Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement.

Returning to running postpartum presents challenges such as musculoskeletal pain and pelvic floor dysfunction for some females, but there is little guidance on developing and progressing postpartum training programmes. This study aims to establish expert consensus recommendations on designing and modifying a postpartum return-to-running training programme, highlight costs and access to qualified professionals as potential barriers and discuss clinical, research and sports policy implications.A three-round Delphi survey of clinical and exercise professionals working with postpartum runners was conducted. Round I consisted of open-ended questions related to designing the training plan, modifications based on biopsychosocial factors, key muscle groups to train and referral and payment sources. Rounds II and III involved Likert-scale voting to identify consensus (≥75% agreement).118 participants completed Round I, 107 completed Round II (response rate 90.6%) and 95 completed Round III (response rate 80.5%). Consensus was reached in 42/47 (89%) statements, including recommendations for a period of relative rest, gradual increases in duration and intensity, starting with a walk-run protocol and incorporating strength training. Training should be modified based on musculoskeletal or pelvic symptoms, sleep, mental health, lactation or energy availability concerns. Cost and access to experienced postpartum running professionals were identified as potential barriers for runners to receive care.Consensus recommendations for a postpartum return-to-running programme include an individualised exercise prescription, gradual increases in physical activity, walk-run protocols and targeted muscle strengthening. Further research and improved access to clinical and exercise professionals are needed to inform and facilitate best practices.

Clinical and exercise professional opinion of return-to-running readiness after childbirth: an international Delphi study and consensus statement.

Female athletes have identified a lack of guidance as a barrier to successfully returning to running postpartum, and existing guidelines are vague. Our aim was to define the current practice of determining postpartum run-readiness through a consensus survey of international clinicians and exercise professionals in postpartum exercise to assist clinicians and inform sport policy changes.A three-round Delphi approach was used to gain international consensus from clinicians and exercise professionals on run-readiness postpartum. Professionals who work with postpartum runners participated in an online survey to answer open-ended questions about the following postpartum return-to-running topics: definitions (runner and postpartum), key biopsychosocial milestones that runners need to meet, recommended screening, timeline to initiate running, support items, education topics and factors that contribute to advising against running. Consensus was defined as ≥75% participant agreement.One hundred and eighteen professionals participated in round I, 107 participated in round II (response rate 90.6%) and 95 participated in round III (response rate 80.5%). Responses indicated that, following a minimum 3-week period of rest and recovery, an individualised timeline and gradual return to running progression can be considered. Screening for medical and psychological concerns, current physical capacity, and prior training history is recommended prior to a return to running.This study proposes recommendations for the initial guidance on return-to-running postpartum, framed in the context of current research and consensus from professionals. Future research is needed to strengthen and validate specific recommendations and develop guidelines for best practice when returning-to-running after childbirth.

The effect of attentional cues on mechanical efficiency and movement smoothness in running gait: An interdisciplinary investigation.

The aim was to examine the effect of focus of attention cues on foot angle for retraining movement purposes. Twenty (females: 8) rearfoot-striking recreational runners (mass: 72.5 ± 11.8 kg; height: 1.73 ± 0.09 m; age: 32.9 ± 11.3 years) were randomly assigned to an internal focus (IF) (n = 10) or external focus (EF) (n = 10) verbal cue group. Participants performed 5 × 6 minute blocks of treadmill running (control run, 3 × cued running, retention run) at a self-selected running velocity (9.4 ± 1.1 km∙h-1) during a single laboratory visit. Touchdown foot angle, mechanical efficiency, internal and external work were calculated and, centre of mass (COM) and foot movement smoothness was quantified. Linear-mixed effect models showed an interaction for foot angle (p < 0.001, ηp2 = 0.35) and mechanical efficiency (p < 0.001, ηp2 = 0.40) when comparing the control to the cued running. Only the IF group reduced foot angle and mechanical efficiency during cued running, but not during the retention run. The IF group produced less external work during the 1st cued run than the control run. COM and foot smoothness were unaffected by cueing. Only an IF produced desired technique changes but at the cost of reduced mechanical efficiency. Movement smoothness was unaffected by cue provision. Changes to foot angle can be achieved within 6 minutes of gait retraining.

Characterizing Longitudinal Alterations in Postural Control Following Lower Limb Injury in Professional Rugby Union Players.

Assessment of player's postural control following a lower limb injury is of interest to sports medicine practitioners due to its fundamental role in daily tasks and sporting activities. The aim was to longitudinally monitor professional rugby union players' postural control during each phase of the rehabilitation program (acute, middle, and late) following a lower limb injury. Seven male rugby union players (height 1.80 [0.02] m; mass 100.3 [11.4] kg; age 24 [4] y) sustained a time loss, noncontact lower limb injury. Static postural control was assessed via sway path (in meters), and dynamic postural control was assessed via vertical postural stability index. Group differences (P < .05) were reported across the acute, middle, and late phase. Smaller magnitudes of sway path were observed for eyes-open sway path, and for the middle and late phase smaller magnitudes of vertical postural stability index (P < .05) at the end session compared with first session. Whereas larger magnitudes of vertical postural stability index were found between baseline and the last session (P < .05). Large interindividual and intraindividual variation was apparent across the 3 phases of rehabilitation. Postural control improvements were identified during rehabilitation. However, postural control did not return to baseline, with altered kinetics throughout each rehabilitation phase.

Female athlete health domains: a supplement to the International Olympic Committee consensus statement on methods for recording and reporting epidemiological data on injury and illness in sport.

The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) to female athlete health data.In May 2021, five researchers and clinicians with expertise in sports medicine, epidemiology and female athlete health convened to form a consensus working group, which identified key themes. Twenty additional experts were invited and an iterative process involving all authors was then used to extend the IOC consensus statement, to include issues which affect female athletes.Ten domains of female health for categorising health problems according to biological, life stage or environmental factors that affect females in sport were identified: menstrual and gynaecological health; preconception and assisted reproduction; pregnancy; postpartum; menopause; breast health; pelvic floor health; breast feeding, parenting and caregiving; mental health and sport environments.This paper extends the IOC consensus statement to include 10 domains of female health, which may affect female athletes across the lifespan, from adolescence through young adulthood, to mid-age and older age. Our recommendations for data capture relating to female athlete population characteristics, and injuries, illnesses and other health consequences, will improve the quality of epidemiological studies, to inform better injury and illness prevention strategies.

Sports Medicine and the Pelvic Floor.

ABSTRACT: The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.

Movement strategy correspondence across jumping and cutting tasks after anterior cruciate ligament reconstruction.

There are currently a multitude of tests used to assess readiness to return to sport (RTS) following anterior cruciate ligament reconstruction (ACLR). The aim of this study was to establish the extent to which movement strategies transfer between three common assessment tasks to help improve design of athlete testing batteries following ACLR. A cohort of 127 male patients 8-10 months post-ACLR and 45 non-injured controls took part in the study. Three movement tasks were completed (unilateral and bilateral drop jump, and 90° pre-planned cut), while ground reaction forces and three-dimensional kinematics (250 Hz) were recorded. Compared to the bilateral drop jump and cut, the unilateral drop jump had a higher proportion of work done at the ankle (d = 0.29, p < 0.001 and d = -1.87, p < 0.001, respectively), and a lower proportion of work done at the knee during the braking phase of the task (d = 0.447, p < 0.001 and d = 1.56, p < 0.001, respectively). The ACLR group had higher peak hip moments than the non-injured controls, although the proportion of work done at the ankle, knee and hip joints were similar. Movement strategies were moderately and positively related at the ankle (rs  = 0.728, p < 0.001), knee (rs  = 0.638, p < 0.001) and hip (rs  = 0.593, p < 0.001) between the unilateral and bilateral drop jump, but there was no relationship at the ankle (rs  = 0.10, p = 0.104), knee (rs  = 0.106, p = 0.166) and hip (rs  = -0.019, p = 0.808) between the unilateral drop jump and the cut. Clinicians could therefore consider omitting one of the drop jumps from assessment batteries but should include both jumping and cutting tasks.

Concussion increases within-player injury risk in male professional rugby union.

OBJECTIVES: To assess within-player change in injury risk and between-player subsequent injury risk associated with concussive and common non-concussive injuries in professional rugby union. METHODS: This prospective cohort study in Welsh professional male rugby union analysed within-player and between-player injury risk for five common injuries: concussion, thigh haematoma, hamstring muscle strain, lateral ankle sprain and acromioclavicular joint sprain. Survival models quantified within-player injury risk by comparing precommon (before) injury risk to postcommon (after) injury risk, whereas between-player subsequent injury risk was quantified by comparing players who had sustained one of the common injuries against those who had not sustained the common injury. HRs and 95% CIs were calculated. Specific body area and tissue type were also determined for new injuries. RESULTS: Concussion increased the within-player overall injury risk (HR 1.26 (95% CI 1.11 to 1.42)), elevating head/neck (HR 1.47 (95% CI 1.18 to 1.83)), pelvic region (HR 2.32 (95% CI 1.18 to 4.54)) and neurological (HR 1.38 (95% CI 1.08 to 1.76)) injury risk. Lateral ankle sprains decreased within-player injury risk (HR 0.77 (95% CI 0.62 to 0.97)), reducing head/neck (HR 0.60 (95% CI 0.39 to 0.91)), upper leg and knee (HR 0.56 (95% CI 0.39 to 0.81)), joint and ligament (HR 0.72 (95% CI 0.52 to 0.99)) and neurological (HR 0.55 (95% CI 0.34 to 0.91)) injury risk. Concussion (HR 1.24 (95% CI 1.10 to 1.40)), thigh haematomas (HR 1.18 (95% CI 1.04 to 1.34)) and hamstring muscle strains (HR 1.14 (95% CI 1.01 to 1.29)) increased between-player subsequent injury risk. CONCLUSION: Elevated within-player injury risk was only evident following concussive injuries, while lateral ankle sprains reduced the risk. Both concussion and ankle injuries altered head/neck and neurological injury risk, but in opposing directions. Understanding why management of ankle sprains might be effective, while current concussion management is not at reducing such risks may help inform concussion return to play protocols.

Angular Velocities and Linear Accelerations Derived from Inertial Measurement Units Can Be Used as Proxy Measures of Knee Variables Associated with ACL Injury.

Given the high rates of both primary and secondary anterior cruciate ligament (ACL) injuries in multidirectional field sports, there is a need to develop easily accessible methods for practitioners to monitor ACL injury risk. Field-based methods to assess knee variables associated with ACL injury are of particular interest to practitioners for monitoring injury risk in applied sports settings. Knee variables or proxy measures derived from wearable inertial measurement units (IMUs) may thus provide a powerful tool for efficient injury risk management. Therefore, the aim of this study was to identify whether there were correlations between laboratory-derived knee variables (knee range of motion (RoM), change in knee moment, and knee stiffness) and metrics derived from IMUs (angular velocities and accelerations) placed on the tibia and thigh, across a range of movements performed in practitioner assessments used to monitor ACL injury risk. Ground reaction forces, three-dimensional kinematics, and triaxial IMU data were recorded from nineteen healthy male participants performing bilateral and unilateral drop jumps, and a 90° cutting task. Spearman's correlations were used to examine the correlations between knee variables and IMU-derived metrics. A significant strong positive correlation was observed between knee RoM and the area under the tibia angular velocity curve in all movements. Significant strong correlations were also observed in the unilateral drop jump between knee RoM, change in knee moment, and knee stiffness, and the area under the tibia acceleration curve (rs = 0.776, rs = -0.712, and rs = -0.765, respectively). A significant moderate correlation was observed between both knee RoM and knee stiffness, and the area under the thigh angular velocity curve (rs = 0.682 and rs = -0.641, respectively). The findings from this study suggest that it may be feasible to use IMU-derived angular velocities and acceleration measurements as proxy measures of knee variables in movements included in practitioner assessments used to monitor ACL injury risk.

A Novel Method to Categorize Stretch-Shortening Cycle Performance Across Maturity in Youth Soccer Players.

ABSTRACT: Pedley, JS, Lloyd, RS, Read, PJ, Moore, IS, Myer, GD, and Oliver, JL. A novel method to categorize stretch-shortening cycle performance across maturity in youth soccer players. J Strength Cond Res 36(9): 2573-2580, 2022-This study used a novel method to categorize stretch-shortening cycle (SSC) function during a drop jump (DJ) using the force-time curve. This method was then used to determine the effect of maturity status upon SSC function and effect of SSC function on DJ performance. Prepeak, circa-peak, and postpeak height velocity male youth soccer players completed a preseason 30-cm DJ onto a force plate. Stretch-shortening cycle function was categorized as poor (impact peak and not spring-like), moderate (impact peak and spring-like), or good (no impact peak and spring-like). Interactions between SSC function and maturity status, and SSC function and kinetic variables were explored. Youth soccer players displaying good SSC function were older and more mature than those with poor SSC function; however, 9.9% of post peak height velocity still displayed poor SSC function. Players with good SSC function recorded significantly shorter ground contact times, reduced time between peak landing and takeoff force, reduced center of mass displacement, and significantly greater takeoff forces than players with moderate and poor SSC function (all p < 0.05). SSC function during a standardized DJ improves with maturation, but a portion of mature players still demonstrate poor SSC function. Good SSC function was associated with improved DJ outcome measures except jump height. Tailored training interventions based on SSC competency may be required to optimally enhance SSC function.

Kinetics and Stabilization of the Tuck Jump Assessment.

CONTEXT: Kinetic profiles of athletes performing the tuck jump assessment (TJA) are unknown and may provide insight into the risk of anterior cruciate ligament injury. DESIGN: The purpose of this study was to (1) analyze vertical kinetics of the TJA and (2) determine the stabilization of the kinetics across successive jumping cycles. METHODS: Twenty-five healthy female athletes (age = 22.0 [4.6] y; height = 1.69 [0.07] m; body mass = 69.3 [10.3] kg) completed one trial of repeated tuck jumps on a force plate for 10 seconds. RESULTS: Vertical ground reaction force data were used to calculate the following variables across all jump cycles: time of jump cycle (0.65 [0.04] s), ground contact time (0.22 [0.03] s), flight time (0.43 [0.04] s), duty factor (0.34 [0.05]), jump height (0.23 [0.04] m), peak vertical force (5.52 [0.91] body weight [BW]), peak center of mass displacement (0.15 [0.02] m), vertical leg stiffness (27.09 [7.06] BW·m-1), vertical average loading rate (105.94 [28.43] BW·s-1), vertical instantaneous loading rate (140.90 [28.49] BW·s-1), and net impulse (0.43 [0.03] BW·s). A sequential averaging technique indicated a minimum of 11 jumps were required for stabilization of the kinetics. CONCLUSIONS: The TJA exposes athletes to high magnitudes of vertical force. Based on the high variability of performance during early repetitions and the potential to miscategorize high-risk landing in female athletes, practitioners should consider scoring the TJA after 11 successive cycles and using kinetic profiling to support landing assessments.

Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women.

OBJECTIVES: To examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI). METHODS: 881 postpartum women completed an online questionnaire. Clinically and empirically derived questions were created relating to running experiences and multidisciplinary, biopsychosocial contributory factors. Logistic regression was used to determine predictors for return-to-running, returning to pre-pregnancy level of running and running-related SUI. RESULTS: Median time to first postpartum run was 12 weeks. Running during pregnancy (OR: 2.81 (1.90 to 4.15)), a high weekly running volume (OR: 1.79 (1.22 to 2.63)), lower fear of movement (OR: 0.53 (0.43 to 0.64)) and not suffering vaginal heaviness (OR: 0.52 (0.35-0.76)) increased the odds of return-to-running. Factors that increased the odds of returning to pre-pregnancy running level were a low weekly running volume (OR: 0.38 (0.26 to 0.56)), having more than one child (OR: 2.09 (1.43 to 3.05)), lower fear of movement (OR: 0.78 (0.65 to 0.94)), being younger (OR: 0.79 (0.65 to 0.96)) and shorter time to running after childbirth (OR: 0.74 (0.60 to 0.90)). Risk factors for running-related SUI were having returned to running (OR: 2.70 (1.51 to 4.76)) and suffering running-related SUI pre-pregnancy (OR: 4.01 (2.05 to 7.82)) and during pregnancy (OR: 4.49 (2.86 to 7.06)); having a caesarean delivery decreased the odds (OR: 0.39 (0.23 to 0.65)). CONCLUSION: Running during pregnancy may assist women safely return-to-running postpartum. Fear of movement, the sensation of vaginal heaviness and running-related SUI before or during pregnancy should be addressed early by healthcare providers.

Effects of a 4-Week Neuromuscular Training Program on Movement Competency During the Back-Squat Assessment in Pre- and Post-Peak Height Velocity Male Athletes.

ABSTRACT: Dobbs, IJ, Oliver, JL, Wong, MA, Moore, IS, Myer, GD, and Lloyd, RS. Effects of a 4-week neuromuscular training program on movement competency during the back-squat assessment in pre- and post-peak height velocity male athletes. J Strength Cond Res 35(10): 2698-2705, 2021-The back-squat assessment (BSA) is a novel movement screen to detect functional deficits; however, its sensitivity to detect meaningful changes in movement competency after exposure to short-term neuromuscular training remains unclear. Twenty-six pre- and 22 post-peak height velocity (PHV) males were divided into experimental (EXP) and control groups (CON) and performed the BSA before and after a twice weekly, 4-week neuromuscular training intervention. Intra-rater reliability was determined by rating both EXP group's baseline BSA on 3 separate sessions. Intraclass correlation coefficient (ICC) revealed very strong agreement for BSA total score in pre-PHV (ICC ≥ 0.81) and post-PHV (ICC ≥ 0.97) groups across all sessions, but systematic bias was evident in the pre-PHV group for sessions 1-2. Analysis of kappa values for BSA individual criteria showed greater variability for pre-PHV (K ≥ 0.31) than post-PHV (K ≥ 0.62) across sessions. At baseline, there were no differences in total score between the EXP and CON cohorts (p > 0.05). There were significant within-group improvements in total score for the EXP pre-PHV (5.0 to 3.0, effect size [ES] = 0.68) and post-PHV (2.0 to 1.0, ES = 0.82) cohorts, with no changes in total score for either CON groups (p > 0.05). Hip position was the criterion with the greatest improvement for both the EXP pre-PHV (12.0 to 7.0) and post-PHV (7.0 to 0.0) groups. The BSA seems to be a reliable screening tool for measuring movement competency in youth male athletes and was sensitive to adaptations in movement competency after neuromuscular training.

Movement competency and measures of isometric and dynamic strength and power in boys of different maturity status.

An understanding of how movement competency, strength, and power interact with natural growth and maturation is required in order to determine meaningful changes with developing athletes. Isometric and dynamic testing in youth athletes provides insight into the natural development of the force-velocity (F-V) spectrum. Two-hundred and six young male athletes, aged 9-17 years of age, were grouped according to stage of maturation based on their maturity offset which was determined as number of years from peak height velocity (PHV). All participants performed the back-squat assessment (BSA), isometric mid-thigh pull (IMTP), countermovement jump (CMJ), and squat jump (SJ) tests. Absolute and scaled force-time variables were collected from the IMTP, CMJ, and SJ. No significant differences were observed between maturational groups for squat movement competency (P > .05). One-way ANOVA with Bonferroni post-hoc analysis revealed that increasing maturity led to significant, moderate to large increases in allometrically scaled peak force (PFallo ) for all tests (P < .05). Multiple stepwise linear regression models revealed IMTP PFallo significantly predicted 34.8% and 41.3% of variance in SJ and CMJ jump height, respectively (P < .05). Natural growth and maturation induces positive adaptations to movement competency as well as isometric and dynamic strength and power. Trends from the IMTP, SJ, and CMJ tests indicate the largest differences in strength, and power may occur around the adolescent growth spurt despite the large variation in rates of change within the circa-PHV group.

Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sport Trauma Research Center questionnaires.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses-The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Effects of a 12-Week Training Program on Isometric and Dynamic Force-Time Characteristics in Pre- and Post-Peak Height Velocity Male Athletes.

Dobbs, IJ, Oliver, JL, Wong, MA, Moore, IS, and Lloyd, RS. Effects of a 12-week training program on isometric and dynamic force-time characteristics in pre- and post-peak height velocity male athletes. J Strength Cond Res 34(3): 653-662, 2020-Literature shows that training children and adolescents can enhance strength and power irrespective of their stage of development; however, the development of the kinetic variables that underpin strength and power performance are typically unreported in youth training studies. Twenty-four pre- and 14 post-peak height velocity (PHV) male athletes were divided into maturity-specific experimental (EXP) and control groups (CON), with the EXP groups completing a twice-weekly, 12-week training program. Force-time characteristics during the isometric midthigh pull (IMTP), countermovement jump, and squat jump tests were quantified at both baseline and after the completion of the 12-week program. Alpha level was set at p < 0.05. No changes in total score for back-squat assessment were observed in any group (p > 0.05). Analysis of IMTP data revealed that only the post-PHV EXP group significantly increased absolute isometric peak force (PFabs) and peak rate of force development within the IMTP after training. Both EXP groups displayed significant increases in isometric PF at time epochs 0-90, 0-150, 0-200, and 0-250 ms. Data from the dynamic tests indicated that the pre-PHV EXP cohort improved concentric qualities as reflected by increased squat jump height and countermovement jump concentric power. There were no significant changes for any variables across all tests within either CON group (p > 0.05). Maturity-related differences in response to short-term training affects the kinetic variables associated with strength and power performance, but not movement competency in young male athletes.

An interdisciplinary examination of attentional focus strategies used during running gait retraining.

The aim was to investigate the biomechanical, physiological, and perceptual responses to different motor learning strategies derived to elicit a flatter foot contact. Twenty-eight rearfoot-striking recreational runners (age 24.9 ± 2.8 years; body mass 78.8 ± 13.6 kg; height 1.79 ± 0.09 m) were matched by age, mass, and height and assigned to one verbal cue group: internal focus of attention (IF), external focus of attention (EF), and a clinically derived condition (CLIN) incorporating an IF followed by an EF statement. Participants completed two treadmill runs at 10 km h-1 for 6 minutes each: normal running (control) followed by the experimental condition (IF, EF, or CLIN). Lower limb kinematics, oxygen consumption ( V ˙ O 2 ), and central and peripheral ratings of perceived exertion (RPE) were recorded for each run. Compared to the control condition, foot angle was reduced in the IF (difference = 5.86°, d = 2.58) and CLIN (difference = 3.00°, d = 1.31) conditions, but unchanged in the EF condition (difference = 0.33°, d = 0.14), while greater knee flexion at initial contact in the EF and CLIN conditions was observed (difference = -5.19°, d = 1.97; difference = -3.66°, d = 1.39, respectively). A higher V ˙ O 2 was observed in the CLIN condition (difference = -4.56 mL kg-1  min-1 , d = 2.29), but unchanged in the IF (difference = -1.87 mL kg-1  min-1 , d = 0.94) and EF conditions (difference = -0.37 mL kg-1  min-1 , d = 0.19). All experimental conditions increased central and peripheral RPE (difference = -1.08, d = 0.54 and difference = -2.39, d = 1.33, respectively). Providing gait retraining instructions using an internally directed focus of attention was the most effective way to target specific changes in running kinematics, with no detrimental effect on physiological responses. Yet, perceptual effort responses increased regardless of the type of cue provided.

On average, a professional rugby union player is more likely than not to sustain a concussion after 25 matches.

OBJECTIVES: To investigate concussion injury rates, the likelihood of sustaining concussion relative to the number of rugby union matches and the risk of subsequent injury following concussion. METHODS: A four-season (2012/2013-2015/2016) prospective cohort study of injuries in professional level (club and international) rugby union. Incidence (injuries/1000 player-match-hours), severity (days lost per injury) and number of professional matches conferring a large risk of concussion were determined. The risk of injury following concussion was assessed using a survival model. RESULTS: Concussion incidence increased from 7.9 (95% CI 5.1 to 11.7) to 21.5 injuries/1000 player-match-hours (95% CI 16.4 to 27.6) over the four seasons for combined club and international rugby union. Concussion severity was unchanged over time (median: 9 days). Players were at a greater risk of sustaining a concussion than not after an exposure of 25 matches (95% CI 19 to 32). Injury risk (any injury) was 38% greater (HR 1.38; 95% CI 1.21 to 1.56) following concussion than after a non-concussive injury. Injuries to the head and neck (HR 1.34; 95% CI 1.06 to 1.70), upper limb (HR 1.59; 95% CI 1.19 to 2.12), pelvic region (HR 2.07; 95% CI 1.18 to 3.65) and the lower limb (HR 1.60; 95% CI 1.21 to 2.10) were more likely following concussion than after a non-concussive injury. CONCLUSION: Concussion incidence increased, while severity remained unchanged, during the 4 years of this study. Playing more than 25 matches in the 2015/2016 season meant that sustaining concussion was more likely than not sustaining concussion. The 38% greater injury risk after concussive injury (compared with non-concussive injury) suggests return to play protocols warrant investigation.

Use of Wearables: Tracking and Retraining in Endurance Runners.

Wearable devices are ubiquitous among runners, coaches, and clinicians with an ever-increasing number of devices coming on the market. In place of gold standard measures in the laboratory, these devices attempt to provide a surrogate means to track running biomechanics outdoors. This review provides an update on recent literature in the field of wearable devices in runners, with an emphasis on criterion validity and usefulness in the coaching and rehabilitation of runners. Our review suggests that while enthusiasm should be tempered, there is still much for runners to gain with wearables. Overall, our review finds evidence supporting the use of wearables to improve running performance, track global training loads applied to the runner, and provide real-time feedback on running speed and run cadence. Case studies illustrate the use of wearables for the purposes of performance and rehabilitation.