PURPOSE:Low back pain (LBP) is a complex, multifactorial condition with numerous contributors across biopsychosocial domains. To advance understanding of this complexity, we synthesized diverse expert knowledge on treatment effectiveness and underlying mechanisms using a systems-based, collaborative modeling approach. METHODS:Twenty-nine experts from diverse disciplines created individual fuzzy cognitive maps (FCMs) to represent their understanding of factors affecting pain, disability, and quality of life (QoL), along with treatment mechanisms. These maps were aggregated into a meta-model comprising 142 Components and 1,161 weighted Connections. Centrality was used to quantify the relative contribution of each domain within the meta-model. Simulations with the meta-model based on expert knowledge (1) estimated the relative effectiveness of treatments on pain, disability, and QoL and (2) identified key Mediators and mediating Domains based on their relative contribution to mediating treatment effects. RESULTS:Psychological, biomechanical, and social/contextual Domains were central to expert conceptualizations of LBP. Simulation indicated cognitive behavioral therapy was considered the most effective among all interventions. Most interventions were mediated by Components across multiple Domains, with psychological factors frequently serving as mediators. The structure of the conceptual meta-model reflected both the multifactorial complexity of LBP and the diversity of expert perspectives regarding factors that influence treatment effectiveness. CONCLUSION:The developed meta-model provides a novel, systems-based representation of expert knowledge about LBP, enabling quantitative exploration of treatment effects and underlying mechanisms. This conceptual framework also offers a foundation for advancing research on multi-modal, personalized care.

OBJECTIVES:Sport-related concussions are often unreported by athletes. This may lead to insufficient medical treatment and negative health effects. Reporting sport-related concussion symptoms is context-dependent and influenced by factors such as sex, sporting code, and culture. Women may have unique experiences of sport-related concussions and reporting compared with men. However, these experiences of women athletes have not been explored in an Australian context. This study aimed to identify enablers and barriers to sport-related concussion reporting amongst Australian women competing in collision sports, informing initiatives to support safe participation. DESIGN:Qualitative study. METHODS:Semi-structured interviews explored experiences with sport-related concussion disclosure within the context of Australian women's collision team-sports. Interview questions were informed by the Theoretical Domains Framework. Thematic analysis occurred via deductive coding of responses to Theoretical Domains Framework domains, followed by inductive coding within each domain. Interviews were conducted until thematic saturation was reached. RESULTS:Twelve adult women competing in Australian collision sports were interviewed. One overarching theme (procedural tension) and three main themes (validation pressure, injury hierarchy, and conflicted cultural logics) were identified. The themes highlighted how gender-related factors interact with sport-specific norms in the context of playing sport and reporting sport-related concussions in Australia. CONCLUSIONS:Concussion reporting is multidimensional and influenced by micro, meso, and macro level factors. Factors have been identified that could be targeted by interventions aimed at improving sport-related concussion reporting amongst non-professional divisions of this population. These findings highlight implications, including strengthening recruitment, fostering team-level reporting norms, and addressing status quo practices at the club level.

PURPOSE:To evaluate a data-efficient segmentation approach for quantifying lumbar paraspinal muscle (LPM) at the single-slice L4/L5 level across multi-sequence MRI, minimizing annotation burden while achieving reliable group-level quantification. MATERIALS AND METHODS:A total of 943 MRI scans from 486 participants were retrospectively analyzed, with a single axial slice at the L4/L5 disc level selected from each scan. The images included T1-weighted, T2-weighted, and Dixon MRI. A training-free Segment Anything Model 2 (SAM2) was applied for dataset-level LPM segmentation. For each dataset, one, two, or three ground-truth masks were used as prompt labels (4, 8, and 12 images in total across all four datasets), with the remaining images used for testing (939, 935, and 931 images, respectively). Segmentation accuracy was evaluated using the Dice similarity coefficient (DSC). Automated quantifications were assessed using two one-sided tests (TOST), intraclass correlation coefficients (ICC), and Bland-Altman analysis. RESULTS:With three-shot prompting, SAM2 achieved the highest segmentation accuracy for the left and right lumbar erector spinae and multifidus muscles (DSC: 0.871 ± 0.128 to 0.944 ± 0.063). Automated measurements were statistically equivalent to manual references within a 5% margin for bilateral muscle area and a 10% margin for bilateral fat ratio, except for the fat ratio of left erector spinae, which required a 14.14% margin. ICCs ranged from 0.822 to 0.856 for muscle area and 0.771-0.927 for fat ratio. CONCLUSION:L4/L5 slice-level LPM segmentation and quantification are achieved using only three labeled examples per dataset, with multicenter evaluation and publicly available code and data.

OBJECTIVES:Deficits in vestibulo-ocular function have been reported in athletes following concussion and in healthy developing adolescent athletes. There is a known increase in injury risk in athletes returning to sport following concussion; however, the relationship between vestibulo-ocular dysfunction in adolescents and injury risk is unknown. The aim of this study was to determine i) the prevalence of vestibulo-ocular dysfunction and ii) the relationship between vestibulo-ocular dysfunction and playing season injuries in adolescent rugby union players. DESIGN:Cross-sectional. METHOD:Seventy-one male adolescent rugby union players were recruited from four schools in Queensland, Australia. In the preseason, clinical assessments of oculomotor and vestibular function were conducted. 'Time-loss' injuries were recorded during the season. Statistical analysis was conducted using Pearson's chi-square test with significance set at p < 0.05. RESULTS:In preseason assessment, 40 players (57 %) had one or more, and of these, 18 players (25.7 %) had two or more positive vestibular and oculomotor findings indicating vestibulo-ocular dysfunction. There were 39 injuries sustained by 33 players during the season. No between group differences for vestibulo-ocular function were found between players who did and did not sustain an in-season injury (p = 0.55). CONCLUSION:Vestibulo-ocular dysfunction is common in male adolescent rugby union players and positive findings should include comparison with baseline function or symptom profile. The wider impact of vestibulo-ocular dysfunction on sporting performance in adolescents is unknown.

Chronic low back pain is a global health issue with considerable socioeconomic burdens and is associated with changes in lumbar paraspinal muscles (LPMs). In this retrospective study, a deep learning method was trained and externally validated for automated LPM segmentation, muscle volume quantification, and fatty infiltration assessment across multisequence MR images. A total of 1302 MR images from 641 participants across five centers were included. Data from two centers were used for model training and tuning, while data from the remaining three centers were used for external testing. Model segmentation performance was evaluated against manual segmentation using the Dice similarity coefficient (DSC), and measurement accuracy was assessed using two one-sided tests and intraclass correlation coefficients (ICCs). The model achieved global DSC values of 0.98 on the internal test set and 0.93 to 0.97 on external test sets. Statistical equivalence between automated and manual measurements of muscle volume and fat ratio was confirmed in most regions (P < .05). Agreement between automated and manual measurements was high (ICCs > 0.92). In conclusion, the proposed automated method accurately segmented LPM and demonstrated statistical equivalence to manual measurements of muscle volume and fatty infiltration ratio across multisequence, multicenter MR images. Keywords: MR-Imaging, Muscular, Volume Analysis, Segmentation, Vision, Application Domain, Quantification, Supervised Learning Type of Machine Learning, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms Supplemental material is available for this article. © RSNA, 2025.

Scapulothoracic motion during arm elevation involves scapular posterior tilt (PT), upward rotation (UR), and external rotation (ER). Abnormal scapular kinematics are common in people with chronic shoulder pain, potentially exacerbating symptoms and impairing function. Push-ups, a common exercise for shoulder rehabilitation, may influence scapular motion but have not been extensively studied in this context. Thus, this study aimed to investigate the effect of hand position on scapular kinematics during a push-up exercise in athletes with and without chronic shoulder pain (CSP). Twenty-four male overhead athletes were allocated into two groups: CSP (n = 12) and Control (CON; n = 12). Scapular kinematics in three planes (PT, UR, and ER) were measured using a Vicon motion capture system during push-ups in three hand positions (internal rotation, IR; neutral rotation, NR; and external rotation, ER). Measurements were taken in the concentric phase of the push-up. Statistical analyses using repeated-measures ANOVA assessed the effects of hand position and elbow extension on scapular kinematics between the two groups. For PT of the scapula, in the IR hand position, participants from both the CON and CSP groups showed similar decreases (CON group = from 25.74° to -16.10°; P < 0.001). In the NR hand condition, the CON group decreased PT from 16.12° to -15.98° (P < 0.001), but there was no significant change in the CSP group. In the ER hand condition, for the CON group, PT decreased from 18.63° to -9.38° (P < 0.026), with no significant change observed in the CSP group. For UR of the scapula, the CON group showed significant decreases in the IR hand condition (from 15.37° to -2.28°; P < 0.019), while the CSP showed minimal changes. In the IR hand condition, the ER of the scapula increased from 20.44° to 25.13° (P < 0.003) in the CON group. At the same time, the CSP showed smaller changes. In the NR hand condition, ER of the scapula in the CON group decreased from 24.79° to 9.38° (P < 0.001), with no significant change observed in the CSP group. Scapular kinematics (UR, PT, and ER) differed significantly across hand rotation conditions and groups. The CON group exhibited more pronounced changes in these kinematic measures, while the CSP group showed limited variation. This may indicate an association between chronic pain and movement restriction. These findings emphasize the need for targeted rehabilitation strategies that consider these kinematic differences.

AIM:(1) Explore the role of core abdominal exercise in people living with a stoma in Australia; (2) determine whether the presence of a parastomal hernia influenced participant symptoms and complications, health status, experiences with different types of exercise, recall advice given by healthcare professionals; (3) determine whether there is an appetite for supervised/supported exercise programs. DESIGN:A cross-sectional, anonymous survey. METHODS:Between August and September 2022. The survey included Likert scales and a single free text response. Logistic regression and Cramer's V were used to explore relationships between variables. RESULTS:Approximately half (45.5%) of 105 participants reported a parastomal hernia. Those with a parastomal hernia were less likely to recall having received advice (15.20%) or demonstration (9.40%) pertaining to exercise. Less than a quarter of all participants completed strengthening (23.80%) or vigorous (22.90%) exercise. Fear of vigorous exercise, abdominal exercise and heavy lifting were high in both groups. Relationships between healthcare advice, exercise-related fears and avoidance of heavy lifting were observed. CONCLUSION:Many Australians living with a stoma are not achieving physical activity recommendations. While exercise behaviours did not differ between people with and without a parastomal hernia, recall of healthcare advice around exercise did. Fear-avoidance relationships were observed. IMPACT:Most people living with a stoma do not recall advice about core abdominal exercises. Healthcare practitioners need to be aware of fear-avoidance related to lifting among people living with a stoma. This was the first study in Australia, exploring perspectives and experiences regarding exercise; providing foundations for future research particularly exercise programs. REPORTING METHOD:This study adhered to relevant EQUATOR guidelines and the reporting of survey studies (CROSS). PATIENT OR PUBLIC CONTRIBUTION:This study did not include patient or public involvement in its design, conduct, or reporting.

BACKGROUND:Female athletes are more susceptible to sports-related concussions and experience greater and prolonged symptomatology. Changes in the cervico-vestibular systems have been observed in the acute phase post-concussion, but it is unknown if residual impairments persist in the following 12 months. OBJECTIVES:To determine if there was an association between baseline screening of the cervical spine, vestibular and oculomotor systems in female athletes with and without a history of concussion. DESIGN:Cross-sectional study. METHODS:94 elite and pre-elite female athletes participating in soccer, water polo and rugby-7s were recruited from the Queensland Academy of Sport, Australia. Athletes completed the Sport Concussion Assessment Tool (SCAT6), Vestibular/Ocular Motor Screening (VOMS), and assessment of the cervical spine (manual examination and joint proprioception). History of concussion (yes/no) in the last 12 months was self-reported. RESULTS:A history of headaches, findings on manual examination of the cervical spine (altered segmental mobility and tissue resistance) and symptom provocation on the VOMS were significantly different between groups for those with and without a history of concussion (all p < 0.05). Unadjusted odds ratios were 4.2 (95 % CI: 1.3-13.4) for history of headaches, 3.8 (95 % CI: 1.2-11.8) for abnormal VOMS and 3.2 (95 % CI: 1.1-9.3) for increased tissue resistance on manual examination of the cervical spine, suggesting that players with these findings on clinical examination are more likely to have a history of concussion. CONCLUSIONS:The results of this study suggest that athletes with a history of concussion should undergo manual assessment of the cervical spine and vestibulo-ocular system screening regardless of baseline self-reported symptom profile.

Objectives: Primary prevention of concussions is a priority in contact sports, with growing interest in the role of neck strength in mitigating the risks of concussion. The aim of this study was to determine if neck function was associated with in-season concussions in adolescent rugby union and league athletes, and to establish clinical values to identify players with increased risk of sustaining a concussion. Design: Prospective cohort study. Methods: Assessment of neck function included isometric strength, endurance and proprioception. In-season concussion injuries were recorded. Preliminary multivariate analysis-of-covariance models were conducted to investigate differences in neck function between players who did and did not sustain an in-season concussion. If significant, receiver operated characteristic curves were used to determine optimal cut-points for each variable to distinguish between concussion groups. Unadjusted odds ratios were estimated from the cross tabulation chi-squared test. Significance was set at p < 0.1. Results: A total of 43 players (aged 15-18 years) were assessed during preseason. Eleven players sustained a concussion during the season. Players who sustained a concussion during the season had weaker neck extension strength in kilogrammes (p = 0.043, effect size = 0.74) and when normalised to body weight (p = 0.041, effect size = 0.74). The optimal cut-point for extension strength was 32.1 kg (sensitivity 0.64, specificity 0.75) and 3.71 N/kg (sensitivity 0.64, specificity 0.66). Players with a flexor to extensor strength ratio above 0.74 were 3-times more likely to sustain a concussion (p = 0.09). There were no differences for other neck function variables. Conclusions: Interventions targeting neck strength could reduce the risk of concussion. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

There has been considerable public concern regarding the effects of repetitive head impacts associated with heading the ball in soccer. This is relevant for adolescents whose brains are undergoing rapid development. The study investigated the relationship between strength, proprioception, endurance and range of motion of the cervical spine and impacts associated with heading the ball in adolescent male soccer players. The participants were 20 skilled players aged 15-18 years. Outcome measures included questionnaires, assessments of cervical spine function (range of motion, joint position error, isometric muscle strength and endurance) and the ratio of maximum head acceleration to maximum T3 acceleration (impact ratio) during each ball impact when heading the ball. Results showed that increased range of motion of extension of the cervical spine and lower joint position error in flexion of the cervical spine were associated with higher impact ratios. Greater isometric strength of the lateral flexors was associated with lower impact ratios. Endurance of the deep neck flexors was not associated with impact ratios. Strength training may be beneficial to decrease head impacts during soccer ball heading, especially in those with increased range of motion of extension of the cervical spine.

Aim:To investigate the feasibility of testing exercise-induced hypoalgesia (EIH) in a field setting. The effect of knee pain on EIH was also explored. Design:Within-group pre-post design. Materials and Methods:Fourteen athletes (8 male, 6 female) competing at an international level in badminton were tested on the sideline during an in-season training session. Participants completed questionnaires and a single leg decline squat to evaluate the presence of knee pain. A blinded examiner measured PPT over the quadriceps muscle before and after two conditions (3-minute quiet rest and 3-minute isometric wall squat). Results:The exercise protocol was completed by 13 (93%) participants. Mean (SD) exertion was 8.4 (1.7), and mean thigh pain was 7.9 (2.0) at 3 minutes. Very high reliability was observed for PPT collected before and after rest (ICC 0.94, 95% CI 0.85, 0.98). PPT significantly increased by 22.4% (95% CI 15.1, 29.7) after wall squat but not after rest. Relative increases in PPT were similar in participants with and without knee pain on single leg decline squat (22.2% versus 22.6%, 7 participants each). Conclusion:Simple, field-based tests of endogenous analgesia are feasible and could provide new opportunities to evaluate an athlete's risk of persistent pain.

Techniques that reduce mechanical energy have been linked to lower chances of experiencing an Anterior Cruciate Ligament (ACL) injury. Although there is evidence that movement patterns are altered in athletes who have undergone Anterior Cruciate Ligament Reconstruction (ACLR), energy transfer mechanisms have not been examined. This study aimed to compare energy flow mechanisms during single-leg drop landing between athletes with and without history of ACLR. A total of 20 female athletes were included in this study. Ten participants underwent ACLR 12 months ago (mean age, 21.57 ± 0.41 years) and 10 were healthy controls (mean age, 20.89 ± 0.21 years). Participants executed the single-leg drop landing (SLL) maneuver by descending from a 30 cm wooden box and landing on the tested leg on an embedded force plate. Information collected during the SLL trials was refined using rigid-body analysis and inverse dynamics within Nexus software, ultimately allowing construction of skeletal models of the athletes. Ankle and knee mechanical energy expenditure (MEE) was higher in the control participants during landing. However, the result for the hip MEE demonstrated that MEE of the control group was significantly lower compared with the ACLR group, but MEE of the control subjects was higher as compared to ACLR group (p ˂ 0.05). Results suggest the avoidant use of the quadriceps muscle post ACLR leads to knee-avoidant mechanics and loss of knee joint power generation during a SLL task.

Disorders affecting the neurological and musculoskeletal systems represent international health priorities. A significant impediment to progress in trials of new therapies is the absence of responsive, objective, and valid outcome measures sensitive to early disease changes. A key finding in individuals with neuromuscular and musculoskeletal disorders is the compositional changes to muscles, evinced by the expression of fatty infiltrates. Quantification of skeletal muscle composition by MRI has emerged as a sensitive marker for the severity of these disorders; however, little is known about the composition of healthy muscles across the lifespan. Knowledge of what is ‘typical’ age-related muscle composition is essential to accurately identify and evaluate what is ‘atypical’. This innovative project, known as the MuscleMap, will achieve the first important steps towards establishing a world-first, normative reference MRI dataset of skeletal muscle composition with the potential to provide valuable insights into various diseases and disorders, ultimately improving patient care and advancing research in the field.

Head, neck and face injuries are a concern in contact sports. This exploratory study aimed to establish 1) injury risk factors for head, neck and face injuries and 2) clinical cut-off values related to strength, endurance and proprioception of the cervical spine in a team of professional rugby league players. Pre-season assessments of isometric strength of the flexor, extensor and lateral flexor muscles, endurance of the flexor muscles and joint position error were conducted. Injuries resulting in games missed were recorded. Cross-tabulations were used to determine the unadjusted odds ratios for the measures as risk factors for playing season injuries. The unadjusted odds ratio (OR) values indicated that if a player had weaker extensors of the neck (<36.4 kg, p = 0.014; <3.4N/kg, p = 0.014) or asymmetry of isometric strength of their lateral flexor muscles (left-to-right ratio <0.91, p = 0.005), their odds of games missed due to season head, neck and face injuries was increased (OR extensors = 8; 95% CI = 1.5-42.5 OR asymmetry of lateral flexor muscles OR = 12.6; 95% CI = 2.0-79.4). As muscle strength is modifiable, the clinical application of this study would involve targeting players in the team beneath the clinical cut-off value.

Due to its dynamic nature, lower limb injuries are common in badminton. Overuse injuries of the knee, including tendon related conditions, are the most common. During jumping and landing, force transference and dissipation through the trunk is required, with the trunk muscles playing a vital role. However, the relationship between knee pain and the ability to voluntarily contract the trunk muscles has not yet been explored in badminton players. A cross-sectional study of Australian badminton players was therefore conducted. Players performed a single leg decline squat to identify those with knee pain. Ultrasound imaging was used to image and measure the size of the multifidus and quadratus lumborum, and the ability to contract the abdominal and multifidus muscles. Voluntary contraction of the trunk muscles was conducted with the subjects lying down. Independent samples TTests were performed to test for between group differences. Badminton players with knee pain had larger quadratus lumborum muscles and demonstrated a greater change in muscle thickness from the rested to contracted state. While we cannot comment on causation or direction, over co-contraction of trunk muscles has been shown in other studies to be associated with increased ground reaction forces on landing. Motor control training has been successfully used in other conditions to modify trunk muscle recruitment patterns and may therefore potentially represent a useful approach for badminton players.

OBJECTIVES: The primary objective was to compare sensory processing measures in people attending specialist orthopaedic consultation for management of persistent shoulder pain with control participants. The secondary objective was to compare the groups' sociodemographic, clinical, general health and lifestyle, and psychological characteristics. DESIGN: Observational cross-sectional. METHODS: Participants with shoulder pain for >= 3 months, who attended a public hospital orthopaedic department (n = 119), and community participants without shoulder pain (n = 44) underwent a standardized quantitative sensory testing protocol, measuring pressure pain threshold, temporal summation, and conditioned pain modulation. Sociodemographic, clinical, general health and lifestyle, and psychological characteristics were also collected. RESULTS: Participants with shoulder pain had significantly lower pressure pain thresholds at all sites (ie, local and widespread mechanical hyperalgesia) and significantly decreased conditioned pain modulation effect (ie, descending inhibition of nociception) than control participants. There was no significant difference between groups for temporal summation. Participants with shoulder pain had decreased general health and function, less healthy lifestyles, and poorer psychological health compared with controls. CONCLUSION: People referred to specialist orthopaedic care for management of persistent shoulder pain had clinical signs of altered sensory processing and poor health outcomes. J Orthop Sports Phys Ther 2024;54(10):647-656. Epub 25 July 2024. doi:10.2519/ jospt.2024.12512

Space agencies plan crewed missions to the Moon and Mars. However, microgravity-induced lumbopelvic deconditioning, characterized by an increased fat fraction (FF) due to reduced physical activity, poses a significant challenge to spine health. This study investigates the spatial distribution of FF in the lumbopelvic muscles to identify the most affected regions by deconditioning, utilizing a computer-vision model and a tile-based approach to assess FF changes. Twenty-four healthy individuals (8 F) were recruited, and automatic segmentation of the lumbopelvic muscles was applied before and after 59 days of head-down tilt bed rest (HDTBR + 59) and 13 days of reconditioning (R + 13). Axial Dixon sequence images were acquired from 3 T magnetic resonance imaging. FF in the lumbar multifidus (LM), lumbar erector spinae (LES), quadratus lumborum, psoas major, gluteus maximus (GMax), gluteus medius (GMed), and gluteus minimus (GMin) muscles from the upper margin of L1 vertebra to the inferior border of GMax muscle were automatically derived using a computer-vision model. Lumbar muscles were segmented into eight tiles (superficial and deep, lateral to medial), and gluteal muscles into regions (anterior/superior for GMed and GMin, superior/inferior for GMax). At HDTBR + 59, the deep centrolateral region at L5/S1 for LM (18.7 ± 15.7%, P < 0.001; d = 0.97) and the deep medial region at Upper L4 for LES (5.4 ± 5.9%, P < 0.001; d = 0.34) showed the largest increase in FF compared with baseline data collection. These regions did not recover at R + 13 (P < 0.05; d ≥ 0.25). These findings highlight the need to target deep fascicles of LM and LES in countermeasure strategies to mitigate microgravity-induced lumbopelvic deconditioning, optimizing spine health, and performance.NEW & NOTEWORTHY This study reveals novel insights into fat fraction changes in lumbopelvic muscles after 60 days of head-down bed rest and 13 days of reconditioning. Lipids increased in the deep regions of the lumbar multifidus (LM) and lumbar erector spinae (LES), particularly at lower vertebral levels, and persisted after reconditioning. These findings highlight the need to target deep fascicles of LM and LES in future countermeasures to mitigate microgravity-induced deconditioning and optimize spine health.