Adolescent Athlete Population Research Articles

Dietary inflammatory index, physical activity, body composition, and high sensitivity c-reactive protein levels in adolescent athletes in Central Java

Inflammation is the body's response to tissue damage and infection. Prolonged inflammation can increase the risk of non-communicable diseases, including cardiovascular disease. Some factors that can trigger inflammation are dietary patterns, high physical activity, and body composition. This study examined the correlation between dietary inflammatory index (DII), physical activity, body composition, and high sensitivity C-reactive protein (hs-CRP) levels. It examined differences in characteristics based on gender. This study was a cross-sectional design of 55 adolescent athletes at the Student Sports Education and Training Center in Central Java. The exclusion criteria were an athlete who had a physical injury (did not participate in training) and a smoker. The DII score was calculated based on the dietary pattern using SQFFQ, anthropometric data (weight, height, and nutritional status based on BMI/age), body composition (body fat percentage, fat mass, and fat-free mass) using the BIA tool, physical activity data for the last seven days using IPAQ and hs-CRP levels using the FIA method. Our result showed that the DII score was significantly correlated with hs-CRP (p=0.013). There was no correlation between physical activity, body composition, and anthropometry with hs-CRP levels (p0.05). There were differences in body height, body weight, body fat percentage, and fat-free mass between males and females (p0.001). The diet of athletes had anti-inflammatory potential (83.6%), as evidenced by the intake of vitamins and minerals, and athletes had low hs-CRP levels 1 mg/L (85.5%), indicating that no inflammation occurred. Future longitudinal research is needed with a large population of adolescent athletes to explain the role of anti-inflammatory and pro-inflammatory diets on the incidence of inflammation and measure physical exercise in athletes to reduce inflammatory bias.

Psychological Well-Being From Sports Injuries in Adolescence: A Narrative Review.

The objective of this paper is to review how the mental and psychological well-being of the adolescent athlete population may be impacted by sports injuries, specifically the development of their personal identities. To answer this question, we conducted a narrative review using keywords such as "adolescence," "psychological," "injury," and "sport" in the PubMed database. When conducting the research, we included sources from the past 15 years in order to gain a more present and accurate analysis of our question, and no countries were excluded from our population. Through our research, we identified risk factors that contribute to the rising psychological stress on adolescents. The return to sport was also found to be primarily affected by implied psychological illnesses such as self-confidence and identity, along with parental and coach guidance through the rehabilitation process. Despite the lack of research, scientists work to pursue additional psychological interventions to ensure the emotional well-being of adolescent athletes. Through this review, we aim to inform athletes, coaches, parents, and pediatricians about psychological issues that they may face as they continue to pursue their respective roles in sports. This study also paves a path for future research concerning potential interventions to prevent such psychological issues and ensure both physical and mental health for young athletes.

Opioids and Youth Athletes.

The ongoing opioid epidemic and associated adverse effects impart a large burden on our current healthcare system. The annual economic and noneconomic cost of opioid use disorder and fatal opioid overdose is currently estimated at $1 trillion. This review presents the prevalence, frequency of use, need, and effectiveness of opioid analgesia in the youth and adolescent athlete population. It identifies current indications for opioid versus nonopioid analgesic use in the setting of acute orthopaedic injuries, postoperative management, concussion, and chronic pain. Current knowledge of youth athlete opioid use, risks related to use, misuse, diversion, and addiction are reviewed. A PubMed, Medline, and Cochrane Library search was conducted in February 2023 to review opioid pain management strategies in the pediatric athlete population from 2000 to present. Searches were restricted to English language articles and human subjects. Initial reviews of titles and abstracts were performed by all authors and relevant full-text articles were selected. Priority was given to systematic and narrative reviews, meta-analyses, and prospective studies. Narrative review. Level 3. First author name, publication year, study design, study country, subject demographics, and data on the frequency, type, and duration of analgesic treatments for musculoskeletal injuries, postsurgical care, chronic pain disorders, and concussion were extracted. Pediatric athletes comprise a high-risk population seeking analgesic relief for injury-related pain. Participation in high school sports is associated with increased risk of opioid use. An average of 28% to 46% of high school athletes have used opioids in their lifetime. Participation in ≥1 high school sport puts adolescents at 30% greater odds of future opioid misuse. The use of opioids in the pediatric athlete population is common and associated with both short- and long-term risks of misuse and addiction.

The effect of age on baseline neurocognitive performance

ABSTRACT Objective Evaluate the independent effect of age on baseline neurocognitive performance. Study Design Baseline ImPACT scores from tests taken by 7454 athletes aged 12–22 from 2009 to 2019 were split into three age cohorts: 12–14 years (3244), 15–17 years (3732), and 18–22 years (477). Linear regression analyses were used to evaluate the effect of age on ImPACT composite scores while controlling for demographic differences, medication-use, and symptom burden. Significance values have been set at p < 0.05. Results Linear regression analyses demonstrated that increased age does not significantly affect symptom score (β = 0.06, p = 0.54) but does improve impulse control (β = −0.45, p < 0.0001), verbal memory (β = 0.23, p = 0.03), visualmotor (β = 0.77, p < 0.0001), and reaction time (β = −0.008, p < 0.0001) scores. However, age did not have an effect on visual memory scores (β = −0.25, p = 0.07). Conclusions Age was shown to be an independent modifier of impulse control, verbal memory, visual motor, and reaction time scores but not visual memory or symptom scores. This underscores the previous literature showing developmental differences as age increases among the adolescent athlete population. This data also indicates the need for repeat neurocognitive baseline testing every other year as baseline scoring is likely to change as athletes become older.

Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria

BackgroundThe inclusion of electrocardiogram (ECG) in medical examinations for sports practice serves as a valuable tool for identifying potential life-threatening conditions during physical exercise. However, its applicability in young individuals remains a subject of controversy, primarily due to relatively high rates of false positives and the associated costs of further investigations. Furthermore, the validation of International Criteria for athletes below 12 years of age in optimizing pre-participation screening for young athletes is yet to be established. In light of these considerations, this study aims to describe the prevalence of ECG findings in a sample of children and young-adolescent athletes aged 11–16 years, employing refined Seattle interpretation criteria. Additionally, we seek to compare these findings based on age group and sex. MethodsThis was a retrospective and observational study of 3747 athletes 11–16 year-olds. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. The primary outcome measure was abnormal ECG findings according to the International Recommendations for Electrocardiographic Interpretation in Athletes. ResultsAmong the evaluated population of pediatric and young adolescent athletes (77.5% boys; >99% Caucasian), the vast majority exhibited normal electrocardiogram (ECG) results, with adaptive findings related to sports participation being more frequent among young adolescents and males. The presence of significant ECG abnormalities in young-adolescent athletes was uncommon (2.05%; 1.92% children and 2.32% young-adolescent) and required additional examinations. 0.27% of the total population were diagnosed with a previously unknown cardiac pathology only through the ECG. ConclusionsThis study provides valuable insights into the prevalence of normal, borderline, and abnormal electrocardiogram (ECG) findings in a large population of pediatric and young-adolescent athletes. These findings serve as guidance in detecting potentially serious cardiac alterations within this specific group, considering variations based on age and sex. The study confirms that ECG screening is a useful tool for identifying cardiac abnormalities in pediatric and young-adolescent athletes, even though the prevalence of significant findings in this population is relatively low. Furthermore, our findings support the utilization of the refined Seattle criteria as a sensitive and specific technique for screening pediatric and young-adolescent athletes, further enhancing the accuracy of ECG-based evaluations.

The Influence of Gender on Food Consumption Patterns Among National-Level Adolescent Cyclists.

Background and objective Adolescents in general make poor food choices due to a lack of awareness, social pressure, and other factors, leading to a faulty lifestyle. On the other hand, the adolescent athletic population is associated with a healthy eating pattern. In light of this, this study aimed to evaluate the eating behavior of adolescent cyclists competing at the national level. Methods A total of 50 national-level adolescent cyclists (26 males and 24 females) were assessed for eating behavior, daily food consumption patterns, and eating habits around exercise time by using a pre-tested validated questionnaire, Food Frequency Questionnaire (FFQ), and 24-hour Food Recall. Results The majority (82%) of the cyclists were non-vegetarians, followed by lacto-vegetarians (14%) and lacto-ovovegetarians (14%). Of note, 72% of the cyclists consumed four meals consisting of breakfast, lunch, snacks, and dinner daily, while 28% skipped at least one of the meals. The preference for takeaways (52%) surpassed dine-outs (34%) and home-cooked (14%) food. Pre-training snack was consumed by 37% and post-training snack by 47%. Cyclists daily consumed breakfast cereals (76%), bread (94%), pulses (92%), fruits (100%), vegetables (62%), milk (84%), milk products (90%), egg (82%), poultry, fish, and meat (74%), dry fruits, nuts, and seeds (78%), and saturated fats (100%). Junk foods (94%) and sweetened beverages (70%) were consumed at least once a week. No significant difference was observed in eating behavior and daily food consumption pattern between male and female cyclists. Conclusion The eating behavior of adolescent cyclists was inclined towards the consumption of saturated fats, junk food, and sweetened beverages. Male and female athletes have similar food habits. There is a need for the implementation of behavior change-oriented nutrition strategies to inculcate healthy eating habits among adolescent cyclists.

Exploring the Relationship between Athletic Identity on Certain Coping Mechanisms in Adolescent Athletes

OBJECTIVE: (1) To describe athletic identity and coping mechanisms in an adolescent athletic population, and (2) to examine the relationship between athletic identity and coping mechanisms in an adolescent population. MAIN.OUTCOME.MEASURES: Descriptive statistics were calculated for the summated AIMS-7 score and three CISS-SSC subscale scores. Pearson correlation coefficients were calculated between each AIMS-7 subscale and CISS-SSC subscale. Additionally, three independent t-tests were conducted with the independent variable, low, moderate, or high AIMS score, and the dependent variables, avoidance, emotion, or task-focused CISS-SSC score. Alpha level was set at 0.05 for all analyses.

Age-Related Electrocardiographic Characteristics of Male Junior Soccer Athletes.

IntroductionVery limited data exist on normal age-related ECG variations in adolescents and no data have been published regarding the ECG anomalies induced by intensive training, which are relevant in pre-participation screening for sudden cardiac death prevention in the adolescent athletic population. The purpose of this study was to establish normal age-related electrocardiographic measurements (P wave duration, PR interval, QRS duration, QT, and QTc interval) grouped according to 2-year age intervals.MethodsA total of 2,151 consecutive healthy adolescent Soccer athletes (trained for a mean of 7.2 ± 1.1 h per week, 100% male Caucasians, mean age 12.4 ± 1.4 years, range 7–18) underwent pre-participation screening, which included ECG and transthoracic echocardiography in a single referral center.ResultsTheir heart rate progressively slowed as age increased (p < 0.001, ranging from 80.8 ± 13.2 to 59.5 ± 10.2 bpm), as expected. The P wave, PR interval, and QRS duration significantly increased in older age classes (p = 0.019, p = 0.001, and p < 0.001, respectively), and after Bonferroni's correction, the difference remained significant in all age classes for QRS duration. The QTc interval diminished progressively with increasing age (p = 0.003) while the QT interval increased progressively (p < 0.001).ConclusionsSignificant variations in the normal ECG characteristics of young athletes exist between different age groups related to increasing age and training burden, thus, age-specific reference values could be adopted, as already done for echocardiographic measurements, and may help to further discriminate potentially pathologic conditions.

Win At Any Cost: Examining Personality Correlates of Achievement in Adolescent Athletes

Achievement in sports is often attributed to being highly competitive or doing “whatever it takes” to win as opposed to being agreeable. The current consensus is that these traits, manifested as hypercompetitiveness, Machiavellianism, and agreeableness, tend to be highly related within adult populations and athletes. Machiavellianism, the “whatever it takes' ' attribute and hypercompetitiveness have been found to be positively correlated with one another while both are negatively correlated with agreeableness. Previous studies have failed to examine the same phenomenon in individual-sport adolescent athlete populations, in addition to how these trends may influence athletic achievement. In this study, a random sampling of an adolescent athlete population was given a battery of personality scales: The Hypercompetitive Attitude Scale, the MACH-IV, and an IPIP Agreeableness Measure. The participants’ highest national rankings in their sport were also examined. Previous findings in adult populations were replicated in this study, as Machiavellianism and hypercompetitiveness were found to have a strong negative correlation with agreeableness(r= -0.678, p= 0.000039, and r= -0.690, p= 0.000025, respectively). Machiavellianism displayed a moderate, positive correlation with hypercompetitiveness(r= 0.496, p= 0.005312). However, the differences in Machiavellianism and hypercompetitiveness between those who had achieved a rank of at least top 15 in the country and other participants were not found to be statistically significant. These results show that athletic achievement in adolescents was not significantly affected by the personality traits of Machiavellianism and hypercompetitiveness. Additional research is needed to discover what personality traits constitute a champion. &#x0D;

Perioperative Complications and Early Clinical Outcomes Following ACL Reconstruction with Soft Tissue Quadriceps Tendon Autograft in Adolescent Athletes

Objectives:Quadriceps tendon (QT) autograft has emerged as an increasingly popular soft tissue graft alternative to the hamstring tendon (HS) autograph for ACL reconstruction (ACLR). However, utilization of the technique is not yet widespread, particularly in the population of adolescent athletes, for whom safety and effectiveness of the technique remains under-investigated, despite this being the most affected epidemiologic sub-population, with regard to primary ACL injury, post-ACLR re-tear, and overall complications. The study hypothesis was that QT-ACLR would have equivalent or lower rates of perioperative complications and early ACL re-tear than historically reported for HS ACLR.Methods:A retrospective review of all 12-19 year-old athletes who underwent primary QT-ACLR by a single surgeon at a tertiary care pediatric hospital were included, with prospective outreach performed at 1 and 2 years to collect PROs and confirm absence of ACL re-tear or revision surgery. Patients with <6 months follow-up were excluded to insure adequate reporting of early perioperative complications. Patients with between 6-12 month follow up were excluded from the ACL re-tear analysis. Concomitant procedures at the time of primary ACL surgery, perioperative and early post-operative complications, and subsequent surgeries were analyzed. A sub-analysis excluding the first 25 knees was performed to eliminate any potential effects of a surgical ‘learning curve’.Results:90 patients (93 knees, 70% female) were included, with a mean age of 16.0 years (±1.85) and mean follow up of 12.6 months (IQR 9.1-21.4). Concomitant meniscal pathology was detected in more than half of patients, with 30% undergoing meniscal repair and 27% partial meniscectomy. There were 51 complications overall in 36 knees (39%, Table 1). Secondary surgery for a complication was performed in 22 knees (24%), most commonly for a cyclops lesion/arthrofibrosis (15%), but also for revision ACLR (5%) and removal of implants (1%). Of note, 6 additional knees (6%) were diagnosed by MRI for a cyclops lesion/arthrofibrosis, but were successfully treated with non-operative measures, including physical therapy, dynamic splinting, and/or intra-articular cortisone injections. ACL graft tear was more common in the first 25 knees for whom QT-ACLR was performed (16% vs. 1%, p=0.02), indicating that initial re-tear could be a function of the surgical learning curve and technique adjustments. Early graft tear rate of 5% is similar to reported rates in HS autograft in adolescents. Arthrosibrosis/cyclops lesions were more frequently observed than historically reported for other graft types, and were not significantly different based on learning curve (20% vs. 22%, p=1.00). Pedi-IKDC (Table 2) showed significant improvement from baseline to 6-month (p<0.001) and 1-year time (p<0.001) period. Patients without complications had a significantly higher Pedi-IKDC score at 1 year follow up (mean, 93.9) compared to those with complications (mean, 85.5; p=0.04).Conclusions:Quad tendon ACLR shows a relatively high overall early post-operative complication and subsequent surgery rate in adolescents, most notably cyclops lesions/arthrofibrosis, most cases of which underwent arthroscopic debridement/LOA. This is consistent with previous adult QT-ACLR studies. Graft tear rates at 1-year post-operatively are similar to historically reported re-tear rates of the HS ACLR for adolescents, with a higher re-tear rate in the earlier sub-cohort, which may relate to surgical learning curve. Continued research into minimizing risks and quantifying longer term ACL re-tear risk will be critical for this young, active population, who are increasingly undergoing ACLR with the QT autograft, which remains relatively understudied, particularly in the adolescent sub-population.

Type of injury and recovery time in elite adolescent Korean judo athletes: An epidemiological study

We aimed to assess the risk of injury associated with training activities in a population of elite adolescent judo athletes, expected to represent South Korea. From 2019, we prospectively collected data on elite adolescent judo athletes at the Korean Training Center. The athletes were assessed by sports medicine doctors, and data were stratified according to sex, weight class, and injury location. We used χ2 tests to compare groups. Injury rates were expressed as Poisson rates with 95% confidence intervals. One-way analysis of variance was used to investigate the pain score and recovery time due to type of injury. The study included 240 elite adolescent judo athletes whose 617 injuries (annual average, 2.57 injuries/athlete) were recorded. When all athletes were considered, most injuries occurred in the lower extremities (39.71%), followed by the upper extremities (36.63%), trunk (16.69%), and head and neck area (6.97%). Recovery time significantly differed according to the body regions in the weight classes. The pain score and recovery time according to the type of injury were significantly different. When the pain score decreased by 1, the recovery time decreased by about 1.47 days. In all weight classes, female athletes had a higher injury rate than male athletes; both male and female athletes had different recovery time depending on their weight class. The type of injury influenced the pain score and recovery time, with pain score being associated with recovery time.

Low energy availability and impact sport participation as risk factors for urinary incontinence in female athletes

Relative Energy Deficiency in Sport (RED-S) is a clinical syndrome that includes the many complex health and performance consequences of low energy availability (EA) in athletes, when there is insufficient caloric intake to meet exercise-related energy expenditure and to support basic physiologic functions. There is a high prevalence of urinary incontinence (UI) in female athletes and it is more common in female athletes than non-athletes. The objective of this study was to determine if low EA is associated with UI in a population of adolescent and young adult female athletes and to evaluate for an association between sport categories and UI. 1000 nulliparous female patients, ages 15-30 years, presenting to a sports medicine subspecialty clinic, provided informed consent/assent to participate in a cross-sectional study involving a comprehensive survey, anthropomorphic measurements, and medical record review. Low EA was defined as meeting ≥1 criterion: self-reported history of eating disorder/disordered eating (ED/DE), and/or a high score on the Brief Eating Disorder in Athletes Questionnaire (BEDA-Q), and/or a high score on the Eating Disorder Screen for Primary Care (ESP). UI was assessed using questions adapted from the International Consultation on Incontinence-Urinary Incontinence Short Form (ICIQ-UI-SF), questions regarding timing of UI onset/duration, and a binary question regarding UI during sport activities. A total of 36 sport types were included in the survey and sub-divided into categories. Of the 1000 female athletes surveyed, 165 (16.5%) reported a history of experiencing UI during athletic activities. ICIQ- UI-SF responses indicated that 14% (137/1000) of the cohort experienced slight incontinence, 4% (35/1000) moderate incontinence, and 2 athletes experienced severe incontinence. There was a significant difference between UI categories in age (p=0.01), low EA (p<0.001), and sport category (p<0.001). Females who had low EA had twice the likelihood (OR=1.97; 95% CI=1.39 to 2.81; p<0.001) of UI compared to those with adequate EA, controlling for sports category and menstrual dysfunction. Females who participated in high impact sports were 4.5 times more likely (OR=4.47; 95% CI=2.29 to 8.74; p<0.001) to have had UI compared to females who participated in ball sports, controlling for EA and menstrual dysfunction. UI during athletic activities is a common problem among nulliparous adolescent and young adult female athletes, occurring in 16.5% of female athletes surveyed. UI was significantly associated with low EA across all sport categories. Sport type was significantly associated with UI, with the highest impact sport group demonstrating a higher prevalence and symptom severity compared to other sport categories.

Patient expectations and perceived social support related to return to sport after anterior cruciate ligament reconstruction in adolescent athletes

ObjectiveExamine the relationship between pre-operative competitive status and return to sport expectations post-operatively among adolescents undergoing ACL reconstruction. Assess the association between perceived levels of social support and doubts in returning to sport after ACL reconstruction. DesignCross-sectional. SettingOutpatient sports medicine clinic at a single institution. Participants12–18 years old with an ACL tear who were planning to undergo ACL reconstruction. Main outcome measuresPsychovitality questionnaire responses and Multidimensional Scale of Perceived Social Support (MSPSS) questionnaire scores. Results86% of participants expected to return to sports in six months or less after surgery; there was no significant difference in expected time to return to sport between competitive vs. recreational athletes. Competitive athletes were less likely to be content returning to a lower activity level after surgery compared to recreational athletes. There were no significant differences in MSPSS scores between those who did and did not report doubts in their ability to return to their previous sports. ConclusionMost of our adolescent athlete population expected to return to sport after ACL reconstruction within six months of surgery. Those with and without doubts in their ability to return to sports did not significantly differ in levels of perceived social support.

First-degree atrioventricular block in children and adolescent athletes

Abstract Introduction Intense regular training produces cardiac adaptations that manifests in various changes in the electrocardiogram (ECG), with sinus bradycardia being the most common finding. In adults the PR interval may be elongated and according to different series it can occur in 10–33% of cases, in the contrary in children and adolescent athletes the prevalence categorized by age has not been studied. Purpose Determine the incidence of first-degree atrioventricular (AV) block in a population of children and adolescent athletes in our environment, categorized by age. Methods We performed a cross-sectional study involving children and adolescent athletes between 5 and 16 years old who received a sport medical examination between August 2018 and May 2019. The ECG were obtained and analyzed following international standards, adequate electrode placement was ensured and was interpreted by cardiologists. The PR interval was obtained, considering prolonged if PR&amp;gt;180 milliseconds (ms) in children under 10 years old, PR&amp;gt;190 ms between 10 and 14 and PR&amp;gt;200 ms in those over 14. We categorized our athletes by age into the following four groups corresponding to approximated quartiles: G1 5–8 years, G2 9–11 years, G3 12–13 years, and G4 14–16 years Results A total of 6401 subjects were included, mean age was 11.2±2.9 years, 93.7% were male, soccer players (97.2%) and Caucasian (99.2%). They trained a mean of 5.4±2.3 hours a week. 11.4% of the patients had mild (50–59 bpm) or moderate (40–49 bpm) bradycardia, but none had severe bradycardia (&amp;lt;40 bpm). Sixty-one patients (0.96%) had 1st degree AV block and 19 (0.30%) had a PR interval at higher limit of normality. When stratified by age groups, the prevalence of 1st degree AV block was higher in the second quartile (Table 1). We did not find cases of Wenckebach or high-grade AV block (Mobitz II or 3rd degree AV block). Conclusions In children and adolescent athletes, the incidence of first-degree AV blockade is low (around 1%) and significantly lower than what is reported in adults. This may be due to a lower vagal tone in this population. If detected it may prompt clinicians to pursue further investigation given the low proportion of 1st degree AV block in children and adolescent athletes. Figure 1. Sixteen year old patient ECG Funding Acknowledgement Type of funding source: None

Exploring the Psychometric Properties of the Disablement in the Physically Active Scale Short Form-8 in Adolescents.

Patient-reported outcomes are widely used in health care. The Disablement in the Physically Active (DPA) Scale Short Form-8 (SF-8) was recently proposed as a valid scale for the physically active population. However, further psychometric testing of the DPA SF-8 has not been completed, and scale structure has not been assessed using a sample of adolescent athletes. To assess scale structure of the DPA SF-8 in a sample of adolescent high-school athletes. Adolescent athletes (n = 289) completed the DPA SF-8. Confirmatory factor analysis (CFA) was conducted to assess the psychometric properties of the scale. The CFA of the DPA SF-8 indicated that the model exceeded recommended fit indices (Comparative Fit Index = .976, Tucker-Lewis Index = .965, Root Mean Square Error of Approximation = .061, and Bollen's Incremental Fit Index = .976). All factor loadings were significant and ranged from .62 to .86. Modification indices did not suggest that meaningful cross-loadings were present or additional specifications that could further maximize fit or parsimony. The CFA of the DPA SF-8 met contemporary model fit recommendations in the adolescent athlete population. The results confirmed initial findings supporting the psychometric properties of the DPA SF-8 as well as the uniqueness of the quality-of-life and physical summary factors in an adolescent population. Further research (eg,reliability, invariance between groups, minimal clinically important differences, etc) is warranted to inform scale use in clinical practice and research.

Web-Based Exercise Program Increases Cervical Strength in Adolescent Athletes.

Wilson, JC, Levek, C, Daoud, AK, Brewer, M, Brooks, K, Sochanska, A, Randall, M, and Provance, AJ. Web-based exercise program increases cervical strength in adolescent athletes. J Strength Cond Res 35(4): 1149-1155, 2021-This cohort study aimed to evaluate the efficacy of a web-based 6-week cervical strengthening program on cervical strength in adolescent athletes. It was hypothesized that subjects completing the program would demonstrate significant increase in cervical muscle strength compared with baseline strength. Eighty-three high school soccer athlete subjects were recruited from 2 local nationally competitive soccer clubs. Teams were assigned to either control or intervention groups to minimize information crossover. Fifty subjects were recruited to the intervention group (29 male, 21 female; average age 15.1 years). Thirty-three subjects were recruited to the control group (21 male, 12 female; average age 15.1 years). Intervention group subjects completed a web-based progressive cervical strengthening program over 6 weeks. Cervical strength in flexion, extension, right and left lateral flexion (LLF) was measured in Newton (N) of force at 3 time points during the competitive season for both control and intervention groups. Intervention group subjects significantly increased cervical strength [mean difference (95% confidence interval)] in LLF [24.1 (15.9-32.4)], extension [27.9 (18.4-37.5)], right lateral flexion [18.8 (11.6-26.1)], and flexion [mean ratio: 1.2 (1.1-1.2)] at follow-up testing; whereas control subjects did not see significant changes in strength. A web-based progressive cervical strengthening program improves cervical muscular strength in a population of adolescent athletes over a period of 6 weeks. Such a program could be used by researchers in future studies evaluating the influence on concussion risk and by practitioners as a means of reducing sport-related head and neck injuries.

The Latarjet Procedure for Anterior Shoulder Instability in Pediatric and Adolescent Athletes

Objectives:To investigate surgical outcomes of the Latarjet procedure in the pediatric and adolescent athletic population compared to alternative techniques used to treat anterior shoulder instability with glenoid bone loss.Methods:This retrospective comparative cohort study involved a review of 40 patient records with a mean age of 16.7 years (range: 14.3 to 19.2) with anterior shoulder instability and glenoid bone loss (mean: 19%). Demographic and clinical features were recorded pre- and post-operatively, with mean follow up of 26.3 months (sd, 22.8). Advanced imaging and arthroscopic assessment were used to quantify concomitant pathology. Percent glenoid bone loss was calculated using the “glenoid rim distances” method. Glenoid track width and Hill-Sachs interval (HSI) were measured to determine if shoulders were on-track or off-track. Patients were contacted to obtain validated functional outcome questionnaires, including Quick-DASH, ASES, and Marx shoulder activity scale.Results:Of the 40 patients, 18 underwent the Latarjet procedure and 22 underwent alternative stabilization procedures. At presentation, both groups were statistically similar with regard to presence of HS (overall 92%), and mechanism of initial dislocation. However, patients who underwent the Latarjet procedure were slightly older at surgery (p=0.045), had longer symptom duration (p=0.015), and had failed more arthroscopic Bankart repair procedures (p=0.002). Additionally, more patients had “off-track” glenohumeral bone loss in the Latarjet group (38%) compared to the control group (9%), (p=0.049). Post-operatively, the Latarjet and control groups had comparable minimal loss of external rotation (47% vs .45%, p=0.768) and high rates of return to sports (94% vs 100%) at a similar time (5.3 vs. 5.4 months, p=1.0). There was a 17% recurrent instability rate in the Latarjet cohort similar to 23% in the control cohort (p=0.709). There were no cases of post-operative nerve palsy or coracoid non-union in those who underwent the Latarjet, compared to one non-union following bony Bankart ORIF in the control group. Functional outcome scores were similarly high across both groups (Table 1).Conclusion:Despite being a technically challenging, salvage-type, open reconstructive shoulder procedure, the Latarjet procedure yielded low complication rates and comparably good outcomes in an adolescent cohort with more risk factors for recurrence than a control group of adolescents undergoing other procedures. For young, athletic patients with multiple instability recurrences, previous surgeries, long symptom duration, and glenohumeral bone loss—including severe, ‘off track’ variations—the Latarjet procedure provides a high rate of return to sports, good/excellent functional outcome scores, and low rates of recurrent instability and complications.

A Prospective Study on the Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Background: Sport specialization is associated with an increased risk of musculoskeletal lower extremity injuries (LEIs) in adolescent athletes presenting in clinical settings. However, sport specialization and the incidence of LEIs have not been investigated prospectively in a large population of adolescent athletes. Purpose: To determine if sport specialization was associated with an increased risk of LEIs in high school athletes. Study Design: Cohort study; Level of evidence, 2. Methods: Participants (interscholastic athletes in grades 9-12) were recruited from 29 Wisconsin high schools during the 2015-2016 school year. Participants completed a questionnaire identifying their sport participation and history of LEIs. Sport specialization of low, moderate, or high was determined using a previously published 3-point scale. Athletic trainers reported all LEIs that occurred during the school year. Analyses included group proportions, odds ratios (ORs) and 95% CIs, and days lost due to injury (median and interquartile range [IQR]). Multivariate Cox proportional hazard ratios (HRs) with 95% CIs were calculated to investigate the association between the incidence of LEIs and sport specialization level. Results: A total of 1544 participants (50.5% female; mean age, 16.1 ± 1.1 years) enrolled in the study, competed in 2843 athletic seasons, and participated in 167,349 athlete-exposures. Sport specialization was classified as low (59.5%), moderate (27.1%), or high (13.4%). Two hundred thirty-five participants (15.2%) sustained a total of 276 LEIs that caused them to miss a median of 7.0 days (IQR, 2.0-22.8). Injuries occurred most often to the ankle (34.4%), knee (25.0%), and upper leg (12.7%) and included ligament sprains (40.9%), muscle/tendon strains (25.4%), and tendinitis/tenosynovitis (19.6%). The incidence of LEIs for moderate participants was higher than for low participants (HR, 1.51 [95% CI, 1.04-2.20]; P = .03). The incidence of LEIs for high participants was higher than for low participants (HR, 1.85 [95% CI, 1.12-3.06]; P = .02). Conclusion: Athletes with moderate or high sport specialization were more likely to sustain an LEI than athletes with low specialization. Sports medicine providers need to educate coaches, parents, and interscholastic athletes regarding the increased risk of LEIs for athletes who specialize in a single sport.

The Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

Objectives:Sport specialization has been shown to be associated with increased risk of musculoskeletal lower extremity injuries (LEI) in adolescent athletes presenting in clinical settings. However, the association of sport specialization and incidence of LEI has not been studied prospectively in a large population of adolescent athletes. The objective of this study was to compare the incidence of LEI in high school athletes identified as having low (LOW), moderate (MOD) or high (HIGH) levels of sport specialization.Methods:Subjects (male and female, interscholastic athletes, grades 9 - 12) were recruited from a diverse sample of 29 Wisconsin high schools during the 2015/16 school year to participate in the study. Subjects d a questionnaire identifying all of the interscholastic and club sports they participated in during the previous and current school years, history of previous LEI, their primary sport and the number of primary sport competitions in which they participated in within the previous 12 months. Sport specialization status was determined using a previously published 3 item specialization scale (total score: 0 - 1 = LOW, 2 = MOD, 3 = HIGH). Athletic trainers at each school reported all athletic exposures and LEI that occurred for each subject during each interscholastic sport season they participated in during the school year. Analyses included group proportions, Odds Ratios (OR, [95%CI]) and median days lost due to injury (Med [IQR 25th,75th]. Multivariate Cox Proportional Hazards Ratios (HR, [95%CI]) were calculated to investigate the association between the incidence of LEI and sport specialization level while controlling for gender, grade, history of previous LEI, primary sport and the number of primary sport competitions.Results:A total of N =1,544 subjects (Female = 50%, Age =16.1+1.1 yrs.) enrolled in the study, competed in 2,843 athletic seasons and participated in 167,349 athletic exposures during the school year. Subjects were classified as being LOW (60%), MOD (27%) or HIGH (13%) specialization. Females were more likely to be classified as HIGH than males (OR = 2.07 [1.53 - 2.81, p < 0.001]. The sports with the greatest percentage of HIGH participants were soccer (22%), baseball/softball (19%), volleyball (17%), and basketball (13%). Two hundred thirty five subjects (15%) sustained a total of n = 276 LEI that caused them to miss a median of 7.0 [2.0, 22.8] days. Injuries occurred most often to the ankle (34%), knee (25%), upper leg (13%) and lower leg (12%). LEI were acute (66%) or gradual / recurrent (34%) onset. Common injuries included ligament sprains (41%), muscle / tendon strains (25%) and tendonitis / tenosynovitis (20%). Surgical treatment was required for n = 23 (8%) of the LEI. The incidence of LEI for MOD subjects was higher than LOW subjects (HR = 1.51 [1.04 - 2.20], p = 0.029). The incidence of LEI for HIGH subjects was higher than LOW subjects (HR = 1.85 [1.12 - 3.06], p = 0.017).Conclusion:Interscholastic athletes with MOD or HIGH sport specialization were more likely to sustain a LEI than athletes with LOW specialization. Sports medicine providers need to educate officials of sport governing bodies, school coaches, parents and interscholastic athletes regarding the increased risk of LEI for athletes who specialize in a single sport.

Perceived Stress has a Negative Impact on Variables Related to Exercise Recovery in Adolescent Athletes

PURPOSE: Psychological stress has been shown to impair recovery in laboratory settings, but no study has done so in field settings. This study was designed to test the impact of perceived stress on variables related to recovery in an adolescent athlete population who were participating in a 6-wk Summer training program. METHODS: Participants included 100 high school athletes (M age = 15.1; 78% Male; 46% African American). Data were collected during 4 consecutive days in the middle of the training program. Recovery was indicated by measures of feeling states and arousal, fatigue, and soreness. These were collected prior to each day’s training. The Perceived Stress Scale was used to assess stress. Growth curve analysis was used to examine change in these variables throughout the week. We hypothesized stress to be associated with greater soreness to begin the week, and greater decrements in all variables throughout the week. RESULTS: Stress had a significant (p < .05) impact on the reference value of the feeling scale (β00 = 1.2) and soreness (β00 = 1.4). As stress increases by 1 SD, there was a .7 decrease in average feeling scale response and a .4 increase in reported soreness. In addition, stress had a significant impact the change in both felt arousal (β10 = -.1) and soreness (β10 = .3) during the week, with each 1 SD increase in stress associated with a daily .14 drop in felt arousal, and a daily increase of.16 in soreness. CONCLUSION: Stress appears to be associated with reduced recovery during a week of intense, Summer training in high school athletes. Not only was stress associated with reduced mood and increased soreness overall, it was also associated with a greater increase in soreness and reduction in felt arousal across the week. It may be important to help athletes better cope with stress to enhance their response to training. Research reported in this publication was supported by Dairy MAX: UTA16-000534.