Concussion Health Improvement Program (CHIP): study protocol for a randomized controlled optimization trial for youth with persistent post-concussive symptoms.

BACKGROUND: Up to 1.9 million youth in the USA sustain a concussion each year, and up to 30% experience persistent post-concussive symptoms (PPCS) lasting 1 month or more. PPCS can substantially interfere with social, emotional, and academic functioning. Despite these concerns, few evidence-based treatments are available for youth with PPCS. We previously found effectiveness in treating youth with concussion using a collaborative care intervention that integrates mental health care into a medical model, with improvements in concussive symptoms and quality of life at 1 year. Using the multiphase optimization strategy (MOST) framework, we now aim to assess the contribution of each of the three components that were part of collaborative care: concussion-focused cognitive behavioral therapy (cf-CBT), parenting skills training (PST), and care management (CM). METHODS: The MOST factorial design examines all three intervention components with two levels of each (present or absent), resulting in 8 possible treatment combinations. We will recruit 368 youth with PPCS from 2 geographic locations (Seattle and Dallas), randomizing them to 1 of 8 treatment groups. Youth and/or parents will attend treatment sessions via video conferencing software over 3 months, and complete surveys regarding primary outcomes (concussive symptoms and health-related quality of life) and secondary outcomes (sleep, pain, mood, and parental distress) at 6 weeks and 3, 6, and 12 months. We will also assess potential mediators and moderators to allow for future tailoring and refinement. DISCUSSION: The overarching goal of this investigation is to determine which collaborative care components (delivered individually or in combination) are most effective in treating PPCS in concussion-exposed youth. The investigation will inform mental health screening, intervention, and referral procedures for youth and families following concussion. At the completion of this study, we will have an optimized and refined intervention for youth with PPCS ready for large-scale implementation and dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT06036147. Registered on September 13, 2023.

The applied study to improve the treatment of knee sports injuries in ultimate frisbee players based on personalized exercise prescription: a randomized controlled trial.

Objective: Ultimate frisbee can lead to severe sports injuries, especially joint injuries in the lower limbs, such as knee meniscus injuries. This study examines the impact of personalized exercise therapy on knee meniscus injuries in ultimate frisbee players in the Lingnan region of China. Methods: Seventy-six patients with confirmed meniscal injuries participated in the study, divided into an intervention group (n = 38) and a control group (n = 38). The control group received standard treatment, including drug therapy and physical therapy. The intervention group received standard treatment plus a personalized exercise regimen based on FITT-VP (frequency, intensity, time, type, volume, and progression) principles, incorporating strength training, aerobic exercise, flexibility training, neuromuscular training, and aquatic exercise. This program was monitored and adjusted over a six-month period through both online and offline methods. The primary outcomes were joint range of motion (ROM), thigh circumference atrophy index (TCAI), Lysholm Rating Scale (LRS) scores, and visual analog scores (VAS). The secondary outcome was the International Knee Documentation Committee (IKDC) score. Data were collected before the intervention, and at 1 month and 6 months after the intervention. Statistical analysis was conducted using SPSS 24.0 and GraphPad 10.0, with a significance level set at α = 0.05. Results: After 1 month, the intervention group showed significantly better results in ROM (116.67 ± 9.063), LRS score (86.316 ± 3.750), and IKDC score (80.473 ± 5.421) compared to the control group (111.784 ± 4.778, 82.579 ± 3.818, and 77.684 ± 4.430, respectively) (p < 0.05). The TCAI (3.219 ± 1.889) and VAS score (1.921 ± 0.673) in the intervention group were significantly lower than those in the control group (5.228 ± 2.131 and 2.710 ± 1.112, respectively) (p < 0.01). After 6 months, the differences in LRS and VAS scores between the groups were not significant. However, the intervention group continued to show significant improvements in ROM (134.934 ± 3.011), TCAI (1.107 ± 1.158), and IKDC score (93.315 ± 1.847) compared to the control group (125.395 ± 18.554, 4.574 ± 1.109, and 87.789 ± 4.437, respectively) (p < 0.05). Conclusion: Personalized exercise prescriptions offer significant therapeutic and rehabilitative benefits for ultimate frisbee players with knee meniscus injuries. This approach helps to reduce symptoms, alleviate pain, and improve joint function, muscle strength, and athletic performance after sports-related injuries.

Understanding the Interactions Between Loading, Pain Dynamics, and Imaging Characteristics for Osgood Schlatter: A Cross-Sectional Study.

Osgood Schlatter's disease (OSD) is characterized by pain at the tibial tuberosity provoked during knee-loading activities, and is common in adolescent athletes. The aim of this study was to characterize clinical, pain and ultrasound imaging characteristics in participants with OSD compared to controls. This cross-sectional study included adolescents diagnosed with OSD and matched controls. Following baseline evaluation including ultrasound, participants completed the following aggravating activities in a randomized order: single-leg isometric knee hold, single-leg squat, single-leg vertical jump, hopping, running, cutting, lunges, and walking. Participants rated pain intensity on a numeric rating scale (0-10; no pain to worst pain imaginable) and localization during activities. We included 35 participants with OSD (48.5% females, age 13.0 [SD 1.5]) and 21 controls (47.6% females, age 13.4 [SD1.4]). Doppler signal was more prevalent in OSD participants at the tendon (77% vs. 30%) and tuberosity (29% vs. 10%). Tendon thickness was greater in OSD at distal (mean difference = 4.5 mm 95% CI 1.5-7.5) and proximal sites (mean difference = 4.2 95% CI 0.1-8.3). Aggravating activities induced higher pain in OSD. The greatest differences between OSD and control were the dynamic single-leg squat (mean difference = 4.2 (95% CI 3.22-5.1)). Pain was localized at the tibial tuberosity and patellar tendon during activities. Sex, sports participation, bilateral pain, and Doppler were associated with greater pain during aggravating activities. Single-leg activities loading the tibial tuberosity through the tendon appear to provoke OSD-related pain more than other sports specific movements. This may be useful to guide adolescents on which activities are likely to aggravate pain.

Framing racial disparities within sports related concussion (SRC): an ecological framework for understanding biases and disparities in concussion care for black athletes.

Privilege and marginalization associated with racial background have been posited as contributors to why Black athletes face disparities within their care, treatment, and recovery from sport-related concussion (SRC). However, empirical findings have limited exploration on how disparate outcomes have emerged, and the interaction with systems of biases, power and disenfranchisement. To understand concussion care disparities, a qualitative content analysis was conducted in three phases: [I] identifying salient literature on racial differences for Black athletes with SRC (N = 29), [II] qualitative analysis of literature to determine salient topics, themes and patterns within the literature, and [III] constructing a novel ecological-systems framework that encapsulates the 'why' and 'how' related to psychosocial and sociocultural experiences of power, access, and biases for Black athletes. The content analysis yielded two patterns, where concussion care decisions are influenced by (1) biased, unconscious beliefs that posit Black athletes as uniquely invincible to injury and pain, and (2) inadequate access to concussion knowledge and resources, which both moderate SRC injury risk, diagnosis, recovery and outcomes. Ultimately, our novel framework provides a clear thread on how historical, macro-level policy and perceptions can impact micro-level clinical care and decision-making for Black athletes with SRC.

Arachnoid Cysts in Athletes with Sports-Related Concussion: A Case Series and Literature Review.

BACKGROUND: Arachnoid cysts (AC) are associated with a risk of rupture or haemorrhage following head impact and pose a potential predisposing factor for significant complications of sport-related concussion. Despite a recognised association between ACs and intracranial haemorrhage/cyst rupture, the risk profile of participating in contact sports with AC is not well defined. We report a retrospective case series of players presenting to the Birmingham Sports Concussion Clinic between 2017 and 2023 and underwent MRI head, with a comprehensive review of the prior literature. RESULTS: 432 athletes underwent MRI of which 11 were identified to have AC (middle fossa n = 8; posterior fossa n = 2, intraventricular n = 1). Average maximal diameter was 4.1 ± 1.2 cm. 64% had a protracted recovery (≥ 3 months). 9% experienced an AC specific complication (cyst rupture, complete neurological recovery, maximal diameter 6.5 cm, Galassi II, 4 previous concussions). 91% of patients (mean maximal diameter 3.9 ± 1.0 cm) experienced no complications despite multiple previous accumulated sports-related concussions (mean 3.3, range 1-9). Case studies from the literature are summarised (n = 63), with 98% reporting complications, none of which resulted in adverse or unfavourable neurological outcomes. Across prospective and retrospective cohort studies, 1.5% had a structural injury, and (where outcome was reported) all had a favourable outcome. CONCLUSIONS: AC is an incidental finding in athletes, with the majority in our cohort having sustained serial concussions without AC complication. The single complication within this cohort occurred in the largest AC, and AC size is proposed as a tentative factor associated with increased risk of contact sports participation. Complications of AC appear to be a rare occurrence. This case series and review has not identified evidence to suggest that participation in sports with AC is of significant risk, though individualised assessment and discussion of the potential risks of contact sports participation should be offered.

Reliability and validity of knee valgus angle calculation at single-leg drop landing by posture estimation using machine learning.

Background: The consensus on anterior cruciate ligament (ACL) injury prevention involves the suppression of dynamic knee valgus (DKV). The gold standard for evaluating the DKV includes three-dimensional motion analysis systems; however, these are expensive and cannot be used to evaluate all athletes. Markerless motion-capture systems and joint angle calculations using posture estimation have been reported. However, there have been no reports on the reliability and validity of DKV calculations using posture estimation. Research question: This study aimed to clarify the reliability and validity of DKV calculation using posture estimation. Methods: Fifteen participants performed 10 single-leg jump landings from a height of 20 cm, and the knee joint angle was calculated using joint points measured using machine learning (MediaPipe Pose) and motion-capture systems (VICON MX). Two types of angle calculation methods were used: absolute value and change from the initial ground contact (IC). Intra- and inter-rater reliabilities were examined using intraclass correlation coefficients, and concurrent validity was examined using Pearson's correlation coefficients. To examine intra-examiner reliability, we performed single-leg jump landings at intervals of ≥3 days. Results: The calculation by MediaPipe Pose was significantly higher than that by the 3-D motion analysis systems (p < 0.05, error range 18.83-19.68°), and there was no main effect of knee valgus angle or time on the excursion angle from IC (p > 0.05). No significant concurrent validity was found in the absolute value, which was significantly correlated with the change in IC. Although the inter-rater reliability of the absolute value was low, the change in IC showed good reliability and concurrent validity. Significance: The results of this research suggest that the DKV calculation by pose estimation using machine learning is practical, with normalization by the angle at IC.

Increased rate of injuries to the anterior cruciate ligament in amateur soccer players after the COVID-19 pandemic lockdown.

The COVID-19 pandemic led to the discontinuation of soccer activities at all levels of play. Injuries to the anterior cruciate ligament (ACL) are still one of the most severe injuries in soccer. The aim of this investigation was to analyze the changes in the incidence and mechanism of ACL injuries in professional and amateur soccer before and after the lockdown period. Injury data were prospectively collected using the database 'ACL registry in German soccer'. Between 2019 and 2021, 10 matches in professional, semi-professional, and amateur leagues before and after the lockdown were analyzed for the incidence and mechanism of ACL injuries. Data were collected using standardized and recently published study methods. Mean incidence of the 84 ACL injuries recorded during the study period was 0.083 injuries per 1000 h of exposure before and 0.079 injuries per 1000 h of exposure after the lockdown period (p = 0.699). In amateur soccer, the incidence of ACL injuries increased significantly from 0.058 injuries per 1000 h of exposure before to 0.128 injuries per 1000 h of exposure after the lockdown period (p = 0.026), in contrast to professional (p = 0.436) and semi-professional (p = 0.802) soccer. The predominant mechanisms of ACL injuries were non-contact injuries (pre-COVID: 59.1%; post-COVID: 57.7%) and indirect contact injuries (pre-COVID: 31.8%; post-COVID: 30.8%). The absence from training and match practice in German soccer during the COVID-19 lockdown led to a significantly increased ACL injury rate in amateur leagues, while in professional and semi-professional soccer no differences were reported. The mechanism of ACL injuries did not change after the lockdown period.Level of evidence: II.

The Effect of Blood Flow Restriction during Low-Load Resistance Training Unit on Knee Flexor Muscle Fatigue in Recreational Athletes: A Randomized Double-Blinded Placebo-Controlled Pilot Study.

Background/Objectives: Despite the growing popularity of training with a controlled form of vascular occlusion, known as blood flow restriction (BFR) training, in the rehabilitation of orthopedic patients and sports medicine, there remains ample space for understanding the basis of its mechanism. The pilot study assessed the effect of BFR during a low-load resistance training unit on knee flexor muscle fatigue, intending to decide whether a larger trial is needed and feasible. Methods: The study used a prospective, randomized, parallel, double-blind, placebo-controlled design. Fifteen male healthy recreational athletes were randomly assigned to three equal groups: BFR Group, Placebo Group, and Control Group. The primary outcome was the change in the surface electromyography-based (sEMG-based) muscle fatigue index, which was determined by comparing the results obtained before and after the intervention. The intervention was the application of BFR during low-load resistance training for knee flexors. The occurrence of any adverse events was documented. Results: In all groups, the sEMG-based fatigue index for semitendinosus and biceps femoris muscles decreased after low-load resistance training, with the largest decrease in the BFR group. Although not statistically significant, BFR showed moderate and large effect sizes for the fatigue index of semitendinosus and biceps femoris, respectively. No adverse events were noted. Conclusions: The pilot study suggested that BFR during a low-load resistance training unit might affect knee flexor muscle fatigue, supporting the development of a larger randomized clinical trial.

The Relationship between Training Load and Injury Risk in Basketball: A Systematic Review.

The relationship between training load and injury risk in basketball is an important area in sports injury prevention and performance enhancement; however, there is limited conclusive evidence of their associations. The aim of this systematic review was to examine the evidence of the relationship between training load and injury risk in basketball, which is one of the most common sports worldwide. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was conducted on the PubMed, SCOPUS, and Web of Science databases up until March 2024. The search aimed to identify studies that prospectively and/or retrospectively examined the relationship between training load and injury risk in basketball. Inclusion criteria were limited to studies published before February 2024. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale and Oxford Centre for Evidence-Based Medicine levels of evidence. A narrative synthesis of the findings was performed. A total of 14 articles met the inclusion criteria and were included in the review. Of these, 11 studies reported at least partially statistically significant results, providing evidence of a relationship between training load and injury risk. In conclusion, the findings of this review suggest a clear relationship between training load and injury risk in basketball.

Demographic and Injury Characteristics as Potential Risk Factors for Anterior Cruciate Ligament Injuries: A Multicentric Cross-Sectional Study.

Background: Anterior cruciate ligament (ACL) injuries are prevalent and can have debilitating consequences, with various factors potentially influencing their occurrence. This multicentric study aimed to comprehensively analyze the epidemiological characteristics of ACL injuries. We hypothesized that specific patient characteristics, such as age, sex, body mass index (BMI), and sports involvement, would be associated with distinct injury patterns and risk profiles. Methods: This cross-sectional study analyzed the medical records of 712 patients aged 15-60 diagnosed with ACL rupture. Data on demographics, injury mechanisms, associated injuries, graft type, and sports involvement were collected. Results: The majority of patients were male (93.1%), aged 15-30 years (80.2%), and overweight (66.7%). Autografts were the predominant graft choice (96.07%). Associated injuries were present in 79.5% of cases, with medial meniscus ruptures being the most common (37.36%). Sports-related (49.3%) and non-sports-related (50.7%) injuries were nearly equal, with non-contact injuries more prevalent (71.1%). In the sports-related subgroup, associated injuries emerged as a significant risk factor for ACL rupture (p = 0.014, OR = 1.596, 95% CI: 1.101-2.314), whereas non-contact mechanisms showed borderline significance (OR = 0.75, p = 0.09). Moreover, younger athletes were more susceptible to sports-related injuries (p = 0.024), with football being the primary sport involved. Conclusions: This study identified a high prevalence of concomitant injuries with ACL injury, which increased the risk of ACL injury, particularly in sports-related cases. Age-related differences in injury patterns highlight the need for age-appropriate preventive measures, especially for younger athletes participating in high-risk sports. This underscores the need for comprehensive injury assessment, targeted prevention strategies, and optimized clinical management approaches tailored to different populations' specific characteristics and risks.

Is There a Pathologic Running Motion Associated with Running-Related Injuries? A Methodological Study Using a Motion Analysis System Without Sensors.

(1) Background and objectives: Running-related injuries (RRIs) are commonly attributed to improper running posture and overuse. This study aims to analyze the running motions of individuals with and without RRIs using a sensor-free method, which offers a user-friendly and straightforward approach. (2) Materials and Methods: A total of 155 runners were divided into two groups: the normal runner group (runners who had never been injured, n = 50) and the RRI group (runners who had experience at least one injury while running, n = 105). The forward head posture (FHP), trunk lean, hip rotation, horizontal movement of the center of gravity (COG), vertical movement of the COG, pelvic rotation, hip hike, and type of strike were measured for posture analysis. (3) Results: We found that the left-right balance of the pelvis and the spinal posture during running were associated with RRIs. The difference in hip hike and FHP emerged as key predictors of running-related musculoskeletal injury occurrence from our logistic regression analysis. (4) Conclusions: Identifying pathological movements in runners through running motion analysis without the use of sensors can be instrumental in the prevention and treatment of RRIs.

Emerging Patterns of Foot and Ankle Injuries in Pickleball Players: A Short Report.

BACKGROUND: Pickleball's surging popularity has driven an increase in injuries presenting to medical providers. This study seeks to describe the epidemiology of pickleball foot and ankle injuries including patient demographics, diagnoses, and mechanism of injury. METHODS: A retrospective review from our institutional database identified patients treated in the foot and ankle clinic whose medical records included the search terms "pickleball" and "pickle ball." Only injuries sustained while playing pickleball were included. Patient demographics, diagnosis, mechanism of injury, and treatment were collected. Injury incidence and descriptive analyses were calculated. RESULTS: A total of 198 patients with pickleball foot and ankle injuries were identified. The incidence of injuries increased 6.5-fold from 2019 to 2023. The mean age of patients was 58.3 years (SD = 12.2). Most patients were male (58.6%) and reported a traumatic injury (77.8%). The most common diagnosis was Achilles tendon rupture (39.4%). The most common mechanisms of injury were running or lunging forward (30.9%), planting the foot (16.5%), and inverting the foot and ankle (15.5%). Most injuries were treated nonoperatively (71.2%); however, 62.8% of Achilles tendon ruptures were treated surgically. CONCLUSION: The incidence of pickleball foot and ankle injuries increased dramatically from 2015 to 2023. Injuries occurred more frequently in older, male patients, with Achilles tendon rupture being the most common diagnosis.

Risk factors of metatarsal stress fracture associated with repetitive sports activities: a systematic review.

Background: Metatarsal stress fracture is common in people engaged in repetitive weight-bearing activities, especially athletes and recruits. Identifying risk factors in these contexts is crucial for effective prevention. Methods: A systematic search on Web of Science, PubMed, EBSCO, SPORTDiscus, MEDLINE, and Cochrane Library was conducted and the date range for the retrieval was set from January 1984 to April 2024. Results: 32 eligible studies were selected from 1,728 related research. Anatomical and biomechanical factors, such as higher foot arch, abnormal inversion/eversion of foot, and longer metatarsal length or larger angles, relatively influence stress fracture risk. However, given that there is no standardized measurement, the results remain to be examined. Soccer is associated with fifth metatarsal fractures, while long-distance running and recruit training often lead to fractures of the second or third metatarsals. High exercise intensity, non-adaptive training, and inadequate equipment heighten fracture risk. Conclusion: This review highlights the complex interplay of anatomical, biomechanical, and sports-related factors in the risk of metatarsal stress fractures. Relatively, high arches, specific metatarsal morphologies, and foot inversion/eversion patterns are significant risk factors, particularly among athletes. Sports type also correlates with metatarsal stress fracture locations. Despite extensive research, study heterogeneity and inherent biases necessitate cautious interpretation. Comprehensive, multifactorial approaches and personalized injury prevention strategies are essential for reducing the incidence of these injuries and improving the health and performance of athletes.

Coverage from medical teams and injury/illness epidemiology within youth athletics in Africa: A prospective study during the 2023 African Youth Under 18/20 Athletics Championships.

OBJECTIVES: To describe athletes' coverage by national medical teams, and injuries and illnesses occurring during the four weeks before and during the 2023 African Youth Under 18/20 Athletics Championships. DESIGN: Cross-sectional and prospective cohort study design. METHODS: We conducted a study with data collection of: 1) national medical teams, 2) injury and illness complaints during the four weeks preceding the championships using an online pre-participation health questionnaire, and 3) newly incurred in-championship injuries and illnesses collected by national medical teams and the local organising committee using daily standardised online report forms, for all registered athletes at the championships. RESULTS: Among the 43 countries participating at the championships, 15 (34.9 %) countries had a medical team with at least one medical personnel. Of the 15 countries, 6 (40.0 %) countries had at least one physiotherapist and one physician, 4 (26.7 %) countries had only physiotherapist(s), and 5 (33.3 %) countries had only physician(s). Nine (60 %) countries participated in the injury surveillance study, including 397 athletes: 61 (15.4 %) completed the pre-participation health questionnaire and 11 athletes (18.0 %) reported an injury complaint and 6 (9.8 %) an illness complaint during the four weeks before the championships. During the championships, there were 52.9 injuries and 50.4 illnesses per 1000 registered athletes. The main injury location was the thigh (33.3 %), and the main injury type was the muscle (47.6 %). The most common system affected by illness was the upper respiratory tract (55.0 %), and the main illness cause was idiopathic (50.0 %). CONCLUSIONS: This preliminary study provides foundational information to improve medical coverage and services during international championships, and orient injury/illness prevention in youth athletics across Africa.

Prevalence, severity, and predictors of self-reported depression in ultra-distance runners: An online survey based on 265 athletes.

BACKGROUND: Literature suggests a high prevalence of mental health disorders among athletes practicing elite and extreme sports. One of the most commonly encountered disorders in this group of individuals is depression. OBJECTIVE: The aim of this study was to examine the prevalence, severity, and risk factors of symptoms of self-reported depression among ultra-distance runners. METHODS: Data was collected using an online survey (February to April 2023) and included 265 (age 48.35 ± 10.52 years) adult ultra-runners. The Beck Depression Inventory-II (BDI-II) was used to measure self-reported depression. Additional variables comprised basic sociodemographic information and information regarding training, ultramarathon experience, and previous injury. Descriptive and interferential statistics were performed using JASP Version 0.16.4. RESULTS: We found that 21.9 % (n = 58) of ultra-runners suffered from self-reported depression (i.e., BDI-II score ≥ 14) with an average BDI-II score of 22.7 ± 7.1 (moderately severe symptoms). Female ultra-runners had a higher prevalence (30.8 %) of self-reported depression than males (16.2 %, p = .001). Logistic regression revealed that ultra-runners without previous sports injury (p = .01) and those of increasing age (p = .003) had a significantly lower risk of self-reported depression. Similarly, linear regression showed the absence of injury (p < .001) and increasing age (p = .02) resulted in significantly lower BDI-II scores. Training volume in distance and hours per week as well as ultra-running experience did not show any significant association. CONCLUSIONS: Affecting more than one-fifth of our collective, depressive symptoms appear to be highly prevalent among ultra-runners. Our findings underline the importance of screening for clinical depression, especially among injured athletes. However, the previously assumed peculiarities of the sport in the area of high training volume do not appear to be a significant factor.

Primary Care Considerations for the Adolescent Wrestler.

PURPOSE OF REVIEW: Adolescent wrestlers undergo intense physical combat. While guidelines are effective in keeping the sport safer, concerns specific to the adolescent wrestler may be missed at primary care visits without knowledge of the unique challenges faced by these athletes. The following review highlights important characteristics of the adolescent wrestler which are of interest to primary care providers. RECENT FINDINGS: Recommendations for concussion management are evolving to gradual return-to-sport after physician clearance rather than total sport removal. Prolonged skin-to-skin contact also places athletes at greater risk of dermatologic infections, which often require removal from competition, treatment, and/or coverage. Finally, adolescent nutritional literature recommends limiting pre-match weight loss to 3-5% body weight due to noted kidney damage that may result from larger deficits. Adolescent wrestlers are more prone to acute injuries than chronic overuse injuries, with most injuries occurring above the trunk. Primary care providers should consider obtaining imaging to rule out severe injuries or referring to specialist providers. Current guidelines for skin infections require frequent pre-match skin checks and mandatory waiting periods when certain infections are identified. However, the primary care provider is well-equipped for more in-depth skin examination, discussion of skin hygiene, and appropriate treatment of skin infections. Athletes attempting to meet lower weight classes may put themselves at risk of acute kidney damage, under-fueling, and eating disorders. Current guidelines attempt to mitigate excessive weight changes in the adolescent wrestler during competition season, but primary care providers should emphasize healthier methods of weight fluctuation and look for indicators of physiological or psychological effects.

The effect of fresh and used ankle taping on lower limb biomechanics in sports specific movements.

OBJECTIVES: We aimed to investigate the effects of ankle taping on lower extremity biomechanics related to injury development and how these effects change after sports-specific use. DESIGN: Randomized, repeated measures design with three conditions: Barefoot, tape applied fresh, and tape after sports-specific use (between-subject factor: sex). METHODS: Twenty-five healthy participants (ten female) performed sports-specific movements, including running, drop jumping, and 180° change of direction, under the three conditions. Kinetic and kinematic data were collected using 3D motion capturing and force platforms. RESULTS: Tape applied fresh and tape after sports-specific use significantly reduced peak ankle inversion. Biomechanical risk factors for anterior cruciate ligament or running overuse injuries were either unchanged or decreased with tape applied fresh, except for the peak loading rate of the resultant ground reaction force, which increased between 4% and 18% between movement types. After 15 minutes of sports-specific use of the tape, the alterations induced by tape applied fresh remained for some biomechanical risk factors while they became closer to barefoot again for others, indicating a differential response to prolonged use of taping for different biomechanical variables. CONCLUSIONS: Ankle taping protects the ankle joint by reducing biomechanical risk factors associated with ankle sprains, and most biomechanical risk factors for anterior cruciate ligament or running overuse injuries are not increased. Further research is needed to explore the duration of protective effects, variations across sports, and its impact on patients with chronic ankle instability, contributing to a more comprehensive understanding of ankle taping's influence on lower extremity biomechanics.

Psychological risk factors for a first hamstring strain injury in soccer: a qualitative study.

Introduction: Hamstring strain injuries (HSIs) remain one of the most burdensome injuries in soccer. Current recommendations to prevent sports injuries suggest the importance for coaches and medical staff to consider psychological and contextual risk factors and to specify them according to the injury type and context. HSI risk factors in soccer have been widely investigated, mainly from physiological and biomechanical perspectives. However, psychological and health-related risk factors are still unexplored. Therefore, the objective of this study was to determine the psychological and health-related risk factors for a first HSI in male competitive soccer. Method: Individual semi-structured interviews were conducted with ten male competitive soccer players, who had recently sustained a HSI. Based on multifactorial models of sports injury causation, soccer players' individual, contextual, and situational risk factors at the time of their first HSI were investigated. Interviews were analyzed using thematic analysis with deductive and inductive approaches. Results: Individual psychological risk factors included common at-risk personality traits, obsessive passion for soccer with competitive motivational goals, strong athletic identity, and poor health literacy. The injured players were exposed to a controlling coaching style, with a fear of negative staff evaluations, and had recently experienced life stressors. They were injured during matches or overload periods and were highly engaged in the activity. Discussion: Previously injured soccer players exhibit a lack of perspective concerning the repercussions of their actions on their health. From a preventive viewpoint, these results suggest enhancing the players' health literacy, supporting their autonomy, and moderating the controlling coaching style.

Pulmonary contusion with hemoptysis from lacrosse ball strike: A case report.

Lacrosse, a sport of increasing popularity, is played with netted sticks and a firm rubber ball propelled at speeds frequently reaching over 100 miles/hour. While lacrosse injuries have been previously described, little published literature exists on lacrosse balls causing pulmonary contusion. We present a case of a 17-year-old male lacrosse player athlete who suffered a lacrosse ball strike to the left posterolateral chest, leading to a clinical presentation of local bruising, shortness of breath, and hemoptysis. Despite delayed arrival to the emergency room, where imaging revealed pulmonary contusion, multidisciplinary supportive management led to favorable clinical outcome with no residual effect on athletic ability and quality of life. Although pulmonary contusion may be a rare injury in the setting of thoracic trauma from lacrosse ball strikes, prompt evaluation and a high index of suspicion can rule out more life-threatening processes and ensure an excellent clinical prognosis.

Clinical Determinants of Knee Joint Loads While Sidestepping: An Exploratory Study With Male Rugby Union Athletes.

Background: While several clinical factors have independently been linked to anterior cruciate ligament (ACL) injury risk factors, their collective impact on knee loading during the sidestep maneuver is unknown. To better understand these factors, we assessed the relationship between strength, balance, and sprint kinetics and external knee abduction moments during sidestepping on each leg. Methods: Sixteen male academy-level rugby union athletes (age, 20 ± 3 years; body-height, 186 ± 9 cm; body-mass, 99 ± 14 kg) were bilaterally assessed in single-leg: isokinetic concentric and eccentric knee and concentric hip strength, balance at 2 difficulty levels, vertical and horizontal force production during maximal sprinting, and 3-dimensional motion capture while sidestepping on the preferred and non-preferred leg. A hierarchical multiple regression analysis based on this theoretical approach of the mechanics of ACL injury risk was performed. Results: When sidestepping on the preferred leg, larger abduction moments were explained by less concentric hip extension strength and vertical force production during maximal sprinting (R 2 = 41%; ES = 0.64); when sidestepping on the non-preferred leg, larger abduction moments were explained by more concentric hip flexion strength (R 2 = 8%; ES = 0.29). Larger symmetry scores between the legs (representing greater abduction moments) were explained by more horizontal force production during maximal sprinting and less eccentric knee flexion strength (R 2 = 32%; ES = 0.56). Conclusions: Independently, the preferred and non-preferred legs contribute to increased knee abduction moments via unique distributions of strength and/or sprint kinetics. The allocations of strength and sprint kinetics appear interrelated through weaker posterior muscular strength and may be modifiable through a targeted strength training approach.