Background: Off-road running is a growing sport with little research investigating injury profiles of female participants. Bone stress injuries (BSIs) are a particularly detrimental injury with little known about their incidence and risk factors in female off-road runners. Objective: Collate and review the available evidence reporting epidemiological data and risk factors associated with BSI in female off-road runners. Design: Systematic literature review, without meta-analyses. Data Sources: MEDLINE OVID, PubMed, SPORTDiscus, and MEDLINE EBSCO. Searches were finalized in July 2024. Eligibility Criteria: Studies that reported injury surveillance statistics and/or risk factors associated with BSIs in female off-road runners. Results: Seventeen eligible studies were included, of which all reported surveillance statistics and 2 reported risk factors associated with BSI among 897 female runners. Owing to the scarcity of data, cross-country runners were included in the population of off-road runners. Most BSIs were high severity and in the lower leg, with an overall incidence ranging from 0 to 34.39 BSIs per 100,000 athlete-exposures and prevalence ranging from 0% to 40.9%. Study characteristics were reported alongside risk of bias, quality, and level of evidence assessment outcomes from varying tools. Eight significant intrinsic risk factors were associated with BSIs in female off-road runners: increasing age, disrupted menstruation, previous BSI, increased female triad risk, and lower calcium, vitamin D, and calorie intake. Discussion: Limited by the number of studies available reporting data on the specific target population, which highlights the need for performing high-quality prospective studies in the future, this review summarizes the current epidemiological data and risk factors associated with BSIs in female off-road runners.
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Bone Stress Injury Epidemiology and Risk Factors in Female Off-Road Runners: A Systematic Review
Richard Stennett, Volker Scheer, and Kelly Kaulback
Illnesses and Diseases Constitute a Quarter of Medical Conditions in an Under-21 National Football Team
Panu H. Nordback
Context: There is a minimal number of studies of under-21-year-old national football teams, and the literature is injury centric. Particularly, current knowledge is deficient regarding noninjurious medical conditions, such as illnesses and diseases. Design: The objectives of this study were to analyze the descriptive characteristics of injuries and illnesses or diseases encountered in an under-21 football team during 2 European championship qualification tournaments. Methods: Medical records of 2 consecutive men’s Union of European Football Associations European Under-21 Championship qualification competition tournaments were retrospectively analyzed for the study from September 2015 to October 2018. All match- and training-related injuries, illnesses, and diseases were analyzed and further categorized. Results: In the 20 international caps played within 13 separate events, the players encountered 81 injuries and 26 other conditions, illnesses, or diseases requiring medical attention. In total, 25 injuries and 5 diseases led to attendance inability. The incidence of injury was 0.6 per match and disease 0.3 per day. Many overuse injuries appeared during prematch training and in relation to previous history. Twenty-four percent of all medical conditions during 2 qualification tournaments were illnesses or diseases. The injury and disease incidences were low and mild or moderate rather than severe. Conclusions: A variety of illnesses and diseases constitute a quarter of conditions requiring medical attention in an under-21 national football team. Attendance at under-21 national team events can be stated as safe as the incidence and severity rates are low.
Psychological Responses Among Individuals Undergoing Anterior Cruciate Ligament Reconstruction Surgery
Airi Naoi, Yasukazu Yonetani, Yoshinari Tanaka, and Shuji Horibe
This study elucidated how previous surgery experience, coping, and optimism influenced the mood of patients who underwent anterior cruciate ligament (ACL) reconstruction surgery. Additionally, it examined the relationships among age, preoperative mood, and postoperative mood. Sixty-four patients (n = 42 men, n = 22 women; age range = 18–51 y) who underwent ACL reconstruction surgery at one hospital in western Japan completed questionnaires before and after surgery. Results revealed that patients who underwent previous ACL reconstruction surgery reported higher tension-anxiety (P < .01) and total mood disturbance (TMD) (P < .05) than did patients who underwent primary surgery. Additionally, tension-anxiety, anger-hostility, TMD (P < .001), depression-dejection, fatigue, and confusion (P < .01) assessed before surgery were significantly reduced after surgery, and preoperative mood was positively related to postoperative mood. Furthermore, positive interpretation was negatively related to TMD before surgery (P < .05), and evading one’s responsibility was positively related to TMD after surgery (P < .05). Therefore, psychological support might be necessary for patients who underwent previous ACL reconstruction surgery and patients who evade responsibility. The results of this study will help sport medicine professionals identify several individual factors that are related to psychological responses of patients who underwent ACL reconstruction surgery.
Comparing the Hip and Lumbar Joint Range of Motion in Patients With Lower Lumbar Disc Herniation and Healthy Subjects
Mahdieh Mirzapour, Omid Shahpari, Neda Mostafaee, Saeed Akhlaghi, and Majid Shahbazi
Background: One possible factor contributing to low back pain is hip range of motion (ROM). However, there is inconstancy in published studies, which may be due to the heterogeneity of patients. Therefore, the present study focuses on the relationship between hip ROM and lower lumbar disc herniation (LLDH). Method: A cross-sectional study involved 52 participants between 18 and 65 years old. Two digital inclinometers were utilized to measure the ROM of the lumbar and hip joints in all study participants. For each outcome, 2 measurements were conducted, and the mean of the 2 measurements was utilized for analysis. The level of statistical significance was established at P ≤ .05. Results: The difference in all ROM between the 2 groups is significant except for dominant hip flexion (P < .05). Lumbar flexion was reduced in LLDH compared with healthy individuals (P = .003). The findings manifested a significant correlation between right lumbar rotation and nondominant hip abduction (P = .05, R = .388) and between left lumbar lateral bending and nondominant hip flexion (P = .008, R = .510). Conclusion: Patients with LLDH have reduced hip ROM and lumbar flexion compared with healthy individuals. The study showed correlations between hip and lumbar ROM and emphasized the significance of evaluating hip ROM in LLDH for assessment and treatment planning.
The Effect of Myofascial Release Applied to Thoracolumbar Fascia on Flexibility, Muscular Endurance, and Balance in Healthy Young Adults: A Single-Blind Randomized Controlled Trial
Hatice Ozdemir, Ummuhan Bas Aslan, Hasan Atacan Tonak, and Ibrahim Cagda Kal
Context: Although cranial distant effects occur in self-myofascial release interventions for lower-extremity muscles and fascia, the results of caudal distant effects are still unclear. The aim of this study was to examine the distant effects of myofascial release applied to the thoracolumbar fascia together with exercise training on balance, lower-extremity flexibility, and muscular endurance in healthy young adults. Design: Single-blinded randomized control trial design. Methods: Thirty-six healthy participants aged 18–35 years were randomly divided into 3 groups: myofascial release and exercise group (group 1, n = 12), exercise group (group 2, n = 12), and control group (group 3, n = 12). Three days a week for 4 weeks, group 1 applied the thoracolumbar fascia foam roller massage together with the warm-up, muscular endurance, balance, and stretching exercise program, and group 2 applied the same exercise program except for the foam roller massage. No intervention was made in group 3. Flexibility was assessed with sit and reach test, muscular endurance with the 1-minute sit to stand test, and balance with star excursion balance test before the intervention and at the end of the fourth week. Results: Flexibility, muscular endurance, and dynamic balance values increased significantly in groups 1 and 2 after the intervention (P < .05). When the difference values (Δ) of groups 1 and 2 were compared, there was a difference in favor of group 1 for flexibility, muscular endurance, and dynamic balance (P < .05). Conclusions: The results of the study showed that the effect of the distant myofascial release technique added to the exercise training on flexibility, muscular endurance, and dynamic balance was greater than the exercise training alone.
The Effects of Floor Isometric Trunk Extension Exercise on Muscle Thickness and Activation Vary Between Different Combinations of Duration and Repetition Number
Eleftherios Kellis, Athanasios Konstantopoulos, and Athanasios Ellinoudis
Context: Intermittent floor trunk extensions are popular exercises in group fitness programs. The aim of this study was to investigate whether fewer repetitions of longer isometric trunk extension efforts compared with more repetitions of shorter isometric contractions have different acute effects on muscle thickness and activation as well as perceived exertion. Design: This study followed a cross-sectional design. Methods: Twenty healthy young males performed floor prone trunk extension exercises using 3 different exercise protocols of repetition and duration: 10 × 5 seconds (D10 × 5), 2 × 25 seconds (D2 × 25), and 5 × 10 seconds (D5 × 10). Ultrasound multifidus thickness and rate of perceived exertion on a 10-point scale were measured immediately after each protocol. Electromyographic activation from the erector spinae, multifidus, and gluteus maximum during each protocol was measured using bipolar surface electrodes. Results: The longer duration (D2 × 25) protocol showed a significant greater rate of perceived exertion (6.22 [0.73]) and rest multifidus thickness change (median: 8.04%) compared with the other protocols (P < .05). Within each protocol, root mean square of all muscles increased from trial to trial in the D2 × 25 and D5 × 10 (P < .05), but not during the D10 × 5 protocol (P > .05). The maximum root mean square was achieved in the shorter duration (D10 × 5) protocol compared with the other ones (P < .05). Conclusion: If trunk extension exercises on the floor are used in a training setting, then using exercises with long duration and fewer repetitions may elicit a greater metabolic response.
Gaze Stability Test Asymmetry Before and After Individualized Rehabilitation in Youth Athletes With Concussion
Amy Alexander, Rachel Sweenie, Bradley Meacham, and Jamie Pardini
Context: Concussion causes physiological disruptions, including disruptions to the vestibular and visual systems, which can cause dizziness, imbalance, and blurry vision. The vestibular ocular reflex functions to maintain a stable visual field, which can be measured using the gaze stability test (GST). Design: This preliminary study used retrospective chart review to examine changes in GST performance and asymmetry in a sample of 117 youth athletes with concussion (mean age = 14.51, SD = 2.08) before (T1) and after (T2) they completed a vestibular therapy program that included in-office treatment by a vestibular physical therapist and a customized home exercise program. Examples of exercises that may be assigned in the home exercise program during vestibular therapy are provided. Methods: After examining descriptive information, changes in GST scores and asymmetry percentage between time points were compared via Wilcoxon signed-rank tests. Results were also compared descriptively with previously published findings. Results: Results revealed significant improvements in median GST in leftward and rightward direction head movements from T1 to T2 and a significant reduction in GST asymmetry (P < .001). Both GST in leftward and rightward direction head movements improved from 145.00 to 210.00°/s, which is above the 50th percentile in previously published literature with uninjured athletes. Asymmetry decreased from an average of 10.07% (SD = 7.89) to 4.11% (SD = 3.88), which is lower than in previously published literature. Conclusions: Concussion produces symptoms that vary among individuals and between injuries. GST velocity and asymmetry values provide objective data about an athlete’s impairment and progress in recovery within the vestibular domain. This can aid in making clinical decisions on return to play progression and promote a successful and safe return to sport.
Performance on the Concussion Balance Test Is Indicative of Time to Recovery in Athletes Following Sports-Related Concussion: An Exploratory Analysis
Carolina P. Quintana, Shelly Massingale, Nicholas R. Heebner, Jamie Pardini, Tamara C. Valovich-McLeod, Anne D. Olson, Arnold Stromberg, and Matthew C. Hoch
Objective: Sports-related concussions (SRCs) are commonly occurring injuries among athletic and recreationally active populations. SRCs can result in vestibular dysfunction that should resolve before returning to activity. It has been suggested that vestibular impairment is a factor that may influence recovery time. The objective of this study was to evaluate the effect of vestibular function on recovery following SRC. Design: Retrospective chart review. Setting: Multidisciplinary Concussion Clinic. Intervention: A total of 32 patient charts (21 males, 15.34 [1.47] y, 171.29 [8.44] cm, 68.37 [15.47] kg) from patients diagnosed with SRC presenting to a concussion clinic between August of 2016 and July 2017 with clinician-identified vestibular involvement were included. Main Outcome Measures: Scores on the Post-Concussion Symptom Scale, Dynamic Visual Acuity Test, Gaze Stabilization Test, Concussion Balance Test (COBALT), and other clinical data were used for analysis. Descriptive statistics were calculated for all variables. Pearson correlations were used to identify variables related to time to recovery. Variables were entered into a forward linear regression model. Results: Moderate to good relationships were identified between days to recovery and Dynamic Visual Acuity Test lines lost in the leftward direction (1.17 [0.52]; r = .39, P = .04), COBALT-condition 8 sway velocity (1.20 [0.18]; r = .44, P = .01), and days to successful completion of the COBALT (14.72 [8.35]; r = .63, P < .001). Patients’ predicted time to recover was equal to 14.61 (0.86) (days to successful COBALT). The model was significant (P < .001, R 2 = .30). Conclusion: The single predictor of time to recover was the number of days to successful completion of the COBALT. Thus, the ability to complete the task may be more informative than the performance on the task in predicting recovery time.
A Qualitative Longitudinal Exploration of Interactions Between Female Athletes and Sport Medicine Staff During Injury Rehabilitation
Kirsten Hutt and Katherine A. Tamminen
Context: Sport injury is a prevalent setback experienced by athletes, wherein they are required to spend time in rehabilitation and interact with sport medicine staff. Sport medicine staff are a frequent line of contact line of contact for athletes at this time and represent an important part of their support network. There is little exploration surrounding the interactions that female athletes have with sport medicine staff during injury rehabilitation and how these interactions may impact the rehabilitation process. The purpose of this research is to explore the experiences of injured female athletes and their interactions with sport medicine staff during injury rehabilitation. Design: Qualitative study using semistructured qualitative interviews and audio diaries. Interpretive descriptive methodology. Methods: A total of 11 injured female varsity athletes who had sustained a musculoskeletal injury within 2 to 4 weeks of being recruited participated. A total of 6 upper body injuries and 5 lower body injuries are represented. Athletes completed 2 semistructured interviews and weekly audio diary entries across 6 weeks. Data were analyzed using reflexive thematic analysis. Results: Results demonstrated that female athletes felt supported by sport medicine staff when provided with clear information about rehabilitation, when they perceived sport medicine staff as competent, and when sport medicine staff made a personal connection. An overarching theme of mattering was identified as underpinning the athletes’ experiences of feeling supported by sport medicine staff during rehabilitation. Conclusions: When sport medicine staff made female athletes feel that they mattered, they were perceived as more supportive during rehabilitation. Sport medicine staff can help athletes to feel that they matter by engaging in supportive behaviors during the rehabilitation process.
Resting Metabolic Rate and Recovery From Sport-Related Concussion: A Critically Appraised Topic
J. Matthew Nerrie and Tamara C. Valovich McLeod
Clinical Scenario: Critical appraisal of whole-body metabolism as a measure of concussion recovery is lacking in the available evidence. There has been extensive exploration of options for a gold standard assessment for concussion, including blood biomarkers, electroencephalogram, and neuroimaging, but none have yet to demonstrate good empirical evidence of efficacy. Clinical Question: In patients with sport-related concussion (SRC), can resting metabolic rate (RMR), as measured through indirect calorimetry, be used as a physiologic assessment of recovery? Summary of Key Findings: Three studies demonstrated relevance to the clinical question. Of the selected studies, 2 studies were case–control, and 1 was a case series. All studies observed reduced total energy expenditure and increased energy balance when initially assessed between 24 and 72 hours after injury. Clinical Bottom Line: Evidence exists to suggest that RMR as measured with indirect calorimetry is a poor indicator of SRC recovery. All 3 articles found that RMR was not affected by SRC, even when compared with healthy controls. One article did observe a between sex difference in RMR, but a very small sample size was included in the case series. Strength of Recommendation: The findings of this critically appraised topic suggest a strength of recommendation of grade B, demonstrating that RMR is a poor indicator of recovery from SRC.