 months, p < 0.05) but were able to return at a similar rate (83.3% vs. 88.9%, n.s.). Medial and lateral sided injuries had similar RTP rates (89.3% vs. 87.9%, n.s.) though lateral sided injuries took longer before returning to play (13.4 vs. 11.6 months, p < 0.05). Further surgery was required in 54 (39.9%) patients including 25 (18.4%) manipulations under anaesthesia. Four (2.9%) of the athletes underwent revision ligament surgery. CONCLUSION: Modern surgical techniques used in the treatment of multi-ligament knee injuries can lead to high return to play rates in elite athletes. LEVEL OF EVIDENCE: IV.

Hand Carpometacarpal Joint Instability in Elite Boxers: Injury Characteristics, Surgical Technique, and Outcomes.

PURPOSE: We describe a single-surgeon's experience of managing hand carpometacarpal joint (CMCJ) instability in elite boxers, focusing on injury characteristics, surgical technique, and outcomes. METHODS: This retrospective cohort included consecutive elite boxers undergoing surgery for hand CMCJ instability from 2009 to 2021. CMC joint instability is usually clear on clinical examination using a 'seesaw' test. All cases had a plain radiograph and in equivocal cases for instability advanced imaging such as MRI or ultrasound scan. CMCJs were accessed via longitudinal incisions between index/middle rays, and additionally ring/little. Often marked deficiency in the CMCJ ligamentous capsule was seen. The articular surfaces were decorticated to cancellous bone and autogenous bone graft impacted. The CMCJs were fixed in extension using various methods, latterly memory staples. Outcomes included radiographic fusion, return to boxing, and complications. RESULTS: Forty hands had surgery in 38 boxers. In total, 101 CMCJs were fused, with an average of 2.5 joints per patient. Patients were mainly young (mean age 24.1 years), male (37/38) with the trailing hand more commonly affected (trailing hand 87.5%, leading hand 12.5%). The most frequently fused CMCJ was the index (97.5%, n = 39), then middle (95%, n = 38), ring (45%, n = 18), and little (15%, n = 6). There were 82% (31/38) of patients who returned to the same level of boxing at a median of 8 months from surgery (range 3-27 months). Three patients had revision surgery for non-union, a median of 10.3 months after initial surgery (range 9.4-133.1 months): 2 for index/middle and one for the little CMCJ. All 3 revisions fused and the patients returned to boxing at the same level, although the little CMCJ required a second bone graft and fixation. CONCLUSIONS: Patients can achieve full recovery after treatment of CMCJ instability, and most can return to boxing at the same level with little risk of complications. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Reactive Strength as a Metric for Informing Return-to-Sport Decisions: A Case-Control Study.

OBJECTIVE: Current return-to-sport decisions are primarily based on elapsed time since surgery or injury and strength measures. Given data that show rates of successful return to competitive sport at around 55%, there is strong rationale for adopting tools that will better inform return to sport decisions. The authors' objective was to assess reactive strength as a metric for informing return-to-sport decisions. DESIGN: Case-control design. METHODS: Fifteen elite athletes from national sports teams (23 [6.0] y) in the final phase of their return-to-sport protocol following a unilateral knee injury and 16 age-matched control athletes (22 [4.6] y) performed a unilateral isometric strength test and 24-cm drop jump test. Pairwise comparisons were used to determine differences between legs within groups and differences in interleg asymmetry between groups. RESULTS: Strength measures did not distinguish the control from the rehabilitation group; however, clear differences in the degree of asymmetry were apparent between the control and rehabilitation groups for contact time (Cohen d = 0.56; -0.14 to 1.27; 8.2%; P = .113), flight time (d = 1.10; 0.44 to 1.76; 16.0%; P = .002), and reactive strength index (d = 1.27; 0.50 to 2.04; 22.4%; P = .002). CONCLUSION: Reactive strength data provide insight into functional deficits that persist into the final phase of a return-to-sport protocol. The authors' findings support the use of dynamic assessment tools to inform return-to-sport decisions to limit potential for reinjury.

Start Fast, Swim Faster, Turn Fastest: Section Analyses and Normative Data for Individual Medley.

The aims of the study were to provide benchmarks and normative data for 100 m, 200 m, and 400 m short-course individual medley (IM) races, investigate differences between the various swimming strokes and turns involved in IM, and quantify the effect and contribution of various race sections on swimming performance. All IM races (n = 320) at the 2019 European Short-Course Swimming Championships were video monitored and digitized with interrater reliability described by a mean intra-class correlation coefficient of 0.968. Normative data were provided for the eight finalists of each event (FINA points = 886 ± 37) and the eight slowest swimmers from each event (FINA points = 688 ± 53). Contribution and effects of race sections on swimming performance were investigated using stepwise regression analysis based on all races of each event. Regression analysis explained 97-100% of total variance in race time and revealed turn time (ß ≥ 0.53) as distinguishing factor in short-course IM races in addition to swim velocity (ß ≥ -0.28). Start time only affected 100 m (ß ≥ 0.14) and 200 m (ß ≥ 0.04) events. Fastest turn times were found for the butterfly/backstroke turn. Breaststroke showed slowest swim velocities and no difference between fastest and slowest 100 m IM swimmers. Therefore, breaststroke may provide largest potential for future development in IM race times. Correlation analyses revealed that distance per stroke (r ≥ -0.39, P < 0.05) rather than stroke rate (r ≤ -0.18, P > 0.05) is a performance indicator and may be used by coaches and performance analysts to evaluate stroke mechanics in male IM swimmers despite its more complex assessment. Performance analysts, coaches, and swimmers may use the present normative data to establish minimal and maximal requirements for European Championship participation and to create specific drills in practice.

Inhibitory Control Across Athletic Expertise and Its Relationship With Sport Performance.

Inhibitory control may be vital in elite sport. The authors examined the link between athletic expertise, inhibitory control, and sport performance in a two-part quasi experiment. Inhibitory control was indexed using the Stop-Signal Task, athlete expertise was categorized on literary recommendations, and sport performance was assessed using athlete and coach ratings. Study 1 examined cross-sectional and longitudinal patterns of inhibitory control across athletic expertise. Study 2 investigated whether the inhibitory control-sport performance relationship was moderated by expertise. Study 1 showed that expertise was linked to greater inhibitory control cross-sectionally and longitudinally. Study 2 revealed that expertise was related to superior performance on the Stop-Signal Task and athlete and coach performance ratings, and this relationship was moderated by athletic expertise. Inhibitory control relates to sport performance, increases with greater athlete expertise, and develops longitudinally. Long-term participation in sport may bring about changes in inhibitory control, which may lead to improved sport performance.

The kinematic differences between skill levels in the squash forehand drive, volley and drop strokes.

Knowledge of the kinematic differences that separate highly skilled and less-skilled squash players could assist the progression of talent development. This study compared trunk, upper-limb and racket kinematics between two groups of nine highly skilled and less-skilled male athletes for forehand drive, volley and drop strokes. A 15-camera motion analysis system recorded three-dimensional trajectories, with five shots analysed per participant per stroke. The highly skilled group had significantly (p < 0.05) larger forearm pronation/supination range-of-motion and wrist extension angles at impact than the less-skilled. The less-skilled group had a significantly more "open" racket face and slower racket velocities at impact than the highly skilled. Rates of shoulder internal rotation, forearm pronation, elbow extension and wrist flexion at impact were greater in the drive stroke than in the other strokes. The position of the racket at impact in the volley was significantly more anterior to the shoulder than in the other strokes, with a smaller trunk rotation angular velocity. Players used less shoulder internal/external rotation, forearm pronation/supination, elbow and wrist flexion/extension ranges-of-motions and angular velocities at impact in the drop stroke than in the other strokes. These findings provide useful insights into the technical differences that separate highly skilled from less-skilled players and provide a kinematic distinction between stroke types.

A qualitative exploration of mentally tough behaviour in Australian football.

The primary aim of this research was to generate insight into observable mentally tough behaviours, or MTb, across different contexts (e.g., training and competition) in an Australian football (AF) environment. A second aim of this research was to explore the utility of MTb as a distinct concept, and identify common behavioural qualities associated with MTb that separate it from other similar constructs. In total, 10 experienced full-time football operations staff were interviewed using a semi-structured interview guide, with inductive thematic analysis employed to analyse the data. Five main themes relating to MTb were identified: adaptive development, consistent training conduct, composed performance actions, responsible and accountable, and team supportive. Overall, the findings of the research provided preliminary support for the proposition that there exists a collection of MTb that are displayed more frequently by athletes considered to possess high levels of mental toughness compared to athletes who are perceived to have low levels of this psychological capacity. We propose a collection of necessary and sufficient behavioural qualities and a working definition of MTb to further our understanding of potential strategies to develop MT.

Sport-Specific Use of Doping Substances: Analysis of World Anti-Doping Agency Doping Control Tests between 2014 and 2017.

Background: In recent years, there has been a solid effort across all sports organizations to reduce the prevalence and incidence of doping in sport. However, the efficacy of current strategies to fight against doping might be improved by using anti-doping polices tailored to the features of doping in each sport. Objectives: The aim of this investigation was to analyze the substances more commonly found in doping control tests in individual and team sports. Material and Methods: The publicly accessible Testing Figures Reports made available by the World Anti-Doping Agency, were analyzed from 2014 to 2017. Results: The most commonly detected groups of banned substances were anabolic agents and stimulants but the distribution of adverse findings per drug class was very different depending on the sports discipline. Weightlifting, athletics, rugby, hockey and volleyball presented abnormally high proportions of anabolic agents (p = 2.8 × 10-11). Cycling, athletics and rugby presented atypically elevated proportions of peptide hormones and growth factors (p = 1.4 × 10-1). Diuretics and masking agents were more commonly found in boxing, wrestling, taekwondo, judo, shooting, and gymnastics than in other sports (p = 4.0 × 10-68). Cycling, rowing, aquatics, tennis, gymnastics and ice hockey presented abnormally high proportions of stimulants (p = 1.8 × 10-5). Conclusions: These results indicate that the groups of banned substances more commonly detected in anti-doping control tests were different depending on the sports discipline. These data suggest the prohibited substances used as doping agents might be substantially different depending on the type of sport and thus, sports-specific anti-doping policies should be implemented to enhance the efficacy of anti-doping testing.

Prevalence of Biopsychosocial Factors of Pain in 865 Sports Students of the Dach (Germany, Austria, Switzerland) Region - A Cross-Sectional Survey.

When sports are part of a person's profession or education, their careers are often handicapped by pain, a complex physical and mental state that may already occur at lower career stages. This study was designed to assess the occurrence of pain among sports students and the prevalence of relevant contributing psychosocial co-factors. Exploratory cross-sectional study surveying students at 89 sports faculties of universities in the DACH region using the German Sports Pain Questionnaire. It includes several validated surveys related to pain occurrence in different body regions, injuries, pain diagnoses and pain intensity, depression, anxiety, stress, self-compassion, analgesic and alcohol consumption, as well as sleep quality, health-related quality of life and impairments of quality of life by pain. A total of 865 sports students gave consent to participate in the study, and 664 participants (78%; 23.3 ± 2.84 years, 60% female, 40% male) completed the full survey. More than half of the students (53%; n = 403) showed current pain in 2-5 regions of the body, while subjective pain tolerance was enhanced. General injuries or accidents, medically and self-diagnosed pain diagnoses during the last eight weeks were reported by 30%. A current pain intensity ≥ 3 NRS was prevalent in 28% (n = 205), which correlated with increased pain-related biopsychosocial scores. Sports students had increased scores for depression, anxiety and stress, and self-compassion was reduced (compared to age-controlled national reference data, sports students head increased scores). The mean weekly training workload was 5-7 hours. Analgesics and alcohol consumption was increased, 61% reported insomnia. Across sports students, pain and biopsychosocial burden seem significantly increased when compared to other students and age-controlled cohorts. The data implies the need of giving greater importance to pain management at least from the time of sports studies in order to prevent pain and health risks in sports.

Subtotal Occlusion of Left Anterior Coronary Artery in a Professional Athlete.

Screening for cardiovascular disease in athletes is crucial to avoid life-threatening complications. Here, we present the case of a fairly asymptomatic young professional soccer player with several cardiovascular risk factors, who proved to have significant coronary artery disease on coronary computed tomography which was ordered based on clinical suspicion and his family history. Informed consent for publication was obtained from the patient.