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Background: The Nine Plus screening battery test (9+) is a functional movement test intended to identify limitations in fundamental movement patterns predisposing athletes to injury. However, the interseason variability is unknown.Aim: To examine the variability of the 9+ test between 2 consecutive seasons in professional male football players.Methods: Asymptomatic Qatar Star League players (n=220) completed the 9+ at the beginning of the 2013 and 2014 seasons. Time-loss injuries in training and matches were obtained from the Aspetar Injury and Illness Surveillance Program. No intervention was initiated between test occasions.Results: A significant increase in the mean total score of 1.6 points (95% CI 1.0 to 2.2, p<0.001) was found from season 1 (22.2±4.1 (SD)) to season 2 (23.8±3.3). The variability was large, as shown by an intraclass correlation coefficient (ICC) of 0.24 (95% CI 0.11 to 0.36) and a minimal detectable change (MDC) of 8.7 points. Of the 220 players, 136 (61.8%) suffered a time-loss injury between the 2 tests. There was an improvement in mean total scores in the injured (+2.0±0.4 (SE), p<0.001) group but not in the uninjured group (+0.9±0.5, p=0.089). The variability from season 1 to season 2 was large both in the injured (ICC 0.25, 0.09 to 0.40, MDC 8.3) and uninjured (ICC 0.24, 0.02 to 0.43, MDC 9.1) groups.Conclusions: The 9+ demonstrated substantial intraindividual variability in the total score between 2 consecutive seasons, irrespective of injury. A change above 8 points is necessary to represent a real change in the 9+ test between seasons. [ABSTRACT FROM AUTHOR]

Objective: The Football World Cup is among the biggest sporting events in the world, but data to inform the requirements of medical care for such tournaments are limited. This study describes the athlete and team medical services at the FIFA World Cup Qatar 2022 ., Methods: Three different medical service entities were identified through a needs analysis based on expert advice, team physician interviews and questionnaires prior to the event: 'Team Services' to provide any workforce or equipment needs of the teams, a 'Polyclinic' to manage any acute medical demands, and a 'recovery centre' to improve game readiness throughout the tournament. All services had been set up prior to the tournament and thoroughly tested., Results: Of a total of 832 athletes, ~1300 team delegation and ~130 match officials, 167 individuals including 129 (77%) athletes and 38 (23%) non-athletes were assessed in the polyclinic. For the 129 athletes (median 4 players per team), medical imaging was the most requested service, which peaked during the group phase of the tournament. Most requests were received during normal working hours despite many games finishing late at night. 30 of the 32 participating teams solicited medical services for their players at least once. Three teams made use of the recovery facilities, and 17 teams requested additional medical equipment or clinical assistance., Conclusion: Central imaging services was the most used medical resource at the FIFA World Cup Qatar 2022, and over half of teams required additional medical equipment or personnel. These data may inform planning of medical services for similar events in the future., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To evaluate the efficacy of early versus delayed introduction of lengthening (ie, eccentric strengthening) exercises in addition to an established rehabilitation programme on return to sport duration for acute hamstring injuries in a randomised controlled superiority trial., Methods: 90 male participants (age: 18-36 years, median 26 years) with an MRI-confirmed acute hamstring injury were randomised into an early lengthening (at day 1 of rehabilitation) group or a delayed lengthening (after being able to run at 70% of maximal speed) group. Both groups received an established rehabilitation programme. The primary outcome was time to return to sport (ie, time from injury to full unrestricted training and/or match play). The secondary outcome was reinjury rate within 12 months after return to sport. Other outcomes at return to sport included the Askling H-test, hamstring strength, clinical examination and readiness questions., Results: The return to sport in the early lengthening group was 23 (IQR 16-35) days and 33 (IQR 23-40) days in the delayed lengthening group. For return to sport (in days), the adjusted HR for the early lengthening group compared with the delayed lengthening group was 0.95 (95% CI 0.56 to 1.60, p=0.84). There was no significant difference between groups for reinjury rates within 2 months (OR=0.94, 95% CI 0.18 to 5.0, p=0.94), from 2 to 6 months (OR=2.00, 95% CI 0.17 to 23.3, p=0.58), and 6 to 12 months (OR=0.57, 95% CI 0.05 to 6.6, p=0.66)., Conclusion: Accelerating the introduction of lengthening exercises in the rehabilitation of hamstring injury in male athletes did not improve the time to return to sport nor the risk of reinjury., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services., Aim: The aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template., Results: eHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education., Conclusion: teleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms-eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: The 9+ screening battery test consists of 11 tests to assess limitations in functional movement., Aim: To examine the association of the 9+ with lower extremity injuries and to identify a cut-off point to predict injury risk., Methods: Professional male football players in Qatar from 14 teams completed the 9+ at the beginning of the 2013/2014 and 2014/2015 seasons. Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff during these seasons. Univariate and multivariate Cox regression analyses were used to calculate HR and 95% CI. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity and identify the optimal cut-off point for risk assessment., Results: 362 players completed the 9+ and had injury and exposure registration. There were 526 injuries among 203 players (56.1%) during the two seasons; injuries to the thigh were the most frequent. There was no association between 9+ total score and the risk of lower extremity injuries (HR 1.02, 95% CI 0.99 to 1.05, p=0.13), even after adjusting for other risk factors in a multivariate analysis (HR 1.01, 95% CI 0.98 to 1.04, p=0.37). ROC curve analysis revealed an area under the curve of 0.48, and there was no cut-off point that distinguished injured from non-injured players., Conclusion: The 9+ was not associated with lower extremity injury, and it was no better than chance for distinguishing between injured and uninjured players. Therefore, the 9+ test cannot be recommended as an injury prediction tool in this population., Competing Interests: Competing interests: KMK is the Editor-in-Chief of BJSM and was at arm’s length (and blinded) from the review process., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Despite the widespread use of periodic health evaluation (PHE) to detect and prevent injury and illness in athletes, its effectiveness in detecting health conditions and relevant risk factors is still debated., Aim: To assess health conditions detected by a comprehensive PHE in professional male football players and evaluate their consequences for participation clearance., Methods: A total of 558 professional football players in Qatar completed a PHE prior to the 2013 or 2014 seasons: history, general medical (including blood test), cardiovascular (12-lead ECG and echocardiography) and a musculoskeletal examination, including a specific test battery targeting lower extremity strength and flexibility. On the basis of the PHE, players were either cleared or not cleared for participation., Results: In 533 players (95.5%), at least one health condition was detected requiring treatment or follow-up. Vitamin D deficiency or insufficiency (≤30 ng/mL) was the most common medical condition (n=499, 89.4%), followed by hepatitis B non-immunity or infection (n=164, 29.4%). Cardiac screening identified 48 players (8.6%) with one or more abnormal findings (ECG (n=19, 3.4%) and echocardiography (n=14, 2.5%)). Musculoskeletal conditions were observed in 180 players (32.3%); injuries to or strength deficits of the hip/groin and thigh accounted for the largest proportion. Medical clearance was temporarily not given in 69 players (12.4%), while further examinations were being conducted. One player was disqualified from competitive football., Conclusions: PHE revealed a high prevalence of health conditions requiring treatment or follow-up in professional footballers; however, only 12.4% of conditions impacted on final clearance for participation., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To determine the frequency and nature of injuries sustained during the IRB 2011 Rugby World Cup., Design: A prospective, whole population survey., Population: 615 international rugby players representing 20 teams competing at the IRB 2011 Rugby World Cup in New Zealand., Method: The study was implemented according to the international consensus statement for epidemiological studies in rugby union; the main measures included the players' age (years), stature (cm) and body mass (Kg) and the incidence (number of injuries/1000 player-hours), mean and median severity (days absence), location (%), type (%) and cause (%) of match and training injuries., Results: The incidences of injuries were 89.1/1000 player-match-hours (forwards: 85.0; backs: 93.8) and 2.2/1000 player-training-hours (forwards: 2.7; backs: 1.7). The mean severity of injuries was 23.6 days (forwards: 21.2; backs: 26.2) during matches and 26.9 (forwards: 33.4; backs: 14.3) during training. During matches, lower-limb muscle/tendon (31.6%) and ligament (15.8%) and, during training, lower-limb muscle/tendon (51.4%) and trunk muscle/tendon (11.4%) injuries were the most common injuries. The most common cause of injury during matches was the tackle (forwards: 43.6%, backs: 45.2%), and during training was full and semicontact skills activities., Conclusion: The results confirm that rugby, like other full-contact sports, has a high incidence of injury: the results from IRB Rugby World Cup (RWC) 2011 were similar to those reported for RWC 2007.