Using complex systems to understand running-related injuries
This study aims to investigate anthropometric and training characteristics associated with injuries in runners using a complex approach. We conducted a cross-sectional study with 97 Brazilian runners of both sexes (age: 39.1 ± 11.5 years; body mass index: 24.2 ± 4.2 kg/m). A web survey was used for data collection, including age, sex, body weight, body height, training volume/frequency, session duration, running pace and injury information (yes or no; the number of injuries). The partial correlation parameter was used for network estimation, considering both sexes. For women, injury occurrence was positively and strongly associated with training frequency ( = 0.57) and the number of competitions ( = 0.64), while for men, a negative and strong association was found with age (=-0.69), and positive associations were observed with BMI ( = 0.89) and training volume ( = 0.82). Network centrality showed that training session duration and the number of competitions/year presented a higher expected influence value for women (-1.47) and men (-1.31). Using a non-linear approach with Brazilian non-professional runners, training characteristics had a stronger influence on running-related injuries.
Change in interleukin (IL)-6, 8, and 10 and its association with an increase in core temperature following a 7-mile running race in the warm weather
The purposes of this study were 1) to investigate if cytokines were increased following a running road-race, and 2) to examine associations between cytokines and hyperthermia. Seventy-seven recreational runners participated in this study which occurred at the 7-mile race in the heat (ambient temperature, 25.0-26.7°C; %RH, 56.7-79.0 ± 5.0%). Before and following the race, blood draws were performed to measure circulating inflammatory cytokines. Core temperature was measured using an ingestible thermistor throughout the race. Core temperature was significantly higher at post-race (39.5 ± 0.7°C) than pre-race (36.9 ± 0.4°C, < 0.001). IL-6, IL-8, and IL-10 significantly increased at post-race (IL-6, 48.0 ± 22.3 pg⋅ml; IL-8, 63.8 ± 23.9 pg⋅ml; IL-10, 29.2 ± 20.0 pg⋅ml) compared to pre-race (IL-6, 28.4 ± 13.6 pg⋅ml; IL-8, 53.2 ± 19.4 pg⋅ml; IL-10, 18.6 ± 11.9 pg⋅ml, < 0.001). A greater increase in core temperature pre- to post-race was predicted by the faster finish time, a greater increase in IL-6, and greater body mass loss during the race (r = 0.298, < 0.001). Small associations were found between IL-8 and core temperature at post-race ( = 0.255, = 0.025). In conclusion, cytokines concentrations and core temperature increased following the race. Moreover, post-race hyperthermia is associated with increased IL-6, faster finish times, and higher body mass losses.
Illness, the overlooked research topic for time-loss in women's football - a scoping review
The best medical care for female football athletes should be evidence-based, and patient- and context-specific. A 2019 scoping review identified key knowledge gaps relating to the health of female footballers. Since then, research in women's football has been intensifying. To aid in the direction of future research, this study aims to scope peer-reviewed, illness-related research in women's football. Five databases were searched in July 2023. In combination with identified studies from the 2019 review, 72 studies were included for data extraction of sample characteristics (age, playing level, geography), illness characteristics according to IOC guidance, and broader research themes. Results reveal an overall lack of quantity and variety in illnesses investigated, with a growing popularity in mental health research. Minimal female athlete-specific illnesses were identified. Future research must address urgent female-specific illness topics, and also consider where knowledge from adjacent populations might be safe to adapt into women's football.
How are female rugby players affected by contact breast injuries and exercise-induced breast pain - an international survey
Female Rugby Union players were affected by contact breast injuries (CBI) and exercise-induced breast pain (EIBP). Hundred and eighty-two female Rugby players from 25 different countries reported incurring a CBI or EIBP which affected sport performance. A higher percentage of 7s players (7s: 64.3%, 15s: 51.9%) reported at least one CBI over a 12-month period. EIBP frequency, during the same period, was notably low for 7s and 15s. Sprinting, jumping and running were the most frequent activities precipitating the severest EIBP. Being tackled or tackling most frequently caused a CBI. Respondents affected by either CBI (57.3%) or EIPB (51.3%) reported always playing-on during matches despite their pain or injury. Between 19.4% and 32.1% of the respondents did not have a CBI or EIBP prevention strategy. A paucity of player knowledge on prevention strategies was noted, indicating a need for education addressing breast pain and injury among players.
Determinants of symptom presentation and resolution following concussions in high school sports
Sport-related concussions (SRCs) are prevalent in high school (HS) sports, though the determinants of, and relationships between concussion symptoms in this population remain relatively unknown. We analysed SRC data captured within the HS RIO injury surveillance system during 2014/15-2018/19. We used Generalized Estimating Equations to simultaneously assess covariate predictors of symptom presentations and identify pairwise symptom associations and employed multivariable ordinal logistic regressions to determine symptom resolution time (SRT) predictors. Among the 8,969 concussions assessed, headaches (94.3%) and dizziness (73.3%) were the most prevalently reported symptoms. In 5,953 boys' concussion assessed, class year, event type and injury mechanism emerged as determinants of various concussion symptoms, while in 3,016 girls' concussions assessed, class year, event type, injury mechanism, and sport type emerged as significant symptom determinants. In both groups, difficulty concentrating, sensitivity to light, sensitivity to noise, and disorientation were symptoms with the strongest associations with other symptoms. Odds of longer SRT were higher with greater endorsement (i.e. counts) of the subset of symptoms with strongest cross-domain associations (OR = 1.35; 95% CI = [1.30, 1.40]). Our findings provide valuable information for informing sideline and follow-up clinical concussion assessment algorithms in high school athletes.
The influence of menstrual cycle phase on isokinetic knee flexor and extensor strength in female soccer players: a pilot study
The prevalence of anterior cruciate ligament injury in female soccer players has been attributed to hormonal fluctuations during the menstrual cycle (MC), with injury incidence greatest during the follicular phase. Eight, eumenorrheic, collegiate soccer players (19.5 ± 0.75 years, 1.62 ± 4.90 cm, 61.12 ± 7.6 kg mean ± SD) completed eccentric knee flexor and concentric knee extensor trials at 60 and 240°·s during the follicular, ovulation and luteal phases of their MC. Peak torque and corresponding angle of peak torque were maintained across all phases of the MC, irrespective of testing modality and speed ( ≥ 0.149). Strength ratios defined using peak torque were also not sensitive to MC phase ( ≥ 0.933). However, Functional Range in eccentric knee flexion was significantly lower during the follicular phase ( = 0.017), at both testing speeds. This supports epidemiological observations but highlights the importance of analysing isokinetic data beyond the peak of the strength curve. Interpretation of isokinetic data should therefore focus on points of "weakness" as opposed to maximum strength, whilst (p)rehabilitative strategies should consider strength through range of motion, and at different speeds. Eccentric hamstring strength was observed to decrease significantly at the higher speed, contrary to observations in elite male players, and potentially reflecting a differential training adaptation.
The management of a professional footballer recovering from a surgical repair of the proximal adductor longus tendon through a return-to-performance pathway. A case report
This case report details the management of a 23-year-old professional footballer who sustained a rupture of the proximal adductor longus (AL) tendon. Following surgical reattachment of the tendon, the player completed an eleven-phase return to performance (RTP) pathway designed to ensure a rapid and safe return to play (RTP). The pathway uses distinct phases that incorporate clinical, performance, and sport-specific criteria to guide decision-making throughout the process. This case report outlines the phases and criteria used in conjunction with shared decision-making by the interdisciplinary team (IDT) to ensure a successful RTP. The effectiveness of this pathway was demonstrated by the player's return to competitive play 12 weeks post-surgery.
Effects of Tai Chi training on functionality, dynamic balance, kinesiophobia, and quality of life in athletes with functional ankle instability
This study investigated the effects of Tai Chi training on functionality, dynamic balance, kinesiophobia, and quality of life in athletes with Functional Ankle Instability (FAI). Forty-three athletes with FAI were randomly assigned to either a Tai Chi group ( = 21) or a control group ( = 22). The Tai Chi group followed a tailored exercise protocol addressing ankle instability through a three-phase progression, while the control group had no intervention but continued their usual activities. Measurements, including Cumberland Ankle Instability Tool (CAIT), Star Excursion Balance Test (SEBT), Tampa Scale for Kinesiophobia (TSK), Short Form-12 (SF-12), figure-8 hop test, and perceived treatment effect were assessed before and after the intervention. The Tai Chi group showed significant improvements in CAIT score and SEBT reach distance compared to the control group ( < 0.001). Tai Chi exercises also reduced TSK, improved figure-8 hop score, and enhanced the physical component of SF-12 ( < 0.005), with no significant effect on the mental component of SF-12 ( = 0.7). The findings imply that Tai Chi may be a valuable consideration for athletic trainers and sports medicine professionals working with athletes with FAI.
The effect of resistance training on patients with knee osteoarthritis: a systematic review and meta-analysis
The objective of this study is to investigate the beneficial effects of resistance training (RT) on individuals suffering from knee osteoarthritis (KOA). In order to gather relevant studies from the beginning of various databases until January 2023, a comprehensive search was conducted on PubMed, Embase, Scopus, Web of Science, and The Cochrane Library. Additionally, manual searches were performed on the reference lists. The association between RT and KOA was analysed using a random-effects model. The results indicated that patients with KOA who underwent RT experienced a significant reduction in the WOMAC (Western Ontario and McMaster Universities Osteoarthritis) Pain index (WMD = -2.441; 95% CI = -3.610 to -1.273; < 0.01), the WOMAC Stiffness index (WMD = -1.018; 95% CI = -1.744 to -0.293; < 0.01), the WOMAC Function index (WMD = -7.208; 95% CI = -10.412 to -4.004; < 0.01), and the VAS (Visual Analogue Scale) index (WMD = -5.721; 95% CI = -9.320 to -2.121; < 0.01). These improvements were observed when compared to the control group. However, no significant difference was found in the 6-MWT (6-Minute Walk Test) index between the two groups (WMD = 2.659; 95% CI= -16.741 to 22.058; = 0.788). Consequently, RT has the potential to positively enhance pain, stiffness, and function in patients with KOA, while the 6-MWT index may not exhibit significant improvement.
Incidence and burden of 671 injuries in professional women footballers: time to focus on context-specific injury risk reduction strategies
This study investigated the extent of injury incidence and burden in a professional women football team of the Scottish Women's Premier League during two seasons. All injuries causing time-loss or required medical attention were recorded prospectively. A total of 671 injuries, 570 requiring medical attention and 101 causing time-loss were recorded in 41 players. Injuries occurring with National Team resulted in 12% of the club's international players' lay-off. Overall injury incidence was 11.1/1000-hours and burden was 368.9 days/1000-hours. Injury incidence (23.9/1000-hours vs 8.2/1000-hours) and burden (1049.8 days/1000-hours vs 215.1 days/1000-hours) were higher for match compared to training. Foremost mechanism of match injury burden was indirect-contact, which was different than the non-contact predominantly observed for training injury burden. Injury incidence, burden and patterns differed between training, match and playing positions. Tailoring injury-risk reduction strategies considering context, circumstances and playing position deserve consideration to enhance player's injury resilience in professional women footballers.
Hidden support for the lionesses: a breast/bra intervention
Despite health and performance benefits of appropriate breast support in sport, elite women athletes' knowledge of breasts/bras is poor leading to poor bra choices, breast pain and performance decrements. This multiphase intervention assessed breast/bra issues and preferences, individually prescribed sports bras and evaluated outcomes for the England Senior Women footballers. Breast/bra workshops were delivered to England players; all 36 completed pre-intervention surveys and breast/bra assessments, before being prescribed bras six weeks before European and World Championships (2022, 2023). 24 players completed post-intervention surveys. Pre-intervention outcomes identified poor knowledge, poor bra fit, many bra issues, and cultural sensitivities. Breast pain was prevalent (61%), with 25% reporting clinically significant breast pain. Post-intervention, players reported significant improvements with prescribed sports bras. 91% reported improvements in knowledge and benefiting from the intervention. This successful intervention provided an evidence-base for ongoing breast health initiatives with England Teams, plus roll-out to all levels of women's football.
The mechanical response to hockey-specific running gait: implications for the objective monitoring of (p)rehabilitation
Field hockey is characterized by a unique dribbling position which has been associated with a prevalence of low back pain and lumbar injury. To quantify the biomechanical response of the hockey-specific running gait, twelve field hockey players completed treadmill running at speeds of 6, 9 and 12 km·hr with a normal running gait and whilst manipulating the hockey stick to replicate dribbling. Mechanical loading was quantified using tri-axial accelerometery at L4, and muscular activity was measured for biceps femoris (BF), gluteus medius (GM) and quadratus lumborum (QL) of each limb. Running with the stick elicited greater mechanical loading in the medio-lateral ( = 0.001) and antero-posterior ( = 0.003) planes, and increased peak ( = 0.004) and mean ( = 0.002) EMG response of QL ( = 0.004). The greater planar mechanical loading and QL activation in response to hockey-specific running technique support epidemiological observations of lower back pain prevalence. The sensitivity of uni-axial mechanical loading to the hockey-specific running posture provides an efficacious means of objectively monitoring mechanical loading in-vivo, whilst the QL activation response has implications for (p)rehabilitative interventions. Running posture and speed can be considered as discrete progressions when considering training load.
What do we know about beach soccer injuries? Systematic video analysis of four consecutive years with 580 match injuries
The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact ( < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) ( < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.
The combined effectiveness of therapeutic ultrasound, electrical stimulations, and blood flow restriction to treat symptoms of muscle damage
This study assessed whether symptoms of muscle damage could be reduced by a combination of therapeutic ultrasound and electrical stimulations, and whether this could be enhanced by blood flow restriction. Before and 48 h after performing eccentric elbow flexion exercises, individuals completed assessments of muscle damage. A 10-min therapeutic ultrasound and electrical stimulation treatment was then applied with and without blood flow restriction to assess short (5 min) and long-term (24 h) improvements. Twenty-three individuals completed the study (11 females). Data were analysed using Bayesian repeated measures ANOVAs. The damaging exercise increased discomfort (BF = 2.93e14) and relaxed joint angle (BF = 2425.90) while decreasing pain pressure threshold (BF = 289.71). Each of these variables was acutely improved with the combination treatment protocol (all BF ≥ 74) with no added effect of blood flow restriction. A combination of therapeutic ultrasound and interferential electrical stimulations appeared effective at acutely alleviating symptoms of muscle damage with no additive effect of blood flow restriction.
The impact of a mid-season FIFA World Cup™ on injury occurrence and patterns in French professional soccer clubs
This study retrospectively compared the effect of holding the 2022 FIFA World Cup™ (WC) mid-season (season 2022/23) on injury rates and patterns in French Ligue 1 soccer clubs. Epidemiological data in 17 clubs were prospectively recorded by their physicians. Time-loss injuries (injuries leading to a player being unable to fully participate in play over the following 72-hour period) were compared with those reported during a regular season (2021-22). In the WC season, an increase of approximately 23% (training + match-play) was observed for both the total number of injuries and knee, ankle and muscle injuries combined. Incidences for match-play injury overall and for the knee, ankle and muscle regions combined and the hamstrings and calf regions specifically also rose significantly (range: < 0.05-p < 0.01). These results suggest that injury occurrence and patterns in French L1 soccer clubs were substantially affected during the 2022/23 season when a mid-season WC was held.
Acute effects of static stretching and proprioceptive neuromuscular facilitation on non-local range of movement
Acute effects of static stretching (SS) and proprioceptive neuromuscular facilitation (PNF) on local and non-local range of motion (ROM) were assessed in 29 participants. Three evaluations were performed one week apart: week-1 Control session (CS); weeks 2-3 either SS or PNF interventions (randomized). Dominant and non-dominant limbs, local (hamstring extensibility) and non-local ROMs (Shoulder extension-ShE) were collected at baseline (T0), immediately after (T1), and fifteen minutes post-intervention (T2). No differences were found between time-points during the CS. Local-ROM significantly increased (=0.0002, ES=0.74 and 0.0079, 0.56, for dominant and non-dominant lower limbs, respectively) after both SS and PNF. No interaction between time and treatment was detected for ShE in both limbs. However, post-hoc analysis revealed a significant increase in dominant upper limb ShE between T0 and T1 only after SS (=0.002; +6.5%). Acute bouts of SS and PNF can increase local-ROM, however, no clear effects were observed for non-local ROM.
Sodium bicarbonate improved CrossFit® Benchmark Fran, but not subsequent 500 m rowing performance
The aim of this study was to evaluate the influence of sodium bicarbonate (SB) supplementation on physical performance, neuromuscular and metabolic responses during CrossFit® exercise. Seventeen Advanced CrossFit®-trained athletes completed the randomized, double-blind, placebo-controlled crossover protocol consisting of four visits, including two familiarization sessions and two experimental trials separated by a 7-day washout period. Participants supplemented 0.3 g/kg body mass (BM) of SB or placebo 120-min prior to performing the CrossFit® benchmark Fran followed by 500 m of rowing. SB improved time to complete Fran compared to PLA (291.2 ± 71.1 vs. 303.3 ± 77.8 s, = 0.047), but not 500 m rowing (112.1 s ± 7.9 vs. 113.2 s ± 8.9 s, = 0.26). No substantial side-effects were reported during the trials. This study showed that SB improved CrossFit® benchmark Fran performance, but not subsequent 500-m rowing. These data suggest that SB might be an interesting supplementation strategy for CrossFit® athletes.
Well-being fluctuations and injuries during an entire season in male professional soccer players: an observational study
This study aimed to describe and relate the well-being perception and injury incidence of soccer players in an entire soccer season. For 37 weeks, twenty-eight male professional soccer players (25.2 ± 4.3 years old; 22.8 ± 1.4 kg/m) daily scored (from 1: bad; to 5: perfect) well-being perception (fatigue, sleep, muscle soreness, stress and mood and Hooper Index (HI) as general status). Injuries were also registered. Results showed that players had the lowest well-being perception during Preseason (in terms of HI, fatigue, muscle soreness and stress), being lower than EarlySeason (p < 0.05, d > 1.0) and/or InSeason (p < 0.05, d > 1.0). The injury incidence was 8.3 ± 9.2/1000 h, being always higher in training compared to competition (35.0 vs 11.1/1000 h). A lower stress perception (worse) correlated with a higher rate of new injuries during PreSeason ( = -0.84), while a greater muscle soreness and fatigue correlated with the new injuries occurring in the following week during the whole season ( = -0.38 and = -0.39, respectively). As a conclusion, the well-being perception of professional soccer players was especially low during Preseason, with fatigue, muscle soreness and stress as the most affected items that correlated with injury incidence.
Effects of combined resistance training and Tai Chi on oxidative stress, blood glucose and lipid metabolism and quality of life in elderly patients with type 2 diabetes mellitus
This study examined the effects of resistance training (RT), Tai Chi (TC) and combination intervention (RT & TC) on the oxidative stress, blood glucose and lipid metabolism and quality of life of elderly patients with type 2 diabetes mellitus (T2DM). Ninety-four elderly patients with T2DM were randomly divided into an RT group (RTG, = 23), TC group (TCG, = 24), combination intervention group (CIG, = 24) and control group (CG, = 23). All participants were given nutrition and medication. On this basis, RTG, TCG and CIG were administered for 24 weeks (3 times/week, 40 minutes/time). Observation indicators were malondialdehyde (MDA), superoxide dismutase (SOD), 8-hydroxy-2 deoxyguanosine (8-OHdG), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), haemoglobin A1c (HbA1c) and diabetes specific quality of life (DSQL). RT, TC and joint intervention can reduce the oxidative stress damage on elderly patients with T2DM to different degrees, control the levels of blood sugar and blood lipid and improve the quality of life. Compared with single intervention, combination intervention can further reduce the level of oxidative stress but has no additional benefits on blood glucose and lipid control and quality of life.
Aetiology, epidemiology and treatment of musculoskeletal injuries in badminton players: a systematic review and meta-analysis
The present study has two main goals: to conduct a systematic review of musculoskeletal injuries experienced by badminton players, and to examine the management of such injuries. Searches were conducted of the PROSPERO, PubMed, Scopus, and SPORTDiscus databases, from their inception until March 2023. The papers analysed were all based on a study population consisting of individuals aged 18 years or more, diagnosed with badminton-related injuries. The methodological quality assessments was using the Newcastle-Ottawa Scale and REVMAN. A total of 28 studies were included in the systematic review. In total, the analysis included 2435 participants. Of these athletes, 35.6% (1012) were female and 64.4% (1503) were male. By type of injury, sprains were the most commonly studied and the most prevalent, accounting for 36.06% of the sample. These were followed by muscle injuries, representing 23.86% of the total. Injuries to the joints were the least prevalent, accounting for 4.97% of the sample. Lower limb injuries accounted for 52.15% of the total. Of these, ankle injuries were the most common. Despite the generally low quality of the studies considered, the evidence suggests that musculoskeletal injuries, especially to the lower limb, most commonly affect badminton players of all levels.
Hip adduction and abduction strength in different test positions and their relationship to previous groin injuries in women footballers
Hip strength has been shown to influence the incidence of injury in women's football. The first objective of our study was to examine the differences in isometric strength of the adductors and abductors between two test positions (0° vs. 45° hip angle). Our second objective was to verify the sensitivity of the two test positions in discriminating between women footballers with and without a history of groin pain in the last twelve months. One hundred and one elite players from the Slovenian women's football league were tested. The isometric strength of the adductors, abductors, and the ratio between hip abductor and adductor strength in two different test positions were assessed. We found statistically significant differences ( < 0.05; effect size range 0.12-0.13) between the two test positions in hip adduction, abduction strength, and abductor/adductor strength ratio. The ROC analysis showed that only the abductor/adductor strength ratio at the 0° hip angle position can differentiate between players with and without a history of groin pain, with an optimal cut-off point of ≤ 1.01 ( < 0.05; AUC = 0.734). The results should help practitioners plan hip strength training for returning to sport or preventing groin pain among women football players.