OBJECTIVES:This study examined the association between adolescent (aged 11-18 years) sport-related concussion (SRC) or musculoskeletal (MSK) injury and long-term (ie, 5-15 years postinjury) health-related quality of life (HRQoL). DESIGN:This was a substudy of a historical cohort study. SETTING:This study was conducted in a university setting. PARTICIPANTS:Individuals who participated in adolescent sport 5 to 15 years before assessment were included in this study. ASSESSMENT OF RISK FACTORS VARIABLES:Reports of SRC, MSK injury, or no injury during adolescent sport participation. MAIN OUTCOME MEASURES:Multivariable regression models assessed associations between an adolescent SRC or MSK injury and long-term HRQoL (EQ-5D-5L visual analog scale [VAS] and Index Score) standardized to Canadian population preferences. Models were adjusted for sex, time since injury, athlete identity, and 4 physical activity exposures modeled separately to reduce collinearity. Effect measure modification was evaluated for all two-way interactions. RESULTS:A total of 325 individuals participated (aged 16-33 years). EQ-5D-5L median [interquartile range] scores were high across groups [Index Score, no injury: 0.91 (0.88, 0.95), MSK injury: 0.91 (0.87, 0.95), SRC: 0.91 (0.87, 0.95); VAS score, no injury: 85 (78, 90), MSK injury: 85 (78, 90), SRC: 85 (75, 90)]. The SRC group demonstrated lower EQ-5D-5L index scores across all models (β-range: -1.93 to -1.97, 95% confidence interval range: -3.61-0.34) compared with the uninjured group. No VAS score differences were observed between groups; however, the age-by-group interaction was significant, indicating lower VAS scores among older participants who sustained a SRC. CONCLUSION:Sport-related concussion may influence HRQoL years after injury, and targeted interventions focusing on the specific domains of HRQoL that are impacted may be indicated.
Objective: To examine the lifetime and one-year prevalence of concussion, including suspected and medically diagnosed, among high school students (ages 14-19 years) in Alberta, Canada. Design: Cross-sectional survey. Setting: High schools across Alberta, Canada. Participants: Grade 10 to 12 students from 24 schools. Independent Variables: Students completed an anonymous and validated online survey during class (October 2018-March 2019), including their sex and participation in sport and recreational activity. Main Outcome Measures: Prevalence estimates for lifetime and one-year concussion, including suspected and medically diagnosed, were estimated with 95% confidence intervals (CI) adjusted for cluster by school. Results: In total, 1972 students (97.14%) were included. At least 1 suspected lifetime concussion was reported by 292 of 923 males (31.64%; 95% CI: 24.45-39.83) and 262 of 1027 female students (25.51%; 95% CI: 20.92-30.72), and at least 1 suspected concussion in the past year by 138 of 923 males (14.95%; 95% CI: 10.92-20.92) and 118 of 1027 female students (11.49%; 95% CI: 9.07-14.46). For male students, ice hockey (16.67%; 95% CI: 12.28-22.07), lacrosse (13.79%; 95% CI: 5.27-31.52), and rugby (13.11%; 95% CI: 6.02-26.24) had the highest period prevalence of sport-related concussion in the previous year. For female students, ringette (19.05%; 95% CI: 9.92-33.46), rugby (15.52%; 95% CI: 8.04-27.84), and wrestling (12.00%; 95% CI: 3.68-32.77) had the highest prevalence. Conclusions: One in 3 male and 1 in 4 female high school students from Alberta reported at least 1 suspected concussion in their lifetime. One in 7 male and 1 in 9 female students reported at least 1 suspected concussion in the past year. Concussion prevention strategies are a key priority.
OBJECTIVE:This study aimed to evaluate the effects of upper extremity strengthening exercises in individuals with subacromial impingement syndrome (SAIS). DESIGN:Systematic review. Inclusion criteria were (1) randomized controlled trials (RCTs) and quasi-experimental studies published in English; (2) participants aged 18 years or older diagnosed with subacromial or shoulder impingement syndrome; (3) studies comparing strengthening exercise interventions with other exercise programs, treatment protocols, or standard care. Exclusion criteria included case reports, case series, narrative reviews, editorials, and analytical studies. SETTING:N/A. PATIENTS:Individuals diagnosed with SAIS. INTERVENTIONS:Upper extremity strengthening exercises. MAIN OUTCOME MEASURES:The effects of strengthening exercises on pain, muscle strength, range of motion (ROM), quality of life, and function in individuals with SAIS. RESULTS:A systematic review of 3 electronic databases up to May 2024 identified RCTs investigating strengthening exercises in the management of SAIS. Thirteen studies (n = 914) meeting the prespecified criteria were selected using relevant keywords. These trials assessed pain, muscle strength, quality of life, ROM, and functionality. CONCLUSIONS:This review demonstrates that upper extremity strengthening exercises may reduce shoulder pain, improve ROM, and enhance muscle strength in individuals with SAIS. However, the evidence regarding their effects on functionality and quality of life remains limited, highlighting the need for further high-quality RCTs. Nevertheless, incorporating strengthening exercises into rehabilitation programs is recommended as a potentially effective approach in the management of SAIS.
OBJECTIVE:To determine the role of player self-report in concussion evaluation and diagnosis. DESIGN:Retrospective; cross-sectional. SETTING:National Football League (NFL). PARTICIPANTS:National Football League players between 2018 and 2023. INTERVENTIONS:Unaffiliated Neurotrauma Consultant gameday reports; Electronic Medical Records; Game Statistics and Information System. MAIN OUTCOME MEASURES:Concussion evaluations and diagnoses; concussion evaluation trigger; player demographics and characteristics (eg, age, injury history). RESULTS:From 2018 to 2023, player self-report occurred in 24% (preseason) and 30% (regular season) of all concussion evaluations and 32% (preseason) and 39% (regular season) of diagnosed concussions. The proportion of self-report was largest among individuals with 6 to 10 years of NFL experience, offensive and defensive linemen, and those with 2 or more previous concussions. CONCLUSIONS:This study found that NFL players self-report concussion-like symptoms to initiate evaluation approximately one-third of the time, which increased to almost 40% in concussed players. This may indicate enhanced improvement in player understanding of the injury and motivation to report to improve their symptoms, which is supported by the finding that players with more experience in the NFL and those with multiple previous concussions showed a higher percentage of triggering the evaluation by self-report. These findings help inform future educational efforts to promote timely reporting and improve postinjury recovery.
ABSTRACT:Platelet-rich plasma (PRP) is increasingly used for the treatment of knee osteoarthritis (OA), especially in younger patients. Adverse effects are rare but can include synovitis and effusions. In this case, we present a 43-year-old woman with no history of calcium pyrophosphate deposition disease (CPPD) developed acute swelling and stiffness of the knee within 1 h after a leukocyte-poor PRP injection. Synovial fluid analysis revealed positively birefringent rhomboid-shaped crystals, confirming pseudogout. She was treated conservatively with NSAIDs and physical therapy, with complete symptom resolution in 2 weeks. This case highlights a rare complication of PRP injection, underscoring the importance of considering subclinical CPPD in patients with early onset OA. Pseudogout should be discussed as a potential, though uncommon, risk when counseling patients about PRP therapy.
OBJECTIVE:To identify the independent predictors of mental health and quality of life (QOL) among elite youth soccer athletes. DESIGN:Cross-sectional observational study. SETTING:Study materials were distributed to the Elite Clubs National League (ECNL) clubs through an online survey. PARTICIPANTS:668 adolescent athletes aged 13 to 18 years. ASSESSMENT OF RISK FACTORS:Independent variables included age, sex, previous week sleep duration, athletic identity (AI), previous injury, and racial/ethnic minority status. MAIN OUTCOME MEASURES:Main outcome measures were anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and QOL (PedsQL). Separate multivariable regression models evaluated independent predictors of each outcome. RESULTS:Independent predictors of anxiety were age (β = 0.28 ± 0.072, P < 0.001), female sex (β = -1.7±-0.40, P < 0.001), sleep (β = -0.88 ± 0.16, P < 0.001), AI (β = 0.11±-0.034, P = 0.002), and injury (β = 1.2±-0.37, P = 0.001), but not racial/ethnic minority status (β = 0.35 ± 0.39, P = 0.37). Independent predictors of depression included age (β = 0.29 ± 0.070, P < 0.001), female sex (β = -1.4 ± 0.41, P < 0.001), sleep (β = -1.2 ± 0.16, P < 0.001), injury (β = 0.88 ± 0.37, P = 0.019), and racial/ethnic minority status (β = 0.81 ± 0.40, P = 0.004), but not AI (β = 0.049 ± 0.035, P = 0.16). Independent predictors of QOL were age (β = -0.60 ± 0.19, P = 0.001), sleep (β = 2.6 ± 0.43, P < 0.001), injury (β = -3.7 ± 0.98, P < 0.001), and AI (β = -0.22 ± 0.092, P = 0.016), but not sex (β = 1.8 ± 1.1, P = 0.10) or racial/ethnic minority status (β = -1.5 ± 1.0, P = 0.16). In all models, sleep had the greatest relative importance (38%-56%). CONCLUSIONS:Among youth soccer athletes, greater age, female sex, previous injury, and less sleep were independent predictors of anxiety and depression, whereas greater age, previous injury, less sleep, and higher AI predicted lower QOL. Sleep emerged as the strongest modifiable factor, highlighting its importance in psychosocial wellbeing, to the extent that sleep contributes to these outcomes.
OBJECTIVE:To map and evaluate the implementation of soccer concussion prevention programs and identify barriers and facilitators across all demographics using the RE-AIM framework. DATA SOURCE:A scoping review was conducted in accordance with PRISMA-ScR guidelines. The protocol was registered on the Open Science Framework (10.17605/OSF.IO/DBT8M). Studies were eligible if they reported quantitative outcomes of concussion-related programs implemented in soccer settings. Searches were conducted in 6 electronic databases and gray literature, with the search period limited to 2010 to 2025. Data extraction was completed independently by 2 reviewers. Program characteristics and outcomes were mapped to the 5 RE-AIM dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Risk of bias was assessed using the ROBINS-I tool. MAIN RESULTS:Fourteen studies met inclusion criteria, primarily from the United States (n = 7) and the United Kingdom (n = 4). Interventions focused on concussion education, baseline neurocognitive testing, guideline implementation, and neuromuscular or neck-strengthening exercises. All studies reported Reach, and most demonstrated short-term improvements in knowledge or recognition (Effectiveness). Adoption and Implementation were inconsistently reported, often limited by organizational and resource constraints. Maintenance was the least addressed dimension, with minimal long-term follow-up and no standardized outcomes beyond 6 months. Evidence for reduced concussion incidence was limited. CONCLUSIONS:Concussion programs in soccer seem to produce short-term benefits but remain inadequately evaluated in adoption, implementation, fidelity, and sustainability. Future research should prioritize longitudinal designs and comprehensive RE-AIM reporting to support scalable and sustainable concussion program implementation strategies.
Objective: To evaluate whether hamstring strain (HS) is associated with subsequent nonhamstring lower-extremity injury (NHLEI) after return to play (RTP) in National Football League (NFL) players and whether RTP timing influences risk. Design: Retrospective matched cohort study. Setting: Publicly available NFL injury reports from the 2014 to 2024 regular seasons. Participants: NFL players sustaining HS were matched 1:1 to controls by season, week, position, age, and workload. A total of 1236 HS episodes were matched to 1236 controls. Assessment of Risk Factors: HS status and RTP timing. Main Outcome Measures: NHLEI within 30, 60, and 90 days after RTP. Results: HS was associated with increased NHLEI risk at 30 days (hazard ratio [HR], 1.28; P = 0.002), 60 days (HR, 1.34; P < 0.001), and 90 days (HR, 1.39; P < 0.001). In adjusted analyses (584 pairs), HS remained associated with increased injury risk at all time points (adjusted HRs, 1.38-1.40; all P ≤ 0.003). Players returning within 0 to 7 days had higher subsequent injury risk than those missing 7 to 14 days (HR, 0.72; P = 0.027) or ≥14 days (HR, 0.75; P = 0.019). HS was associated with increased hazards of foot/ankle, knee, groin, and quadriceps injuries. Conclusions: NFL players sustaining HS had increased subsequent NHLEI hazard after RTP, with highest risk among earlier RTP. These findings support further study of RTP timing and post-RTP injury prevention. Clinical Relevance: RTP after HS may represent a period of elevated lower-extremity injury vulnerability in NFL players.
OBJECTIVE:Our study evaluated long-term outcomes of nonoperative treatment of spondylolysis in adolescents and young athletes. DESIGN:Retrospective case series. SETTING:High-volume sports medicine clinical and research center. PARTICIPANTS:Spondylolysis patients initially treated nonoperatively (10-25 year old; ≥5 years from diagnosis). MAIN OUTCOME MEASURES:We collected self-reported function (Oswestry Disability Index, ODI) and return-to-sport outcomes (for athletes) and compared ODI scores and follow-up between athletes and nonathletes, and between male and female patients. RESULTS:A total of 150 patients (133 competitive athletes; 108 males; mean age at diagnosis = 16.3 years; mean follow-up time = 8.0 years) were included. Bilateral defects were more common (75%) than unilateral defects (25%), and L5 was the primary affected level (63%). Nonoperative treatment approaches included activity modification (95%), physical therapy (93%), Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (64%), bracing (38%), and non-NSAID pain medication (23%). The mean ODI score at follow-up was 3.6 (0-100; best score = 0). ODI scores were higher (worse) in female patients versus male patients (P = 0.01), but did not statistically-differ between athletes and nonathletes (P = 0.29). Of competitive athletes, 91% returned to their preinjury sport at the same level or higher. Only 5 patients underwent subsequent back-related surgery after initial nonoperative treatment. CONCLUSIONS:We found excellent long-term outcomes after nonsurgical treatment of spondylolysis in a cohort of adolescents and young adults, including a large proportion of competitive athletes. Our findings underscore that nonsurgical interventions should be the mainstay treatment for spondylolysis in young individuals.
OBJECTIVE:To characterize the composition and specialty training of sideline medical providers present during National Collegiate Athletic Association (NCAA) Division I (Power 5) college football games. DESIGN:Cross-sectional survey study. SETTING:Power 5 NCAA Division I football programs during the 2023 to 2024 season. PARTICIPANTS:Head team physicians from 69 institutions were contacted; 53 (76.8%) completed the survey.Intervention: A 25-question REDCap survey assessing on-site personnel during home and away football games, including physician specialties, emergency coverage, imaging availability, emergency medicines, and athletic training support. MAIN OUTCOME MEASURES:Presence, specialty training, and roles of medical providers on the sideline during football games. RESULTS:All responding programs had orthopedic surgeons (OS) on-site at home games, and all but 1 had a primary care sports medicine physician (SMP). SMPs most commonly trained in family medicine (54.2%), followed by emergency medicine (13.5%) and pediatrics (11.9%). OSs were most frequently fellowship-trained in sports medicine (68.6%). Emergency/airway management physicians were present at 37.7% of schools; neurotrauma-specific providers were present at 15.1%. Away game coverage was reduced, with fewer SMPs and OSs traveling. Athletic trainer coverage remained consistent. Only a minority of schools traveled with additional medical specialists. CONCLUSIONS:There is significant variability in sideline medical staffing across Power 5 college football programs. While all schools met or exceeded NCAA minimums, these findings highlight opportunities for standardization and alignment with professional sports models to optimize athlete safety.
OBJECTIVE:Human blood groups classically are described: A, B, AB, and O, and the presence or absence of the Rh antigen on them plays an important role in determining these groups. Previous studies have examined the relationship between blood groups and metabolic diseases. However, no study has yet investigated the relationship between blood groups and musculoskeletal injuries, and this issue has not been fully clarified. This systematic review investigates the association between blood groups and the risk of musculoskeletal injuries. DATA SOURCES:This study was conducted according to the guidelines Preferred Reporting Items for Systematic Reviews and Meta-Analyses. PubMed and Web of Science databases were searched and included in the present systematic review. The quality assessment tool for observational and cross-sectional cohort studies checked the articles' quality. MAIN RESULTS:A total of 12 cross-sectional studies were included in the present systematic review. The results showed that the amount of injury in people with different blood groups is different. For example, common fractures and osteoporosis were more in people with blood group A, and tendon injury was in people with blood group O. CONCLUSIONS:People with certain blood groups may be more prone to some musculoskeletal injuries.
OBJECTIVE:The vestibular ocular motor screen (VOMS) and the Sport Concussion Assessment Tool 6 (SCAT6) are point-of-care concussion assessments administered immediately or soon after sports participation or exercise. To retain validity and accuracy, the results of these tests should not be affected by sporting activity. We assessed the effect on the mVOMS (modified VOMS) and SCAT6 immediately and 20 minutes after performance training in high school athletes. DESIGN:Nonrandomized pilot experimental study. SETTING:High School, Buffalo, NY. PARTICIPANTS:Nonconcussed athletes (n = 23, 39% male, 15.5 ± 1.0 years). INDEPENDENT VARIABLE:Performance Training (pretraining, post-training, 20 minutes post-training). MAIN OUTCOME MEASURES:mVOMS and SCAT6 scores (standardized assessment of concussion, modified balance error scoring system, timed tandem gait [TTG], dual task tandem gait [DTTG]). RESULTS:TTG (P = 0.005) and DTTG (P = 0.045) improved significantly from prepractice to immediate postpractice and from pretraining to 20 minutes post-training (TTG [P = 0.002], DTTG [P = 0.006]). There were no other differences in SCAT6 or mVOMS scores among the 3 time points. CONCLUSIONS:SCAT6 and mVOMS performance was not adversely affected by moderately intense exercise training in high school athletes. TTG and DTTG performance improved after exercise, consistent with the learning effect. Further research should be conducted across other populations to increase generalizability. Clinicians should be confident that fatigue and exertion from acute performance training activities are not likely to affect the performance of these widely used sideline concussion assessment tools.
OBJECTIVE:To examine mouthguard usage, hygiene practices, and oral health status of youth ice hockey players in Ontario. DESIGN:Cross-sectional survey study. SETTING:Ontario, Canada; recruitment conducted online in collaboration with the Ontario Minor Hockey Association. PARTICIPANTS:Youth ice hockey players in Ontario who reported mouthguard use. INTERVENTIONS:Participants voluntarily completed an anonymous online questionnaire administered using REDCap. MAIN OUTCOME MEASURES:Frequency and consistency of mouthguard use, mouthguard cleaning practices, receipt of hygiene instructions, oral hygiene behaviors, and self-reported caries experience and oral health status. RESULTS:Complete responses were obtained from 214 players using mouthguards. Approximately 47% reported wearing mouthguards during both games and practices, with majority (59%) wearing boil-and-bite type. Among custom mouthguard users, 64% reported never receiving care instructions from a dentist, whereas 29% of stock or boil-and-bite users reported no manufacturer guidance. Overall, 52% reported cleaning their mouthguards, and 38% of these did so after every game or practice. Most participants brushed twice daily (71%), whereas fewer flossed daily (28%). Consistent mouthguard use was associated with significantly lower odds of self-reported caries (OR = 0.49; 95% CI: 0.28-0.85). Higher motivation toward oral health was associated with positive self-rated oral health (OR = 3.45; 95% CI: 1.20-9.97). CONCLUSIONS:Youth ice hockey players in Ontario demonstrated inconsistent mouthguard use and suboptimal hygiene practices, compounded by limited guidance from dental professionals and manufacturers. Improved education, clinical engagement, and policy initiatives are needed to enhance mouthguard effectiveness and oral health outcomes among youth athletes.
OBJECTIVE:The aim of this study was to evaluate, in runners participating in the 2019 Rome Marathon, the interaction between resilience and coping and how they are influenced by sex, age, body weight, height, number of weekly training sessions, and the time of the last marathon. DESIGN:Cross-sectional study. SETTING:The 2019 Marathon of Rome. PARTICIPANTS:Six hundred eighty-two athletes (513 men and 169 women; mean age: 47.7 ± 10.6 years, range 19-80 years). INTERVENTIONS:Runners filled in the Connor-Davidson Resilience Scale and Athletic Coping Skills Inventory (ACSI) questionnaires. Statistical analyses were performed by means of the Shapiro-Wilk test, the Mann-Whitney U test, the Kruskal-Wallis test and the Spearman rho. An a priori power analysis was calculated. MAIN OUTCOME MEASURES:Connor-Davidson Resilience Scale (for resilience) and ACSI (for coping) questionnaires. RESULTS:Overall, 682 athletes (513 men and 169 women; mean age: 47.7 ± 10.6 years; mean weight: 70.2 ± 9.6 kg; mean height: 172.8 ± 7.5 cm; mean BMI 23.5 ± 2.5) were included. A statistically significant positive correlation was found between resilience and coping (rho = 0.49 and P < 0.001). No statistically significant difference was found in resilience and coping according to sex, age, BMI, and impact profile (number of training sessions per week). No statistically significant correlations were observed between resilience and performance (ie, last marathon time) and between coping and performance (rho = 0.02 and P = 0.565, rho = 0.04 and P = 0.316; respectively). CONCLUSIONS:Higher levels of resilience correspond with higher levels of coping in adult marathon runner athletes. These factors/characteristics do not correlate with marathon times (sports performance). Physical or demographic features do not influence resilience and coping strategies in adult athletes.
