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Objectives: This systematic review aimed to identify the injury and severity rates of injuries experienced by male professional rugby-15 players. Method: A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies were included if published within the past 10 years (2013-present), were peer-reviewed, provided injury incidence rate during matches or training, and focused on male, professional, Rugby-15 players. The review was preregistered in PROSPERO before starting the search process (CRD42023471046). Four electronic databases (PubMed Central, Embase, CINAHL Complete, and SPORTDiscus) were searched. The modified Downs and Black scale was used for each article to assess the risk of bias. Results: Forwards were estimated to experience injuries at a rate of 5.7–106.4/1,000 player-hours, whereas backs were estimated at a rate of 8.6–86.8/1,000 player-hours. Muscles/tendons (1.38–46.6/1,000 player-hours) and joints/ligaments (1.49–54.5/1,000 player-hours) were most frequently affected. The knee (11.1–14.6/1,000 player-hours) and head/face (11.2–18.3/1,000 player-hours) were the most injured body regions, with recurrent injuries resulting in more time lost than new injuries (28–51 days vs. 22–35 days). Conclusions: The existing literature demonstrates heterogeneous injury incidence and severity estimates for male professional rugby-15 players. Data suggests an increased injury incidence rate among forwards compared with backs and for match play versus training, with recurrent injuries increasing the burden on athletes.

Context: Variables associated with pain catastrophizing and beliefs in athletes presenting with musculoskeletal pain and/or sports-related injuries are largely unexplored. Objective : We aimed to evaluate which anthropometric, sociodemographic, sporting, injury history, and care-seeking characteristics were associated with the Pain Catastrophizing Scale (PCS) and Pain Beliefs and Perceptions Inventory (PBAPI) scores in athletes. Design: This study followed a cross-sectional design. Methods: Three hundred and twelve athletes (40% females) from different sports and levels completed a questionnaire including demographic information, details regarding sports practice, injury history, health care use, PCS, and PBAPI. Univariable associations between PCS and PBAPI scores and each variable were assessed using linear regression. Variables with univariable associations where P < .05 were entered into multivariable regression models. Results: The final multivariable model including gender, recurrent and persistent pain, a history of a severe atraumatic injury, and a history of more than 5 atraumatic injuries explained 14.9% of the variance in PBAPI scores. Performing a team sport and a history of more than 5 atraumatic injuries explained 5.1% of the variance in PCS scores. Conclusions: Gender, sporting, and injury history characteristics explained only a small portion of the variance in PCS and PBAPI scores, whereas having received healthcare support and the number of appointments did not. Most of the variance was left unexplained.

The biomechanics of the rotational shot put technique have been demonstrated. However, the causal relationships among kinematics and kinetics for achieving higher release velocity remain poorly understood. This study investigated these causal relationships among biomechanical variables for achieving a higher release velocity in the rotational shot put technique. The study included 22 male shot putters whose 3-dimensional motion was captured during official competitions. Key kinematic and kinetic variables throughout the shot put motion were calculated, as suggested by previous studies. Path analysis was used to explore a hierarchical model that postulates both direct and indirect effects among variables. The findings revealed that the impulse of the shot, system angular momentum, and system linear momentum were critical kinetic variables contributing directly to release velocity. Additionally, 8 kinematic variables significantly affected the impulse of the shot, including shoulder rotation, shot path length, and trunk tilt, while movements such as swings and extensions of the lower extremities were related to system momentum. This model not only provides a detailed understanding of the mechanics involved in the rotational technique but also informs technical coaching strategies in the shot put.

Context: Femoroacetabular impingement syndrome (FAIS) is a movement-related condition associated with pain and impaired function; yet the evidence for level ground walking hip biomechanics is limited and inconsistent. Challenging the hip with inclined walking for individuals with FAIS might be important for elucidating mechanically driven function loss and informing tailored rehabilitation. The purpose of this study was to determine the effects of progressive inclined walking on sagittal hip biomechanics and hip flexor and extensor activity in individuals with FAIS. Design: Cross-sectional. Methods: Fourteen participants (7 individuals with FAIS and 7 asymptomatic individuals) underwent motion capture and electromyographic analysis during 3 treadmill walking conditions (0°/5°/10°). Statistical parametric mapping was used to compare the sagittal hip kinematic waveforms and hip flexor (rectus femoris) and extensor (gluteus maximus) waveforms between groups and walking conditions. Results: Hip flexion was significantly increased throughout the gait cycle in individuals with FAIS compared with asymptomatic individuals (P < .01) but was not dependent on incline. Rectus femoris activation was significantly increased throughout stance in individuals with FAIS compared with asymptomatic individuals (P < .01). Gluteus maximus activity significantly increased with progressive inclination in asymptomatic individuals (P < .01), with no significant change in activity for individuals with FAIS. Conclusions: Hip biomechanics and muscle activity during inclined walking mirrored that of arthrogenic muscle inhibition, highlighted by a prominent flexor role and lack of hip extensor activity in individuals with FAIS. Future research investigating discordant activity between hip flexors and extensors during complex functional tasks may help identify rehabilitation targets.

Mechanical impingement of the rotator cuff tendons against the acromion (subacromial) and glenoid (internal) during shoulder motions has long been thought to contribute to tears. Clinically, the risk for impingement is thought to be influenced by scapular movement impairments. Therefore, our purpose was to determine the extent to which simulated changes in scapular orientation impact the proximity between the rotator cuff tendon footprint and the acromion and glenoid during scapular plane abduction. Specifically, shoulder kinematics were tracked in 25 participants using a high-speed biplane videoradiography system. Scapular movement impairments were simulated by rotating each participant’s scapula from their in vivo orientation about the scapular axes (±2°, ±5°, and ±10°). Subacromial and internal proximities were described using minimum distances, proximity center locations, and prevalence of contact. Statistical parametric mapping was used to investigate the extent to which these measures were impacted by simulated changes in scapular orientation. Simulated changes in scapular orientation significantly altered proximity patterns in a complex manner that depended on the impingement mechanism, humerothoracic elevation angle, and magnitude of the simulated change. Clinicians should be mindful of these factors when interpreting the potential effects during a clinical examination.

Context: Understanding Paralympic athletes’ perspectives on the importance of sleep is the first step toward developing effective sleep hygiene (SH) strategies. We aim to describe and compare the knowledge about SH and sleep behaviors practiced by medalists and nonmedalists Paralympic athletes at the Tokyo 2020 Paralympic Games and between sexes (female vs male), identify whether the coaching staff encourages SH, and the perspective of these athletes on the importance of SH. Methods: 98 Paralympic athletes responded to the Sleep Beliefs Scale and the Athlete Sleep Behavior Questionnaire-BR. Results: Medalists (68%) and nonmedalists (78%) Paralympic athletes had low knowledge about SH (60% vs 55%; P = .20), with no difference between groups. The Athlete Sleep Behavior Questionnaire-BR score (48.7 [5.9]) for all Paralympic athletes (n = 98) indicated high practice of maladaptive sleep behaviors. Male athletes had significantly worse sleep behaviors than female athletes (49.1 [6.0] vs 39.5 [7.2]; P < .01) and less knowledge about behaviors that can affect sleep (64% vs 72%; P < .05), 26% of Paralympic athletes considered SH practices necessary, and the frequency of coaching staff encouraging SH was higher among medalists Paralympic athletes compared to nonmedalists athletes (29% vs 13%, P = .04). Conclusions: Most Paralympic athletes have inadequate sleep behaviors and knowledge about SH. There was no difference between knowledge about SH and sleep behaviors between medalists and nonmedalists Paralympic athletes, although medalists athletes were more encouraged to practice SH. Male Paralympic athletes had worse sleep behaviors and worse knowledge about SH than female athletes.

Context: Over 80% of patients anticipate fully returning to sport (RTS) within 1 year after anterior cruciate ligament reconstruction (ACLR), but only one quarter of patients succeed. Although several factors influence the RTS process, this study focused on how psychological responses to injury, such as injury-related fear and self-determined motivation, help to explain variation in rehabilitation experiences. There is limited information about how these meaningful psychological responses to injury are connected to responses such as athlete burnout or how patient perceptions of these responses relate to rehabilitation. The purpose of this qualitative study was to explore how patient perceptions of injury-related fear, self-determined motivation, and athlete burnout influence individual psychological and rehabilitation experiences at 4 to 6 months post-ACLR. Design: Qualitative study. Methods: Eight patients (female = 4, age = 16.3 ± 1.9) between 4 and 6 months post-ACLR who injured their knee playing or training for sports were included in the study. Patients completed the Sport Motivation Scale-6, Athlete Burnout Questionnaire, Perceived Stress Scale 4, and Tampa Scale of Kinesiophobia-11 to measure self-determined motivation, athlete burnout, stress, and injury fear. These questionnaires collected descriptive data used to guide audio- and video-recorded semistructured interviews. The interviews were transcribed and analyzed in a 6-stage process of thematic analysis. Results: Thematic analysis revealed 3 themes related to how participants perceived their rehabilitation experiences: (1) acknowledging recurring struggles during recovery, (2) finding motivation to RTS and normal life, and (3) successfully navigating the recovery process. In particular, participants described the impact of positive shifts in their psychological perceptions at 4 to 6 months post-ACLR. Conclusions: Patients 4 to 6 months post-ACLR described how struggles during their recovery and rehabilitation experiences were improved by positive shifts in their psychological perceptions. Increasing positive psychological awareness within a supportive rehabilitation environment may improve rehabilitation experiences and RTS rates after ACLR.

The clinical question examined the use of the Shoulder Return to Sport after Injury (SI-RSI) scale to measure athletes’ mental readiness after a shoulder injury to improve the return-to-play (RTP) decision-making process. In September 2023, a computerized search of PubMed for evidence was completed. Four articles met the inclusion and exclusion criteria. Outcomes included quantitative evidence of SI-RSI scores and if the athletes RTP. All four studies were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology Critical Appraisal Checklist. Points were removed for no explanation of statistical analysis, bias, funding, and loss of participants. Two of the included studies concluded that patients who RTP passed the SI-RSI benchmark 73.1% and 81.4% of the time. One study found that 74% of athletes that passed their determined benchmark returned to the same level of play after the injury. One study revealed that participants who RTP scored higher on the reinjury fear and risk subscale compared with those who did not (42.2 ± 23 vs. 27.3 ± 16, p = .02). The Strength of Recommendation Taxonomy checklist concluded a Level C recommendation because of the consistent Levels 2 and 3 evidence across all four studies. This recommendation accounts for the disease-oriented outcomes measured across all studies. This evidence suggests that the SI-RSI helps evaluate psychological readiness before RTP after a shoulder dislocation. Clinically, this may limit the recurrence of shoulder dislocations by requiring athletes to pass the SI-RSI benchmark.

Context: Clinical concussion assessments do not typically simulate the speed or complexity of sport. Performance changes arising from combined physical, cognitive, and sensory demands of sport may thus remain undetected during rehabilitation. We developed R2Play, a multidomain return-to-play assessment tool for youth with concussions. R2Play involves levels and conditions that vary in physical, cognitive, and sensory load to simulate the multidomain demands of sport. Objectives: To explore cross-site feasibility, face validity, and content validity of R2Play by integrating quantitative and qualitative data. Methods: Convergent mixed-methods feasibility study. Five sites will each recruit 5 clinicians (total n_c = 25) and 10 youth sport participants (ages 10–25 y) with a history of concussion in the previous year (total n_y = 50). Feasibility will be evaluated using quantitative criteria for acceptability, demand, implementation, practicality, and integration, and qualitative investigated data from content analysis of postassessment interviews with youth and clinician participants. Face validity will be investigated in postassessment interviews. Content validity will be established through (1) changes in performance metrics (time to completion, errors, and heart rate) across R2Play levels, (2) youth-perceived physical and cognitive exertion for each level, and (3) overall clinician perceptions determined through postassessment interviews. Qualitative and quantitative data will be merged through joint display to identify areas of convergence, divergence, and complementarity, and to establish meta-inferences about feasibility, face validity, and content validity. Discussion: This study aims to demonstrate the face and content validity of R2Play, and its feasibility for cross-site implementation. Findings will guide further iteration of R2Play and establish the foundation for a larger multicenter validation study to establish the psychometric properties of R2Play. This work represents an important first step toward the implementation of an ecologically valid multidomain assessment tool designed to support a safe and efficient return-to-play after concussion, ultimately reducing the risk of recurrent concussion and subsequent injury.