Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport.

Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal of returning to sport, the rehabilitation focus historically has been on recovery of physical attributes, but more recent research is addressing the psychological factors. This Perspective proposes that-according to the current evidence in sports medicine-the fear that affects choice of treatment, rehabilitation, and return to sports is intertwined with physical capacity and recovery of function. Past injury is also 1 of the main risk factors for a sports injury; therefore, fear of reinjury is not irrational. For an athlete, the fear related to a sports injury encompasses the fear of reinjury along with fear of not being able to return to the sport at their highest performance level-and the fear of having lifelong debilitating pain and symptoms. This Perspective reviews the evidence for the influence of fear of movement and reinjury on choice of treatment, rehabilitation, and return to sport and provides suggestions on how to address this fear during the continuum of treatment and return to sports.

Dance Exposure, Individual Characteristics, and Injury Risk over Five Seasons in a Professional Ballet Company.

PURPOSE: This study aimed to describe the relationships between dance exposure, dancer characteristics, and injury risk across five seasons in a professional ballet company. METHODS: Dance exposure time and clinician-reported time-loss and medical attention injury data were prospectively collected from 118 professional dancers of The Royal Ballet between 2015/2016 and 2019/2020. Cox proportional hazards and shared frailty models were fitted to overuse and traumatic injuries; individualized robust Z-scores for 7- and 28-d accumulated exposure, and week-to-week change in exposure, age, sex, company rank, and injury history were included as time-varying covariates. RESULTS: Across 381,710 h of exposure, 1332 medical attention and 427 time-loss injuries were observed. Positive relationships were observed between week-to-week change in exposure and overuse time-loss (+1 Z-score hazard ratio (HR), 1.27; 95% confidence interval (CI), 1.06-1.53) and medical attention injury risk (+1 Z-score HR, 1.17; 95% CI, 1.06-1.28). A negative relationship was observed between 7-d accumulated exposure and overuse medical attention injury risk (+1 Z-score HR, 0.74; 95% CI, 0.66-0.84). Overuse time-loss injury risk was greater in soloists compared with the corps de ballet (HR, 1.47; 95% CI, 1.01-2.15) and in dancers with a higher previous injury rate (+1 injury per 1000 h HR, 1.06; 95% CI, 1.02-1.10). Only age was associated with traumatic time-loss (+1-yr HR, 1.05; 95% CI, 1.01-1.09) or medical attention injury risk (+1-yr HR, 1.04; 95% CI, 1.01-1.07). CONCLUSIONS: Professional ballet companies should implement training principles such as periodization and progression, particularly in the case of senior-ranking dancers, older dancers, and dancers with high rates of previous injury. These findings provide a basis for future prospective investigations into specific causal injury pathways.

The prognostic value of the hamstring outcome score to predict the risk of hamstring injuries.

OBJECTIVES: Hamstring injuries are common among soccer players. The hamstring outcome score (HaOS) might be useful to identify amateur players at risk of hamstring injury. Therefore the aims of this study were: To determine the association between the HaOS and prior and new hamstring injuries in amateur soccer players, and to determine the prognostic value of the HaOS for identifying players with or without previous hamstring injuries at risk of future injury. DESIGN: Cohort study. METHODS: HaOS scores and information about previous injuries were collected at baseline and new injuries were prospectively registered during a cluster-randomized controlled trial involving 400 amateur soccer players. Analysis of variance and t-tests were used to determine the association between the HaOS and previous and new hamstring injury, respectively. Logistic regression analysis indicated the prognostic value of the HaOS for predicting new hamstring injuries. RESULTS: Analysis of data of 356 players indicated that lower HaOS scores were associated with more previous hamstring injuries (F=17.4; p=0.000) and that players with lower HaOS scores sustained more new hamstring injuries (T=3.59, df=67.23, p=0.001). With a conventional HaOS score cut-off of 80%, logistic regression models yielded a probability of hamstring injuries of 11%, 18%, and 28% for players with 0,1, or 2 hamstring injuries in the previous season, respectively. CONCLUSIONS: The HaOS is associated with previous and future hamstring injury and might be a useful tool to provide players with insight into their risk of sustaining a new hamstring injury risk when used in combination with previous injuries.

Standard RTS criteria effectiveness verification using FMS, Y-balance and TJA in footballers following ACL reconstruction and mild lower limb injuries.

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament. In previous studies, it was demonstrated that patients following ACL reconstruction may present motor deficits which may be related to increased risk of injury. The objective of the study was to determine whether players who have passed RTS assessment still have deficits in movement patterns or in neuromuscular control after such a serious injury as ACL rupture and reconstruction,. Sixty-five male football players (age 18-25 years), recruited from regional teams, were divided into three groups: (1) ACL group-subjects after ACL rupture and reconstruction (n = 24); (2) Mild Injury (MI) group-subjects after mild lower limb injuries (n = 21); and (3) Control (C) group-subjects without injuries (n = 20). For all groups, the Y-balance test, Functional Movement Screen (FMS) and Tuck Jump Assessment (TJA) were performed. For the Y-balance test in ACL group for the injured leg, significantly lower values were demonstrated for anterior reach ((ACL) 69.2 ± 5.7% vs. (MI) 74.8 ± 4.5% vs. (C) 74.0 ± 5.6%), at posterior-lateral reach ((ACL) 103.2 ± 6.4% vs. (C) 108.5 ± 6.0%) and composite score ((ACL) 93.9 ± 4.4% vs. (MI) 97.9 ± 4.3%) in comparison to the remaining two groups. In the FMS test, the ACL group had significantly lower composite score (12 ± 4 points) compared to the C group (15 ± 2 points). Also, compared to the remaining groups, subjects following ACL reconstruction demonstrated significantly lower performance in the TJA test related to the following elements: thighs do not reach parallel, thighs not equal side-to-side, foot placement not shoulder width apart, technique declines prior to 10 s and lower extremity valgus at landing. The authors have observed that athletes after ACL reconstruction still have deficits in movement patterns or in neuromuscular control despite passing the RTS and being cleared to perform sports. Creating a set of sufficiently sensitive assessment methods may significantly reduce the potential risk of injury due to the fact that diagnosed and monitored deficits may be treated on an ongoing basis. The authors suggest that individual elements of the Y-balance and TJA tests may be suitable for such specific assessment.

Better reporting standards are needed to enhance the quality of hop testing in the setting of ACL return to sport decisions: a narrative review.

BACKGROUND/AIM: There is a lack of consistency in return to sport (RTS) assessments, in particular hop tests to predict who will sustain a reinjury following anterior cruciate ligament (ACL) reconstruction. Inconsistent test battery content and methodological heterogeneity might contribute to variable associations between hop test performance and subsequent injury. Our aim was to investigate whether commonly used hop tests are administered in a consistent manner and in accordance with reported guidelines. METHODS: We conducted a narrative review of studies that examined whether hop testing could differentiate RTS pass rates, reinjury and rerupture in athletes after ACL reconstruction. Our specific focus was on the methodological procedures of hop testing as this component is widely used to evaluate patients' function and readiness to RTS. MAIN FINDINGS: Substantial variation exists in RTS hop test administration, scoring and interpretation. Authors often failed to report important details of methods such as warm up activities, randomisation, number of trials, rest periods and landing requirements. CONCLUSION: We recommend researchers provide clearer descriptions of how hop tests are performed to increase standardisation and promote accurate data collection. Absence of reporting to describe test methods and using different test procedures makes it difficult to compare study findings.

Return to sports bridge program improves outcomes, decreases ipsilateral knee re-injury and contralateral knee injury rates post-ACL reconstruction.

PURPOSE: To present the results of a return to sports bridge program designed to reduce knee injuries following ACL reconstruction and physical therapy. METHODS: One hundred and fifty (male = 83, female = 67) patients participated in a whole body neuromuscular control, progressive resistance strength and agility training program. Post-program testing included functional movement form, dynamic knee stability, lower extremity power, agility, and sports skill assessments. Participants completed the Knee Outcome Survey-Sports Activity Scale (KOS-SAS) before and after program initiation. Pre-participation scores were re-estimated following program completion. RESULTS: Global rating KOS-SAS score at program entry was 75 ± 13. Post-program global rating and calculated KOS-SAS were 91.0 ± 9.8 and 90.9 ± 9.7, respectively (p < 0.0001). Pre-participation KOS-SAS score re-estimates at program completion were 54.5 ± 23.3 and 57.3 ± 18.5, respectively. The approximately 20% lower pre-program KOS-SAS score re-estimates (p < 0.0001) observed at program completion suggests that subjects had inaccurately high sports readiness perceptions at program entry. Perceived overall sports activity knee function ratings improved from 2.9 ± 0.6 (abnormal) at program entry to 1.3 ± 0.5 (normal) at completion (p < 0.0001). Most subjects returned back to sports at or above their pre-injury performance skill/performance level (84%, 126/150). By 6.8 ± 3.2 years (range = 2-13 years) post-surgery, ten subjects had sustained an ipsilateral knee re-injury or contralateral knee injury (6.7%). The 2.7% non-contact contralateral and 1.3% non-contact ipsilateral knee injury rates observed were significantly lower than those cited in previous reports. CONCLUSION: Supplementing primary ACL reconstruction and standard physical therapy with a return to sports bridge program prior to release to unrestricted sports performance was effective at improving patient outcomes and decreasing ipsilateral knee re-injury and contralateral knee injury rates. LEVEL OF EVIDENCE: II.