A 19-year-old collegiate fast bowler presented with chronic low back pain that acutely worsened during a tournament. Examination suggested a mechanical origin, but plain radiographs showed subtle lucency at L5 and bilateral sacroiliac sclerosis. MRI was interpreted as bilateral sacroiliitis with effusion, raising concern for axial spondyloarthropathy. Laboratory tests, including HLA-B27, were unremarkable, and rheumatological evaluation did not support a seronegative spondyloarthropathy. Computed tomography ultimately demonstrated stress fractures with developing spondylolysis at L4 and L5. The player was managed conservatively with physiotherapy, core strengthening, and a phased return to sport, including modification of his bowling technique. Full return to sport was achieved at six months after initial presentation. This case highlights the diagnostic pitfalls of interpreting MRI findings in young athletes, where mechanical changes may mimic inflammatory sacroiliitis. CT remains a valuable adjunct in detecting lumbar stress fractures when MRI findings are equivocal.
Background: Ultrasound-guided percutaneous needle electrolysis (PNE) is an emerging minimally invasive technique used for musculoskeletal (MSK) injury management. Despite its growing use in clinical practice, the literature reports mixed findings regarding efficacy, safety, and optimal application in athletic populations. Objectives: This scoping review examines the current literature on PNE for MSK injuries in athletes, evaluating its effectiveness in reducing pain, improving functional recovery, and enhancing return-to-play outcomes. The review also explores its safety profile and comparative advantages over conventional rehabilitation strategies. Methods: A systematic search was conducted in PubMed, Scopus, ScienceDirect, Google Scholar, and Web of Science. Peer-reviewed articles published between 2010 and 2024 were selected based on relevance to PNE, MSK injury management, and athlete populations. Studies were analysed for intervention protocols, outcome measures, and follow-up durations. Eligible articles included randomised controlled trials, cohort studies, pilot studies, systematic reviews, and meta-analyses. Data were charted for study design, population, intervention protocols, outcome measures, and follow-up duration. Findings were synthesised descriptively in line with a scoping review approach. Results: Eighteen studies met the inclusion criteria, encompassing randomised controlled trials, cohort studies, pilot studies, systematic reviews, and meta-analyses. Findings indicate that PNE significantly reduces pain and enhances functional recovery, particularly when combined with eccentric exercise. The most commonly treated conditions include patellar tendinopathy, supraspinatus tendinopathy, and lateral epicondylitis. While adverse effects are generally mild (e.g., transient soreness, hematoma), variations in treatment protocols hinder standardisation. Conclusion: PNE demonstrates promise as an effective treatment for MSK injuries in athletes, particularly when integrated with rehabilitation programs. However, methodological heterogeneity and limited long-term data necessitate further research to establish standardised protocols and optimise treatment outcomes. Expanding the evidence base through high-quality trials will be essential for its broader implementation in sports medicine.
The content of the report is based on data collected by the South African Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.
The content of the report is based on data collected by the South African Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP) steering group.
Background:CrossFit is a rapidly growing sport characterised by high-intensity functional movements that place substantial demands on the shoulder complex. Although shoulder injuries are frequently reported, the prevalence of self-reported shoulder pain and shoulder function among uninjured CrossFit athletes remains unclear. Objectives:To determine the prevalence of self-reported shoulder pain and to describe shoulder function among uninjured CrossFit athletes in Pretoria, Gauteng. Methods:A cross-sectional study was conducted among CrossFit athletes recruited from gyms in Pretoria. Participants completed a sociodemographic and training questionnaire. Pain presence and severity were assessed using the Numeric Pain Rating Scale (NPRS), based on current shoulder pain intensity. Shoulder function was assessed using the Penn Shoulder Score (PSS). Descriptive statistics (means, standard deviations, frequencies, and percentages) were used to summarise the data. Chi-square tests were used to explore associations between shoulder pain and selected demographic and training-related variables. Results:Sixty-eight participants provided valid responses for pain analysis, while all participants completed the PSS. The prevalence of self-reported shoulder pain was 76% (95% CI: 64%-85%), with a mean NPRS score of 2.97 ± 2.75/10, indicating predominantly low-intensity pain. Shoulder function was generally preserved, with a mean total PSS of 87.8 ± 12.2 (out of 100). Shoulder pain was significantly associated with previous shoulder injury (p < 0.05). No significant associations were found between demographic or training-related variables and shoulder function. Conclusion:Self-reported shoulder pain is highly prevalent among uninjured CrossFit athletes despite largely preserved shoulder function. These findings suggest that athletes may continue training despite experiencing pain, highlighting the importance of routine screening and early intervention strategies.
Background: The association between persisting symptoms after concussion (PSaC) and symptoms of depression and/or anxiety is a growing concern in athlete populations. However, the evidence base is complex and inconsistent, creating significant diagnostic challenges and uncertainty regarding appropriate screening protocols. This scoping review maps the literature from the past five years to examine the evidence for this association in adult athletes and to identify the screening tools employed. Objectives: The objectives of this scoping review were: (1) to systematically map the extent, range, and nature of the empirical literature on the association between PSaC and symptoms of depression and/or anxiety in adult athletic populations; (2) to identify and categorize the screening tools used to assess symptoms of depression and/or anxiety; and (3) to identify gaps and limitations in the existing body of research to provide direction for future investigations. This review was guided by the following questions: 1) What is the nature of the reported association between PSaC and symptoms of depression and/or anxiety in adult athletes? 2) What screening tools are most frequently utilized in the literature to assess symptoms of depression and/or anxiety in this population? Methods: This scoping review followed the Joanna Briggs Institute (JBI) methodology, incorporating the framework by Arksey and O'Malley and subsequent JBI refinements. A systematic search of English-language literature was conducted in the PubMed, Scopus, and Google Scholar databases. Studies were included if they: (1) involved adult populations (≥18 years); (2) focused on sport-related concussion (SRC) as a mechanism of injury; (3) assessed symptoms persisting for four weeks or more (i.e., PSaC); and (4) explored the association between PSaC and symptoms of depression and/or anxiety. Results: The review identified 14 studies. A majority (n=9) reported a positive association between PSaC and symptoms of depression and anxiety. However, the overall evidence base was marked by significant methodological heterogeneity, including a wide range of study designs, participant numbers (ranging from single case reports to large surveys (n = 1-3406), populations (from active to retired athletes), and time since injury (28 days to 55 years). There was a lack of consensus in assessment methods, with an inconsistent collection of 13 different screening tools used across the included studies to measure symptoms of depression and/or anxiety. Furthermore, a foundational challenge identified was the inconsistent terminology used across studies to describe persisting symptoms. Conclusion: While the evidence suggests a link between PSaC and symptoms of depression and/or anxiety in athletes, a lack of consensus on terminology and screening tools severely limits the comparability of research and the development of clear clinical guidelines. This highlights a potential need for standardisation to improve the quality of research and, ultimately, the clinical care and well-being of athletes with PSaC.
Background: The growing popularity of running has led to a rise in running-related injuries (RRIs), with runners in under-resourced communities facing heightened risks. Objectives: This study aimed to determine the prevalence and risk factors associated with RRIs among recreational and advanced runners in a township area of South Africa. Methods: A cross-sectional study design was employed, involving runners from six running clubs in Soweto township (south of Johannesburg, South Africa). Data were collected using a self-administered questionnaire via the RedCap online platform and analysed using STATA software. Both descriptive and inferential statistics were generated. Results: A total of 84 runners participated, comprising 51% females (n = 43) and 49% males (n = 41). The overall prevalence of RRIs was high (63%, n = 53), with a slightly higher injury rate among females (51%, n = 27) compared to males (49%, n = 26). Age (runners over 25 years) (odds = 1.11, p = 0.004), increased running load (particularly among medium and long distances) (odds = 1.47, p = 0.053; and odds = 2.65, p = 0.021, respectively), and running terrain (varied running inclines) (odds = 1.42, p-value = 0.032) were identified as significant risk factors. Conclusion: The study revealed a high prevalence of RRIs and identified multiple risk factors. These findings underscore the need for targeted intervention studies focusing on injury prevention and rehabilitation to reduce the burden of RRIs.
Letter to the editor in response to a 2025 publication in the South African Journal of Sports Medicine: Moatshe TP, Dawood M. Prevalence and risk factors of non-specific low back pain among amateur overhead athletes in Gauteng Province. S Afr J Sports Med. 2025; 37:1-6. http://dx.doi.org/10.17159/2078-516X/2025/v37i1a18797. Related article: Moatshe, T. P. (2026). Response: “Nonspecific lower back pain in overhead athletes is multifactorial and is not solely determined by the type and intensity of the sport”. S Afr J Sports Med, 38(1). https://doi.org/10.17159/2078-516X/2026/v38i1a25502.
Recent recommendations in South Africa propose replacing validated neurocognitive baseline and post-injury assessment with NeuroFlex, a vestibular-ocular motor test, as part of a proposed new paradigm in concussion management. This commentary examines the clinical, regulatory, and ethical implications of excluding neurocognitive testing and removing neuropsychologist oversight from concussion protocols. Available evidence indicates that NeuroFlex does not currently hold FDA clearance and lacks validation for concussion identification. In contrast, established platforms such as ImPACT and Sway Medical possess FDA clearance and robust peer-reviewed support for concussion assessment. Neuropsychologists play a critical role in interpreting cognitive data, guiding academic and return-to-play decisions, and monitoring longitudinal cognitive health through annual baseline testing, functions not replaced by vestibular-ocular motor measures. Our evidence-based recommendations advocate routine inclusion of post-injury neurocognitive assessment with neuropsychologist application, preferably including baseline evaluation; optional research-based use of Neuroflex in conjunction with cognitive testing; and transparent, scientifically informed consent for all protocol changes.
Background:Sports injuries remain a significant challenge to athletes' health, performance, and long-term participation, particularly in high-contact and endurance sports. Existing prevention frameworks often lack sport-specific adaptability and integration with rehabilitation. Objectives:This study aimed to develop and refine an Integrated Injury Prevention and Rehabilitation Model (IIPRM) through a qualitative, multi-phase consensus process. Methods:A three-stage, sequential qualitative design was used. Stage 1 was a scoping review of injury risks and prevention strategies in rugby and long-distance running to identify core concepts for the model. Stage 2 used a modified e-Delphi with experts (n=22; three rounds), with consensus predefined as ≥75% agreement; panel retention was 100% across Rounds 1-3 and 18.2% attrition in Round 4. Stakeholder focus groups (n=10) were used to refine clarity, feasibility, and contextual relevance. Stage 3 combined the final fourth Delphi round and focus-group feedback to build consensus and validate the model. Results:Across Delphi rounds, 82% of items reached the ≥75% consensus threshold by Round 2, with remaining items achieving consensus in Round 3. The final IIPRM is a cyclical, athlete-centred framework integrating primary and secondary prevention through education, pre-participation screening, risk-targeted interventions, functional reintegration, and continuous monitoring. Stakeholder input prompted the inclusion of psychological readiness screening, enhanced recovery education, and seasonal alignment of interventions. Conclusion:The IIPRM provides a conceptually practical and adaptable approach to injury prevention and rehabilitation, positioned to facilitate interdisciplinary collaboration and long-term athlete health. As the model has not yet been implemented or evaluated, future research should examine its feasibility, effectiveness, and transferability across sports.
Background: Ankle sprains and acute Achilles tendon ruptures are common injuries among recreational tennis players. Objectives: This study investigated the specific cause, return to play, and ability to play tennis after an ankle sprain and Achilles tendon rupture. Methods: Patients who sustained an ankle sprain (n=39) or an Achilles tendon rupture (n=7) while playing tennis were retrospectively evaluated, with a mean follow-up of 6.0 and 5.2 years, and follow-up rates of 80% and 78%, respectively. Results: Ankle sprain patients were younger (39 years), smaller and lighter (BMI males 24.3, females 22.5) than Achilles tendon rupture patients (49 years, BMI males 26.8). Ankle sprains occurred more often on clay (56% [CI 40-72%]) and Achilles tendon ruptures on carpet courts (57% [CI 18-90%]). The return-to-play rate for tennis was 90% in patients with ankle sprains after a mean of 3.6 months and 29% in patients with Achilles tendon ruptures (two patients), with returns occurring at 5 and 36 months. The return to any sport was 97% and 100%, respectively. Twenty-nine players (74%) with an ankle sprain reported no complaints while playing tennis, and 6 (15%) had some instability or slight pain. Twenty-one per cent of all ankle sprain patients experienced subsequent events (1-3), with a 10% recurrence rate after a first-time event and a 33% rate in patients with recurrent instability episodes. Conclusion: The return-to-play rate for tennis was high after an ankle sprain and low after an Achilles tendon rupture. The reason for not returning in recreational players was either fear of re-injury or preference for other sports, not because of injury-related disabling factors. Patients after Achilles tendon rupture who returned to play tennis did not have any functional problems, and patients after ankle sprain rarely experienced minor instability or pain.
Editorial by Prof Mike Lambert, Editor-in-chief South African Journal of Sports Medicine
Tennis is played globally across diverse climates and surfaces, exposing athletes to variable levels of environmental heat stress. With rising global temperatures and more frequent heat events, protecting players’ health has become a major priority in the sport. This panel discussion aimed to synthesize current evidence and expert perspectives on measuring, managing, and mitigating heat stress in tennis, with a focus on harmonizing policies across governing bodies and player groups. Experts from sport science, medicine, and tournament operations reviewed recent advances in heat measurement tools, including the limitations of the Wet Bulb Globe Temperature (WBGT) and the emergence of tennis-specific heat stress models. Evidence-based cooling strategies—such as ice towels, shaded recovery, and cold-water immersion—were discussed alongside differentiated policy needs for men, women, juniors, seniors, and wheelchair athletes. The discussion further highlighted challenges in achieving effective heat acclimatisation within professional travel schedules and underscored the importance of proactive medical readiness and player education. Enhanced consistency in heat policies, improved access to cooling resources, and continued collaboration between scientists and governing bodies are essential to safeguard player health and performance under increasing environmental heat stress.
Background:Knowledge of the electrical characteristics of the athlete's heart is essential for differential diagnosis with latent cardiac pathologies at risk. Objectives:This study aimed to determine the electrical characteristics induced by refereeing in football. Methods:This was a cross-sectional study conducted with 57 Burkinabe elite referees divided into two groups: the central referees' group and the assistant referees' group. The recorded ECGs were interpreted according to the 2017 expert consensus criteria. Results:PR and QT intervals, then the Sokolow Lyon index of the left ventricle, were increased more (p < 0.05) in the central referees' group than in the assistant referees group. Resting heart rate and corrected QT interval were lower (p < 0.05) in central referees. The number of referees with sinus bradycardia (23 vs 18; p = 0.04), early repolarisation (16 vs 9; p = 0.03), incomplete right bundle branch block (14 vs 6; p = 0.02) and left ventricular electrical hypertrophy (17 vs 11; p = 0.03) were higher in the central referees group than in the assistant referees group. Conclusion:The results indicated that football refereeing was associated with myocardial electrical adaptations, but these adaptations are more frequent in central referees. An evaluation of Doppler echocardiography parameters is recommended to complement these findings.
Background:Although Cricket South Africa has implemented the Long-Term Athlete Development (LTAD) model, there is limited information available about the adoption and implementation of its principles among cricket coaches. Objectives:This study aimed to gain a better understanding of how South African cricket coaches adopt and implement the LTAD model. Methods:This study used a quantitative design approach. The sample comprised 86 cricket coaches from nine provinces in South Africa. Coaches responded to questions on a 5-point Likert scale. Data are reported as the mean ± standard deviation. Results:Overall, coaches reported that the LTAD model helped them to improve their players' performance (4.33±0.90), contributed to their players' development (4.31±0.86), and could be adapted to their coaching needs (4.19±0.87). Also, the LTAD could be effective for the benefit of their players (4.16±0.93) and had agreeable theoretical principles (4.02±0.92). Coaches indicated that the barriers to adopting the LTAD model were the need to educate new coaches and parents (4.33±0.84) and the need to better understand the model's general principles, associated science, and coaching (4.29±0.78). Other barriers included the model's incompatibility with an emphasis on results and competition (3.79±1.08), as well as the players' parents' desire to win at all costs (3.58±1.26). Conclusion:These results have implications that can be used to provide recommendations which may help Cricket South Africa promote the LTAD model in the South African context.
Background:Body composition and bone health are important for netball from a performance and health perspective (e.g., bone stress injury), given the typical characteristics of players and demands of the game. Objectives:The objectives of this study are to quantify and compare the positional group-specific body composition and site-specific bone health outcomes of netball players and to establish within-season changes in these variables. Methods:Forty-seven female netball players (senior: n=23, under-21: n=24) from one Netball Super League (NSL) franchise participated across three seasons (2021-2023). Dual-energy X-ray absorptiometry (DEXA) scans were conducted four times per season. Total body, anteroposterior lumbar spine and total hip scans were performed. General and generalised linear mixed models were used to compare positional groups and age groups, and to investigate within-season changes. Results:Goal circle netball players had greater total mass and bone mass than midcourt netball players at both levels (p<0.05, effect size: moderate to very large), but not when scaled for height. Senior players had greater lean mass, bone mass, total bone mineral density and bone mineral content than under-21 players (p<0.05, effect size: moderate to very large). No group-level significant changes were observed across a playing season, but individual trends varied. Conclusion:These findings highlight the importance of continued physical development in the under-21 squad before progressing to a senior squad, as well as the need for individualised approaches to nutritional and training interventions that support physical development, addressing positional requirements and developmental stages. Future research should explore longitudinal body composition trajectories across career phases and multiple teams to refine normative benchmarks.
Background:Self-determined motivation (SDM) and sport psychological coping skills are important for developing footballers. Objectives:This study examined relationships between chronological age (CA), skeletal age (SA), and psychological variables among South African youth players. Methods:Data were collected from 109 male players across three football academies (mean CA: 14.8±2.4 years, mean SA: 14.2±2.1 years). Participants completed the Sport Motivation Scale-II (SMS-II) and the Athletic Coping Skills Inventory-28 (ACSI-28). Results:Amotivation, external, and introjected regulations differed significantly across CA groups, negatively affecting the Relative Autonomy Index (RAI). SDM, as reflected by the RAI, declined with CA, reaching its lowest point between 15 and 17 years. SA grouping revealed significant differences for amotivation and external regulation. Coachability differed across CA and SA groups. Amotivation, external regulation, and coachability showed positive correlations with CA, while amotivation and coachability showed positive correlations with SA. Concentration showed opposite correlations with CA and SA when controlling for the other variable. Conclusion:CA grouping appeared to reflect differences in SDM more effectively than SA. While some psychological and motivational variables aligned more closely with CA or SA, others did not, highlighting the complex and multifactorial nature of these developmental relationships. Given the low internal consistency of several subscales, these findings should be interpreted cautiously and viewed as exploratory. Future research should adopt longitudinal designs and utilise culturally appropriate, psychometrically robust tools better to understand the development of psychological skills in this population.
Background:Despite extensive research on batting biomechanics among male cricketers, limited studies focus on female cricket players. Objectives:This study examines the biomechanical and performance implications of the lateral batting backlift technique (LBBT) and straight batting backlift technique (SBBT) among female cricketers. Methods:This study aims to bridge this gap by assessing the backlift, its influence on shot execution and its relationship with performance metrics among local (n=18; South African National Women's Cricket Team, also known as the Protea (P) Women's Cricket team (n=9) and non-Protea players (NP) n=9), as well as international (n=34) female players, using high-speed video analysis and StanceBeam bat sensors. Statistical analyses, including Spearman's Rho correlations and Mann-Whitney U tests, were applied to evaluate key performance metrics such as bat speed, impact speed, and wagon wheel shot distribution. Results:Findings show that local (67%) and international (62%) players used the LBBT, which was associated with greater performance metrics, e.g., strong positive correlations were found between bat speed and impact speed (r=0.85, p<0.001). A significant difference in wagon wheel shot distribution was observed between P and NP players (p=0.039). Conclusion:Findings suggest that the LBBT offers biomechanical advantages and may be a key contributing factor in optimising female batting performance. Future longitudinal research studies should focus on three-dimensional (3D) motion capture (as well as markerless motion capture) on the LBBT, integrating real-time analytics and expanding sample sizes to include diverse player populations.
Sports dentistry is an emerging area within Sports Medicine that focuses on the prevention, diagnosis and management of oral pathologies in the athletic population. It is not yet a formally recognised subspecialty; however, it is seeking to gain wider acceptance within the context of sports medicine. Oral health is increasingly being linked to overall athlete well-being and performance. The role of the sports dentist encompasses a broad range of oral pathologies that may present in athletes, including oral trauma, periodontal disease, and temporomandibular disorders. Within a high-performance setting, the role of the sports dentist may become integral in the prevention, management and reduction of time-loss due to avoidable dental pathologies. In South Africa, the establishment of the South African Sports Dentistry Association highlights the growing momentum to formalise the field and embed it within the broader high-performance network. Sports dentistry is an evolving field with the potential to enhance player welfare, safety and longevity.
