The Associations Between Wellbeing and Injury Differ by Time Loss in Collegiate Athletes.

BACKGROUND: Self-reported wellbeing measures such as mood and soreness have been identified as predictors of injury risk. However, most research has focused on investigating time-loss injuries even though nontime-loss injuries are more prevalent. HYPOTHESIS: Impairments in sleep and subjective wellbeing would be associated with increased injury for both time-loss and nontime-loss injuries. STUDY DESIGN: Prospective longitudinal study. LEVEL OF EVIDENCE: Level 3. METHODS: During 2022, 127 athletes completed a daily survey that inquired about training load and sleep from the previous day along with mood, stress, and soreness on the current day. Incidence of injury was also monitored using documentation provided by athletes' respective athletic trainers. Mixed effect models were used to analyze the relationship between wellbeing and sleep measures with injury. RESULTS: Self-reported wellbeing, based most closely on soreness the day of injury, by National Collegiate Athletic Association Division 1 collegiate athletes was predictive of time-loss injuries, whereas no significant relationship was identified for nontime-loss injuries. Specifically, 1 unit increase in soreness was associated with a 39% increase in odds of sustaining a time-loss injury. CONCLUSION: This study found that subjective wellbeing and sleep have a different relationship with injury dependent upon whether the resulting injury leads to time loss. CLINICAL RELEVANCE: Self-reported wellbeing appears to be a relevant predictor of injury among collegiate athletes for time-loss injuries.

Anxiety and Depression Prevalence in Incoming Division I Collegiate Athletes From 2017 to 2021.

BACKGROUND: Young adults report increased rates of anxiety and depression than other age groups. Furthermore, young adult athletes experience additional stressors that may negatively impact their mental health. The aim of this study was to investigate the prevalence of anxiety and depression symptoms among Division I collegiate athletes and the influences of sex, sport type, and distance from home. HYPOTHESIS: It was hypothesized that self-reported levels of anxiety and depression would increase among this population during this timeframe. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 3. METHODS: Participants included 792 incoming Division I collegiate athletes. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores were completed by all incoming student athletes at a single institution as part of their preparticipation examination over 5 years. Both survey scores were categorized into different levels of severity and separately compared with chi-square tests. Continuous scores were modeled separately using negative binomial regression models including year, sex, sport type, and home location as covariates. RESULTS: Results showed consistent levels of anxiety and depression over time. Female athletes reported higher levels of both anxiety and depression than male athletes, and individual sport athletes reported higher levels of depression than team sport athletes. Distance from home was not associated with anxiety or depression levels. CONCLUSION: Overall, levels of anxiety and depression did not change in this population over this time period. However, differences in anxiety and depression were seen between sexes and depression between sport types. CLINICAL RELEVANCE: Understanding anxiety and depression risk factors among collegiate athletes can enhance early identification and intervention to improve mental health and allow for better allocation of resources to at-risk groups among Division I collegiate athletes.

Association of in-competition injury risk and the degree of rapid weight cutting prior to competition in division I collegiate wrestlers.

OBJECTIVES: Weight cutting is thought to offer a competitive advantage in wrestling. Dehydration has deleterious effects on physical and cognitive function, which may increase the risk of injury. The purpose of the study was to investigate whether the degree of weight cutting was associated with injury risk. METHODS: Data were collected prospectively in a cohort of collegiate wrestlers over seven seasons. Changes in weight, body fat and lean mass were measured during the preseason, at midseason and before competition. Cox proportional-hazard ratios were calculated for risk of in-competition injury. RESULTS: Among 67 unique division 1 collegiate wrestlers (163 athlete seasons), there were 53 unique injuries affecting 46 athletes. There was no difference in absolute weight change, per cent weight change, per cent body fat change or per cent lean mass change between injured and non-injured wrestlers from the preseason to midseason measurements. From midseason to competition weight, change in body weight was -7.0%±3.2% (-5.3 kg±2.6) in injured athletes compared with -5.7%±3.3% (-4.3 kg±2.5) in non-injured athletes. For every kilogram of body weight lost, wrestlers had a 14% increased hazard of injury (HR 1.14, 95% CI 1.04 to 1.25, p=0.004). For every 1% of body weight lost, wrestlers had an 11% increased hazard of injury (HR 1.11, 95% CI 1.03 to 1.19, p=0.005). CONCLUSION: Rapid weight cutting was associated with a higher risk of in-competition injuries in division 1 collegiate wrestlers. For every per cent in body weight lost, wrestlers had an 11% increased hazard of injury during competition.

Preseason Eccentric Strength Is Not Associated with Hamstring Strain Injury: A Prospective Study in Collegiate Athletes.

INTRODUCTION: Established risk factors for hamstring strain injuries (HSI) include older age and prior HSI. However, these are nonmodifiable and have a limited role in injury prevention. Eccentric hamstring strength is a common component of HSI prevention programs, but its association with injury is less clear. PURPOSE: This study aimed to determine if eccentric hamstring strength was prospectively associated with HSI among collegiate athletes, while controlling for sex, age, and prior HSI. We hypothesized that athletes with lower eccentric hamstring strength or greater between-limb strength asymmetry at preseason would have an increased risk of HSI. METHODS: Hamstring eccentric strength measures, maximum total force ( FTotal ) and between-limb asymmetry in maximum force ( FAsym ), were measured at preseason on male and female athletes. HSIs were tracked over the subsequent 12 months. Generalized estimating equations were used to identify univariable and multivariable associations between athlete demographics, eccentric hamstring strength, and HSI risk. RESULTS: Data for 326 athletes (85 female; 30 track, 43 basketball, 160 American football, 93 soccer) were included, and 64 HSIs were observed. Univariable associations between eccentric hamstring strength and subsequent HSI were nonsignificant ( FTotal : odds ratio [OR], 0.99 (95% confidence interval (CI), 0.93-1.05); P = 0.74; FAsym : OR, 1.35 (95% CI, 0.87-2.09); P = 0.23). No relationship between eccentric hamstring strength and HSI ( FAsym : OR, 1.32 (95% CI, 0.84-2.08); P = 0.23) was identified after adjusting for confounders including sex, age, and prior HSI. CONCLUSIONS: No association between preseason eccentric hamstring strength and risk of subsequent HSI was identified after controlling for known risk factors and sex among collegiate athletes. Eccentric hamstring strengthening may continue to serve as a preventative approach to HSI, but it does not provide additional insight into HSI risk beyond factors such as age and prior HSI.

Comparing High School Sport Specialization Trends Between Division I and Club Collegiate Athletes.

BACKGROUND: Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes. HYPOTHESIS: There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes. STUDY DESIGN: Retrospective cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one's primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately. RESULTS: Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes. CONCLUSION: High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary. CLINICAL RELEVANCE: Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.

Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners.

OBJECTIVES: To determine if running biomechanics and bone mineral density (BMD) were independently associated with bone stress injury (BSI) in a cohort of National Collegiate Athletic Association Division I cross country runners. METHODS: This was a prospective, observational study of 54 healthy collegiate cross country runners over three consecutive seasons. Whole body kinematics, ground reaction forces (GRFs) and BMD measures were collected during the preseason over 3 years via motion capture on an instrumented treadmill and total body densitometer scans. All medically diagnosed BSIs up to 12 months following preseason data collection were recorded. Generalised estimating equations were used to identify independent risk factors of BSI. RESULTS: Univariably, step rate, centre of mass vertical excursion, peak vertical GRF and vertical GRF impulse were associated with BSI incidence. After adjusting for history of BSI and sex in a multivariable model, a higher step rate was independently associated with a decreased risk of BSI. BSI risk decreased by 5% (relative risk (RR): 0.95; 95% CI 0.91 to 0.98) with each one step/min increase in step rate. BMD z-score was not a statistically significant risk predictor in the final multivariable model (RR: 0.93, 95% CI 0.85 to 1.03). No other biomechanical variables were found to be associated with BSI risk. CONCLUSION: Low step rate is an important risk factor for BSI among collegiate cross country runners and should be considered when developing comprehensive programmes to mitigate BSI risk in distance runners.

Star Excursion Balance Test Anterior Asymmetry Is Associated With Injury Status in Division I Collegiate Athletes.

Study Design Retrospective cohort. Background Star Excursion Balance Test (SEBT) performance differs by sport in healthy collegiate athletes, and lower extremity injury rates also vary by sport, sex, and athletic exposure. The relationship between SEBT performance and injury risk has not been evaluated with consideration of these additional variables, which may be necessary to fully describe the relationship between SEBT performance and injury risk. Objectives To assess the association between preseason SEBT performance and noncontact injury occurrence to the knee or ankle in Division I collegiate athletes when controlling for sport, sex, and athletic exposure. Methods Star Excursion Balance Test performance, starting status, and injury status were reviewed retrospectively in National Collegiate Athletic Association Division I collegiate athletes from a single institution. A total of 147 athletes were healthy at the time of preseason SEBT testing and either remained healthy (n = 118) or sustained a noncontact injury to the knee or ankle (n = 29) during their sport's subsequent competitive season. Side-to-side asymmetries were calculated in each direction as the absolute difference in reach distance between limbs. Star Excursion Balance Test reach distances and asymmetries were compared between groups using multivariable regression, controlling for sport, sex, and athletic exposure (starter, nonstarter). Receiver operating characteristic curves were used to determine optimal sensitivity and specificity for significant models. Results When controlling for sport, sex, and athletic exposure, SEBT side-to-side asymmetry in the anterior direction, expressed as an absolute or normalized to limb length, discriminated between injured and noninjured athletes (area under the curve greater than 0.82). Conclusion Assessing side-to-side reach asymmetry in the anterior direction of the SEBT may assist in identifying collegiate athletes who are at risk for sustaining noncontact injuries to the knee or ankle. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2017;47(5):339-346. Epub 29 Mar 2017. doi:10.2519/jospt.2017.6974.

High School Sport Specialization Patterns of Current Division I Athletes.

BACKGROUND: Sport specialization is a strategy to acquire superior sport performance in 1 sport but is associated with increased injury risk. Currently, the degree of high school specialization among Division I athletes is unknown. HYPOTHESIS: College athletes will display increased rates of specialization as they progress through their high school careers. STUDY DESIGN: Descriptive epidemiological study. LEVEL OF EVIDENCE: Level 4. METHODS: Three hundred forty-three athletes (115 female) representing 9 sports from a Midwest Division I University completed a previously utilized sport specialization questionnaire regarding sport participation patterns for each grade of high school. McNemar and chi-square tests were used to investigate associations of grade, sport, and sex with prevalence of sport specialization category (low, moderate, high) (a priori P ≤ 0.05). RESULTS: Specialization increased throughout high school, with 16.9% (n = 58) and 41.1% (n = 141) of athletes highly specialized in 9th and 12th grades, respectively. Football athletes were less likely to be highly specialized than nonfootball athletes for each year of high school ( P < 0.001). There was no difference in degree of specialization between sexes at any grade level ( P > 0.23). CONCLUSION: The majority of Division I athletes were not classified as highly specialized throughout high school, but the prevalence of high specialization increased as athletes progressed through high school. Nonfootball athletes were more likely to be highly specialized than football athletes at each grade level. CLINICAL RELEVANCE: Most athletes who are recruited to participate in collegiate athletics will eventually specialize in their sport, but it does not appear that early specialization is necessary to become a Division I athlete. Athletes should be counseled regarding safe participation in sport during high school to minimize injury and maximize performance.

Star Excursion Balance Test Performance Varies by Sport in Healthy Division I Collegiate Athletes.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To describe performance and asymmetry on the Star Excursion Balance Test (SEBT) by sex and sport, and to determine if differences exist within a collegiate athlete population. BACKGROUND: Performance on the SEBT may differ between sexes and levels of competition, though the results of previous studies have been inconsistent. Investigation of performance and asymmetry differences between sports is limited. Sex- and sport-specific reference values likely need to be determined to best assess SEBT performance. METHODS: Performance on the SEBT was retrospectively reviewed in 393 healthy National Collegiate Athletic Association Division I collegiate athletes from 8 sports. Means, standard deviations, and 95% confidence intervals were calculated for all variables. Normalized reach distance (percent limb length) and asymmetry between limbs were compared for the anterior (ANT), posterolateral (PL), and posteromedial (PM) directions and for the composite (COMP) score using a 2-way analysis of variance (ANOVA) of sex by sport, and a 1-way ANOVA to separately compare sports within each sex. RESULTS: Average normalized reach distance ranged from 62% to 69%, 84% to 97%, and 99% to 113% in the ANT, PL, and PM directions, respectively, and from 82% to 92% in the COMP score. Normalized asymmetry ranged from 3% to 4%, 5% to 8%, and 5% to 6% in the ANT, PL, and PM directions, respectively. A significant sex-by-sport interaction (P = .039) was observed in the ANT direction, with a sex effect for soccer players (P<.001; men less than women). Significant differences were observed in the PL and PM directions and in the COMP score among women's teams, with women's ice hockey players reaching the farthest (COMP, 90.0%). Among men's teams, significant differences were observed in all directions and in the COMP score. Men's ice hockey players (COMP, 91.9%) and wrestlers achieved the farthest distances (COMP, 88.8%). CONCLUSION: Performance on the SEBT varies by team, with a difference between sexes also present for soccer. Performance on the SEBT and potential injury risk should be interpreted within the context of the athlete's sport.

Lean mass asymmetry influences force and power asymmetry during jumping in collegiate athletes.

The purpose of this investigation was to (a) examine how asymmetry in lower extremity lean mass influenced force and power asymmetry during jumping, (b) determine how power and force asymmetry affected jump height, and (c) report normative values in collegiate athletes. Force and power were assessed from each limb using bilateral force plates during a countermovement jump in 167 division 1 athletes (mass = 85.7 ± 20.3 kg, age = 20.0 ± 1.2 years; 103 men and 64 women). Lean mass of the pelvis, thigh, and shank was assessed using dual-energy x-ray absorptiometry. Percent asymmetry was calculated for lean mass at each region (pelvis, thigh, and shank) as well as force and power. Forward stepwise regressions were performed to determine the influence of lean mass asymmetry on force and power asymmetry. Thigh and shank lean mass asymmetry explained 20% of the variance in force asymmetry (R = 0.20, p < 0.001), whereas lean mass asymmetry of the pelvis, thigh, and shank explained 25% of the variance in power asymmetry (R = 0.25, p < 0.001). Jump height was compared across level of force and power asymmetry (p > 0.05) and greater than 10% asymmetry in power tended to decrease the performance (effect size >1.0). Ninety-five percent of this population (2.5th to 97.5th percentile) displayed force asymmetry between -11.8 and 16.8% and a power asymmetry between -9.9 and 11.5%. A small percentage (<4%) of these athletes displayed more than 15% asymmetry between limbs. These results demonstrate that lean mass asymmetry in the lower extremity is at least partially responsible for asymmetries in force and power. However, a large percentage remains unexplained by lean mass asymmetry.

Hamstring strength and morphology progression after return to sport from injury.

PURPOSE: Hamstring strain reinjury rates can reach 30% within the initial 2 wk after return to sport (RTS). Incomplete recovery of strength may be a contributing factor. However, relative strength of the injured and unaffected limbs at RTS is currently unknown.The purpose was to characterize hamstring strength and morphology at the time of RTS and 6 months later. METHODS: Twenty-five athletes who experienced an acute hamstring strain injury participated after completion of a controlled rehabilitation program. Bilateral isokinetic strength testing and magnetic resonance imaging (MRI) were performed at RTS and 6 months later. Strength (knee flexion peak torque, work, and angle of peak torque) and MRI (muscle and tendon volumes) measures were compared between limbs and over time using repeated-measures ANOVA. RESULTS: The injured limb showed a peak torque deficit of 9.6% compared to the uninjured limb at RTS (60°·s, P < 0.001) but not 6 months after. The knee flexion angle of peak torque decreased over time for both limbs (60°·s, P < 0.001). MRI revealed that 20.4% of the muscle cross-sectional area showed signs of edema at RTS with full resolution by the 6-month follow-up. Tendon volume of the injured limb tended to increase over time (P = 0.108), whereas muscle volume decreased between 4% and 5% in both limbs (P < 0.001). CONCLUSIONS: Residual edema and deficits in isokinetic knee flexion strength were present at RTS but resolved during the subsequent 6 months. This occurred despite MRI evidence of scar tissue formation (increased tendon volume) and muscle atrophy, suggesting that neuromuscular factors may contribute to the return of strength.