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Context: Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions. Case Presentation: A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options. Management and Outcomes: The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient's complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up. Conclusion: In this article, we present a case in which OP was successfully treated with ozone injection. [ABSTRACT FROM AUTHOR]

Background: The health benefits associated with recreational running are challenged by the occurrence of running-related injuries (RRIs). Effective preventive measures require knowledge of sport injury etiology. Psychological factors such as perfectionism, mental toughness, and passion are believed to predispose to sports injury by influencing training behaviors, motivation to run, and suppression of feelings of fatigue and pain. Yet their association with RRIs are understudied. Hypothesis: Perfectionism, mental toughness, and passion predict an increased risk of RRIs in recreational runners. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A total of 143 recreational runners (age 34.9 ± 13.9 years, 37% women) with a response rate of 76.5% answered an online questionnaire about their characteristics, running behaviors, and psychological variables (perfectionism, mental toughness, and running passion) as well as a sports injury survey. Then, as a primary outcome, RRIs were recorded biweekly for 6 months. The incidence of injuries was expressed as RRI per 1000 hours of running. The association between predictive factors and RRIs was estimated using logistic regression. Results: The incidence of RRIs during follow-up was 5.16 per 1000 hours of running. The knee was the location injured most often (26.4%), followed by the foot (18.9%) and lower leg (13.2%). Higher obsessive passion (OP) for running (odds ratio [OR], 1.11; 95% CI, 1.04-1.20) and perfectionistic concerns (OR, 1.22; CI,1.05-1.41) were associated with a greater risk of RRIs, as were previous injury (OR, 2.49; CI,1.10-5.70), weekly running distance (OR,1.10; CI, 1.03-1.16), and both supinated (OR, 4.51; CI, 1.11-18.30) and pronated (OR, 3.55; CI, 1.29-9.80) foot type. Following a running schedule (OR, 0.24; CI, 0.09-0.66) was associated with a lower risk of RRIs. Conclusion: History of previous RRI, pronated and supinated foot type, weekly running distance, perfectionistic concerns, and OP increased RRI risk in recreational runners. Following a running schedule was a protective factor. Clinical Relevance: Multiple factors, including runners' psychological characteristics, predict RRIs. These findings can inform the development of injury risk management strategies. [ABSTRACT FROM AUTHOR]

Background: Running is a widely practiced sport worldwide associated with a host of benefits on cardiovascular, metabolic, musculoskeletal, and mental health, but often leads to musculoskeletal overuse injuries. The prescription of a foot orthosis (FO) is common to manage musculoskeletal impairments during physical activity or functional tasks. Although FOs are frequently prescribed by clinicians for symptomatic populations of runners, the existing literature supporting the prescription of FOs in runners has predominantly focused on either uninjured individuals or a mix of uninjured and symptomatic populations. Thus, the effects of FOs on the treatment and/or prevention of overuse running injuries need to be investigated to guide future research and assist clinicians in their decision-making process. Main body: This scoping review aimed to evaluate the immediate and long-term effects of FOs on lower limb biomechanics, neuromuscular parameters, and pain and disability in symptomatic runners, and to identify factors that may influence the effects of FOs. Five databases (CINAHL, SPORTDiscus, MEDLINE, Embase, and Web of Science) were searched, resulting in 2536 studies. A total of 30 studies, published between 1992 and 2023 (730 symptomatic runners), were included following the removal of duplicates and the screening process. Wearing FOs while running is related to an immediate and a long-term decrease in pain and symptoms of overuse running injuries. Also, wearing FOs while running decreases eversion at the foot/ankle complex, leads to a more lateral plantar pressure at the heel and forefoot, and may change running motor control strategies. Finally, the effectiveness of FOs is influenced by its added features. Conclusions: This study provides recommendations for future research such as the need for standardized methods in describing FOs, considering participant characteristics such as foot morphology, and comparing different types of FOs. Also, this scoping review provides valuable insights for guiding the prescription and design of FOs, and suggests that integrating FOs into a comprehensive treatment plan may yield better results than standalone first-line treatments. Nonetheless, this scoping review highlights the need for future research to explore the optimal integration of FOs into injury-specific treatment plans. Key Points: Foot orthoses may redistribute loads onto non-injured structures, thereby resulting in an immediate decrease in pain and potentially contributing to the treatment of injuries. A rearfoot medial wedge decreases rearfoot and/or calcaneal eversion motion and moments in injured runners. A foot orthosis integrated into a comprehensive treatment plan may yield better results compared to standalone first-line treatments. The use of sham/flat insoles as a control/blinding condition is crucial in evaluating the effect of a foot orthosis. [ABSTRACT FROM AUTHOR]

Background: Calcaneal apophysitis is the most common cause of heel pain in children and adolescents. However, the relationship between skeletal maturity and heel pain in the specific youth cohort is unclear. Purpose: To clarify the relationship between the maturity stages of the calcaneal apophysis and heel pain in youth baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 336 youth male baseball players participated in this study. Ultrasound scanning of the calcaneal apophysis was performed along the longitudinal line connecting the middle of the Achilles tendon, the middle of the calcaneus, and the second toe, between the proximal calcaneal edge and the medial calcaneal tubercle. The authors classified the maturity of the calcaneal apophysis into 5 stages, from nonpresence of the apophysis (stage 1) to complete fusion (stage 5). The diagnosis of heel pain was based on subjective report of feeling pain on the squeeze test. The relationship between the maturity stages and physical characteristics was investigated using 1-way analysis of variance or the Kruskal-Wallis test, and the relationship between the maturity stages and heel pain was investigated using the chi-square test. Results: Of the 336 players, 49 had heel pain, for a prevalence of 14.6%. Eighteen (5.4%) players had unilateral heel pain, and 31 (9.2%) players had bilateral heel pain. There were no significant differences in the maturity stages of the calcaneal apophysis between the players with no heel pain and those with heel pain. However, no players had heel pain during stage 5, when the calcaneus had completed its maturation. Conclusion: The prevalence of heel pain was 14.6% in Japanese youth male baseball players. There was no relationship between the maturity stages of the calcaneal apophysis and heel pain. Heel pain that could be associated with calcaneal apophysitis did not occur during stage 5, when maturation of the calcaneal apophysis was complete. [ABSTRACT FROM AUTHOR]

Abstract Background Running is a widely practiced sport worldwide associated with a host of benefits on cardiovascular, metabolic, musculoskeletal, and mental health, but often leads to musculoskeletal overuse injuries. The prescription of a foot orthosis (FO) is common to manage musculoskeletal impairments during physical activity or functional tasks. Although FOs are frequently prescribed by clinicians for symptomatic populations of runners, the existing literature supporting the prescription of FOs in runners has predominantly focused on either uninjured individuals or a mix of uninjured and symptomatic populations. Thus, the effects of FOs on the treatment and/or prevention of overuse running injuries need to be investigated to guide future research and assist clinicians in their decision-making process. Main body This scoping review aimed to evaluate the immediate and long-term effects of FOs on lower limb biomechanics, neuromuscular parameters, and pain and disability in symptomatic runners, and to identify factors that may influence the effects of FOs. Five databases (CINAHL, SPORTDiscus, MEDLINE, Embase, and Web of Science) were searched, resulting in 2536 studies. A total of 30 studies, published between 1992 and 2023 (730 symptomatic runners), were included following the removal of duplicates and the screening process. Wearing FOs while running is related to an immediate and a long-term decrease in pain and symptoms of overuse running injuries. Also, wearing FOs while running decreases eversion at the foot/ankle complex, leads to a more lateral plantar pressure at the heel and forefoot, and may change running motor control strategies. Finally, the effectiveness of FOs is influenced by its added features. Conclusions This study provides recommendations for future research such as the need for standardized methods in describing FOs, considering participant characteristics such as foot morphology, and comparing different types of FOs. Also, this scoping review provides valuable insights for guiding the prescription and design of FOs, and suggests that integrating FOs into a comprehensive treatment plan may yield better results than standalone first-line treatments. Nonetheless, this scoping review highlights the need for future research to explore the optimal integration of FOs into injury-specific treatment plans.

Dancers and musicians have unique physical demands that can lead to injury of the peripheral nerves. Specific dance movements and specific instrument positions, combined with countless hours of practice and repetition, create an environment for potential nerve injury. Familiarity with these variables and recognition of the common presentations of neuropathic syndromes are essential in the evaluation of a performing artist with a suspected peripheral nerve injury. Assessment should include an understanding and analysis of their dance style or instrument playing posture, particularly in the position or motion that recreates the symptoms if possible. Practice and performance schedules should also be considered. Diagnosis may require electrodiagnostic testing, imaging, or diagnostic injections. Treatment should be comprehensive and may include modifications in practice schedule, posture/position, and technique in addition to consideration of medications, splints/orthoses, physical therapy, and injections. The instructor/teacher should be involved in the treatment plan if applicable. Complete rest in this population may not be realistic or necessary. Early and accurate diagnosis of nerve injury is important for safe return to dance or instrumental music. [ABSTRACT FROM AUTHOR]

Year-round participation in youth sport that involves high levels of repetitive movement fosters an environment in which overuse injuries are likely to occur. Epiphyseal primary physeal stress injuries (PSIs), unique to skeletally immature athletes, are a particular concern, given their potential for growth disturbance. Initially observed in Little League baseball players, these injuries are now known to affect the long bones around the shoulder, elbow, wrist, hand, knee, ankle, and foot of skeletally immature athletes involved in a variety of sport activities. This article offers an epidemiological and radiologic perspective on the extent and distribution of epiphyseal PSIs in youth sport. We also review a novel framework for understanding the pathophysiologic mechanisms causing these injuries. This information is essential for the early identification of epiphyseal PSIs and devising preventive measures that can reduce a delayed diagnosis and long-term morbidity. Preventing and reducing injury to the epiphyseal growth plates is essential because impairment and dysfunction can result in lifelong morbidity and a risk of premature osteoarthritis. [ABSTRACT FROM AUTHOR]

Patellar tendon (PT) complaints are frequent in competitive alpine skiers and such complaints are characterized by a long-lasting affection. Since PTs are subject to maturation up to 1-2 years after growth spurt, this early career stage may be decisive for the further course of complaints. The aim of this study was to investigate the evolution of PT complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. The PT complaints and SWV patterns of forty-seven skiers were analysed at baseline (i.e., immediately after their peak height growth at 13-15 years of age) and were re-analysed at 4-year follow-up. The PTs were scanned via threedimensional SWE. Symptomatic skiers were identified based on pain sensation under loading and pressure-induced pain around the PT. The prevalence of PT complaints decreased from 29.8% at baseline to 12.8% at follow-up (Pearson's 2 = 9.429; p = 0.002). SWV decreased from the baseline assessment to the follow-up in the proximal and distal regions (p < 0.05). SWV coefficient of variation (CV) in the distal and mid-portion regions was greater at baseline than at follow-up (p < 0.05). At the follow-up assessment, compared to "healthy" skiers, "healed" skiers who recovered from PT complaints had lower SWVs in the proximal region (p = 0.020) and greater SWV CVs in the proximal region (p = 0.028). Moreover, symptomatic skiers had significantly greater SWV CVs in the mid-portion region than did "healthy" subjects with no history of PT complaints (p = 0.020). The average SWV was negatively correlated with the SWV (proximal: r = -0.74, p < 0.001; mid-portion: r = -0.37 p = 0.011; and distal: r = -0.58, p < 0.001). The occurrence of PT complaints decreased over a 4-year post-growth spurt follow-up. "Healed" skiers who were symptomatic at baseline had an even greater average decrease in the proximal and mid-portion SWV than "healthy" skiers with no history of PT complaints. This may lead to the hypothesis that PT complaints in adolescent skiers are not self-eliminating towards the end of adolescence, as at least structural irregularities appear to persist for several years after the onset of initial symptoms. Furthermore, "healed" and symptomatic tendons exhibited increased SWV variability, supporting the hypothesis that SWV CV may provide additional valuable information on the mechanical properties of PTs affected by overuse-related complaints. [ABSTRACT FROM AUTHOR]

The aim of the present study was to compare the coordination patterns and levels of coordination variability of healthy and injured runners with iliotibial band syndrome (ITBS). Sixty runners divided into four groups (15 healthy males, 15 healthy females, 15 males with ITBS and 15 females with ITBS) ran at a steady and freely chosen pace on an over-ground track, and their coordination patterns of the lower limbs were calculated during 10 running stances using the vector coding technique. Both male and female runners with ITBS showed a greater dominance of the pelvis segment and the anti—phase patterns in the frontal plane thigh—pelvis coupling (p = 0.001, η2 = 0.36). In addition, injured female runners showed a greater hip adduction dominance, whereas injured males presented a greater anti—phase pattern in the transverse plane—frontal plane hip coupling (p = 0.003, η2 = 0.08). The levels of coordination variability during running stance did not change between ITBS injured and healthy runners in any of the couplings. Currently injured runners with ITBS appeared to present altered coordination patterns on the hip couplings that were partly dependent on gender but did not lead to changes in the coordination variability levels. [ABSTRACT FROM AUTHOR]

This is a case of a 21-year-old male, African American Division I basketball player with a fibula stress fracture. The athlete initially reported pain, without distinct injury and was diagnosed with a stress fracture. After a short period of immobilization in a walking boot, this individual opted to undergo surgical intervention consisting of an intramedullary screw inserted in his left fibula. This was in consultation with the orthopedic team physician and orthopedic trauma surgeon. After a brief period of rest and continued immobilization in a walking boot, weight bearing as tolerated, the patient was able to start rehabilitation. He continued rehabilitation and progressive return to activity and was able to return to limited practice approximately 4 weeks. He played 13 min of a game in under 5 weeks (31 days). Stress fractures are not uncommon in basketball players, but a fibula stress fracture is one not often seen, and there is a paucity of data in the literature regarding this injury. A nonoperative approach to treatment of a fibula stress fracture typically yields good results but may lead to longer return than a surgical intervention. Providing athletes options for treatment may result in a quicker recovery. This case demonstrates a novel treatment option resulting in a quicker return to play. [ABSTRACT FROM AUTHOR]

Bouldering is a distinctive discipline within the broader realm of climbing sports, characterized by its dynamic nature and the absence of ropes, which leads to a higher frequency of falls. This climbing style has seen a surge in global popularity, with an increasing number of indoor bouldering facilities emerging worldwide. Bouldering, regarded by some authors as parkour adapted to vertical terrain, involves more dynamic movements than other climbing disciplines. This contributes to a considerable risk of overuse injuries in specific areas of the upper limbs and traumatic injuries in the lower limbs. Furthermore, bouldering, like other climbing disciplines, presents a risk of nail damage and subsequent fungal infections. In addition to examining injury risks, this review also touches on the issue of airborne chalk dust exposure, a well-documented concern in enclosed spaces during indoor bouldering. Our study aims to consolidate the available information, highlighting the potential health hazards of indoor bouldering, raising awareness of these risks, and underscoring the need for further research to better understand and mitigate these dangers.

To develop and validate the Youth Overuse Injury Questionnaire (YOvIQ). A cross-sectional study. Online platforms. Two content experts (in sports injury epidemiology and in sports science and medicine) and seven end-users (youth volleyball athletes) provided feedback during development of the YOvIQ. 227 competitive youth athletes across 14 different sports assessed the psychometric properties of the YOvIQ. Participants completed both YOvIQ and the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O2) for anatomical areas of the shoulder, elbow, lower back, knee, and ankle/foot. Validity was assessed via convergent validity. Reliability was assessed using internal consistency estimation and interclass correlation coefficient. Following feedback from content experts, examples and quantitative symbolization were added to the options in YOvIQ, with positive feedback from end-users. Convergent validity between YOvIQ and the OSTRC-O2 was demonstrated with non-significant differences (P ≥.05) and significant correlations (P < 0.001) for prevalence and severity scores. YOvIQ demonstrated internal consistency for prevalence (Cronbach's alpha coefficient >0.70) and moderate-to-good reliability for severity scores (ICC: 0.51 to 0.88) for shoulder, lower back, and knee. The YOvIQ is a valid and reliable instrument to identify overuse injuries to the shoulder, lower back, and knee in youth athletes. • The Youth Overuse Injury Questionnaire (YOvIQ) for youth athletes is validated for shoulder, elbow and knee overuse injuries. • YOvIQ can reliably determine shoulder, lower back and knee overuse injuries. • Use of YOvIQ can allow for prompt training and/or medical intervention for overuse injuries in youth athletes. • Use of YOvIQ can allow for development of overuse injury prevention strategies in youth sport. [ABSTRACT FROM AUTHOR]

To determine if preseason lower extremity ROM, flexibility, and strength differ in collegiate gymnasts (NCAA Division 1) who do or do not sustain an injury during the competitive season. Over four seasons, a total of 15 female gymnasts (age = 20.5 ± 1.0 years) underwent preseason screening (30 gymnast-season). We tested joint ROM (hip: flexion, internal and external rotation; ankle: weightbearing dorsiflexion), muscle flexibility (passive straight leg raise, Thomas,' Ober's, Ely's tests) and strength (hip extensors, abductors, and flexors isometric strength via a handheld dynamometer; knee: quadriceps and hamstring isokinetic strength at 60°/sec). The team athletic trainer tracked overuse lower extremity injuries (restricted gymnasts from full participation, occurred as from participation in organized practice or competition, and required medical attention) during each season. For athletes that tested multiple seasons, each encounter was considered independent, and each preseason assessment was linked to overuse injuries sustained during the same competitive season. Gymnasts were dichotomized into injured and non-injured groups. An independent t-test was used to measure differences in preseason outcomes between injured and non-injured groups. During four years, we recorded 23 overuse lower extremity injuries. Gymnasts that sustained an in-season overuse injury demonstrated significantly lower hip flexion ROM (mean difference: −10.6°; 95% confidence interval: −16.5, −4.6; p < 0.01) and lower hip abduction strength (mean difference: −4.7% of body weight; 95% confidence interval: −9.2, −0.3; p = 0.04). Gymnasts who sustain an in-season overuse lower extremity injury have significant preseason deficit of hip flexion ROM and weakness in the hip abductors. These findings indicate potential impairments in the kinematic & kinetic chains responsible for skill performance and energy absorption during landing. [ABSTRACT FROM AUTHOR]

In recent years, the surge in sport and exercise participation, particularly in running, has coincided with the widespread adoption of running-related technology, such as fitness trackers. This study investigates the correlation between the use of running-related technology and running-related injuries among recreational and elite long-distance runners. We conducted a quantitative, cross-sectional online survey of 282 adult runners. Data were analyzed using descriptive statistics and a multivariable logistic regression analysis. Participants, with an average age of 37.4 years, reported varied running experience, with 90.07% utilizing running-related technology during their runs to some degree, primarily smartwatches like Garmin and Apple Watch. Running-related technology users showed a higher likelihood of experiencing running-related injuries compared to non-users (OR = 0.31, p < 0.001). However, those who utilized the metrics obtained from running-related technology to guide their training decisions did not exhibit a higher risk of injury. This nuanced relationship highlights the importance of considering individual training behaviors and the potential psychological impacts of technology on running practices. The study underscores the need for future research integrating biomechanical and psychosocial factors into running-related technology to enhance injury prevention strategies. [ABSTRACT FROM AUTHOR]

Collegiate baseball players with professional aspirations often participate in summer leagues; foremost among them is the Cape Cod Baseball League (CCBL). Injuries acquired during the collegiate baseball season can be carried into the CCBL season and vice versa. To assess the history of throwing arm injury and current functionality in midseason CCBL players. Cross-sectional study. Online questionnaire. A total of 123 CCBL players participated. Qualifying athletes were ≥18 years old and were rostered CCBL players with remaining collegiate eligibility. After collecting background information, we used the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow questionnaire to assess the history of throwing arm injury and current functionality. The maximum KJOC score is 100.0; higher scores correspond with greater functionality. The mean KJOC score was 86.6 ± 14.5 (n = 92); 24.5% (23/94) of players reported a prior diagnosis of throwing arm injury other than a strain or sprain. A total of 49 (49/96, 51.0%) players had undergone rehabilitation for a throwing arm injury, and 7 (7/96, 7.3%) had experienced a medical procedure. Players with no previous treatment (n = 41, mean KJOC score = 88.9 ± 19.0) more frequently demonstrated KJOC scores of ≥90 than players with such treatment (n = 55, 80.9 ± 17.1; P <.001). The 18 players with time-loss arm injury in the last year had lower mean KJOC scores (71.3 ± 20.0) than players with no injury or time loss (90.3 ± 9.8; P <.001). Similarly, players who reported current arm trouble (n = 15) had lower KJOC scores (71.6 ± 17.5) than players with healthy arms (89.5 ± 11.9; P <.001). The average KJOC score of the CCBL players was <90, with particularly low scores in athletes with prior arm injury and treatment. [ABSTRACT FROM AUTHOR]

This article provides a comprehensive analysis of calcaneal apophysitis, or Sever's disease, a major cause of heel pain in children. This overuse injury stems from repetitive mechanical stress on the calcaneal apophysis, often intensified by rapid growth spurts and high physical activity. It is particularly prevalent among young athletes involved in sports with repetitive impact. The condition's pathophysiology involves microtrauma and inflammation at the calcaneus's secondary ossification center due to traction forces from the Achilles tendon. Diagnosis is primarily clinical while imaging is used to rule out other conditions. Symptoms include localized heel pain and tenderness, worsened by activity. Risk factors encompass intrinsic elements like limited ankle dorsiflexion and foot alignment issues, and extrinsic factors such as intense physical activity. Management mainly involves conservative treatments: rest, NSAIDs, stretching exercises, and orthotics. Physical therapy and proper footwear are also effective. Prevention focuses on maintaining a healthy weight, adequate rest, supportive footwear, low-impact activities, and regular stretching to reduce re-injury risk.

Patellar tendon (PT) complaints are frequent in competitive alpine skiers and such complaints are characterized by a long-lasting affection. Since PTs are subject to maturation up to 1–2 years after growth spurt, this early career stage may be decisive for the further course of complaints. The aim of this study was to investigate the evolution of PT complaints and shear wave velocity patterns among competitive alpine skiers during a 4-year post-growth spurt follow-up. The PT complaints and SWV patterns of forty-seven skiers were analysed at baseline (i.e., immediately after their peak height growth at 13–15 years of age) and were re-analysed at 4-year follow-up. The PTs were scanned via three-dimensional SWE. Symptomatic skiers were identified based on pain sensation under loading and pressure-induced pain around the PT. The prevalence of PT complaints decreased from 29.8% at baseline to 12.8% at follow-up (Pearson’s χ2 = 9.429; p = 0.002). SWV decreased from the baseline assessment to the follow-up in the proximal and distal regions (p < 0.05). SWV coefficient of variation (CV) in the distal and mid-portion regions was greater at baseline than at follow-up (p < 0.05). At the follow-up assessment, compared to “healthy” skiers, “healed” skiers who recovered from PT complaints had lower SWVs in the proximal region (p = 0.020) and greater SWV CVs in the proximal region (p = 0.028). Moreover, symptomatic skiers had significantly greater SWV CVs in the mid-portion region than did “healthy” subjects with no history of PT complaints (p = 0.020). The average SWV was negatively correlated with the SWV (proximal: r = −0.74, p < 0.001; mid-portion: r = −0.37 p = 0.011; and distal: r = −0.58, p < 0.001). The occurrence of PT complaints decreased over a 4-year post-growth spurt follow-up. “Healed” skiers who were symptomatic at baseline had an even greater average decrease in the proximal and mid-portion SWV than “healthy” skiers with no history of PT complaints. This may lead to the hypothesis that PT complaints in adolescent skiers are not self-eliminating towards the end of adolescence, as at least structural irregularities appear to persist for several years after the onset of initial symptoms. Furthermore, “healed” and symptomatic tendons exhibited increased SWV variability, supporting the hypothesis that SWV CV may provide additional valuable information on the mechanical properties of PTs affected by overuse-related complaints.

Clinical Scenario: Youth athletes may specialize in a sport of their choosing, or based on external pressures, to pursue elite status in that sport. Current evidence shows an association between highly specialized athletes and an increase in injuries as well as a connection between injury and lower health-related quality of life (HRQOL). Clinical Question: In college athletes, do early sport specialization characteristics (ie, age at specialization and degree of specialization) impact current HRQOL? Summary of Key Findings: The literature was searched for studies that investigated the age of specialization (early vs late) or degree of specialization (high, moderate, and low) and the impact on HRQOL. (1) The search returned 6 possible studies related to the clinical question. Three of the studies met the inclusion criteria and were used for this appraisal. (2) Two of the 3 included studies reported that highly specialized athletes noted lower HRQOL. (3) One study found there to be no significant difference in HRQOL between athletes who specialized early versus late but did find those who specialized early to have a greater incidence of injuries that required surgery. Clinical Bottom Line: There is moderate evidence that early sport specialization is associated with lower HRQOL compared with late sport specialization. It is important to educate athletes, parents, and coaches on the potential detriments that are associated with early sport specialization to allow stakeholders to make informed decisions regarding participation. Strength of Recommendation: Grade B evidence exists to support the idea that early, intensive sport specialization may be associated with decreased HRQOL in current college athletes. [ABSTRACT FROM AUTHOR]

Context: Injury prevention programs are effective when implemented in team sports, but many recreational runners have less access to such focused interventions or peer support and often seek other sources to learn about injury reduction strategies. Objective: This study aimed to explore runners' motivations in attending a prehabilitation (prehab) for runners workshop, establish their comprehension of prehab, and identify barriers to ongoing engagement with injury prevention. Design: Qualitative study using focus groups. Participants and Setting: Twenty-two runners participating in prehab for runners workshops took part in one of 4 focus groups, each recorded, transcribed, and analyzed using Grounded Theory to create codes, subthemes, and themes. Results: Four themes emerged: (1) Participation was influenced by experience of previous injury and worry of cessation of running. As the workshop ran weekly for 4 weeks, opportunity to see someone more than once who was also a physiotherapist influenced participation. (2) Runners welcomed clarification for online exercises and advice suggested for runners. They were surprised by the difficulty of single-leg neuromuscular facilitation exercises and reported benefit from most or all information especially non-exercise-based approaches such as load management, pain monitoring, and running cues. (3) Participants were empowered by a structured, holistic, and evidence-based approach that embraced autonomy for exercise self-selection and progression. Confidence to engage in open discussion was due to small group size. (4) Barriers to prehab were personal responsibility, equipment, time, lack of supervision, and peer influence. Conclusion: A composite approach to strategies for injury risk reduction during prehab, combining progressive exercises with educational resources, can address runners' individual needs. Early discussion of motivational tools on commencement of prehab with guidance from runners on how to incorporate prehab independently into running training is recommended. Providing these tools allows runners to self-identify the approach best suited to their personal running profile at that given time. [ABSTRACT FROM AUTHOR]

Lateral epicondylalgia, commonly known as tennis elbow, is a chronic overuse injury characterised by acute inflammation at the common wrist extensor origin, resulting in pain. Scapular muscle weakness has been linked to lateral epicondylalgia, as weakness or instability in proximal muscles can trigger distal issues. Non-operative interventions, such as activity adjustments, physiotherapy, and various therapeutic methods, have been effective in managing symptoms. This case report demonstrates the effectiveness of scapular muscle strengthening in improving lateral epicondylalgia, along with extensor strengthening. The patient, a 36-year-old male construction manager, underwent a comprehensive course of physical therapy, including scapular muscle strengthening exercises. Comprehensive follow-up using outcome measures such as the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and handheld dynamometer was done. The treatment resulted in improvements in daily function, physical activity, and sports performance, indicating the potential benefits of incorporating scapular muscle strengthening in the management of lateral epicondylalgia. This case emphasizes the need for a tailored approach, suggesting scapular muscle strengthening exercises as a more targeted intervention for lateral epicondylalgia.

Abstract Objectives To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. Methods A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Results A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052–0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). Conclusion The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

ObjectiveTo observe the effect of pushing method on the repair and regeneration of rats with overuse injury of skeletal muscle, and to explore its mechanism of action based on Wnt/β-catenin signaling pathway.MethodsForty-two rats were selected and divided into blank group, model group and intervention group according to randomized table method, with 14 rats in each group. In addition to the blank group, the model group and intervention group were trained with Armstong centrifugal exercise program to establish a rat skeletal muscle overuse injury model. In the blank and model groups, the right hind limb gastrocnemius muscle and adjacent muscles were coated with petroleum jelly, but no pushing intervention was performed; in the intervention group, the right hind gastrocnemius muscle was pushed (the pressure was about 2 N, the frequency was 80 beats/min, and the intervention was performed once a day in the morning and once a day in the afternoon, lasting for a total of 3 d. The intervention was performed in the right hind limb gastrocnemius muscle for 24 h after the modeling, and in the intervention group for 3 d after the modeling was completed.) The balance beam test was used to assess the motor function of the rats after skeletal muscle injury at 24 h after the end of modeling and 24 h after the end of the intervention, respectively; hematoxylin-eosin staining (HE) method was used to observe the pathological changes of the gastrocnemius muscle; EM-1400 transmission electron microscope was used to observe the ultrastructure of the skeletal muscle fibers; and fluorescence PCR was used to detect the myogenic regulatory factor myogenic differentiation antigen (Myogenic differentiation antigen (MyoD), myogenin (MyoG) and paired box 7 (Pax7) mRNA transcript levels were detected by fluorescence quantitative PCR; MyoD, MyoG, Pax7, Wnt3a, Axin2 and β-catenin protein expression levels were detected by Western blot. Catenin protein expression levels.Results(1) Comparison of motor function：compared with the blank group, the time of passing through the balance beam and the number of times of sliding paw were significantly increased in the model group and intervention group after intervention, and the difference was statistically significant (PPPPPPPP

Background: Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury. Runners encounter varied surface steepness (gradients) when running outdoors and may adapt their speed according to the gradient. This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients. Methods: Twenty recreational runners ran on a treadmill at 3 different speeds (2.5 m/s, 3.0 m/s, and 3.5 m/s) and gradients (level: 0%; uphill: +5%, +10%, and +15%; downhill: –5%, –10%, and –15%). Force and marker data were collected synchronously throughout. Bending moments were estimated at the distal third centroid of the tibia about the medial–lateral axis by ensuring static equilibrium at each 1% of stance. Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse. Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses. Results: There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress. Higher running speeds resulted in greater tibial loading. Running uphill at +10% and +15% resulted in greater tibial loading than level running. Running downhill at –10% and –15% resulted in reduced tibial loading compared to level running. There was no difference between +5% or –5% and level running. Conclusion: Running at faster speeds and uphill on gradients ≥+10% increased internal tibial loading, whereas slower running and downhill running on gradients ≥–10% reduced internal loading. Adapting running speed according to the gradient could be a protective mechanism, providing runners with a strategy to minimize the risk of tibial stress injuries.

Purpose: To determine if workload and seasonal periods (preseason vs in season) are associated with the incidence of injuries and illnesses in female professional cyclists. Methods: Session rating of perceived exertion was used to quantify internal workload and was collected from 15 professional female cyclists, from 33 athlete seasons. One week (acute) workload, 4 weeks (chronic) workload, and 3 acute:chronic workload models were analyzed. Two workload models are based on moving averages of the ratios, the acute:chronic workload ratio (ACWR), and the ACWR uncoupled (ACWRuncoup). The difference between both is the chronic load; in ACWR, the acute load is part of the chronic load, and in ACWRuncoup, the acute and chronic load are uncoupled. The third workload model is based on exponentially weighted moving averages of the ratios. In addition, the athlete season is divided into the preseason and in season. Results: Generalized estimating equations analysis was used to assess the associations between the workload ratios and the occurrence of injuries and illnesses. High values of acute workload (P =.048), ACWR (P =.02), ACWRuncoup (P =.02), exponentially weighted moving averages of the ratios (P =.01), and the in season (P =.0001) are significantly associated with the occurrence of injury. No significant associations were found between the workload models, the seasonal periods, and the occurrence of illnesses. Conclusions: These findings suggest the importance of monitoring workload and workload ratios in female professional cyclists to lower the risk of injuries and therefore improve their performances. Furthermore, these results indicate that, in the preseason, additional stressors occur, which could lead to an increased risk of injuries. [ABSTRACT FROM AUTHOR]

The relationship between internal loading dose and low-back injury risk during lifting is well known. However, the implications of movement parameters that influence joint loading rates—movement frequency and speed—on time-dependent spine loading responses remain less documented. This study quantified the effect of loading rate and frequency on the tolerated cumulative loading dose and its relation to joint lifespan. Thirty-two porcine spinal units were exposed to biofidelic compression loading paradigms that differed by joint compression rate (4.2 and 8.3 kN/s) and frequency (30 and 60 cycles per minute). Cyclic compression testing was applied until failure was detected or 10,800 continuous cycles were tolerated. Instantaneous weighting factors were calculated to evaluate the cumulative load and Kaplan–Meier survival probability functions were examined following nonlinear dose normalization of the cyclic lifespan. Significant reductions in cumulative compression were tolerated when spinal units were compressed at 8.3 kN/s (P <.001, 67%) and when loaded at 30 cycles per minute (P =.008, 45%). There was a positive moderate relationship between cumulative load tolerance and normalized cyclic lifespan (R2 =.52), which was supported by joint survivorship functions. The frequency and speed of movement execution should be evaluated in parallel to loading dose for the management of low-back training exposures. [ABSTRACT FROM AUTHOR]

Objectives: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. Methods: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. Results: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052–0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). Conclusion: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns. [ABSTRACT FROM AUTHOR]

Tibial stress injuries are problematic among runners. The loading magnitude is the most important mechanical contributor to bone damage accumulation, but loading quantity is also important, and faster runners require fewer loading cycles to complete a given distance than slower runners. This study estimated tibial loading and damage accumulation throughout a demanding 10‐km run in recreational (RR) and competitive runners (CR). Male runners reporting a 10‐km season‐best run slower than 47:30 min (RR) or faster than 37:30 min (CR) completed a 10‐km treadmill running protocol at 105% of their season's best time. Tibial loading was estimated from bending moments at the distal 1/3rd of the tibia by ensuring static equilibrium at each 1% of stance. Peak loading was obtained, and cumulative damage per kilometer was estimated using a tissue‐dependent weighting factor. Peak tibial loading and damage accumulation per kilometer significantly decreased throughout the run, by 5% and 4%, respectively. Peak loading was significantly higher (31%) in CR than RR, and there was an indication (p = 0.058 and large effect size) of a greater rate of damage accumulation in CR than RR. Tibial loading per step and the rate of accumulation per kilometer decreased throughout a demanding 10‐km run suggesting that changes in running mechanics as a result of prolonged running may not be a primary mechanism for stress injury development. Competitive runners experience greater peak tibial loading and possibly greater cumulative tibial damage when they complete 10 km faster than recreational runners. Highlights: Peak tibial loading per step and the rate of damage accumulation decreased throughout a demanding 10‐km run in both recreational and competitive runners.Running‐induced changes in gait mechanics may not be a predominant mechanism for the development of tibial stress injuries.Completing a 10‐km run at a faster speed requires fewer loading cycles, but this does not result in reduced tibial damage accumulation due to the greater loading magnitude. [ABSTRACT FROM AUTHOR]

Objective: The relationship between health-related quality of life (HRQoL) and injury type has not been analyzed for young athletes. We hypothesized that there would be no difference in HRQoL between injured athletes, injured nonathletes, and normative data for healthy youth (NDHY) or among athletes with acute, overuse, or concussion injuries. Design: Cross-sectional clinical cohort. Setting: Primary care sports medicine clinics at 3 academic institutions. Participants: Patients aged 8 to 18 years presenting with injury. Independent Variables: Injury type and athletic participation. Main Outcome Measures: Health-related quality of life measured 1 month after injury through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 v2.0 assessed pain interference, peer relationships, depression, fatigue, anxiety, and mobility. One-way analysis of variance was performed with P values of <0.05 considered significant. Concussion Learning Assessment and School Survey (CLASS) evaluated academic performance. Results: Three hundred fifty-seven patients (36% male), with average age of 14.2 years, completed HRQoL and CLASS surveys following injury. There were 196 overuse injuries (55%), 119 acute injuries (33%), and 42 concussions (12%). Ninety-four percent were athletes. Six percent were nonathletes; 90.5% of concussed patients reported grades worsening. Concussed athletes reported more fatigue (P = 0.008) compared with other injury types but no worse than NDHY. Athletes with overuse injuries had lower mobility (P = 0.005) than other injury types and NDHY. Patients with lower HRQoL were female, older age, or required surgery. No other domains had significant differences by injury type nor did HRQoL differ between the athletes, nonathletes, and NDHY. Conclusions: With the exception of injuries requiring surgery, HRQoL of injured young athletes was similar to NDHY in most domains. [ABSTRACT FROM AUTHOR]

Background: Elbow pain is common among youth baseball players and elbow MRI is increasingly utilized to complement the clinical assessment. Objective: To characterize, according to skeletal maturity, findings on elbow MRI from symptomatic youth baseball players. Materials and methods: This IRB-approved, HIPAA-compliant retrospective study included pediatric (<18 years of age) baseball players with elbow pain who underwent MRI examinations between 2010 and 2021. Two radiologists, blinded to the outcome, independently reviewed examinations to categorize skeletal maturity and to identify osseous and soft tissue findings with consensus used to resolve discrepancies. Findings were compared between skeletally immature and mature patients and logistic regression models identified predictors of surgery. Results: This study included 130 children (115 boys, 15 girls): 85 skeletally immature and 45 mature (12.8±2.3 and 16.2±1.0 years, respectively, p<0.01). Kappa coefficient for interobserver agreement on MRI findings ranged from 0.64 to 0.96. Skeletally immature children, when compared to mature children, were more likely to have elbow effusion (27%, 23/85 vs 9%, 4/45; p=0.03), medial epicondyle marrow edema (53%, 45/85 vs 16%, 7/45; p<0.01), avulsion fracture (19%, 16/85 vs 2%, 1/45; p=0.02), and juvenile osteochondritis dissecans (OCD, 22%, 19/85 vs 7%, 3/45; p=0.04), whereas skeletally mature children were more likely to have sublime tubercle marrow edema (49%, 22/45 vs 11%, 9/85; p<0.01) and triceps tendinosis (40%, 18/45 vs 20%, 17/85; p=0.03). Intra-articular body (OR=4.2, 95% CI 1.5–47.8, p=0.02) and osteochondritis dissecans (OR=3.7, 95% CI 1.1–11.9, p=0.03) were independent predictors for surgery. Conclusion: Differential patterns of elbow MRI findings were observed among symptomatic pediatric baseball players based on regional skeletal maturity. Intra-articular body and osteochondritis dissecans were independent predictors of surgery. [ABSTRACT FROM AUTHOR]

• Running speed and surface incline independently influence internal tibial loading. • Running at faster speeds increases internal tibial loading. • Running uphill on a slope of 10% or steeper increases internal tibial loading. • Running downhill on a slope –10% or steeper reduces internal tibial loading. • Adapting running speed according to the surface steepness could be a protective mechanism against tibial stress injuries. Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury. Runners encounter varied surface steepness (gradients) when running outdoors and may adapt their speed according to the gradient. This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients. Twenty recreational runners ran on a treadmill at 3 different speeds (2.5 m/s, 3.0 m/s, and 3.5 m/s) and gradients (level: 0%; uphill: +5%, +10%, and +15%; downhill: –5%, –10%, and –15%). Force and marker data were collected synchronously throughout. Bending moments were estimated at the distal third centroid of the tibia about the medial–lateral axis by ensuring static equilibrium at each 1% of stance. Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse. Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses. There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress. Higher running speeds resulted in greater tibial loading. Running uphill at +10% and +15% resulted in greater tibial loading than level running. Running downhill at –10% and –15% resulted in reduced tibial loading compared to level running. There was no difference between +5% or –5% and level running. Running at faster speeds and uphill on gradients ≥+10% increased internal tibial loading, whereas slower running and downhill running on gradients ≥–10% reduced internal loading. Adapting running speed according to the gradient could be a protective mechanism, providing runners with a strategy to minimize the risk of tibial stress injuries. [Display omitted] [ABSTRACT FROM AUTHOR]

Low back pain is common in mountain biking due to the sustained flexion of the lumbar spine, particularly during fatiguing hill climbs. In this study, we investigated whether an ergonomic mountain bike saddle including a raised rear, a longitudinal dip, and a subtle lateral instability (the ‘Active’-technology) can reduce acute low back pain at the end of a hill climb (>1 h) in a group of mountain bikers with a history of cycling-related low back pain (n = 28). In addition, we conducted a laboratory experiment to investigate the isolated effects of the ‘Active’-technology on the cyclists’ pelvis and spine motion as well as on the activity of surrounding muscles. The field test demonstrated a significant reduction in numerical low back pain ratings with the experimental saddle compared to the riders’ own standard saddle (p = 0.001, strong effect). The laboratory-based data suggested that the ‘Active’-technology does lead to potentially beneficial effects on pelvis-spine kinematics and muscle activity, which in combination with an optimised saddle geometry may explain the observed reduction in low back pain following mountain bike hill climbing. [ABSTRACT FROM AUTHOR]

Introduction: The growing adolescent athlete has a significant risk for overuse injury due to multiple intrinsic and extrinsic factors. We present the case of an 11-year-old girl gymnast and multisport athlete with symptomatic stress injury to the right triradiate cartilage. Case description: The injury was recognized on magnetic resonance imaging (MRI) following 6 months of right hip pain with activity. Load reduction strategies did not alter her symptoms, and rest from provocative activity was prescribed. A good outcome was achieved after 6 weeks with resolution of bone marrow edema and pain-free activity progression. Conclusion: We place importance on the recognition of such overuse injuries to avoid long-term sequelae of growth plate injuries. [ABSTRACT FROM AUTHOR]

Lateral epicondylalgia, commonly known as tennis elbow, is a chronic overuse injury characterised by acute inflammation at the common wrist extensor origin, resulting in pain. Scapular muscle weakness has been linked to lateral epicondylalgia, as weakness or instability in proximal muscles can trigger distal issues. Non-operative interventions, such as activity adjustments, physiotherapy, and various therapeutic methods, have been effective in managing symptoms. This case report demonstrates the effectiveness of scapular muscle strengthening in improving lateral epicondylalgia, along with extensor strengthening. The patient, a 36-yearold male construction manager, underwent a comprehensive course of physical therapy, including scapular muscle strengthening exercises. Comprehensive follow-up using outcome measures such as the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and handheld dynamometer was done. The treatment resulted in improvements in daily function, physical activity, and sports performance, indicating the potential benefits of incorporating scapular muscle strengthening in the management of lateral epicondylalgia. This case emphasizes the need for a tailored approach, suggesting scapular muscle strengthening exercises as a more targeted intervention for lateral epicondylalgia. [ABSTRACT FROM AUTHOR]

Fatigue-related changes in gait biomechanics, specifically plantar pressures, are well documented in the general population. However, research is generally confined to unilateral measures across a limited range of speeds, while changes in more well-trained populations remain largely unknown. Therefore, we sought to assess the impact of fatigue on bilateral peak plantar pressure (PP) and plantar pressure symmetry angle (SA) in well-trained runners across a range of speeds. Data from 16 (females, n = 9) well-trained runners were collected using in-sole pressure sensors pre- and post-fatigue at the following speeds: walking (1.3 m/s), jogging (2.7 m/s), running (3.3 m/s), and sprinting (4.5 m/s). Pre-fatigue PP significantly increased from walking to jogging (p < 0.001) and from jogging to running (p < 0.005) with no difference between running and sprinting (p > 0.05). Post-fatigue PP for walking was less than jogging (p < 0.002), running (p < 0.001), and sprinting (p < 0.001), with no other significant differences (p > 0.05). Post-fatigue PP was significantly greater when compared to pre-fatigue PP at all speeds (p < 0.001 for all). Though SA was not significantly different pre- to post-fatigue across speeds (p’s > 0.05) at the cohort level, noteworthy changes were observed at the individual level. Overall, fatigue effects are present at all running speeds but isolating these effects to a single side (left or right) may be inadequate.

Abstract Background Massage is widely used in exercise-induced skeletal muscle damage (EIMD). It has been proven that massage can improve the morphology and function of damaged skeletal muscle in multiple ways. However, whether massage can protect skeletal muscles from injury during long-term heavy-duty exercise has not yet been determined. Methods In this study, a rat model of overuse injury was established by eccentric running for 4 weeks, and pressing at constant pressure and frequency and massage were used as intervention methods to explore whether massage could protect skeletal muscle from injury through upregulating integrin and the basement membrane laminin. Results The results showed that compared with the model group, the ultrastructure of skeletal muscle in the massage group was relatively complete and clear, and the maximum isotonic and tetanic contraction forces were significantly increased (P

Several targeted upper extremity injury prevention programs have been developed to mitigate the risk of upper extremity overuse injuries among youth athletes in overhead sports; however, their effectiveness on performance outcome measures has not been investigated. This systematic review evaluated the effectiveness of existing upper extremity injury prevention programs that focused on modifying intrinsic risk factors, and performance outcome measures in overhead youth athletes. The secondary aim was to identify the training components of these programs. PubMed, Physiotherapy Evidence Database (PEDro), SPORTDiscus (via EBSCOhost), and Web of Science were searched from January 2000 to November 2020 for studies that implemented training programs or exercises for upper extremity injury prevention among youth athletes in overhead throwing or striking sports. An updated search was conducted from December 2020 to October 2022. A program was deemed effective for a performance outcome measure if significant improvements were observed in the intervention group as compared to the control group. Of the 1 394 studies identified, five studies met the inclusion criteria. The effectiveness of the injury prevention programs on the identified performance outcome measures of strength, mobility, and sport-specific measures were 30.4%, 28.6%, and 22.2%, respectively. The training components targeted were strength, mobility, and plyometrics. Strength was the most common training component and was also the most widely investigated performance outcome measure. Overall, current upper extremity injury prevention programs seem effective at improving performance outcome measures of strength, mobility, and sport-specific outcomes with training components of strength, mobility and plyometrics. Standardized protocols are required for the measurement and reporting of performance outcomes measures, and the reporting of training components.

Purpose: The aim of this study was to investigate the individual triceps surae muscle forces during the execution of six different functional movements and rehabilitation exercises in patients with Achilles tendinopathy compared to a control group. Methods: Triceps surae muscle forces of 15 participants with Achilles tendinopathy (AT) and 15 healthy controls were estimated through a combination of experimental data and musculo‐skeletal modeling. Three‐dimensional motion capture and force plates were used to collect the ankle and knee joint angles and moments during three functional movements (walking, heel walking, and toe walking) and three rehabilitation exercises (bilateral heel drop, unilateral heel drop with extended knee and with flexed knee). A dynamic optimization method was used to obtain the modeled triceps surae muscle forces. Force‐sharing strategies were calculated at the peak triceps surae muscle force and compared between groups. Results: Lower peak triceps surae forces were obtained for the AT group during dynamic exercises. Across all exercises, the average contribution of the soleus (SOL) to the total triceps surae muscle force was the largest (60.83 ± 13.89% [AT] > 56.90 ± 16.18% [healthy]), followed by the gastrocnemius medialis (29.87 ± 10.67% [AT] < 32.19 ± 12.90% [healthy]) and the gastrocnemius lateralis (9.30 ± 4.31% [AT] < 10.91 ± 4.66% [healthy]). The triceps surae force‐sharing strategy was different for the toe walking, heel walking, and the bilateral and unilateral heel drop with extended knee. Conclusion: This study provides evidence for altered triceps surae muscle force‐sharing strategies during dynamic tasks in patients with AT. The influence of altered muscle force‐sharing on the subtendon nonuniformity and/or the tendon loading should be explored in future work. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this literature review was to analyze, understand, and disclose prior empirical findings about the injury risks associated with youth sport specialization. Data Sources: Articles were included in this review if they examined the association between youth sport specialization status and injury. Nine articles from 5 journals met these criteria. All articles summarized the findings of cross-sectional (N = 5) or cohort studies (N = 4). Main Results: Each article included in this review indicated that specialized youth athletes are more susceptible to injury. Only 5 studies assessed the injury risks linked to specialization independent of sport training volume. These studies produced contradictory results. Conclusions: Although specialized youth athletes are more prone to injury, future research is needed to determine the independent and inherent injury risk associated with specialization. Nevertheless, youth athletes should refrain from specialization until at least adolescence. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinic visits and running-related injury (RRI) characteristics among child and adolescent runners seeking care at an outpatient clinic over a 10-year time frame. Design: Retrospective chart review. Setting: Outpatient hospital-affiliated Injured Runners Clinic. Patients: Children and adolescent runners (6-17 years) with RRIs. Independent Variables: We examined electronic medical records (EMRs) among child and adolescent patients in the hospital database from 2011 to 2021 to obtain RRI characteristics and key demographic factors. Main Outcome Measures: We assessed volume and frequency of patient visits to the clinic by RRI characteristics. Chi square analyses were used to compare the proportion of clinic visits over time and injury trends by body region and diagnosis. Results: There were 392 patients (sex; 277 F; mean age: 16.1 ± 1.3years) and an average of 5 clinic visits per diagnosis (5 ± 4 visits; min: 1 visit, max: 31 visits). Number of visits generally increased over time up to 2016 but declined most drastically during the years of the pandemic (2020-2021; χ² = 644, P < 0 .001). Of the 654 new injury diagnoses, 77.68% were attributed to repetitive stress. Bone stress injuries to the tibia were the most common RRI (χ² = 1940,P < 0.001; N = 132; 20.2% of all injuries) and constituted most of the clinic visits (χ² = 9271, P < 0.001; N = 591; 25.4% of all visits). Conclusion: We identified that adolescents with overuse injuries, particularly bone stress injuries to the tibia, constituted most of the visits to the outpatient healthcare setting. Clinicians should emphasize injury prevention efforts in clinical practice to reduce RRI burden. [ABSTRACT FROM AUTHOR]

Objective: Softball players commonly suffer overuse injuries due to the demands of repetitive throwing. The biceps tendon plays an important role in stabilizing the shoulder during the windmill pitch. The purpose of this study was to evaluate the measures used to identify and study biceps tendon pathology in softball players. Design: This was a systematic review. Setting: PubMed MEDLINE, Ovid MEDLINE, and EMBASE were searched. Participants: Studies that investigated biceps tendon injuries in softball players. Interventions: None. Main Outcome Measures: Range of motion (ROM), strength, and visual analog scale data were collected. Results: Of 152 search results, 18 were included. A total of 536 of 705 athletes (76%) were softball players (average age 14-25 years). Five of 18 articles (27.7%) studied changes in external rotation with the shoulder at 90 degrees of abduction, and 4 of 18 (22.2%) studied internal rotation. Two of 18 studies (11.1%) examined ROM or strength changes in forward flexion. Conclusions: While researchers agree that the windmill pitch places significant stress on the biceps tendon, our study finds that the metrics used to evaluate shoulder pathology in these players primarily evaluate the rotator cuff without isolating the biceps tendon. Future studies should include clinical tests and biomechanical metrics more specific to identifying biceps and labral pathology (eg, strength, fatigue, and ROM in glenohumeral forward flexion, elbow flexion, and forearm supination) and attempt to clarify differences in pathology between pitchers and position players to better characterize the frequency and severity of biceps tendon pathology in softball players. [ABSTRACT FROM AUTHOR]

Background: Physical tests are commonly used in patellar tendinopathy to aid the clinical diagnosis, assess the prognosis, and monitor treatment. However, it is still unknown whether these physical measures are associated with patient-reported outcomes after exercise therapy. Purpose: To identify the prognostic value of baseline physical test results and to determine the association between physical response after exercise therapy and clinical improvement over 24 weeks. Study Design: Case-control study; Level of evidence, 3. Methods: This study recruited 76 consecutive athletes with patellar tendinopathy who were randomized to 2 different programs of exercise therapy for 24 weeks. Athletes underwent a range of physical tests before and during exercise therapy (12 and 24 weeks), including isometric muscle strength (quadriceps and hip abductors), muscle flexibility (quadriceps, hamstrings, soleus, and gastrocnemius), vertical jump height, and visual analog scale (VAS) scores by palpation, after 3 jump trials, and after single-leg squat (VAS-SLS). The Victorian Institute of Sports Assessment–Patella (VISA-P) questionnaire was used as the primary patient-reported outcome. Linear mixed-effect models were used to assess the prognostic value of baseline physical tests. The change in VISA-P score was further dichotomized into clinical responsiveness (≥14 points) and nonresponsiveness (<14 points). Multiple linear and logistic regression models were performed to evaluate associations between physical response and clinical improvement. Results: Of the 76 included patients, 67 (88%) had complete follow-ups. The estimated mean VISA-P score increased by 23 points (95% CI, 19-28 points) after 24 weeks. No association was found between any baseline physical test results and a 24-week change in VISA-P score (all P interaction >.2, using the likelihood ratio test). Improvement in VAS-SLS after exercise therapy was not associated with VISA-P improvement after adjustment (β = −1.76; P =.01; Bonferroni-corrected P =.10; R 2 = 36.3%). No associations were found between changes in other physical test results and clinical improvement (all P >.05). Conclusion: In patients with patellar tendinopathy, physical test results including strength and flexibility in the lower limb, jump performance, and pain levels during pain-provoking tests were not identified as prognostic factors for patient-reported outcomes after exercise therapy. Similarly, changes in physical test results were not associated with changes in patient-reported outcomes after adjustments. These results do not support using physical test results to estimate prognosis or monitor treatment response. Registration: NCT02938143 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Attitudes and beliefs of parents about sport specialization may indicate why youth athletes decide to specialize. The purpose of this study was to determine the association between sport specialization level, ice hockey position, and the parent/guardians' attitudes and beliefs on sport specialization. Our results demonstrate that goalies were the most likely to specialize, and parents of specialized ice hockey players tend to believe that sport specialization helps their child achieve future sporting aspirations. Increased sport specialization may put ice hockey goalies at an increased risk for overuse injuries, and parents' beliefs about sport specialization may impact their child's sporting behaviors. [ABSTRACT FROM AUTHOR]

Background: Anterior knee pain is very common in the young and active age groups but there are no significant studies on the normal population. Therefore, the objective of the study was to understand the relation between medial knee joint space to the development of knee pain and functional disability with special reference to the 20–45-year age group. Materials and methods: 250 cases with mean age of 36.36 years presenting with knee pain for at least 1 month were included in this prospective study (July 2021 and June 2022) and were asked to self-complete questionnaires on knee pain which included KNEST, AKPQ, VAS and IPAQ. Patients underwent X-rays of bilateral knees in AP view with weight bearing and then medial and lateral knee joint spaces were calculated. Results: There was a higher incidence of knee pain in women compared to men. The average medial and lateral joint space widths (MJSW and LJSW) of the right knee were 4.22 mm and 4.57 mm, respectively. For the left knee it was 4.19 mm and 4.42 mm, respectively. There is a decrease in MJSW with increasing age, level of pain and BMI. Also, with an increase in physical activity, there was a higher incidence of knee pain. Conclusion: Overuse injuries are the main cause of knee pain in this age group. There is a significant association between medial joint space width and age, gender, level of pain, and BMI. Rising BMI patterns at a young age, leads to an increase in physical activity, which in turn leads to early knee pain and also predisposes to osteoarthritis. [ABSTRACT FROM AUTHOR]

Fatigue-related changes in gait biomechanics, specifically plantar pressures, are well documented in the general population. However, research is generally confined to unilateral measures across a limited range of speeds, while changes in more well-trained populations remain largely unknown. Therefore, we sought to assess the impact of fatigue on bilateral peak plantar pressure (PP) and plantar pressure symmetry angle (SA) in well-trained runners across a range of speeds. Data from 16 (females, n = 9) well-trained runners were collected using in-sole pressure sensors pre- and post-fatigue at the following speeds: walking (1.3 m/s), jogging (2.7 m/s), running (3.3 m/s), and sprinting (4.5 m/s). Pre-fatigue PP significantly increased from walking to jogging (p < 0.001) and from jogging to running (p < 0.005) with no difference between running and sprinting (p > 0.05). Post-fatigue PP for walking was less than jogging (p < 0.002), running (p < 0.001), and sprinting (p < 0.001), with no other significant differences (p > 0.05). Post-fatigue PP was significantly greater when compared to pre-fatigue PP at all speeds (p < 0.001 for all). Though SA was not significantly different pre- to post-fatigue across speeds (p's > 0.05) at the cohort level, noteworthy changes were observed at the individual level. Overall, fatigue effects are present at all running speeds but isolating these effects to a single side (left or right) may be inadequate. [ABSTRACT FROM AUTHOR]