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Purpose: To present training load (TL) and heart-rate variability (HRV) in an elite sprinter monitored before, during, and after a COVID-19 infection until successful return to performance. Methods: TL, subjective morning fatigue (MF), and supine HRV were monitored during a 12-week period. Results: During a high-TL period (training camp), MF and heart rate increased and vagally mediated HRV variables decreased. MF increased and stayed high 3 days after the camp despite decrease in TL. In contrast, 4 days after the camp, heart rate decreased and vagally mediated HRV variables increased, reflecting parasympathetic hyperactivity. Elevated MF and suboptimal training performance led to a PCR test decision, which returned positive. After a 10-day training suspension, TL was progressively increased with low MF and high vagal tone. The athlete was able to return to competition 17 days after medical clearance for return to participation and 1 week later beat his indoor 60-m personal best. Conclusions: In this athlete, COVID-19 infection induced parasympathetic hyperactivity with subjective fatigue. This case report presents how performance capacity was only negatively influenced by a COVID-19 infection in the short term, with a quick and successful return to performance, thanks to state-of-the-art medical management. This highlights the importance of TL and HRV monitoring in return-to-participation and return-to-competition decisions.

There have been repeated calls to re-evaluate how clinicians provide care for people presenting with persistent non-traumatic musculoskeletal conditions. One suggestion is to move away from the 'we can fix and cure you' model to adopting an approach that is more consistent with approaches used when managing other persistent non-communicable diseases; education, advice, a major focus on self-management including lifestyle behavioural change, physical activity and medications as required. Currently the global delivery of musculoskeletal care has many of the elements of a 'super wicked problem', namely conflict of interest from stake-holders due to the consequences of change, prevailing expectation of a structural diagnosis and concomitant fix for musculoskeletal pain, persistent funding of high risk, more expensive care when low risk more economic viable options that don't impact on the quality of outcome exist, and an unquestionable need to find a solution now with the failure resulting in a growing social and economic burden for future generations. To address these issues, 100 participants included clinicians, educators and researchers from low-, middle- and high-income countries, eight presenters representing the physiotherapy, sport medicine and the orthopaedic professions and the insurance industry, together with three people who shared their lived experiences of persistent musculoskeletal pain, discussed the benefits and barriers of implementing change to address this problem. This paper presents the results from the stakeholders' contextual analysis and forms the basis for the proposed next steps from an action and advocacy perspective.

(1) To assess the period prevalence of SARS-CoV-2 infections and willingness to vaccinate in Swiss elite athletes and (2) to evaluate whether sociodemographic and sport-related characteristics were associated with infection of SARS-CoV-2 in athletes.A total of 1037 elite athletes (MDuring the first year of the pandemic, 14.6% of all Swiss elite athletes were found to be infected with SARS-CoV-2, and 5.4% suspected that they had been infected. Male athletes, young athletes and team sports athletes had an increased likelihood of being infected with SARS-CoV-2. There was considerable heterogeneity in the duration and severity of a COVID-19 illness in athletes. Overall, 68% of respondents indicated a willingness to be vaccinated if they were offered an opportunity to do so.In the first year of the pandemic, Swiss elite athletes were tested more often positive for SARS-CoV-2 than the general Swiss population. Because COVID-19 illness can impair health for a relatively long time, sports federations are advised to motivate athletes to be vaccinated.

Context Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. Objective To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. Design Randomized controlled clinical trial. Setting Laboratory. Patients or Other Participants A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. Intervention(s) The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. Main Outcome Measure(s) All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. Results In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. Conclusions Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population.

Context: The validity and reliability of manual goniometry is highly dependent on the examiner’s expertise. Technological advances can overcome these problems to some extent. Inertial goniometry, for instance, could bridge the gap between 2D and manual goniometry, but its validity remains to be studied. Participants: 40 healthy individuals (mean ± SD: 31 men, age = 23.9 ± 4.1 years, 184 ± 6 cm, 80.7 ± 10.0 kg; 9 women, age = 23.6 ± 3.6 years, 170 ± 4 cm, 60.6 ± 5.1 kg). Measurements: 2D and inertial goniometry by mobee med™ were used to measure active and passive single straight-leg raise mobility performance. Intracorrelation coefficients (ICCs) and typical error of the estimate (TEE) inform the reliability and quality of the measurement by the rater. Results: The relationship of the inertial goniometry for active and passive mobility of the single straight-leg raise was practically perfect (r = .95–.98). Based on the Bland-Altman plots, the means of the difference between the 2D and inertial based goniometry were small (2–3°). Conclusion: Due to its high concurrent validity, ease of use, and efficiency with regard to time and personnel requirements, this inertial goniometer device is an effective and efficient approach to measuring range of motion. However, additional validity and reliability studies should investigate joints with more degrees of freedom.

© Author(s) (or their employer(s)) 2019. Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.

British Journal of Sports Medicine, 55 (2), ISSN:0306-3674, ISSN:1473-0480

The past year has brought on a new challenge for Swiss sport and the sports and exercise medicine (SEM) community. This is a global challenge that requires our unqualified attention. No, we are not talking about a virus, but rather about a much more insidious problem that plagues sports throughout the world: harassment and abuse.1 In June 2020, Swiss gymnasts came forward and reported abusive experiences in their training environment.2 Soon athletes from other sports followed, feeling empowered. Most troubling was that many of the athletes were minors at the time of the reported incidents. While situations of harassment and abuse in sport had previously been uncovered, never had they stirred the country like this. The magnitude of the testimonies, and the fact that national media outlets quickly investigated further, led to a parliamentary response: action is required and athletes must count on a system that effectively safeguards them. Currently, independent investigations are underway. Elite sport requires high levels of commitment and pushes athletes to test their physical and mental limits. Equally, the training environment necessitates focus and discipline. Inevitably, athletes suffer from mental stress, illness …

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.

There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion–adduction–internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head–neck radiographs are the initial diagnostic imaging of choice—advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

In sports medicine and rehabilitation of musculoskeletal conditions, training, knowledge and expertise of clinicians are the guarantors of good clinical practice. But are they really? Since the 1970s, a growing body of sociological and behavioral science has developed the concepts of cognitive biases and thinking errors. In a nutshell, it tries to explain how we approach decision-making using shortcuts, or heuristics. Our brains will alternatively use 2 systems to think and decide: system 1 is fast, intuitive and emotional, whereas system 2 is slow, logical and conscious. We may think clinicians use the latter systematically, but they actually use system 1 in many situations. Whether due to intrinsic thinking errors or external forces that cloud our judgment, we are under unconscious influences and so are all the stakeholders in the rehabilitation setting, including the patient/athlete. We present some of the most prevalent biases that pervade clinical decision-making and attempt to give a bit of background context starting from the typical tension between academic authority and personal experience. The field of sports performance is also riddled with beliefs, egocentrism and a general tendency to search for magic bullets that will bring the marginal gains and edge over the competition. This plays into the rehabilitation of patient-athletes in different ways. Finally, there are ways to mitigate the effect of cognitive biases to improve decision-making. This must include better communication, shared decisions and ultimately the understanding that we should drive our profession to deliver high-value care tailored to the patients, in line with the best evidence at the best possible cost. Hopefully, we can shed some light without too many of our own biases on the complexities of thinking in sports medicine and rehabilitation.

It is well demonstrated that physical activity can improve the control of diseases such as diabetes, or dyslipidemia. Introduction of regular and frequent physical activity is also part of the useful measures in the management of excess weight. It is therefore surprising that the prescription of physical activity for the treatment of these diseases is still not part of the curriculum of medical studies, and that reimbursement remains very scarce. This article summarizes the state of scientific knowledge in the field and outlines their clinical application.Il est bien démontré que l’activité physique (AP) peut participer à l’amélioration du contrôle de maladies telles que le diabète ou l’hyperlipidémie. La reprise d’une AP régulière et fréquente fait également partie des mesures reconnues utiles dans la gestion de l’excès de poids. Il est dès lors étonnant que la prescription d’AP dans le cadre du traitement de ces maladies soit peu enseignée, et sa prise en charge très mal remboursée. Cet article fait le point sur les connaissances dans le domaine, et la manière de les appliquer cliniquement.

Neuropathic arthropathy is a pathology involving both upper and lower limbs. Different neurological diseases can cause this arthropathy. For instance, shoulder Charcot arthropathies are mostly associated to syringomyelia. The initial diagnosis of this arthropathy is difficult and often delayed in the presence of usually non specific symptoms. Since articular destruction is present in this disease, early diagnosis and primary management of the neurological condition is important, as it slows down the destruction of the joint.L’arthropathie neuropathique est une pathologie touchant les membres supérieurs et inférieurs en lien avec différentes affections neurologiques. Dans le cadre de l’épaule, la syringomyélie est la cause la plus fréquente. La symptomatologie initiale est peu spécifique, peu douloureuse et conduit à la destruction articulaire. Le diagnostic est par conséquent difficile et souvent retardé. Une prise en charge optimale est nécessaire afin de traiter la pathologie neurologique sous-jacente, ce qui permet de ralentir la destruction articulaire.

In faculties of health sciences, almost 30% of nursing students exercise less than once a week. This mixed-method case report presents the 38-month evolution of the physiological and psychological health parameters of a sedentary and physically inactive nursing student. During this period, she first took part in a one-semester institutional physical activity (PA) program that was offered by her university before being selected for participation in the Race Across America (RAAM) with a university relay team. In the four months leading up to the RAAM, she followed a cycling training program. After the RAAM, she was followed-up for the next 28 months. The results showed that each phase of the study had an important impact on the subject and showed that sedentary and physical inactive behaviours are reversible. Institutional PA programs, including training education in addition to concurrent strength and endurance training, can lead to physiological and psychological health improvements. For some individuals, participating in an athletic challenge can improve motivation and long-term adherence to PA participation. An individualised approach should be considered in future interventions that aim to promote PA participation. In the specific context of a university of health sciences, this kind of initiative could positively influence the general population&rsquo, s health by empowering students to become role models towards PA promotion.

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS—the HAGOS and iHOT—as well as the other (currently not recommended) PROMS.

Vitamin D concentrations corresponding to 75 nmol/L 25(OH)D have been associated with maintained muscle function, growth and regeneration, optimal bone health and immunology in athletes. The objective of this study was to investigate the prevalence and predictors of insufficient 25(OH)D concentrations in athletes. Six hundred three Swiss athletes were assessed. 25(OH)D was analysed by high-performance liquid chromatography (HPLC). A standardized questionnaire was used to gather information about potential predictors for 25(OH)D concentrations; 50.5% showed insufficient 25(OH)D concentrations. Differences in predicted probability of insufficient 25(OH)D were found for those vitamin D supplemented (42%) versus not supplemented (52%), in those performing indoor (58%) versus outdoor sports (43%), and during the sun-deprived seasons of fall (49%), winter (70%) and spring (57%) compared with summer (17%). Higher BMI z-scores and age were associated with higher 25(OH)D concentrations. In conclusion, insufficient 25(OH)D concentrations were common among athletes especially at a younger age, among those not supplemented, in athletes who trained indoors, and during the sun-deprived seasons. Because the prevalence of insufficient 25(OH)D concentrations in this study was high, regular supplementation in athletes may be indicated, except perhaps during the summer season. Further research is needed to determine which 25(OH)D concentrations lead to optimal health and performance in athletes.

Abstract. Physical activity provides huge opportunities for the health of nations. Understanding this, the World Health Organization has published a Global Action Plan which aims to provide member states with a framework for action, namely to create active societies, people, environments and systems. The target is set at a 15 % reduction in physical inactivity levels by 2030. We explore in this paper some of the challenges and opportunities that come with it, and give the practitioner some real-world opportunities for relevant action at the local level, as well as for their patients, staying true to the Physician’s Pledge (Declaration of Geneva): “I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”

The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

The foot is a complex system with multiple degrees of freedom that play an essential role in running or sprinting. The intrinsic foot muscles (IFM) are the main local stabilizers of the foot and are part of the active and neural subsystems that constitute the foot core. These muscles lengthen eccentrically during the stance phase of running before shortening at the propulsion phase, as the arch recoils in parallel to the plantar fascia. They play a key role in supporting the medial longitudinal arch, providing flexibility, stability and shock absorption to the foot, whilst partially controlling pronation. Much of the foot rigidity in late stance has been attributed to the windlass mechanism - the dorsiflexion of the toes building tension up in the plantar aponeurosis and stiffening the foot. In addition, recent studies have shown that the IFM provide a necessary active contribution in late stance, in order to develop sufficient impedance in the metatarsal-phalangeal joints. This in turn facilitates the propulsive forces at push-off. These factors support the critical role of the foot in providing rigidity and an efficient lever at push-off. During running or sprinting, athletes need to generate and maintain the highest (linear) running velocity during a single effort in a sprinting lane. Acceleration and sprinting performance requires forces to be transmitted efficiently to the ground. It may be of particular interest to strengthen foot muscles to maintain and improve an optimal capacity to generate and absorb these forces. The current evidence supports multiple exercises to achieve higher strength in the foot, such as the "short foot exercise," doming, toes curl, towing exercises or the more dynamic hopping exercises, or even barefoot running. Their real impact on foot muscle strength remains unclear and data related to its assessment remains scarce, despite a recognized need for this, especially before and after a strengthening intervention. It would be optimal to be able to assess it. In this article, we aim to provide the track and field community with an updated review on the current modalities available for foot strength assessment and training. We present recommendations for the incorporation of foot muscles training for performance and injury prevention in track and field.

BACKGROUND: "When will I be able to play again?" is the most frequent question asked by injured athletes. Due to the complex nature of sports injury, deciding when an injured athlete may safely ret ...

The past year has been a repetitive tale of challenges and adaptations, as each new wave of the pandemic spread across the world. One striking feature has been each country or region’s race for ‘safe ground’, including border closures and idiosyncratic rules and regulations. When the going gets tough, everyone seems to revert to strategies of the past, usually involving silos and fences. Sometimes, this happens in medicine too. As problems become more complex, specialised care and specialists become more isolated from one another, meaning they cannot see the forest for the trees. SEM clinicians have a strong culture of transversal collaboration, necessary because of the complex multistakeholder environment and the extreme pressure we have to navigate. As challenging as it is, the pandemic has added a new layer by erasing most in-person …

Trail running races are a real challenge for medical and paramedical workers committed to aid station/medical support system, because of their technical and geographical particularities. In this article, we review the different etiologies of collapse, digestive problems, kidney complications, diseases related to the environment and musculoskeletal injuries. Field care and prevention are also examined. Although injuries are often benign, some more serious problems may require rapid and effective intervention. Medical teams must be prepared for each of the different situations discussed in this article.Les courses de trail présentent, du fait de leurs particularités techniques et géographiques, un réel défi pour les intervenants médicaux et paramédicaux engagés au sein des dispositifs sanitaires. Dans cet article, nous passons en revue les différentes causes de malaise, les problèmes digestifs et les complications rénales, les affections liées à l’environnement, ainsi que les principales lésions musculosquelettiques. La prise en charge sur le terrain et la prévention sont également discutées. Même si les affections rencontrées lors d’un trail sont souvent bénignes, certaines problématiques plus graves peuvent nécessiter l’intervention rapide et efficace des secours qui doivent être préparés aux différentes situations abordées.

Adolescent athletes frequently complain of fatigue. Acute fatigue after intense training is physiological and necessary in order to develop capacity and increase performance. However, healthcare practitioners must question persistant fatigue, which causes are multiple, sometimes clear, though mostly multifactorial. A comprehensive and holistic approach is especially required in adolescents, with a complete somatic, psychosocial and athletic history. The role of healthcare professionals is to quickly identify specific signs and complex diagnoses, which can lead to physical and psychological consequences in the long term (overtraining, burnout, abuse, eating disorders). Finally, in a time where overweight and inactivity is rampant in the youth, we must imperatively avoid adolescents dropping out of sports and activity.La fatigue est un motif de consultation fréquent chez l’athlète adolescent. Une fatigue aiguë après un effort intensif est physiologique, voire même recherchée dans le but d’améliorer les performances. Une fatigue qui s’installe doit interpeller. Les causes sont multiples, parfois bien précises, mais souvent multifactorielles. Une approche holistique est indispensable, surtout chez l’adolescent, avec une anamnèse somatique, psychosociale et sportive détaillée. Le rôle du professionnel de la santé est de détecter au plus vite les premiers signes, certains diagnostics difficiles à poser pouvant avoir de lourdes conséquences physiques et psychiques à long terme (surentraînement, burnout, abus, trouble du comportement alimentaire). En cette ère d’épidémie de surpoids chez les jeunes, l’abandon du sport est à éviter absolument.

RED-S is a clinical concept introduced in 2014 that broadens the understanding of the athlete's triad. It includes nine areas affected by energy deficiency relative to the body's needs for optimal functioning and it is known that both adolescents and athletes are at higher risk of suffering from a RED-S than the general population. We highlight that sports coaches in French-speaking Switzerland do not know of RED-S nor of its health consequences. They desire to learn more but mention several barriers to this training. Since they have a central role in the lives and health of adolescent athletes, they are the key persons to train in order to improve the prevention and detection of adolescent athletes in need of medical attention.Le RED-S (Relative Energy Deficiency in Sports) est un concept clinique qui élargit la compréhension de la triade de l’athlète. Il comprend neuf domaines affectés par un déficit énergétique et survient lorsque les apports sont insuffisants pour les besoins de fonctionnement optimal. Les adolescents et les athlètes sont à risque de souffrir d’un RED-S en raison de leurs besoins énergétiques augmentés. Notre étude met en évidence un besoin de formation des entraîneurs sportifs, car ils ne connaissent ni le RED-S ni ses conséquences sur la santé. Ils sont en revanche désireux de se former, mais mentionnent des barrières d’accès à la formation. Leur rôle central dans la vie et la santé des athlètes adolescents en fait les acteurs-clés pour améliorer la prévention et la détection du RED-S et l’orientation vers une prise en charge médicale.

Competitive sports demand numerous sacrifices from young adolescent athletes to reach early performance. This comes at a high price: many injuries, sometimes serious, recurrent fatigue, or undue pressure, bordering on abuse definitions. We present a new concept, which seems quite obvious: health for performance. In the presence of complete biopsychosocial health, adolescent athletes can thrive and meet their athletic, social and academic goals. A conducive sports environment, one which integrates interdisciplinarity with healthcare stakeholders, can allow for a complete harmonious positive development, one which is aligned with Public Health goals. Healthy adolescents may become performing athletes, but they will most definitely contribute positively to their wellbeing, as well as society in general.Le sport de compétition exige des jeunes adolescents de nombreux sacrifices pour la performance dès le plus jeune âge. Ceci n’est pas sans conséquences, comme en témoignent les blessures parfois graves, la fatigue fréquente et les pressions subies, proches des définitions de la maltraitance. Nous présentons ici un concept nouveau, pourtant si évident : la santé pour la performance. En présence d’une santé bio-psycho-sociale complète, les jeunes athlètes se développent harmonieusement et peuvent atteindre leurs objectifs. Un environnement sportif favorable, fonctionnant en interdisciplinarité avec les acteurs de la santé, permet un apprentissage physique complet et favorise un développement positif des adolescents, en accord avec les objectifs de santé publique. Ainsi ils contribueront tant à leur bien-être qu’à celui de la société.

Deciding when to return to sport after injury is complex and multifactorial—an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups—each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.

Offering an interdisciplinary approach to the athletic adolescent helps to expand the evaluation framework when investigating a medical complaint. It is important to use the opportunity of each consultation to take not only a detailed history of the sporting practice, but also to investigate the social and familial context as well as healthy lifestyle of the young athlete. Considering young athletes within the larger picture of their developmental context of adolescence offers an opportunity to better respect the psychological and physical needs of this life phase. These needs are strongly related to the promotion of a good health among young athletes.L’approche interdisciplinaire de l’adolescent qui pratique du sport permet d’élargir le cadre d’évaluation lors de l’investigation d’une plainte médicale. Il est important de profiter de chaque opportunité de consultation pour faire non seulement une anamnèse détaillée de la pratique sportive, mais également du contexte social et familial ainsi que de l’hygiène de vie du jeune sportif. Replacer le jeune sportif dans le contexte développemental de l’adolescence offre une possibilité de mieux respecter les besoins fondamentaux psychiques et physiques liés à cette phase de vie, éléments qui sont fortement liés à la promotion d’une bonne santé.

This study aimed to investigate the differences in maximal oxygen uptake (V̇O2max) and submaximal thresholds between a standard graded exercise test (GXT) and a perceptually regulated graded exercise test (PRGXT) in trained runners. Eleven well-trained middle- to long-distance runners performed both tests in a randomized order. PRGXT used incremental “clamps” of rating of perceived exertion (RPE) over 10×1-min stages on an automated treadmill equipped with a sonar sensor allowing them to change their running speed instantly and in a natural way. GXT used fixed 1 km.h−1 increment every minute. Ventilatory threshold (VT) and respiratory compensation point (RCP) were determined using ventilatory equivalents. No differences were found in V̇O2max (68.0 (5.3) vs. 69.5 (5.9) ml·min−1·kg−1, p=0.243), minute ventilation (V̇E) (159.4 (35.0) vs. 162.4 (33.7) l·min−1, p=0.175), heart rate (HR) (188.4 (6.9) vs. 190.7 (5.2) bpm, p=0.254) and speed (21.0 (1.7) vs. 21.1 (2.3) km·h-1, p=0.761) between GXT and PRGXT. At VT, there were no significant differences between GXT and PRGXT for any outcome variables. For 8 of 11 subjects, it was not possible to determine RCP from ventilatory equivalent in PRGXT. GXT appears more relevant for a comprehensive gas analysis in trained runners.

Welcome to the 2019 Swiss Sports Medicine issue of BJSM. Our past 2 years have been busy with the development of interdisciplinary collaborations and the involvement of undergraduates in sports and exercise medicine (SEM). These have led to the successful #sportsuisse2018 Hip and Groin conference with our friends from the Swiss Sports Physiotherapy Association, and the continuation of our yearly Student’s Day, a preconference event to our Annual Meeting. Sports medicine being the dynamic branch that we cherish, we strive to bring new projects to life, in order to disseminate knowledge and improve the well-being of our Swiss population. Two new domains have kept us busy recently: the reform of our national sports medicine curriculum and the development of the ‘exercise’ component in Swiss SEM. Under the leadership of Drs Andre Leumann and Kerstin Warnke, the Swiss Sports Medicine Society set out to revise our curriculum to bring the best current content to our future graduates. New topics have emerged in the past few years, and doctors’ expanded activities in SEM mean this must …