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Objectives: To describe the incidence, severity, burden and sport specific characteristics of injuries reported in elite diving athletes., Design: Descriptive epidemiology study., Methods: Medical attention and time-loss injuries from 63 (43 female, 20 male) Australian national diving programme athletes were prospectively collected over four seasons (September 2018-August 2022). Injury incidence rates and burden were calculated, standardised per 365 athlete days, and compared across groups using negative binomial generalised linear models., Results: In total 421 injuries were reported (female = 292, male = 129) at an injury incidence rate of 2.36 (95 % confidence interval = 2.14-2.60) per 365 athlete days. Annual injury prevalence ranged from 70.0 to 85.1 %. Approximately two-thirds of injuries (67.2 %) resulted in a period of time-loss. The overall injury burden was 91 days of absence (95 % confidence interval = 81-102) per 365 athlete days. Stress fractures in springboard diving athletes incurred the largest mean days of time-loss compared to other injured tissue types. The majority of injuries were reported to occur during training (79.3 %) as opposed to competition (2.4 %), with more than half (55.3 %) of all reported injuries occurring during pool training sessions. Water entry (30.4 %) or take-off (27.8 %) were the most frequently reported mechanism of injury., Conclusions: Annual injury prevalence reported in competitive Australian diving athletes was found to be high. Contrary to existing literature, competitive diving injuries were reported to occur within the daily training environment, with few injuries occurring during competition. Notable injury differences between springboard and platform athletes were observed., Competing Interests: Declaration of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Co-author previously was the editor-in-chief at the journal to which we are submitting. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study aimed to build on previous work by the authors. It examines how socioecological level and gender influence high-performance sport system (HPSS) stakeholders' perspectives of the relative importance and feasibility to address athlete attrition factors within an Australian high-performance pathway system (HPPS)., Design: Mixed methods., Methods: Sub-analysis was conducted of rating data from 30 participants who had contributed to identifying 83 statements in 13 clusters in a previous Concept Mapping study. The 13 clusters were statistically analysed in 'R' using cumulative link mixed models (CLMMs) to determine differences in perceived importance and feasibility between 1) socioecological levels, and 2) genders., Results: Mean ratings for 11 and three of the 13 clusters were statistically significantly different between at least two of the five socioecological levels, for importance and feasibility, respectively. Athletes had the largest variation in mean ratings from the most (athlete health 4.59), to least (performance potential 2.83) important cluster, when compared to the other four socioecological levels. There were statistically significant differences between the ratings between genders (Men/Women) for two clusters for each rating scale: Importance: 'athlete health' (M3.33:W3.84 [p 0.012]); 'performance potential' (M3.35:W2.57; [p 0.001]), Feasibility: 'abuse and mismanagement of health' (M2.97:W3.68; [p 0.000]) and 'athlete health' (M2.54:W3.33; [p 0.000])., Conclusions: This study highlights the need to implement more robust athlete attrition monitoring protocols. It also highlights the importance of listening to youth athletes' voices, and enabling equal gender representation to ensure holistically tailored environments are created to retain talented athletes in high-performance pathway programmes., Competing Interests: Declaration of interest statement MD and RA worked at an Australian Institute of Sport; and KM and SG worked at the NSW institute of Sport at the commencement of this study. These institutes did not influence or approve the final version of this manuscript. No other conflict of interests to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: Primary: To gain a system-wide perspective on factors leading to athlete attrition from a high-performance sport system (HPSS). Secondary: To identify what a sample of system-wide stakeholders and past athletes value as the most important and feasible attrition factors to address to retain talented athletes., Design: Mixed-methods., Methods: Concept mapping was used for qualitative data collection and quantitative data analysis. Sixty-one participants including: (i) past athletes from an Australian state sporting institute; (ii) their families; and (iii) internal and external stakeholders to a HPSS who supported past athletes., Results: Participants brainstormed 83 unique statements (i.e. attrition factors) that were mapped into 13 clusters of attrition factors following multidimensional scaling and hierarchical cluster analysis performed on the participants sorting data: 'abuse and mismanagement of health'; 'athlete health'; 'limited support/resourcing'; 'coaching'; 'inconsistent processes'; 'financial and career support'; 'pathway structure'; 'organisational dynamics'; 'competitive stress'; 'performance potential'; 'challenges with selection and transition'; 'psychological state'; and 'competing non-sport priorities'. 'Abuse and mismanagement of health' had the highest mean importance (3.76 out of 5) and feasibility (3.31) rating. The 13 clusters were further grouped into four overarching domains: 'sport system policy, structure and processes'; 'pathway structure, transition and support'; 'individual athlete health and capability'; and 'whole-of-life demands and priorities'. The domain 'sport system policy, structure and processes' contained the most important and feasible clusters., Conclusions: Macro (system-level) and micro (intrapersonal and interpersonal) level athlete attrition factors should be considered together. Athlete health was considered the most important athlete retention issue to address., (Copyright © 2022. Published by Elsevier Ltd.)

Objectives: To report the medical attention and time-loss injury epidemiology of Australia's premier netball competition., Design: Descriptive epidemiological study., Methods: One-hundred and nineteen players in the Suncorp Super Netball league were under surveillance during three consecutive seasons (2017-2019), inclusive of pre-, in-, and post- season phases. Medical attention injuries were recorded by medical personnel, and additionally sub-categorised according to time loss. Injury incidence rates (IIR) and injury burden were calculated per 365 player contract days, with differences between season and season phase IIRs compared using negative binomial generated incidence rate ratios (IRR)., Results: Eight hundred and sixty-six medical attention injuries and 393 time-loss injuries were recorded. The majority of the players had multiple (≥2) medical attention (n = 92; 77.3%) and time-loss (n = 75, 63.0%) injuries reported. The ankle (n = 181; 20.9%), knee (n = 136; 15.7%) and foot (n = 98; 11.3%) were the body sites with the most frequently reported medical attention injuries. Overall, there was a comparable injury incidence rate between the pre-season and in-season periods (IRR = 1.13, 95%CI = 0.98-1.30, p = 0.0842), although variation in the injury burden was identified. Ankle tendon injuries (23.5 days absence) and knee joint injuries (44.9 days absence) the most burdensome injuries in the pre-season and in-season periods respectively., Conclusions: Lower limb injuries are the most frequent in professional level netball. Knee and ankle injuries are the most burdensome overall, however the type of injuries with a high burden vary between pre- and in-season periods. Time-loss, non-time loss and subsequent injuries are prominent in professional level netball., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: To 1) investigate the incidence, prevalence, burden and characteristics of injuries; and 2) explore the frequency of physiotherapy and medical servicing for elite sports academy athletes over a 12-month season., Design: Prospective cohort study., Methods: Medical attention and time-loss injuries were prospectively recorded by Physiotherapy and Medical (Sports Physician) staff for 94 athletes (72.3% females). The number of linked physiotherapy and medical servicing appointments was also recorded. Injury incidence rates (IIR), point and period prevalence, and injury burden were calculated and compared by athlete gender, sport, and categorisation (performance level) using incidence rate ratios (IRR)., Results: The number of injuries reported was 193 in 71 (75.5%) athletes. The IIR was 2.1 (95%CI: 1.8 to 2.4) injuries per 365 days, with no gender difference observed (IRR: 1.1, 0.8 to 1.4). The injury burden was 43.5 (95%CI: 37.8 to 50.1) days absent per 365 days. More than one-quarter (point prevalence, 26.6%) of athletes commenced the season with an injury. In-season injury risk was 2.5 fold greater in athletes who started the season with an injury compared to athletes who started the season without an injury (IRR: 2.5, 1.9 to 3.4). The majority (81.2%) of the 1164 appointments recorded were physiotherapy, with an overall 4.3:1.0 physiotherapy to medical appointment ratio., Conclusions: One in four athletes began the elite pathway season with a pre-existing injury, while also demonstrating a 2.5 fold greater risk of subsequent injury in the scholarship period. Sports should not assume their athletes are uninjured at the beginning of their scholarship. Injury profiles, and physiotherapy and medical servicing varied across sports. To reduce health as a barrier in the successful transition of talented young athletes to elite athletes, injury management strategies at the commencement of recruitment and throughout the scholarship should be prioritised in the development pathway., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Objectives: To identify if basketball players aged <20 years (U20) self-report hip and/or groin pain and if they perceive this as a problem. To determine potential differences in self-reported playing (training and match play) loads and Copenhagen Hip and Groin Outcome Score (HAGOS) between those with and without hip/groin pain., Design: Cross-sectional., Methods: Fifty-one pre-elite (state/national representative level) male U20 basketball players (Australian n=38; Italian n=13) self-reported current/historical hip/groin 'discomfort/pain' and 'problems', and playing loads. A two-factor regression model was fitted including main effects for hip/groin pain and Cohort and their interaction, with outcome variables playing loads and HAGOS subscale scores and dependent variable hip/groin pain., Results: Twenty-one players (41%) self-reported hip/groin 'discomfort/pain', of which nine perceived no 'problems'. Two of these nine players reported training/playing time loss due to pain. Those self-reporting hip/groin discomfort/pain scored lower than those without in HAGOS subscales Symptoms (mean difference in score 8.94; 95%CI -25.24, -5.97), Pain (5.00; -16.42, -2.81), Function in daily living (0.00; -26.72 to -5.59), Function in sport and recreation (6.25; -21.24, -5.33), and hip and/or groin Quality of Life (5.00; -28.63, -8.10), indicating worse hip/groin problems. Participation subscale scores were different only for Italian players (36.25; -51.25, -20.00), with players self-reporting hip/groin discomfort/pain scoring lower., Conclusion: Most players who perceive both hip/groin 'discomfort/pain' and 'problems' also report training/playing time loss, suggesting players' perceptions of problematic symptoms and time-loss are associated. Adolescent basketball players perceive hip/groin pain to negatively impact their daily lives and sporting function., (Copyright © 2021 Sports Medicine Australia. All rights reserved.)

Objective: To investigate the incidence, site, nature and cause of injuries sustained during and four weeks following the 2018 Australian National Netball Championships (ANNC's) using medical attention and self-report surveillance tools., Design: Prospective cohort study., Method: Injuries were recorded prospectively using medical attention and self-report data collection methods. One hundred and ninety-two athletes competed at the 2018 ANNC's with 96 athletes in each age group (17/U & 19/U)., Results: There were 103 medical attention injuries sustained by 80 athletes resulting in an incidence rate of 89.4 per 1000 player hours. The most frequently recorded medical attention injury diagnoses across both age groups were lateral ankle ligament sprain (n=14, 13.6%), foot blisters (n=11, 10.7%), and lumbar pain (n=10, 9.7%). Ankle sprains (n=4), anterior cruciate ligament (ACL) ruptures (n=3) and concussion (n=3) recorded as the highest sports incapacity injuries. The self-report data collection revealed that 46 (27.2%) athletes arrived at the tournament with an existing self-reported injury/illness and 57 (39.3%) athletes had a self-reported injury/illness at the conclusion of the ANNC (RR 1.44 95%CI 1.05-1.99, p=0.030)., Conclusion: There are no recent studies reporting injury rates specifically in pre-elite netball players. This study found an incidence rate of 89.4 per 1000 player hours. Ankle sprains are the highest medical attention and sports-incapacity injury in pre-elite netball athletes. Foot blisters and low back pain also feature in the highest medical attention injuries and ACL rupture and concussion were high sports incapacity injuries at the ANNC's. Finally, combining both the medical attention and self-report injury/illness data collection methods identified more injuries/illnesses than the use of one method alone., (Copyright © 2019 Sports Medicine Australia. All rights reserved.)

Objectives: To examine the epidemiology of bone stress injuries in an elite sports institute., Design: Retrospective cohort study at the Australian Institute of Sport., Methods: A retrospective analysis of the clinical records contained within the Australian Institute of Sport Athlete Management System electronic database was performed. Records with Orchard Sports Injury Classification System codes relating to bone stress injuries and stress fractures were reviewed and descriptive statistics relating to sport, site of injury, athlete age, sex and activity were analysed., Results: In the three-year period January 2014-2017, 11,942 injuries were recorded across 48 sports. 181 bone stress injuries (0.15% of all injuries) were recorded across 16 sports. BSIs in the foot and lumbar spine were the most common accounting for 30% and 23% of all the reported BSIs respectively. Gymnasts had a high frequency of lumbar spine stress injuries (n=24, 51%) and rowers had a high frequency of rib stress injuries (n=22, 88%). The most common location for stress injuries, equally distributed across a variety of sports, were in the foot (n=54, 30%). Female athletes recorded more BSIs than males., Conclusion: Across a three-year period, 0.15% of injuries were related to bone stress injuries. Almost double the cases were recorded in female athletes. Sport specific injury sites were observed in the dataset., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Objectives: To analyse the characteristics of injuries sustained by elite sprint kayak athletes, to investigate relationships between initial and subsequent injuries, and to examine injury differences between male and female athletes., Design: Descriptive epidemiology study., Methods: Data from 63 athletes (37 male, 26 female) of the Australian national sprint kayak squad were prospectively collected over three continuous years (September 2014-August 2017). All medical attention injuries were recorded irrespective of time-loss and modality of training. Descriptive analyses were performed, and frequency comparisons across genders assessed with chi squared tests., Results: Forty-nine athletes (78%) sustained 146 injuries (median=2, interquartile range=1-4, range=0-12). Most injuries were to the upper limb (48%), with the shoulder being the most common body site injured (27%). Thirty-one athletes (49%) sustained at least one subsequent injury, equating to 97 subsequent injuries. The majority (68%) of subsequent injuries occurred at a different site and nature to previous injuries. Male athletes were more likely to sustain an injury than remain injury free compared to female athletes (Chi 2 (1) =6.75, p=0.009), but there was no difference between males and females who thereafter sustained a subsequent injury (Chi 2 (1) =0.84, p=0.359)., Conclusions: Injury occurrence is common in sprint kayak, with many athletes experiencing more than one injury. Small variations in injury characteristics exist between male and female athletes in sprint kayak. This study identifies upper limb and trunk, and joint and muscle injuries as the most prevalent sprint kayak injuries, providing a focus for the development of future injury prevention strategies., (Copyright © 2019 Sports Medicine Australia. All rights reserved.)

Objectives: To describe and evaluate injury prevention interventions for pre-elite athletes who compete in an Olympic or professional sport., Design: Systematic review., Methods: This review was prospectively registered (PROSPERO CRD42017065083) and a systematic electronic search was conducted in May 2017. The following inclusion criteria were applied: (1) studies including and analysing data specific to pre-elite athletes (determined by the T3/T4 levels of the FTEM model); (2) featured injury prevention interventions; (3) provided sufficient data related to injury such that the effect can be analysed e.g. injury rates, incidence, prevalence, injury rate ratios; (4) featured randomised and non-randomised controlled trials or prospective cohorts., Results: A total of 13,480 articles were retrieved with 121 titles identified and 11 studies satisfying the inclusion criteria. No studies demonstrated a low risk of bias. Four different interventions were identified: exercise (n=7, 64%), psychological (n=2, 18%), equipment (n=1, 9%), nutrition (n=1, 9%). Of the seven exercise interventions, four showed a protective effect and three found no significant effect, providing conflicting evidence. Caution is advised due to high risk of bias, low intervention reporting and minimal evidence for implementation planning in all seven studies., Conclusions: There is limited evidence from level 2 and 3 studies suggesting exercise and psychology interventions may prevent injury in pre-elite athletes. There is an absence of evidence to support the use of equipment and nutrition interventions in pre-elite athletes. There is a need for quality research designs confirming the clinical impact of existing injury prevention interventions for pre-elite athletes., (Copyright © 2019 Sports Medicine Australia. All rights reserved.)

Objectives: Heart rate (HR), blood lactate concentration [La] and/or rating of perceived exertion (RPE) have been utilised to monitor judo training load in technical and randori (competition training) sessions, but are yet to be investigated in mixed sessions containing both elements. Therefore the purpose of this study was to: (1) determine the stability of these variables, and (2) to assess the efficacy of RPE as a load variable for mixed judo sessions., Design: Cross-sectional study., Methods: Twenty-nine athletes attended two mixed training sessions at an international training camp. Bout and session characteristics, including RPE, physical and mental effort, heart rate (HR) and post-session [La] were recorded. A two-way random-effects intra-class correlation assessed variable stability. Multilevel mixed-effects ordered logistic regression investigated relationships between RPE and other variables for bouts and sessions., Results: Average and minimum HR across sessions correlated highly (ICC=0.95 and 0.94, respectively). Good correlations existed between [La], session-RPE and mental effort, and fair correlation of max HR and physical effort. No relationships existed between [La]/HR and session-RPE. A unit increase in bout-RPE resulted in a 2.09 unit increase in physical, or a 1.36 unit increase in mental, effort holding all other bout variables constant. Gender and competitive level did not influence statistical models., Conclusions: Results provide further evidence that RPE can be used across a range of competitive levels and genders to monitor workload of mixed sessions and individual randori in judo. Physical effort may play a larger role than mental effort when athletes reflect on exertion during training., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: Determine whether clinically feasible tests of isometric lower limb strength and range of motion (ROM) in Australian Football (AF) athletes are useful in Periodic Health Examinations to identify persistent deficits following hamstring strain injury (HSI)., Design: Case-control., Methods: Thirty-seven male, semi-professional AF athletes (mean±SD; age, 20.2±2.9years; height, 1.7±0.5m; mass, 81±9.2kg) participated, ten athletes (37%) reported HSI within the previous three seasons of competition. Comparisons of pre-season isometric knee flexion and hip extension strength variables (peak force, torque and torque normalised to body mass) and hip, knee and ankle ROM measures were made between athletes with and without past-history of HSI using linear mixed-effect models. A logistic regression evaluated whether any of the outcome measures could differentiate athletes with a past-history of HSI., Results: Knee flexion peak force, torque and torque normalised to body mass were significantly reduced in athletes with a past-history of HSI (coefficient, 95% CI) (-44.8N, -86.3 to -3.3), (-22.2Nm, -40.5 to -3.7) and (-0.2Nmkg -1 , -0.4 to 0.0) respectively. Knee flexion peak torque normalised to body mass (Nmkg -1 ) approached significance as a test was able to differentiate athletes with history of HSI (p=0.068). There were no differences between groups for any hip extension strength or lower limb ROM outcome measures., Conclusions: Deficits in isometric peak knee flexion strength persist for up to three seasons following HSI in AF athletes. Isometric knee flexion strength testing may be a clinically feasible option for Periodic Health Examinations and inform tertiary injury prevention strategies., (Copyright © 2018 Sports Medicine Australia. All rights reserved.)

Objectives: The use of microsensor technologies to conduct research and implement interventions in sports and exercise medicine has increased recently. The objective of this paper was to determine the validity and reliability of the ViPerform as a measure of load compared to vertical ground reaction force (GRF) as measured by force plates., Design: Absolute reliability assessment, with concurrent validity., Methods: 10 professional triathletes ran 10 trials over force plates with the ViPerform mounted on the mid portion of the medial tibia. Calculated vertical ground reaction force data from the ViPerform was matched to the same stride on the force plate. Bland-Altman (BA) plot of comparative measure of agreement was used to assess the relationship between the calculated load from the accelerometer and the force plates. Reliability was calculated by intra-class correlation coefficients (ICC) with 95% confidence intervals., Results: BA plot indicates minimal agreement between the measures derived from the force plate and ViPerform, with variation at an individual participant plot level. Reliability was excellent (ICC=0.877; 95% CI=0.825-0.917) in calculating the same vertical GRF in a repeated trial. Standard error of measure (SEM) equalled 99.83 units (95% CI=82.10-119.09), which, in turn, gave a minimum detectable change (MDC) value of 276.72 units (95% CI=227.32-330.07)., Conclusions: The ViPerform does not calculate absolute values of vertical GRF similar to those measured by a force plate. It does provide a valid and reliable calculation of an athlete's lower limb load at constant velocity., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: To assess the association between workload, subjective wellness, musculoskeletal screening measures and non-contact injury risk in elite Australian footballers., Design: Prospective cohort study., Methods: Across 4 seasons in 70 players from one club, cumulative weekly workloads (acute; 1 week, chronic; 2-, 3-, 4-week) and acute:chronic workload ratio's (ACWR: 1-week load/average 4-weekly load) for session-Rating of Perceived Exertion (sRPE) and GPS-derived distance and sprint distance were calculated. Wellness, screening and non-contact injury data were also documented. Univariate and multivariate regression models determined injury incidence rate ratios (IRR) while accounting for interaction/moderating effects. Receiver operating characteristics determined model predictive accuracy (area under curve: AUC)., Results: Very low cumulative chronic (2-, 3-, 4- week) workloads were associated with the greatest injury risk (univariate IRR=1.71-2.16, 95% CI=1.10-4.52) in the subsequent week. In multivariate analysis, the interaction between a low chronic load and a very high distance (adj-IRR=2.60, 95% CI=1.07-6.34) or low sRPE ACWR (adj-IRR=2.52, 95% CI=1.01-6.29) was associated with increased injury risk. Subjectively reporting "yes" (vs. "no") for old lower limb pain and heavy non-football activity in the previous 7 days (multivariate adj-IRR=2.01-2.25, 95% CI=1.02-4.95) and playing experience (>9 years) (multivariate adj-IRR=2.05, 95% CI=1.03-4.06) was also associated with increased injury risk, but screening data were not. Predictive capacity of multivariate models was significantly better than univariate (AUC multivariate =0.70, 95% CI 0.64-0.75; AUC univariate range=0.51-0.60)., Conclusions: Chronic load is an important moderating factor in the workload-injury relationship. Low chronic loads coupled with low or very high ACWR are associated with increased injury risk., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: Illness can disrupt training and competition performance of athletes. Few studies have quantified the relative contribution of the known medical, behavioural and lifestyle risk factors., Design: Cross-sectional., Methods: Olympic athletes from 11 sports (n=221) were invited to complete questionnaires administered nine months before the Rio 2016 Olympic Games. These included the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. An illness (case) was defined as an event which limited training or competition for greater hours in the prior month. Odds ratios and attributable fractions in the population (AFP) were utilised for categorical variables with independent t-tests or Wilcoxon rank-sum for continuous variables., Results: Eighty-one athletes responded (male, n=26; female, n=55). There were 16 illness cases and 65 controls. Female athletes were at higher odds of illness (OR=9.4, 95%CI 1.3-410, p=0.01, AFP=0.84). Low energy availability (LEAF-Q score ≥8: OR=7.4, 95%CI 0.78-352, p=0.04, AFP=0.76), depression symptoms (DASS-21: depression score >4, OR=8.4, 95%CI 1.1-59, p<0.01; AFP=0.39) and higher perceived stress (PSS: 10-item, p=0.04) were significantly associated with illness., Conclusions: Female sex, low energy availability, and mental health are associated with sports incapacity (time loss) due to illness. Low energy availability had high attributable fractions in the population and stands out as a primary association with illness., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Objectives: To identify the most accurate method of predicting peak height velocity in adolescents., Design: Systematic review., Methods: A comprehensive literature search of six electronic databases and reference lists was conducted. Studies that met selection criteria of (1) observational longitudinal cohort study (2) reproducible method/s of predicting peak height velocity (3) minimum six-month follow-up (4) healthy male and/or female adolescent subjects, with the exception of participants with adolescent idiopathic scoliosis, were considered for review. Studies were screened using a modified quality assessment checklist, with only those scoring >50% included. The type of surrogate measure of peak height velocity, its reliability and ability to predict peak height velocity were extracted from the year or stage immediately preceding peak height velocity. We defined "predict" as when both the estimates of effect and 95% confidence intervals of the surrogate occurred prior to the actual age of PHV., Results: The nine included studies examined three anthropometric, three equation and four radiographic-based surrogates for PHV. Of these, the radiographic measures were reported to exhibit moderate to high intra- and inter-rater reliability. Three of the four radiographic surrogates predicted PHV. Two anthropometric measures also predicted PHV but reliability of the measures is unknown. All equation-based methods predicted the timing of PHV to occur later than it actually happened when applied in the year prior to expected PHV., Conclusions: In the year/stage immediately preceding peak height velocity, radiograph-based methods appear to be accurate and reliable surrogates., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: To investigate the impact of training modification on achieving performance goals. Previous research demonstrates an inverse relationship between injury burden and success in team sports. It is unknown whether this relationship exists within individual sport such as athletics., Design: A prospective, cohort study (n=33 International Track and Field Athletes; 76 athlete seasons) across five international competition seasons., Methods: Athlete training status was recorded weekly over a 5-year period. Over the 6-month preparation season, relationships between training weeks completed, the number of injury/illness events and the success or failure of a performance goal at major championships was investigated. Two-by-two table were constructed and attributable risks in the exposed (AFE) calculated. A mixed-model, logistic regression was used to determine the relationship between failure and burden per injury/illness. Receiver Operator Curve (ROC) analysis was performed to ascertain the optimal threshold of training week completion to maximise the chance of success., Results: Likelihood of achieving a performance goal increased by 7-times in those that completed >80% of planned training weeks (AUC, 0.72; 95%CI 0.64-0.81). Training availability accounted for 86% of successful seasons (AFE=0.86, 95%CI, 0.46 to 0.96). The majority of new injuries occurred within the first month of the preparation season (30%) and most illnesses occurred within 2-months of the event (50%). For every modified training week the chance of success significantly reduced (OR=0.74, 95%CI 0.58 to 0.94)., Conclusions: Injuries and illnesses, and their influence on training availability, during preparation are major determinants of an athlete's chance of performance goal success or failure at the international level., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: This is the first study to evaluate the mechanical sensitivity, clinical classifications and prevalence of groin pain in Australian football players., Design: Case-control., Methods: Professional (n=66) and semi-professional (n=9) Australian football players with and without current or previous groin injuries were recruited. Diagnoses were mapped to the Doha Agreement taxonomy. Point and career prevalence of groin pain was calculated. Pressure pain thresholds (PPTs) were assessed at regional and distant sites using handheld pressure algometry across four sites bilaterally (adductor longus tendon, pubic bone, rectus femoris, tibialis anterior muscle). To assess the relationship between current groin pain and fixed effects of hyperalgesia of each site and a history of groin pain, a mixed-effect logistic regression model was utilised. Receiver Operator Characteristic (ROC) curve were determined for the model., Results: Point prevalence of groin pain in the preseason was 21.9% with a career prevalence of 44.8%. Adductor-related groin pain was the most prevalent classification in the pre-season period. Hyperalgesia was observed in the adductor longus tendon site in athletes with current groin pain (OR=16.27, 95% CI 1.86 to 142.02). The ROC area under the curve of the regression model was fair (AUC=0.76, 95% CI 0.54 to 0.83)., Conclusions: Prevalence data indicates that groin pain is a larger issue than published incidence rates imply. Adductor-related groin pain is the most common diagnosis in pre-season in this population. This study has shown that hyperalgesia exists in Australian football players experiencing groin pain indicating the value of assessing mechanical pain sensitivity as a component of the clinical assessment., (Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: Forearm injuries are common and debilitating to elite rowers. Chronic exertional compartment syndrome, intersection syndrome and proximal radial bone stress injuries have been documented in this population. This paper explores the imaging findings related to these conditions in asymptomatic elite rowers., Design: Observational study., Methods: 19 asymptomatic senior elite and under-23 rowers currently competing at National level or above underwent ultrasound (US), Magnetic Resonance Imaging (MRI) and muscle functional MRI evaluation of their forearms. A comprehensive evaluation sheet identifying characteristics of bone stress, intersection syndrome and chronic exertional compartment syndrome was utilised based on a literature search and review by senior clinicians working with this population., Results: Peritendinous fluid of Extensor Carpi Radialis Longus (n=10, 53%) or Extensor Carpi Radialis Brevis (n=6, 32%) was a common finding on US. MRI had a higher rate of identification than US. Extensor Digitorum (Coeff=-1.76, 95%CI -3.04 to -0.49), Flexor Carpi Radialis (Coeff=-2.86, 95%CI -5.35 to -0.38) and Flexor Carpi Ulnaris (Coeff=-3.31, 95%CI -5.30 to -1.32), Pronator Teres (Coeff=-3.94, 95%CI -6.89 to -0.99), and Supinator (Coeff=-168, 95%CI -3.28 to -0.02) showed statistically significant changes immediately post-exercise. Mild proximal radial marrow hyperintensity was present (n=15, 78.9%) with three participants (15.8%) also having mild periosteal oedema of the radius., Conclusions: Imaging findings commonly seen in symptomatic populations are observed in elite, asymptomatic rowers. Care should be taken when diagnosing bone stress injuries, intersection syndrome and compartment syndrome on imaging findings alone. Data presented can be utilised as a normative dataset for future case studies., (Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Objectives: To investigate inter and intra-tester reliability of an externally fixed dynamometry unilateral hamstring strength test, in the elite sports setting., Design: Reliability study., Methods: Sixteen, injury-free, elite male youth football players (age=16.81±0.54 years, height=180.22±5.29cm, weight 73.88±6.54kg, BMI=22.57±1.42) gave written informed consent. Unilateral maximum isometric peak hamstring force was evaluated by externally fixed dynamometry for inter-tester, intra-day and intra-tester, inter-week reliability. The test position was standardised to correlate with the terminal swing phase of the gait running cycle., Results: Inter and intra-tester values demonstrated good to high levels of reliability. The intra-class coefficient (ICC) for inter-tester, intra-day reliability was 0.87 (95% CI=0.75-0.93) with standard error of measure percentage (SEM%) 4.7 and minimal detectable change percentage (MDC%) 12.9. Intra-tester, inter-week reliability results were ICC 0.86 (95% CI, 0.74-0.93), SEM% 5.0 and MDC% 14.0., Conclusions: This study demonstrates good to high inter and intra-tester reliability of isometric externally fixed dynamometry unilateral hamstring strength testing in the regular elite sport setting involving elite male youth football players. The intra-class coefficient in association with the low standard error of measure and minimal detectable change percentages suggest that this procedure is appropriate for clinical and academic use as well as monitoring hamstring strength in the elite sport setting., (Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.)