'Every turn can be the last one I do' - Perceptions of injury risk in high-performance snow sports and its implication for injury prevention.

OBJECTIVES: High-performance snow sports (HPSS) athletes compete in a performance-driven context with a high risk of injury. While there is a lack of evidence on effective prevention measures in snow sports, this study explored the perspectives and perceptions of HPSS stakeholders on sports injury prevention. METHODS: We conducted an exploratory qualitative study based on the grounded theory principles through 11 semistructured interviews with athletes, coaches and healthcare providers from different national teams about sports injury prevention. The interviews were inductively analysed through constant comparative data analysis. RESULTS: Participants defined risk management as a central concept in which they approached injury prevention by assessing, managing and sometimes accepting risks. Many factors, such as athlete-related and external factors, are considered in this process, ultimately influencing their decision-making. Participants acknowledged the value of experience when managing and dealing with risks, a key aspect of their learning process and career development. Within this context, open and trustworthy communication and shared responsibilities among all stakeholders influenced and shaped injury prevention strategies and behaviours. Understanding and balancing out speed and risks was considered pivotal in their daily practice. Therefore, injury prevention awareness, ownership, communication, teamwork and shared responsibilities may contribute to the success of sports injury prevention in HPSS. CONCLUSION: These findings substantiate the significance of such contextual factors in sports injury prevention. Considering the high-risk nature of HPSS, injury prevention suggests a shift towards risk management strategies, with a strong emphasis on contextual factors and their interactions. Young athletes might benefit from educational interventions centred on developing skills to assess and manage risks.

We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing.

BACKGROUND: Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues. MATERIALS AND METHODS: We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix. RESULTS: Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season. CONCLUSIONS: We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.

Evaluating workforce needs: an investigation of healthcare professionals' attitudes, beliefs and preparedness towards the management of Para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVES: To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games. METHODS: A cross-sectional observational study was conducted. National Paralympic Committee's HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics. RESULTS: The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes. CONCLUSION: HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health.

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

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

What do we know about beach soccer injuries? Systematic video analysis of four consecutive years with 580 match injuries.

The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact (p < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) (p < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.

Evaluating workforce well-being: an investigation of healthcare professionals' mental health and burnout symptoms at the Tokyo 2020 and Beijing 2022 Paralympic Games.

OBJECTIVE: To explore the prevalence of symptoms of mental health conditions and burnout of healthcare professionals (HCPs) working during the Tokyo 2020 Paralympic Games and the Beijing 2022 Paralympic Winter Games. METHODS: In this cross-sectional, observational study, HCPs working during the Tokyo 2020 and Beijing 2022 Paralympic Games were asked to complete an online, anonymous survey, which included demographic questions and questions regarding mental health symptoms including depression (Patient Health Questionnaire 9-item depression scale) and anxiety (Generalized Anxiety Disorder 7-item scale) as well as burnout (Maslach Burnout Inventory-Human Services Survey: depersonalisation, emotional exhaustion, personal accomplishment). Correlation coefficients (r) were calculated between demographic characteristics and mental health symptoms. RESULTS: In total, 256 HCPs (of 857 HCPs; 30%) completed the surveys. Twelve and eight per cent of HCP scores fell within the moderate to severe depression and moderate to severe anxiety categories, respectively. More than 30% reported moderate to high burnout (depersonalisation: 36%; emotional exhaustion: 36%; personal accomplishment: 58%). In addition, thoughts of self-harm and/or suicidality were reported by some HCPs (8%). Weak correlations were observed between age and depression (r=-0.13, p=0.046), anxiety (r=-0.16, p=0.010) and burnout (emotional exhaustion: r=-0.14, p=0.032; personal accomplishment: r=0.27, p<0.001). CONCLUSION: Although most HCPs reported good mental health, this study suggests that a subset of HCPs experienced symptoms of depression, anxiety, burnout or thoughts of self-harm during the Tokyo 2020 and Beijing 2022 Paralympic Games. While the generalisability of these findings outside of COVID-19 restrictions should be tested, appropriate guidance and mental health support of HCPs leading up to the Paralympic Games should be prioritised.

Effectiveness of a warm-up programme to reduce injuries in youth volleyball players: a quasi-experiment.

OBJECTIVES: To establish the effectiveness of the 'VolleyVeilig' programme on reducing injury rate, injury burden and injury severity in youth volleyball players. METHODS: We conducted a quasi-experimental prospective study over one season of youth volleyball. After randomisation by competition region, we instructed 31 control teams (236 children, average age 12.58±1.66) to use their usual warm-up routine. The 'VolleyVeilig' programme was provided to 35 intervention teams (282 children, average age 12.90±1.59). This programme had to be used during each warm-up before training sessions and matches. We sent a weekly survey to all coaches, collecting data on each player's volleyball exposure and injuries sustained. Multilevel analyses estimated differences in injury rates and burden between both groups, and we used non-parametric bootstrapping to compare the differences in injury numbers and injury severity. RESULTS: We found an overall reduction in injury rates of 30% for intervention teams (HR 0.72; 95% CI 0.39 to 1.33). Detailed analyses revealed differences for acute (HR 0.58; 95% CI 0.34 to 0.97) and upper extremity injuries (HR 0.41; 95% CI 0.20 to 0.83). Compared with control teams, the intervention teams had a relative injury burden of 0.39 (95% CI 0.30 to 0.52) and a relative injury severity of 0.49 (95% CI 0.03 to 0.95). Only 44% of teams fully adhered to the intervention. CONCLUSION: We established that the 'VolleyVeilig' programme was associated with reduced acute and upper extremity injury rates and lower injury burden and severity in youth volleyball players. While we advise implementation of the programme, programme updates to improve adherence are needed.

Surveillance of athlete mental health symptoms and disorders: a supplement to the International Olympic Committee's consensus statement on injury and illness surveillance.

In 2019, the International Olympic Committee (IOC) published a consensus statement outlining the principles for recording and reporting injury and illness in elite sport. The authors encouraged sport federations to adapt the framework to their sport-specific context. Since this publication, several sports have published extensions to the IOC consensus statement.In response to a paucity of epidemiological data on athlete mental health, the IOC mental health working group adapted the IOC consensus statement on injury and illness surveillance to improve the capturing of athlete mental health data. In addition to the members of the working group, other experts and athlete representatives joined the project team to address gaps in expertise, and to add stakeholder perspective, respectively. Following an in-person meeting, the authors worked remotely, applying the scientific literature on athlete mental health to the IOC injury and illness surveillance framework. A virtual meeting was held to reach consensus on final recommendations.Practical outcomes based on the analysis of the scientific literature are provided with respect to surveillance design, data collection and storage, data analysis and reporting of athlete mental health data. Mental health-specific report forms for athlete and health professional utilisation are included for both longitudinal and event-specific surveillance.Ultimately, this publication should encourage the standardisation of surveillance methodology for mental health symptoms and disorders among athletes, which will improve consistency in study designs, thus facilitating the pooling of data and comparison across studies. The goal is to encourage systematic surveillance of athlete mental health.

Implementation of the International Olympic Committee Sport Mental Health Assessment Tool 1: Screening for Mental Health Symptoms in a Canadian Multisport University Program.

OBJECTIVE: To apply the International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) to determine the prevalence of mental health symptoms in a cohort of university student athletes over an academic year. A secondary objective was to explore the internal consistency of the screening tools from the SMHAT-1. DESIGN: Cross-sectional design with 3 repeated measurements over an academic year. SETTING: A large university multisport program. PARTICIPANTS: Five hundred forty-two university-level student athletes from 17 sports. INTERVENTION: N/A. MAIN OUTCOME MEASURES: On 3 occasions, the participants completed the SMHAT-1, which consists of the Athlete Psychological Strain Questionnaire. If an athlete's score was above the threshold (≥17), the athlete completed step 2, consisting of (1) Generalized Anxiety Disorder-7; (2) Patient Health Questionnaire-9; (3) Athlete Sleep Screening Questionnaire; (4) Alcohol Use Disorders Identification Test Consumption; (5) Cutting Down, Annoyance by Criticism, Guilty Feeling, and Eye-openers Adapted to Include Drugs; and (6) Brief Eating Disorder in Athletes Questionnaire. Internal consistency of the SMHAT-1 was also measured. RESULTS: Participants reported mental health symptoms with prevalence of 24% to 40% for distress, 15% to 30% for anxiety, 19% to 26% for depression, 23% to 39% for sleep disturbance, 49% to 55% for alcohol misuse, 5% to 10% for substance use, and 72% to 83% for disordered eating. Female athletes were more likely to suffer psychological strain, depression, and sleep disturbance; male athletes were more likely to report substance use. CONCLUSIONS: The SMHAT-1 was feasible to implement with good internal consistency. University-level athletes suffer from a variety of mental health symptoms underscoring the necessity for team physicians to have the clinical competence to recognize and treat mental health symptoms.

Risk Factors for Musculoskeletal Injury in CrossFit: A Systematic Review.

The objective of this systematic review was to identify potential risk factors for injury in CrossFit participants. Embase, Medline, Web of Science, Cochrane, CINAHL, Google Scholar, and SportDiscuss databases were all searched up to June 2021. Cohort studies that investigated risk factors for CrossFit injuries requiring medical attention or leading to time loss in sports were included. A best-evidence synthesis was performed combining all the outcomes from prospective cohort studies. From 9,452 publications identified, we included three prospective cohort studies from which two had a low risk of bias and one a high risk of bias. The studies examined 691 participants of whom 172 sustained an injury. There was limited evidence that switching between prescribed and scaled loads during training is associated with increased injury risk and that increased duration of participation is a protective factor for injury. This could mean that novice CrossFit athletes and those increasing their training load should have closer supervision by CrossFit coaches. These risk factors should be considered when developing preventive interventions.

Anxiety and Depressive Symptoms During the COVID-19 Emergency Period: A Comparative Cross-Sectional Study in Professional Football.

OBJECTIVE: The primary objective of our study was to establish the prevalence of anxiety and depressive symptoms among professional football (ie, soccer; hereinafter "football") players during the COVID-19 emergency period, drawing comparisons with players assessed before exposure to the COVID-19 emergency period. DESIGN: Observational comparative cross-sectional study by means of electronic questionnaire. SETTING: Professional football. PARTICIPANTS: A total of 468 female (mean age: 22.8 years) and 1134 male (mean age: 26.0 years) players participated. The non-COVID-19 comparison group consisted of 132 female (mean age: 23.1 years) and 175 male (mean age: 24.8 years) professional footballers. INTERVENTION: N/A. MAIN OUTCOME MEASURES: Anxiety symptoms were measured with the validated Generalized Anxiety Disorder 7 and depressive symptoms with the validated Patient Health Questionnaire 9. Both instruments have been widely used in both clinical and research settings among different populations, showing excellent psychometric properties. RESULTS: During the COVID-19 emergency period, the 2-week prevalence of symptoms consistent with a diagnosis of generalized anxiety disorder and depression was 18.2% and 21.6%, respectively, among female professional footballers and 15.5% and 12.9%, respectively, among male players. The 2-week prevalence of anxiety and depressive symptoms among professional footballers was significantly higher during the COVID-19 emergency period than before the global pandemic (P < 0.01). Differences were most pronounced for those worried about the playing future. CONCLUSIONS: The COVID-19 emergency period is associated with increased symptoms of anxiety and depression in professional footballers, especially among those worried about their future as players.

Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group.

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes' mental health.

OBJECTIVES: To develop an assessment and recognition tool to identify elite athletes at risk for mental health symptoms and disorders. METHODS: We conducted narrative and systematic reviews about mental health symptoms and disorders in active and former elite athletes. The views of active and former elite athletes (N=360) on mental health symptoms in elite sports were retrieved through an electronic questionnaire. Our group identified the objective(s), target group(s) and approach of the mental health tools. For the assessment tool, we undertook a modified Delphi consensus process and used existing validated screening instruments. Both tools were compiled during two 2-day meeting. We also explored the appropriateness and preliminary reliability and validity of the assessment tool. SPORT MENTAL HEALTH ASSESSMENT TOOL 1 AND SPORT MENTAL HEALTH RECOGNITION TOOL 1: The International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) was developed for sports medicine physicians and other licensed/registered health professionals to assess elite athletes (defined as professional, Olympic, Paralympic or collegiate level; aged 16 years and older) potentially at risk for or already experiencing mental health symptoms and disorders. The SMHAT-1 consists of: (i) triage with an athlete-specific screening tool, (ii) six subsequent disorder-specific screening tools and (iii) a clinical assessment (and related management) by a sports medicine physician or licensed/registered mental health professional (eg, psychiatrist and psychologist). The International Olympic Committee Sport Mental Health Recognition Tool 1 (SMHRT-1) was developed for athletes and their entourage (eg, friends, fellow athletes, family and coaches). CONCLUSION: The SMHAT-1 and SMHRT-1 enable that mental health symptoms and disorders in elite athletes are recognised earlier than they otherwise would. These tools should facilitate the timely referral of those athletes in need for appropriate support and treatment.

Athlete health and safety at large sporting events: the development of consensus-driven guidelines.

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

Clinical Hip Osteoarthritis in Current and Former Professional Footballers and Its Effect on Hip Function and Quality of Life.

The objective of the study was to establish the prevalence of clinical hip osteoarthritis in current and former professional footballers and to explore its consequences on hip function and health-related quality of life (HRQoL). A cross-sectional study by means of questionnaire was conducted among current and former professional footballers fulfilling the following inclusion criteria: (1) male (2) active or retired professional footballer (3) member of FIFPRO (Football Players Worldwide) (4) between 18 and 50 years old (5) could read and understand texts in French, Spanish, or English. Controls (matched for: gender, age, body weight and height) were also recruited. The main outcome measures were clinical hip osteoarthritis, hip function and HRQoL. Questionnaires were sent to 2,500 members of which 1,401 participated (1,000 current and 401 former professional footballers). Fifty-two controls were recruited. Prevalence of hip osteoarthritis was 2% among current and 8% among former professional footballers. Hip function was significantly (p ≤ 0.001) lower in both types of footballers with hip osteoarthritis than in footballers without hip osteoarthritis and controls. Current and former professional footballers with hip osteoarthritis reported significantly lower physical health scores (p = 0.032, p = 0.002) than those without. Hip osteoarthritis led to a significantly lower score in the physical (p = 0.004) and mental (p = 0.014) component of HRQoL in former footballers compared to the controls, while in current footballers only the physical component was significantly (p = 0.012) lower compared to the controls. Hip osteoarthritis has a higher prevalence in former than in current professional footballers and impacts hip function and HRQoL negatively.

Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players.

BACKGROUND: Despite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis. PURPOSE: To evaluate the effectiveness of an e-health prevention programme for reducing tennis injury prevalence. STUDY DESIGN: Two-arm, researcher-blinded randomised controlled trial. METHODS: Adult tennis players of all playing levels were randomised in an unsupervised programme lasting 12 weeks (TennisReady group or control group). The primary outcome was the overall injury prevalence over a 16-week period, measured at 2 weekly intervals with the Oslo Sports and Trauma Research Centre questionnaire. Estimates for the primary outcome and associated 95% CIs were obtained using generalised estimating equation models. Secondary outcome scores included prevalence of substantial injuries, overall incidence, adherence and time-loss injuries. RESULTS: A total of 579 (83%) (TennisReady n=286, control n=293) participants were included in the primary analysis. The mean injury prevalence was 37% (95% CI 33% to 42%) in the TennisReady vs 38% (95% CI 34% to 42%) in the control group (adjusted p-value 0.93). The prevalence of substantial injuries was 11% (95% CI 9% to 14%) in the TennisReady vs 12% (95% CI 9% to 15%) in the control group (p value of 0.79). Analysis of the secondary outcome scores showed no difference between groups. The mean prevalence rates between high (8%) and low (92%) adherent groups were 32% (95% CI 23% to 44%) and 37% (95% CI 33% to 42%), respectively (p value 0.36). CONCLUSION: Providing an unsupervised e-health tennis-specific exercise programme did not reduce the injury rates and should not be implemented. TRIAL REGISTRATION NUMBER: NTR6443.

Mental health management of elite athletes during COVID-19: a narrative review and recommendations.

Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.

A systematic review of injuries in recreational field hockey: From injury problem to prevention.

The purpose of this study was to gather information from scientific literature related to all steps of Van Mechelen's "sequence of prevention" for injuries applied to youth and adult recreational field hockey players. A systematic review was conducted in Medline via Pubmed and in SPORTDiscus via EBSCOhost. Twenty-six original studies were included. Regarding injury incidence (step 1) results showed several overall injury incidence rates (youth: 1.47 per 1,000 Athlete Exposure (AE) time-loss (TL) injury up to 11.32 per 1,000 AE TL ánd non-time loss (NTL) injury, adults: 2.2 NTL injury per 1,000 AE, 15.2 injury per 1,000 hours of sports participation). Considering games and practices, most injuries were sustained in games (youth: 4.9, adults: 7.87 per 1,000 AE). Considering body parts, highest injury incidence rates were found in body parts in the lower extremities (youth: knee injuries in games (0.33 per 1,000 AE), adults: hamstring injuries in pre-season (0.75 per 1,000 AE)) and injuries in the head/face/eye (youth: 0.66 and adults: 0.94 head/face/eye, 0.71 head/face and 0.63 concussion per 1,000 AE). Regarding aetiology (step 2), no studies were found. Regarding the efficacy of available interventions (step 3 and 4), one study was found among youth players, describing a warm-up programme.

Preventing injuries among recreational adult volleyball players: Results of a prospective randomised controlled trial.

The objective was to evaluate the effectiveness of an exercise-based warm-up programme ("VolleyVeilig") on the one-season occurrence of musculoskeletal injuries among recreational adult volleyball players. A prospective randomised controlled trial was conducted over the 2017-2018 volleyball season. Recreational adult volleyball players were allocated either to an intervention or control group. The Dutch version of the Oslo Sports Trauma Research Centre questionnaire was used to register and monitor acute and overuse injuries. A total of 672 volleyball players were enrolled: 348 in the intervention group (mean age: 30) and 324 in the control group (mean age: 27). The incidence rate of acute injury was 21% lower in the intervention group, namely 8.9 versus 11.3 per 1,000 h in the control group (Cox mixed effects crude model: hazard ratio = 0.82 [95%CI: 0.69-0.98]; Cox mixed effects adjusted model: 0.85 [95%CI: 0.71-1.02]). No significant difference in mean prevalence of overuse injury was found between the intervention (4.8%) and control (4.2%) groups. The severity of injuries was not significantly different between groups, while injury burden was slightly lower in the intervention group. The exercise-based warm-up programme led to a trend in less acute injuries among recreational adult volleyball players.

Does a bounding exercise program prevent hamstring injuries in adult male soccer players? - A cluster-RCT.

BACKGROUND: Although the Nordic Hamstring Exercise (NHE) prevents hamstring injury in soccer players effectively, the annual incidence of these injuries still increases. This may be because of poor long-term compliance with the program. Furthermore, the timing and amplitude of gluteal and core muscle activation seem to play an important role in hamstring injury prevention, the NHE program was not designed to improve activation of these muscles. Therefore, we propose plyometric training as an alternative to reduce hamstring injuries in soccer players. PURPOSE: To determine the preventive effect of the Bounding Exercise Program (BEP) on hamstring injury incidence and severity in adult male amateur soccer players. STUDY DESIGN: A cluster-Randomized Controlled Trial. METHODS: Thirty-two soccer teams competing in the first-class amateur league were cluster-randomized into the intervention or control group. Both groups were instructed to perform their regular training program, and the intervention group additionally performed BEP. Information about player characteristics was gathered at baseline and exposure, hamstring injuries and BEP compliance were weekly registered during one season (2016-2017). RESULTS: The data of 400 players were analyzed. In total, 57 players sustained 65 hamstring injuries. The injury incidence was 1.12/1000 hours in the intervention group and 1.39/1000 hours in the control group. There were no statistically significant differences in hamstring injury incidence (OR = 0.89, 95% CI 0.46-1.75) or severity between the groups (P > 0.48). CONCLUSION: In this large cluster-randomized controlled trial, no evidence was found for plyometric training in its current form to reduce hamstring injuries in amateur soccer players.