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Problem Statement: In athletes with spondylolisthesis, segmental instability and impaired spinopelvic alignment are considered as clinically relevant. Functional MRI in supine and upright position enables a load-dependent acquisition, but neither the reposition effect nor the difference in the extent of inter-position-related differences has been investigated for their reliability. This study evaluates the intra- and inter-positional test-retest reliability of segmental instability and spinopelvic alignment in athletes with low-grade isthmic lumbar spondylolisthesis using supine and upright MRI.Methods: 22 athletes with spondylolisthesis were analyzed in a test-retest design. Parameters quantifying segmental instability (anterior translation [mm], segmental hinging [], disc height [mm]) and spinopelvic alignment (lordosis angle [], Sacral slope []),) were assessed in supine (0) and upright (82) MRI position. Intra-positional changes and differences of inter-positional changes were analyzed using absolute and relative indicators of reliability (amongst other intraclass-correlation-coefficient (ICC 2.1) and standard error of measurements (SEM%)).Results: Intra-positional changes showed high correlations and low absolute changes in both positions (ICC: 0.91-0.98; SEM%: 1-7%). Differences of inter-positional changes presented poor-to-moderate correlations and higher absolute changes (ICC: 0.34-0.74; SEM%: 33-60%).Discussion: Intra-positional changes can be determined reliably among all assessed outcomes. Inter-position-related changes of segmental instability indicate a reduced reproducibility in the current population.Conclusion: Functional MRI can be considered a valuable diagnostic tool for evaluating segmental instability and spinopelvic alignment in spondylolisthesis patients. Key Words: Reproducibility, MRI, Spinopelvic Balance, Repositioning, Functional Imaging

Introduction: An infection with SARS-CoV-2 is relevant especially in high-performance sport due to possible organ damage and reduced performance which occurs in individual cases. Various recommendations are found in the literature concerning when safe return to sports is possible and what examinations are suitable to support this decision. The dominance of other virus variants than those at the start of the pandemic makes revision of earlier recommendations necessary. Methods and Analysis: The recommended actions are based on the currently-available scientific knowledge of the pathogenicity of the virus and on clinical experiences in general and elite athletes. Twenty-one recommended actions were proposed by the Scientific Council of the DGSP, discussed and agreed on in consensus with experts from German-language sports-medical facilities and evaluated by an independent co-author. The resultant position paper was subsequently released by mutual agreement. Results: The recommendations are oriented to the severity of the course and the symptoms. The required medical diagnostic is deduced therefrom. During persistent symptoms, sports should be paused and training only begun again at low intensity after a three-day symptom-free period. If COVID-19-associated complaints recur, physical exertion should be stopped and a doctor consulted. After moderate and serious course, medical diagnostics are required prior to the start of training. Summary: To prevent a health risk due to sports and thereby resultant organ damage after a SARS-CoV-2 infection, a procedure adapted to the symptoms and course before return to training and finally to competitive sports is recommended.

Anne-Katrin Puschmann,1 David Drießlein,2 Heidrun Beck,3 Adamantios Arampatzis,4 Maria Moreno Catalá,4 Marcus Schiltenwolf,5 Frank Mayer,6 Pia-Maria Wippert1,7 1Sociology of Health and Physical Activity, University of Potsdam, Potsdam, Germany; 2Statistical Consulting Unit, Ludwig-Maximilians-University Munich, Munich, Germany; 3University Center of Orthopedics and Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany; 4Department of Training and Movement Sciences, Humboldt-University of Berlin, Berlin, Germany; 5Conservative Orthopaedics and Pain Management, Center of Orthopaedics and Trauma Surgery, University Hospital Heidelberg, Heidelberg, Germany; 6University Outpatient Clinic, University of Potsdam, Potsdam, Germany; 7Department of Health Sciences and Technology, ETH Zürich, Zürich, SwitzerlandCorrespondence: Anne-Katrin PuschmannUniversity of Potsdam, Am Neuen Palais 10, House 12, Potsdam 14469, GermanyTel +49 331 9771075Email ak.puschmann@gmail.comPurpose: Psychosocial variables are known risk factors for the development and chronification of low back pain (LBP). Psychosocial stress is one of these risk factors. Therefore, this study aims to identify the most important types of stress predicting LBP. Self-efficacy was included as a potential protective factor related to both, stress and pain.Participants and Methods: This prospective observational study assessed n = 1071 subjects with low back pain over 2 years. Psychosocial stress was evaluated in a broad manner using instruments assessing perceived stress, stress experiences in work and social contexts, vital exhaustion and life-event stress. Further, self-efficacy and pain (characteristic pain intensity and disability) were assessed. Using least absolute shrinkage selection operator regression, important predictors of characteristic pain intensity and pain-related disability at 1-year and 2-years follow-up were analyzed.Results: The final sample for the statistic procedure consisted of 588 subjects (age: 39.2 (± 13.4) years; baseline pain intensity: 27.8 (± 18.4); disability: 14.3 (± 17.9)). In the 1-year follow-up, the stress types “tendency to worry”, “social isolation”, “work discontent” as well as vital exhaustion and negative life events were identified as risk factors for both pain intensity and pain-related disability. Within the 2-years follow-up, Lasso models identified the stress types “tendency to worry”, “social isolation”, “social conflicts”, and “perceived long-term stress” as potential risk factors for both pain intensity and disability. Furthermore, “self-efficacy” (“internality”, “self-concept”) and “social externality” play a role in reducing pain-related disability.Conclusion: Stress experiences in social and work-related contexts were identified as important risk factors for LBP 1 or 2 years in the future, even in subjects with low initial pain levels. Self-efficacy turned out to be a protective factor for pain development, especially in the long-term follow-up. Results suggest a differentiation of stress types in addressing psychosocial factors in research, prevention and therapy approaches.Keywords: low back pain, psychosocial risk factors, stress, self-efficacy, MiSpEx

Problem: Core-specific sensorimotor exercises (CSSE) combined with technically applied unexpected high-intensity perturbations (UHIP) are able to enhance neuromuscular activity of the trunk muscles (TM). SinceincludingUHIP into clinical practice is complicated, it is warranted to implement a feasible perturbation task. Aim of the study was to analyze the effects of an additional motoric-task perturbation on trunk neuromuscular activation pattern during CSSE exercise.Methods: Ten participants (5m/5f; 292years; 1777cm, 7412kg) were included and prepared with a surface EMG-setup for trunk muscles. EMG-data were collected during a side plank on stable surface (SP; 30sec) and randomly in 3 different conditions: adding a pad under the right elbow (SPP), adding a perturbation task (SP+P) and adding pad and perturbation task (SPP+P). Root mean square (RMS) was calculated for the whole exercise cycle (30sec) and normalized to MVIC (%MVIC). Muscles were grouped to ventral (VR; VL) and dorsal (DR; DL) right/left. In addition, the ratios of Ventral: Dorsal (V: D) and Side-Right: Side-Left (SR: SL) were calculated. Differences between conditions were assessed for muscle groups and ratios (repeated-measures ANOVA; =0.05).Results: SPP+P showed the highest EMG-RMS for all muscles except DL, showing significant differences between conditions SP and SP+P in VR and VL,respectively. No differences (p

Background: This overview provides an introduction to neuromuscular adaptations by exercise interventions based on random perturbations. It is outlined that specific therapeutic intervention based on perturbations may improve spine stability during disturbances as well as neuromuscular control errors and thereby may increase the efficiency of treatment in low back pain.Methods: Specific experimental approaches to assess neuromuscular control of trunk stability during and after perturbations are presented. Further, evidence of neuromuscular adaptations after perturbation-based exercise interventions is given. Finally, a concept to transfer perturbation-based exercises from laboratory conditions to low-back pain therapy settings is introduced.Results and Discussion: Well-established (e.g. quick-release experiments) and novel (e.g. walking perturbations) techniques could indicate neuromuscular deficits in low-back pain compared to asymptomatic controls in response to sudden perturbation experiments applied during quick-release experiments, during perturbed isokinetic strength testing and during sudden stumbling incidents in walking. A novel perturbation training, induced by continuously variable and unpredictable disturbances, successfully served to increase the neural noise in the nervous system. Evidence indicated that neural networks that have been formed in the presence of noise would be more robust and efficient to cope with environmental changes. Finally, the development and evaluation of a perturbation-based training program consisting of core-specific exercises which can be carried out without expensive laboratory perturbation equipment isoutlined. KEY WORDS: MiSpEx, Perturbation Training, Neuromuscular Control, Low Back Pain

Idiopathic as well as nonspecific low back pain is relevant in health care systems as well asinleisure and high-performance sports. Neuromuscular and/or structural deficits, mostly accompanied by biopsychological factors,are known risk factors for both the onset and chronification of symptoms. Meta-analytic evidence describes positive effects of physical activity. However, type, dose-response relation, minimum of training required and setting-specific implementation has not been fullyclarified. Since 2011, the national research network Medicine in Spine Exercise [MiSpEx] has beenfollowing a project layout called Ran Rcken focussing on the development and validation of intervention programs including neuromuscular and pain adaptation moderated by individual training status, pain behaviour, allostatic load and social settings. Overall about 8000 patients and athletes have been and are being followed experimentally and clinically in 34 studies. It could be shownthat a training program focussing on compensation of external loads elicited by perturbations is effective in prevention and rehabilitation in both athletes and general population. Besides validation of further consecutively developed programs emphasis is put on the evaluation of transfer strategies to medical systems, sports as well as general population. Finally, the evaluation of an efficient dose-response relation is addressed.KEY WORDS: Low Back Pain, MiSpEx, Sports, Perturbations, Therapy, Prevention, Training

Joint replacement surgery has showna tremendous increase within the last decades. Advanced operation techniques and modern implants support operative treatment of younger patients with increased demands during daily-living, leisure time as well as sports activity. Physical activity after total joint replacement is generally recommended. This leads to improved osteointegration of the prosthesis, decreased loosening rates, enhanced muscular performance and a reduced cardiovascular risk. Potential recommendations regarding suitable activitiesand intensities depend on the affected joints, surgical techniques, implantsusedas well as accompanying pathologies. While low-impact-sport with mainly cyclic endurance activity is generally recommended, high-impact-sport can only be permitted with previous experience and atcertain arthroplasty sites. Due to high risk of injuries participation in contact and game sports should generally be avoided.KEY WORDS: Sport Recommendation, Physical Activity, Joint Replacement, Prosthesis, Patients

Objective: Information about dietary supplement (DS) use in young German athletes beginning their sporting career is scarce and possible differences to their non-athlete counterparts are unknown. Therefore, the purpose of this study was to analyze DS use in young elite German athletes (A) and non-athlete (NA) controls.Method: During pre-participation examinations, 562 athletes (323m/239f, 11.70.6 years) and 69 non-athletes (12m/57f; 12.50.5 years) answered a standardized questionnaire analyzing the prevalence of DS use, reasons for intake, and sources of information. Group differences were analyzed with Chi test (=0.05).Results: 14% of A and 20% of NA used DS, with no statistically significant differences between groups (p=0.231). Magnesium (A: 35%; NA: 36%) and calcium (A: 28%; NA: 7%) were the most frequently used minerals. Vitamin C (A: 37%; NA: 36%) and multi-vitamin supplements (A: 40%; NA: 29%) were the most often used vitamins. The main reason for DS intake was for health improvement (A: 77%; NA: 71%). The main information source was cited as their parents (A: 66%, NA: 71%).Discussion: Young German athletes beginning their sporting career show similar supplementation habits astheir non-athletic counterparts. Compared to the literature, prevalence of DS use amongst the observed athletes is low. This is likely to increase with age and growing performance level. Keeping that and possible doping infractions or overdoses in mind, nutritional education should start early in ones sporting career and should include the parents.KEY WORDS: Dietary Supplement, Nutritional Supplement, Elite Athlete, Adolescent, Sports Nutrition, Non-Athlete

Adolescent athletes are a vulnerable target group for nutritional education and nutritional interventions. Although the level of nutritional knowledge and food literacy should be known before conducting nutritional interventions, there is no valid tool available to assess the nutritional knowledge of German adolescent athletes. Thus, the aim of the study was to modify and validate an internationally established nutrition knowledge questionnaire for adults for use in German adolescent athletes. The General Nutrition Knowledge Questionnaire (GNKQ) was translated into German and subsequently tested in two phases. In total, 75 adolescent athletes (40 m/35 f; 14 1 years) attending Elite Schools of Sports participated. First, 34 participants answered 45 questions allocated into four knowledge sections. All questions correctly answered by 80% or 20%, were eliminated as part of the validation strategy (N=13 questions). The remaining questions were then analyzed for internal and test-retest reliability, with 41 new participants completing the validated version. Overall, reliability values of the validated questionnaire were 0.86 (Cronbachs alpha) and 0.92 (Pearsons correlation coefficient). Taken together, participants answered 48 21% of the questions correctly (males: 50 11% vs. females: 45 9%, p = 0.03). In conclusion, with this modified GNKQ it is now possible to reliably assess the nutritional knowledge and food literacy of German adolescent athletes and to use this modified assessment tool to measure improvements evoked by nutritional education programs.KEY WORDS: Nutritional Knowledge, Adolescent Athletes, Questionnaire, Validity and Reliability