Media narratives commonly portray elite women’s football as experiencing an ‘ACL epidemic’, suggesting a sharp and alarming rise in ACL injuries. Such claims warrant scrutiny as they may influence perceptions of women’s sport. This paper combines published injury surveillance data over the past 25 years to observe trends in ACL injury incidence and volume in elite women’s football. Data were extracted from 10 peer-reviewed studies identified through recent systematic reviews and targeted searches, covering top leagues in six countries and UEFA competitions. ACL injury incidence rate in training, match play and overall, as well as the number of injuries per team per season, were examined across leagues and time periods. Despite limitations in geographical coverage and gaps in longitudinal data, findings consistently demonstrate low stable ACL injury incidence rates, with fewer than one ACL injury per team per season in almost all studies. Notably, some of the lowest match incidence rates were reported in the most recent seasons. Overall, the available evidence does not support the notion of an ACL injury ‘epidemic’ in elite women’s football with similar trends of <1 ACL injury in all studies collected apart from one study assessing the German league 2003–2004 season with 1.2 ACL injuries per team per season. This highlights the need for evidence-based, non-sensationalist discourse.
Background Musculoskeletal disorders (MSDs) are a leading cause of disability worldwide and account for a substantial proportion of healthcare utilisation. Injection therapy combining corticosteroids with local anaesthetic (LA) is widely used for MSD management, including within physiotherapy practice. Despite widespread use, uncertainty remains regarding the safety profile of LAs and the potential risk of adverse events.Objective To map the available evidence on adverse events and associated risk factors following local anaesthetic use in the management of musculoskeletal disorders.Methods A scoping review was conducted following Joanna Briggs Institute methodology and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. MEDLINE, CINAHL, PubMed and Cochrane were searched from database inception to 2025, alongside targeted grey literature searching. Studies reporting adverse effects of LAs administered for musculoskeletal conditions within physiotherapy scope of practice were included. Data were extracted by multiple reviewers and synthesised thematically.Results 39 sources were included. Cytotoxicity, particularly chondrotoxicity, was the most frequently reported adverse effect, appearing in 74% of included sources. Evidence indicated reduced chondrocyte viability, mitochondrial dysfunction and apoptosis following exposure to commonly used agents such as lidocaine and bupivacaine. Systemic toxicity, allergic reactions and psychogenic responses were reported less frequently. Key risk factors included higher dose or concentration, prolonged exposure duration, continuous intra-articular infusion, patient comorbidities and accidental intravascular injection.Conclusion Evidence on adverse effects of LA use in MSD management is heterogeneous but consistently highlights cytotoxicity as a potential concern. Further clinical research is required to quantify risk and guide safer injection practices.
Objective To describe the methodological characteristics and content of published hamstring muscle injury (HMI) rehabilitation programmes in order to inform clinical practice and guide future research.Methods We searched the MEDLINE (PubMed), Scopus and Web of Science electronic databases, on October 2024, using key terms “hamstring” and “rehabilitation”, with strategies refined after a preliminary search. Eligible studies included English-language publications involving non-surgically managed acute HMI in humans and reporting rehabilitation protocols.Results We included 137 articles. Primary research (43.1%, n=59) included mostly cohort and randomised controlled trials (RCTs); secondary research articles (54.0%, n=74) were predominantly narrative reviews. Overall, 54.7% of studies had a low level of evidence. Only 44.2% of primary research focused on HMI rehabilitation programmes of which 47.8% were RCTs. Rehabilitation programme details were often missing. In the subacute/functional phases, strengthening (78.3%) and stretching (55.6%) were most frequently reported. Return-to-sport criteria were reported in only 43.5% of primary research, often based on pain resolution. Across both primary and secondary research, 40 different rehabilitation strategies were identified, with the most frequently reported being eccentric-based strengthening, flexibility exercises, progressive running and agility protocols. Key gaps included lack of standardisation, under-reporting of programme parameters and limited inclusion of diverse sporting populations.Conclusions Current scientific literature on HMI rehabilitation programmes shows wide variety, limited high-level evidence primary research and under-reporting of key clinical details. More rigorous and inclusive studies are needed to improve the standardisation and clinical applicability of rehabilitation strategies.
Objectives:To map and summarise the existing scientific literature on on-field rehabilitation (OFR) exercises, progression and principles supporting athletes' return to contact team sports after anterior cruciate ligament (ACL) injury. Design:Scoping review. Data sources:PubMed, CINAHL, AMED, Cochrane, SPORTDiscus, PEDro, Scopus and Embase Library were searched in April 2025. Eligibility criteria for selecting studies:Sources of any design published between 2010 and 2025 that described or evaluated OFR for athletes returning to contact team sports after ACL injury or reconstruction, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines; studies involving athletes of any age, sex or competition level were eligible. Results:The search identified 6880 records; 38 sources met the inclusion criteria. Most sources were descriptive and focused predominantly on football, with limited representation of basketball, rugby and ice hockey. OFR was commonly described using multistage (2-5 steps) frameworks progressing from linear running and controlled drills to multidirectional movements, sport-specific skills and practice simulations. Progression was primarily criterion-based rather than time-based, guided by minimal pain or swelling, restored knee range of motion, adequate strength and limb symmetry, and tolerance to running loads. Several articles applied the control-chaos continuum. Collaboration between physiotherapists, coaches and athletes was emphasised, although roles, responsibilities and organisational structures were rarely described. Conclusion:The current OFR literature after ACL injury is largely descriptive, emphasising staged, criterion-based progression and multidisciplinary collaboration. However, actionable guidance on roles, responsibilities and organisational structures is minimal, underscoring the need for empirical studies to establish and evaluate standardised OFR practices. Trial registration number:10.17605/OSF.IO/T6UN2.
Objectives Around 80% of children/adolescents globally do not meet recommended levels of physical activity (PA). The 2020 WHO consensus updated PA guidelines, changing from ‘60 minutes of PA/day’ to at least ‘an average of 60 min/day’. This means that attaining 420 min/week expresses the minimum threshold for PA.This analysis examined the effects of the changed guidelines on children/adolescents meeting PA guidelines. A coprimary research question examines single-item PA questions to determine the number of days of 60 min of activity that best reflect meeting the new PA guideline.Methods Data were from five population-level Australian and New Zealand surveys (two representative population surveillance datasets and three large community interventions). PA questions included the single item question (days/week of 60 min) and detailed PA measures including International Physical Activity Questionnaire-adolescent questions. The single-item analysis used receiver operating characteristic (ROC) curves to identify the best fit between the single-item and more extensive PA measures (maximising sensitivity and specificity).Results The proportion meeting the old PA guidelines ranged from 28–55%, compared with 35–84% meeting the new guideline (average absolute increase of 26.2%). ROC analysis described areas under the ROC curve between 0.728 and 0.907. The best fit (Youden’s Index >0.5) was 4–5 days/week where the single item best classified children and adolescents meeting the new guideline.Conclusions The new guideline classified 26% more children and adolescents meeting updated PA guidelines. National research reports should use updated PA guideline criteria, and for surveillance, 4–5 reported days/week on the single PA question best estimates meeting the PA guideline threshold.
