Heart rate variability activity in soccer athletes after a musculoskeletal injury.

OBJECTIVES: The aim of this study is to analyse the adaptations of the autonomic nervous system after a musculoskeletal injury, obtained by measuring heart rate variability in athletes. It was hypothesized that there is an alteration in heart rate variability after a musculoskeletal injury. STUDY DESIGN: Cohort study. SUBJECTS: 15 semi-professional soccer players from three football teams, aged between 21 and 33 (mean age: 29.4 ± 3.31 years), with a recent musculoskeletal injury. METHODS: Heart rate variability was collected using the Polar m200 and the chest strap H10 in two moments: within 72 h after the injury and between 5 and 7 days after full return-to-play. RESULTS: Results show differences between T1 and T2 (p ≤ 0.05) in low-frequency power (n.u.) (p = 0.001) and high-frequency power (n.u.) (p = 0.001), in low-frequency/high-frequency ratio (p = 0.001) and in high-frequency power (ms2) (p = 0.017) measures. No statistical differences were found in low-frequency power (ms2) (p = 0.233). The low frequency power (n.u.) was significantly lower after injury compared with LF power (n.u.) values after full return-to-play. In high-frequency power there was a significant difference between both moments with high values after injury. CONCLUSIONS: The use of heart rate variability therefore seems to be promising to detect an imbalance in the autonomic nervous system and help clinical departments to identify a possible non-traumatic musculoskeletal injury. Further research should be performed considering a wide range of musculoskeletal injuries and to establish baseline values of the athletes.

Characterizing Muscle Activity in Soccer Players with a History of Hamstring Strain Injuries during Accelerated Sprinting.

This study aimed to characterize muscle activity in male soccer players with a history of hamstring strain injuries (HSI) during accelerated sprinting. Thirteen patients each in the HSI group (history of HSI) and in the healthy group (with no history of HSI) were included. 26 male soccer players of which 13 with and 13 without HSI history were included in this study. Ten muscles were evaluated on electromyography activity during overground sprinting. The testing protocol consisted of a maximal sprint over a distance of 30 meters. One running stride was divided into the early stance phase, late stance phase, early swing phase, mid-swing phase, and late swing phase, and the average muscle activity per phase and the timing of the peak root-mean-square value appearance during each stride were calculated. Statistical analysis was performed using repeated-measures two-way ANOVA (group × phase), and multiple comparison tests were performed using the Bonferroni method when the interaction or main effect was significant. The statistical significance level was set at p < 0.05. Gluteus maximus (Gmax), gluteus medius (Gmed), and external oblique (EO) showed activity differences based on HSI history. Gmax was 30% lower, EO was 20% lower, and Gmed was 40% higher in HSI group. This study suggests that, despite previous findings that HSI is most likely during the late swing phase, the HSI group shows a higher injury risk in the early stance phase. This is due to differences in trunk and gluteal muscle activity between the late swing and early stance phases compared to the healthy group. In summary, HSI group had lower activity in the muscles contributing to trunk instability, especially EO and Gmax, before and after ground impact during accelerated sprinting, compared to Healthy.

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion.

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

Effects of stiffness-altered sport compression garments on lower-limb biomechanics in cutting maneuvers.

Athletes commonly use compression garments (CGs) for perceived effectiveness in preventing injury occurrence. However, limited evidence is available on whether lower-limb CGs reduce the risk of injury. This study aimed at (1) evaluating the effects of CGs on mitigating the risk factors of cutting-related knee injuries; (2) identifying undesirable side-effects of CGs on other joints and cutting performance; and (3) identifying possible interactions between sex and condition. 62 healthy adults performed pre-planned 90˚ cutting tasks under four conditions: control, knee sleeves, placebo leggings and stiffness-altered leggings. Joint angle at initial contact, range of motion, moments, and ground reaction force were measured. A mixed two-way (sex*condition) ANOVA was performed, followed by post-hoc comparisons and subset analyses for sexes. Results showed that the leggings restricted hip sagittal (45.4 ± 1.3 vs. control 50.0 ± 1.3˚, p = 0.001) and rotational (16.8 ± 0.8 vs. control 22.5 ± 1.1˚, p < 0.001) motion. At initial contact, the stiffness-altered leggings reduced knee valgus (0.4 ± 0.8 vs. control -2.1 ± 0.8˚, p = 0.031). However, the altered alignment of lower-limb joints did not reduce multiplanar knee joint moments (p > 0.05). CGs were not effective protective equipment yet. There was no significant difference between knee sleeves and control, nor between leggings conditions (p > 0.05). Force plate measurements, such as increased rate of force development (stiffness-altered 42.6 ± 1.1 & placebo 42.9 ± 1.1 vs. control 39.9 ± 1.0 BW/s, p < 0.028), implied the possibility of performance enhancement through CGs. While further investigations on the optimal compression and stiffness alterations are warranted, athletes are recommended to be aware of the discrepancies between the claimed and actual biomechanical effects of CGs.

Mental Fatigue in Sport-From Impaired Performance to Increased Injury Risk.

The literature describing the effects of mental fatigue (MF) has grown tremendously. This is accompanied by identification of a host of performance-determining parameters affected by MF. MF results from prolonged cognitive effort and predominantly affects physical, technical, tactical, and perceptual-cognitive dimensions of sport, while physiological parameters (eg, heart rate, lactate) and physical aspects of maximal and supramaximal efforts are predominantly unaffected. The aim of this paper was to provide an overview of the parameters described in the literature as influenced by MF. By identifying the different parameters, we not only see how they affect the performance of athletes but also raise concerns about the potentially increased injury risk due to MF. Preliminary evidence suggests that subsequent disturbances in balance, motor skills, and decision-making processes could potentially increase the vulnerability to injury. An abundance of lab-based studies looked into the effects of MF on performance; however, many questions remain about the mechanisms of origin and neurophysiological causes of MF, and only small steps have been taken to translate this knowledge into practice. Thus, there is a need for more research into the underlying mechanisms of MF and the role of the brain, as well as more applied research with a high ecological validity that also takes into account the potential increased risk of injury due to MF.

Concussion History Moderates Trunk Motion and Lower Extremity Biomechanical Relationships During Jump Landing and Cutting.

Concussion history, trunk motion, and lower extremity biomechanics associate with musculoskeletal injury risk. We aimed to examine the interaction between concussion history and trunk motion as possible modifiable factors for injury risk biomechanics during jump landing and cutting. Division I female athletes (24 with, 20 without concussion history) performed jump landings and jump-to-cuts at 45° in the opposite direction of the landing limb. We used multiple linear regressions with interaction terms to examine ankle dorsiflexion angle, knee flexion and abduction angle, and external knee flexion and abduction moment. We observed a group by trunk flexion interaction for nondominant external knee flexion moment (P = .042) during jump landing. Concussion history associated with increased external knee flexion moment as trunk flexion increased. We observed a group by trunk flexion interaction for the dominant limb dorsiflexion angle (P = .044), and group by trunk lateral bending interactions for the dominant (P = .039) and nondominant limb (P = .016) external knee flexion moment during cutting. During cutting, concussion history associated with decreased dominant dorsiflexion angles as trunk flexion increased, and decreased dominant and nondominant external knee flexion moment as lateral bending toward the planted limb increased. Concussion history associated with atypical biomechanics as trunk flexion and lateral bending increased.

Uncovering the hidden effects of repetitive subconcussive head impact exposure: A mega-analytic approach characterizing seasonal brain microstructural changes in contact and collision sports athletes.

Repetitive subconcussive head impacts (RSHI) are believed to induce sub-clinical brain injuries, potentially resulting in cumulative, long-term brain alterations. This study explores patterns of longitudinal brain white matter changes across sports with RSHI-exposure. A systematic literature search identified 22 datasets with longitudinal diffusion magnetic resonance imaging data. Four datasets were centrally pooled to perform uniform quality control and data preprocessing. A total of 131 non-concussed active athletes (American football, rugby, ice hockey; mean age: 20.06 ± 2.06 years) with baseline and post-season data were included. Nonparametric permutation inference (one-sample t tests, one-sided) was applied to analyze the difference maps of multiple diffusion parameters. The analyses revealed widespread lateralized patterns of sports-season-related increases and decreases in mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) across spatially distinct white matter regions. Increases were shown across one MD-cluster (3195 voxels; mean change: 2.34%), one AD-cluster (5740 voxels; mean change: 1.75%), and three RD-clusters (817 total voxels; mean change: 3.11 to 4.70%). Decreases were shown across two MD-clusters (1637 total voxels; mean change: -1.43 to -1.48%), two RD-clusters (1240 total voxels; mean change: -1.92 to -1.93%), and one AD-cluster (724 voxels; mean change: -1.28%). The resulting pattern implies the presence of strain-induced injuries in central and brainstem regions, with comparatively milder physical exercise-induced effects across frontal and superior regions of the left hemisphere, which need further investigation. This article highlights key considerations that need to be addressed in future work to enhance our understanding of the nature of observed white matter changes, improve the comparability of findings across studies, and promote data pooling initiatives to allow more detailed investigations (e.g., exploring sex- and sport-specific effects).

Effects of adding dual-task or sport-specific task constrains to jump-landing tests on biomechanical parameters related to injury risk factors in team sports: a systematic review.

Background: Jumping and landing tests are frequently used as a tool to assess muscle function. However, they are performed in a controlled and predictable environment. The physical tests commonly used as part of the criteria for return to sport after injury are often performed with little or no cognitive load and low coordinative demand compared to game-specific actions. The aim of this systematic review was to examine the influence of performing a dual task (DT) or sport-specific task constrains during jump-landing tests on biomechanical variables related to lower limb injury risk in team sports. Methods: This systematic review followed the specific methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted in the databases Medline (PubMed), Web of Science, Cochrane Plus, and SportDiscus for studies published from 2013 until June 30, 2023. To be eligible, studies had to include: (1) kinematic and/or kinetic assessment of injury risk factors in the lower extremity; (2) a comparison between a simple jump or landing test and a DT jump or landing test which included cognitive information. The risk of bias in the selected articles was analyzed using the recommendations of the Cochrane Collaboration. Results: Of the 656 records identified, 13 met the established criteria. Additionally, two more articles were manually included after screening references from the included articles and previous related systematic reviews. Regarding the Risk of bias assessment, 12 studies did not surpass a score of 3 points (out of a total of 7). Only three studies exceeded a score of 3 points, with one article achieving a total score of 6. From the included studies, comparative conditions included actions influenced by the inclusion of a sports ball (n = 6), performing tasks in virtual environments or with virtual feedback (n = 2), participation in cognitive tasks (n = 6), and tasks involving dual processes (n = 7). The execution of decision-making (DM) during the jump-landing action resulted in biomechanical changes such as lower peak angles of hip flexion and knee flexion, along with increased vertical ground reaction force, knee abduction, and tibial internal rotation. Regarding limitations, discrepancies arise in defining what constitutes DT. As a result, it is possible that not all studies included in this review fit all conceptual definitions of DT. The inclusion of DT or constraints in jump-landing tests significantly alters biomechanical variables related to lower extremity injury risk in team sports. In future research, it would be beneficial to incorporate tasks into jumping tests that simulate the specific cognitive demands of team sports. This systematic review was registered in PROSPERO (registration number: CRD42023462102) and this research received no external funding.

Video Analysis of Anterior Cruciate Ligament Injuries in National Basketball Association Athletes.

PURPOSE: Research surrounding the biomechanics and video analysis of anterior cruciate ligament (ACL) injuries at the professional level has emerged in recent years as a tool to screen athletes for potential biomechanical deficits. The purpose of this study was to analyze and discuss the most common mechanism, body position, and activity at the time of ACL injury among NBA players. METHODS: Anterior cruciate ligament injuries over 10 consecutive NBA seasons (2009-2010 to 2019-2020) were reviewed from publicly available sources. A 10-question survey was developed and utilized to analyze each video clip. These questions were divided into three categories: 1. contact mechanism, 2. activity at the time of injury, and 3. position of the involved lower extremity at the time of injury. Two reviewers analyzed the videos individually, and differing answers were resolved via consensus review, with a senior author arbitrating in the case of any discrepancies. RESULTS: Overall, 23 ACL ruptures were included. The most common injury mechanism was indirect contact with another player without knee contact (56.5%), and no patients had an ACL rupture as a result of direct knee contact with another player. The most common action at the time of injury was pivoting (47%), and the most common basketball action was dribbling (43.5%). Additionally, the vast majority of patients were injured while on offense (91.3%). The most common knee positions were early flexion (73.9%) and abduction (95.7%). The most common foot positions were abduction relative to the knee (82.6%), in eversion (73.9%), and dorsiflexion (56.5%). The most common hip position was early flexion (87%), and all hips were abducted (100%). CONCLUSION: Our study found that the majority of ACL ruptures occurred during offensive play and over half were secondary to contact with an opposing player (but without a direct blow to the injured knee), indicating that such perturbations may alter the kinematics of the players' movement. Additionally, a large majority of ACL injuries occurred while the hip was abducted with the knee in abduction relative to the hip and while the knee was in early flexion from 0° to 45°.

Comparison between arthroscopic Bankart repair versus arthroscopic Bankart/SLAP lesion repair in limited-contact athletes with type V SLAP lesion. A prospective cohort study.

PURPOSE: The aim of this study was to compare the functional outcomes, recurrence rate, range of motion (ROM) and return to sports activities between arthroscopic Bankart repair (ABR) versus arthroscopic Bankart/SLAP repair (ABR/S) in limited contact-athletes with a type V SLAP lesion in the scenario of recurrent anterior shoulder instability (RASI). Our hypothesis was that there is no difference between the two treatments. METHODS: Two groups of 45 limited-contact athletes with type V SLAP lesion were created. Group 1 underwent an arthroscopic Bankart repair, while group 2 had an arthroscopic Bankart/SLAP repair. The minimum follow-up period was 2 years. The WOSI and ASES scores were used to assess primary functional outcomes. Recurrence rate, ROM and return to sport were also evaluated. RESULTS: Significant differences were reported in the WOSI and ASES scores pre- and post-operatively in each group. There were no significant differences between the two groups (P = 0.78 and 0.43). We reported 4 recurrences (8.8 %) in group 1 and 5 (11.1 %) in group 2, with no difference between them (P = 0.62). There were no significant differences between the range of motion of each of the groups as well as between them. More than 90% of the athletes in both groups returned to their previous sporting activities. CONCLUSIONS: Limited-contact athletes with RASI who have a type V SLAP lesion as their primary diagnosis can be treated using either ABR or ABR/S with equal efficacy. Both treatment alternatives preserve athlete's function, stability, ROM and return to sport.

The Influence of Induced Head Acceleration on Lower-Extremity Biomechanics during a Cutting Task.

Sports-related concussions are caused by one substantial impact or several smaller-magnitude impacts to the head or body that lead to an acceleration of the head, causing shaking of the brain. Athletes with a history of sports-related concussion demonstrate lower-extremity biomechanics during landing tasks that are conducive to elevated injury risk. However, the effect of head acceleration on lower-extremity biomechanics during landing tasks is unknown. Twenty participants were evenly separated into a vertical hopping group and a lateral hopping group. Participants performed several land-and-cut maneuvers before and after a hopping intervention. Vertical head acceleration (g) was measured via an accelerometer during the hopping interventions. Comparisons in head acceleration during the hopping tasks were made between groups. Additionally, kinematic and kinetic variables were compared pre- and post-intervention within groups as well as post-intervention between groups. The vertical hopping group demonstrated greater vertical head acceleration compared to the lateral hopping group (p = 0.04). Additionally, the vertical hopping group demonstrated greater knee abduction angles during landing post-intervention compared to the lateral hopping group (p < 0.000). Inducing head acceleration via continuous hopping had an influence on lower-extremity biomechanics during a landing task.

Orthostatic Vital Signs After Sport-Related Concussion: A Cohort Study.

BACKGROUND: The 6th International Consensus Statement on Concussion in Sport guidelines identified that measuring autonomic nervous system dysfunction using orthostatic vital signs (VSs) is an important part of the clinical evaluation; however, there are limited data on the frequency of autonomic nervous system dysfunction captured via orthostatic VSs after concussion. PURPOSE: To compare orthostatic changes in heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) between athletes with acute sport-related concussion (SRC) and control athletes. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We compared 133 athletes (mean age, 15.3 years; age range, 8-28 years; 45.9% female) with acute SRC (<30 days after injury) with 100 control athletes (mean age, 15.7 years; age range, 10-28 years; 54.0% female). Given the broad age range eligible for study inclusion, participants were subdivided into child (younger than 13 years of age), adolescent (13-17 years of age), and adult (18 years of age and older) age groups for subanalyses. Participants completed a single standard orthostatic VS evaluation including HR, SBP, and DBP in the supine position then immediately and 2 minutes after standing. Linear regression was used to compare delayed supine-to-standing changes in HR, SBP, and DBP as a continuous variable (ΔHR, ΔSPB, and ΔDBP) between groups, and logistic regression was used to compare patients with positive orthostatic VS changes (sustained HR increase ≥30 beats per minute [bpm], SBP decrease ≥20 mm Hg, and DBP ≥10 mm Hg at 2 minutes) between groups, accounting for age and sex. RESULTS: Between-group differences were present for delayed ΔHR (18.4 ± 12.7 bpm in patients with SRC vs 13.2 ± 11.0 bpm in controls; P = .002) and ΔSPB (-3.1 ± 6.6 bpm in patients with SRC vs -0.4 ± 6.5 bpm in controls; P = .001), with positive orthostatic HR changes present more frequently in patients with SRC (18% vs 7%; odds ratio, 2.79; P = .027). In the SRC group, a weak inverse relationship was present between age and ΔHR (r = -0.171; P = .049), with positive orthostatic HR findings occurring primarily in the child and adolescent SRC subgroups. CONCLUSION: Patients with acute SRC had greater orthostatic VS changes compared with controls, the most prominent being sustained HR elevations. Clinical evaluation of autonomic change after SRC via standard orthostatic VS assessment may be a helpful clinical biomarker in the assessment of SRC, especially in children and adolescents.

Association of Sport Helmet Status on Concussion Presentation and Recovery in Male Collegiate Student-Athletes.

Sporting helmets contain force attenuating materials which reduce traumatic head injury risk and may influence sport-related concussion (SRC) sequelae. The purpose of this study was to examine the association of sport helmet status with SRC-clinical presentation and recovery trajectories in men's collegiate athletes. Sport helmet status was based on the nature of sports being either helmeted/non-helmeted. 1070 SRCs in helmeted (HELM) sports (Men's-Football, Ice Hockey, and Lacrosse), and 399 SRCs in non-helmeted (NOHELM) sports (Men's-Basketball, Cheerleading, Cross Country/Track & Field, Diving, Gymnastics, Soccer, Swimming, Tennis, and Volleyball) were analyzed. Multivariable negative binomial regression models analyzed associations between sport helmet status and post-injury cognition, balance, and symptom severity, adjusting for covariate effects (SRC history, loss of consciousness, anterograde/retrograde amnesia, event type). Kaplan-Meier curves evaluated median days to: initiation of return to play (iRTP) protocol, and unrestricted RTP (URTP) by sport helmet status. Log-rank tests were used to evaluate differential iRTP/URTP between groups. Two independent multivariable Weibull accelerated failure time models were used to examine differential iRTP and URTP between groups, after adjusting for aforementioned covariates and symptom severity score. Overall, the median days to iRTP and URTP was 6.3 and 12.0, respectively, and was comparable across NOHELM- and HELM-SRCs. Post-injury symptom severity was lower (Score Ratio 0.90, 95%CI 0.82, 0.98), and cognitive test performance was higher (Score Ratio 1.03, 95%CI 1.02, 1.05) in NOHELM-compared to HELM-SRCs. Estimated time spent recovering to iRTP/URTP was comparable between sport helmet status groups. Findings suggest that the grouping of sports into helmeted and non-helmeted show slight differences in clinical presentation but not recovery.

Relationship between Tilt Sensation Ability and Lower Limb Injuries in Junior Athletes.

The purpose of this study was to devise a tilt sensation measurement method to evaluate ankle proprioception and to examine its reliability. It was also used to determine the relationship among tilt sensation abilities, physical development, and lower limb injuries in junior athletes. In this study, a step platform created tilt angles. Participants with eye masks answered "yes" or "no" to sensing a tilt, evaluated over nine or seven trials. Experiment 1 involved 22 university students (20.6 ± 0.9 years). The minimum angle at which a tilt could be sensed while standing on both feet was determined, and measurements were taken again to examine reliability. Experiment 2 involved 40 junior athletes (12.3 ± 2.0 years), where the minimum angle for tilt sensation was obtained, and medical checks were conducted to assess injuries in the knee, lower leg, and foot. Reliability studies showed a moderately significant correlation between the first and second sessions (r = 0.504, p = 0.017), suggesting the reliability of the experimental method. The proportion capable of sensing a tilt of 1.1° and 1.6° was significantly higher in junior high school students than in elementary school students (1.1°; χ2 = 8.839, p = 0.003. 1.6°; χ2 = 4.038, p = 0.044). The group unable to sense a tilt of 1.6° and 2.1° had a significantly higher positive rate of knee injuries compared to the sensed group among junior high school students (1.6°; χ2 = 4.622, p = 0.032. 2.1°; χ2 = 4.622, p = 0.032). Our findings suggested that a reduced tilt sensation ability was associated with knee injuries in junior high school students. Utilizing our devised tilt sensation assessment could play a crucial role in preventing and detecting early injuries in junior high school students.

Neurite orientation dispersion and density imaging reveals abnormal white matter and glymphatic function in active young boxers.

The neurological effects and underlying pathophysiological mechanisms of sports-related concussion (SRC) in active young boxers remain poorly understood. This study aims to investigate the impairment of white matter microstructure and assess changes in glymphatic function following SRC by utilizing neurite orientation dispersion and density imaging (NODDI) on young boxers who have sustained SRC. A total of 60 young participants were recruited, including 30 boxers diagnosed with SRC and 30 healthy individuals engaging in regular exercise. The assessment of whole-brain white matter damage was conducted using diffusion metrics, while the evaluation of glymphatic function was performed through diffusion tensor imaging (DTI) analysis along the perivascular space (DTI-ALPS) index. A two-sample t-test was utilized to examine group differences in DTI and NODDI metrics. Spearman correlation and generalized linear mixed models were employed to investigate the relationship between clinical assessments of SRC and NODDI measurements. Significant alterations were observed in DTI and NODDI metrics among young boxers with SRC. Additionally, the DTI-ALPS index in the SRC group exhibited a significantly higher value than that of the control group (left side: 1.58 vs. 1.48, PFDR = 0.009; right side: 1.61 vs. 1.51, PFDR = 0.02). Moreover, it was observed that the DTI-ALPS index correlated with poorer cognitive test results among boxers in this study population. Repetitive SRC in active young boxers is associated with diffuse white matter injury and glymphatic dysfunction, highlighting the detrimental impact on brain health. These findings highlight the importance of long-term monitoring of the neurological health of boxers.

The Influence of Sports-Related Concussion on Cognition and Landing Biomechanics in Collegiate Athletes.

Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports-related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1-year post-SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land-and-cut tasks and cognitive assessments. Group-based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land-and-cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport-specific land-and-cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk.

Effect of aquatic versus conventional physical therapy program on ankle sprain grade III in elite athletes: randomized controlled trial.

INTRODUCTION: Ankle sprains are the second most common sports injury after knee injuries, with about 85% of them affecting the lateral ankle ligaments. These injuries are particularly prevalent in sports like basketball and volleyball. PURPOSE: To investigate the effect of Aquatic therapy as an early rehabilitation protocol for elite athletes with acute lateral ankle sprain grade III on back-to-sport time, dynamic balance, pain, Athletic performance, and muscle power compared to land-based exercise training. METHODS: Thirty elite athletes have ankle sprain grade III with sprain onset from 1 to 7 days, their age ranges from 18-30 years old were recruited. All participants are professional athletes; mainly participating in above-head sports such as volleyball and basketball. The patients were randomly allocated into two treatment groups: Group I (control group): 15 patients received a conventional physical therapy program of structured therapeutic exercise program, manual therapy and land-based exercises, in addition to external support, and Group II (Aquatic therapy group): 15 patients received aquatic training. Visual Analog Scale (VAS) was used to measure the pain intensity, while the dynamic balance was measured by the Star Excursion Balance Test. Athletic performance was measured by HOP Tests (Single, Triple, 6-m, and Cross-over hops) aided by the Agility T-Test (ATT) and Illinois Agility Test (IAT). Muscle power was tested by a Single Leg Press. Finally, back to sports time was recorded for each participant in both groups. RESULTS: There was a significant interaction effect of Aquatic therapy and time for VAS (p < 0.001), single hop (p < 0.001), triple hop (p < 0.001), cross-over hop (p < 0.001), IAT (p = 0.019) and ATT (p < 0.001) of both affected and nonaffected. There was no significant interaction effect of Aquatic therapy and time for 6-MHT of affected (p = 0.923), and nonaffected (p = 0.140). There was a significant main effect of time for all dependent variables (p < 0.001) except for 6-MHT of affected (p = 0.939), nonaffected (p = 0.109), and IAT (p = 0.099). The Star excursion dynamic balance test (SEBT) and Single leg press revealed a significant difference between groups on affected and non-affected sides (p < 0.001*). Lastly and most importantly the back-to-sport time revealed a significant difference in the return-to-sport time in favor of the Aquatic therapy group who returned faster than the control group (p < 0.001*). CONCLUSION: Aquatic therapy is more effective than traditional protocols regarding early rehabilitation of acute ankle sprain grade III in Elite professional athletes for reducing pain intensity, improving dynamic balance and athletic performance and power and accelerating their return to sports time. Because aquatic therapy produces better outcomes, it is advised to be included in the rehabilitation programs of athletic patients with acute ankle sprains grade III.

Neuromuscular Training Effects on Athletes' Jumping and Lower Limb Injury: A Systematic Review.

This study assessed the impact of integrated neuromuscular training (INT) on athletes' jumping performance and lower limb injury prevention. A thorough search across multiple databases, including PubMed, Web of Science, Science Direct, and the Cochrane Library, identified a sample of 19,805 athletes aged between 8.5 and 27.7 years. Results showed that INT led to a significant improvement in jumping ability (SMD = 0.45, 95% CI 0.30-0.60, P = 0.000) and a reduction in lower limb injuries (SMD = 0.68, 95% CI 0.62-0.74, P = 0.000). The most effective interventions lasted at least 25 minutes, conducted 2-5 times per week, for a minimum of 9 weeks. This approach was particularly beneficial for children and adolescents, as it enhanced their countermovement jump (CMJ) ability and helped in the prevention of injuries.

Strength and clinical test combinations enhance predictions of sagittal and frontal plane biomechanics in single-leg landing.

OBJECTIVES: To determine whether clinical screening tests can predict lower limb joint kinematics and kinetics outcomes eliciting anterior cruciate ligament (ACL) injury risk in single-leg landings. DESIGN: Cross-sectional study. SETTING: Laboratory research. PARTICIPANTS: Twenty-six professional male futsal athletes. MAIN OUTCOME MEASURES: Participants completed the Modified Star Excursion Balance Test (mSEBT), Lateral Step Down (LSD), Lunge, Hop tests, and isometric strength tests for clinical screening of lower extremity injury risk and performed single-leg landings to assess lower extremity 3D kinematics and kinetics outcomes. RESULTS: mSEBT, LSD, and isometric strength were the more important tests when constructing the prediction models. The predictive power of clinical tests for screening injury risk significantly increases when combined with strength measurements (p = 0.005, f2 = 0.595). We discerned 11 biomechanical predictions, six explicitly related to the sagittal plane's biomechanics. Some predictions were leg-dependent, with muscle strength tests predominantly predicting biomechanical outcomes of the preferred leg. CONCLUSION: Combining clinical screening tests with strength measures enhances ACL injury risk factors prediction during single-leg landings. Clustering at least two tests improves prediction accuracy, aiding injury prevention planning and decision-making.