Contact Breast Injuries Among Female Athletes: A Systematic Review.

BACKGROUND: Robust surveillance of injury aetiology and epidemiology is recognised as fundamental for effective injury reduction and management programmes. However, while sex-specific differences in injury type and nature are noted in the literature, it is unclear if these are reflected in surveillance practices, and how the athlete is affected. OBJECTIVE: Therefore, this study aimed to systematically review contact breast injuries (CBIs) among adult female athletes. METHODS: The following databases were searched: PubMed, EMBASE, SPORTDiscus including MEDLINE, Web of Science and Scopus. The literature search was conducted in May 2023 and the search was limited to articles in the English and German language. Studies including female athletes, aged 18 years and above, in any sports (team or individual) at any level (amateur, semi-professional and professional), where an occurrence of CBI was documented were included. Studies were included irrespective of their investigated timeframes (e.g. the whole career, one or multiple seasons). Findings were categorised (e.g. sport, level of competition and investigated timeframe of the study) to enable possible comparisons. Case studies were excluded due to the non-generalisability of findings. RESULTS: Of the six studies included, rugby codes (rugby union, rugby league and rugby sevens) had the highest occurrence rate (62.0%) of CBIs among eight different investigated sports (rugby codes 62.0%, softball 59.5%, Australian Football League (AFL) 51.0%, water polo 50.0%, soccer 46.7%, basketball 27.6-48.8%, volleyball 34.6%, boxing 0.0%). Between 25.6% and 62.0% of participants reported incurring a CBI and between 0.0% and 42.9% of CBIs were reported to a medical professional or support staff. The reported treatment rate for CBIs ranged between 0.0% and 2.1%, The main mechanisms for CBIs (where reported) were contact with another athlete (AFL 37.6%, rugby codes 56%) the ball (AFL 31.6%, rugby codes 25.5%) and the ground (AFL 6.6%, rugby codes 22%). Between 18.2% and 48% of the participants reported that CBIs negatively affected their performance. Risk factors increasing CBIs were positional differences, larger breast size and higher body mass index (BMI). In-season injury data collection and surveillance supported through education of both players and medical staff were identified to be of relevance for future CBI prevention. None of the studies reported incidence rate. CONCLUSION: Despite the frequent occurrence of CBIs among female athletes, reporting and treatment remains low. Awareness and education of all stakeholders are fundamental to ensuring better breast safety in female sport. Identifying the mechanics, severity and risk factors of CBIs through thorough injury surveillance must be a focus of further research. REGISTRATION: The study was preregistered on Open Science Framework (OSF).

Coaches of youth field sports as delivery agents of injury prevention programmes: how are we training the trainers? A scoping review.

OBJECTIVE: To systematically map the coach education (CE) component of injury prevention programmes (IPPs) for youth field sports by identifying and synthesising the design, content and facilitation strategies used to address competency drivers and behaviour change. DESIGN: Scoping review. DATA SOURCES: PubMed, PsycInfo, EMBASE, CINAHL, SportDiscus and Google Scholar electronic databases were searched using keywords related to IPPs and youth field sports. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies of IPPs in youth field sports, that provided 'train-the-trainer' education to coaches as designated delivery agents. RESULTS: 20 studies from two field sports (soccer/football; n=17, Rugby Union; n=3) fulfilled the eligibility criteria. Eleven CE interventions occurred in the preseason and 18 occurred at one time-point (single day). Five studies cited use of a behavioural change theory or model in the design of their CE, most frequently the Health Action Process Approach model (n=5); and use of behavioural change techniques varied. Twelve of twenty studies (60%) reported some form of ongoing support to coaches following the CE primary intervention concurrent with IPP implementation. CONCLUSION: CE that occurs on 1 day (one time-point) is most popular for preparing coaches as delivery agents of IPPs in youth field sports. While recognising pragmatic barriers, more expansive in-service training, support and feedback may enhance the effective implementation of IPPs. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/FMHGD.

The design and evaluation of an integrated training load and injury/illness surveillance system in competitive swimming.

OBJECTIVE: To design and evaluate an integrated training load monitoring and injury/illness surveillance system in a competitive swimming environment. DESIGN: Descriptive/mixed methods. SETTING: Swim Ireland National Training Centres. PARTICIPANTS: Fourteen competitive athletes and seven coaches/medical data collectors participated in the evaluation process. OUTCOME MEASURES: System satisfaction, usefulness and burden were evaluated. Barriers to the implementation and effectiveness of the system were explored. RESULTS: Most athletes were 'extremely' or 'very' satisfied with the overall data collection process and also found it to be 'extremely' or 'very' useful in the training centre environment. All practitioners were 'extremely satisfied with the system and found it to be either 'extremely' or 'very' useful in their role. Process constraints and data access and control were significant themes related to the athletes, while practitioners highlighted communication and cooperation amongst stakeholders, layering context to the data, maintaining data integrity and the coach's influence in the monitoring process as being important to the monitoring/surveillance process. CONCLUSIONS: Training load monitoring and injury/illness surveillance are necessary to elevate the standard of prospective injury/illness prevention research. Integrated systems should be designed in line with key consensus statements, while also being implemented in a way that counteracts the challenges within the real-world training environment.

International survey of injury surveillance practices in competitive swimming.

OBJECTIVE: The purpose of this study was to identify the injury surveillance practices being used in competitive swimming environments. It explored the nature of the data collected, the injury definitions used and the perceived effectiveness of injury surveillance. Finally, this study also examined barriers to injury surveillance. DESIGN: Online cross-sectional. PARTICIPANTS: Twenty-two responders working in competitive swimming. OUTCOME MEASURES: Injury surveillance methods, data collected, perceived level of effectiveness and barriers associated with injury surveillance. RESULTS: Fifteen responders participated in injury surveillance, with 13 responders using a recognised definition for injury. Ten responders did not use any sports injury classification system. Ten responders found injury surveillance to be very effective at identifying injury trends, while previous injury history and training load data were perceived to be most influential in preventing injury. Limited time, funding and compliance were common obstacles, while poor staff communication and engagement were barriers to the effective implementation of injury surveillance. CONCLUSIONS: The implementation of injury surveillance is related to the system objectives, competitive level of those under surveillance and the resources available. This implementation requires the balance of adhering to the principles outlined in prominent consensus statements and overcoming the barriers associated with implementing a system effectively.

The Association Between Training Load Indices and Injuries in Elite Soccer Players.

ABSTRACT: Tiernan, C, Comyns, T, Lyons, M, Nevill, AM, and Warrington, G. The association between training load indices and injuries in elite soccer players. J Strength Cond Res 36(11): 3143-3150, 2022-To investigate the association between contact injuries, noncontact injuries, and training load indices, across different lag periods in elite soccer players. Internal load (session rate of perceived exertion) was collected from 15 elite soccer players over 1 season (40-weeks). Acute (7 days), chronic (28 days), acute:chronic workload ratio (ACWR) (uncoupled), exponentially weighted moving averages (EWMA) ACWR, and 2-, 3-, and 4-week cumulative load were calculated on a rolling weekly basis. Multilevel logistic regression was used to analyze the associations between contact, noncontact injuries, and training load indices, across different lag periods (5 and 7 days). A player was at a significantly higher risk of a noncontact injury 5 days later, if week-to-week acute load changes increased (odds ratio [OR] = 1.97). An increase in EWMA ACWR was associated with an increased risk of both a contact (OR = 1.30) and noncontact injury (OR = 1.35), 5 days later. An increase in 2-week cumulative load (OR = 1.77) was associated with an increased risk of a contact injury 7 days later and 3-week cumulative load (OR = 1.55) 5 days later. These findings suggest that to reduce the potential risk of a noncontact injury, training load should be gradually increased, avoiding an increase in week-to-week acute load change (≥9%) or EWMA ACWR (>1.20). Findings indicated that EWMA ACWR may be a more sensitive measure for detecting a player at a higher risk of an injury than ACWR. Furthermore, a high 2- and 3-week cumulative load was associated with an increased risk of a contact injury, which may indicate accumulated fatigue. Practitioners must note that this study investigated associations with injury risk and not injury prediction.

International survey of training load monitoring practices in competitive swimming: How, what and why not?

OBJECTIVE: The purpose of this study is to identify the training load (TL) monitoring practices employed in real-world competitive swimming environments. The study explores data collection, analysis and barriers to TL monitoring. DESIGN: Cross-sectional. SETTING: Online survey platform. PARTICIPANTS: Thirty-one responders working in competitive swimming programmes. MAIN OUTCOME MEASURES: Methods of data collection, analysis, level of effectiveness and barriers associated with TL monitoring. RESULTS: 84% of responders acknowledged using TL monitoring, with 81% of responders using a combination of both internal and external TL, in line with current consensus statements. Swim volume (mileage) (96%) and session rate of perceived exertion (sRPE) (92%) were the most frequently used, with athlete lifestyle/wellness monitoring also featuring prominently. Thematic analysis highlighted that "stakeholder engagement", "resource constraints" or "functionality and usability of the systems" were shared barriers to TL monitoring amongst responders. CONCLUSIONS: Findings show there is a research-practice gap. Future approaches to TL monitoring in competitive swimming should focus on selecting methods that allow the same TL monitoring system to be used across the whole programme, (pool-based training, dryland training and competition). Barriers associated with athlete adherence and coach/National Governing Body engagement should be addressed before a TL system implementation.

The relationship between training load and pain, injury and illness in competitive swimming: A systematic review.

BACKGROUND: Research suggests that the frequency of training, combined with the repetitive motion involved in high volume swimming can predispose swimmers to symptoms of over-training. The prevention of pain, injury and illness is of paramount importance in competitive swimming in order to maximise a swimmer's ability to train and perform consistently. A significant factor in the prevention of pain, injury or illness is the appropriate load monitoring and management practices within a training programme. OBJECTIVE: The purpose of this systematic review is to investigate the relationship between training load and pain, injury and illness in competitive swimmers. METHODS: The databases SPORTDiscus, CINAHL, Scopus, MEDLINE and Embase were searched in accordance with PRISMA guidelines. Studies were included if they reported on competitive swimmers and analysed the link between training load and either pain, injury or illness. The methodological quality and study bias were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: The search retrieved 1,959 articles, 15 of which were included for review. The critical appraisal process indicated study quality was poor overall. Pain was the most explored condition (N = 12), with injury (N = 2) and illness (N = 1) making up the remaining articles. There was no evidence of an association between training load and pain, while there may be some evidence to suggest a relationship between training load and injury or illness. CONCLUSIONS: The relationship between training load and pain, injury or illness is unclear owing to a host of methodological constraints. The review highlighted that youth, masters and competitive swimmers of a lower ability (e.g. club versus international) may need particular consideration when planning training loads. Winter periods, higher intensity sessions and speed elements may also need to be programmed with care. Monitoring practices need to be developed in conjunction with consensus guidelines, with the inclusion of internal training loads being a priority. Future research should focus on longitudinal prospective studies, utilising the session Rating of Perceived Exertion (sRPE) monitoring method and investigating the applicability of Acute/Chronic Workload Ratio (ACWR) and exponentially weighted moving average (EWMA). Improved methods and study design will provide further clarity on the relationship between load and pain, injury, and illness.

Intra-Trial Reliability and Usefulness of Isometric Mid-Thigh Pull Testing on Portable Force Plates.

The aim of this study was to assess the intra-trial reliability and usefulness of portable force plates and a customised Isometric Mid-Thigh Pull rig. Twenty males (age: 24.1 ± 2.5 years, body height: 177.7 ± 0.09 cm, body mass: 88.4 ± 17.9 kg) with weightlifting experience ± 12 months attended 1 familiarisation session and 1 testing session where 4 isometric mid-thigh pulls were performed. Maximum force, absolute peak force (PF), relative PF, allometrically scaled PF, and force (150, 200, 250 ms) were deemed reliable (ICC ≥ 0.91 and CV ≤ 9.8%) based on predetermined criteria (ICC ≥ 0.8 and CV ≤ 10%). The impulse and the rate of force development (RFD) were deemed unreliable (ICC ≤ 0.91 and CV ≥ 10 %) at all time points. Maximum force, absolute PF, relative PF to body weight and body mass, rand allometrically scaled PF, had a typical error (TE) lower than the smallest worthwhile change small effect (SWC0.2) and moderate effect (SWC0.5) and were rated as good with regard to usefulness. The TE for force at selected time points (150, 200, 250 ms) was also higher than the SWC0.2, achieving a rating of marginal, but TE was higher than SWC0.5, achieving a rating of good with regard to usefulness. Portable force plates and customised rigs can reliably determine peak force and force output at different time points and for detecting the SWC in maximum and absolute force measures, greater familiarisation may be required to establish reliability of other variables such as the impulse and the RFD.

Low Dose Resistance Exercise: A Pilot Study Examining Effects on Blood Pressure and Augmentation Index Between Intensities.

INTRODUCTION: The effects of resistance exercise on vascular function are unclear. AIM: To investigate the acute haemodynamic (blood pressure and augmentation index) and rate of perceived exertion (RPE) response to two types of resistance exercises of equal workload-a set of unilateral 35% of one repetition maximum (1RM) quadriceps extension and a set of unilateral 70% 1RM quadriceps extension. METHODS: Twenty two young healthy males completed both exercises on separate days. Heart rate, central and peripheral systolic and diastolic blood pressure (BP), augmentation pressure, augmentation index (AIx), augmentation index at a heart rate of 75 beats per minute (AIx75), and RPE were measured using applanation tonometry before exercise, immediately after exercise, 5 min after exercise and 15 min after exercise. RESULTS: AIx75 was significantly lower 5 min after exercising at 35% of 1RM than 70% of 1RM. Systolic blood pressure was significantly lower at 5 min post exercise for both intensities. There was no significant difference in RPE between conditions or time points. CONCLUSIONS: Results suggest that changes in blood pressure and augmentation index vary depending on the intensity of resistance exercise regardless of the volume of exercise carried out. Changes in AIx75 in response to resistance exercise may be independent of changes in BP.

A blood biomarker and clinical correlation cohort study protocol to diagnose sports-related concussion and monitor recovery in elite rugby.

INTRODUCTION: In professional rugby, sports-related concussion (SRC) remains the most frequent time loss injury. Therefore, accurately diagnosing SRC and monitoring player recovery, through a multi-modal assessment process, is critical to SRC management. In this protocol study, we aim to assess SRC over multiple time points post-injury to determine the value of multi-modal assessments to monitor player recovery. This is of significance to minimise premature return-to-play and, ultimately, to reduce the long-term effects associated with SRC. The study will also establish the logistics of implementing such a study in a professional setting to monitor a player's SRC recovery. METHODS AND ANALYSIS: All players from the participating professional rugby club within the Irish Rugby Football Union are invited to participate in the current study. Player assessment includes head injury assessment (HIA), neuropsychometric assessment (ImPACT), targeted biomarker analysis and untargeted biomarker analysis. Baseline HIA, ImPACT, and blood draws are performed prior to the start of playing season. During the baseline tests, player's complete consent forms and an SRC history questionnaire. Subsequently, any participant that enters the HIA process over the playing season due to a suspected SRC will be clinically assessed (HIA and ImPACT) and their blood will be drawn within 3 days of injury, 6 days post-injury, and 13 days post-injury. ETHICS AND DISSEMINATION: Ethical approval was attained from the Science and Engineering Research Ethics Committee, University of Limerick (Approval Code: 2018_06_11_S&E). On completion of the study, further manuscripts will be published to present the results of the tests and their ability to measure player recovery from SRC. TRIAL REGISTRATION NUMBER: NCT04485494.

Salivary IgA as a Predictor of Upper Respiratory Tract Infections and Relationship to Training Load in Elite Rugby Union Players.

Tiernan, C, Lyons, M, Comyns, T, Nevill, AM, and Warrington, G. Salivary IgA as a predictor of upper respiratory tract infections and relationship to training load in elite rugby union players. J Strength Cond Res 34(3): 782-790, 2020-Upper Respiratory Tract Infections (URTI) are among the most common illnesses reported in athletes. An URTI can result in missed training days, which in turn may lead to performance decrements. The purpose of this study was to investigate the use of salivary immunoglobulin A (sIgA) as a predictor of URTI, while also exploring the relationship to weekly training load in elite rugby union players. Nineteen male elite rugby union players provided morning saliva swabs, biweekly (Monday and Friday), over a 10-week training period. Participants completed an illness log documenting symptoms of URTI. Session Rate of Perceived Exertion (sRPE) was collected to determine training load (sRPE × session duration). Weekly training load was also calculated. Logistic regression was used to analyze the relationship between incidences of URTI with sIgA and training load. Multilevel regression was conducted to compare associations between sIgA and training load. The results found that the likelihood of suffering from an URTI increased when sIgA significantly decreased (p = 0.046). Where sIgA decreased by 65% or more, a player was at a greater risk of contracting an URTI within the following 2 weeks. No association was found between sIgA and training load. In conclusion, sIgA may be a useful predictor for determining the likelihood of players contracting an URTI. This will allow the coach to make informed decisions on training status, helping reduce the risk of players missing training, which may have performance decrements. Coaches will benefit from the fast, easy, and instant results available, to analyze a player's immune function.

Investigation of the Relationship Between Salivary Cortisol, Training Load, and Subjective Markers of Recovery in Elite Rugby Union Players.

PURPOSE: Insufficient recovery can lead to a decrease in performance and increase the risk of injury and illness. The aim of this study was to evaluate salivary cortisol as a marker of recovery in elite rugby union players. METHOD: Over a 10-wk preseason training period, 19 male elite rugby union players provided saliva swabs biweekly (Monday and Friday mornings). Subjective markers of recovery were collected every morning of each training day. Session rating of perceived exertion (sRPE) was taken after every training session, and training load was calculated (sRPE × session duration). RESULTS: Multilevel analysis found no significant association between salivary cortisol and training load or subjective markers of recovery (all P > .05) over the training period. Compared with baseline (wk 1), Monday salivary cortisol significantly increased in wk 4 (14.94 [7.73] ng/mL; P = .04), wk 8 (16.39 [9.53] ng/mL; P = .01), and wk 9 (15.41 [9.82] ng/mL; P = .02), and Friday salivary cortisol significantly increased in wk 5 (14.81 [8.74] ng/mL; P = .04) and wk 10 (15.36 [11.30] ng/mL; P = .03). CONCLUSIONS: The significant increase in salivary cortisol on certain Mondays may indicate that players did not physically recover from the previous week of training or match at the weekend. The increased Friday cortisol levels and subjective marker of perceived fatigue indicated increased physiological stress from that week's training. Regular monitoring of salivary cortisol combined with appropriate planning of training load may allow sufficient recovery to optimize training performance.

Ultra-Short Race-Pace Training (USRPT) In Swimming: Current Perspectives.

The last decade has seen a dramatic rise in sports science research due to the ever-increasing professionalization of sport. As a result, many alternative training methodologies that challenge traditional training philosophies have emerged. In the sport of swimming, ultra-short race-pace training (USRPT) was recently proposed. The aim of this article was to provide current perspectives on USRPT in competitive swimming. A systematic review was conducted to determine the effects of USRPT on performance in competitive swimmers. Of the 1347 studies retrieved, 1332 were excluded. The full-texts of 15 studies were assessed for eligibility. However, all 15 studies were excluded as the intervention did not consist of USRPT. Consequently, there are concerns surrounding USRPT as it is not currently based on peer-reviewed published literature. In addition, the recommendations within USRPT to avoid resistance training, cross-training activities, training intensities less than race-pace velocity and part practice swimming drills are highly controversial and lack scientific evidence. There is evidence to suggest that USRPT is a derivative of high-intensity training (HIT) and there is peer-reviewed published literature available to support the effects of HIT on performance in competitive swimmers. Swimming coaches and sports scientists are advised to consider the applications of USRPT with caution. The authors suggest that USRPT is a training method, which may be incorporated within a holistic periodized training program that includes a variety of training methods and stimuli. Future research should involve a randomized controlled intervention of USRPT in competitive swimmers.

Altered Strength Profile in Achilles Tendinopathy: A Systematic Review and Meta-Analysis.

BACKGROUND: Persistent strength deficits secondary to Achilles tendinopathy (AT) have been postulated to account for difficulty engaging in tendon-loading movements, such as running and jumping, and may contribute to the increased risk of recurrence. To date, little consensus exists on the presence of strength deficits in AT. Consequently, researchers are uncertain about the appropriate methods of assessment that may inform rehabilitation in clinical practice. OBJECTIVE: To evaluate and synthesize the literature investigating plantar-flexion (PF) strength in individuals with AT. STUDY SELECTION: Two independent reviewers searched 9 electronic databases using an agreed-upon set of key words. DATA EXTRACTION: Data were extracted from studies comparing strength measures (maximal, reactive, and explosive strength) between individuals with AT and healthy control participants or between the injured and uninjured sides of people with AT. The Critical Appraisal Skills Programme Case-Control Study Checklist was used to assess the risk of bias for the included studies. DATA SYNTHESIS: A total of 19 studies were eligible. Pooled meta-analyses for isokinetic dynamometry demonstrated reductions in maximal strength (concentric PF peak torque [PT] slow [Hedges g = 0.52, 44% deficit], concentric PF PT fast [Hedges g = 0.61, 38% deficit], and eccentric PF PT slow [Hedges g = 0.26, 18% deficit]). Reactive strength, particularly during hopping, was also reduced (Hedges g range = 0.32-2.61, 16%-35% deficit). For explosive strength, reductions in the rate of force development (Hedges g range = 0.31-1.73, 10%-21% deficit) were observed, whereas the findings for ground reaction force varied but were not consistently altered. CONCLUSIONS: Individuals with AT demonstrated strength deficits compared with the uninjured side or with asymptomatic control participants. Deficits were reported across the strength spectrum for maximal, reactive, and explosive strength. Clinicians and researchers may need to adapt their assessment of Achilles tendon function, which may ultimately help to optimize rehabilitation outcomes.

The Relationship Between Adductor Squeeze Strength, Subjective Markers of Recovery and Training Load in Elite Rugby Players.

Tiernan, C, Lyons, M, Comyns, T, Nevill, AM, and Warrington, G. The relationship between adductor squeeze strength, subjective markers of recovery and training load in elite Rugby players. J Strength Cond Res 33(11): 2926-2931, 2019-The adductor squeeze strength test has become a popular training monitoring marker, particularly in team sports. The aim of this study was to investigate the relationship between adductor squeeze strength scores, subjective markers of recovery and training load in elite Rugby Union players, because of limited research in this area. Nineteen elite male Rugby Union players completed daily monitoring markers (adductor squeeze strength and 5 selected subjective markers of recovery), over a 10-week preseason training period. Rate of perceived exertion (RPE) was collected to determine training load (session RPE; RPE × session duration) and to calculate weekly training load. Spearman's correlation was used to analyze the relationship between adductor squeeze strength scores, subjective markers of recovery, and weekly training load. The results found that where adductor squeeze scores decreased, both perceived fatigue levels (r = -0.335; R = 11.2%; p < 0.001) and muscle soreness (r = -0.277; R = 7.7%; p < 0.001) increased. A weak correlation was found between Monday adductor squeeze strength scores and the previous week's training load (r = -0.235; R = 5.5%; p < 0.001) and Friday adductor squeeze strength scores and the same week's training load (r = -0.211; R = 4.5%; p < 0.05). These results show that adductor squeeze strength may provide coaches with a time-efficient, low-cost objective, player monitoring marker. Additionally, the combination of adductor strength squeeze, with subjective markers, perceived fatigue, and muscle soreness, and appropriately planned training load may help coaches to optimize training adaptations by determining a player's training status.