OBJECTIVE:Figure skating is a sport with a high risk of eating disorders (EDs), disordered eating (DE), and low energy availability (LEA). There is currently a limited understanding of athlete experiences and factors affecting body image and nutritional choices. We assessed the prevalence of ED/DE and awareness of LEA pathology [Relative Energy Deficiency in Sport (REDs) and female athlete triad (Triad)]. We also assessed experiences and qualitative factors affecting food choices and feelings about body weight and/or shape. DESIGN:Cross-sectional study. SETTING:One-time survey. PARTICIPANTS:Fifty-seven adolescent/young adult figure skaters ages 13 to 25 years (75.4% female). INTERVENTION:Electronic REDCap survey including demographic and health data, questions from standardized ED/DE screens, and open text responses. MAIN OUTCOME MEASURES:Eating disorders/DE rates as identified by self-report of ED/DE or a positive score on ED/DE screen, affirmative responses to specific questions, open text responses coded for qualitative data thoughts/experiences. RESULTS:The prevalence of a positive screen for ED/DE was 35.1%. More than half (51.8%) of athletes had received comments about their body weight and/or shape, and this was associated with athletes having a positive screen for ED/DE ( P < 0.01). Less than 16% of participants had heard of Triad or REDs. CONCLUSIONS:Athletes had high rates of screening positive for ED/DE and having received comments about their body weight/shape. The notable association between these variables necessitates further attention. Combined with a low awareness of LEA pathology, there is a need for education and future research to enhance the prevention and treatment of ED/DE and REDs.

Medical education is becoming a more structured and recognized field of medicine. Beyond working at an academic medical center or doing occasional didactic or clinical teaching, some physicians dedicate significant time and effort to becoming medical educators. Little is known about the ways in which these physicians enter the field of medical education. This qualitative study utilized purposeful sampling to identify medical educators from different institutions and geographical areas, categorized by gender and career stage. Semi-structured interviews were conducted. Data related specifically to participants’ initial interest in medical education and foundational work in this area were identified and evaluated. Reflexive thematic analysis was used to develop themes across items and participants. Twenty-two medical educators (11 male, 11 female) were interviewed. The average age of the participants was 51 (range: 31–72). Time from completion of training averaged 18 years (range: <1–41 years). Their paths to medical education were evaluated as part of a larger study examining the motivations of medical educators. The participants described varied ways of entering the field of medical education: by chance, through the influence and direction of others, or via self-advocacy. Physicians become medical educators along different pathways, and their stories reflect varied perspectives and interpretations of career influences. Informal channels provide opportunities for some. However, offering positions to known contacts severely limits the number of potential applicants. This process may hinder efforts to create a diverse workforce in medical education.

Background Medical educators face many challenges, including the absence of defined roles, lack of standard career paths, and limited support in systems that generally prioritize research and clinical productivity over educational activities. Providers also teach to widely varying degrees. This study was designed to specifically examine the professional rewards and obstacles experienced by physicians who have dedicated significant energy and career focus to medical education. Methodology A phenomenological approach was used in this qualitative study. Purposeful sampling was utilized to identify medical educators from different institutions and geographical areas. Participants were categorized by gender and career stage. Semi-structured interviews were conducted, and reflexive thematic analysis was used to develop themes across items and participants. Results Twenty-two medical educators were interviewed (11 males, 11 females), with an average age of 51 (range: 38-72) years. The average time from completion of training was 18 years (range: <1 to 41 years). Two main themes were constructed, which related to medical educators' career motivations and challenges: (1) Joy and purpose (subthemes: Interaction with learners, Impact, and Innovation) and (2) Everyone teaches (subthemes: Lack of recognition, Lack of reward, Malalignment of metrics) Conclusions The greatest source of motivation and satisfaction for medical educators is linked to the work itself; in addition to interactions with learners, educators derive pleasure from the innovation, collaboration, and systems thinking involved in their work. Importantly, participants also experience dissatisfaction, primarily due to a lack of recognition and reward, and metrics that do not consistently demonstrate their achievements. Participants provided examples of metrics that more accurately reflected the work of education; they identified clear benefits of academic promotion; and they highlighted significant challenges in the promotional system. The implementation of appropriate systems of measurement and reward is needed to better support the work of medical educators. Our aim should be not only to increase opportunities for satisfaction but also to reduce factors that cause frustration and limit advancement.

BACKGROUND:Recent studies utilizing magnetic resonance imaging (MRI) for the evaluation of symptomatic lumbar spondylolysis in pediatric and adolescent athletes have indicated that upper level lumbar involvement has a higher incidence than previously reported. There has been a paucity of literature evaluating sport-specific patterns of lumbar spondylolysis, specifically upper versus lower level involvement. PURPOSE:To assess the potential risk factors for upper level stress injuries of the lumbar spine in pediatric and adolescent athletes. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:The medical records of 902 pediatric and adolescent athletes (364 female, 538 male; mean age, 14.5 ± 2.1 years) diagnosed with symptomatic pedicle and pars interarticularis stress injuries at 2 academic medical centers (July 2016 to June 2021) were reviewed. All patients had undergone MRI at the time of diagnosis. Only patients with pars/pedicle edema on MRI were included. Data regarding single-sport specialization, sport participation, sport category by biomechanics (axial rotation vs extension/axial loading), and vertebral level of injury over the 5-year period were analyzed. Stress reaction or active spondylolysis (SRAS) was the terminology used to designate grade 1, 2a, or 3 stress injuries according to the adapted Hollenberg classification system on MRI. Upper level vertebrae were defined as L3 or superior, whereas lower level vertebrae included L4 or inferior. RESULTS:Of the 902 patients with SRAS injuries, most (n = 753 [83.5%]) had exclusively single-level lower stress injuries, while 67 (7.4%) had multilevel stress injuries. There were 82 athletes (9.1%) who had single-level upper stress injuries. Athletes with upper level pars/pedicle stress injuries were older at the time of diagnosis (15.8 ± 1.9 vs 14.3 ± 2.1 years, respectively; P < .001), had a shorter duration of low back pain before presentation (2.50 ± 2.70 vs 4.14 ± 6.73 months, respectively; P < .001), were more likely to specialize in a single sport (43.9% vs 32.3%, respectively; P = .046), and had a lower incidence of active spondylolysis on MRI at the time of diagnosis (42.7% vs 59.8%, respectively; P = .004) compared with athletes with lower level stress injuries. Athletes with lumbar stress injuries who specialized in a single sport had nearly twice the odds of having upper level involvement compared with multiple-sport athletes (adjusted odds ratio, 1.80 [95% CI, 1.06-3.04]; P = .03). Athletes with active spondylolysis on MRI at the time of diagnosis had nearly half the odds of having upper level involvement (adjusted odds ratio, 0.55 [95% CI, 0.33-0.91]; P = .02). CONCLUSION:Age at the time of diagnosis, duration of low back pain, single-sport specialization, and presence/absence of active spondylolysis on MRI at the time of diagnosis were primary predictors of whether an athlete's lumbar stress injury was classified as either upper or lower level involvement. Overall, the variables included in multivariate analysis were modest predictors, explaining only 15.1% of the variance in the rates of lumbosacral stress injuries classified by spinal level. These specific biomechanical factors and other potential contributors to these findings warrant further investigation.

# Background Fencing is a unique and increasingly popular sport, but limited data exist regarding related injuries. # Purpose To examine the types of injuries incurred by fencing athletes, and to analyze associations between age, sex, and hand dominance with type and location of injury. # Study Design Cross-sectional # Methods Retrospective chart reviews were performed to evaluate fencing related injuries in athletes evaluated in the sports medicine and orthopedic clinics of a large teaching hospital. # Results One hundred and eighty-six patients (98 male, 88 female) were included. Average age at time of injury was 14.6 years (range 9 - 32 years). 73% of injuries involved the lower extremity, 16% involved the upper extremity and 10% affected the back. In the lower extremity, the knee (49%), ankle (16%) and hip (11%) were most commonly affected. 80% of injuries were treated with physical therapy. Only 5% required surgical intervention. Injuries of both upper and lower extremities were more commonly seen on the athlete's dominant side, and the majority of injuries (77%) occurred in athletes 13 years or older. # Conclusion The majority of injuries in these fencing athletes affected the lower extremity, most commonly the knee. Extensor mechanism dysfunction, primarily patellofemoral pain, was the most common diagnosis. Hand dominance, patient age, and patient sex did affect different injury characteristics. # Level of Evidence 2b

ABSTRACT Objective Hallux sesamoid injuries are well described and can be debilitating and chronically disabling. The role of orthobiologics such as platelet-rich plasma (PRP) in sesamoid injuries has not been reported. This study describes three cases of recalcitrant hallux sesamoid injuries in teenage athletes who returned to impact activities, pain free, following one treatment of PRP. Methods This is a case-series study describing three teenage athletes presenting to a tertiary level pediatric sports medicine practice with chronic hallux sesamoid injuries. Results The three patients (two female, one male) described in this case series were 13-, 16-, and 17-year-old athletes. Their primary sports were ballet, basketball, and Irish step dance, respectively. All three athletes received PRP: two received unilateral treatment (one tibial sesamoid, one fibular sesamoid) and one received treatment to bilateral tibial sesamoids. The average duration of symptoms prior to PRP was 52.5 weeks (14–128 weeks). The average time out of their primary sport was 48.7 weeks (20–78 weeks). Three of the 4 sesamoids treated with PRP were tibial sesamoids. Each site of injury was treated with one treatment of leukocyte-rich PRP. All three athletes were cleared to return to impact activities such as running and jumping at 6–9 weeks following PRP, specifically 9 weeks after the final PRP injection for the patient who underwent bilateral treatments. Conclusion In the three cases provided of sesamoid injuries treated with PRP, the time to return to impact activities was less than reported for athletes not treated with PRP. Acknowledging that other management factors likely contributed to return to impact activities, this case series sets the groundwork for future research investigating the role of PRP with needle fenestration in the treatment of sesamoid injuries.

Background As a result of the coronavirus disease 2019 (COVID-19) pandemic, graduate medical education, along with most of daily life, was disrupted. The goal of this study was to explore the experiences of fellows in primary care/medical sports medicine (MSM) and view the changes made to training programs through their eyes. Methodology A questionnaire was developed to collect qualitative and quantitative data regarding the fellow's experiences in training from March to June 2020. Fellows on the American Medical Society for Sports Medicine list of current Sports Medicine Fellows in the United States and Canada were invited to participate. Of the 329 invited, 90 (27.4%) fellows returned questionnaires. Results MSM fellows highlighted positive adaptations as well as losses to their educational programs related to the pandemic. The biggest gain reported was additional learning time, and the greatest loss was to sports and event coverage. Most fellows reported attending collaborative sessions, and they noted an increase in didactics compared to pre-pandemic levels. The largest losses were noted in event coverage and training room exposures, with smaller declines in ultrasounds, procedures, and research experiences. They also described challenges, including changing clinical roles, managing social isolation and boredom, and balancing work and family responsibilities. Conclusions Fellows identified gains, losses, and challenges due to pandemic-related changes to their fellowship programs. Fellowship directors and educators in different fields can use this understanding of the fellows' experiences to build on current resources, further develop collaborative efforts, create new educational opportunities, and provide additional support for fellow learning.

Background. Strategies to reduce anxiety prior to injection procedures are not well understood. The purpose is to determine the effect of a meditation monologue intervention delivered via phone/mobile application on pre-injection anxiety levels among patients undergoing a clinical injection. The following hypothesis was tested: patients who listened to a meditation monologue via phone/mobile application prior to clinical injection would experience less anxiety compared to those who did not. Methods. A prospective, randomized controlled trial was performed at an orthopedics and sports medicine clinic of a tertiary level medical center in the New England region, USA. Thirty patients scheduled for intra- or peri-articular injections were randomly allocated to intervention (meditation monologue) or placebo (nature sounds) group. Main outcome variables were state and trait anxiety inventory (STAI) scores and blood pressure (BP), heart rate, and respiratory rate. Results. There were 16 participants who were allocated to intervention (meditation monologue) while 14 participants were assigned to placebo (nature sounds). There was no interaction effect. However, a main time effect was found. Both state anxiety (STAI-S) and trait anxiety (STAI-T) scores were significantly reduced post-intervention compared to pre-intervention (STAI-S: p = 0.04, STAI-T: p = 0.04). Also, a statistically significant main group effect was detected. The pre- and post- STAI-S score reduction was greater in the intervention group (p = 0.028). Also, a significant diastolic BP increase between pre- and post-intervention was recorded in the intervention group (p = 0.028), but not in the placebo group (p = 0.999). Conclusion. Listening to a meditation monologue via phone/mobile application prior to clinical injection can reduce anxiety in adult patients receiving intra- and peri-articular injections. Registration: ClinicalTrials.gov NCT02690194

The optimal screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Pre-participation screening with electrocardiogram (ECG) remains controversial. The utility and accuracy of limb-lead (LL) ECG alone in identifying cardiac abnormalities associated with SCD has not been studied. This study was a comparative secondary data analysis, comparing the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. Each physician interpreted a total of 100 ECGs: 50 normal ECGs (25 LL and 25 standard 12L) and 50 abnormal ECGs (25 LL and 25 standard 12L). The agreement between LL ECGs and 12L ECGs was assessed by Cohen's kappa coefficient and the accuracy of identifying an abnormal ECG was compared across LL and 12L ECGs using a chi-squared test. Inter-rater reliability was assessed by estimating the Fleiss's kappa coefficient. The sensitivity of LL ECG and 12L ECG was identical at 86%. The specificity of LL ECG was 75% (95% CI = 65% to 83%) and 12L ECG was 82% (95% CI = 73% to 89%). Substantial agreement was seen between LL ECG and 12L ECG interpretation across all readers (k = 0.63; 95% CI = 0.49 to 0.77). Interpretation accuracy was 81% (95% CI = 74% to 86%) and 84% (95% CI 78% to 89%) using LL ECG and 12L ECG, respectively (p = 0.43). In conclusion, the accuracy, sensitivity, and specificity were high and comparable for both LL ECG and 12L ECG in identifying cardiovascular conditions associated with SCD. Agreement between LL ECG and 12L ECG was substantial. (C) 2021 Elsevier Inc. All rights reserved.

The best screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Using the electrocardiogram (ECG) as a part of a pre-participation examination remains controversial due to the cost and rate of false positives. Screening athletes can be both time intensive and costly. Our previous study demonstrated that using a limb-lead ECG is faster than using a 12-lead ECG. However, the utility and accuracy of limb-leads alone in identifying cardiac abnormalities associated with SCD have never been studied. PURPOSE: To assess agreement and diagnostic accuracy in the interpretation of limb lead v. 12-lead ECG in identifying cardiac abnormalities associated with SCD. METHODS: This study compared the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. 4 Medical Sports Medicine fellows participated in the study and each interpreted a total of 100 ECGs: 50 normal ECGs (25 limb lead and 25 12-lead) and 50 abnormal ECGs (25 limb lead and 25 12-lead). The agreement between limb lead and 12-lead ECGs was assessed by Cohen’s kappa coefficient and the accuracy of identifying an abnormal ECG was compared across limb lead and 12-lead ECGs using a chi-squared test. Inter-rater and intra-rater reliability were assessed by estimating the Fleiss’s kappa coefficient. RESULTS: Preliminary data of 150 interpreted ECGs showed an accuracy of 77.8% and 82.1% in identifying abnormal from normal ECGs using 12-lead v. limb-lead, respectively (p = 0.513). Based on the readings of the physicians in this study, the sensitivity of limb-lead was 97.2% and 12-lead was 89.5%. The specificity of limb-lead was 69.1% and 12-lead was 64.7%. CONCLUSIONS: There was no significant difference in the accuracy of physicians’ interpretations of limb lead ECGs compare to standard 12-lead ECGs in identifying cardiac conditions associated with SCD.

Objective: To describe the evaluation, management and recovery time of hallux sesamoid fractures in young athletes. Methods: A retrospective chart review was performed in a large academic teaching institution over a 5-year period (1/1/2010-12/31/2014). All patients with a sesamoid injury were initially included. Excluded were those patients who: 1) did not receive the diagnosis of hallux sesamoid fracture, had a history of prior foot surgery, or had medical records inadequate for analysis, 2) had missing or unclear diagnostic imaging, 3) were age >21 years, or 4) did not report sports participation. Descriptive statistics were employed to analyze the data. Results: Fifty-eight patients (51 females and 7 males) with a mean age of 15.4 years (range: 9-21) were identified with a total of 59 sesamoid fractures. Dancing (37.9%), running (13.8%), and gymnastics (13.8%) were the most common sports reported among these patients. A greater number of fractures were classified as repetitive stress injuries (83.1%), rather than acute traumatic injuries (16.9%). Fractures were treated conservatively in the majority of cases (89.8%), and only six fractures (10.2%) were treated surgically. Most patients (84.7%) were able to return to sports and activities. The average time from diagnosis/start of treatment to pain-free state/cleared to return to sport was 161.4 days. Conclusion: Diagnosis of sesamoid fractures can be challenging, but overall most patients do well with conservative treatment and are able to return to sports and activities. Providers should keep sesamoid fracture in the differential when evaluating patients with pain in the area around the base of the first toe, especially in dancers, gymnasts, and runners. Understanding that the recovery from a sesamoid fracture can be a prolonged process may help patients develop realistic expectations.

Background Sesamoid injuries of the first metatarsal phalangeal joint in athletes occur with sports that place repetitive stress on the plantar aspect of the great toe. Performing artist athletes are particularly at risk for injury given the load placed on the hallucal sesamoid bone often inherent in the activity. Risk factors may include choice of sport, volume of training, sex, bone density, BMI and biomechanical profile of the lower extremity. Hallucal sesamoid evaluation and treatment remains poorly defined in the literature. The aim of this study is to analyze all sesamoid injuries presenting to a sports medicine clinic. The goal of the study is to increase understanding of the injury profile, diagnostic evaluation, treatment regime, and return to sport of athletes with hallucal sesamoid injuries. The long-term goal is to develop evaluation and treatment algorithms that serve to guide clinical decision-making, and improve time to return to sport. Methods A comprehensive retrospective chart review was conducted of athletes presenting to a tertiary level sports medicine clinic located within a pediatric medical center. Electronic medical records were searched using the search term sesamoid. To be included in the study, the injury had to definitively involve the hallucal sesamoid and be related to sports participation. Exclusion criteria included patients with a chronic disease or condition that might affect bone healing or confuse the diagnosis of sesamoid injury, prior history of surgery to the foot, and insufficient management records. Descriptive statistics were used to analyze outcome variables including specific diagnosis, clinical prognoses, diagnostic imaging tools and treatment types. Additionally, a correlation analysis was performed for time from pain onset to first clinic visit, and time to return to participation. Little or no correlation was considered 0.00-0.25, weak correlation was considered 0.25-0.50, moderate correlation was considered 0.50-0.75 and strong correlation was considered 0.75 -1.00. Results 326 athletes with 359 hallucal sesamoid injuries were identified. The mean age of the cohort was 15.8 ± 3.8 years (median: 15.3, 95% CIs: 15.46 – 16.24); 86% (n=309) were female and 14% (n=50) of the injuries were male. The mean BMI of the cohort was 21.28 ± 3.5 mg/kg2. Table 1 presents the sports for the athletes in the cohort. The leading sports included 40% (n=144) dance, 13% (n=48) running, and 13% (n=47) soccer. Activities that top the list for females include dance 44% (n=137) and running 13% (n=39). In comparison, male athletes participated in soccer (20%, n=10), running (18%, n=9), and football (10%, n=5) as well as other diverse sports. The most common injuries across both sexes were sesamoiditis (30%, n=107), followed by sesamoid stress fracture (13%, n=46). Table 2 Where self-reported data on dance/sport practice time was recorded, 31% (n=65) reported practicing 10-15 hours per week. Figure 1 The average reported time between injury or the onset of pain to the first clinic visit was 143 days (median: 42, 95% CIs:116.87-169.15). The mean time between pain onset and first clinic visit was greater for female athletes as compared to male athletes (146 days and 119 days). The average time from first presentation to clinic to returning to participation was 115 days (median: 72, CIs:100.7-129.49). Spearman’s rho demonstrated a strong correlation between time from pain onset to first clinic visit and the time to return to participation in both males (? (rho) = 0.82, p < 0.001) and females (? = 0.79, p < 0.001). Males experienced a shorter duration from the first clinic visit to return to participation (mean: 72 days, median 33), than females (mean: 121 days, median 77). The most common diagnostic imaging modalities used were radiographs (72.14%, n=259) and MRI (56.55%, n=203). In both males and females the most common initial treatments included a combination of: walking boot (51.53%, n= 185), physical therapy (38.72%, n=139), and activity modification (34.82%, n=125). These remained the most popularly prescribed treatments in the second and third treatments as well. Conclusions/significance Female athletes participating in dance and running, and male soccer, running and football athletes lead the list for injury to the hallucal sesamoid. Sesamoiditis and sesamoid stress fracture were the leading diagnoses in this cohort. Athletes who presented to clinical attention sooner also returned to sport/dance sooner when compared to athletes who delayed seeking medical attention. Continued research will serve to support anticipatory guidance and education surrounding hallucal sesamoid clinical presentation and need for timely evaluation and treatment in order to minimize time loss from sport/performing artist activity. Table 1. Primary sport for athletes who sustained a sesamoid injury. Sport Male Female Total N(%) N (%) N (%) Dance 7(11.86%) 137 (44.34%) 144 (40.11%) Running 9(15.25%) 39 (12.62%) 48 (13.37%) Soccer 10 (16.95%) 37 (11.97% 47 (13.09%) Basketball 4(6.78%) 16 (5.18%) 20 (5.57%) Lacrosse 3(5.08%) 14 (4.53%) 17 (4.74%) Gymnastics 0 16 (5.18%) 16 (4.46%) Other 4(6.78) 12 (3.88%) 16 (4.46%) Softball 0 11 (3.56%) 11 (3.06%) Hockey 3(5.08%) 4 (1.29%) 7 (1.95%) Figure Skating 0 6 (1.94%) 6 (1.67%) Tennis 1 (1.69%) 4 (1.29%) 5 (1.39%) Football 5 (8.47%) 0 5 (1.39%) Ultimate Frisbee 0 3 (0.97%) 3 (0.84%) Baseball 3(5.08%) 0 3 (0.84%) Swimming 1 (1.69) 2 (0.65%) 3 (0.84%) Field Hockey 0 2 (0.65%) 2 (0.56%) Biking 0 2 (0.65%) 2 (0.56%) Volleyball 0 1 (0.32%) 1 (0.28%) Martial Arts 0 1(0.32%) 1 (0.28%) Cheerleading 0 1 (0.32%) 1 (0.28%) Horseback riding 0 1 (0.32%) 1 (0.28%) Total 50 (13.9%) 309 (86.1%) 359 (100%) Table 2. Frequency of Sesamoid Injury Diagnoses Diagnosis N (%) Sesamoiditis 107 (29.81%) Stress Fracture 46 (12.81%) Sesamoiditis + Bipartite 32 (8.91%) Acute Fracture 29 (8.08%) Stress Reaction 23 (6.41%) Sesamoditis + Stress Reaction 18 (5.01%) Stress Reaction + Bipartite 14 (3.90%) Painful Nonunion 13 (3.62%) Bipartite 12 (3.34%) Sesamioditis + Stress Fracture 8 (2.23%) Acute Fracture + AVN 7 (1.95%) Total 309 (86.07%) ** The table contains the eleven most frequent diagnoses; the remaining 13.93% of diagnoses are composed of various combinations of sesamoid injuries, each accounting for less than 1% of sesamoid injuries. Figure 1. Self-Reported Hours of Sport Participation / Week **Figure 1 includes the known hours of participation per week. Not included in the chart are those who did not report hours spent participating as well as those who reported participating 50+ hours/ week (N=2, <1%).

The purpose of this study was to investigate associations between sedentary behaviors, sleep hours, and body mass index (BMI) in 12- to 17-year-old dancers. This was a cross sectional survey in which bivariate correlation and simple linear regression were used to determine associations between self-reported components. One hundred fifteen dancers were queried, 91.3% of whom were female. The mean BMI was 19.6 ± 2.3 kg/m2. Two-thirds of dancers fell below the 50th percentile for age-adjusted BMI, and 30.4% fell below the 25th percentile. Better than 12% of dancers reported a history of anxiety, and 2.6% reported depression. Mean hours of sleep per night was 7.8 ± 0.9, with 58% of the dancers getting less than 8 hours of sleep per night. The mean total screen time for dancers was 3.4 ± 2.1 hours/day, which consisted of tablet and computer usage: 1.6 ± 1.1 hours/day; texting: 0.5 ± 1.1 hours/day; watching television: 1.2 ± 1.1 hours/day; and playing video games 1.2 ± 1.1 hours/ day. Total screen time was independently associated positively with BMI, explaining nearly 10% of the variability in BMI. Age, hours dancing per day, and hours of sleep per night were not independently associated with BMI. To summarize: screen time was associated with increased BMI in this young dancer cohort; the majority of dancers slept less than 8 hours per night; anticipatory guidance addressing media use and sleep hygiene in the adolescent dancer population is needed.

PURPOSE: Several studies report delayed growth and hormonal changes during high intensity training in gymnasts, yet no studies specifically investigate the growth rate of gymnasts during periods of rest. The purpose of this investigation is to determine if an increased growth rate, or “catch-up growth”, exists in high level female gymnasts during periods of rest following injury. METHODS: A 5-year retrospective chart review was conducted at a large pediatric hospital. A search of medical records (1/1/2010-12/31/2015) identified female gymnasts 10-16 years old, training ≥10 hours/week or Junior Olympic level ≥7 who suffered an anterior cruciate ligament (ACL) tear requiring at least 6 months (m) recovery time out of training (Gym-ACL). The 6m growth rate of this group (n=23) was compared to female non-gymnast athletes with ACL injury and similar competitive level (Non-gym-ACL, n=29) and high level gymnasts training with minor injuries (Gym-min, n=27). One-way ANOVA with post-hoc correction was used to analyze the 6m rate of change in height, weight, and BMI of the 3 groups. RESULTS: There were no differences in mean ages (Gym-ACL: 14.8±1.8; Non-gym-ACL: 14.6±1.2; Gym-min: 13.9±2.0), nor significant differences in 6m changes in weight or BMI among the 3 groups. However, there was significant differences in the 6m height change among the 3 groups (p=0.024). A significantly greater height increase was observed in Gym-ACL (+1.40±2.16cm) compared to Non-gym-ACL (+0.02±1.72cm) groups (p=0.047), but no significant differences were found between the Gym-min (+1.32±2.27cm) and Non-gym-ACL (p=0.051) groups. CONCLUSIONS: The 6m growth rate of high level female gymnasts during periods of rest is greater than non-gymnast athletes, suggesting that catch-up growth does occur during periods of rest for highly active gymnasts. This evidence may help us better understand how growth is affected by training load and timing and help develop future training protocols and growth predictions.

Objective To describe musculoskeletal conditions in children with Ehlers-Danlos syndrome (EDS).Study design A retrospective medical record review was performed, which evaluated 205 patients with EDS (ages 6-19 years) seen in sports medicine or orthopedic clinic at a large pediatric hospital over a 5-year period.Results Female (n = 147) and male (n = 57) patients were identified (mean age 12.7 years). The most common EDS subtype (55.6%) was hypermobility type. Patients had between 1 and 69 visits (median 4), and 764 diagnoses were recorded, most commonly laxity/instability, pain, subluxation, and scoliosis/spinal asymmetry. Nearly onehalf of patients (46.8%) received a general diagnosis of pain because no more specific cause was identified, in addition to 8.3% who were diagnosed with chronic pain syndrome. The most common sites of presenting issue were knee (43.4%), back (32.2%), and shoulder (31.2%). Over three-fourths (77.1%) of patients had imaging. Most (88.1%) were prescribed physical therapy and/or other conservative measures, such as rest (40.5%), orthotics (35.6%), and medication (32.2%). Surgery was recommended to 28.8% of the study population.Conclusions Many pediatric and adolescent patients with EDS experience joint pain, instability, and scoliosis, along with other musculoskeletal issues. Despite extensive workup, the etiology of pain may not be identified. Large numbers of office visits, imaging studies, treatment prescriptions, and specialist referrals indicate considerable use of medical resources and highlight a great need for injury prevention and additional study.

Few studies have evaluated cigarette use specifically in dancers, but those that exist suggest that there is a high prevalence of smoking. The purpose of this study was to evaluate cigarette smoking behaviors and attitudes in dancers of different ages and levels of training. Between June 2011 and September 2012 questionnaires were distributed to dancers at three different sites: a performing arts high school, a college-level conservatory, and a professional ballet company. One hundred and thirty-eight dancers (114 females and 24 males) between 12 to 31 years of age were surveyed. At the time of data collection, 8.7% of these dancers were current smokers and 9.4% were former smokers. The percentage of male dancers who smoked was almost 5 times that of female dancers who smoked. Over 40% of smokers expressed a desire to quit. Close to 80% of dancers had had teachers or choreographers who smoked. Over half of participants overestimated

Objective To investigate the association between physical maturity and risk of prolonged concussion symptoms in adolescent ice hockey players.Study design Prospective cohort study of 145 patients ages 13-18 years with concussion referred to 3 hospital-affiliated sports medicine clinics between September 1, 2012 and March 31, 2015. Concussion evaluations included Post Concussive Symptom Score, neurologic examination, and postinjury computerized neurocognitive testing. Pubertal development at initial visit was assessed by the Pubertal Developmental Scale. Duration of concussion symptoms (days) was the main outcome. Statistical comparisons were conducted using Student t test, Wilcoxon rank sum, and logistic regression.Results Mean symptom duration was 44.5 +/- 48.7 days. Nearly one-half (48.3%) of all players enrolled had prolonged concussion symptoms (>= 28 days); most (86.9%) had symptom resolution by 90 days. Among males, less physically mature adolescents took longer to recover than more physically mature players (54.5 days vs 33.4 days; P=.004). " Early" Pubertal Category Score was the strongest predictor of prolonged symptoms (OR=4.29, 95% CI 1.24-14.85; P=.021) among males. Among females, heavier weight increased the odds of experiencing prolonged symptoms (OR 1.07, 95% CI 1.00-1.14; P=.039).Conclusions Among adolescent ice hockey players, early-pubertal stage is independently associated with longer recovery from concussion in males, and heavier weight is associated with longer concussion recovery in females. Until further studies determine valid physical maturity indicators, peripubertal collision sport athletes should compete in leagues grouped by relative age and be discouraged from "playing up" on varsity teams.

Objective:Few studies have examined the experience and concerns of the concussed athlete. The purpose of this study was to identify the most pressing concerns of athletes with concussion.Design:Cross-sectional survey of athletes who presented for evaluation of a new sport-related concussion during an 8-month period.Setting:Tertiary-level sports medicine division of a large academic pediatric medical center.Participants:One hundred twenty one patients (67 male, 54 female) aged 8 to 18 years who had sustained a sport-related concussion participated in the study by responding to What is the worst thing for you about having a concussion? on the study questionnaire. Questionnaires were completed in the clinic waiting room before the visit with a provider.Intervention:Inductive content analysis was used to identify themes in the responses to the study question.Main Outcome Measures:Age, sex, sport played at the time of the current injury, history of previous concussion, known contacts with concussion, and subjective report of worst aspect of concussion.Results:Seventy respondents (57.9%) cited symptoms, and 68 (56.2%) reported loss of activity as the worst part of concussion, including 17 (14.0%) who listed both symptoms and loss of activity.Conclusions:Over half of concussed athletes indicate that the most distressing part of the injury is loss of activities, which may result from symptoms of the injury itself and/or the prescribed treatment.Clinical Relevance:Health care providers should not underestimate the degree to which symptoms and loss of activities affect young athletes' general well-being. In addition to the negative impact of concussion symptoms, there is an obvious cost of physical, cognitive, and social activity restrictions for patients recovering from sport-related concussions that should be explicitly addressed.