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Repetitive strain injuries (RSIs) encompass a broad clinicopathologic spectrum which includes discrete patterns of tissue injury involving tendons, bursae and nerves although an element of subjective symptomatology may be contributory. Upper extremity RSIs include De Quervain's tenosynovitis, intersection syndromes, epicondylitis, ulnar, and median neuritis as well as other compressive neuropathies. It is estimated that RSIs cost the US economy over $60 billion annually and while detailed clinical examination remains the diagnostic mainstay, imaging can aid in diagnosis, guide management and reduce costs.

Objective To investigate predictors of low back and lower extremity musculoskeletal injury in a cohort of Naval cadets. Design Prospective Cohort Study Methods 545 Naval cadets (Males, n = 394, 72%) were followed-up over eight months. Nine variables were investigated as predictors: history of musculoskeletal symptoms in the last 12 months, ankle dorsiflexion range of motion, sit and reach test, isometric hip abduction and external rotation strength, alignment during the single leg squat test, single leg hop test for distance, prone plank and side plank tests. All injuries that required medical attention were registered. Predictive associations were examined using univariable and multivariable logistic regression analyses. Results The incidence of all injuries was 7%. Cadets who failed the 60-second plank test (OR = 3.3; 95% CI, 1.2−8.8, P = 0.04), had ≤18 cm in the sit and reach test (OR = 4.0; 95% CI, 1.4−11.2, P = 0.01), or reported pain in the last 12 months in two or more body regions (OR = 2.7; 95% CI, 1.02−7.3, P = 0.04), had greater odds of sustaining an overuse injury. No predictors were identified for acute injuries. Conclusion Decreased trunk endurance on the prone plank test, reduced posterior chain flexibility on the sit and reach test, and a history of pain reported in two or more sites in the last 12 months were predictors of overuse injuries in Naval cadets. Assessment and intervention of these modifiable risk factors may be clinically relevant in injury screening and prevention.

The young, overhead throwing athlete is prone to overuse injuries because of their variable skeletal maturity and often improper technique. An overuse injury to the digit(s) in the overhead throwing athlete, Little Leaguer's Finger, has never been discussed in the literature to our knowledge. We present a case of a 14-year-old man with atraumatic pain, swelling, and edema to his dominant pitching index finger after throwing greater than 90 pitches in one setting. Initial workup of the patient, including an MRI, ruled out an infectious process, and it was determined that there was a stress epiphysitis within the proximal phalanx of the digit. Symptoms within the digit resolved given time, rest, and cessation of throwing activities. The purpose of this report was to stress the importance of establishing the etiology of finger pain in the throwing athlete and to describe a previously unreported overuse injury, Little Leaguer's Finger.

Overuse injuries affect persons of all ages and physical participation levels. These injuries involve repetitive overload causing damage and pain to various joints, affecting performance and ability to continue participation. Even when an injury diagnosis is apparent, functional assessment is useful in discovering the underlying mechanism.

The aims of this study were to determine the prevalence of sport specialisation in youth football, and to investigate the associations of sport specialisation and volume of sport participation with injury history.Cross-sectional questionnaire.New Zealand youth football teams.414 youth football players aged 10-15 years.The level of specialisation, average weekly sport participation and free-play volume were recorded. 12-month injury history was captured and grouped by injury type. Associations between level of specialisation and demographic variables were analysed using chi square tests. Logistic regression was used to investigate associations between injury history, level of specialisation, and volume of participation.Participants were classified as high (43%), moderate (38%), or low (19%) specialised (n = 399 complete). High specialisation was more likely in boys, older participants, and those from large schools. Highly specialised participants were more likely to report a history of gradual onset injury than those who were low specialised (n = 340 with complete injury data). Odds of reporting a gradual onset injury also increased with greater weekly and annual sport participation volume.There is a high prevalence of sport specialisation in youth football, and it is associated with increased incidence of gradual onset injury.

Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively.

In pair skating and ice dance, performance seems to have increased at international competitions, which is potentially associated with changes in athlete age. We hypothesized increasing age, numbers of total points and more complex jumps of the best elite couples at international championships in recent years. Corresponding data were assessed via the results databases of the European and World Championships, as well as the Winter Olympics since 2005. Linear regression statistics were conducted, and significance was assessed via one-way ANOVAs. There were no significant changes in age. Increases in total points were found in both disciplines (World and European Championships both p < 0.001 for both disciplines, Olympics pair skating p = 0.003, ice dance n/a). Significant increases were found in the number of double and triple twist jumps at the European Championships (Double p = 0.046, triple p = 0.041), but not at the World Championships or the Olympics. At the World Championships, single solo jumps decreased (p = 0.031) in favor of triple jumps, which increased (p = 0.020), without a similar effect at the European Championships or Olympics. In conclusion, increases in total points and more complex jumps were observed at international championships without associated changes in age. Attention should be given to possible changes in the incidence of acute and overuse injuries following this development.

The aim of this study is to analyse women's wrist and elbow acute work injuries together with cumulative trauma disorders, such as carpal tunnel syndrome (CTS) and epicondylitis. Five years records (2015-2019) on women's wrist/elbow acute work injuries and CTS/epicondilytis, from Italian National Compensation Authority, were collected and pooled all together as 'dis-ac' (disorders + acute) events. A statistical analysis was performed in comparing the different female-dominated work sectors. Results showed that hairdressing/laundry sector was associated with the highest risk for wrist acute work injuries and cleaning for elbow while manufacturing for CTS and epicondylitis. Hairdressing/laundry and manufacturing were associated with the highest risk for dis-ac events (hairdressing: wrist dis-ac OR: 4.89; CI 95% 4.22-5.67; elbow dis-ac OR: 3.70; CI 95% 2.99-4.58; manufacturing: wrist dis-ac OR: 3.39; CI 95% 3.13-3.66; elbow dis-ac OR: 2.45; CI 95% 2.20-2.73). The relationship between acute injuries and cumulative trauma disorders is discussed to preserve women's safety and health in ergonomics.

Patellar tendon (PT) complaints are frequent throughout the population, with increased occurrence in athletes and, particularly, in youth competitive alpine skiers. Timely detection and treatment might improve prospects of recovery. Diagnostic modalities in clinical use to date rely on pain symptoms, manual palpation, and potentially, magnetic resonance imaging (MRI); however, MRI-based imaging yields limited sensitivity. Quantitatively measuring the morphological and mechanical properties of PTs by means of B-mode ultrasound and shear wave elastography (SWE), instead, may allow improved diagnosis or even early detection. We performed B-mode scans and three-dimensional ultrasound shear wave velocity (SWV) mapping and MRI of the PT in 106 youth skiers. A prospective one-year survey on health problems combined with clinical assessments served to categorize symptomatic and asymptomatic youth skiers. Skiers suffering from distal or proximal tendon complaints showed lower SWV in the respective tendon region than asymptomatic skiers (p = 0.035 and p = 0.019, respectively). Youth skiers with distal tendon complaints additionally exhibited decreased SWV in the proximal region compared to asymptomatic counterparts (p = 0.020). Cross-validated analysis of retrospective prediction indicated sensitivity and specificity in detecting tendon complaints in the range of 0.606-0.621 and 0.536-0.650, respectively. MRI detected distal tendon complaints with a sensitivity of 0.410 (12/29) but failed to detect any proximal cases. This study agrees with the most recent literature in that SWE holds promise as a valuable adjunct modality for the diagnosis of PT complaints or even the detection of subclinical prestages. However, to evaluate its prospective predictive value, long-term studies are warranted., European Journal of Sport Science, 23 (6), ISSN:1746-1391, ISSN:1536-7290

Study design Cadaveric. Objective The aim of this study was to quantify the amplitude and duration of surgeons' muscle exertion from pedicle cannulation to screw placement using both manual and power-assisted tools in a simulated surgical environment using surface electromyography (EMG). Summary of background data A survey of Scoliosis Research Society members reported rates of neck pain, rotator cuff disease, lateral epicondylitis, and cervical radiculopathy at 3×, 5×, 10×, and 100× greater than the general population. The use of power-assisted tools in spine surgery to facilitate pedicle cannulation through screw placement during open posterior fixation surgery may reduce torque on the upper limb and risk of overuse injury. Methods Pedicle preparation and screw placement was performed from T4-L5 in four cadavers by two board-certified spine surgeons using both manual and power-assisted techniques. EMG-recorded muscle activity from the flexor carpi radialis, extensor carpi radialis, biceps, triceps, deltoid, upper trapezius, and neck extensors. Muscle activity was reported as a percentage of the maximum voluntary exertion of each muscle group (%MVE) and muscle exertion was linked to low- (0-20% MVE), moderate- (20%-45% MVE), high- (45%-70% MVE) and highest- (70%-100% MVE) risk of overuse injury based on literature. Results Use of power-assisted tools for pedicle cannulation through screw placement maintains average muscle exertion at low risk for overuse injury for every muscle group. Conversely with manual technique, the extensor carpi radialis, biceps, upper trapezius and neck extensors operate at levels of exertion that risk overuse injury for 50% to 92% of procedure time. Power-assisted tools reduce average muscle exertion of the biceps, triceps, and deltoid by upwards of 80%. Conclusion Power-assisted technique protects against risk of overuse injury. Elevated muscle exertion of the extensor carpi radialis, biceps, upper trapezius, and neck extensors during manual technique directly correlate with surgeons' self-reported diagnoses of lateral epicondylitis, rotator cuff disease, and cervical myelopathy.Level of Evidence: N/A.

Background Iliotibial band friction syndrome (ITBFS) is a common disorder of the lateral knee. Previous research has reported that the iliotibial band (ITB) thickness (ITBT) is correlated with ITBFS, and ITBT has been considered to be a key morphologic parameter of ITBFS. However, the thickness is different from inflammatory hypertrophy. Thus, we made the ITB cross-sectional area (ITBCSA) a new morphological parameter to assess ITBFS. Methods Forty-three patients with ITBFS group and from 43 normal group who underwent T1W magnetic resonance imaging were enrolled. The ITBCSA was measured as the cross-sectional area of the ITB that was most hypertrophied in the magnetic resonance axial images. The ITBT was measured as the thickest site of ITB. Results The mean ITBCSA was 25.24 ± 6.59 mm2 in the normal group and 38.75 ± 9.11 mm2 in the ITBFS group. The mean ITBT was 1.94 ± 0.41 mm in the normal group and 2.62 ± 0.46 mm in the ITBFS group. Patients in ITBFS group had significantly higher ITBCSA (P < 0.001) and ITBT (P < 0.001) than the normal group. A receiver operator characteristic curve analysis demonstrated that the best cut-off value of the ITBT was 2.29 mm, with 76.7% sensitivity, 79.1% specificity, and area under the curve (AUC) 0.88. The optimal cut-off score of the ITBCSA was 30.66 mm2, with 79.1% sensitivity, 79.1% specificity, and AUC 0.87. Conclusions ITBCSA is a new and sensitive morphological parameter for diagnosing ITBFS, and may even be more accurate than ITBT.

Determine the association between concussion and subsequent contact, non-contact, and overuse lower extremity (LE) injuries in a cohort of adolescent athletes. Secondarily, to identify this association between males and females.Cross-sectional.Summer athletic events with participants ages 12-18.Anonymous survey included sport-related injuries (injury month/year) and participants classified injuries as a contact, non-contact, overuse injury, or concussion. Multivariable logistic regression analyses were used to examine associations between a concussion event and a subsequent LE injury while controlling for age and any previous LE injury.A concussion was reported in 219 athletes (Female = 96, 44%) and were matched with 219 non-concussed athletes (438 total participants). Concussion was not association with a specific injury mechanism but was significant for any subsequent LE injury (OR = 1.58 95%CI = [1.03-2.41]; p 0.05). Concussed females were more likely to report any subsequent LE injury compared to non-concussed female athletes (2.49[1.31, 4.74]; p 0.01). This relationship was not observed between concussed and non-concussed males (1.11[0.62-1.99]; p 0.5).A history of concussion was associated with any subsequent LE injury, but not associated with a specific mechanism of injury. The association with concussion and a subsequent LE injury was different between males and females.

Purpose: Overuse injury risk increases during periods of accelerated growth, which can subsequently impact development in academy soccer, suggesting a need to quantify training exposure. Nonprescriptive development scheme legislation could lead to inconsistent approaches to monitoring maturity and training load. Therefore, this study aimed to communicate current practices of UK soccer academies toward biological maturity and training load. Methods: Forty-nine respondents completed an online survey representing support staff from male Premier League academies (n = 38) and female Regional Talent Clubs (n = 11). The survey included 16 questions covering maturity and training-load monitoring. Questions were multiple-choice or unipolar scaled (agreement 0–100) with a magnitude-based decision approach used for interpretation. Results: Injury prevention was deemed highest importance for maturity (83.0 [5.3], mean [SD]) and training-load monitoring (80.0 [2.8]). There were large differences in methods adopted for maturity estimation and moderate differences for training-load monitoring between academies. Predictions of maturity were deemed comparatively low in importance for bio-banded (biological classification) training (61.0 [3.3]) and low for bio-banded competition (56.0 [1.8]) across academies. Few respondents reported maturity (42%) and training load (16%) to parent/guardians, and only 9% of medical staff were routinely provided this data. Conclusions: Although consistencies between academies exist, disparities in monitoring approaches are likely reflective of environment-specific resource and logistical constraints. Designating consistent and qualified responsibility to staff will help promote fidelity, feedback, and transparency to advise stakeholders of maturity–load relationships. Practitioners should consider biological categorization to manage load prescription to promote maturity-appropriate dose–responses and to help reduce the risk of noncontact injury.

peer-reviewed The full text of this article will not be available in ULIR until the embargo expires on the 09/01/2022 Background Research suggests that the frequency of training, combined with the repetitive motion involved in high volume swimming can predispose swimmers to symptoms of over-training. The prevention of pain, injury and illness is of paramount importance in competitive swimming in order to maximise a swimmer’s ability to train and perform consistently. A significant factor in the prevention of pain, injury or illness is the appropriate load monitoring and management practices within a training programme. Objective The purpose of this systematic review is to investigate the relationship between training load and pain, injury and illness in competitive swimmers. Methods The databases SPORTDiscus, CINAHL, Scopus, MEDLINE and Embase were searched in accordance with PRISMA guidelines. Studies were included if they reported on competitive swimmers and analysed the link between training load and either pain, injury or illness. The methodological quality and study bias were assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results The search retrieved 1,959 articles, 15 of which were included for review. The critical appraisal process indicated study quality was poor overall. Pain was the most explored condition (N = 12), with injury (N = 2) and illness (N = 1) making up the remaining articles. There was no evidence of an association between training load and pain, while there may be some evidence to suggest a relationship between training load and injury or illness. Conclusions The relationship between training load and pain, injury or illness is unclear owing to a host of methodological constraints. The review highlighted that youth, masters and competitive swimmers of a lower ability (e.g. club versus international) may need particular consideration when planning training loads. Winter periods, higher intensity sessions and speed elements may also need to be programmed with care. Monitoring practices need to be developed in conjunction with consensus guidelines, with the inclusion of internal training loads being a priority. Future research should focus on longitudinal prospective studies, utilising the session Rating of Perceived Exertion (sRPE) monitoring method and investigating the applicability of Acute/Chronic Workload Ratio (ACWR) and exponentially weighted moving average (EWMA). Improved methods and study design will provide further clarity on the relationship between load and pain, injury, and illness.

Background Tendinosis in the common extensor tendon and accompanying ligament, bone, and plica abnormalities can be observed on magnetic resonance imaging (MRI). Purpose To determine whether there is a difference between accompanying abnormalities according to the degree of common extensor tendon injury Material and Methods Patients who underwent 1.5-T MRI tests with a prediagnosis of lateral overuse syndrome were retrospectively reviewed, and 56 patients who had an injury in the common extensor tendon (CET) were included. The degree of tendon and ligament injury, muscle signal change, bone marrow signal change, presence of joint effusion, and morphological features in the presence of plica were evaluated via MRI examinations of the elbow. Results Overall, 32, 16, and eight patients had mild, moderate, and severe CET damage, respectively. As the severity of CET damage increased, the presence of joint effusion, and the presence and degree of damage to the lateral ulnar collateral ligament (LUCL) and radial collateral ligament (RCL) increased. The radiohumeral (RH) plica area was significantly larger in the group with mild CET damage. There was no statistically significant correlation between the severity of CET damage and the end of RH plica with a blind-end, coverage of one-third or more of the radius, its signal, thickness, and presence of olecranon fold. Conclusion As the severity of CET injury increases, damage to the LUCL, RCL, and the presence of effusion in the joint increases. RH plica should be evaluated in terms of concomitant pathology in patients with mild CET injuries on MRI.

Background: Baseball is one of the most popular boy’s youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players. Hypothesis: Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent’s assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. Results: Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year ( P < 0.01) or traveling overnight regularly for showcases ( P = 0.01) were associated with a worse score on the YTS. Conclusion: While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players. Clinical Relevance: Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.

Irisin is a novel exercise-induced myokine that may be involved in regulating energy metabolism. We determined whether overtraining syndrome (OTS) and its biochemical markers are associated with plasma irisin levels in athletes. Seven severely overtrained athletes (OA) and 10 healthy control athletes (CA) were recruited and examined at the time of diagnosis (baseline) and after 6- and 12-months follow-up. Training volume and intensity were initially restricted but progressively increased in OA as OTS symptoms alleviated; CA continued their normal training routine. A maximal cycle ergometer test was performed with irisin analyzed before and after the test. Before the exercise test, irisin levels tended to be lower in OA than in CA at baseline (154.5 ± 28.5 vs. 171.7 ± 58.7 ng/mL). In both groups, at rest irisin levels changed only marginally during follow-up and were not affected by maximal exercise, nor were they associated with physical performance or body fat percentage. Irisin concentration at rest correlated positively with an oxidative stress marker, malondialdehyde (MDA) and negatively with an antioxidant protection marker, oxygen radical absorbance capacity (ORAC) in response to the exercise test in OA at baseline. Our findings help to clarify the possible contribution of irisin and its association with oxidative stress in the pathophysiology of OTS.

Persons with spinal cord injury (SCI) are at high risk for developing neurogenic obesity due to muscle paralysis and obligatory sarcopenia, sympathetic blunting, anabolic deficiency, and blunted satiety. Persons with SCI are also at high risk for shoulder, elbow, wrist, and hand injuries, including neuromusculoskeletal pathologies and nociceptive pain, as human upper extremities are poorly designed to facilitate chronic weight-bearing activities, including manual wheelchair propulsion, transfers, self-care, and day-to-day activities. This article reviews current literature on the relationship between obesity and increased body weight with upper extremity overuse injuries, detailing pathology at the shoulders, elbows, and wrists that elicit pain and functional decline and stressing the importance of weight management to preserve function.

Highlights • A previous running-related injury was the strongest risk factor for an injury in long-distance runners. • Previous injuries not attributed to running, was the strongest risk factor in short-distance runners. Higher body mass index, higher age, sex (male), having no previous running experience and lower running volume were strong risk factors for short-distance runners. • Low quality evidence was found for all risk models as predictor for running-related injuries in short- and long-distance runners. • The quality of evidence for risk factors for running-related injurie is limited and running injuries seem to have a multifactorial origin both in short- and long-distance runners., Purpose The aim of this study was to review information about risk factors for lower extremity running injuries in both short-distance (mean running distance ≤20 km/week and ≤10 km/session) and long-distance runners (mean running distance >20 km/week and >10 km/session). Methods Electronic databases were searched for articles published up to February 2019. Prospective cohort studies using multivariable analysis for the assessment of individual risk factors or risk models for the occurrence of lower extremity running injuries were included. Two reviewers independently selected studies for eligibility and assessed risk of bias with the Quality in Prognostic Studies Tool. The GRADE approach was used to assess the quality of the evidence. Results A total of 29 studies were included: 17 studies focused on short-distance runners, 11 studies focused on long-distance runners, and 1 study focused on both types of runners. A previous running-related injury was the strongest risk factor for an injury for long-distance runners, with moderate-quality evidence. Previous injuries not attributed to running was the strongest risk factor for an injury for short-distance runners, with high-quality evidence. Higher body mass index, higher age, sex (male), having no previous running experience, and lower running volume were strong risk factors, with moderate quality evidence, for short-distance runners. Low-quality evidence was found for all risk models as predictors of running-related injuries among short- and long-distance runners. Conclusion Several risk factors for lower extremity injuries have been identified among short- and long-distance runners, but the quality of evidence for these risk factors for running-related injuries is limited. Running injuries seem to have a multifactorial origin both in short- and long-distance runners., Graphical Abstract Image, graphical abstract

Objectives To investigate how elite track and field athletes with a history of musculoskeletal pain (MSKP) describe their perceptions of clinical treatments based on dry needling guided by a neurological map (neuroanatomical dry needling (naDN)). Design Qualitative study. Methods In-depth interviews were conducted with eight elite Swedish track and field athletes (6 males, 2 females, median age 28.5) treated at a clinic specialised in MSKP management. All interviews were audio recorded and transcribed verbatim. The data were structured and analysed using a thematic method. Results The athletes approached clinical MSKP treatment from a performance-orientated perspective. They explained that they inevitably suffered MSKP episodes due to the intense physical demands of their sport. The use of naDN was considered an integral part of their sports practice and the study clinic's services were readily utilised when MSKP caused minor reductions in physical capacity. The athletes appreciated an unambiguous anatomical diagnosis, preferably supported by imaging scans, as this increased their confidence in clinical services. They valued the naDN treatment as it was perceived to provide fast-acting analgesia that enabled rapid return-to-play. These factors combined to reduce performance-related stress. Conclusions Elite track and field athletes with a history of MSKP sought and appreciated clinical treatment with naDN largely because it provided fast-acting analgesia that enabled rapid return-to-play at a high-performance level. These athletes’ expectations of MSKP diagnosis and management appear incongruent with current research indicating that MSKP sensitivity within the nervous system does not accurately reflect musculoskeletal tissue state or recovery following tissue damage.

Objective: 1) to determine the proportion of sport specialization among female figure skaters, 2) to compare proportion of low back injuries between specialized female figure skaters and non-specia...

Background:Low levels of vitamin D have well-known impacts on bone health, but vitamin D also has a more global role throughout many tissues, including skeletal muscle. The high prevalence of hypovitaminosis D and the vast physiological features of vitamin D have led researchers to examine the influence of vitamin D on physical performance and injury. Because of the critical role of vitamin D in maintaining musculoskeletal health and function, a high rate of hypovitaminosis D among female patients with a variety of musculoskeletal issues could be of high clinical relevance.Hypothesis:There is a high prevalence of low vitamin D in female patients with both acute and overuse sports-related issues of both soft tissue and bone.Study Design:Prospective cohort study.Level of Evidence:Level 3.Methods:Female patients, aged 16 to 40 years, presenting with lower extremity injury diagnosed within the past 4 weeks, no use of multivitamin or vitamin D supplement, and no history of malabsorption syndrome met the inclusion criteria. Vitamin D levels were assessed and categorized as normal (≥32 ng/mL) and low, which includes insufficient (20.01-31.9 ng/mL) and deficient (≤20 ng/mL).Results:Of the 105 patients enrolled, 65.7% had low vitamin D. Within the low vitamin D cohort, 40.6% were deficient and 59.4% were insufficient. Injuries were grouped into overuse or acute with 74 overuse injuries and 31 acute injuries, exhibiting low vitamin D prevalence of 60.8% and 77.4%, respectively. Patients with ligamentous/cartilaginous injuries exhibited the highest percentage of low vitamin D (76.5%), followed by those with patellofemoral-related complaints (71.0%), muscle/tendon injuries (54.6%), and bone stress injuries (45.5%). In univariable analysis, older age, non-White race, less physical activity, less high-intensity interval training days, less endurance training days, and more rest days showed an association with low vitamin D, but none showed an independent association in multivariable analysis.Conclusion:The prevalence of low vitamin D in female patients with various musculoskeletal complaints was high. Clinicians should evaluate for low vitamin D in both acute and overuse injuries.Clinical Relevance:In addition to screening, this study suggests that clinicians should evaluate for low vitamin D levels beyond bone stress injuries in the setting of acute and overuse injuries.

Studies conducting quantitative surveys in school-aged children and adolescents help identify sports-related risk factors for acute and overuse injuries are scarce. This study aimed to quantify the risk factors for sports-related injury in school-aged children and adolescents by school categories. University students (n = 484) retrospectively recalled their sports experiences and related injuries in a questionnaire according to the following school categories: lower elementary school (LE), upper elementary school (UE), junior high school (JH), and high school (H). Both sports-related acute and overuse injuries were recorded. After adjusting various covariates, weekly hours in sports were identified as a significant risk factor in LE and UE. The interaction of weekly hours in sports and sports specialization was significant in LE and UE, suggesting that early specialization would be a risk factor in lower school categories. In JH and H, female sex, high-level competition, and injury experienced in a previous school category were significantly related to sports-related injuries. In conclusion, weekly hours in sports, high-level competitions, previous injury experience, and sex were confirmed as risk factors in specific school categories. Most identified risk factors are modifiable, suggesting that sports-related injuries can be prevented in school-aged children and adolescents.

The aim of this study was to investigate physical fitness, football-specific skills and their association with injury risk in youth football. Altogether 447 male and female players aged 9 to 14 years (median 12 years) participated in performance tests and prospective follow-up. The physical fitness tests included five-jump test for distance, 30-m sprint, football-specific figure of eight agility, countermovement jump, and Yo-Yo intermittent endurance test level 1. The football-specific skill tests included dribbling and passing tests. Injuries and exposure were registered during the 20-week follow-up. Our candidate risk factors were low/high level of physical fitness measured with a composite score of physical fitness tests and low/high level of football-specific skills measured with a composite score of dribbling and passing tests. Secondarily, we investigated performance in individual tests and their association with injury risk. During the follow-up, players reported 565 injuries (264 acute and 301 overuse injuries). High level of physical fitness was associated with increased rate of all injuries (age-, sex- and mean team exposure - adjusted IRR 1.28, 95% CI 1.04–1.58). The level of football-specific skills had no influence on the overall injury rate. Burden of overuse injuries, but not acute injuries was significantly higher in most fit players compared with the players in the reference group (IRR 2.09, 95 % CI 1.04–4.24). In conclusion, most fit players were at greater risk of sustaining injuries in youth competitive football. peerReviewed

The effectiveness of manual therapy in reducing the catabolic effects of performing repetitive intensive force tasks on bones has not been reported. We examined if manual therapy could reduce radial bone microstructural declines in adult female Sprague–Dawley rats performing a 12-week high-repetition and high-force task, with or without simultaneous manual therapy to forelimbs. Additional rats were provided 6 weeks of rest after task cessation, with or without manual therapy. The control rats were untreated or received manual therapy for 12 weeks. The untreated TASK rats showed increased catabolic indices in the radius (decreased trabecular bone volume and numbers, increased osteoclasts in these trabeculae, and mid-diaphyseal cortical bone thinning) and increased serum CTX-1, TNF-α, and muscle macrophages. In contrast, the TASK rats receiving manual therapy showed increased radial bone anabolism (increased trabecular bone volume and osteoblast numbers, decreased osteoclast numbers, and increased mid-diaphyseal total area and periosteal perimeter) and increased serum TNF-α and muscle macrophages. Rest, with or without manual therapy, improved the trabecular thickness and mid-diaphyseal cortical bone attributes but not the mineral density. Thus, preventive manual therapy reduced the net radial bone catabolism by increasing osteogenesis, while rest, with or without manual therapy, was less effective.

Even though practicing sports has great health benefits, it also entails a risk of developing overuse injuries, which can elicit a negative impact on physical, mental, and financial health. Being able to predict the risk of an overuse injury arising is of widespread interest because this may play a vital role in preventing its occurrence. In this paper, we present a machine learning model trained to predict the occurrence of a lower-limb overuse injury (LLOI). This model was trained and evaluated using data from a three-dimensional accelerometer on the lower back, collected during a Cooper test performed by 161 first-year undergraduate students of a movement science program. In this study, gender-specific models performed better than mixed-gender models. The estimated area under the receiving operating characteristic curve of the best-performing male- and female-specific models, trained according to the presented approach, was, respectively, 0.615 and 0.645. In addition, the best-performing models were achieved by combining statistical and sports-specific features. Overall, the results demonstrated that a machine learning injury prediction model is a promising, yet challenging approach. ispartof: SENSORS vol:22 issue:8 ispartof: location:Switzerland status: published

We implemented a machine learning approach to investigate individual indicators of training load and wellness that may predict the emergence or development of overuse injuries in professional volleyball. In this retrospective study, we collected data of 14 elite volleyball players (mean ± SD age: 27 ± 3 years, weight: 90.5 ± 6.3 kg, height: 1.97 ± 0.07 m) during 24 weeks of the 2018 international season. Physical load was tracked by manually logging the performed physical activities and by capturing the jump load using wearable devices. On a daily basis, the athletes answered questions about their wellness, and overuse complaints were monitored via the Oslo Sports Trauma Research Center (OSTRC) questionnaire. Based on training load and wellness indicators, we identified subgroups of days with increased injury risk for each volleyball player using the machine learning technique Subgroup Discovery. For most players and facets of overuse injuries (such as reduced sports participation), we have identified personalized training load and wellness variables that are significantly related to overuse issues. We demonstrate that the emergence and development of overuse injuries can be better understood using daily monitoring, taking into account interactions between training load and wellness indicators, and by applying a personalized approach.Highlights With detailed, athlete-specific monitoring of overuse complaints and training load, practical insights in the development of overuse injuries can be obtained in a player-specific fashion contributing to injury prevention in sports.A multi-dimensional and personalized approach that includes interactions between training load variables significantly increases the understanding of overuse issues on a personal basis.Jump load is an important predictor for overuse injuries in volleyball.

Achilles tendinopathy is a common overuse injury, especially among runners. It should be divided into midportion Achilles tendinopathy and insertional Achilles tendinopathy, as the treatments are different. Achilles tendinopathy is a clinical diagnosis, which includes a combination of pain, swelling and stiffness. If pain is located 2-6 cm above the insertion to the calcaneus, it is considered a midportion tendinopathy. Pain located more distally, close to the insertion, is defined as insertional tendinopathy. Both midportion and insertional Achilles tendinopathies are primarily treated with physiotherapy during three to six months. Exercise has the highest level of evidence and is more successful in midportion Achilles tendinopathy. Insertional tendinopathy more often requires surgical treatment, with removal of bony exostosis and chronically inflamed bursa.

Running overuse injuries result from an imbalance between repetitive loadings on the anatomical structures and their ability to adapt to these loadings. Unfortunately, the measure of these in-vivo loadings is not easily accessible. An optimal amount of movement variability is thought to decrease the running overuse injury risk, but the influence of movement variability on local tissue loading is still not known. A 3D dynamic finite element foot model driven by extrinsic muscle forces was developed to estimate the stress undergone by the different internal foot structures during the stance phase. The boundary conditions of different trials with similar running speed were used as input. Variability in bone stress (10%) and cartilage pressure (16%) can be expected while keeping the overall running speed constant. Bone and cartilage stress were mainly influenced by the muscle force profiles rather than by ground reaction force. These findings suggest, first, that the analysis of a single trial only is not representative of the internal tissue loadings distribution in the foot and second, that muscle forces must be considered when estimating bone and cartilage loadings at the foot level. This model could be applied to an optimal clinical management of the overuse injury.