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Objectives To describe the design and implementation of an injury surveillance system for youth mountain bike racing in the United States, and to report preliminary first-year results. Design Descriptive sports injury epidemiology study. Methods After two and a half years of development and extensive beta-testing, an electronic injury surveillance system went live in January, 2018. An automated email is sent to a Designated Reporter on each team, with links to the injury reporting form. Data collected include demographic information, injured body part, injury diagnosis, trail conditions and other factors associated with injury occurrence. Results 837 unique injuries were reported in 554 injury events among 18,576 student-athletes. The overall injury event proportion was 3.0%. The most common injury among student-athletes was concussion/possible concussion (22.2%), followed by injuries to the wrist and hand (19.0%). Among 8,738 coaches, there were 134 unique injuries reported that occurred in 68 injury events, resulting in an overall injury event proportion of 0.8%. The shoulder (38.2%) was the most commonly injured body part among coaches. Injuries among coaches tended to more frequently result in fractures, dislocations and hospital admission compared with injuries among student-athletes. Among student-athletes, female riders sustained lower limb injuries more than male riders (34.0% vs. 20.7%, p Conclusions A nationwide injury surveillance system for youth mountain bike racing was successfully implemented in the United States. Overall injury event proportions were relatively low, but many injury events resulted in concussions/possible concussions, fractures, dislocations and 4 weeks or longer of time loss from riding.

ObjectiveTo describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures.MethodsDaily illnesses were recorded via the web-based injury and illness surveillance system (teams with their own medical staff; n=81), and local polyclinic services (teams without their own medical staff; n=81). Illness proportion, incidence and burden were reported for all illnesses and in subgroups by sex, age, competition period, sports and physiological system.Results4403 athletes (1853 female and 2550 male) from 162 countries were monitored for the 15-day period of the Tokyo Paralympic Games (66 045 athlete days). The overall incidence of illnesses per 1000 athlete days was 4.2 (95% CI 3.8 to 4.8; 280 illnesses). The highest incidences were in wheelchair tennis (7.1), shooting (6.1) and the new sport of badminton (5.9). A higher incidence was observed in female compared with male athletes (5.1 vs 3.6; p=0.005), as well as during the precompetition versus competition period (7.0 vs 3.5; p1 day.ConclusionThe incidence of illness at the Tokyo 2020 Paralympic Games was the lowest yet to be recorded in either the summer or winter Paralympic Games. Dermatological and respiratory illnesses were the most common, with the burden of respiratory illness being the highest, largely due to time loss associated with COVID-19 cases. Infection countermeasures appeared successful in reducing respiratory and overall illness, suggesting implementation in future Paralympic Games may mitigate illness risk.

A web-based injury surveillance system was implemented through a collaboration between University of Utah researchers and the National Interscholastic Cycling Association (NICA) to better understand injury characteristics in mountain biking. Data were collected from NICA leagues during the 2018 and 2019 seasons. Injuries were tracked in 41,327 student-athlete-years, identifying 1750 unique injuries during 1155 injury events. Rider-dependent and rider-independent variables were analyzed. The most commonly reported injuries were concussion (23.6%), injuries to the wrist/hand (22.3%), and shoulder (15.6%). Half of all injury events occurred on downhills. Men and women reported similar yet significantly different injury rates (2.69% and 3.21%, respectively; P = 0.009). Women sustained more lower-limb injuries (37.8% vs 28.3%; P = 0.003). Nearly 50% of crashes resulted in an emergency room visit. Youth mountain bike racing is a rapidly growing sport. Acute traumatic injuries are common. Injury surveillance system data are now being used to inform injury prevention strategies and direct future research.

Interscholastic youth cross-country mountain bike racing in the United States has grown significantly over the past decade, yet little is known about the risk profile in this age group. Aiming to protect participants, we implemented a prospective, longitudinal injury surveillance system for the purpose of better understanding youth mountain biking injuries and implementing safety measures. Data were collected during competition years 2018–2020, totaling 66,588 student athlete-years. Designated reporters from each team received weekly emails with exposure and incident report forms. Variables analyzed included demographic, rider-related, trail-related, and other data. Injury characteristics during the COVID-19 pandemic in 2020 were compared to the years 2018 and 2019. More student athletes participated in the 2020 season (25,261) than in prior seasons (18,575 in 2018 and 22,752 in 2019). During competition year 2020, overall injury proportion was lower (1.7% versus 3.0% in 2018 and 2.7% in 2019). Variables associated with injury, body part injured, type of injury, time-loss, and disposition following injury were similar between all years. Despite the pandemic and resultant changes to competition, student athletes continued to ride their bikes and become injured, but the proportion of injuries differed. This report details injury characteristics in youth mountain bike racing, including a comparison of before and during the pandemic.

Injury management is critical in the National Basketball Association (NBA), as players experience a wide variety of injuries. Recently, it has been suggested that game schedules, such as back-to-back games and four games in five days, increase the risk of injuries in the NBA. The aim of this study was to examine the association between game schedules and player injuries in the NBA.Descriptive epidemiology study.The present study analyzed game injuries and game schedules in the 2012-13 through 2014-15 regular seasons. Game injuries by game schedules and players' profiles were examined using an exact binomial test, the Fisher's exact test and the Mann-Whitney-Wilcoxon test. A Poisson regression analysis was performed to predict the number of game injuries sustained by each player from game schedules and injured players' profiles.There were a total of 681 cases of game injuries sustained by 280 different players during the three years (total N=1443 players). Playing back-to-back games or playing four games in five days alone was not associated with an increased rate of game injuries, whereas a significant positive association was found between game injuries and playing away from home (p0.05). Playing back-to-back games and away games were significant predictors of frequent game injuries (p0.05).Game schedules could be one factor that impacts the risk of game injuries in the NBA. The findings could be useful for designing optimal game schedules in the NBA as well as helping NBA teams make adjustments to minimize game injuries.

Understanding and characterizing confounding factors to the Athlete Biological Passport (ABP) is crucial for the reliable interpretation of biological profiles in the antidoping field. The physiological effects on hematological parameters and plasma volume (PV) following competition in a long-distance triathlon, as seen in the Ironman discipline, have yet to be fully described and are the focus of this study. Complete blood count blood tests were conducted on 19 Ironman triathletes before and after an Ironman triathlon to characterize changes in hematological parameters and the effect on ABP interpretation, as it was hypothesized that changes in the plasma volume may result in the presentation of atypical ABP profiles. Baseline blood samples were collected from the athletes prior to the event, and one sample was collected per day for up to 1 week following the race. Differences were observed between the male and female athletes across multiple parameters. Most importantly to the ABP, decreases in hemoglobin concentration (HGB) and hematocrit (HCT) were identified post-race, with the largest decreases identified on day +2. The average HGB returned to pre-race baseline levels on day +5. Beginning 5-6 days after the race, increases in the reticulocyte percentage (Ret%) were identified. Atypical Passport Findings were identified in 32% (6/19) of the ABPs, flagged mainly due to atypical hemoglobin concentration and one instance in which the OFF-score exceeded the adaptive model limits. These results offer a characterized timeline of hematological changes and expected shifting of plasma volume following an Ironman triathlon providing important data for the reliable interpretation of ABP profiles in this field.

The benefit of sport for athletes with impairments is well established. However, sport participation is not without risk. The existing literature informs us that injury patterns are sport and disability specific. Further research is needed to study injuries in this population.

The laboratory profile of intranasal testosterone gel has not been previously reported from an anti-doping perspective. Because intranasal testosterone gel is newly available as a commercial product, we sought to examine the laboratory parameters following administration of this formulation, with particular attention to anti-doping guidelines. Five healthy and active male subjects were administered testosterone intranasal gel three times daily for four weeks, using a pattern of five consecutive days on, two days off. Urine was collected after each five-day round of drug administration and analyzed using a full steroid screen and isotope ratio mass spectrometry (IRMS). Windows of detection for elevated testosterone/epitestosterone (T/E) and other steroid ratios, World Anti-Doping Agency (WADA) athlete biological passport (ABP) findings, and IRMS results were analyzed in this study. In the 0-24 h window post-administration, 70% of samples were flagged with a suspicious steroid profile and 85% were flagged as atypical passport findings according to the WADA ABP steroid module. In the 24-48 h window, 0% of samples displayed suspicious steroid profiles while 40% resulted in atypical passport findings. IRMS testing confirmed the presence of exogenous testosterone in 90% and 40% of samples in the 0-24 h and 24-48 h windows post-administration, respectively. Additionally, IRMS data were analyzed to determine commonalities in the population changes in δ13 C values of testosterone, androsterone, etiocholanolone, 5αAdiol, and 5βAdiol. Though no discernible metabolic trend of the route of administration was identified, we discovered that intranasal gel testosterone is detectable using conventional anti-doping tests. Copyright © 2016 John Wiley & Sons, Ltd.

ObjectiveTo describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games.MethodsA total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems.ResultsThere were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)).ConclusionsIn a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games.

ObjectiveTo describe the epidemiology of illness at the Sochi 2014 Winter Paralympic Games.MethodsA total of 547 athletes from 45 countries were monitored daily for 12 days over the Sochi 2014 Winter Paralympic Games (6564 athlete days). Illness data were obtained daily from teams without their own medical support (13 teams, 37 athletes) and teams with their own medical support (32 teams, 510 athletes) through electronic data capturing systems.ResultsThe total number of illnesses reported was 123, with an illness incidence rate (IR) of 18.7 per 1000 athlete days (95% CI 15.1% to 23.2%). The highest IR was reported for wheelchair curling (IR of 20.0 (95% CI 10.1% to 39.6%)). Illnesses in the respiratory system (IR of 5.6 (95% CI 3.8% to 8.0%)), eye and adnexa (IR of 2.7 (95% CI 1.7% to 4.4%)) and digestive system (IR of 2.4 (95% CI 1.4% to 4.2%)) were the most common. Older athletes (35–63 years) had a significantly higher IR than younger athletes (14–25 years, p=0.049).ConclusionsThe results of this study indicate that Paralympic athletes report higher illness incidence rates compared to Olympic athletes at similar competitions. The highest rates of illness were reported for the respiratory and digestive systems, eye and adnexa, respectively. Thus, the results of this study form a basis for the identification of physiological systems at higher risk of illness, which can in turn inform illness prevention and management programmes with eventual policy change to promote athlete safety in future editions of the Winter Paralympic Games.

Context Clomiphene is a performance-enhancing drug commonly abused by males in sport, but the extent to which testosterone increases in healthy males following its use is unknown. In addition, evidence suggests that clomiphene, a mixture of cis- and trans-isomers zuclomiphene and enclomiphene, is detectable in urine for months following use; the isomer-specific urinary detection window has yet to be characterized in a controlled study. Objective To determine the effect of once-daily, 30-day clomiphene treatment on serum testosterone and gonadotropin levels in the subject population studied and the urinary clearance and detection window of clomiphene isomers following administration for antidoping purposes. Participants and Design Twelve healthy males aged 25 to 38 years, representing a recreational athlete population, participated in this open-label, single-arm study. Intervention Oral clomiphene citrate (50 mg) was self-administered once daily for 30 days. Serum and urine samples were collected at baseline and at days 7, 14, 21, 28, 30, 32, 35, 37, 44, 51, and 58; urine collections continued periodically up to day 261. Results Mean testosterone, LH, and FSH levels increased 146% (SEM, ±23%), 177% (±34%), and 170% (±33%), respectively, during treatment compared with baseline. Serum drug concentrations and urinary excretion were nonuniform among individuals as isomeric concentrations varied. The zuclomiphene urinary detection window ranged from 121 to >261 days. Conclusions Clomiphene significantly raised serum testosterone and gonadotropin levels in healthy men and thus can be abused as a performance-enhancing drug. Such abuse is detectable in urine for ≥4 months following short-term use.

Background The epidemiology of injury in Paralympic football has received little attention. A study of all sports at the London 2012 Paralympic Games identified football 5-a-side as the sport with the highest injury rate, meriting further detailed analysis, which may facilitate the development of strategies to prevent injuries. Objective To examine the injury rates and risk factors associated with injury in Paralympic football. Design Secondary analysis of a prospective cohort study of injuries to football 5-a-side and football 7-a-side athletes. Setting London 2012 Paralympic Games. Participants Participants included 70 football 5-a-side athletes and 96 football 7-a-side athletes. Athletes from all but one country chose to participate in this study. Methods The Paralympic Injury and Illness Surveillance System was used to track injuries during the Games, with data entered by medical staff. Main Outcome Measurements Injury incidence rate (IR) and injury incidence proportion (IP). Results The overall IR for football 5-a-side was 22.4 injuries/1000 athlete-days (95% confidence interval [CI], 14.1-33.8) with an IP of 31.4 injuries per 100 athletes (95% CI, 20.9-43.6). In 5-a-side competition, 62.5% of injuries were associated with foul play. The overall IR for football 7-a-side was 10.4 injuries/1000 athlete-days (95% CI, 5.4-15.5), with an IP of 14.6 injuries per 100 athletes (95% CI, 7.5-21.6). The most commonly injured body region in both sports was the lower extremity. Conclusions To our knowledge, this study is the first to examine IR and risk factors associated with injury in Paralympic football. Future studies are needed to determine mechanisms of injury and independent risk factors for injury, thus informing prevention strategies.

Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7-day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete-days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete-days (95% CI 24.0-42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8-29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.

To examine whether changing weigh-in from the same day of the match to the day before the match and prohibiting 6-oz gloves are associated with fatalities in boxing matches sanctioned by the Japan Boxing Commission (JBC).We analyzed the rates of boxing fatalities before and after the two rule changes above via secondary analysis of data. Demographics and boxing records of deceased boxers were examined using descriptive statistics, exact binomial test the Mann-Whitney-Wilcoxon test and Fisher's exact tests.As of this study, a total of 38 boxers (23.9 ± 3.3 years of age) reportedly died due to injuries sustained in JBC-sanctioned boxing matches since 1952. Changing weigh-in to the day before the match or prohibiting 6-oz gloves was not significantly associated with the rates of boxing fatalities 5 years and 10 years before and after the rule changes (p 0.05). Deceased boxers after these rule changes were significantly older, completed significantly more rounds in the final match, and were significantly less likely to lose the previous match (prior to the final match) and to do so by knockouts (p 0.05).Changing weigh-in to the day before the match and prohibiting 6-oz gloves may not result in reducing boxing fatalities.

To characterize factors associated with helmet use and risk-taking behavior among recreational skiers and snowboarders.Observational study.Large, western United States mountain resort.1285 male and female recreational skiers and snowboarders were interviewed during a single winter ski season.Helmet use, demographic, and sport-related characteristics.Brief sensation seeking scale (BSSS) as a measure of risk-taking behavior and self-reported risk compensation.Of the respondents (N = 1285), 17.5%, 12.5%, and 70.0% reported that they never, sometimes, and always wore a helmet, respectively. Multiple linear regression analysis showed that individuals reporting sometimes wearing a helmet had significantly higher BSSS scores than those reporting never wearing a helmet (P = 0.031) or always wearing it (P = 0.018). Male gender, younger age, snowboarding, higher perceived sport ability, more days per year skiing or snowboarding, and more time spent in the terrain park were significantly associated with higher BSSS scores (P0.05). Logistic regression analysis focusing on subgroups of respondents who reported either sometimes or always wearing a helmet indicated that the odds of taking more risks when wearing a helmet for inconsistent helmet users was 75% higher than the odds for those who reported always wearing a helmet (P = 0.06).Inconsistent helmet users have characteristics of risk-taking behavior and risk compensation. Male gender, younger age, snowboarding, higher perceived sport ability, and more time spent on the mountain and in the terrain park are also important determinants of risk-taking behavior.

The rapid evolution of Paralympic sports, which includes an increase in participation, the addition of new sports, and advancements in technology, is essential to understanding the literature analyzing risk of injury in adaptive sports. Interpreting the injury data is complicated by the variability in the definition of injury across studies as well as the unique grouping of sports by disability. The goal of this chapter is to review the current literature on adaptive sports epidemiology, ultimately in a quest to better care for Paralympic patients. In order to better understand possible patterns of injury, this chapter is organized by location, type, and rate of injury with further division between winter and summer sports. It is clear that patterns of injury are emerging with the assistance from injury surveillance studies. More recent results have identified significant differences in injury rates between sports and events. However, there is still a need for longitudinal event-specific, sport-specific, and impairment-specific studies.

Background In this study we describe (1) the implementation of a novel web-based injury and illness surveillance system (WEB-IISS) for use by a team of physicians at multisport events and (2) the incidence and characteristics of injuries and illness in athletes during the London 2012 Paralympic Games. Methods Overall, 3565 athletes from 160 of the 164 participating countries were followed daily over a 14-day period, consisting of a precompetition period (3 days), and a competition period (11 days) (49 910 athletedays). Daily injury and illness data were obtained from teams with their own medical support (78 teams, 3329 athletes) via the WEB-IISS, and without their own medical support through the London Organising Committee of the Olympic Games and Paralympic Games database (82 teams and 236 athletes). Results There were no differences between incidence rates (IR) of injury and illness, or between the precompetition and competition periods. The IR of injury during the competition period was 12.1/1000 athlete-days, with an incidence proportion (IP) of 11.6% (95% CI 11.0% to 13.3%). Upper limb injuries (35%), particularly of the shoulder (17%) were most common. The IR of illness during the competition period was 12.8/1000 athlete-days (95% CI 12.18 to 1421), with an IP of 10.2%. The IP was highest in the respiratory system (27.4%), skin (18.3%) and the gastrointestinal (14.5%) systems. Conclusions During the competition period, the IR and IP of illness and injury at the Games were similar and comparable to the observed rates in other elite competitions. In Paralympic athletes, the IP of upper limb injuries is higher than that of lower limb injuries and non-respiratory illnesses are more common.

Background The incidence and factors associated with illness in Paralympic athletes have not been documented. Aim To determine the factors associated with illness in athletes participating in the London 2012 Paralympic Games. Methods A cohort of 3565 athletes from 160 of the 164 participating countries in the London 2012 Paralympic Games were followed over a 14-day period (precompetition period=3 days, competition period=11 days; 49 910 athlete-days). Daily illness data were obtained from (1) teams with their own medical support who completed a daily illness log (78 teams, 3329 athletes) on a novel web-based system and (2) teams without their own medical support through the local organising committee database (82 teams, 236 athletes). Illness information from all athletes included age, gender, type of sport and the main system affected. Main outcome measurement Incidence rate (IR) of illness (illness per 1000 athlete-days) and factors associated with IR (time period, gender, age and sport). Results The IR of illness was 13.2 (95% CI 12.2 to 14.2). The highest IR of illness was in the respiratory system, followed by the skin, digestive, nervous and genitourinary systems. The IR in the precompetition period was similar to that in the competition period, but the IR was significantly higher in athletics compared with other sports. Age and gender were not independent predictors of illness. Conclusions Illness is common in Paralympic athletes and the main factor associated with higher IR of illness was the type of sport (athletics).

Background The characteristics and incidence of injuries at the Summer Paralympic Games have not previously been reported. A better understanding of injuries improves the medical care of athletes and informs future injury prevention strategies. Objective The objective of this prospective cohort study was to characterise the incidence and nature of injuries during the London 2012 Summer Paralympic Games. Methods Injury information was obtained from two databases. One database was populated from medical encounter forms completed by providers at the time of assessment in one of the medical stations operated by the Organising Committee. The second database was populated daily with information provided by team medical personnel who completed a comprehensive, web-based injury survey. Results The overall injury incidence rate was 12.7 injuries/1000 athlete-days. Injury rates were similar in male and female athletes. The precompetition injury rates in women were higher than those in the competition period. Higher injury rates were found in older athletes and certain sports such as football 5-a-side (22.4 injuries/1000 athlete-days). Overall, 51.5% of injuries were new onset acute traumatic injuries. The most commonly injured region (percentage of all injuries) was the shoulder (17.7%), followed by the wrist/hand (11.4%), elbow (8.8%) and knee (7.9%). Conclusions This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes. Injury rates differ according to age and sport. Upper limb injuries are common. The knowledge gained from this study will inform future injury surveillance studies and the development of prevention strategies in Paralympic sport. The Epidemiology of Injuries at the London 2012 Paralympic Games.

Teramoto, M, Cross, CL, Rieger, RH, Maak, TG, and Willick, SE. Predictive validity of national basketball association draft combine on future performance. J Strength Cond Res 32(2): 396-408, 2018-The National Basketball Association (NBA) Draft Combine is an annual event where prospective players are evaluated in terms of their athletic abilities and basketball skills. Data collected at the Combine should help NBA teams select right the players for the upcoming NBA draft; however, its value for predicting future performance of players has not been examined. This study investigated predictive validity of the NBA Draft Combine on future performance of basketball players. We performed a principal component analysis (PCA) on the 2010-2015 Combine data to reduce correlated variables (N = 234), a correlation analysis on the Combine data and future on-court performance to examine relationships (maximum pairwise N = 217), and a robust principal component regression (PCR) analysis to predict first-year and 3-year on-court performance from the Combine measures (N = 148 and 127, respectively). Three components were identified within the Combine data through PCA (= Combine subscales): length-size, power-quickness, and upper-body strength. As per the correlation analysis, the individual Combine items for anthropometrics, including height without shoes, standing reach, weight, wingspan, and hand length, as well as the Combine subscale of length-size, had positive, medium-to-large-sized correlations (r = 0.313-0.545) with defensive performance quantified by Defensive Box Plus/Minus. The robust PCR analysis showed that the Combine subscale of length-size was a predictor most significantly associated with future on-court performance (p ≤ 0.05), including Win Shares, Box Plus/Minus, and Value Over Replacement Player, followed by upper-body strength. In conclusion, the NBA Draft Combine has value for predicting future performance of players.

The National Football League (NFL) Scouting Combine is held each year before the NFL Draft to measure athletic abilities and football skills of college football players. Although the NFL Scouting Combine can provide the NFL teams with an opportunity to evaluate college players for the upcoming NFL Draft, its value for predicting future success of players has been questioned. This study examined whether the NFL Combine measures can predict future performance of running backs (RBs) and wide receivers (WRs) in the NFL. We analyzed the 2000-09 Combine data of RBs (N = 276) and WRs (N = 447) and their on-field performance for the first 3 years after the draft and over their entire careers in the NFL, using correlation and regression analyses, along with a principal component analysis (PCA). The results of the analyses showed that, after accounting for the number of games played, draft position, height (HT), and weight (WT), the time on 10-yard dash was the most important predictor of rushing yards per attempt of the first 3 years (p = 0.002) and of the careers (p < 0.001) in RBs. For WRs, vertical jump was found to be significantly associated with receiving yards per reception of the first 3 years (p = 0.001) and of the careers (p = 0.004) in the NFL, after adjusting for the covariates above. Furthermore, HT was most important in predicting future performance of WRs. The analyses also revealed that the 8 athletic drills in the Combine seemed to have construct validity. It seems that the NFL Scouting Combine has some value for predicting future performance of RBs and WRs in the NFL.

Running is an excellent activity to promote general health and well-being. However, running injuries are common, and concern is sometimes raised that running might lead to osteoarthritis in weight-bearing joints. This article reviews the relevant in vitro and in vivo literature that looks at possible associations between running and the development of osteoarthritis. Also reviewed is the limited literature on running barefoot and with minimalist footwear. Low- and moderate-volume runners appear to have no more risk of developing osteoarthritis than nonrunners. The existing literature is inconclusive about a possible association between high-volume running and the development of osteoarthritis. The early literature on running barefoot and running with minimalist footwear has primarily focused on biomechanics but has not yet focused on any effect on cartilage health. Experienced and beginner runners should be encouraged to allow the body adequate time to adapt to changes in gait biomechanics caused by changing footwear, which can be done by slowly increasing running mileage in the new footwear. Clinicians can improve the health of runners by encouraging appropriate treatment of musculoskeletal injuries, encouraging maintenance of an optimal body mass index, and correcting gait abnormalities caused by deficits in flexibility, strength, or motor control along the kinetic chain.

Objective To identify risk factors for volleyball-related shoulder pain and dysfunction. Design Cross-sectional, observational. Setting National championship sporting event. Participants Competitors at the 2006 National Intramural & Recreational Sports Association Collegiate Club Volleyball Championship competition were invited to volunteer for the study. A total of 422 athletes returned questionnaires, of whom 276 also underwent a structured physical examination. Assessment of Risk Factors Study participants provided information on any history of volleyball-related shoulder pain or dysfunction. The simple shoulder test (SST) and a visual analog scale permitted subjects to quantify the extent of their perceived functional limitation. Subjects also were invited to undergo a physical examination in which dynamic scapular positioning, glenohumeral range of motion, shoulder girdle strength, and core stability were assessed. Main Outcome Measurements Standard statistical methods of comparison and tests of association were used to identify risk factors for shoulder pain among participating volleyball athletes. Results Approximately 60% of participants reported a history of shoulder problems. Attackers and "jump" servers were more likely to have shoulder problems than setters, defensive specialists, and "float" servers. Nearly half of the athletes who reported shoulder problems perceived some associated functional limitation, with female athletes providing lower SST scores than male athletes (9.0 versus 10.1, P = .001). Athletes reporting shoulder pain and dysfunction were more likely to have SICK scapula scores of 3 or greater ( P = .010). Participants who demonstrated core instability also had greater SICK scapula scores (3.9 versus 2.9, P = .038), and were more likely to report a history of shoulder problems (χ 2 = 8.83, P = .032). Although the authors observed a significant mean left-right difference of 8.9° in available glenohumeral internal rotation among participating athletes, this deficit was not associated with shoulder problems. However, there was an association between asymmetric coracoid tightness /pectoral shortening and shoulder pain ( P = .030), as well as for restricted shoulder flexion in the sagittal plane and shoulder problems ( P = .015). Conclusions Although most risk factors for volleyball-related shoulder problems are similar to those identified for other overhead sports, there appear to be additional volleyball-specific risk factors that may reflect the biomechanical demands of the sport. An understanding of modifiable risk factors is critical to providing optimal care for overuse injuries and may facilitate future efforts to prevent shoulder problems among volleyball athletes.

Medical care of athletes with disabilities parallels medical care for nondisabled athletes. Limb deficiencies, whether congenital, traumatic, or secondary to disease, confer certain challenges to sports participation. Although sports medicine research for people with disabilities lags behind sports medicine research for the nondisabled, there are nonetheless important points to be learned from the available body of published literature in this area. This article reviews the pertinent research literature and supplements it with clinical wisdom that may assist physicians, coaches, prosthetists, and trainers to help keep athletes with limb deficiencies active. The relevant epidemiologic, biomechanical, medical, and psychological issues are discussed.

To critically review the best available studies evaluating the efficacy of lumbosacral transforaminal epidural steroid injections (TFESIs) in the treatment of radicular pain.MEDLINE, EMBASE, and the Cochrane database were searched for the period between 1950 and May 2008. Search terms included epidural steroid injection (ESI), transforaminal ESI, foraminal ESI, selective nerve root block, nerve root injection (NRI), selective NRI, periradicular infiltration, and periradicular injection. Randomized controlled trials (RCTs), published in English, which evaluated the efficacy of fluoroscopically guided TFESIs were reviewed.Studies were analyzed with a quality checklist modeled after the 2001 CONSORT Statement: Revised Recommendations for Improving the Quality of Reports of Parallel-Group Randomized Trials. Nine studies were found to include a majority of these items.Data included study design, inclusion criteria, symptom duration, randomization protocol, blinding protocol, intervention, control, outcomes, follow-up, dropout, statistical analysis, and conclusions.Each article was assigned a level of evidence: I (high-quality RCT) or II (RCT with80% follow-up, no blinding or improper randomization). Studies were divided according to control, and overall evidence was graded as A (good), B (fair), C (conflicting/poor quality), or I (insufficient).There is fair evidence supporting TFESIs as superior to placebo for treating radicular symptoms. There is good evidence that TFESIs should be used as a surgery-sparing intervention, and that TFESIs are superior to interlaminar ESIs (ILESIs) and caudal ESIs for radicular pain. In patients with subacute or chronic radicular symptoms, there is good evidence that a single TFESI has similar efficacy as a single transforaminal injection of bupivacaine or saline. Future studies should address the ideal number of injections. While more placebo-controlled trials are needed to conclusively define the role of TFESIs, current studies support their use in the treatment of lumbosacral radicular pain.

Objective This self-directed learning module highlights medical coverage of sports events and artistic performances. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on performance anxiety, exercise-associated collapse, exercise-induced asthma, transient quadriparesis, stingers/burners and anterior glenohumeral joint dislocations. The goal of this article is to improve the learner's ability to formulate and implement an appropriate evaluation and treatment algorithm for certain conditions associated with sports and performing arts events.

Objective This self-directed learning module highlights upper limb sports and performing arts injuries. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on shoulder, elbow and finger pain in athletes and wrist pain in musicians. The goal of this article is to enhance the learner's understanding on how to approach common upper limb pain conditions and injuries in these populations.

Objective This self-directed learning module highlights tendinopathy associated with sports and performing arts. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on the etiology, pathophysiology, clinical presentation, diagnostic imaging, and management recommendations for tendinopathy. The goal of this article is to allow the learner to better describe the pathophysiology and diagnostic imaging characteristics of tendinopathy, and to formulate an appropriate nonsurgical management algorithm for tendinopathies.

Background: The incidence rates (IRs) and factors associated with injuries in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied. Purpose: To determine injury IRs, characteristics of injuries, and associated factors in the sport of athletics at the London 2012 Paralympic Games. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 977 athletes competing in the sport of athletics were followed over a total 10-day competition period of the Paralympic Games. Daily injury data were obtained via 2 databases: (1) a custom-built, web-based injury and illness surveillance system (WEB-IISS), maintained by team medical personnel; and (2) the organizing committee database, maintained by medical providers in the medical stations operated by the London Organising Committee of the Olympic and Paralympic Games. Athlete impairment and event discipline were obtained via the International Paralympic Committee athlete database. IRs (injuries per 1000 athlete-days) by impairment, event discipline, sex, and age were examined. Results: The overall IR was 22.1 injuries per 1000 athlete-days (95% CI, 19.5-24.7). In track disciplines, ambulant athletes with cerebral palsy experienced a lower incidence of injuries (IR, 10.2; 95% CI, 4.2-16.2) when compared with ambulant athletes from other impairment categories. Athletes in seated throwing experienced a higher incidence of injuries (IR, 23.7; 95% CI, 17.5-30.0) when compared with athletes in wheelchair racing (IR, 10.6; 95% CI, 5.5-15.6). In both track and field disciplines, the majority of injuries did not result in time loss from competition or training. Ambulant athletes experienced the greatest proportion of injuries to the thigh (16.4% of all injuries; IR, 4.0), observed predominantly in track athletes. Wheelchair or seated athletes experienced the greatest proportion of injuries to the shoulder/clavicle (19.3% of all injuries; IR, 3.4), observed predominantly in field athletes. Conclusion: This is the first prospective cohort study examining injury IRs and associated factors in the sport of athletics at the Paralympic Games. Injury patterns were specific to the event discipline and athlete impairment. The majority of injuries occurred to the thigh (ambulant athletes) or shoulder/clavicle (wheelchair or seated athletes) and did not result in time loss.

Background: The majority of studies on concussion in the National Football League (NFL) focus on testing, evaluation, and outcomes. Meanwhile, there is a paucity of research on how a team’s style of play influences the risk of concussion. Hypothesis: Style of play, such as offensive and defensive strategies, is associated with the rate of concussions in the NFL. Study Design: Descriptive epidemiology study. Methods: The current study retrospectively analyzed data from the 2012 to 2014 NFL regular seasons. Reported numbers of concussions were stratified by each team and each position and were compared based on style of play, including offensive scheme (West Coast offense, Air Coryell offense, or other offensive schemes) and defensive alignment (3-4 or 4-3), attempts statistics, per-drive statistics, and offensive and defensive productions, along with strength of schedule (SoS) and team quality measured by simple rating system (SRS). Data analyses included descriptive statistics, 1-way analysis of variance, correlation analysis, and regression analysis. Results: There were 437 documented concussions during the 2012 to 2014 NFL regular seasons, with a mean 4.6 concussions per season per team. In general, players most involved in pass plays reported more concussions. The number of concussions sustained by offensive players was significantly higher among the teams adopting the West Coast offense (mean, 3.0) than among those utilizing the Air Coryell offense (mean, 1.6; P = .006) or those with non–West Coast offenses combined (mean, 1.9; P = .004). The multiple regression analysis revealed that the West Coast offense or not, SoS, and SRS explained 25.3% of the variance in the number of concussions by offensive players. After accounting for SRS, the West Coast offense was found to be a significant predictor of the number of concussions ( P = .007), while there was a tendency for SoS to be inversely associated with the number of concussions ( P = .105). None of the variables for attempts statistics, per-drive statistics, and offensive production were significantly associated with the number of concussions in the regression analysis. Conclusion: In the NFL, players most involved in pass plays appear to be at increased risk for concussions. The West Coast offense may be associated with a greater risk of concussion. Furthermore, teams with easier schedules may have more players sustaining concussions.

A 70-year-old woman with a right hemisensory deficit caused by an incomplete cervical spinal cord injury presented with left hip pain. The clinical assessment suggested that her left-sided hip pain was attributable to severe right hip osteoarthritis. Her left hip pain resolved completely after she underwent a right total hip arthroplasty. This case is presented, along with a review of the literature on spinal and supraspinal neuronal reorganization after spinal cord injury. This case report suggests the occurrence of central sensory reorganization after an incomplete cervical spinal cord injury, which resulted in a patient perceiving right hip pathology in her left hip.

Background: Concussion prevention in the National Football League (NFL) is an important priority for player safety. The NFL now has modified game schedules, and one concern is that unconventional game schedules, such as a shortened rest period due to playing on a Thursday rather than during the weekend, may lead to an increased risk of injuries. Hypothesis: Unconventional game schedules in the NFL are associated with an increased rate of concussion. Study Design: Descriptive epidemiological study. Methods: This study analyzed concussions and game schedules over the NFL regular seasons from 2012 to 2015 (4 years). Documented numbers of concussions, identified by use of the online database PBS Frontline Concussion Watch, were summarized by regular-season weeks. Association of days of rest and game location (home, away, or overseas) with the rate of concussion was examined by use of the χ2 test. Logistic regression analysis was performed to examine the relationships of days of rest and home/away games to the risk of repeated concussions, with adjustment for player position. Results: A total of 582 concussions were analyzed in this study. A significantly greater number of concussions occurred in the second half of the season (P < .01). No significant association was found between the rate of concussion and the days of rest, game location, or timing of the bye week by the team or the opponent (P > .05). Game schedules were not significantly associated with the occurrence of repeat concussions (P > .05). Conclusion: Unconventional game schedules in the NFL, including playing on Thursday and playing overseas, do not seem to put players at increased risk of concussions.

Background Very little data have been published on medical imaging services at disability games. 7.9 million euros (£6.6 million, US$11 million) were invested in setting up radiology facilities within purpose built polyclinics at the London 2012 Olympic and Paralympic games. This paper details imaging services at the 2012 Paralympic Games. Data analysis on imaging at 2012 Olympics has been published in a separate paper. Aim To analyse the workload on the polyclinics’ radiology services, provided for the Paralympic athletes during the London 2012 Paralympic Games. Method Data were prospectively collected during the period of the Paralympic games from the Picture Archive Communications System (PACS) and the Radiological Information System (RIS). Data were correlated with the medical encounter database (ATOS). Results 655 imaging episodes were recorded, which comprised 38.8% (n=254) MRI, 33% (n=216) plain radiographs, 24% (n=157) ultrasound scans and 4.2% (n=28) CT scans. Investigations on the Paralympic athletes accounted for 65.2% of workload, with the remainder divided between Paralympic family and workforce. Conclusions MRI was the most used imaging resource and CT was the least used imaging modality at the Paralympic village polyclinic. Analysis of demographic data provides a useful index for planning radiology infrastructure and manpower at future international competitions for athletes with a disability.

Study Design. Multicenter, prospective, observational study. Objectives. To document the incidence of and factors associated with intravascular uptake during lumbar spinal injection procedures. Summary of Background Data. In prior reports, the incidence of inadvertent intravascular needle placement during contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures has been incidentally noted to range from 6.4% to 9.2%. We present the first systematic prospective documentation of intravascular uptake of contrast dye during different types of lumbar injection procedures. Methods. Fifteen interventional spine physicians in seven centers recorded data regarding intravascular uptake during 1219 contrast-enhanced, fluoroscopically guided lumbar spinal injection procedures. Results. The overall incidence of intravascular uptake during lumbar spinal injection procedures as determined by contrast enhanced fluoroscopic observation is 8.5%. Caudal and transforaminal routes have the highest rates at 10.9% and 10.8%, respectively, followed by zygapophyseal joint (6.1%), sacroiliac joint (5.3%), and translaminar (1.9%) injections. Intravascular uptake is twice as likely to occur in those patients over rather than under 50 years of age. Preinjection aspiration failed to produce a flashback of blood in 74% of cases that proved to be intravascular upon injection of contrast dye. Conclusion. The incidence of intravascular uptake during lumbar spinal injection procedures is approximately 8.5%. The route of injection and the age of the patient greatly affect this rate. Absence of flashback of blood upon preinjection aspiration does not predict extravascular needle placement. Contrast-enhanced, fluoroscopic guidance is recommended when doing lumbar spinal injection procedures to prevent inadvertent intravascular uptake of injectate.