The Association Between Menstrual Cycle Phase, Menstrual Irregularities, Contraceptive Use and Musculoskeletal Injury Among Female Athletes: A Scoping Review.

BACKGROUND: The influence of menstrual cycle phases (MCPs), menstrual irregularities (MI) and hormonal contraceptive (HC) use on injury among female athletes has been scrutinised. Existing systematic reviews investigating the effect of exposures affecting the endogenous reproductive hormone status on sporting injuries are limited in terms of the types of studies included and injuries investigated. OBJECTIVE: This scoping review aims to summarise the coverage of the literature related to the extent, nature and characteristics of the influence of MCP, MI and HC use on musculoskeletal injuries among athletes. It also aims to summarise key concepts and definitions in the relevant literature. Observational and experimental studies investigating the effect of MCP, MI, and HC on musculoskeletal injuries among female individuals of reproductive age were included. Studies specifically stating pregnant women, perimenopausal/postmenopausal athletes, or those using medication (other than HC) that affects reproductive hormone profiles or the musculoskeletal system were excluded. METHODS: This scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping reviews and JBI scoping review guidelines. Published and unpublished studies were sourced from several databases and resources. Initial keywords used included terms related to "menstrual cycle", "hormonal contraception" and "injury." Titles and abstracts of identified citations were screened independently and assessed for eligibility by two independent reviewers. Data from the included studies were extracted using a standard data extraction form. RESULTS: The search yielded 10,696 articles, of which 96 met the eligibility criteria. Most studies investigated MI (77%), and 49% included MCP as a contributing injury risk factor. Publications have increased over the last two decades. Collectively, only 16% of research has been conducted in Africa, Asia and Oceania. There were no studies from South America. Seventy-five percent of the studies investigated individual versus team (25%) sport athletes. Most studies only investigated elite or professional (n = 24; 25%) level athletes. The definitions of injury, eumenorrhea and MI differ vastly among studies. Regarding MI, most studies (69%) investigated secondary amenorrhea, followed by oligomenorrhea (51%) and primary amenorrhea (43%). Concerning HC, the influence of oral contraceptive pills was mainly investigated. CONCLUSIONS: Research related to MCP, MI and HC as contributing musculoskeletal injury risk factors is increasing; however, several gaps have been identified, including research from countries other than North America and Europe, the study population being non-professional/elite level athletes, athletes participating in team sports and specific injuries related to MCP, MI and HC, respectively. Differences in methodology and terminology of injury, MCP and MI hinder comparative summative research, and future research should consider current published guidelines during the study design. Identifying barriers to following standard guidelines or research investigating the most practical yet accurate methods to investigate the influence of MCP on musculoskeletal health might yield valuable insights for future research designs. CLINICAL TRIAL REGISTRATION: Scoping review registration number: Open Science Framework ( https://doi.org/10.17605/OSF.IO/5GWBV ).

Sex, training variables, history of chronic disease, and chronic injury are risk factors associated with a history of exercise-associated muscle cramping in 10,973 ultramarathon race entrants: a safer XXXVIII study.

BACKGROUND: The prevalence of a history of exercise-associated muscle cramping (hEAMC) among ultramarathon runners is high. While the Comrades is one of the most popular mass community-based participation ultramarathons (90 km) globally, research on the epidemiology, clinical characteristics, and risk factors of entrants' lifetime hEAMC are scarce. This research aimed to describe the epidemiology, clinical characteristics, and risk factors of hEAMC among Comrades Marathon entrants. METHODS: This was a retrospective, cross-sectional study in which 10973 race entrants of the 2022 Comrades Marathon participated. Entrants completed a prerace medical screening questionnaire that included questions related to the lifetime prevalence (%; 95% CI), severity, treatment and risk factors (demographics, training/racing variables, chronic disease/allergies, injury) for EAMC. RESULTS: One thousand five hundred eighty-two entrants reported hEAMC in their lifetime (14.4%; 95% CI: 13.77-15.09). There was a significantly (P<0.01) higher prevalence of male (16.10%; 95% CI:15.34-16.90) than female (8.31%; 95% CI: 7.27-9.50) entrants with hEAMC (PR=1.94; 95% CI:1.68-2.23). The prevalence of hEAMC was highest in entrants with a: 1) 1 disease increase in composite disease score (PR=1.31; 95% CI:1.25-1.39); 2) history of collapse (PR=1.87; 95% CI 1.47-2.38); 3) past chronic musculoskeletal (MSK) injury (PR=1.71; 95% CI 1.50-1.94); and 4) MSK injury in the previous 12 months (PR=2.38;95% CI: 2.05-2.77). Training-related risk factors included an increase of 10 km weekly running distance (PR=0.97; 95% CI:0.95-0.99) and a training pace increase of 1min/ km (slower) (PR=1.07; 95% CI:1.03-1.12). CONCLUSIONS: Future research should investigate the causal relationship between risk factors identified and hEAMC in ultramarathon runners. Findings from this study could assist in effective anticipation and adequate planning for treating EAMC encounters during community-based mass participation events.

Effect of neuromuscular injury prevention strategies on injury rates in adolescent males playing sport: a systematic review protocol.

OBJECTIVE: This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports. INTRODUCTION: Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This review will include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population. INCLUSION CRITERIA: Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies that evaluate neuromuscular injury prevention strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and training, warm up, cool down, stretches, neuromuscular control) vs no intervention or standard training and competition exposure will be included. The outcomes of interest are injury incidence and prevalence rates. METHODS: Databases searched will include MEDLINE (PubMed), CINAHL Complete (EBSCOhost), ClinicalKey, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCOhost), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer. REVIEW REGISTRATION: PROSPERO CRD42022327047.

Altered sagittal plane mechanics is associated with Functional Movement Screen deep squat score.

Background: The Functional Movement Screen (FMS) assesses the quality of movements, including the deep squat (DS), which is used in sports settings. The validity of the individual item scores has yet to be established. Objectives: To investigate the validity of the FMS DS by comparing the sagittal plane kinematics of participants who achieve different observer scores. Method: Seventeen injury-free, adolescent male cricket bowlers were assessed. The movement was captured using the Optitrack® motion capture system. Simultaneously, observers scored participants' execution of the DS according to the standard FMS scoring criteria. Participants were grouped into Group 1 (lowest score), Group 2 (altered movement mechanics) or Group 3 (perfect score) according to observer scores. Specific joint angles of each group were compared using the Kruskal-Wallis and Mann-Whitney U tests. Results: There were significant differences in the degree to which the femur passed the horizontal between Group 3 and Group 1 (p = 0.04, r = 0.61) and Group 2 and Group 1 (p = 0.03, r = 0.66) and the difference in the degree to which the torso was kept vertical between Group 3 and Group 1 (p = 0.02, r = 0.66) and Group 2 and Group 1 (p = 0.02; r = 0.72). Conclusion: Kinematic differences exist between participants who achieve different observer scores for the FMS DS. Clinical implications: While differences in sagittal plane kinematics have been observed in participants scoring high on the FMS DS and participants scoring low, further investigation into the validity of the frontal plane kinematics is warranted, as well as the concurrent validity of the individual scoring criteria.

Erratum: Injury surveillance in community cricket: A new innings for South Africa.

[This corrects the article DOI: 10.4102/sajp.v78i1.1756.].

Injury surveillance in community cricket: A new inning for South Africa.

Published injury rates amongst elite and club-level youth cricketers highlight the need to implement injury risk-reducing strategies amongst the youth cricketing population. Data from sports injury surveillance systems are a prerequisite for the development and evaluation of strategies to reduce injury risk. Therefore, collecting injury surveillance data is a positive move towards reducing injuries in cricket. In South Africa, a systematic, standardised, evidence-informed injury surveillance system currently does not exist for community levels of play, namely, in cricket-playing high schools and cricket clubs. Although injury surveillance systems exist at elite levels, the obvious differences in elite versus community cricket settings mean that these systems cannot be implemented in their current form at community-level cricket. An innovative model is required to implement an injury surveillance system in community cricket. Clinical implications: This article proposes and describes a new research-practice partnership model to implement a systematic, standardised, evidence-informed injury surveillance system at cricket-playing high schools or cricket clubs within South Africa. Once this model has been employed, database systems will need to be established to allow long-term data management and sharing.

The association between physical fitness parameters and in-season injury among adult male rugby players: a systematic review.

INTRODUCTION: The high prevalence of injury among rugby players emphasizes the need for research related to injury risk factors. Physical fitness-related risk factors are likely culprits contributing to both contact and non-contact injuries. Establishing associations between preseason measured physical fitness aspects and injury risk, not only provide players' baseline fitness parameters but could also identify injury prone players, thereby contributing to injury prevention strategies. Therefore, the objective of this review was to assess and summarize scientific literature related to the association between preseason measured physical fitness tests and in-season injury among male rugby players. EVIDENCE ACQUISITION: A systematic review was performed in compliance with the PRISMA 2020 Guidelines. This review considered observational, prospective cohort study designs. Studies that included male rugby (rugby union, rugby league, Australian football rules and rugby sevens) players aged 18 years or above from all levels of participation, evaluating the association between physical fitness test outcome and injury, were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies in any language. Searched databases included Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), the Cochrane Controlled Trials Register in the Cochrane Library, ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, SPORTDiscus with Full Text, SCOPUS and Science Direct. Key words used were "rugby," "injury," "physical fitness," and "risk factors." Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal tool for cohort studies from the Joanna Briggs Institute (JBI SUMARI). EVIDENCE SYNTHESIS: A total of 16 studies were eligible for inclusion in this review. The mean critical appraisal score was 82.63% (SD=17.86). Forty-meter sprint speed was associated with injury in all three (100%) studies that included the test. Inconsistencies in the statistical analysis, however, make comparison difficult. None of the studies that investigated upper (N.=1) and/or lower body power (N.=3) identified power as a risk factor. Conflicting results were found for the association between strength, flexibility, cardiorespiratory fitness, and injury. CONCLUSIONS: Identifying factors associated with injury risk is an important step in the injury prevention paradigm. Once identified, players can be screened for risk factors prior to participation in sport. Interventions, based on screening results, which not only improve performance but also decrease players' risk of sustaining injuries (i.e., physical fitness related risk factors), provide additional incentive for compliance. Overall, this review highlights the inconsistency in testing methods used to gauge specific physical fitness constructs among rugby players, limiting the extent to which comparison of results and pooling of data is possible.

Sport Science Lab® Screening Protocol: The association between physical fitness Parameters and injury among elite rugby players.

CONTEXT AND OBJECTIVES: The Sport Science Lab® (SSL®) screening protocol includes novel methods of assessing flexibility, strength, plyometric ability and rugby specific fitness. The objective of this study was to investigate the association between these tests and injury among professional rugby players. DESIGN: Prospective cohort study. SETTING: Fitness facilities of participating teams. PARTICIPANTS: Thirty-nine injury-free, elite, adult (>18 years), male rugby players. MAIN OUTCOME MEASURES: The test battery consisted of eleven flexibility-, nine strength- and six plyometric tests and a rugby specific fitness test (RSFT). Injuries were recorded weekly during the 2019 rugby season. Associations between test results and injuries were analysed utilising suitable tests of association i.e., sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value and odds ratios (OR) (with confidence intervals (CI)). Bivariate correlations and logistic regression were performed to assess the relationship of the predictor variables to the outcome. RESULTS: Players who achieved the set standard for the RSFT (OR = 3.17; 95% CI = 0.79-12.75), triple horizontal broad jump (OR = 2.40; 95% CI = 0.86-19.61) and lateral depth jumps (OR = 2.40-3.44; 95% CI = 0.53-18.84) were two to three times less likely to sustain an injury during the season. CONCLUSION: Players with superior rugby specific fitness and cyclic linear- and lateral plyometric ability, may have a decreased risk of sustaining injuries.

The interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® screening protocol amongst professional rugby players.

BACKGROUND: Considering the injury incidence rate (IR) associated with elite-level rugby, measures to reduce players' injury risk are important. Establishing scientifically sound, pre-season musculoskeletal screening protocols forms part of injury prevention strategies. OBJECTIVE: To determine the interrater and intrarater reliability of the flexibility and strength tests included in the Sport Science Lab® (SSL) screening protocol. METHODS: We determine the interrater and intrarater reliability of 11 flexibility and nine strength tests. Twenty-four injury-free, elite, adult (> 18 years), male rugby players were screened by two raters on two occasions. To establish intrarater and interrater reliability, Gwet's AC1, AC2 and intraclass correlation coefficients (ICC) were used for the analysis of binary, ordinal and continuous variables, respectively. Statistical significance was set at 95%. RESULTS: Flexibility tests which require lineal measurement had at least substantial interrater (ICC = 0.70-0.96) and intrarater reliability (ICC = 0.89-0.97). Most of the flexibility tests with binary outcomes attained almost perfect interrater and intrarater reliability (Gwet's AC1 = 0.8-0.97). All strength tests attained at least substantial interrater (Gwet's AC2 = 0.73-0.96) and intrarater (Gwet's AC2 = 0.67-0.97) reliability. CONCLUSION: The level of interrater and intrarater reliability of most of the flexibility and strength tests investigated supports their use to quantify various aspects of neuromusculoskeletal qualities and possible intrinsic risk factors amongst elite rugby players. CLINICAL IMPLICATIONS: Establishing the reliability of tests, is one step to support the inclusion thereof in official screening protocols. Results of our study, verify the reliability of the simple, clinically friendly strength and flexibility tests included and therefore support their use as preparticipation screening tools for rugby players. Further investigation as to the association thereof to athletes' injury risk and performance is warranted.