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In 2020, the IOC released a consensus statement that provides overall guidelines for the recording and reporting of epidemiological data on injury and illness in sport. Some aspects of this statement need to be further specified on a sport-by-sport basis. To extend the IOC consensus statement on methods for recording and reporting of epidemiological data on injury and illness in sports and to meet the sport-specific requirements of all cycling disciplines regulated by the Union Cycliste Internationale (UCI). A panel of 20 experts, all with experience in cycling or cycling medicine, participated in the drafting of this cycling-specific extension of the IOC consensus statement. In preparation, panel members were sent the IOC consensus statement, the first draft of this manuscript and a list of topics to be discussed. The expert panel met in July 2020 for a 1-day video conference to discuss the manuscript and specific topics. The final manuscript was developed in an iterative process involving all panel members. This paper extends the IOC consensus statement to provide cycling-specific recommendations on health problem definitions, mode of onset, injury mechanisms and circumstances, diagnosis classifications, exposure, study population characteristics and data collection methods. Recommendations apply to all UCI cycling disciplines, for both able-bodied cyclists and para-cyclists. The recommendations presented in this consensus statement will improve the consistency and accuracy of future epidemiological studies of injury and illness in cycling.

BackgroundDespite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap.MethodsWe used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses.ResultsSixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement—PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session).ConclusionExpert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury.Trial registration numberACTRN12619000522112.

The IOC has proposed standard methods for recording and reporting of data for injury and illness in sport. The IOC consensus statement authors anticipated that sport-specific statements would provide further recommendations. This statement is the tennis-specific extension of the partner IOC statement. The International Tennis Federation Sport Science and Medicine Committee, in collaboration with selected external experts, met in June 2019 to consider athlete health monitoring issues specific to tennis. Once the IOC consensus statement was finalised, the tennis-specific consensus was drafted and agreed on by the members over three iterations. Compared with the IOC consensus statement, the tennis consensus contains tennis-specific information on injury mechanism, mode of onset, injury classification, injury duration, capturing and reporting exposure, reporting risk and study population. Our recommendations apply to able-bodied as well as wheelchair tennis players. Where applicable, specific recommendations are made for wheelchair tennis.

BACKGROUND: Rugby carries a risk for serious injuries, including acute spinal cord injuries. The lifetime health consequences of these injuries may be far-reaching. PURPOSE: In this study, we aimed to describe barriers and facilitators to healthcare and rehabilitation, in individuals with rugby-related spinal cord injuries in South Africa. METHODS: This study adopted a pragmatic qualitative approach. Stratified purposive sampling was used to select interviews from players from a variety of socio-economic status and geographical areas for inclusion in this study. The final sample consisted of thirty-one (n = 31) participants. Thematic analysis was used to analyze the data. RESULTS: Participants described long-term, accessible, affordable, quality healthcare and rehabilitation as important contributors to their quality of life. Even though public healthcare is accessible from a cost point of view, quality of care, availability of rehabilitation services and factors such as affordability and availability of adequate transport remain a barrier for lower socio-economic groups. CONCLUSION: This population was unique, as the support from a dedicated organization enabled participants to overcome some barriers, highlighting the challenges of the healthcare system in maintaining the health of people with spinal cord injuries. Every effort should be made to create equitable access to healthcare and rehabilitation for persons with spinal cord injuries in South Africa.

Sport is historically designated by the binary categorization of male and female that conflicts with modern society. Sport's governing bodies should consider reviewing rules determining the eligibility of athletes in the female category as there may be lasting advantages of previously high testosterone concentrations for transwomen athletes and currently high testosterone concentrations in differences in sex development (DSD) athletes. The use of serum testosterone concentrations to regulate the inclusion of such athletes into the elite female category is currently the objective biomarker that is supported by most available scientific literature, but it has limitations due to the lack of sports performance data before, during or after testosterone suppression. Innovative research studies are needed to identify other biomarkers of testosterone sensitivity/responsiveness, including molecular tools to determine the functional status of androgen receptors. The scientific community also needs to conduct longitudinal studies with specific control groups to generate the biological and sports performance data for individual sports to inform the fair inclusion or exclusion of these athletes. Eligibility of each athlete to a sport-specific policy needs to be based on peer-reviewed scientific evidence made available to policymakers from all scientific communities. However, even the most evidence-based regulations are unlikely to eliminate all differences in performance between cisgender women with and without DSD and transwomen athletes. Any remaining advantage held by transwomen or DSD women could be considered as part of the athlete's unique makeup.

Para football is currently played in impairment-specific formats by thousands of people worldwide. To date, there have been no prospective longitudinal injury surveillance studies. This study aimed to implement a prospective injury surveillance study within elite English Para football and analyse the injury risk within the England Blind and Cerebral Palsy (CP) squads. Match and training injury data based on a 'time loss' definition were collected and analysed for each squad including incidence per 1,000 player hours, severity, injury location and associated event of injury. Injury incidence were lower in training than matches (CP 67.6/1000 player match hours (CI 33.8-135.2) and 5.7/1000 training hours (CI 3.8-8.7) and Blind 44.0/1000 player match hours (CI 26.1-74.3) and 5.5/1000 training hours (CI 3.5-8.6). Training injuries were more severe than match injuries across both squads (CP median 12 days lost in matches and 16 training and Blind median days 5 matches and 12 training). 73% Blind and 74% CP footballer injuries were to the lower limb and 17% head and neck equally across both Para football squads. 'Muscle and tendon injuries' (51%) represented the greatest proportion of injuries for CP footballers, and 'joint (non-bone)/ligament injuries' (43%) for Blind footballers. Collaboration and implementation of higher quality surveillance methodology and data collection in Para sport with greater athlete numbers are needed to inform injury prevention strategies.

Resume Introduction Mieux comprendre les consequences psychologiques d’une blessure et l’influence de celle-ci sur les modifications de comportement et la realisation d’un programme de prevention semble pertinent pour la prise en charge therapeutique et dans une optique de prevention. Ainsi, l’objectif de cette presente etude a donc ete (1) d’analyser la perception des blessures par les athletes, et (2) d’analyser l’influence de celles-ci sur la realisation de mesures de prevention. Methodes Nous avons conduit une etude observationnelle quantitative retrospective nationale de recueil du ressenti des athletes de competition licencies a la Federation francaise d’athletisme vis-a-vis de leurs antecedents de blessures, leur perception de la blessure et les programmes de prevention des blessures, par un questionnaire informatique envoye aux athletes au printemps 2020. Resultats Au total, 7712 reponses d’athletes ont ete incluses dans cette analyse, incluant 37 % de femmes et 63 % d’hommes, âges de 37,9 ± 14,8 ans (de 18 a 87 ans), allant de niveau international a departemental, couvrant toutes les disciplines de l’athletisme. Soixante-dix pour cent des athletes n’avaient jamais realise de programme de prevention des blessures durant leur carriere, alors que 30 % estimaient en avoir suivi un de maniere partielle ou totale. Quatre-vingt dix pour cent des athletes avaient eu au moins une blessure depuis le debut de leur pratique. Les sportifs rapportaient qu’une blessure engendrait une tristesse, une frustration, un degout et une preoccupation de se refaire mal au meme endroit. Ils etaient conscients qu’une mauvaise prise en charge pouvait entrainer une recidive ou une nouvelle blessure. Les athletes avec antecedent de blessure realisaient significativement plus un programme de prevention des lesions que ceux ne s’etant jamais blesses. Ceux s’etant deja blesses croyaient en l’efficacite des programmes de prevention, davantage que ceux sans antecedent de blessure. En revanche, il n’y avait pas de difference de perception de l’interet de mesures preventives telles que l’hygiene de vie, l’ecoute de son corps, de ses douleurs et de sa fatigue entre les athletes avec et sans antecedent de blessures. Conclusion Une blessure peut entrainer des consequences psychologiques non negligeables pour l’athlete. Ses repercussions sont importantes a prendre en compte dans la prise en charge globale des lesions.

While mental fatigue (MF) increases the probability of losing balance, the underlying neural mechanisms remain to be studied. Balance is commonly represented by technical outcomes difficult to translate to clinical practice. Therefore, the aims of this study were to assess how MF affects clinician-friendly balance tests and if MF interacts with brain activity during these tests. Twelve healthy recreational athletes (age = 23 ± 2 years) participated. MF was induced by a 90-minute Stroop test, while the control task encompassed a time-matched documentary. Two clinician-friendly balance tests (ie, Y-balance test [YBT], reactive balance test [RBT]) were performed before and after the 90-minute tasks. Brain activity was measured using electroencephalography during YBT and RBT. MF significantly decreased RBT accuracy compared to pre-MF and compared to post-control. MF did not affect YBT performance and visuomotor reaction time on the RBT. During the YBT, MF significantly induced higher prefrontal cortex theta activity. Brain activity during the RBT remained unchanged post-MF. MF impairs RBT performance, but no underlying brain activity changes were observed. In contrast, YBT performance did not change due to MF, but alterations in brain activity during YBT performance were in line with previous MF research.

ObjectivesWe aim to describe time trends of severe sports-related emergency department (ED) visits in the Netherlands, from 2009 to 2018.MethodsData were extracted from the Dutch Injury Surveillance System by age, gender, sports activity and injury diagnosis, from 2009 to 2018. Absolute numbers and time trends of severe sports-related ED visits were calculated.ResultsBetween 2009 and 2018, the overall numbers of severe sports-related ED visits in the Netherlands have significantly decreased by 14% (95% CI −19% to −9%). This trend was seen among men (−12%; 95% CI −18% to −6%), women (−19%; 95% CI −26% to −11%) and individuals aged 18–34 years (−19%; 95% CI −28% to −10%). The number of ED visits has significantly decreased over time in soccer (−15%; 95% CI −24% to −6%), ice-skating (−80%; 95% CI −85% to −73%) and in inline/roller skating (−38%; 95% CI −55% to −15%). This was not the case in road cycle racing (+135%; 95% CI +85% to +198%) and mountain bike racing (+80%; 95% CI +32% to+146%). In terms of sports injury diagnoses, the number of fractured wrists (−15%; 95% CI −24% to −5%), fractured hands (−37%; 95% CI −49% to −21%), knee distortions (−66%; 95% CI −74% to −55%), and fractured lower legs (−38%; 95% CI −55% to −14%) significantly decreased over time.ConclusionOur study shows a promising reduction in the number of severe sports-related ED visits across most age groups and sports activities. As the number of ED visits increased in road cycle and mountain bike racing, it is important to find out what caused these increases. Furthermore, it is essential to determine trends in exposure hours and to evaluate and implement injury prevention programmes specific for these sports activities.

The understanding that sports injury is the result of the interaction among many factors and that specific profiles could increase the risk of the occurrence of a given injury was a significant step in establishing programs for injury prevention. However, injury forecasting is far from being attained. To be able to estimate future states of a complex system (forecasting), it is necessary to understand its nature and comply with the methods usually used to analyze such a system. In this sense, sports injury forecasting must implement the concepts and tools used to study the behavior of self-organizing systems, since it is by self-organizing that systems (i.e., athletes) evolve and adapt (or not) to a constantly changing environment. Instead of concentrating on the identification of factors related to the injury occurrence (i.e., risk factors), a complex systems approach looks for the high-order variables (order parameters) that describe the macroscopic dynamic behavior of the athlete. The time evolution of this order parameter informs on the state of the athlete and may warn about upcoming events, such as injury. In this article, we describe the fundamental concepts related to complexity based on physical principles of self-organization and the consequence of accepting sports injury as a complex phenomenon. In the end, we will present the four steps necessary to formulate a synergetics approach based on self-organization and phase transition to sports injuries. Future studies based on this experimental paradigm may help sports professionals to forecast sports injuries occurrence.

Qualitative research is increasingly recognised as relevant and useful to uncovering and understanding\ud new and differentiated insights that move both research and practice forward. The field of athlete health\ud protection – that is, injury and illness prevention and management – is reliant on high-quality knowledge\ud of athlete and other key stakeholders’ perspectives, understanding of the complex relations within the\ud athlete health protection system, the socio-ecological context in which athletes are provided with\ud prevention and care, and how best to influence those involved in athlete health protection for better and\ud more effective outcomes. Yet, deep interrogation of these aspects is often overlooked in favour of\ud quantitatively-driven research questions. As athlete health protection research and practice matures, we\ud argue that there is a need for research that complements traditional approaches, connects researchers \ud 3\ud from different disciplines - but which also distinctly holds space for the unique insights that qualitative\ud approaches can add. The purpose of this editorial is to highlight the importance, value, and relevance of\ud qualitative research to the field of athlete health protection – in other words, why qualitative research\ud matters.

ObjectivesTo systematically develop an injury prevention programme in judo and test its feasibility: Injury Prevention and Performance Optimization Netherlands (IPPON) intervention.MethodsWe used the five-step Knowledge Transfer Scheme (KTS) guidelines. In the first two steps, we described the injury problem in judo and showed possibilities to reduce the injury rates. In the third step, the Knowledge Transfer Group (KTG) translated this information into actions in judo practice. Expert meetings and practical sessions were held. In the fourth step, we developed the injury prevention programme and evaluated its feasibility in judo practice in a pilot study. As a final step, we will evaluate the injury prevention programme on its effectiveness to reduce injuries.ResultsIn the first two steps, information collected indicated the need for reducing judo injuries due to high incidence rates. Injury prevention programmes have shown to be effective in reducing injuries in other sports. For judo, no injury prevention programme has yet been systematically developed. In the third step, the KTG reached consensus about the content: a trainer-based warm-up programme with dynamic exercises focusing on the shoulder, knee and ankle. In the fourth step, the intervention was developed. All exercises were approved in the pilot study. Based on the pilot study’s results, the IPPON intervention was extended and has become suitable for the final step.ConclusionWe developed the IPPON intervention using the systematic guidance of the KTS. This trainer-based programme focuses on the prevention of shoulder, knee and ankle injuries in judo and consists of 36 exercises classified in three categories: (1) flexibility and agility, (2) balance and coordination and (3) strength and stability. The effectiveness and feasibility of the intervention on injury reduction among judo athletes will be conducted in a randomised controlled trial.

Purpose Mental fatigue impairs psychomotor skill performance by affecting visuomotor reaction time, accuracy, and decision-making. Recently, neurocognitive functional performance tests (FPT) that integrate these outcomes have been developed. The aim of this study was to assess the effect of mental fatigue on traditional and neurocognitive FPT in healthy adults. Methods Fourteen volunteers (four women; mean ± SD age, 22 ± 1 yr; height, 176.9 ± 8.4 cm; weight, 69.7 ± 10.4 kg) participated in a randomized counterbalanced crossover design. A 100% incongruent Stroop color word test of 90 min was used to induce mental fatigue and the control task encompassed watching a 90-min documentary. Traditional FPT comprised a single-leg hop for distance, countermovement jump, and Y-balance test, whereas the neurocognitive FPT encompassed the reactive balance test (RBT). All FPTs were evaluated pre-post the 90-min task. Mental fatigue was assessed using the Stroop task, visual analog scale for mental fatigue, and the Eriksen-Flanker task. Results Mental fatigue was successfully induced, as shown by a significant increase in visual analog scale for mental fatigue (P < 0.001), with no decrease in performance on the Stroop and Eriksen-Flanker task. No interaction effect of mental fatigue was found for the Y-balance test, single-leg hop, and countermovement jump. For the RBT accuracy, a significant interaction effect of mental fatigue and time was observed (P = 0.024), with participants performing significantly worse when mentally fatigued. No interaction effect or main effect of condition and time was observed when considering the effect of mental fatigue on visuomotor reaction time in the RBT. Conclusions Mental fatigue negatively affects a neurocognitive FPT, indicated by a decreased accuracy in response to visual stimuli in the RBT. Traditional FPT remained unaffected by mental fatigue.

Confinement measures during the COVID-19 pandemic have caused substantial reductions in global physical activity (PA) levels. In view of the manifold health benefits of PA, the development of interventions counteracting this trend is paramount. Our survey with 15,261 participants (38 ± 15 years, 58.5% females) examined preferences towards digital home exercise programs in 14 countries affected by COVID-19. More than two-thirds of the sample (68.4%, n = 10,433) indicated being interested in home exercise, and most participants were willing to work out at least three times per week (89.3%, n = 9328). Binary logistic regression revealed that female sex, working part-time, younger age, and being registered in a gym were associated with willingness to exercise. Flexibility (71.1%, n = 7377), resistance (68.6%, n = 7116), and endurance training (62.4%, n = 6478) were the most preferred types of exercise. Our results may guide health providers in developing individually tailored PA interventions during the current and future pandemics.

The understanding that sports injury is the result of the interaction among many factors and that specific profiles could increase the risk of the occurrence of a given injury was a significant step in establishing programs for injury prevention. However, injury forecasting is far from being attained. To be able to estimate future states of a complex system (forecasting), it is necessary to understand its nature and comply with the methods usually used to analyze such a system. In this sense, sports injury forecasting must implement the concepts and tools used to study the behavior of self-organizing systems, since it is by self-organizing that systems (i.e., athletes) evolve and adapt (or not) to a constantly changing environment. Instead of concentrating on the identification of factors related to the injury occurrence (i.e., risk factors), a complex systems approach looks for the high-order variables (order parameters) that describe the macroscopic dynamic behavior of the athlete. The time evolution of this order parameter informs on the state of the athlete and may warn about upcoming events, such as injury. In this article, we describe the fundamental concepts related to complexity based on physical principles of self-organization and the consequence of accepting sports injury as a complex phenomenon. In the end, we will present the four steps necessary to formulate a synergetics approach based on self-organization and phase transition to sports injuries. Future studies based on this experimental paradigm may help sports professionals to forecast sports injuries occurrence.

PURPOSE: To assess injury risk in elite-level youth football (soccer) players based on anthropometric, motor coordination and physical performance measures with a machine learning model. METHODS: A total of 734 players in the U10 to U15 age categories (mean age, 11.7 ± 1.7 yr) from seven Belgian youth academies were prospectively followed during one season. Football exposure and occurring injuries were monitored continuously by the academies' coaching and medical staff, respectively. Preseason anthropometric measurements (height, weight, and sitting height) were taken and test batteries to assess motor coordination and physical fitness (strength, flexibility, speed, agility, and endurance) were performed. Extreme gradient boosting algorithms (XGBoost) were used to predict injury based on the preseason test results. Subsequently, the same approach was used to classify injuries as either overuse or acute. RESULTS: During the season, half of the players (n = 368) sustained at least one injury. Of the first occurring injuries, 173 were identified as overuse and 195 as acute injuries. The machine learning algorithm was able to identify the injured players in the hold-out test sample with 85% precision, 85% recall (sensitivity) and 85% accuracy (f1 score). Furthermore, injuries could be classified as overuse or acute with 78% precision, 78% recall, and 78% accuracy. CONCLUSIONS: Our machine learning algorithm was able to predict injury and to distinguish overuse from acute injuries with reasonably high accuracy based on preseason measures. Hence, it is a promising approach to assess injury risk among elite-level youth football players. This new knowledge could be applied in the development and improvement of injury risk management strategies to identify youth players with the highest injury risk.

Background/aimBokSmart is a nationwide injury prevention programme that aims to reduce players’ injury risk mainly through education of coaches and referees in mandatory biennial education courses. These courses are held throughout each rugby season. The objective of this cross-sectional study was to assess whether these courses were associated with improvements in attendees’ behavioural determinants.MethodsCoaches and referees completed a questionnaire based on the theory of planned behaviour, immediately before and after their 2012 BokSmart courses. Twelve behavioural determinants were assessed on a five-point Likert scale and open-ended questions. A meaningful change was defined as an improvement of ≥1 unit score supported by null hypothesis testing. Odds of improving by ≥1 unit score (compared with not improving) were assessed in attendees using multivariate logistic regression.ResultsIn total, 390 coaches and 74 referees completed both questionnaires. ‘Before’ scores were high for most outcomes, except for knowledge. Although there was a significant (pConclusionAlthough the only meaningful improvement in 2012 BokSmart course attendees was in one outcome, it should be noted that before-course scores were already high, reducing the questionnaire’s ability to assess change because of a ceiling effect. Nonetheless, the knowledge acquisition of these courses was low and not related to previous course attendance or more years of rugby experience. These results justify the biennial nature of this safety course but also indicate that knowledge acquisition is generally low.

Objective To identify the causal relation between growth velocity and injury in elite-level youth football players, and to assess the mediating effects of motor performance in this causal pathway. Design Prospective cohort study. Methods We measured the body height of 378 male elite-level football players of the U13 to U15 age categories three to four months before and at the start of the competitive season. At the start of the season, players also performed a motor performance test battery, including motor coordination (Korperkoordinationstest fur Kinder), muscular performance (standing broad jump, counter movement jump), flexibility (sit and reach), and endurance measures (YoYo intermittent recovery test). Injuries were continuously registered by the academies’ medical staff during the first two months of the season. Based on the causal directed acyclic graph (DAG) that identified our assumptions about causal relations between growth velocity (standardized to cm/y), injuries, and motor performance, the causal effect of growth velocity on injury was obtained by conditioning on maturity offset. We determined the natural indirect effects of growth velocity on injury mediated through motor performance. Results In total, 105 players sustained an injury. Odds ratios (OR) showed a 15% increase in injury risk per centimetre/year of growth velocity (1.15, 95%CI: 1.05–1.26). There was no causal effect of growth on injury through the motor performance mediated pathways (all ORs were close to 1.0 with narrow 95%CIs). Conclusions Growth velocity is causally related to injury risk in elite-level youth football players, but motor performance does not mediate this relation.

SYNOPSIS: High-quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best-practice methods-methods matter (greatly!). The first METHODS MATTER meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting. Meeting participants agreed that the definition of sport injury depends on the research question and context. It was considered essential to be explicit about the goal of the research effort and to use frameworks to illustrate the assumptions that underpin measurement and the analytical strategy. Complex systems were discussed to illustrate how potential risk factors can interact in a nonlinear way. This approach is often a useful alternative to identifying single risk factors. Investigating changes in exposure status over time is important when analyzing sport injury etiology, and analyzing recurrent injury, subsequent injury, or injury exacerbation remains challenging. The choice of statistical model should consider the research question, injury measure (eg, prevalence, incidence), type and granularity of injury data (categorical or continuous), and study design. Multidisciplinary collaboration will be a cornerstone for future high-quality sport injury research. Working outside professional silos in a diverse, multidisciplinary team benefits the research process, from the formulation of research questions and designs to the statistical analyses and dissemination of study results in implementation contexts. This article has been copublished in the British Journal of Sports Medicine and the Journal of Orthopaedic & Sports Physical Therapy.

BackgroundAdverse long-term effects of playing football due to repetitive head impact exposure on neurocognition and mental health are controversial. To date, no studies have evaluated such effects in women.AimsTo (1) compare neurocognitive performance, cognitive symptoms and mental health in retired elite female football players (FB) with retired elite female non-contact sport athletes (CON), and to (2) assess whether findings are related to history of concussion and/or heading exposure in FB.MethodsNeurocognitive performance, mental health and cognitive symptoms were assessed using computerised tests (CNS-vital signs), paper pen tests (Category fluency, Trail-Making Test, Digit Span, Paced Auditory Serial Addition Test), questionnaires (Hospital Anxiety and Depression Scale, SF-36v2 Health Survey) and a symptom checklist. Heading exposure and concussion history were self-reported in an online survey and in a clinical interview, respectively. Linear regression was used to analyse the effect of football, concussion and heading exposure on outcomes adjusted for confounders.ResultsFB (n=66) performed similar to CON (n=45) on neurocognitive tests, except for significantly lower scores on verbal memory (mean difference (MD)=−7.038, 95% CI −12.98 to –0.08, p=0.038) and verbal fluency tests (MD=−7.534, 95% CI –13.75 to –0.46, p=0.016). Among FB weaker verbal fluency performance was significantly associated with ≥2 concussions (MD=−10.36, 95% CI –18.48 to –2.83, p=0.017), and weaker verbal memory performance with frequent heading (MD=−9.166, 95% CI –17.59 to –0.123, p=0.041). The depression score differed significantly between study populations, and was significantly associated with frequent heading but not with history of concussion in FB.ConclusionFurther studies should investigate the clinical relevance of our findings and whether the observed associations point to a causal link between repetitive head impacts and verbal memory/fluency or mental health.

In the past two decades, there has been a revolution in literature relating to the epidemiology, aetiology, early recognition, prevention, diagnosis and treatment of sports-related concussion (SRC). This research has resulted in the publication of five international concussion in sport consensus statements.1 Are those recommendations impacting on pitch-side rulings and contributing to the real-life management of SRC? We ask: ‘Is evidence-based SRC information reaching those it concerns the most, i.e. the athletes?’2 Within alpine ski racing, SRC is the most frequent head injury.3 The International Ski Federation (FIS) has established SRC return-to-play guidelines,4 but athletes aim to dodge the guidelines by under-reporting their symptoms (eg, persistent headache, blurred vision),5 possibly resulting in premature return to sport. Besides this, athlete adherence to such guidelines may be impeded by insufficient understanding of the potential long-term consequences of SRC (eg, increased risk of reinjury, prolonged recovery from subsequent concussions, mild cognitive impairment or depression). To better understand alpine ski racing athletes’ perceptions, beliefs and experiences of concussion, we conducted a qualitative interview study with 11 participants. These 11 participants were representatives from a world-leading ski association comprising 88 athletes. The underlying …

Objectives To provide reference values for handgrip strength, shoulder and ankle range of motion (ROM) and upper-limb and lower limb stability for youth judokas of both sexes and investigate the effects of sex and side dominance. Design Cross-sectional. Methods A total of 137 youth judokas from under-18 (n = 60) and under-21 (n = 77) categories of both sexes were assessed. Handgrip strength was assessed using a Jamar dynamometer, ankle ROM was measured by lunge test, shoulder ROM was assessed by an inclinometer and upper-limb and lower limb stability were assessed by the Closed Kinetic Chain Upper Extremity Stability Test and by the Modified Star Excursion Balance Test (mSEBT). Results In both categories, males had greater handgrip strength. In the under-18 category, the dominant side had greater handgrip strength, the non-dominant side of females had smaller shoulder external rotation ROM than the dominant side and also than both sides of males, and females had greater shoulder IR ROM. In the under-21 category, the dominant side of females had greater ankle dorsiflexion ROM than the dominant side of males, the dominant sides and females had greater shoulder ER ROM, and males had better performance in the mSEBT. Conclusions This study provided reference values for handgrip strength, shoulder and ankle ROM, upper and lower limb stability for youth judokas, which can be used to guide assessment during preseason. Sex influenced on shoulder ER and IR ROM, handgrip strength and lower limb stability. In addition, side dominance influenced on shoulder ER ROM and on handgrip strength.

The objective was to evaluate the effectiveness of an exercise-based warm-up programme ("VolleyVeilig") on the one-season occurrence of musculoskeletal injuries among recreational adult volleyball players. A prospective randomised controlled trial was conducted over the 2017-2018 volleyball season. Recreational adult volleyball players were allocated either to an intervention or control group. The Dutch version of the Oslo Sports Trauma Research Centre questionnaire was used to register and monitor acute and overuse injuries. A total of 672 volleyball players were enrolled: 348 in the intervention group (mean age: 30) and 324 in the control group (mean age: 27). The incidence rate of acute injury was 21% lower in the intervention group, namely 8.9 versus 11.3 per 1,000 h in the control group (Cox mixed effects crude model: hazard ratio = 0.82 [95%CI: 0.69-0.98]; Cox mixed effects adjusted model: 0.85 [95%CI: 0.71-1.02]). No significant difference in mean prevalence of overuse injury was found between the intervention (4.8%) and control (4.2%) groups. The severity of injuries was not significantly different between groups, while injury burden was slightly lower in the intervention group. The exercise-based warm-up programme led to a trend in less acute injuries among recreational adult volleyball players.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses—The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Where not too long ago we serviced athletes; nowadays, we have the responsibility to lead a multidisciplinary team that is mandated to protect the athletes’ health, ensure competition availability and ability to compete at peak performance. In essence, our roles have shifted from being a service provider to a health and performance manager who steers a multidisciplinary team of specialists. In this viewpoint, we question whether we really have the skills to lead a ‘team’ like this effectively. We provide a potential definition of leadership and discuss the importance of leadership for health and performance teams with recent literature. Finally, we share our baseline ‘leadership’ pearls that allow you to elevate collaboration through leadership.

ObjectiveThe aim of this study was to investigate whether dynamic balance, measured with the anterior component of the Star Excursion Balance Test (SEBT-ANT), is a risk factor for ankle injuries in physical education teacher education (PETE) students.Design and settingA prospective monocentre study in first-year PETE students.ParticipantsA total of 196 subjects, of which 137 men (70%) and 59 women (30%).Outcome measuresThis study consisted of measures of the SEBT-ANT at baseline (September 2015) and an injury registration procedure during a follow-up period (September 2015–June 2016). The association between the SEBT-ANT score and subsequent ankle injury was analysed with generalised estimating equations analysis at the leg level.ResultsMen and women had an average SEBT-ANT score of, respectively, 65.1% and 67.7% of leg length. In 20 (15%) subjects, the first injured body site involved the ankle. Across all participants, a below average SEBT-ANT score was not associated with increased ankle injury odds (OR OR=2.43, 95% CI: 0.94 to 6.29, p=0.07). In men, a below average SEBT-ANT score indicated sevenfold increased odds for ankle injury (OR=7.06, 95% CI: 1.43 to 34.92, p=0.02). In women, this relationship was not significant (OR=0.72, 95% CI: 0.19 to 2.71, p=0.62).ConclusionsBelow average normalised SEBT-ANT scores were associated with sevenfold likelihood for ankle injuries in men. In contrast, no relationship was found for the SEBT-ANT score and ankle injuries in woman. These results may provide directions for the implementation of screening tools, as part of an injury prevention programme, to identify male PETE students with an increased likelihood for ankle injuries.

Background: Many governments have restricted public life during the COVID-19 pandemic. Related measures, among others, include closures of sports facilities and gyms. As regular movement is essential for immune function, bodily health and mental wellbeing, this study examined the effect of pandemic-related confinements on global physical activity (PA) levels. Methods: A multinational survey was performed in 14 countries. To quantify self-reported PA, the times spent in moderate and vigorous physical activities (MVPA) as well as in vigorous physical activities only (VPA) were assessed by means of the Nordic Physical Activity Questionnaire (short-form). Data were obtained for leisure and occupational PA pre and during restrictions of public life. Compliance with PA guidelines was calculated based on the recommendations of the World Health Organization (WHO). To estimate the risk of non-response bias, wave analyses were performed. Findings: A population of n=13,503 respondents (39±15 years, 59% females) were surveyed without indication of non-response bias. Compared to pre-restrictions, overall self-reported PA decreased by 41% (MVPA) and 42·2 % (VPA) during restrictions. Reductions were higher for occupational vs. leisure time, young and old vs. middle-aged persons, previously more active vs. less active individuals, but similar between men and women. Compared to pre-pandemic, compliance with WHO guidelines decreased from 81·0% to 62·5%. Interpretation: Results suggest PA levels have substantially decreased globally during the COVID-19 pandemic. Key stakeholders should consider strategies to mitigate loss in PA in order to preserve health during the pandemic and in future crises. Funding Statement: There was no external funding. Declaration of Interests: The authors declare there is no conflict of interest. Ethics Approval Statement: Ethics approval was obtained in each involved country (Australia, Austria, Argentina, Brazil, Chile, France, Germany, Italy, Netherlands, South Africa, Singapore, Switzerland, Spain, USA). All participants provided digital informed consent.

Background The prescription of physical activity (PA) in clinical care has been advocated worldwide. This “exercise is medicine” (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. Objective This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. Methods PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. Results This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. Conclusions The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients’ health, while minimizing the burden on clinicians.

Lateral ankle sprain injury is the most common musculoskeletal injury incurred by individuals who participate in sports and recreational physical activities. Following initial injury, a high proportion of individuals develop long-term injury-associated symptoms and chronic ankle instability. The development of chronic ankle instability is consequent on the interaction of mechanical and sensorimotor insufficiencies/impairments that manifest following acute lateral ankle sprain injury. To reduce the propensity for developing chronic ankle instability, clinical assessments should evaluate whether patients in the acute phase following lateral ankle sprain injury exhibit any mechanical and/or sensorimotor impairments. This modified Delphi study was undertaken under the auspices of the executive committee of the International Ankle Consortium. The primary aim was to develop recommendations, based on expert (n=14) consensus, for structured clinical assessment of acute lateral ankle sprain injuries. After two modified Delphi rounds, consensus was achieved on the clinical assessment of acute lateral ankle sprain injuries. Consensus was reached on a minimum standard clinical diagnostic assessment. Key components of this clinical diagnostic assessment include: establishing the mechanism of injury, as well as the assessment of ankle joint bones and ligaments. Through consensus, the expert panel also developed the International Ankle Consortium Rehabilitation-Oriented ASsessmenT (ROAST). The International Ankle Consortium ROAST will help clinicians identify mechanical and/or sensorimotor impairments that are associated with chronic ankle instability. This consensus statement from the International Ankle Consortium aims to be a key resource for clinicians who regularly assess individuals with acute lateral ankle sprain injuries.

ObjectiveHelmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS.MethodsThe intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season.ResultsOverall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (β=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders.ConclusionsExposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.

OBJECTIVE: The objective of this study was to assess the efficacy of a newly developed warm-up programme ('11+ Kids') regarding its potential to reduce injuries in children's football.METHODS: Children's football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by '11+ Kids', while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis.RESULTS: In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32-0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10-0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24-0.84) were also reduced. Injury incidence decreased with increasing compliance.CONCLUSION: '11+ Kids' is efficacious in reducing injuries in children's football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02222025.

ObjectiveThe aim of this study was to determine whether there is a difference in the prevalence of tennis injuries between the four most common court surfaces in the Netherlands, including hard court, clay, sand-fill artificial grass and red-sand-fill artificial grass. Natural grass was not included in this study.MethodsThis was a repeated cross-sectional study over 6 months, involving members of the Royal Netherlands Lawn Tennis Association (KNLTB). A monthly questionnaire was sent to a random sample of 20 000 KNLTB members, stratified by their club’s playing surface. The questionnaire included questions on court surface, tennis exposure and physical complaints, using the Oslo Sports Trauma Research Centre questionnaire on health problems.ResultsA total of 3656 (18%) of the 20 000 invited members completed at least one of the monthly questionnaires [mean age 49 years (15)]. A total of 4047 injuries were reported by 1957 respondents. Of these injuries, 3246 (80%) were overuse and 801 (20%) were acute. There were no statistically significant differences in injury prevalence between groups who played primarily on any one of the four court surfaces. However, players who played on multiple surfaces had a higher injury prevalence, particularly of overuse injuries, than those who primarily played on one court surface. Compared with the other court surfaces, there was a higher prevalence of lower limb overuse injuries when playing on hard court.ConclusionThere is no significant difference in the overall prevalence of injury on clay, hard court, sand-fill artificial grass and red-sand-fill artificial grass.

The primary aims were to determine the 12-month incidence (and comorbidity) of symptoms of common mental disorders (CMD) among male professional rugby players and to explore their association with potential stressors. A secondary aim was to explore the view of male professional rugby players about the consequences of symptoms of CMD and related medical support/needs. An observational prospective cohort study with three measurements over a 12-month period was conducted among male professional rugby players from several countries. Symptoms of CMD (distress, anxiety/depression, sleep disturbance, eating disorders and adverse alcohol use) and stressors (adverse life events, rugby career dissatisfaction) were assessed through validated questionnaires. A total of 595 players (mean age of 26 years; mean career duration of 6 years) were enrolled, of which 333 completed the follow-up period. The incidence of symptoms of CMD were: 11% for distress, 28% for anxiety/depression, 12% for sleep disturbance, 11% for eating disorders and 22% for adverse alcohol use (13% for two simultaneous symptoms of CMD). Professional rugby players reporting recent adverse life events or career dissatisfaction were more likely to report symptoms of CMD but statistically significant associations were not found. Around 95% of the participants stated that symptoms of CMD can negatively influence rugby performances, while 46% mentioned that specific support measures for players were not available in professional rugby. Supportive and preventive measures directed towards symptoms of CMD should be developed to improve not only awareness and psychological resilience of rugby players but also their rugby performance and quality-of-life.

Purpose: To evaluate the effectiveness of an individually tailored intervention for improvement in lifestyle behavior, health indicators, and prevention and reduction of overweight among construction workers. Design: Randomized controlled trial. Setting: Various blue-collar departments of a large construction company in the Netherlands. Participants: Blue-collar workers randomized to an intervention (n = 162) or a control group (n = 152). Intervention: The intervention group received individual coaching sessions, tailored information, and materials to improve lifestyle behavior during a 6-month period, and the control group received usual care. Measures: Body weight, body mass index (BMI), waist circumference, physical activity (PA) levels, dietary behavior, blood pressure, and blood cholesterol were assessed. Analysis: Effectiveness of the intervention on outcome measures at 6- and 12-month follow-up was assessed by using linear and logistic regression models adjusting for baseline levels. Results: After 6 months, a statistically significant intervention effect was found on body weight ( B = −1.06, P = .010), BMI ( B = −0.32, P = .010), and waist circumference ( B = −1.38, P = .032). At 6 months, the percentage of those meeting public health guidelines for PA increased significantly in the intervention group compared to the control group ( B = 2.06, P = .032), and for sugar-sweetened beverages, an intervention effect was found at 6 months as well ( B = −2.82, P = .003). At 12 months, for weight-related outcomes, these differences were slightly smaller and no longer statistically significant. The intervention was not effective on the total amount of moderate to vigorous PA and other dietary and health outcomes. Conclusion: Intervention participants showed positive changes in vigorous PA and intake of sugar-sweetened beverages compared to controls, as well as effects on weight-related outcomes at 6 months. Long-term effects were still promising but not statistically significant.

Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available "Strengthen your ankle" App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up.

Summary Findings from efficacy studies have shown decreased in ACL injury rates in (predominantly female) athletes participating in prevention programs. Given the inherent higher ACL injury risk for females, the majority of intervention studies, have focused on female athletes. Subsequently, the content of exercises in ACL prevention programs is directed to target the modifiable ACL injury risk factors for female athletes. The literature is generally scarce regarding the efficacy of prevention programs to reduce ACL injuries in male athletes. In general, reduction of ACL injury rates seem to be limited to (young) female athletes and male athletes playing at low level of sports. Typically, ACL injury prevention programs entail a combination of plyometrics, strength training, agility and balance exercises. A problem is that improvements of movement patterns are not sustained over time. The reason may be related to the type of instructions given during training. Encouraging athletes to consciously control knee movements during exercises may not be optimal for the acquisition of complex motor skills. In the motor learning domain, these type of instructions are defined as an internal attentional focus. An internal focus, on one's own movements results in a more conscious type of control that may hamper motor learning. It has been established in numerous studies that an external focus of attention facilitates motor learning more effectively due to the utilization of automatic motor control. Subsequently, the athlete has more recourses available to anticipate on situations on the field and take appropriate feed forward directed actions. The purpose of this manuscript was to present methods to optimize motor skill acquisition of athletes and elaborate on athletes' behavior.

BackgroundTrail running is popular worldwide, but there is no preventive intervention for running-related injury (RRI).AimTo evaluate the effectiveness of adding online tailored advice (TrailS6) to general advice on (1) the prevention of RRIs and (2) the determinants and actual preventive behaviour in Dutch trail runners.MethodsTwo-arm randomised controlled trial over 6 months. 232 trail runners were randomly assigned to an intervention or control group. All participants received online general advice on RRI prevention 1 week after baseline. Every 2 weeks, participants in the intervention group received specific advice tailored to their RRI status. The control group received no further intervention. Bayesian mixed models were used to analyse the data.ResultsTrail runners in the intervention group sustained 13% fewer RRIs compared with those in the control group after 6 months of follow-up (absolute risk difference −13.1%, 95% Bayesian highest posterior credible interval (95% BCI) −23.3 to −3.1). A preventive benefit was observed in one out of eight trail runners who had received the online tailored advice for 6 months (number needed to treat 8, 95% BCI 3 to 22). No significant between-group difference was observed on the determinants and actual preventive behaviours.ConclusionsOnline tailored advice prevented RRIs among Dutch trail runners. Therefore, online tailored advice may be used as a preventive component in multicomponent RRI prevention programmes. No effect was observed on determinants and actual preventive behaviours.Trial registration numberThe Netherlands National Trial Register (NTR5431).

Enkelbandletsel is het meest voorkomende letsel aan de onderste extremiteit bij sporters. Huisartsen kunnen een belangrijke rol spelen bij de secundaire preventie van dergelijke letsels. Taping, bracing en neuromusculaire training blijken effectieve maatregelen.

The aim of the study was to determine the prevalence and comorbidity of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, eating disorders, adverse alcohol use) among current and former Dutch elite athletes, and to explore the inference between potential risk indicators (severe injury, surgery, life events, sport career dissatisfaction, social support) and the outcomes measures under investigation. Cross-sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study among 203 current and 282 former elite Dutch athletes (response rate: 28% among current athletes and 95% among former athletes). Based on validated scales, an electronic questionnaire was set up and distributed. Prevalence (4-week) ranged from 6% for adverse alcohol use to 45% for anxiety/depression among current elite athletes, and from 18% for distress to 29% for anxiety/depression among former elite athletes. A higher number of past severe injuries, higher number of past surgeries, higher number of recent life events, higher level of career dissatisfaction and lower level of social support were related to the occurrence of symptoms of common mental disorders among both current and former elite athletes. On average, the 4-week prevalence of common mental disorders as shown in our study among current and former Dutch elite athletes were similar to the ones found among athletes from other sports disciplines and does compare with the lifetime prevalence estimates in the general population of the Netherlands.

Researches have been performed to investigate the effects of phototherapy on improving performance and reduction of muscular fatigue. However, a great variability in the light parameters and protocols of the trials are a concern to establish the efficacy of this therapy to be used in sports or clinic. The aim of this study is to investigate the effectiveness, moment of application of phototherapy within an exercise protocol, and which are the parameters optimally effective for the improvement of muscular performance and the reduction of muscular fatigue in healthy people. Systematic searches of PubMed, PEDro, Cochrane Library, EMBASE, and Web of Science databases were conducted for randomized clinical trials to March 2017. Analyses of risk of bias and quality of evidence of the included trials were performed, and authors were contacted to obtain any missing or unclear information. We included 39 trials (861 participants). Data were reported descriptively through tables, and 28 trials were included in meta-analysis comparing outcomes to placebo. Meta-analysis was performed for the variables: time until reach exhaustion, number of repetitions, isometric peak torque, and blood lactate levels showing a very low to moderate quality of evidence and some effect in favor to phototherapy. Further investigation is required due the lack of methodological quality, small sample size, great variability of exercise protocols, and phototherapy parameters. In general, positive results were found using both low-level laser therapy and light-emitting diode therapy or combination of both in a wavelength range from 655 to 950 nm. Most of positive results were observed with an energy dose range from 20 to 60 J for small muscular groups and 60 to 300 J for large muscular groups and maximal power output of 200 mW per diode.

The aim of the study was to determine the prevalence of symptoms of common mental disorders among professional rugby players across countries. A cross-sectional analysis of the baseline questionnaires from an ongoing prospective cohort study was conducted. Nine national players’ associations and three rugby unions distributed questionnaires based on validated scales for assessing symptoms of common mental disorders. Among the whole study sample (N=990; overall response rate of 28%), prevalence (4-week) of symptoms of common mental disorders ranged from 15% for adverse alcohol use to 30% for anxiety/depression. These findings support the prevalence rates of symptoms of common mental disorders found in previous studies among professional (i. e., elite) athletes across other sports, and suggestions can be made that the prevalence of symptoms of anxiety/depression seems slightly higher in professional rugby than in other general/occupational populations. Awareness of the prevalence of symptoms of common mental disorders should be improved in international rugby, and an interdisciplinary approach including psychological attention should be fostered in the medical care of professional rugby players. Adequate supportive measures to enhance awareness and psychological resilience would lead not only to improved health and quality of life among rugby players but arguably to enhanced performance in rugby.

A decade ago, Blair1 pondered the future of physical activity research, much of which has since come to pass. More recently, a BJSM Blog2 invited readers to consider how their future research would look. Given the increased international focus on reducing injury/illness in athletes, it is timely to consider what research needs to be undertaken and acted on to achieve feasible reductions over the next 10 years. ‘Future Studies’3 or ‘Thought Leadership’ happens when a defined group of experts calls attention to what they think will be important for their field in the future. This is common in social science disciplines (eg, finance) and in scientific areas with major implications for policy development (eg, in climate control/environmental science). It has been less commonly applied in medicine, though it has underpinned discussion in areas like cancer research4 and academic medicine.5 Thought leadership involves big picture thinking and can lead to new ideas for major developments over time. There is evidence that such exercises can significantly shape research agenda and priority setting. This novel approach was applied to Sports and Exercise Medicine through asking a select group of international experts to contribute their priority research directions for the next 10 years. This is intended as a starting point only, to stimulate discussion with, and elicit responses from, the broader community interested in the prevention of injury and illness in athletes. International experts were invited to participate if they had delivered ≥1 keynote addresses at the International Olympic Committee (IOC) World Conferences of Prevention of Injury and Illness in Sport in 2011, 2014 or their precursor conferences organised by the Oslo Sports Trauma Research Centre in 2005 and 2008. Of 21 keynote speakers, 12 contributed their views to this paper. The experts covered a range of disciplines, including clinical sports …

Currently, there is no overview of the incidence and (volleyball-specific) risk factors of musculoskeletal injuries among volleyball players, nor any insight into the effect of preventive measures on the incidence of injuries in volleyball. This study aimed to review systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures of volleyball injuries. To this end, a highly sensitive search strategy was built based on two groups of keywords (and their synonyms). Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports and sports medicine literature) via EBSCOhost. The results showed that ankle, knee and shoulder injuries are the most common injuries sustained while playing volleyball. Results are presented separately for acute and overuse injuries, as well as for contact and non-contact injuries. Measures to prevent musculoskeletal injuries, anterior knee injuries and ankle injuries were identified in the scientific literature. These preventive measures were found to have a significant effect on decreasing the occurrence of volleyball injuries (for instance on ankle injuries with a reduction from 0.9 to 0.5 injuries per 1000 player hours). Our systematic review showed that musculoskeletal injuries are common among volleyball players, while effective preventive measures remain scarce. Further epidemiological studies should focus on other specific injuries besides knee and ankle injuries, and should also report their prevalence and not only the incidence. Additionally, high-quality studies on the aetiology and prevention of shoulder injuries are lacking and should be a focus of future studies.

BACKGROUND: Despite a rapidly growing body of research, a systematic evidence compilation of the risk and protective factors for middle- and long-distance running-related injury (RRI) was lacking.OBJECTIVES: Our objective was to compile the evidence about modifiable and non-modifiable training-related and behavioral risk and protective factors for middle- and long-distance RRI.METHODS: We searched five databases (PubMed, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO) for the dates 1 January 1970 to 31 December 2015, inclusive, for original peer-reviewed articles. The eligible designs were cross-sectional, case-control, longitudinal observational studies, and randomized controlled trials involving runners competing at distances from ≥800 m to ≤42.2 km. Outcomes were any specific and/or general RRI, and exposures included training-related and behavioral factors. We extracted authors and date, study design, injury type(s), descriptors and comparators for each exposure, and results and measures of association from the selected studies. Methodological quality was independently appraised using two separate checklists: a modified checklist for observational study designs and the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials.RESULTS: Among 73 articles eligible for inclusion, 19 (26.0%) and 30 (41.0%) were of high or satisfactory methodological quality, respectively. As a non-modifiable exposure, a history of previous injury was found to be associated with an increased risk of both general and specific RRI. In terms of modifiable exposures, irregular and/or absent menstruation was found to be associated with an increased risk of stress fracture development, whereas the use of oral contraceptives was found to be associated with a decreased risk. High clinical, methodological, and statistical heterogeneity meant it was not feasible to estimate a pooled effect size across similar studies.CONCLUSIONS: A history of previous injury was associated with an increased risk of both general and specific RRI. The use of oral contraceptives was found to be associated with a decreased risk of skeletal stress fracture. Conversely, irregular and/or absent menstruation was associated with an increased risk. The varied effect directions and/or a number of statistically insignificant results associated with the majority of factors hindered our ability to draw any definitive conclusions about their relationship to RRI risk.

Although injuries to the upper extremity are most costly, the picture of the upper extremity injury problem remains incomplete. This study is the first to describe the etiology and mechanisms of upper extremity injuries in Danish children. A 2.5-year observational prospective cohort study was conducted to record upper extremity injuries in 1048 children. Data were weekly collected by sending a text message. A total of 176 upper extremity injuries were reported (128 acute injuries). Of the acute upper extremity injuries, 55% were sprains, 47% occurred in the hand/wrist, and 53% of cases were caused by a fall. When corrected for exposure to physical activity, this resulted in an acute upper extremity injury incidence density of 0.18 per 1000 h of physical activity. The odds of sustaining an upper extremity injury was higher in the older children (HR: 1.84, 95% CI: 1.10–3.09), a tendency was found suggesting that girls are at increased acute upper extremity risk compared to boys (HR: 1.40 95% CI: 0.97–2.04). The findings that most injuries occur after a fall, that injury risk increases over age and that girls seem to be at increased injury risk provides essential information to guide future childhood injury prevention.

Most contact sports, including rugby union, carry a risk of injury. Although acute spinal cord injuries (ASCIs) in rugby are rare, the consequences of such injuries are far-reaching. Optimal management of these injuries is challenging, and a detailed understanding of the different barriers and facilitators to optimal care is needed. In this study, we aimed to describe the perception of players, regarding factors related to the optimal immediate management of a catastrophic injury in a developing country with socioeconomic and health care inequities. The most frequently reported barriers were transportation delays after injury and admission to appropriate medical facilities. Other barriers included inadequate equipment, the quality of first aid care, and barriers within the acute hospital setting. Barriers were more prevalent in rural and lower socioeconomic areas. These findings are relevant for all rugby stakeholders and may help shape education, awareness, and future policy around the immediate management of ASCIs.

BackgroundChoice architecture interventions, which subtly change the environment in which individuals make decisions, can be used to promote behavior change. This systematic review aimed to summarize studies on micro-environmental choice architecture interventions that encouraged physical activity or discouraged sedentary behavior in adults, and to describe the effectiveness of those interventions on these behaviors – and on related intentions or health outcomes – in presence of the intervention and after removal of the intervention (i.e. post-intervention, regardless of the time elapsed).MethodsWe systematically searched PubMed, Embase, PsycINFO and the Cochrane Library for (quasi) experimental studies published up to December 2019 that evaluated the effect of choice architecture interventions on physical activity and sedentary behavior, as well as on intentions and health outcomes related to physical activity/sedentary behavior. Studies that combined choice architecture techniques with other behavior change techniques were excluded. All studies were screened for eligibility, relevant data was extracted and two independent reviewers assessed the methodological quality using the QualSyst tool.ResultsOf the 9609 records initially identified, 88 studies met our eligibility criteria. Most studies (n = 70) were of high methodologic quality. Eighty-six studies targeted physical activity, predominantly stair use, whereas two studies targeted sedentary behavior, and one targeted both behaviors. Intervention techniques identified were prompting (n = 53), message framing (n = 24), social comparison (n = 12), feedback (n = 8), default change (n = 1) and anchoring (n = 1). In presence of the intervention, 68% of the studies reported an effect of choice architecture on behavior, whereas after removal of the intervention only 47% of the studies reported a significant effect. For all choice architecture techniques identified, except for message framing, the majority of studies reported a significant effect on behavioral intentions or behavior in presence of the intervention.ConclusionsThe results suggest that prompting can effectively encourage stair use in adults, especially in presence of a prompt. The effectiveness of the choice architecture techniques social influence, feedback, default change and anchoring cannot be assessed based on this review. More (controlled) studies are needed to assess the (sustained) effectiveness of choice architecture interventions on sedentary behavior and other types of physical activity than stair use.

Introduction: Lateral ankle sprains are the most prevalent injury in sports with the highest recurrence rate of all musculoskeletal injuries. Most individuals return to sport (RTS) quickly after a lateral ankle sprain, likely because lateral ankle sprains are often assumed to be minor injuries and there are currently no criteria-based guidelines to guide the RTS decision making. There is need to determine and collate expert opinion to inform RTS practice. The aim of this study was to use a Delphi approach to develop consensus for RTS criteria for individuals who have sustained an acute lateral ankle sprain injury. Methods: A Delphi approach was used to establish consensus of opinion from a panel of international experts. Panelists were required to be: i) a health professional; ii) currently working with athletes competing in nationally selected representative teams or teams in Tier/Division 1 national competitions; iii) currently working in field or court sports in which the primary gross motor skills are running and jumping/landing or changing direction and there is a high prevalence of lateral ankle sprain injuries; iv) involved in making RTS decisions for individuals with an acute lateral ankle sprain injury; v) proficiency in the English language. Consensus was a priori defined as > 70 % agreement between panelists. Results: Based on responses to the first Delphi survey, assessment of the following items reached consensus to be included as RTS criteria for individuals who have sustained an acute lateral ankle sprain injury: sport specific tasks, hopping, agility, jumping, pain severity of sport specific physical activity, pain severity of the last 24 hours, ankle range of motion, ankle muscle strength, ankle muscle endurance, dynamic postural control/balance, proprioception, perceived ankle reassurance/confidence, perceived ankle instability, and psychological readiness. Discussion: Collation of expert opinion through a Delphi approach informs the development of RTS criteria for acute lateral ankle sprain injuries. Our findings indicate the need to assess performance of sport-specific and athletic skills, pain severity, ankle muscle function, ankle range of motion, balance and proprioception, ankle perception and psychological readiness when determining the ability to athletes to RTS after an acute lateral ankle sprain injury. This information provides the basis for prospective cohort studies to test the use of the proposed criteria for successful RTS after acute lateral ankle sprain injuries.

IntroductionTransitioning out of professional football is a challenging time in most players’ lives. During these preretirement and postretirement years, professional footballers may struggle with their mental, musculoskeletal, neurocognitive and cardiovascular health. Currently, longitudinal data about these health conditions are lacking. This article presents the design of a prospective cohort study with the primary aim of gathering epidemiological evidence about the onset and course of mental, musculoskeletal, neurocognitive and cardiovascular health conditions in professional footballers during their preretirement and postretirement years and evaluating the associations between risk indicators and the health conditions under study in these players.Methods and analysisAn observational prospective cohort study with repeated measurements over a follow-up period of 10 years will be conducted among at least 200 professional footballers (male; 27 (±1) years old). Mental health will be explored by assessing symptoms of distress, anxiety, depression, sleep disturbance, alcohol misuse, drug misuse and disordered eating. Musculoskeletal health will be explored by assessing severe joint injury and related surgery, clinical and radiological osteoarthritis, and joint function (hips, knees and ankles). Neurocognitive health will be explored by assessing the concussion, brain structure and functioning, and neurocognitive functioning. Cardiovascular health will be explored by assessing blood pressure, lipid profile and ECG abnormalities.Ethics and disseminationEthical approval for the study was provided by the Medical Ethics Review Committee of the Amsterdam University Medical Centers. The results of the study will be submitted to peer-reviewed journals, will be presented at scientific conferences and will be released in the media (postpublication).Trial registration numberThe Dutch Trial Registry (Drake Football Study NL7999).