Popping pills in youth elite sports - fact or fiction? A 36-week prospective cohort study of analgesic use in 1195 youth elite athletes and student controls.

OBJECTIVE: To investigate analgesic use in a cohort of Danish youth elite athletes, and compare weekly analgesic use over 36 weeks to student controls. We also investigated and compared reasons for analgesic use and types of analgesics used. DESIGN: Prospective cohort study. METHODS: 690 youth elite athletes (44% females) and 505 student controls (59% females) (age 15-20 years) provided weekly reports on analgesic use over 36 weeks. We asked about number of days with analgesic use, reasons for use, and types of analgesics used. Prevalence and frequency of analgesic use was compared between youth elite athletes and student controls using mixed effects logistic regression and mixed effects Poisson regression models. Reasons for and types of analgesics used was compared between groups using Chi-square tests. Subgroup analyses were performed, stratified by sex. RESULTS: Overall, athletes had lower odds of analgesic use (OR 0.78, 95% CI 0.64 to 0.95) compared with student controls. The overall usage rate was similar between the groups (IRR 1.04, 95% CI 0.99 to 1.11). Subgroup analyses suggested no statistically significant differences in the odds of analgesic use. Significantly more athletes reported using analgesics to prevent or treat pain or injury in relation to sports participation and to use topical gels compared with student controls. CONCLUSION: Participating in youth elite sports was associated with lower odds of analgesic use compared to student controls, but usage rate was similar between the groups. Reasons for use and types of analgesics use differed between athletes and student controls.

Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics.

OBJECTIVE: To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. METHODS: During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). RESULTS: On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). CONCLUSION: The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.

#ReadyToPlay: health problems in women's football-a two-season prospective cohort study in the Norwegian premier league.

OBJECTIVES: To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league. METHODS: During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported. RESULTS: We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss. CONCLUSION: One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe.

Performing Nordic hamstring strength testing with additional weight affects the maximal eccentric force measured: do not compare apples to oranges.

Background: Nordic hamstring test devices are commonly used to measure maximal eccentric hamstring force. The ability to control the final phase of the exercise has been adopted as a criterion to add weight when testing, without substantial evidence. We investigated if adding weight affected the maximal force measured, and if there were differences between players who could and could not control the final phase. Methods: Female (n=84) and male (n=56) football players performed a Nordic hamstring strength test with 0, 5 and 10 kg. We used visual inspection to assess the ability to control the final phase (approximately last 20°), as per previously published studies. Results: Maximal force was higher when tested with 5 kg (females: +8 N (2%), p<0.001; males: +18 N (4%), p<0.001) and 10 kg (females: +17 N (5%), p<0.001; males: +27 N (6%), p<0.001) compared with 0 kg. This was the case for both groups, those who could control the final phase (5 kg: +16 N (4%), p<0.001; 10 kg: +28 N (7%), p<0.001) and those who could not (5 kg: +9 N (3%), p<0.001; 10 kg: +15 N (4%), p<0.001). Conclusion: Both players who could and could not control the final phase of the Nordic hamstring test demonstrated higher maximal force when adding weight to testing. Therefore, this should not be used to decide if players should perform testing with or without weight. Either all participants or none should be tested with weight, and the same approach should be used both for pre-testing and post-testing.

To rest or to compete? A 4-week cohort study of analgesic use and willingness to compete hurt in Danish youth elite athletes.

OBJECTIVES: To assess the association between analgesic use and willingness to compete hurt (WCH) in Danish youth elite athletes, and to explore factors associated with such willingness. DESIGN: 4-week prospective cohort study. METHODS: 592 Danish youth elite athletes (15-20 years) completed a baseline questionnaire assessing demographic information, sport history, and WCH, and provided weekly reports on analgesic use for 4 weeks via text messages. Analgesic use was categorized as no use (0 weeks) or use across 1, 2, 3, or 4 weeks, and as the total number of days with analgesic use. Multinomial logistic regression and zero-inflated negative binomial regression analyses estimated the association between analgesic use and WCH. Linear backward stepwise regression analysis was used to identify factors associated with WCH. RESULTS: Overall, risk of analgesic use increased significantly with increasing WCH scores (relative risk ratios ranging from 1.06 (95% CI 1.0 to 1.12%) to 1.34% (95% CI 1.15 to 1.57)). The incidence rate of analgesic use increased significantly with increasing WCH scores (incidence rate ratio 1.09 (95% CI 1.04 to 1.14)). Associations between the investigated possible antecedent factors and WCH were weak and not considered practically important (R2 = 0.05 or lower). CONCLUSIONS: Higher WCH scores were associated with increasing risk of analgesic use, irrespective of the underlying reason for the use, in Danish youth elite athletes, suggesting that analgesics may be an ingrained part of a sport-specific culture of risk acceptance. Future studies should include measures of culture, norms, and social interaction to better explain the variance in WCH.

An early care void: The injury experience and perceptions of treatment among knee-injured individuals and healthcare professionals - A qualitative interview study.

OBJECTIVES: To better comprehend the initial injury experience and care requirements of knee-injured individuals, as well as healthcare professionals' interactions with early care. DESIGN: Qualitative interviews. SETTING: Public healthcare in Denmark. PARTICIPANTS: Ten individuals (6 women) with major knee injuries (6 anterior cruciate ligament (ACL) and meniscal tears, 2 isolated ACL tears, 1 isolated meniscal tear, 1 patella dislocation), aged 16-33 years (median 19 years), 1-26 months post-injury (median 3 months). Thirteen HCPs (5 physiotherapists, 5 orthopedic surgeons, 3 general practitioners). MAIN OUTCOME MEASURE: Semi-structured individual and focus group interviews, transcribed verbatim and with latent thematic analysis. RESULTS: The three main themes were: 1) Emotional struggles in solitude - knee-injured individuals dealing with emotions alone due to limited HCP resources for emotional support. 2) Blurry beginning - knee-injured individuals finding initial care frustrating, a sentiment shared by HCPs. 3) A journey with no map - knee-injured individuals holding varied outcome expectations, while HCPs hesitate to discuss long-term knee health. CONCLUSION: Early care for knee-injured individuals is filled with worries and unmet emotional and information support needs. HCPs need more support and training to deliver timely and appropriate care.

Validity of Session Rating of Perceived Exertion for Measuring Training Load in Youth Team Handball Players.

ABSTRACT: Pedersen, A, Randers, MB, Luteberget, LS, and Møller, M. Validity of session rating of perceived exertion for measuring training load in youth team handball players. J Strength Cond Res 37(1): 174-180, 2023-Session rating of perceived exertion (sRPE) is a subjective self-reported measure of training load and is a popular method in several different team sports. This study aimed to investigate the validity of sRPE, by correlating sRPE load (sRPE × minutes of training) and heart rate (HR) expressed as Edwards Summated Heart Rate Zones (SHRZ) and PlayerLoad among Danish youth team handball players. Second, the study aimed to investigate sRPE load's ability to descriptively differentiate between a low and a high training load category. A comparative cross-sectional study was conducted in the in-season period. Fourteen training sessions were measured from 6 teams, in which PlayerLoad, Edwards SHRZ, and sRPE load were measured for the training session and collected from 47 subjects (23 males and 24 females). Pearson's product-moment correlation coefficients were calculated between sRPE load and Edwards SHRZ and PlayerLoad. Furthermore, a high and a low load category were made from PlayerLoad or Edwards SHRZ to investigate sRPE load's ability to discriminate between high and low objective load. Large correlations between sRPE load and Edwards SHRZ (0.52 [95% CI 0.27:0.70]) and between sRPE load and PlayerLoad (0.67 [95% CI 0.47:0.80]) were observed. Our findings further indicate that sRPE load can differentiate between a high and a low training load category in both Edwards SHRZ and PlayerLoad. Our results show that sRPE load reflects both internal and external load during team handball training sessions and seems to discriminate between high- and low-intensity training sessions. These results support the validity of sRPE load for measuring training load in young team handball players.

Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus.

OBJECTIVE: This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD: A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS: According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION: The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE: On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.

Injuries in male youth football: a one season prospective cohort study of 223 Danish elite players.

Objectives: This study prospectively investigated injury prevalence, incidence, and burden in male elite under-17 football players (N = 223) during a full season. Methods: The players weekly completed a standardized web-based injury survey (OSTRC-H2) and a physical exposure report throughout the study. Results: Average weekly response rate was 89.5%. Football exposure accounted for 52.4% of total physical exposure. On average (±SD), the players participated in individual football, strength, and rehabilitation practices for 1.2 ± 1.5, 3.0 ± .2.1, and 1.9 ± 3.4 h/week, respectively. In total, 742 health problems were reported. Mean weekly prevalence of health problems, injuries and illnesses were 20.1%, 16.5% and 3.8%, respectively. The injury incidence per 1,000 h of football exposure, match play and team practice were 8.28 (95% CI: 7.54-9.08), 16.77 (95% CI: 13.65-20.4), and 7.24 (95% CI: 6.5-8.04), respectively. Sudden-onset and gradual-onset injuries accounted for 36.7% and 43.4% of the total proportion of health problems. Hip/groin injuries had the highest incidence (1.58/1,000 h), whereas knee injuries had the highest burden (20.86 days lost/1,000 h). On average, the players experienced 3.33 health problems (average duration: 7.8 days). On average pr. player, 2.7 (95% CI: 2.2-3.3) wks of football exposure were lost. Conclusion: Sudden and gradual-onset injuries influenced player availability during the season. Health problem prevalence fluctuated markedly, and injury incidence was higher during match play than training. The players had substantial volumes of training beyond football-specific training and matches. Our findings could assist medical and sports science practitioneers in enhancing training and recovery processes to maximize player availability.

Dialectical behavioral therapy-based group treatment versus treatment as usual for adults with attention-deficit hyperactivity disorder: a multicenter randomized controlled trial.

BACKGROUND: Studies on structured skills training groups have indicated beneficial, although still inconclusive, effects on core symptoms of ADHD in adults. This trial examined effects of Dialectical Behavioral Therapy-based group treatment (DBT-bGT) on the broader and clinically relevant executive functioning and emotional regulation in adults with ADHD. METHODS: In a multicenter randomized controlled trial, adult patients with ADHD were randomly assigned to receive either weekly DBT-bGT or treatment as usual (TAU) during 14 weeks. Subsequently, participants receiving TAU were offered DBT-bGT. All were reassessed six months after ended DBT-bGT. Primary outcomes were the Behavior Rating Inventory of Executive Function (BRIEF-A) and the Difficulties in Emotion Regulation Scale (DERS). Secondary outcomes included self-reported ADHD-symptoms, depressive and anxiety symptoms, and quality of life. We used independent samples t- tests to compare the mean difference of change from pre- to post-treatment between the two treatment groups, and univariate linear models adjusting for differences between sites. RESULTS: In total, 121 participants (68 females), mean age 37 years, from seven outpatient clinics were included, of whom 104 (86%) completed the 14-week trial. Entering the study, 63% used medication for ADHD. Compared to TAU (n = 54), patients initially completing DBT-bGT (n = 50) had a significantly larger mean reduction on the BRIEF-A (-12.8 versus -0.37, P = 0.005, effect size 0.64), and all secondary outcomes, except for symptoms of anxiety. All significant improvements persisted at 6 months follow-up. Change on DERS did not differ significantly between the groups after 14 weeks, but scores continued to decrease between end of group-treatment and follow-up. CONCLUSIONS: This DBT-bGT was superior to TAU in reducing executive dysfunction, core symptoms of ADHD and in improving quality of life in adults with ADHD. Improvements sustained six months after ended treatment. The feasibility and results of this study provide evidence for this group treatment as a suitable non-pharmacological treatment option for adults with ADHD in ordinary clinical settings. TRIAL REGISTRATIONS: The study was pre-registered in the ISRCTN registry (identification number ISRCTN30469893, date February 19th 2016) and at the ClinicalTrials.gov (ID: NCT02685254, date February 18th 2016).

Prevalence, frequency, adverse events, and reasons for analgesic use in youth athletes: A systematic review and meta-analysis of 44,381 athletes.

OBJECTIVES: To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes. DESIGN: Systematic review and meta-analysis. METHODS: Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15-24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively. RESULTS: Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48 % [95 % CI 23 % to 73 %], in-season prevalence 92 % [95 % CI 88 % to 95 %]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2 % [95 % CI 1 % to 3 %]). Seven to 50 % of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3 % to 19.2 %. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance. CONCLUSIONS: Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesic use to understand consumption trajectories.

Cocreating injury prevention training for youth team handball: bridging theory and practice.

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The 'Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)' uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants' contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.

2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels.

SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.

Effects of High and Low Training Volume with the Nordic Hamstring Exercise on Hamstring Strength, Jump Height, and Sprint Performance in Female Football Players: A Randomised Trial.

The evidence-based hamstring strengthening programme for prevention of hamstring injuries is not adopted by football teams because of its high training volume. This study on female football players investigated if high-volume training with the Nordic hamstring exercise is more effective on hamstring strength, jump height, and sprint performance than low-volume training. We also examined the time course of changes in muscle strength during the intervention period. Forty-five female football players were randomised to a high- (21 sessions, 538 total reps) or low-volume group (10 sessions, 144 total reps) and performed an 8-week training intervention with the Nordic hamstring exercise during the preseason. We tested hamstring strength (maximal eccentric force with NordBord and maximal eccentric torque with isokinetic dynamometer), jump height, and 40 m sprint before and after the intervention. The NordBord test was also performed during training weeks 4 and 6. Both groups increased maximal eccentric force (high-volume: 29 N (10%), 95% CI: 19-38 N, p < 0.001, low-volume: 37 N (13%), 95% CI: 18-55 N, p = 0.001), but there were no between-group differences (p = 0.38). Maximal eccentric torque, jump height, and sprint performance did not change. Maximal eccentric force increased from the pretest to week 6 (20 N (7%), 95% CI: 8 to 31 N, p < 0.001), but not week 4 (8 N (3%), 95% CI: -2 to 18 N, p = 0.22). High training volume with the Nordic hamstrings exercise did not lead to greater adaptations in strength, jump height, or speed than a low-volume programme. Players in both groups had to train for at least 6 weeks to improve maximal eccentric force significantly.

Quantifying throwing load in handball: a method for measuring the number of throws.

Shoulder injuries are a common problem in handball. One likely cause of such injuries is excessive throwing. However, it is difficult to measure the number of player throws in large cohort studies using existing methods accurately. Therefore, the purpose of this study is to develop and validate a method for identifying overhead throws using a low-cost inertial measurement unit (IMU) worn on the wrist. In a two-stage approach, we developed a threshold-based automatic identification method for overhead throws in a laboratory study using the IMU. Subsequently, we validated the suggested thresholds in a field setting by comparing throws identified by the threshold-method to throws identified by video recordings of handball practices. The best set of threshold values resulted in a per-player median sensitivity of 100% (range: 84-100%) and a median positive predictive value (PPV) of 96% (range: 86-100%) in the development study. In the validation study, the per-player median sensitivity dropped to 78% sensitivity (range: 52-91%), while the per-player median PPV dropped to 79% (range: 47-90%). The proposed method is a promising method for automatically identifying handball throws in a cheap and feasible way.

"Is it fun and does it enhance my performance?" - Key implementation considerations for injury prevention programs in youth handball.

OBJECTIVES: We aimed to determine the use of injury prevention exercises and injury prevention exercise programs in Danish youth handball and investigate coach and player experiences, beliefs and attitudes of injury and their prevention. DESIGN: A mixed-methods design consisting of cross-sectional quantitative surveys and qualitative interviews. METHODS: We surveyed 481 youth (14-18 years old) handball players and their 33 coaches about their use of injury prevention exercises, and attitudes towards injury and their prevention. Additionally, we interviewed five coaches and three players about barriers and motivational factors for implementing injury prevention programs. RESULTS: Players (71%) and almost all coaches reported performing injury prevention exercises for the shoulder, knee, and ankle. Yet few players (4%) and coaches (1%) reported performing the established full injury prevention programs systematically. Players were willing to implement programs to reduce injury risk (84% agreed) and enhance performance (88% agreed). Key factors influencing program uptake were lack of awareness of evidence-based injury prevention programs and lack of handball-specific exercises. Coaches and players identified continued education and training as vital facilitators in this setting, and all coaches agreed that injury prevention should be an essential part of coach education. CONCLUSIONS: While Danish youth handball players and coaches seemed to recognize the importance of injury prevention, the use of established programs was marginal. Experiences, beliefs, and attitudes about injury and injury prevention influenced program uptake and should be addressed through continued education and training in this context in combination with making the programs more handball specific.

Estimating Throwing Speed in Handball Using a Wearable Device.

Throwing speed is likely a key determinant of shoulder-specific load. However, it is difficult to estimate the speed of throws in handball in field-based settings with many players due to limitations in current technology. Therefore, the purpose of this study was to develop a novel method to estimate throwing speed in handball using a low-cost accelerometer-based device. Nineteen experienced handball players each performed 25 throws of varying types while we measured the acceleration of the wrist using the accelerometer and the throwing speed using 3D motion capture. Using cross-validation, we developed four prediction models using combinations of the logarithm of the peak total acceleration, sex and throwing type as the predictor and the throwing speed as the outcome. We found that all models were well-calibrated (mean calibration of all models: 0.0 m/s, calibration slope of all models: 1.00) and precise (R2 = 0.71-0.86, mean absolute error = 1.30-1.82 m/s). We conclude that the developed method provides practitioners and researchers with a feasible and cheap method to estimate throwing speed in handball from segments of wrist acceleration signals containing only a single throw.

Shoulder Rotation Strength Changes From Preseason to Midseason: A Cohort Study of 292 Youth Elite Handball Players Without Shoulder Problems.

OBJECTIVE: To investigate change in shoulder rotation strength from preseason to midseason during a competitive season in youth elite handball players without shoulder problems. DESIGN: Prospective cohort study. METHODS: Players (n = 292, 45% female, 14-18 years of age) without shoulder problems from Danish youth elite handball clubs were assessed in the preseason and midseason. We measured isometric shoulder strength using handheld dynamometry in internal rotation (IR) and external rotation (ER) in supine, with the shoulder abducted 90° in neutral rotation and in 30° of IR. The primary outcome was the change in corresponding ER/IR ratio. RESULTS: The mean ER/IR ratios increased from preseason to midseason in neutral rotation (male player difference, 0.02; 95% confidence interval [CI]: -0.01, 0.06; female player difference, 0.05; 95% CI: 0.01, 0.09) and in 30° of IR (male player difference, 0.15; 95% CI: 0.11, 0.20; female player difference, 0.12; 95% CI: 0.07, 0.17). The change in ER/IR ratio may be explained by an increase in ER strength in female players and a decrease in IR strength in male players. The amount of change in ER/IR ratio over the season was greater than individual measurement error metrics for 45% to 66% of the players. CONCLUSION: Shoulder rotation strength ratios changed during a competitive season in Danish youth elite handball players. J Orthop Sports Phys Ther 2020;50(7):381-387. doi:10.2519/jospt.2020.9183.

Statement on Methods in Sport Injury Research From the First METHODS MATTER Meeting, Copenhagen, 2019.

SYNOPSIS: High-quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best-practice methods-methods matter (greatly!). The first METHODS MATTER meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting. Meeting participants agreed that the definition of sport injury depends on the research question and context. It was considered essential to be explicit about the goal of the research effort and to use frameworks to illustrate the assumptions that underpin measurement and the analytical strategy. Complex systems were discussed to illustrate how potential risk factors can interact in a nonlinear way. This approach is often a useful alternative to identifying single risk factors. Investigating changes in exposure status over time is important when analyzing sport injury etiology, and analyzing recurrent injury, subsequent injury, or injury exacerbation remains challenging. The choice of statistical model should consider the research question, injury measure (eg, prevalence, incidence), type and granularity of injury data (categorical or continuous), and study design. Multidisciplinary collaboration will be a cornerstone for future high-quality sport injury research. Working outside professional silos in a diverse, multidisciplinary team benefits the research process, from the formulation of research questions and designs to the statistical analyses and dissemination of study results in implementation contexts. This article has been copublished in the British Journal of Sports Medicine and the Journal of Orthopaedic & Sports Physical Therapy. J Orthop Sports Phys Ther 2020;50(5):226-233. doi:10.2519/jospt.2020.9876.

Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 2019.

High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods-methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.