Context Para sport athletes experience concussions at a similar rate to athletes without disabilities; however, published concussion tools have limited applicability to diverse athlete populations. Objective To understand health care provider (HCP) concussion management across different para sports and athlete classifications to identify facilitators and barriers influencing the delivery of concussion care. Design Cross-sectional study. Setting Online survey and virtual interviews. Patients or Other Participants Para sport HCPs completed online surveys (n = 21) and voluntary follow-up interviews (n = 11). Data Collection and Analysis Researchers designed a survey from an established line of health care evaluation surveys and distributed it via chain-referral sampling following expert review (n = 3) and pilot testing (n = 4). We conducted follow-up interviews via Google Meet using automatic transcription technology and reviewed for accuracy. We used phenomenology to analyze the qualitative data with multianalyst triangulation and peer review as credibility strategies. Results Health care providers most often used the Sport Concussion Assessment Tool 6 (85.7%) to guide examinations, the modified Balance Error Scoring System (66.7%) for balance testing, and the Vestibular/Ocular-Motor Screening (81.0%) for vestibular ocular-motor testing. Health care providers noted 3 themes: (1) the importance of developing purposefully flexible classification- and para sport–specific frameworks to promote individualized concussion care while (2) building personal HCP–athlete relationships to understand individual needs and improve concussion diagnostics and emphasizing (3) a multidisciplinary, team-based approach to care. Health care providers emphasized these themes as critical for successful management across para sports to overcome limited education and resource allocation available to often volunteer-based HCPs. Conclusions Para sport HCPs used current concussion assessment tools but reported a lack of effective adaptive guidelines exemplified by variable athlete-specific modifications for concussion care. Our findings emphasize the need to develop flexible frameworks for para sport concussion management while emphasizing a multidisciplinary, team-based approach to care and HCP–athlete relationships to implement effective para sport concussion care.
Context:In the United States, more than 71 000 college students, many of whom participate in athletic programs, are deaf or hard of hearing (D/HoH). Although recent concussion consensus statements have recommended different management for special populations, critical knowledge gaps remain regarding baseline concussion performance in athletes who are D/HoH. Objective:To compare baseline concussion assessments between athletes who are D/HoH and athletes who are hearing. Design:Cross-sectional study. Setting:Collegiate athletic department. Patients or Other Participants:A total of 128 National Collegiate Athletic Association Division III athletes including 64 athletes who are D/HoH (42 who are deaf, 22 who are hard of hearing; age = 21.64 ± 3.23 years, height = 1.70 ± 0.10 m, mass = 80.83 ± 25.24 kg) and 64 athletes who are hearing (age = 19.73 ± 1.13 years, height = 1.76 ± 0.10 m, mass = 78.55 ± 16.95 kg) matched by sex and sport-contact classification. Main Outcome Measures:Participants completed a comprehensive battery of baseline concussion assessments, including symptom inventories (Sport Concussion Assessment Tool 6 symptom evaluation and Brief Symptom Inventory-18), virtual reality-based smooth pursuits, oculomotor function (Vestibular/Ocular Motor Screening), postural control (modified Balance Error Scoring System), instrumented tandem gait, and neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Testing). Results:No differences were found for Sport Concussion Assessment Tool 6 symptom severity (z = -1.41, P = .16) or total number of symptoms (z = -1.62, P = .11), but athletes who are D/HoH had a higher Brief Symptom Inventory-18 Global Severity Index (z = -2.37, P = .02) compared with athletes who are hearing. Athletes who are D/HoH demonstrated better oculomotor tracking (eg, higher velocity gain and lower saccade percentage, P < .01) and lower Vestibular/Ocular Motor Screening total symptom scores (z = 2.57, P = .01) compared with athletes who are hearing. Additionally, athletes who are D/HoH demonstrated poorer performance in postural control (more modified Balance Error Scoring System errors, z = -5.24, P < .001; slower tandem gait speed, z = 3.65, P < .001) and lower neurocognitive assessment scores (visual and verbal memory and visual-motor speed, P < .001) compared with athletes who are hearing. Conclusions:Athletes who are D/HoH exhibited distinct performance profiles across multiple baseline concussion domains, likely influenced by sensory adaptations, vestibular differences, and language-related factors. Clinicians should interpret assessment outcomes while considering these unique biopsychosocial characteristics to ensure accurate concussion management for D/HoH populations.
Objectives:To (1) support athletic trainers (ATs) as they help athletes and other active individuals navigate dietary supplement use while prioritizing health, safety, legality, performance, and a food-first but not always food-only approach and (2) ensure that ATs have the reliable resources they need to provide general education and evaluate the use of dietary supplements. Background:While the market continues to expand, the quality of dietary supplements worldwide is poorly regulated. At the same time, many active individuals report consuming multiple dietary supplements to improve health or performance or both. Athletic trainers are well positioned to proactively educate athletes on concerns that arise with taking dietary supplements. In many cases, the AT is the first health care professional asked to review the safety, effectiveness, and legality of a dietary supplement that an athlete is consuming. Our mission with this position statement is to provide ATs with the tools and resources needed to educate tactical operators and tactical athletes and to know when to refer the individual to a Sports Registered Dietitian Nutritionist and Board-Certified Specialist in Sports Dietetics. Recommendations:An individual's overall dietary pattern and habits should be considered first, but we encourage a food-first but not always food-only approach to dietary supplement education and review. The AT should use reliable resources to understand the risks and benefits of using dietary supplements.
ABSTRACT Objective: We aimed to identify psychological, subjective, and objective recovery factors associated with psychological readiness to return to sport approximately six months after anterior cruciate ligament reconstruction (ACLR). Data Sources: We collected data prospectively from a university-based ACL rehabilitation registry that included patient reported and objective measures obtained at six months post-primary ACLR. Study Selection: We included fifty-eight participants (mean age = 18.95 ± 5.20 years; 53% female) who completed standardized postoperative rehabilitation and follow-up testing. Data Extraction: We measured psychological readiness using the ACL-Return to Sport after Injury (ACL-RSI) scale and conducted hierarchical regression analyses to examine predictors of psychological readiness across five conceptually ordered domains: (1) demographics (age, sex, time since surgery), (2) generalized anxiety (PROMIS-Anxiety), (3) kinesiophobia (TSK-11), (4) knee-specific self-reports [KOOS-Pain, KOOS Symptoms, KOOS-QoL, KOOS-Sport], and (5) objective function measures (quadriceps strength and single-leg hop symmetry). Data Synthesis: We conducted hierarchical linear regression in conceptually ordered blocks. Demographic factors explained minimal variance in psychological readiness (1–4%). General anxiety contributed an additional 18.1%, while kinesiophobia (TSK-11; +22.3%), quality of life (KOOS-QoL; +9.8%), and subjective sport function (KOOS-Sport; +5.3%) emerged as the strongest incremental predictors. Pain, symptoms, and objective function (quadriceps strength and hop symmetry) contributed little additional variance. The full model explained 70.5% of the variance in ACL-RSI scores (adjusted R 2 = 0.64, p < 0.001), and cross validation produced a comparable R 2 (0.61), indicating good model generalizability and minimal overfitting. Conclusions: Fear-related beliefs and perceived function exerted stronger influences on psychological readiness after ACLR than objective functional symmetry. These findings highlight the importance of biopsychosocial assessment models and sport-specific psychological measures to enhance return-to-sport decision making and long-term recovery outcomes.
Context Unbalanced or uncoordinated activity across either the scapulohumeral or the scapulothoracic muscle may impair scapulohumeral rhythm during arm elevation. Objective To compare the effects of progressive resistance exercises (PREs), integrated with and without facilitatory motor-control exercises (MCEs), on scapulohumeral and scapulothoracic myoelectric activities in overhead athletes diagnosed with secondary subacromial impingement syndrome (SAIS). Design Randomized controlled clinical trial. Setting Neuromuscular Rehabilitation Research Center. Patients or Other Participants Overhead athletes diagnosed with secondary SAIS were assigned randomly to 3 parallel groups: 2 intervention groups and 1 control group. Intervention(s) All groups received contemporary physical therapy modalities every other day for 8 weeks. Intervention groups I and II also completed scapulohumeral and scapulothoracic PREs, integrated, respectively, with and without facilitatory MCEs targeting infraspinatus and lower trapezius muscles. Main Outcome Measure(s) Scapulohumeral and scapulothoracic myoelectric activities were recorded during scapular arm abduction between 80° and 110° before and after the prescribed treatment protocols. Results Scapulohumeral and scapulothoracic PREs reduced the corresponding myoelectric activities during scapular arm abduction within the groups ( P ≤ .02, partial η 2 ≥ 0.127). Facilitatory biofeedback-guided exercises integrated into PREs preserved scapulohumeral and scapulothoracic myoelectric activities ( P ≤ .03), excluding teres minor myoelectric activity ( P > .99). Conclusions Scapulohumeral and scapulothoracic PREs reduced the corresponding muscle activations during scapular arm abduction in overhead athletes with secondary SAIS. Facilitatory MCEs targeting infraspinatus and lower trapezius muscles, integrated into PREs, preserved scapulohumeral and scapulothoracic muscle activations.
Objective:To determine whether restrictions in hip external rotation (ER) or internal rotation (IR) range of motion (ROM) are related to overall injury risk in baseball players. Data Sources:Three databases were systematically searched from inception through September 2024 using the following keywords: hip, acetabular, acetabulum, pelvis, pelvic, and baseball. Study Selection:Studies were included if the authors evaluated baseball players, assessed clinical hip measures, and related these measures to injury. Two independent reviewers screened 495 studies, with 17 meeting final inclusion criteria. Authors of 13 studies evaluated youth or high school players, and authors of 4 examined professional players. Data Extraction:Two investigators independently extracted demographic variables, and the primary outcomes included bilateral hip IR and ER ROM measurements and their relationship to injury. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS), with a mean score of 14 ± 3. Data Synthesis:Analysis included over 4000 players across 17 studies. Compared with injured players, healthy youth or high school players had 2° more ER ROM and 3° more IR ROM in the stance hip as well as 1° more ER ROM and 4° more IR ROM in the stride hip. Out of 9 studies in which hip ROM was compared between healthy and injured youth players, authors of 5 studies related stride-leg IR ROM to injury, authors of 2 related stance-leg IR ROM to injury, authors of 3 related stance-leg ER ROM to injury, and authors of 1 related stride-leg ER ROM to injury. Conclusions:Based on these observations, clinicians may consider monitoring IR ROM of the stride leg and ER ROM of the stance leg in baseball players and consider developing injury-prevention or rehabilitation programs to prevent the onset of hip rotational ROM restrictions. However, due to the heterogeneity of the included studies and the small differences in ROM, no strong clinical recommendation can be made before authors of future prospective studies relate clinically significant hip ROM restrictions to baseball injuries.
ABSTRACT Context: Individuals with chronic ankle instability (CAI) demonstrate a high recurrence rate of ankle sprains during sports activities, even after clinical rehabilitation, suggesting altered biomechanical and cognitive-motor performance under demanding conditions. These deficits may be further exacerbated during dynamic movements under cognitive load. However, previous dual-task studies in individuals with CAI have largely examined biomechanical or cognitive-motor performance outcomes separately, leaving their integrated effects insufficiently understood. Objective: To identify delayed reaction time and increased task failures under visuospatial cognitive load in individuals with CAI compared with healthy controls, and to investigate associated changes in lower-extremity kinematics and ground reaction forces during a jump landing-cutting task. Design: Cross-sectional study. Setting: University research laboratory. Patients or Other Participants: Thirty-two physically active participants were included: 16 individuals with CAI (age = 24.81 ± 2.69 years) and 16 healthy controls (age = 24.00 ± 1.75 years). Intervention(s): Participants performed jump landing-cutting tasks under a single-task condition and a visuospatial cognitive-task condition using a FitLight system. Main Outcome Measures: Lower-extremity kinematics, ground reaction forces, and failure counts were assessed in both conditions; reaction time was assessed only in the cognitive-task condition. Results: The CAI group demonstrated delayed reaction time compared with healthy controls during the cognitive-task condition ( P = .033); however, reaction time in the CAI group decreased across repeated trials ( P = .013). Both groups committed more failures in the cognitive-task condition than in the single-task condition ( P < .001, ηp 2 = 0.45). No significant interactions were observed in terms of biomechanical variables ( P > .05). Conclusions: Individuals with CAI exhibited clear cognitive-motor deficits under cognitive load, whereas their characteristic biomechanical movement patterns remained unchanged. These findings suggest that cognitive-motor dysfunction may not be adequately captured by biomechanical assessments alone, and that integrating both domains may improve evaluation and return-to-play decision making.
Context:Under the high physical demands of sports, patellofemoral pain (PFP) in 1 knee may be associated with bilateral alterations in femoral cartilage morphology and quality. However, at the time of this study, no one had investigated bilateral femoral cartilage profiles in athletes with unilateral PFP. Objectives:To (1) compare quantitative and qualitative measures of bilateral femoral cartilage between athletes with unilateral PFP and pain-free athletes and (2) examine the associations of pain severity and self-reported function with femoral cartilage profiles in athletes with PFP. Design:Cross-sectional study. Setting:Laboratory. Patients or Other Participants:A total of 132 knees in 66 athletes, including 33 athletes with unilateral PFP (median [interquartile range (IQR)] age = 20.0 years [20.0-22.0 years], height = 175.6 ± 9.5 cm, median [IQR] mass = 74.0 kg [63.5-83.0 kg]) and 33 pain-free athletes (median [IQR] age = 20.0 years [19.0-21.0 years], height = 174.5 ± 10.7 cm, median [IQR] mass = 67.0 kg [60.5-77.5 kg]). Main Outcome Measures:Pain severity (visual analog scale) and self-reported function (Knee Injury and Osteoarthritis Outcome Score) were obtained. Quantitative ultrasonographic measures of femoral cartilage-cross-sectional area (CSA) and thickness (medial condyle, intercondylar, and lateral condyle)-were evaluated. Femoral cartilage ultrasonography images were assessed qualitatively using a previously validated grading scheme. Results:Compared with pain-free athletes, athletes with unilateral PFP exhibited bilaterally smaller CSA (89.96 versus 81.35 mm2; F 1,64 = 4.47, P = .04), medial condyle thickness (2.46 versus 1.97 mm; F 1,64 = 13.69, P < .001), intercondylar thickness (2.56 versus 2.27 mm; F 1,64 = 4.65, P = .04), and lateral condyle thickness (2.46 versus 2.15 mm; F 1,64 = 8.37, P = .005); however, no differences were observed in ultrasonographic grading. Higher pain severity, but not self-reported function, was associated with smaller bilateral femoral cartilage CSA and thickness in athletes with PFP (ρ range, -0.487 to -0.356; P < .05). Hierarchical regression revealed that pain intensity uniquely explained 11% to 23% of the variance in bilateral femoral cartilage CSA and thickness (ΔF range, 4.96-9.93; P < .05). Conclusions:Athletes with unilateral PFP may experience bilaterally smaller femoral cartilage morphology than pain-free athletes. Higher pain severity in 1 knee appeared to be associated with smaller femoral cartilage CSA and thickness across both limbs, underscoring the importance of bilateral evaluation and management in athletes with PFP.
ABSTRACT Context: Kinesiophobia, a maladaptive fear of movement or re-injury, commonly develops following anterior cruciate ligament reconstruction (ACLR) and may impair postural stability. The underlying neural mechanisms remain poorly understood. Objective: This study aimed to (1) investigate the association between kinesiophobia and postural stability deficits in ACLR patients and (2) identify potential neural mechanisms using resting-state functional magnetic resonance imaging (rs-fMRI). Design: Cross-sectional study. Setting: University research laboratory. Participants: Thirty ACLR patients and 30 healthy controls matched for age, sex and BMI Main Outcome Measure(s): Kinesiophobia was evaluated using the 17-item Tampa Scale of Kinesiophobia (TSK-17). Static postural stability was assessed via barefoot single-leg stance under eyes-open (EO) and eyes-closed (EC) conditions using a force plate, with Romberg ratios (EC/EO), center of pressure (CoP) range and velocity. rs-fMRI (~6-min scan) was employed to examine the functional connectivity (FC) among emotion-processing and motor-coordination regions. Results: Compared with healthy controls, individuals with ACLR reported significantly higher kinesiophobia (TSK-17, p < 0.001) and exhibited greater visual dependency, as indicated by higher Romberg ratios (EC/EO) for CoP range in both mediolateral and anterior–posterior (AP) directions (p = 0.037 and p = 0.024). rs-fMRI revealed increased FC within corticolimbic–cerebellar circuits in the ACLR group, including PFC–Vermis connectivity (p = 0.007, FDR-corrected). Within the ACLR group, higher kinesiophobia was associated with greater visual dependency, as indicated by a higher Romberg ratio of CoP velocity in the AP direction (r = 0.366, p = 0.046), and with lower PFC–Vermis connectivity (r = −0.376, p = 0.041). Reduced PFC–Vermis connectivity was also associated with greater visual dependency (r = −0.378, p = 0.039). Conclusions: Kinesiophobia is significantly associated with postural stability deficits following ACLR and is accompanied by differential PFC–Vermis functional connectivity. Both psychological and neurophysiological factors should be considered in post-ACLR rehabilitation protocols.
Context The percent of normal (PoN) rating is included in the Sport Concussion Office Assessment Tool 6 (SCOAT6) and used in concussion care, but clinicians lack empirical guidance on how to interpret this value. Objective To evaluate the ability of the PoN rating to discriminate athletes with sport-related concussion (SRC) from healthy controls and measure perceived recovery. Design Prospective cohort study. Setting Specialty clinic and research registry. Patients or Other Participants Athletes within 3 to 30 days of SRC and healthy controls aged 13 to 29 years. Intervention(s) Participants completed a comprehensive clinical evaluation at their initial (V1) and follow-up (V2) visit approximately 14 days later. Percent of normal is a single item self-report using a 0% to 100% scale embedded in the SCOAT6 symptom evaluation. Univariate linear regressions examined the association between clinical outcomes at V1/V2 and PoN at V1/V2 for the SRC cohort. Receiver operating characteristic curve analyses with area under the curve examined PoN to discriminate those with SRC from controls at V1 and to discriminate recovery status at V2. Main Outcome Measure(s) Percent of normal ratings, symptom- and performance-based concussion measures, clinical recovery status. Results Percent of normal demonstrated outstanding clinical performance discriminating SRC (area under the curve = 0.95), with an optimal cutoff of <87% PoN (sensitivity = 0.86, specificity = 0.91). Percent of normal ratings at both visits were associated with most symptom- and performance-based measures ( P < .001). A PoN rating of >95% at V2 yielded the most balanced cut point for classifying clearance (sensitivity = 0.70, specificity = 0.74). Conclusions Percent of normal demonstrated strong clinical performance in discriminating those with SRC from controls and moderate congruence with clinical recovery across a multidomain assessment. Percent of normal was also associated with multiple symptom- and performance-based measures across recovery. The PoN provides clinicians with a brief and intuitive adjunctive tool to monitor recovery in athletes after this injury.
ABSTRACT Acetabular dysplasia, a non-arthritic hip joint pain condition in active young and middle-aged adults, is distinct from femoroacetabular impingement syndrome. Despite increasing clinical recognition of acetabular dysplasia over the past decade, it remains a challenging orthopedic condition for athletic trainers to manage due to the complexities of diagnosis, concurrent psychological implications, and overlap with other hip and spine pathologies. Acetabular dysplasia is more prevalent in females and is diagnosed primarily through clinical presentation and radiographic evidence. Altered femoral morphology and soft tissue pathology commonly co-occur. The primary symptoms include anterior, groin, and potentially lateral hip pain exacerbated by movement and prolonged positioning. Individuals with mild acetabular dysplasia typically benefit more from non-surgical rehabilitation, while severe cases often require surgical modification, such as periacetabular osteotomy, to reduce pain and risk of osteoarthritis. When treating athletes with hip pain, especially females, athletic trainers should consider acetabular dysplasia in their differential diagnosis, as early identification and intervention are beneficial for preservation of the natural hip joint.
ABSTRACT Context: Pelvic floor dysfunction is highly prevalent following pregnancy and childbirth and negatively impacts maternal health. However, there are conflicting findings regarding associations of physical activity and pelvic floor dysfunction, suggesting that both underloading and overloading the pelvic floor during pregnancy may be associated with postpartum pelvic floor dysfunction. Objective: Assess the associations of physical activity and sedentary behavior during pregnancy with the development of postpartum pelvic floor dysfunction. Design: Prospective cohort study. Setting: Secondary analysis of data from a prospective cohort study of pregnant individuals in the United States. Patients or Other Participants: Participants were included in this study if they had completed the parent study (Pregnancy 24/7) and had complete physical activity and birth data. Inclusion criteria for the parent study were age of 18-45 and gestational age <13 weeks at the time of study enrollment. Exclusion criteria included cardiovascular or metabolic disease or conditions which severely limited physical activity. Main Outcome Measures: This prospective cohort study (N=486) captured device-measured physical activity and sedentary behavior across pregnancy trimesters and assessed postpartum pelvic floor dysfunction via medical chart abstraction. Logistic regression models analyzed the association between moderate-to-vigorous intensity physical activity, light intensity physical activity, and sedentary behavior in each trimester with the development of postpartum pelvic floor dysfunction. Results: After adjustment for covariates, no association was found between pregnancy physical activity behaviors and postpartum pelvic floor dysfunction. Differences in pelvic floor diagnosis rates were associated with income, education, marital status, and delivery mode. Conclusions: Athletic trainers working with pregnant athletes should continue to promote physical activity to individual tolerance as findings support evidence that pregnancy physical activity is well tolerated by the pelvic floor. Demographic findings highlight a need for standardized screening and referral practices for postpartum pelvic floor dysfunction.
ABSTRACT Context Shoulder and elbow injuries cause pain and disability at all levels of baseball competition. Emerging evidence suggests limited neck mobility is associated with development of arm injury in baseball pitchers. Objective 1) Evaluate group differences in neck mobility of collegiate baseball pitchers and explore group differences by injury history, hand dominance, and pitcher position; 2) Investigate the association of preseason neck mobility and throwing-related arm injury. Design Prospective cohort Setting Seven college baseball programs in 2023 Patients or Other Participants Healthy college baseball pitchers age 18 and older Main Outcome Measure(s) Neck active range of motion (CAROM) and the Cervical Flexion Rotation Test (CFRT) were primary exploratory measures. Primary outcomes included time-loss arm injury, Single Assessment Numerical Evaluation (SANE), and Functional Arm Scale for Throwers (FAST). Results Of 126 pitchers, 68 (54%) reported a previous arm injury, and 25 (20% (95% CI: 13, 27) arm injuries occurred during the season. Arm injury rates were 3.5 (95% CI: 2.3, 4.7) per 1000 baseball exposure days and 21.6 (95% CI: 13.7, 30.6) per 1000 pitching appearances. There was a small positive association (MD: 0.1 (0.0, 0.2)) for dominant and non-dominant CFRT and baseline SANE Elbow scores. There was a small positive association (IRR: 0.98 (95% CI: 0.97, 1.00) in the difference in dominant versus non-dominant CFRT and time-loss arm injury. Starting pitchers demonstrated significant differences (MD: 0.3 (95% CI: 0.1, 0.5); MD; 0.3 (95% CI: 0.1, 0.7)) for dominant and non-dominant CFRT versus relief pitchers, and left-handed pitchers demonstrated a significant difference (MD: 0.3 (95% CI: 0.1, 0.6)) in non-dominant CFRT compared to right-handed pitchers; however, these results were below standard error of measures. Conclusions Pitchers with less CFRT mobility were more likely to sustain pitching related time-loss injury and reported worse overall function, but effect sizes were small.
ABSTRACT CONTEXT: Peripartum women are running yet there is minimal evidence to understand if these runners experience changes in strength or pelvic floor health. Expert guidelines recommend strength training and rehabilitation while returning to running; however, changes in strength and pelvic floor symptoms have not been investigated in cohorts of pregnant and postpartum runners. OBJECTIVE: This pilot study aimed to assess hip strength and pelvic floor symptoms in cohorts of peripartum runners. DESIGN: Cohort study. SETTING: Laboratory data collection. PARTICIPANTS: Healthy runners who were trying to conceive, pregnant or postpartum and reported running at least once a week for ten minutes were eligible to participate. MAIN OUTCOME MEASURES: Four cohorts of participants (each trimester and postpartum) underwent hip strength testing with a dynamometer. All hip motions were measured. The pelvic floor disability index survey (PFDI-20) assessed participant’s weekly prevalence and burden of pelvic floor symptoms. A general linear mixed model analysis was performed to compare the strength among the cohorts. Descriptive statistics of pelvic floor symptoms by cohort were performed. RESULTS: Eighteen runners were included in the study. Runners produced significantly less bilateral hip flexion strength in 2nd and 3rd trimester groups compared to strength values of nulliparous and 1st trimester group. Pelvic floor symptoms were frequently reported by the different cohorts (62.5%–75%) and symptoms were moderately bothersome for multiple weeks from second trimester to postpartum. CONCLUSION: This pilot study identified only hip flexion strength significantly decreased in the second and third trimester in cohorts of perinatal runners. Over 50% of enrolled runners reported moderately burdensome pelvic health symptoms from second trimester through to postpartum. Health care providers should screen for pelvic health symptoms, measure hip strength, and monitor changes over time to keep perinatal runners active and refer to appropriate providers, especially if the symptoms limit participation in physical activity.
ABSTRACT Context: Low energy availability indicators (LEA-I; menstrual dysfunction, eating disorders/disordered eating behaviors) are prevalent health concerns among female athletes. Emerging evidence suggests an impaired neuromusculoskeletal response to training in adults with LEA-I. We hypothesized that an impaired response would similarly be seen in adolescent females with LEA-I. Objective: To determine if there was an impaired response to neuromuscular training in the uninjured limb of female athletes with and without LEA-I post-anterior cruciate ligament (ACL) reconstruction. Design: Retrospective case-control study. Setting: Outpatient sports medicine clinic. Patients or Other Participants: 18 adolescent female athletes with LEA-I (mean [95% confidence interval]: age: 16.2 [15.3, 17.0] years, body mass index [BMI]: 23.0 [21.1, 24.8] kg/m 2 ) and 18 without LEA-I (non-LEA-I; age: 16.2 [15.0, 17.0] years, BMI: 23.9 [20.9, 24.0] kg/m 2 ) completed a 10-session neuromuscular training program 6- to 9-months post-ACL reconstruction. LEA-I were defined as either menstrual dysfunction (primary/secondary amenorrhea, oligomenorrhea) or a diagnosed eating disorder. Those with prior surgery on either leg, hormonal medication exposure (≤60 days of pre-operative clinic visit), and/or polycystic ovarian syndrome were excluded. Main Outcome Measure(s): Gluteus maximus, quadriceps, and hamstrings strength, and single-leg hop for distance on uninjured limbs were measured at 6- and 9-months. Repeated measures analyses of variance were used to compare normalized strength and hop performance by group and time with Hedges g effect sizes. Results: Quadriceps and gluteus maximus strength increased in the non-LEA-I group (Δstrength: 0.29-0.74Nm/kg, p-range: 0.013-0.028, g-range: 0.56-1.30), yet did not for the LEA-I group (strength: 0.13-0.19Nm/kg, p-range: 0.235-0.594, g-range: 0.21-0.37). Hamstrings and gluteus maximus strength and single-leg hop for distance were significantly lower in the LEA-I group at 9-months (p-range: <0.001-0.048, g-range: 0.66-1.74). Conclusions: Female athletes with pre-operative LEA-I demonstrated impaired strength and function in their uninjured limb throughout ACL reconstruction recovery, supporting that LEA-I threaten neuromuscular response.
Context:Hamstring injuries are common in the National Basketball Association (NBA); however, there is a paucity of epidemiological data regarding these injuries. Objective:The primary aims of this study were to characterize the epidemiology and performance outcomes of hamstring injuries in the NBA over 4 seasons. Secondary aims were to analyze the mechanism of hamstring injury through video analysis. Design:Descriptive epidemiology study. Setting:Publicly available injury reports, player statistics, and game footage from the NBA over 4 seasons (2019-2022). Patients or Other Participants:We included a total of 181 injuries sustained by NBA players for analysis. We analyzed available video film for 45 players to determine the mechanism of injury. Main Outcome Measures:We recorded player demographics and performance data. We used Game Score, which uses box score statistics such as points, rebounds, assists, steals, and blocks to measure player performance. We compared performance outcomes by age, body mass index, game score, and position using paired t tests. Results:By position, guards experienced the highest proportion of injuries (65.7%). Players injured their left hamstring most frequently (59.6%; P = .044). Players missed an average of 5.5 games after injury. Within 3 months of returning to play, 16.0% reinjured their ipsilateral hamstring and 5.0% injured their contralateral hamstring. Player performance declined after injury in the short and long term by -1.1 and -0.8 game score units, respectively. Video analysis revealed most injuries were noncontact (62.2%) and occurred as a player initiated a plant/jump movement with the injured extremity (41.9%). Conclusions:High-performing players have higher rates of reinjury and a more significant decline in performance compared with low-performing players. Most injuries occurred on offense when the injured player was jumping or landing. Due to the frequency of hamstring injuries, awareness of injury mechanisms and characteristics of injury can be useful for risk mitigation purposes.
Context Despite the broad impact of sleep in injury-related recovery, there is limited literature investigating how sleep may impact patients after anterior cruciate ligament reconstruction (ACLR). It is unclear whether patients perceive sleep changes as a result of ACLR and whether they perceive these changes to influence their health-related outcomes (eg, physical recovery, psychological functioning) in the early postoperative ACLR recovery phase. Objective This qualitative study aimed to capture patient perceptions of sleep after ACLR as well as how they perceived the impact of sleep on their ACLR recovery within the first 3 months postoperatively. We aimed to better understand patients’ subjective experiences regarding the role of sleep in recovery and to identify any barriers or facilitators to achieving optimal sleep when undergoing acute stages of ACLR rehabilitation. Design Qualitative study. Setting Research university. Patients or Other Participants Twelve participants aged 18 to 35 years and 1 to 3 months post-ACLR completed semistructured interviews via a videoconferencing platform. Data Collection and Analysis Audio and video recordings of each interview were transcribed verbatim to prepare for thematic coding. Transcriptions were anonymized with pseudonyms. Data were interpreted through thematic analysis using an inductive approach. Coding and thematic analysis was carried out by 2 independent reviewers. Results Three major themes were found relating to participants’ perception of their sleep and ACLR experience early in the rehabilitation process: (1) sleep disturbances experienced, (2) repercussions of sleep disturbances, and (3) prior knowledge of sleep hygiene. The most important finding of this study was that patients after ACLR in this sample did perceive significant sleep disturbances leading to poor sleep quality, and these led to perceived negative impacts to health outcomes. Conclusions Future researchers should focus on integrating lifestyle factors, such as sleep, into ACLR rehabilitation protocols as improving sleep may improve ACLR-specific recovery outcomes and quality of life.
In this level 3 clinical Contribution to the Available Sources of Evidence report, we explored potential risk factors in workload (eg, total distance, accelerations, and decelerations) and wellness (daily self-reports) that led to an off-season anterior cruciate ligament injury in a female collegiate lacrosse athlete (age = 19 years, height = 180 cm, mass = 63.5 kg). During the first 8 weeks, the athlete's workload was consistently higher (range, 12.3%-33.3%) compared with the team average. In week 7, the workload of the athlete and team decreased, followed by a workload spike in week 8, creating a load-reload pattern 1 week before injury. The wellness data showed a decrease in muscle readiness and energy and sleep duration 2 weeks before injury. Athletic trainers should be part of an interdisciplinary team using microtechnology and wellness tracking to determine if athletes have participated in high or fluctuating workloads or are experiencing poor wellness that could increase their risk of injury. Load-reload patterns in conjunction with wellness should be considered potential risk factors for athletes' injuries.
Background Lateral ankle sprain (LAS) is the most common injury in sports, and only 30% of patients will fully recover (copers). Currently, no single objective tool exists to help clinicians decide on return to sport between LAS copers and patients likely to develop chronic ankle instability (CAI). The Simple Ankle Value (SAV) is a score developed recently to evaluate function among patients with ankle injury. Objective To evaluate the ability of the SAV to distinguish between LAS copers and patients likely to develop CAI. Setting Clinic. Design Cross-sectional study. Patients or Other Participants A total of 66 participants (34 women, 32 men; age = 32.4 ± 9.3 years) comprising 15 copers, 32 patients with CAI, and 19 healthy controls. Main Outcome Measure(s) Participants completed the SAV, which consisted of a single question rated from 0% to 100%, with 100% corresponding to normal ankle function . The SAV scores were compared among the 3 groups (coper, patients with CAI, and control) via analysis of variance and post hoc Bonferroni correction. The area under the receiver operating characteristic curve with the optimal cutoff score was determined to assess the ability of the SAV to discriminate between copers and patients likely to develop CAI. Results Both LAS copers (96.3% ± 6.8%) and controls (92.8% ± 6.5%) presented higher SAV scores than patients with CAI (74.4% ± 18.0%; F 2,63 = 19.04, P < .001, η 2 = 0.37). Post hoc analysis revealed no difference between LAS copers and controls ( P = .14). The SAV showed a fair-to-good ability to discriminate between copers and patients with CAI (area under the receiver operating characteristic curve = 0.83; 95% CI = 0.72, 0.95; P < .01). A Youden index of 0.65 was observed for an SAV score of 87%, which corresponded to a sensitivity of 87% and a specificity of 78%. Conclusions The SAV is a simple and practical tool that helps distinguish copers from patients at risk of developing CAI after LAS. Scores of ≤87% suggest incomplete recovery. As a complementary patient-reported outcome measure, the SAV should be integrated into a comprehensive clinical assessment to support return-to-sport decision-making in the context of CAI.
