Association Between Longitudinal Changes in Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players.

Background: The relationship between self-reported symptoms and the severity of patellar tendon abnormality (PTA) as seen on magnetic resonance imaging and ultrasound is unclear, but biomechanical testing may resolve this. Purpose: To (1) compare land-jump limb biomechanics between pre- and postseason timepoints, (2) assess whether seasonal changes in biomechanics are associated with seasonal changes in PTA and symptom severity, and (3) explore models that identify seasonal changes in PTA and symptoms with seasonal changes in biomechanics in collegiate basketball players. Study Design: Cohort study; Level of evidence, 2. Methods: Victorian Institute of Sport Assessment Scale - Patellar Tendon (VISA-P) scores and bilateral measurements from 18 National Collegiate Athletic Association Division I and II male basketball players (n = 36 limbs) at the preseason (visit 1) and postseason (visit 2) timepoints were collected. PTA was graded with ultrasound and magnetic resonance imaging morphology measurements proximally and distally, and 3-dimensional lower extremity sagittal kinematics and kinetics were measured during a land-jump test. Multivariate and chi-square analyses assessed timepoint differences. The association of seasonal (Δ = visit 2 - visit 1) biomechanics with seasonal morphology (ΔPTA: no change/worsened) and symptoms (ΔVISA-P: improved/no change/worsened) was tested with multivariate models. Logistic regressions modeled the accuracy of seasonal biomechanics to classify seasonal PTA and symptoms. Results: Three athletes (6 limbs) at visit 1 and 2 athletes (4 limbs) at visit 2 were symptomatic. VISA-P scores were not significantly different between preseason and postseason. Regarding PTA, multivariate analyses found differences among grouped ground-reaction force variables (P < .05); univariate analyses found that worsened PTA was associated with seasonal decreases in peak vertical jumping force and with seasonal increases in knee flexion velocity at contact and maximum knee flexion velocity (P < .05 for all). Regarding VISA-P scores, multivariate analyses found differences among grouped hip (P < .01) and ankle (P < .05) kinematic variables; univariate analyses found that worsened VISA-P was associated with seasonal increases in hip (P < .01) and knee (P < .01) flexion velocity at contact and seasonal increases in ankle range of motion (P < .05). Conclusion: The findings demonstrated an association between seasonal changes in dynamic lower extremity biomechanics and seasonal changes in patellar tendon imaging signals as well as self-reported symptoms.

Injury patterns and healthcare utilisation by runners of the New York City Marathon.

Objectives: The purpose of this study was to describe injury patterns and healthcare utilisation of marathon runners. Methods: This was a previously reported 16-week prospective observational study of runners training for the New York City Marathon. Runners completed a baseline survey including demographics, running experience and marathon goal. Injury surveys were collected every 4 weeks during training, as well as 1 week before and 1 week after the race. Injury details collected included anatomic location, diagnosis, onset, and treatment received. Results: A total of 1049 runners were enrolled. Injuries were reported by 398 (38.4%) during training and 128 (14.1%) during the marathon. The overall prevalence of injury was 447/1049 (42.6%). Foot, knee and hip injuries were most common during training, whereas knee, thigh and foot injuries were most common during the race. The most frequent tissue type affected was the category of muscle, tendon/fascia and bursa. The prevalence of overuse injuries increased, while acute injuries remained constant throughout training. Hamstring injuries had the highest prevalence of diagnosis with 38/564 injuries (6.7%). Of the 447 runners who reported an injury, 224 (50.1%) received medical care. Physical therapy was the most common medical care received with 115/1037 (11.1%) runners during training and 44/907 (4.9%) postrace. Conclusion: Runners training and participating in a marathon commonly experience injuries, especially of the foot and knee, which often are overuse soft tissue injuries. Half of the injured runners sought out medical care for their injury. Understanding the patterns of injuries affecting marathon runners could help guide future injury prevention efforts.

Association Between Patellar Tendon Abnormality and Land-Jump Biomechanics in Male Collegiate Basketball Players During the Preseason.

Background: Patellar tendinopathy is a degenerative condition that predominantly affects jumping athletes. Symptoms may be subtle or nonexistent at preseason, but structural abnormalities may be present. Assessing patellar tendon abnormality (PTA) through magnetic resonance imaging (MRI) and ultrasound (US) and classifying symptoms using the Victorian Institute for Sport Assessment-Patellar tendon (VISA-P) may provide useful insights if combined with biomechanics measurements. Purpose: To (1) assess whether land-jump biomechanical patterns are associated with clinically pertinent PTA as seen on imaging and through VISA-P scores and (2) model the contributing risk and accuracy of biomechanics to classify PTA and symptomatic observations. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 26 National Collegiate Athletic Association Division I and II male basketball players (n = 52 limbs) were recruited during the preseason. We collected VISA-P scores, bilateral PTA through US and MRI morphology measurements, and bilateral 3-dimensional lower extremity kinematics and kinetics measurements from a land-jump test from an 18-inch-high (45.7-cm-high) box. Statistically, each limb was treated independently. The association of biomechanics with PTA and symptoms (VISA-P score <80) was tested with multivariate models and post hoc tests. Logistic regression modeled relative risk and accuracy of biomechanical variables to classify PTA and symptomatic limbs. Results: There were 19 to 24 limbs with PTA depending on US and MRI measurements. Differences in hip and knee kinematic strategies and ground-reaction loads were associated with PTA and symptomatic limbs. Peak landing vertical ground-reaction force was significantly decreased (169 ± 26 vs 195 ± 29 %body weight; P = .001), and maximum hip flexion velocity was significantly increased (416 ± 74 vs 343 ± 94 deg/s; P = .005) in limbs with versus without PTA on imaging. Knee flexion at the initial contact was decreased in symptomatic versus healthy limbs (17°± 5° vs 21°± 5°, respectively; P = .045). Regression models classified PTA limbs and symptomatic limbs with 71.2% to 86.5% accuracy. Hip and knee maximum flexion velocity and vertical ground-reaction force variables were most common across models observing clinically pertinent PTA. Conclusion: Our findings suggested that functional kinematic and kinetic biomechanical strategies at the hip and knee were associated with PTA, identified on imaging, and symptomatic limbs.

Serial Ultrasonography for the Assessment of Healing of Lower Extremity Bone Stress Injury and Correlation With Return to Sport/Exercise.

BACKGROUND: Lower extremity bone stress injuries (BSIs) are common among athletes who participate in high-impact activities. Conventional imaging is limited in assessing healing of BSIs. HYPOTHESIS: Serial ultrasonography (US) can identify changes in appearance of lower extremity BSIs over time that can be correlated with symptoms and return to exercise/sport. STUDY DESIGN: Cohort observational study. LEVEL OF EVIDENCE: Level 3. METHODS: Adults 18 to 50 years old with a recent exercise-associated BSI of distal tibia/fibula or metatarsals diagnosed by magnetic resonance imaging (MRI) were enrolled. US was performed every 2 weeks for 12 weeks. The sonographic appearance (soft tissue edema, periosteal reaction, hyperemia on power Doppler, callus) was correlated with the numerical rating scale (NRS) for pain and ability to return to sport/exercise. RESULTS: A total of 30 patients were enrolled (mean age, 35.3 ± 7.7 years; 21 [70.0%] female). The tibia was most frequently affected (n = 15, 50.0%), followed by metatarsals (n = 14, 46.7%) and fibula (n = 1, 3.3%). At week 4, 25 of 30 (83.3%) had at least 1 US finding associated with the BSI. The degree of hyperemia was correlated with NRS at weeks 4 and 6 (Spearman correlations [ρ] 0.45 [0.09, 0.69] and 0.42 [0.07, 0.67], respectively), as well as return to sport/exercise at week 6 (ρ -0.45 [-0.68, -0.09]). US soft tissue edema was also correlated with NRS at week 6 (ρ 0.38 [0.02, 0.65]). CONCLUSION: Serial US of lower extremity BSIs can provide objective measures of healing. US findings were correlated with clinical outcomes at multiple timepoints. CLINICAL RELEVANCE: US may have advantages over conventional imaging for monitoring healing of lower extremity BSIs. Further research is needed to better understand the prognostic value of these sonographic indicators of BSI healing and role in assessing readiness for return to sport/exercise.

Olympic Games during nationwide lockdown: sports injuries and illnesses, including COVID-19, at the Beijing 2022 Winter Olympics.

OBJECTIVE: The objective of this study is to describe the incidence of injuries and illnesses sustained during the Beijing Winter Olympic Games from 4 February 2022 to 20 February 2022. METHODS: We recorded the daily number of athlete injuries and illnesses (1) through the reporting of all National Olympic Committee (NOC) medical teams and (2) in the polyclinic and medical venues by the Beijing 2022 medical staff. RESULTS: In total, 2848 athletes (1276 women, 45%; 1572 men, 55%) from 91 NOCs were followed prospectively for the occurrence of injury and illness. NOC and Beijing 2022 medical staff reported 289 injuries and 109 illnesses, equalling 10.1 injuries and 3.8 illnesses per 100 athletes over the 17-day period. The injury incidence was highest in ski halfpipe (30%), ski big air (28%), snowboard slopestyle (23%) and ski slopestyle (22%), and lowest (1%-2%) in curling, alpine mixed team parallel slalom, Nordic combined and alpine super-G. The illness incidence was highest in ski aerials (10%), skeleton (8%), cross-country skiing (8%) and Nordic combined (7%). In the study period, COVID-19 affected 32 athletes, accounting for 29% of all illnesses affecting 1.1% of all athletes. CONCLUSION: Overall, 10% of the athletes incurred an injury and 4% an illness during the Beijing Winter Olympic Games. The incidence of illnesses overall, which was the lowest yet recorded in the Winter Olympic Games, and COVID-19 was mitigated through comprehensive countermeasures.

Training patterns associated with injury in New York City Marathon runners.

OBJECTIVE: Training patterns are commonly implicated in running injuries. The purpose of this study was to measure the incidence of injury and illness among marathon runners and the association of injuries with training patterns and workload. METHODS: Runners registered for the New York City Marathon were eligible to enrol and prospectively monitored during the 16 weeks before the marathon, divided into 4-week 'training quarters' (TQ) numbered TQ1-TQ4. Training runs were tracked using Strava, a web and mobile platform for tracking exercise. Runners were surveyed at the end of each TQ on injury and illness, and to verify all training runs were recorded. Acute:chronic workload ratio (ACWR) was calculated by dividing the running distance in the past 7 days by the running distance in the past 28 days and analysed using ratio thresholds of 1.3 and 1.5. RESULTS: A total of 735 runners participated, mean age 41.0 (SD 10.7) and 46.0% female. Runners tracked 49 195 training runs. The incidence of injury during training was 40.0% (294/735), and the incidence of injury during or immediately after the marathon was 16.0% (112/699). The incidence of illness during training was 27.2% (200/735). Those reporting an initial injury during TQ3 averaged less distance/week during TQ2 compared with uninjured runners, 27.7 vs 31.9 miles/week (p=0.018). Runners reporting an initial injury during TQ1 had more days when the ACWR during TQ1 was ≥1.5 compared with uninjured runners (injured IQR (0-3) days vs uninjured (0-1) days, p=0.009). Multivariable logistic regression for training injuries found an association with the number of days when the ACWR was ≥1.5 (OR 1.06, 95% CI (1.02 to 1.10), p=0.002). CONCLUSION: Increases in training volume ≥1.5 ACWR were associated with more injuries among runners training for a marathon. These findings can inform training recommendations and injury prevention programmes for distance runners.

Updated Blood Pressure Guidelines: Implications for Athletes.

PURPOSE OF REVIEW: To review the prevalence, short- and long-term impact of exercise on blood pressure, and the evaluation and treatment of hypertension in competitive athletes. RECENT FINDINGS: Due, in part, to inconsistencies in measurement and the definitions used, the true prevalence of hypertension is unknown as reports range from 0 to 83%. With recent changes in the blood pressure guidelines, the proportion of athletes that meet criteria for elevated blood pressure or stage 1 hypertension has increased dramatically with over one-third of collegiate and professional athletes meeting criteria for hypertension. Data consistently show that American-style football players, particularly linemen, display the highest rates of hypertension. These athletes typically have a larger body mass index, higher body fat percentage, and weight gain in serial follow-up. Many athletes with hypertension have traditional risk factors, and, to date, there is no evidence of a causal relationship between long-term sport participation and increased risk of developing hypertension. Many more athletes now meet criteria for hypertension, given the updated blood pressure guidelines. This should be taken as an opportunity for early intervention, as athletes are not immune to the development of cardiovascular risk factors and disease.

Factors associated with injuries in first-time marathon runners from the New York City marathon.

OBJECTIVES: To determine how baseline characteristics of first-time marathon runners and training patterns are associated with risk of injuries during training and the race. METHODS: First-time adult marathon runners who were registered for the 2017 New York City Marathon were monitored starting 12 weeks prior to the race. Baseline data collection included demographics and running experience. Running frequency, distance, and injury occurrence were self-reported using online surveys every 2 weeks. RESULTS: A total of 720 runners participated of which 675 completed the study. There were 64/675 (9.5%) who had major injuries during training or the race that preventing starting or finishing the race. An additional 332 (49.2%) had minor injuries interfering with training and/or affecting race performance. Injury incidence was not significantly different based on age or sex. Runners who completed a half marathon prior to the study were less likely to report getting injured [multivariable odds ratio (OR) 0.40, (0.22, 0.76), p= 0.005]. Runners who averaged <4 training runs per week during the study were less likely to report getting injured compared to those who averaged ≥4 per week [relative risk 1.36, (1.13-1.63), p= 0.001]. Longest training run distance during the study was inversely associated with race-day injury incidence [OR 0.87 (0.81, 0.94), p< 0.001]. CONCLUSION: Injuries are common among first-time marathon runners. We found that risk of injury during training was associated with lack of half marathon experience and averaging ≥4 training runs per week. Longer training runs were associated with a lower incidence of race-day injuries. These results can inform the development of targeted injury-prevention interventions.

Increased Incidence of Injury Among Runners With COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. HYPOTHESIS: Runners who report having COVID-19 also report a higher incidence of injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. RESULTS: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 (P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). CONCLUSION: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. CLINICAL RELEVANCE: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.

Running races during the COVID-19 pandemic: a 2020 survey of the running community.

OBJECTIVES: To survey runners and triathletes about their willingness to resume in-person racing during the COVID-19 pandemic, health concerns related to mass races and changes in running patterns since the start of the pandemic. DESIGN: An electronic survey was distributed from 15 July to 1 September 2020 to runners and triathletes by New York Road Runners, ASICS North America, and race medical directors, and through social media. PARTICIPANTS: Runners and triathletes 18 years of age or older who participated in at least one race in 2019. RESULTS: A total of 2278 surveys were received. Not all participants answered every question; the denominator represents the number of responses to each question. Most participants were from the USA (1620/1940, 83.5%), of which over half were from New York (812/1475, 55.1%). Regarding when respondents would feel comfortable returning to in-person racing, the most frequent response was 'Whenever local laws allow, but only if there are sufficient precautions' (954/2173, 43.9%), followed by 'Not until there is a vaccine' (540/2173, 24.9%). The most common concerns about in-person races were crowded starting corrals (1802/2084, 86.5%), the number of COVID-19 cases in the race location (1585/2084, 76.1%) and the number of participants (1517/2084, 72.8%). Comparing running patterns before the pandemic to Summer 2020, the mean weekly mileage decreased from 25.5 (SD 15.4) miles to 22.7 (16.2) miles (p<0.001). CONCLUSION: Most runners are willing to return to racing when local laws allow, though as of Summer 2020, many desired certain precautions to feel comfortable.

A Systematic Review of Telehealth and Sport-Related Concussion: Baseline Testing, Diagnosis, and Management.

Background: The use of telehealth has increased as a result of the COVID-19 pandemic. As sports at all levels resume, sports medicine physicians may be interested in how telehealth can be used for concussion care. Questions/Purpose: We sought to assess how telehealth has been used in the baseline testing, diagnosis, and/or management of concussion. Secondarily, we sought to assess the strengths and weaknesses of telehealth for concussion care and identify aspects of concussion care for which telehealth has not yet been studied. Methods: A systematic review was performed in September 2020 of PubMed and Embase using the following terms: concuss*, "mild traumatic brain," "head injur*," telehealth, telemedicine, telecare, "mobile health," m-health, virtual. Studies included were original research articles investigating the use of telehealth in the care of concussion (including baseline testing, diagnosis, and management), published in English, and had full text available. Results: A total of 356 articles were screened, of which 5 were determined to meet inclusion criteria. These articles described the use of telehealth for managing concussion in military and rural settings. No articles involved the use of telehealth for baseline concussion testing of athletes or for sideline evaluation. Conclusion: Despite the limited original research on the use of telehealth for concussion care, the articles identified provide a foundation for exploring the potential value of telehealth in the office practice and sports team setting. Telehealth may expand the ability of a sports medicine physician to provide timely and effective concussion care to athletes during the COVID-19 pandemic and beyond. More rigorous research is needed.

Feasibility and impact of a musculoskeletal health for musicians (MHM) program for musician students: A randomized controlled pilot study.

BACKGROUND: There is a high incidence of performance-related musculoskeletal disorders in musicians that may be reduced via education programs. However, the efficacy of formalized injury prevention programs has not been rigorously studied. PURPOSE: To assess the feasibility and effect of a formalized injury prevention education workshop on incidence and severity of musculoskeletal pain in a cohort of musician-students attending an intensive summer music festival compared to controls. STUDY DESIGN: Randomized-controlled-pilot trial. METHODS: Musicians at an 8-week long intensive summer festival were randomized to an intervention (workshop) or control group. Workshop attendees participated in a 90-minute session of injury prevention strategies. Musculoskeletal outcome data were collected at the start and end of the festival. Outcomes included presence of musculoskeletal pain, adherence level, and sub-scales of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians. RESULTS: A total of 57 musician-students (ages 17-30, 23 females) participated in the study, and 48(84%) completed the study. Seventy-five percent of workshop participants reported adherence over 8 weeks. At baseline, 84% of participants reported a history of playing-related pain, and 47% recent or current pain. Participants played a range of instruments (50% string, 34% piano, 16% woodwind/brass). At baseline, average weekly reported playing time was 39 hours (±11). At follow-up, reported pain decreased by 32% in the intervention group and increased by 8% in controls (P < .01). Pain interference scores were lower (Post - Pre = -4.58, 95% CI -9.26 to 0.11, P = .055). There was no statistically significant difference between groups for pain intensity. CONCLUSIONS: The high compliance and willingness to participate suggests that injury prevention education implementation is feasible. Our preliminary findings suggest a positive effect on pain incidence and pain interference in the intervention group. Future studies will examine the relationship between adherence levels and injury rates in a larger cohort and identify obstacles to implementation.

Youth running consensus statement: minimising risk of injury and illness in youth runners.

Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.

Cardiovascular Screening of Elite Athletes by Sporting Organizations in Australia: A Survey of Chief Medical Officers.

OBJECTIVE: To compare cardiovascular screening policies of Australian elite sporting organizations. DESIGN: Online survey. SETTING: Elite/professional sports in Australia. PARTICIPANTS: Chief medical officers (CMOs) of elite/professional sports in Australia, including rugby union and league, cricket, tennis, Australian football, and cycling. ASSESSMENT OF VARIABLES: Survey questions about each sport's cardiac screening policy: which screening components were included [eg, history and physical (H&P), resting 12-lead electrocardiogram (ECG)], whether screening was mandatory, whether the policy applied to elite junior and/or adult players, and which criteria were used to interpret ECGs. MAIN OUTCOME MEASURES: Which sports had a formal cardiac screening policy, which athletes the policy applied to, components of screening, ECG interpretation criteria used. RESULTS: Chief medical officers for 22/31 (71%) sports responded, representing >5000 athletes. Of these, 19/22 (86%) perform regular screening (100% H&P; 89% included ECG) with international cyclists also having routine echocardiograms and stress testing. Thirty-three percent of CMOs used the 2017 International Criteria for athlete ECG interpretation. Screening was mandatory with enforcement (26%), mandatory without enforcement (48%), and opt-out (26%). All screened adult elite athletes, and 68% screened junior elite athletes. Forty-two percent indicated athletes were required to pay for screening tests, and 63% required athletes to pay for follow-up tests. Almost all (94%) sports with a sports physician as the CMO screened athletes. CONCLUSIONS: Most sports have a screening policy, with reasonable uniformity of components. All included H&P, and almost all included ECG. Only one sport included an echocardiogram and stress test as a standard (international players only). Promoting the latest ECG interpretation criteria may reduce false-positives and cost. Future work should explore cardiac emergency plans, screening infrastructure, cost, and long-term follow-up.

Time Out of Play Due to Illness in Major and Minor League Baseball.

OBJECTIVE: To generate a summative report on the most commonly diagnosed illnesses in Major League Baseball (MLB) and Minor League Baseball (MiLB) athletes with specific attention to their impact based on time out of play. DESIGN: Retrospective analysis. SETTING: Injury and illness data from the MLB Health and Injury Tracking System. PARTICIPANTS: All MLB and MiLB athletes active between 2011 and 2016. ASSESSMENT OF RISK FACTORS: Illnesses were defined as atraumatic medical diagnoses that occurred during the MLB or MiLB season and resulted in at least 1 day out of play. MAIN OUTCOME MEASURES: Incidence of illness diagnoses and resulting time out play. RESULTS: Eight thousand eight hundred thirty-four illnesses were reported, representing 14.7% of all diagnoses resulting in time out of play. Total days missed (DM) due to illness were 39 614, with a mean of 4.6 (SD 9.9 days) and median 2 DM per diagnosis. The annual incidence of illness per season was 20.3 per 100 athletes. The most common diagnosis was nonspecific viral illness (15.3%), followed by gastroenteritis (13.6%), other gastrointestinal illness (8.3%), influenza (7.0%), and upper respiratory infection (6.2%). Appendicitis (15.2%) and Epstein-Barr virus/cytomegalovirus (9.1%) were the most common season-ending diagnoses. CONCLUSIONS: Illnesses represent a significant cause of time out of play in MLB and MiLB. Prevention efforts should focus on limiting the spread of communicable viral, respiratory, and gastrointestinal disease among players, as the majority of diagnoses fell into these categories. This work may be used to guide future research into illness treatment and prevention in professional baseball.