Gender and socioecological level differences in stakeholders' perceptions of athlete attrition factors in an Australian high-performance pathway system.

OBJECTIVES: This study aimed to build on previous work by the authors. It examines how socioecological level and gender influence high-performance sport system (HPSS) stakeholders' perspectives of the relative importance and feasibility to address athlete attrition factors within an Australian high-performance pathway system (HPPS). DESIGN: Mixed methods. METHODS: Sub-analysis was conducted of rating data from 30 participants who had contributed to identifying 83 statements in 13 clusters in a previous Concept Mapping study. The 13 clusters were statistically analysed in 'R' using cumulative link mixed models (CLMMs) to determine differences in perceived importance and feasibility between 1) socioecological levels, and 2) genders. RESULTS: Mean ratings for 11 and three of the 13 clusters were statistically significantly different between at least two of the five socioecological levels, for importance and feasibility, respectively. Athletes had the largest variation in mean ratings from the most (athlete health 4.59), to least (performance potential 2.83) important cluster, when compared to the other four socioecological levels. There were statistically significant differences between the ratings between genders (Men/Women) for two clusters for each rating scale: Importance: 'athlete health' (M3.33:W3.84 [p 0.012]); 'performance potential' (M3.35:W2.57; [p 0.001]), Feasibility: 'abuse and mismanagement of health' (M2.97:W3.68; [p 0.000]) and 'athlete health' (M2.54:W3.33; [p 0.000]). CONCLUSIONS: This study highlights the need to implement more robust athlete attrition monitoring protocols. It also highlights the importance of listening to youth athletes' voices, and enabling equal gender representation to ensure holistically tailored environments are created to retain talented athletes in high-performance pathway programmes.

Martial Arts: Orthopaedic Injuries and Related Biomechanics.

Martial arts are various systems of combat skills encompassing striking and grappling. Many styles have evolved into modern sports, and some have been included in the Olympics. The physicality of these can predispose practitioners to musculoskeletal injuries, such as anterior cruciate ligament ruptures; patellar, shoulder, or elbow instabilities; extremity fractures; and hand and spine injuries, which have been studied both clinically and biomechanically. The most common injury related to longer time loss from participation is an anterior cruciate ligament rupture. Higher injury incidence is associated with a higher level of experience and competition. Orthopaedic management of martial arts injuries should reflect the specific needs of each martial artist and the biomechanics of motions common to each style. Full-contact practitioners may benefit from broader surgical indications and special attention to the choice and positioning of implants; nonsurgical treatment may be appropriate for certain pediatric or noncontact practitioners. Approximately 60% of martial artists can return to the preinjury level of participation after a major injury. Injury prevention and rehabilitation programs should optimize neuromotor control and core engagement to ensure proper body mechanics. Gradual incorporation of martial arts movement into the postoperative physical therapy curriculum can benefit physical progress and help gain confidence toward full participation.

A Randomized, Double-Blind, Placebo-Controlled Clinical Trial Evaluating Transcranial Photobiomodulation as Treatment for Concussion.

INTRODUCTION: Literature indicating that transcranial photobiomodulation (tPBM) may enable the brain to recover normal function after concussion, resulting in symptoms reduction, and improved cognitive function after concussion is limited by small sample sizes and lack of controls. METHODS: We conducted a randomized, double-blind, placebo-controlled trial examining the effect of 6 wk of tPBM in patients 11 yr or older who received care for persistent postconcussion symptoms between September 2012 and December 2015. Our primary outcome measure was the mean difference in Postconcussion Symptom Scale total score and the raw Immediate Postconcussion Assessment and Cognitive Testing composite scores between study entry and treatment completion. Participants received two, 10-min sessions either with tPBM units or via two placebo units, three times per week. We screened for potential confounding variables using univariable analyses. We entered covariables that differed between the two groups on univariable screening into a regression analysis. We considered adjusted odds ratio that did not cross one statistically significant. RESULTS: Forty-eight participants completed the study. Most were female (63%), and a majority sustained their injury during sports or exercise (71%). Despite randomization, those that received tPBM therapy reported a greater number of previous concussions. After adjusting for the effect of previous concussions and multiple comparisons, there were no significant differences between tPBM and placebo groups at 3 or 6 wk of treatment. CONCLUSIONS: Despite showing promise in previous investigations, our study did not show benefit to tPBM over placebo therapy in patients experiencing persistent postconcussion symptoms. Further investigation is needed to determine if varying the dose or timing alters the efficacy of tPBM after concussion.

Chiropractic Care in a Multidisciplinary Sports Health Care Environment: A Survey of Canadian National Team Athletes.

OBJECTIVE: The purpose of this study was to describe the utilization of health team practitioners among national-level athletes and report their injury profile as well as access to and knowledge of chiropractic care. METHODS: This study was a retrospective analysis of non-identifiable, cross-sectional survey data that were previously collected from members of the AthletesCAN organization who voluntarily completed a web-based, bilingual survey in July or August 2017. The sport of the athlete, number of years on a national team, number and type of injuries, health care practitioners visited, and specific details on chiropractic care were collected. Descriptive statistics were performed to summarize the responses in terms of frequencies and percentages. RESULTS: There was an 11% response rate (198/1733), with 67 unique sports identified (21 winter sports [50 athletes] and 46 summer sports [148 athletes]). Athletics and swimming were the sports with the most respondents. Fewer than half (43.9%) of the 198 respondents were members of AthletesCAN for 2 to 5 years. Seventy percent reported 1 to 5 injuries over their career, with ankle, low back, and shoulder the most likely body parts affected. A majority of athletes (93.4%) reported visiting multiple practitioners, including medical physicians, physiotherapists, athletic therapists, massage therapists, and chiropractors. Two-thirds (67%) of athletes sought chiropractic treatment, most typically for neck or back pain (81.3%), despite nearly half (45.7%) being unsure about access to chiropractic care. CONCLUSION: This sample of Canadian national team athletes who experience an injury may seek care from multiple types of health care providers and include chiropractic as part of their approach to health care.

Acupuncture in Sports Medicine.

Acupuncture is gaining popularity and wider acceptance as a treatment modality within the field of sports medicine. Our objective was to provide a comprehensive review of the existing literature pertaining to acupuncture in sports medicine to shed light on approaches utilized in acupuncture while revealing its personalized nature and its impact on athletes' preparation, performance, and recovery. We evaluated acupuncture research in the context of medicine and sports-related injury treatment, assessing its impact on athletic performance across demographics of athletes. Athletes participating in most sports have shown positive outcomes from acupuncture interventions. Acupuncture improves peak oxygen levels, maximum heart rate, delayed-onset muscle soreness, pain, swelling, explosive force production, and joint mobility. Furthermore, the efficacy of acupuncture appears to be similar regardless of age and sex. Lastly, the acceptance of acupuncture is influenced by cultural factors, with Western and traditional East Asian cultures exhibiting distinct perspectives on its rationale and mechanisms of action. Traditional East Asian acupuncturists typically employ qi and meridian theories in their acupuncture practices, with the recent incorporation of Western concepts. Acupuncture shows promise as an effective treatment for musculoskeletal pain and neuropathies in athletes across different age groups and for addressing injuries in various sports. Our comprehensive review will enhance our understanding of acupuncture's potential as a complementary or distinct therapeutic approach compared to conventional therapies. Additionally, our review explores its specific applications within different sports and delves into the cultural dimensions involved in integrating this practice into modern sports medicine.

An epidemiological study of martial arts injuries in patients presenting to US emergency rooms.

INTRODUCTION: With the advent of mixed martial arts (MMA) growing in popularity, there has been a described increase in its participation. The term MMA generally describes the hybridization of combat disciplines including but not limited to: karate, judo, jiu-jitsu, wrestling, taekwondo, boxing, kickboxing, and Muay Thai. With increased participation in MMA and martial arts, differing physical demands are placed on participants. Due to the physical nature of combat sports, there are injuries associated with participation. The purpose of this study is to report the incidence and characteristics of injuries seen from various martial art disciplines presenting to United States Emergency Rooms in order to educate participants and providers alike about risks assumed with participating in martial arts. METHODS: The National Electronic Injury Surveillance System (NEISS) database was queried for martial arts-related injuries from 2009 to 2019. Cases were examined and data including patient age and gender, injury type and location, hospital disposition, and type of martial arts practiced were extracted. RESULTS: A total of 8,400 injuries were recorded, leading to a national estimate of 310,143 martial-arts related injuries over the 11 year period of 2009-2019 (95 % CI 239,063-381,223). The most common types of injuries were strains/sprains (n = 2664, 31.7 %), fractures (n = 1,575, 18.8 %), and contusions/abrasions (n = 1,698, 20.2 %). There were 260 dislocations, with shoulder dislocations being most common (n = 96, 36.9 %). Lower extremities were affected more frequently than upper extremities (n = 3566, 42.5 % versus n = 3026, 36.0 %), with the knee being the single most common location of injury (n = 811, 9.7 %). Males more commonly sustained fractures (19.7 % versus 17.4 %, p = 0.03) and dislocations (3.5 % versus 2.4 %, p = 0.01) when compared to females. Ankle injuries were more common in females than males (10.4 % versus 6.0 %, p < 0.001). Only 2.2 % of patients required admission to the hospital. Risk factors for admission included patients >35 years of age and male sex. CONCLUSION: Martial arts injuries are a significant source of musculoskeletal injuries among patients presenting to US emergency rooms. Lower extremity injuries are seen most frequently, with patients rarely requiring hospital admission. Using this information, both providers and participants may be better equipped to make educated decisions on injury prevention and treatment.

Pediatric Martial Arts-Related Injuries Treated in Emergency Departments in the United States From 2004 to 2021.

BACKGROUND: Participation in martial arts has been increasing for several years, with millions of children and adolescents engaging in the sport annually. Yet, the most comprehensive examination of martial arts-related injuries was completed almost 2 decades ago. PURPOSE: To describe the epidemiology of martial arts-related injuries presenting to US emergency departments (EDs) among pediatric patients. STUDY DESIGN: Descriptive epidemiological study. METHODS: Data were obtained from the National Electronic Injury Surveillance System for patients aged 3 to 17 years who were treated in US EDs from 2004 through 2021. RESULTS: A total of 5656 cases were included in the analysis. An estimated 176,947 children (95% CI, 128,172-225,722) were treated for martial arts-related injuries in US EDs. The rate of martial arts-related injuries per 10,000 children increased from 1.43 in 2004 to 2.07 in 2013 (slope = 0.07; P = .005) and then decreased to 1.44 in 2021 (slope = -0.10; P = .02). The mean injury rates were 2.22 per 10,000 children aged 12-17 years and 1.15 per 10,000 children aged 3-11 years. The most common injuries occurred in children aged 6 to 11 years (39.3%), were strains/sprains (28.4%), and were associated with falling (26.9%). The mechanism of injury differed by the style of martial arts. Compared with other activity types (formal class, horseplay, and unspecified), competition carried a 2.56 times greater risk of head/neck injuries and a 2.70 times greater risk of traumatic brain injuries. CONCLUSION: Martial arts are a significant source of injuries for children aged 3 to 17 years. To continue decreasing the injury rate, the creation and implementation of standardized risk-mitigation rules and regulations that could be applied to all martial arts styles are recommended.

The Use of Imagery to Improve Self-Efficacy of Rehabilitation Capabilities in Athletes Following a Sport-Related Injury: A Critically Appraised Topic.

CLINICAL SCENARIO: Sport-related injuries are a common occurrence within the athletic population and every athlete responds differently. The cognitive, emotional, and behavioral responses associated with injuries ultimately impact the injury rehabilitation process and return to play. Specifically, self-efficacy significantly impacts the rehabilitation process and psychological techniques to improve self-efficacy are crucial in the recovery process. Imagery is one of these beneficial techniques. CLINICAL QUESTION: Does the use of imagery during injury rehabilitation improve self-efficacy of rehabilitation capabilities compared with rehabilitation alone in athletes with a sport-related injury? SUMMARY OF KEY FINDINGS: The current literature was searched to identify the effects of imagery use to improve self-efficacy of rehabilitation capabilities, and 2 studies were selected: a mixed methods ecologically valid design and randomized controlled trial. Both studies investigated the relationship between imagery and self-efficacy and found positive results for imagery use in rehabilitation. Additionally, one of the studies specifically assessed rehabilitation satisfaction and found positive results. CLINICAL BOTTOM LINE: The use of imagery should be considered as a clinical option for increasing self-efficacy during injury rehabilitation. STRENGTH OF RECOMMENDATION: Based on the Oxford Centre for Evidence-Based Medicine strength of recommendation, there is a grade B of recommendation to support the use of imagery to improve self-efficacy of rehabilitation capabilities during an injury rehabilitation program.

Recovery of two elite footballers from adductor strain with dry needling and eccentric strengthening: Two case studies.

INTRODUCTION: Groin injuries are common in sports, almost 68% adductor strain among them, which generally more prone in football, soccer, hockey, and other games. The available literature well describes the rehabilitation phase of adductor strain but an application of dry needling on adductor injuries are not yet established. CASE DESCRIPTION: Two national-level younger football players were clinically diagnosed with the adductor strain. They had severe pain on medial aspect of the thigh, aggravated with kicking and functional activity (VAS- 8/10, LEFS 58/80, 69/80). The therapist assessed the patients and designed their rehabilitation protocol as per their findings of the examination. OUTCOME: The lower extremity functional scale (LEFS), global rating scale, and VAS were used as outcome variables. The total intervention was given for 10-12 weeks, follow up had been taken for 4 months. DISCUSSION: The application of dry needling reduced the pain, improved and relieved the symptoms. The eccentric strengthening of the adductors and core stability improved the strength as well as functional activity of the lower limb. The case study is not generalized the effect of treatment. Thus, a randomized control trial is suggested for further study.

Follow-up visits after a concussion in the pediatric population: An integrative review.

BACKGROUND: Concussions are a significant health issue for children and youth. After a concussion diagnosis, follow-up visits with a health care provider are important for reassessment, continued management, and further education. OBJECTIVE: This review aimed to synthesize and analyse the current state of the literature on follow-up visits of children with a concussive injury and examine the factors associated with follow-up visits. METHODS: An integrative review was conducted based on Whittemore and Knafl's framework. Databases searched included PubMed, MEDLINE, CINAHL, PsycINFO, and Google Scholar. RESULTS: Twenty-four articles were reviewed. We identified follow-up visit rates, timing to a first follow-up visit, and factors associated with follow-up visits as common themes. Follow-up visit rates ranged widely, from 13.2 to 99.5%, but time to the first follow-up visit was only reported in eight studies. Three types of factors were associated with attending a follow-up visit: injury-related factors, individual factors, and health service factors. CONCLUSION: Concussed children and youth have varying rates of follow-up care after an initial concussion diagnosis, with little known about the timing of this visit. Diverse factors are associated with the first follow-up visit. Further research on follow-up visits after a concussion in this population is warranted.

Yoga and Mindfulness Intervention for Concussion Recovery.

Concussion imposes a substantial global health burden, and few evidence-based treatments that approach concussion treatment holistically are available. Moreover, early intervention is important before concussion symptoms become chronic and more refractory to treatment. In this pilot study, we evaluated the tolerability of a protocol called Mindfulness and Yoga for Treatment After Concussion (MYTAC), which was specifically designed for individuals with concussion. We also explored the possible benefit of the MYTAC protocol for concussion recovery. Participants were 15-60 years old with recent concussion and had presented to selected practices within a university health system. Participants used the video-based MYTAC protocol for 5 consecutive days and reported concussion symptoms on an abbreviated version of the Sports Concussion Assessment Tool version 3 (SCAT3). We compared the abbreviated SCAT3 scores across the intervention period, including immediately before and after each yoga session, using standard statistical methods for paired data. Of 25 participants enrolled in the study, 15 completed the MYTAC protocol and 1 completed 2 days of the protocol before withdrawing due to worsening symptoms; the remaining 9 participants did not complete the protocol. On average, total abbreviated SCAT3 scores decreased by 9.9 ± 7.6 points, or approximately 50%, over the intervention period (from an initial value of 18.8 ± 6.7 points prior to the yoga protocol). Although this pilot study had significant methodological limitations, we concluded that the MYTAC protocol had fair tolerability and possibly a beneficial effect on concussion recovery. However, future interventions should evaluate this protocol in larger, more rigorously designed studies.

Injury Incidence and Its Characteristics in Korean Youth and Collegiate Taekwondo Sparring Athletes: A Retrospective Study.

This study aimed to identify the incidence of injury and its characteristics in Korean youth and collegiate Taekwondo athletes during 2021 and to provide a suggestion regarding injury incidence. A total of 183 athletes (95 youth and 88 collegiate athletes) who were registered with the Korea Taekwondo Association (KTA) participated. The research was based on the injury questionnaire developed by the International Olympic Committee (IOC). The questionnaire consists of a total of seven items, including four items related to demographic characteristics and three items related to injuries (locations of injury, types of injury, and causes of injury). A frequency analysis was performed to identify the injury characteristics. Additionally, the injury incidence rate (IIR) was calculated based on 1000 athletic exposures (AEs) during 2021. The IIRs for one recent year (2021) showed 4.43/1000 AEs and 3.13/1000 AEs in youth and collegiate Taekwondo athletes, respectively. The frequency analysis showed that finger (youth: 17.3%, collegiate: 14.6%), contusion (youth: 25.3%, collegiate: 23.8%), and contact with other athletes (youth: 57.6%, collegiate: 54.4%) ranked the highest in terms of the locations of injury, types of injury, and causes of injury, respectively. A continuing injury tracking system can play a key role in accumulating big data for identifying risk factors and developing interventions to reduce injury in Taekwondo sparring.

Injury Occurrence in Amateur Rugby: Prospective Analysis of Specific Predictors over One Half-Season.

Background and objectives: The incidence of injuries in rugby is extremely high, but studies have rarely examined the predictors of injury in amateur players. This study aimed to systematically analyse sports and injury factors as potential predictors of musculoskeletal injuries in senior-level amateur rugby players. Methods: The participants in this study were 101 senior-level rugby players from Croatia (average of 24.64 years old). At baseline, all participants were tested on sociodemographic and anthropometric parameters (age, body height and mass), consumption of dietary supplements, preseason injury status and training volume, and sport factors (position in game). Data on injury occurrence (dependent variable), prevalence of pain, training status, and characteristics of the played match were surveyed prospectively once a week during the three-month period (one half-season). Results: The logistic regression revealed a higher injury occurrence in forward players of the 1st row, 2nd row (OR = 5.07; 95% CI: 1.64-15.69), and center (OR = 4.72; 95% CI: 1.28-14.31), with reference to outside back players. When observed univariately, higher body mass, higher level of competition, more weekly training sessions, self-perceived pain, and playing with pain were significant injury risk factors. The multivariate logistic regression identified pre-season injury (OR = 1.30, 95% CI: 1.09-1.52), higher level of the game/match (OR = 1.44, 95% CI: 1.13-1.76), higher body mass (OR = 1.03, 95% CI: 1.01-1.05), and pain prevalence (OR = 5.71, 95% CI: 3.22-7.70) as multivariate predictors of injury occurrence over the season. Conclusion: The results of this study showed that among sport factors, the playing position, level of competition, and training exposure represent major injury risk factors. Therefore, in order to reduce the number of injuries, special emphasis should be placed on the specific tackling technique of forward players, which could both increase their situational efficiency and protect them from injuries. Additionally, perceived pain, injury history, and playing with injury were noted among injury factors as the ones that can be predictors of future injuries. In that manner, it is important that coaching and medical staff monitor players with previous injuries and with pain symptoms in order to act preventively against injury occurrence.

Nutritional Strategies in the Rehabilitation of Musculoskeletal Injuries in Athletes: A Systematic Integrative Review.

It is estimated that three to five million sports injuries occur worldwide each year. The highest incidence is reported during competition periods with mainly affectation of the musculoskeletal tissue. For appropriate nutritional management and correct use of nutritional supplements, it is important to individualize based on clinical effects and know the adaptive response during the rehabilitation phase after a sports injury in athletes. Therefore, the aim of this PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science PERSiST-based systematic integrative review was to perform an update on nutritional strategies during the rehabilitation phase of musculoskeletal injuries in elite athletes. After searching the following databases: PubMed/Medline, Scopus, PEDro, and Google Scholar, a total of 18 studies met the inclusion criteria (Price Index: 66.6%). The risk of bias assessment for randomized controlled trials was performed using the RoB 2.0 tool while review articles were evaluated using the AMSTAR 2.0 items. Based on the main findings of the selected studies, nutritional strategies that benefit the rehabilitation process in injured athletes include balanced energy intake, and a high-protein and carbohydrate-rich diet. Supportive supervision should be provided to avoid low energy availability. The potential of supplementation with collagen, creatine monohydrate, omega-3 (fish oils), and vitamin D requires further research although the effects are quite promising. It is worth noting the lack of clinical research in injured athletes and the higher number of reviews in the last 10 years. After analyzing the current quantitative and non-quantitative evidence, we encourage researchers to conduct further clinical research studies evaluating doses of the discussed nutrients during the rehabilitation process to confirm findings, but also follow international guidelines at the time to review scientific literature.

Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion.

OBJECTIVE: To examine the frequency and association of neck pain symptoms in patients with a concussion. STUDY SETTING AND PARTICIPANTS: Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. DESIGN: Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. RESULTS: Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. CONCLUSION: Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.

Incidence of Sport Injuries in the Manchester 2019 World Taekwondo Championships: A Prospective Study of 936 Athletes from 145 Countries.

We aimed to describe injury incidence and patterns at the 2019 World Taekwondo Championships (WTC), and to compare them with those of previous WTCs, based on new World Taekwondo (WT) competition rules, medical codes, and the Protector and Scoring System (PSS). This prospective cohort study utilized data obtained through the WT Injury Surveillance System. All athletes with injuries were evaluated by on-site sports medicine specialists, and ultrasonography was used to assess all musculoskeletal injuries. Of 936 athletes, 60 injuries were recorded (6.4 injuries/100 athletes, 95% confidence intervals [CI]: 4.8-8.0), and 4.5% (n = 42) sustained at least one injury. Males had a higher risk of sustaining injuries than females (incidence rate ratio: 1.57; 95% CI: 0.89-2.76). The most common sites, type, and mechanism were lower extremities (n = 26, 43.33%), contusion/hematoma/bruises (n = 33, 55.0%), and contact with another athlete (n = 50, 83.33%). Overall, the injury patterns associated with the mechanism of injury were similar in both the 2019 and 2017 WTCs. Refined WT competition rules and a re-established PSS at the 2019 WTC reduced the overall and severe injury incidence. Our findings can help revise Taekwondo competition rules, enhance protective equipment, optimize on-site venue medical systems, and develop injury prevention projects.

Effectiveness of a judo-specific injury prevention programme: a randomised controlled trial in recreational judo athletes.

OBJECTIVES: To evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence. METHODS: We conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16-26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes. RESULTS: 269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16-26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful. CONCLUSION: The IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes. TRIAL REGISTRATION NUMBER: NTR7698.

Characteristics of Facial Trauma in Professional Mixed Martial Arts.

Background: Injuries are common in mixed martial arts (MMA) competitions. However, the risk factors for facial injury have not been delineated. Objective: Identify the facial injuries and associated risk factors of professional MMA fights. Methods: The Nevada State Athletic Commission medical injury reports from all professional Ultimate Fighting Championship bouts from 2010 to 2020 was reviewed. Fighter characteristics, details of the competition, and injuries sustained were collected. Binary logistic regressions determined significant predictors of facial injury. Results: A total of 1462 fighters were included. Most participants were male (91.0%) with mean age of 29.5 ± 4.1 years. Most fights took place between 135 and 185 lbs., lasted ≥3 rounds (59.4%), and resulted in judges' decision (50.5%) or knockout (31.2%). The facial injury rate was 15.8%, which were predominantly lacerations (12.0%) and fractures (3.6%). Multivariate regression revealed being male (p = 0.026), heavier weight (p = 0.028), more rounds fought (p = 0.019), losing (p < 0.001), and nonsubmission outcome (p = 0.017) predicted facial injury. Conclusion: Facial injuries are common in MMA fighting. The risks should be iterated to participants in this sport.

Factors affecting the shoulder functional profile in elite judo athletes.

The aim was to investigate the effects of sex, age, preferred judo technique, dominance, and injury history on the shoulder functional status of elite judo athletes. Sixty-one elite judo athletes (38 males, age: 18.1 ± 1.2 years, body mass: 69.3 ± 13.3 kg, body height: 172.2 ± 9.8 cm, brown belt to second-degree black belt) completed three questionnaires: Western Ontario Shoulder Instability, Western Ontario Rotator Cuff, and Shoulder Instability-Return to Sport after Injury. They performed four physical tests: the glenohumeral rotator isometric strength test, upper quarter Y-balance test, unilateral seated shot put test, and modified Closed Kinetic Chain Upper Extremity Stability Test. The results showed that the female athletes had less shoulder functional abilities than the male athletes (p < 0.001 to p = 0.02). The younger athletes had poorer shoulder stability and upper extremity power than the older athletes (p < 0.001 to p = 0.02), but their glenohumeral muscles were stronger in both internal (p = 0.03) and external (p = 0.005) rotations. All the judo athletes had similar bilateral differences in shoulder functional status, except for judokas who preferred throwing techniques (p = 0.01). Injury history affected self-perceived functional status (p < 0.001), as well as upper extremity muscle capacity and neuromuscular control (p = 0.01 to p = 0.05). This study provides new insight into the shoulder functional status of elite judo athletes, which may aid in the development of sports-specific injury prevention and return-to-sport programmes to reduce the risk of shoulder injury occurrence and recurrence.HighlightsNormalized levels of upper extremity abilities must be sex- and age-specific in prevention programmes.Prevention programmes may focus on muscle bilateral and anteroposterior symmetry.Prevention programmes may include psychological training tailored to the sex of judo athletes.