“Proprioception training” is widely advocated in rehabilitation and sports practice, yet the term encompasses heterogeneous constructs, interventions, and outcomes. Many trials infer proprioceptive benefits from surrogate outcomes (balance, strength, or pain) rather than direct psychophysical indices. We aimed to examine how proprioception is defined and measured, and how improvement is claimed, in randomized controlled trials. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, PubMed, Scopus, and Web of Science were searched to October 2025. Eligible randomized controlled trials explicitly described interventions as “proprioceptive” or “sensorimotor training” and reported at least one proprioceptive outcome, either direct (e.g., joint position reproduction, threshold to detection of passive motion, active movement extent discrimination) or indirect (e.g., sway, balance). Methodological quality was appraised with the Physiotherapy Evidence Database (PEDro) scale and risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Fifty-one randomized controlled trials (n = 2319) were included. Comparative synthesis showed that improvements inferred from surrogate outcomes were more frequent and often larger than improvements observed in direct psychophysical measures. Directly targeted practice, angle specific, attentionally demanding, and aligned with the measured proprioceptive submodality and task construct, produced the most consistent benefits in position-reproduction accuracy/error, movement-detection sensitivity, or discrimination performance, depending on the outcome assessed. In contrast, multimodal regimens (balance, strengthening, taping, manual therapy) commonly improved balance, pain, strength, or function without comparably consistent evidence of enhanced direct psychophysical proprioceptive function. Specific psychophysical components of proprioceptive function appear modifiable, but only when training explicitly targets the sensory construct measured. The field remains conceptually diffuse, with frequent conflation of sensorimotor performance and proprioception. Progress depends on defining proprioceptive submodalities a priori, privileging validated psychophysical outcomes over surrogate outcomes, and aligning intervention content with measurement to substantiate true perceptual learning rather than generic motor adaptation.
Female athlete health encompasses multiple interconnected domains; however, the self-report screening tools used to assess these domains have not been comprehensively synthesised. To systematically identify self-report health screening tools used to assess female athlete health, map domain coverage, determine validation reporting, and describe application across participation levels. This systematic review was pre-registered with PROSPERO ( CRD420251056910 ) and conducted in accordance with PRISMA guidelines. Four databases (PubMed, MEDLINE, SPORTDiscus and Web of Science) were searched from inception to January 2026 using female health and screening-related terms. Methodological quality was appraised using Joanna Briggs Institute and National Institutes of Health tools, and findings were synthesised descriptively. Eligible, peer-reviewed studies reported the use, development or validation of self-report health screening tools assessing one or more domains relevant to female health applied in female athlete populations, spanning recreational through elite participation levels. All sports and activities were included. The search was restricted to English language with no date limits. In total, 360 studies (1990–2026) representing 134,506 female participants spanning recreational to elite sport and 273 screening tools were included. Mental health (n = 77, 34.1
Tackling is a vital skill in rugby that greatly influences both performance outcomes, such as carry distance and possession gain, and injury risk, such as the frequency of concussions and cervical injuries. Approximately 72
As female athletes' careers lengthen, their periods of peak performance and optimal fertility overlap. Consequently, there is a rising trend of recreational and elite athletes utilizing egg freezing and in-vitro fertilization for reproductive planning. However, there is no empirical evidence supporting exercise recommendations during these periods and the assumed risk of adverse events leads to conservative approaches like reducing or stopping exercise. Therefore, we aimed to examine athletes’ exercise participation while undergoing egg freezing and in-vitro fertilization. We aimed to examine the impact of continued exercise participation during egg freezing and in-vitro fertilization on health and procedure outcomes. We conducted an online survey study of recreational and elite athletes (≥ 18 years of age) who underwent egg freezing and/or in-vitro fertilization in the last 5 years. The survey collected self-reported information on athlete demographics, exercise participation prior to and during egg freezing and/or in-vitro fertilization, health and procedure outcomes and medical advice received during this period. Odds ratios (ORs) or relative risk ratios with 95
Day–night test cricket uses a pink ball that players have reported as less visible than the traditional red ball, particularly at dusk. Around 9
Whilst there is emerging evidence to suggest that individuals who engage in open water swimming may be at increased risk of transient global amnesia (TGA), empirical research in this area is limited. This study aimed to explore the accounts of open water swimmers believed to have experienced TGA-like symptoms as a direct result of the activity. The sample comprised 11 UK-based open water swimmers (7 female, 4 male) and relevant witnesses. Semi-structured interviews were conducted between June and August 2025 to obtain detailed accounts of events occurring before, during and after the amnesic episode. Additional information such as demographic characteristics, swimming behaviours and relevant medical histories were also collected. Participants provided detailed contextual information that aided in the exploration of their TGA-like episodes. Descriptive thematic analysis yielded rich qualitative accounts of the amnesic episodes, along with commonly reported symptoms such as confusion, disorientation and repetitive questioning. Findings were considered in relation to potential precipitating factors and possible aetiological mechanisms, as well as the risks associated with experiencing such episodes in an open water environment. The majority of the cohort did not receive a formal medical diagnosis and as such, definitive conclusions cannot be made. However, despite some atypical symptoms, the reported experiences did, in the main, align with the criteria for TGA. These findings therefore contribute novel insights to the limited body of literature examining TGA-like events in the context of open water swimming.
Return-to-play (RTP) decisions after muscle injury in professional football are complex, influenced by biological healing, functional recovery, and sport-specific demands. RTP models have evolved towards multifactorial and individualized frameworks; however, supporting evidence remains largely consensus-based. This systematic review aimed to describe RTP criteria and study design heterogeneity and integration within RTP frameworks in football. This study was conducted as a systematic review. Studies investigating RTP criteria, RTP decision-making, or rehabilitation frameworks following muscle injuries in football players were included. Searches were performed in five databases. Two reviewers assessed risk of bias using Joanna Briggs Institute appraisal tools. Ten studies included were classified as Classical–Physical, Consensus–Multifactorial, or Individualized RTP models. Studies reported a median of six RTP criteria (range 4–8); most commonly the absence of pain, ≥ 90
Physical literacy integrates physical, affective, cognitive and social elements into a holistic framework for physical activity. Despite the increasing recognition of physical literacy across many sectors, the entire field lacks a prospective roadmap for research, practice and policy. Seeking to determine the content of a ‘Global Physical Literacy (GloPL) Action Framework,’ this study aimed to define goals, principles, actions and pathways that can advance the physical literacy field worldwide. A group Delphi study (based on published protocol) engaged 59 physical literacy-focused academics from 46 countries, 7 representatives of literature gaps, and 24 individuals representing societies/organisations. The representatives independently generated ideas for action through online surveys (Qualtrics). The ideas underwent reflexive thematic analysis (NVivo), informing the subsequent discussions in six online meetings. All decisions were supported by formal voting with pre-defined agreement thresholds for two rounds of voting. Analysis resulted in 849 initial codes grouped into five themes: advocacy, practice, education, assessment and research. Members discussed 15 central topics, of which six reached agreement in the first voting round and nine in the second voting round. Key recommendations included: establishing a core set of physical literacy elements/principles (advocacy); generating more resources/programmes on physical literacy (practice); aligning physical education curricula with physical literacy principles (education); assessing physical literacy at the population level (assessment); and emphasising implementation science (research). The comprehensive consensus findings will inform the pillars of the first GloPL Action Framework. Its release marks the beginning of a dynamic process intended to guide coordinated actions on physical literacy in education, public health, sport, healthcare/promotion, rehabilitation, active recreation and community services/development.
The anterior cruciate ligament (ACL) is both a passive stabiliser and an active mechanoresponsive tissue. Emerging evidence demonstrates that its morphology, material properties, and microstructure adapt to the mechanical milieu imposed by habitual activity, targeted exercise, and surrounding musculature. This narrative review synthesises animal and human evidence on ACL mechanobiology, highlighting how loading parameters, maturational timing, and neuromuscular context shape ligament structure, function, and injury risk. At the molecular level, the ACL responds to mechanical loading through differential collagen isoform expression, matrix remodelling, and angiogenic signalling. These processes are further modulated by sex and maturation, with males typically demonstrating greater upregulation of type I collagen, whereas females synthesise comparatively less. Regional vascularity also influences adaptive capacity, potentially constraining remodelling within the mid-substance, where injury most frequently occurs. Animal ligament research shows that endurance and resistance training can increase stiffness, tensile strength, and cross-sectional area, while human studies report ligament hypertrophy in athletes who begin high-load training during adolescence. Conversely, chronic underloading leaves the ACL undersized, whereas poorly directed or chaotic overload fosters micro-damage accumulation and fatigue failure. Integrating resistance training with variable and sport-specific movement practice enhances ligament resilience and reduces initial and reinjury risk. Collectively, the ACL should be regarded as a mechanoresponsive tissue the capacity of which is determined by the interplay of morphology, vascularity, mechanotransduction, sex, maturation, and load history. An integrated load–adaptation–injury framework is proposed to guide future research and optimise clinical prevention and rehabilitation strategies.
Recent research has attempted to quantify the dose–response relationship between dietary protein intake and fat-free mass preservation during energy restriction in resistance-trained individuals. While meta-regression analyses have helped identify intake ranges associated with fat-free mass retention, these models typically consider only the prescribed intervention dose. However, individuals enter dietary interventions with different baseline protein intakes, which may influence their physiological response to additional protein. We also highlight the importance of obtaining baseline dietary assessments after an appropriate dietary adaptation period, so that baseline protein intake is accurately characterized before the intervention begins. Ignoring this starting point may therefore obscure important heterogeneity in responsiveness across studies. In this Current Opinion, we discuss the potential role of baseline protein intake as a moderator of the protein–fat-free mass relationship and explore how accounting for baseline intake may alter the interpretation of protein dose–response models. We also present exploratory evidence suggesting that higher baseline protein intakes may be associated with diminishing returns in fat-free mass preservation. Considering baseline protein intake may help refine future research designs and support more individualized protein intake recommendations during energy restriction.
Cardiorespiratory fitness (CRF) is a powerful predictor of current and future health across all age groups. Recognising CRF’s ability to screen health-related outcomes is essential for supporting its use in clinical practice. The aim was to evaluate the health-related diagnostic and prognostic accuracy of CRF using an overview of systematic reviews. Five bibliographic databases (MEDLINE, Embase, Scopus, CINAHL and SPORTDiscus) were searched from January 2002 to April 2025 to identify systematic reviews with meta-analyses that reported on the health-related diagnostic and prognostic accuracy of CRF. The results were presented using forest plots, with the certainty of evidence assessed by a modified Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Of the 10,796 papers identified, six systematic reviews with meta-analyses (n = 31,171 observations) were included. Of these, five examined cardiovascular disease, events, or risk, and one examined mitochondrial disorders. CRF was measured objectively or estimated by exercise as maximum or peak oxygen consumption, ventilatory efficiency or fluctuation, or exercise performance or tolerance. All included reviews were graded as having low to critically low quality. CRF demonstrated high prognostic accuracy for predicting severe cardiovascular events in adults with heart failure, with moderate certainty (diagnostic odds ratio [dOR] 4.1–8.1; area under the curve of a summary receiver operating characteristic curve [SROC AUC] 0.73–0.77), and moderate-to-high diagnostic accuracy for detecting coronary artery disease in adults with type 2 diabetes or with suspected coronary artery disease with very low certainty (dOR 2.3–7.6; SROC AUC 0.66–0.79), mitochondrial disorders among adults with high certainty (dOR 18.1–26.6; SROC AUC 0.70–0.83), and cardiovascular disease risk among apparently healthy children and adolescents with low certainty (dOR 3.6–5.7; SROC AUC 0.64–0.71). CRF detects cardiovascular disease and mitochondrial disorders and predicts cardiovascular events among adults with chronic conditions and detects cardiovascular risk among apparently healthy children; however, the certainty of evidence ranged from very low to high certainty due to methodological limitations. Further research is needed to generate high-quality diagnostic evidence for CRF across diverse health outcomes and age groups in the general population. PROSPERO CRD42022370149.
Anterior cruciate ligament (ACL) ruptures are significant knee injuries. Many studies have analysed video footage of the mechanisms of injury; however, the three-dimensional biomechanics of ACL ruptures have not previously been captured and presented. This case series reports on two secondary non-contact ACL ruptures in adolescent females: one ipsilateral ACL re-rupture and one contralateral ACL rupture. The injuries occurred during unplanned 90° cuts, which were completed as part of the clinic's standard of care return-to-play testing. Spatiotemporal parameters, joint and segment kinematics, ground reaction forces and joint moments and forces are presented during the approach, at the penultimate step and initial contact, and during the stance phase of the cutting step. These biomechanics are compared to planned 90° cuts and a pre-injury unplanned 90° cut. While there were slight differences in the exact injury mechanisms, common factors appeared to have contributed to the ACL ruptures. These potential mechanisms of injury included a fast approach speed without sufficient deceleration at the penultimate step; a larger touchdown distance; and a more outstretched leg in the anterior or lateral direction which, when combined with the rotation of the body towards the direction of the cut, may have limited knee flexion which likely contributed to large forces and moments acting at the knee. This case series highlights the need to develop training strategies aimed at reducing risky movement behaviours to reduce the risk of subsequent non-contact ACL injuries.
