Exertional leg pain is a relatively common condition that can negatively impact athletic performance and may pose a diagnostic and management challenge for the sports medicine physician. A comprehensive clinical evaluation is important to narrow the broad differential associated with exertional leg pain and focus the selection of the most appropriate diagnostic tests and treatment modalities in the care of these individuals. This article will provide an update on recent literature regarding the etiologies, pathophysiology, clinical presentation, workup/diagnosis, and treatment of exertional leg pain in athletes with a focus on vascular etiologies, chronic exertional compartment syndrome, and bone stress injury.

The rise in popularity of competitive and recreational rock climbing, particularly following its inclusion in the 2021 Summer Olympics, has led to a corresponding increase in rock climbing-related injuries. Due to the sport's unique biomechanical demands, it often presents injuries not commonly seen in other sports. Additionally, although some injuries align with those encountered in other sports, they manifest through distinctive climbing-related mechanisms unfamiliar to many clinicians. This paper delves into 10 prevalent injuries associated with the sport, exploring both sport-specific injuries and the unique mechanisms behind commonly encountered ones. Each injury receives a comprehensive overview, detailing its clinical presentation, evaluation, specific injury mechanisms with photographic and graphic illustrations, imaging representations, and treatment considerations. This paper aims to serve as a valuable reference for clinicians dealing with rock climbing-related injuries in clinical practice.

This review article explores the multifaceted aspects of early specialization in diving, focusing on its implications for injury prevalence, performance, and mental health. It highlights the increasing trend of early specialization driven by ambitions for collegiate and Olympic success, despite recommendations advocating for diversification. Divers are at risk for acute and overuse injuries, particularly during high-velocity water entries; however, data on injury patterns, especially among elite divers and early specializers, remains scarce. Recent data suggest a correlation between early specialization and reduced rates of certain injuries among youth divers, but distinguishing between acute and overuse injuries is crucial. Additionally, early specialization may pose mental health risks, with divers facing pressures related to performance, body image, and parental expectations. This article underscores the need for tailored guidelines to mitigate injury risks and promote holistic well-being among youth divers, recognizing the complex interplay between physical and psychological factors in sports specialization.

Use of prohibited substances and methods (doping) by elite athletes is a complex and multifactorial behavior. Understanding the factors associated with doping behavior is crucial to identifying potential intervention targets to reduce doping among this group. However, there are limited data on the prevalence and correlations of self-reported prohibited substance use among Brazilian Olympic athletes. We present data from a cross-sectional, self-reported online survey. Participants were elite Brazilian athletes who participated in the 2020 Olympic and Paralympic Games. A total of 209 athletes (52.6% females) from both Brazilian delegations were surveyed. The self-reported doping use of prohibited substances or methods was found to be 7.2%. Receiving a recommendation from a medical doctor, even knowing that the substance is prohibited, was associated with an increased risk of self-reported doping use (OR = 17.474; 95% CI = 4.664-65.470, P < 0.001). Nearly 1 in 10 athletes reported use in their careers. Medical recommendation to use substances was the only factor associated with an increased risk of doping among elite athletes.

We report 2021 and 2022 prescription drug monitoring program data that include pain medication prescriptions, including over-the-counter medications, issued to NFL players by either club physicians or external medical providers and entered in the NFL electronic medical record. Of 3142 players who signed a contract with at least one NFL Club during the 2021 season, there were 14,903 prescriptions for pain medications issued to 2207 players. During the 2022 season, there were 14,880 prescription pain medications issued to 2189 players (out of a population of 3152). Notably, most pain medication prescriptions across the two seasons were for nonsteroidal anti-inflammatory agents (NSAIDs; 85.1%), whereas only 2.9% were for opioids. Despite the demanding physical nature of professional football and the need for pain management during a season, the prevalence of opioid prescriptions among NFL players appears to be similar to and, in some cases, potentially lower than previous U.S. population-based data.

This review provides a synopsis of current injury patterns, potential mechanisms, and off-ice exercise prevention considerations as the sport of figure skating evolves. The lifetime prevalence of injury for all skaters is estimated to be 79.5%, with the most common sites being spine and lower extremity. Singles skaters more often develop chronic injuries compared to acute (68.9% vs 31.1%), whereas non-singles skaters more often experience acute injuries. Lower limb stress fracture prevalence ranges from 10% to 21.4% across disciplines. Emerging contributors include training volume, technical difficulty and repetition of complex elements (multirotational jumps, lifts, holds), extreme ranges of movement about the spine and hip, age and experience level, and functional capacity (dynamic strength, flexibility, balance, and neuromotor control). Prevention programs in competitive figure skaters may include monitoring of training volumes, emphasis on technique, appropriate boot fit, and strength and conditioning content to prepare for increasing neuromotor, balance, and power demands of the sport.

Climbing is an increasingly popular sport. Yet, we have encountered numerous misdiagnosed climbing injuries, highlighting a gap in climbing-related literature and a need for heightened awareness within the sports medicine community. We present a case series that highlights the clinical manifestation of ulnar nerve entrapment and compression in three patients with initially misdiagnosed and mismanaged elbow tendinopathy. After a correct diagnosis of ulnar nerve pathology was made, each patient underwent a prescribed rehabilitation protocol that focused on nerve motility exercises (tensioning and flossing), resulting in a significant reduction in pain and a successful return to their pre-injury climbing performance. We thus aim to raise awareness of this often-mistreated presentation. Furthermore, we highlight other common upper extremity climbing misdiagnoses and provide relevant clinical recommendations to accurately identify and manage such injuries in climbers.

There is a paucity of sport-specific safety data on high diving. This paper describes the results of a survey of all athletes competing in elite international competitions between 2009 and 2021.Sixty-eight athletes completed surveys, representing a response rate of 80%. The rate of water safety team interventions was calculated at one intervention per 295 high dives for the men (0.34%) and one intervention per 265 high dives for the women (0.38%). After safety team intervention, 26% of the male and 42% of the female divers required hospital evaluation.Circumstances reported by high divers that may contribute to an incident were performing a new dive (<10 repetitions), body position at water entry, and environmental factors such as water movement and cold ambient temperature. Statistically, a water safety team will intervene once or twice per 4-d tournament. Injury and illness surveillance both during tournaments and year-round is recommended.

Thoracic outlet syndrome is a complex syndrome that manifests with symptoms based on the presumed injury or impairment of the neurovascular structures in the thoracic outlet space with its intricate anatomy and pathophysiology. The thoracic outlet is a specific anatomical region with three distinct anatomical spaces - interscalene triangle, the costoclavicular space, and the retro-pectoralis minor space. Thoracic outlet syndrome is classified into neurogenic, venous, and arterial thoracic outlet syndrome and often poses diagnostic challenge to implicate a specific condition or cause. Many cases of thoracic outlet syndrome can be effectively managed through conservative measures, but patients with refractory symptoms may warrant surgical intervention. Modalities such as intramuscular anesthetic and botulinum toxin injections hold promise as diagnostic, therapeutic, and prognostic procedures. Further research and collaboration are needed to develop algorithms for diagnosis and treatment of thoracic outlet syndrome symptoms. This review aims to explore our understanding of thoracic outlet syndrome, with a focus on current evidence and emerging trends.

Popliteal artery entrapment syndrome remains difficult to diagnose. Meanwhile, our limited knowledge and understanding make treatment decisions complex. The list of differential diagnoses for exertional leg pain is broad. Oftentimes, patients exhibit confounding and coexisting diagnoses. However, accurate and rapid diagnosis of popliteal artery entrapment syndrome is essential to reduce potential lasting damage to the popliteal artery. A combination of clinical history, physical examination, ankle-brachial index, along with dynamic and static imaging such as duplex ultrasound, computed tomography angiogram, and magnetic resonance angiography, aids diagnosis. Surgical treatment may be definitive depending on the type of popliteal artery entrapment syndrome, but there have been recent advances in diagnostics with intravascular ultrasound and nonsurgical treatment with botulinum toxin type A. Further research is needed to standardize diagnostic criteria, uncover innovative diagnostic methods, and validate promising nonoperative treatment options.

Pediatric hip pain can have orthopedic, infectious, inflammatory, neoplastic, or nonmusculoskeletal etiologies. Organizing the differential diagnosis by symptom chronicity and a determination of intraarticular versus extraarticular pain, as well as the age at pain onset, can be helpful to hone in on the cause. Clinicians should consider plain radiographs in cases of acute trauma, with concern for bony pathology, or in patients with unexplained limp or hip pain, with musculoskeletal ultrasound and magnetic resonance imaging used as advanced imaging when indicated. Relative rest with subsequent strengthening and stretching should be prescribed in nonoperative conditions, though several pediatric hip pain diagnoses require orthopedic or other specialty referral for definitive treatment. This article is a comprehensive review of hip pain etiologies in the pediatric population.