Collision Sports Research Articles

Examining for Cavum Septum Pellucidum and Ventricular Enlargement in Retired Elite-Level Rugby League Players.

ObjectiveA cavum septum pellucidum (CSP) has been reported as a visible brain anomaly in normal individuals as well in some former combat and collision sport athletes. The appearance of CSP with fenestrations and ventricular enlargement are considered associated features of the neuropathological diagnosis of chronic traumatic encephalopathy. The current study examined CSP anatomic features and lateral ventricle size in retired elite rugby league players and controls.MethodsForty-one retired rugby league players and 41 healthy community controls, similar in age and education, underwent structural MRI scans. CSP grade, CSP length, corpus callosum septal length, and Evans' ratio (for lateral ventricle size) were rated by two of the current study authors. All participants also self-reported concussion exposure histories, depressive symptoms, daytime sleepiness, and impulsivity. They completed a neuropsychological test battery assessing premorbid intellectual functioning, attention, processing speed, language, visuospatial skills, memory, and aspects of executive functioning.ResultsThe two raters had high agreement for CSP grade (Cohen's κ = 0.80), CSP length [intraclass correlation (ICC) = 0.99], corpus callosum septal length (ICC = 0.73), the CSP/septal ratio (ICC = 0.99), and the Evans' ratio (ICC = 0.75). Twenty-five retired players (61.0%) had an abnormal CSP compared to 17 controls [41.5%; = 3.12, p = 0.08, odds ratio = 2.21]. The CSP/septal ratio was larger for retired players than for the controls. The Evans' ratio did not differ between the two groups. In the retired rugby league players (n = 41), those with normal (n = 16) and abnormal (n = 25) CSP grades did not differ across age, age of first exposure to collision sport, years of sport exposure, concussion history, or 23 clinical and cognitive variables.ConclusionThis study revealed a difference in the size of the CSP between retired professional rugby league players and controls. There was no significant difference in the size of the ventricles between the two groups. There were no significant differences between those with vs. without an abnormal CSP on age of first exposure to rugby league, years of exposure to repetitive neurotrauma, number of lifetime concussions, depression, impulsivity, perceived cognitive decline, or on any neuropsychological test.

Sub-acute Changes on MRI Measures of Cerebral Blood Flow and Venous Oxygen Saturation in Concussed Australian Rules Footballers

BackgroundSports-related concussion (SRC) is common in collision sport athletes. There is growing evidence that repetitive SRC can have serious neurological consequences, particularly when the repetitive injuries occur when the brain has yet to fully recover from the initial injury. Hence, there is a need to identify biomarkers that are capable of determining SRC recovery so that they can guide clinical decisions pertaining to return-to-play. Cerebral venous oxygen saturation (SvO2) and cerebral blood flow (CBF) can be measured using magnetic resonance imaging (MRI) and may provide insights into changing energy demands and recovery following SRC.ResultsIn this study we therefore investigated SvO2 and CBF in a cohort of concussed amateur Australian Football athletes (i.e., Australia’s most participated collision sport). Male and female Australian footballers (n = 13) underwent MRI after being cleared to return to play following a mandatory 13-day recovery period and were compared to a group of control Australian footballers (n = 16) with no recent history of SRC (i.e., > 3 months since last SRC). Despite the concussed Australian footballers being cleared to return to play at the time of MRI, we found evidence of significantly increased susceptibility in the global white matter (p = 0.020) and a trend (F5,21 = 2.404, p = 0.071) for reduced relative CBF (relCBF) compared to the control group. Further, there was evidence of an interaction between sex and injury in straight sinus susceptibility values (F1,25 = 3.858, p = 0.061) which were decreased in female SRC athletes (p = 0.053). Of note, there were significant negative correlations between straight sinus susceptibility and relCBF suggesting impaired metabolic function after SRC.ConclusionsThese findings support the use of quantitative susceptibility mapping (QSM) and relCBF as sensitive indicators of SRC, and raise further concerns related to SRC guidelines that allow for return-to-play in less than two weeks.

Diagnosis, Management of, and Return to Play Guidance for Venous Thromboembolism in Athletes.

Venous thromboembolism (VTE) is not rare and is becoming more recognized in our athletic population. This diagnosis can be elusive. A provider must have a high clinical suspicion and use pretest probabilities to order the appropriate studies and accurately diagnose a VTE. Treatment using direct oral anticoagulants for 3 months is recommended in most cases. Gradual return to play can be achieved after treatment is complete. Some athletes, however, may require lifelong anticoagulation. Return to collision sports may be possible using a timed dose strategy if long-term anticoagulation is needed. The management of an athlete with a VTE should include an individualized treatment plan and involve shared decision making with the athlete, team physicians, and hematologic specialists.

The Role of Age, Sex, Body Mass Index, and Sport Type on the Dynamic Exertion Test in Healthy Athletes: A Cross-Sectional Study.

The dynamic exertion test (EXiT) was developed to help inform return to play after sport-related concussion, but some factors may threaten the internal validity of EXiT and affect clinical interpretation. To compare age, sex, BMI, and sport types across EXiT physiological [pre-EXiT and post-EXiT percentage of maximum heart rate (HR %max) and blood pressure (BP)], performance (change-of-direction task completion time and committed errors), and clinical [symptoms and rating of perceived exertion (RPE)] outcomes among healthy adolescents and adults. Cross-sectional. Eighty-seven participants ( F = 55, 37.4%) reported symptoms and RPE during the EXiT, which consists of a 12-minute treadmill running protocol, and the dynamic circuit, ball toss, box shuffle (SHUF) and carioca (CAR), zig zag (ZZ), proagility (PA), and arrow agility (AA) tasks. Independent samples t tests were conducted for pre-EXiT and post-EXiT HR %max and BP and change-of-direction task completion time and Mann-Whitney U tests for errors, symptoms, and RPE. A series of 1-way analysis of variance (ANOVAs) and Kruskal-Wallis H tests were conducted to compare collision, contact, and noncontact sport types. Adolescents had lower completion time across AA ( P = 0.01) and male athletes lower than female athletes on CAR, ZZ, PA, and AA ( P < 0.04). Male athletes reported greater RPE after the SHUF, CAR, and AA ( P < 0.03). HR %max , errors, and symptoms were equivocal across all subgroups ( P > 0.05). Age and sex should be considered in the interpretation of performance and clinical, but not physiological, EXiT outcomes. The EXiT is a standardized exercise assessment and generalizable to healthy athletes.

Prolonged restricted training, fixture congestion and player rotation: What the COVID-19 pandemic taught us about injury risk in professional collision sport

ObjectivesThe COVID19-induced suspension of the 2019-20 professional England rugby union season resulted in players being exposed to an extended restricted training period, coupled with a congested match schedule once competition resumed. We assessed the impact of these changes on match and training injuries in the final 20-weeks of the season following competition resumption. DesignEpidemiological study. MethodsThe 2019-20 season was compared to the previous three seasons (2016-19). ResultsThere was no significant difference in the mean incidence, severity and burden of training and match injuries in 2019-20 compared to 2016-19 period mean. The 2019-20 post-suspension mean match injury rate [77/1000 h (95%CIs [confidence intervals]: 67-89)] was comparable to the 2019-20 pre-suspension [93/1000 h (95%CIs: 85-101)] and significantly lower than the 2016-19 equivalent post-suspension period [97/1000 h (95CIs: 90-104) IRR [incidence rate ratio] 0.8 p=0.002]. In the 2019-20 season, there was a significantly higher rate of training injury post-suspension in comparison to pre-suspension [3.8/1000 h (95CIs: 3.3-4.4) vs 2.7/1000 h (95% CIs: 2.5-3.1) IRR 1.4 p=0.005]. There was no significant difference in the overall incidence, severity or burden of injuries sustained in fixtures with shorter (<6 days) turnarounds but there was a significantly higher burden of soft tissue injuries. ConclusionsThis is the first study to assess the effect of restricted training on injury risk in collision sports. Players were at an increased risk of training injury when returning from the suspension, but 10-weeks of preparatory training meant the incidence of match injury was not higher when competition resumed.

Establishing Clinically Significant Outcomes After Anterior Cruciate Ligament Reconstruction in Pediatric Patients.

The purpose of this study was to establish clinically significant outcome values for the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after anterior cruciate ligament reconstruction (ACLR) in the pediatric and adolescent populations and to assess factors that were associated with achieving these outcomes. Patients between the age of 10 to 21 who underwent ACLR between 2016 and 2018 were identified and patient-reported outcomes (PROs) were collected preoperatively and postoperatively. Intraoperative variables collected included graft choice, graft size (diameter), graft fixation method, and concomitant procedures. PROs collected for analysis were the International Knee Documentation Committee Score (IKDC) and Knee Injury and Osteoarthritis Outcome Score (KOOS). MCID and PASS were calculated using receiver operating characteristic with area under the curve analyses for delta (ie, baseline-to-postoperative change) and absolute postoperative PRO scores, respectively. A total of 59 patients were included in the analysis. Of the entire study population, 53 (89.8%) reported satisfaction with their surgical outcome. The established MCID threshold values based on the study population were 33.3 for IKDC, 28.6 for (KOOS) Symptoms, 19.4 for Pain, 2.9 for activities of daily living (ADL), 45.0 for Sport, and 25.0 for Quality of Life (QoL). Postoperative scores greater than the following values corresponded to the PASS: 80.5 for IKDC, 75.0 (KOOS) Symptoms, 88.9 for Pain, 98.5 for ADL, 75.0 for Sport, and 68.8 for QoL. Clinically meaningful outcomes including MCID and PASS were established for pediatric ACLR surgery using selected PRO measures, IKDC, and KOOS. Patient age, sex, graft type, and graft size were not associated with greater achievement of these outcomes. In contrast, collision sports, fixed-object high-impact rotational landing sports, and concomitant meniscectomy surgery were associated with a decreased likelihood of achieving clinically significant improvement. However, findings must be interpreted with caution due to limitations in follow-up and sample size. Level IV: case series.

Performance After Concussion in National Basketball Association Players.

Background:Concussions have received national attention in collision sports such as football, soccer, and hockey, but less focus has been placed on basketball.Purpose:To determine return-to-play (RTP) and player performance in the first and second season after concussion in National Basketball Association (NBA) players.Study Design:Descriptive epidemiology study.Methods:An online database of publicly available NBA athlete injuries was queried for instances of “concussion” between 2010 and 2018. The age at injury, team, position, height, weight, body mass index, NBA experience, date of concussion, date of return, and seasons played postconcussion was recorded for each player. Regular-season statistics (games started, games played, minutes played, and player efficiency rating [PER]) were compiled for the season before, and 2 seasons immediately after, injury. Kaplan-Meier survivorship plots were computed for athlete RTP and retirement endpoints.Results:A total of 81 injuries were identified from 2010 to 2018, with a rate of 2.0 concussions per 100 player-years. Overall RTP was 100% after concussion, with nearly all (88%) returning in the season of injury; 12% of players experienced a season-ending concussion. RTP averaged 37.3 days after injury, varying widely (range, 2-291 days). Compared with preinjury season (78.0%), athletes played in significantly fewer overall games in the season of injury (36.6%; P < .0001), as well as 1 (69.5%; P = .0229) and 2 seasons postinjury (73.2%; P = .3192). PER scores were not significantly different across the study period. Each point increase in a player’s preinjury PER score was associated with a 2.4% decrease in PER from the preinjury season to season of injury (P = .0016) and a 3.1% decrease from preinjury to season after injury (P = .0053). Each increasing year of age or year of experience was associated with 5% decline in PER score at 1 season after injury.Conclusion:NBA players had a high RTP after concussion, with most returning in the same season as the injury. Players sustaining concussions played significantly fewer games for at least 2 seasons after injury. Performance via PER did not change across the entire cohort; however, players with higher preinjury PER, and older players were more likely to sustain a greater decline in performance after injury.

Investigating Concussion Symptom Epidemiology Among Quidditch Players in the United States

<h3>Research Objectives</h3> Quidditch is a growing club sport played in the United States but possesses a stronger prominence among other countries as well as a greater understanding of collision injuries in comparison. Given the growing prominence of this collision sport over the past decade, there is a higher urgency to understand patient awareness of concussion symptom epidemiology. <h3>Design</h3> Cross Sectional Study. <h3>Setting</h3> Online assessment given to current players. <h3>Participants</h3> A cohort of 237 US quidditch players nationwide. <h3>Interventions</h3> Assessment tool evaluating the understanding of 16 signs and symptoms that players believe someone may experience after a head trauma concerning a concussion. <h3>Main Outcome Measures</h3> Player awareness of concussion symptom epidemiology. <h3>Results</h3> Among the cohort of US quidditch players, headaches were believed to be the most common symptom after experiencing a head trauma at 86.9% (p < 0.05%), followed by dizziness at 85.7%. Players also reported panic attacks and reduced breathing rate are symptoms (20.6%). Among the lowest reported symptoms, players believed arthritis and weight changes were associated with concussion symptoms (<0.01%). Additionally, 36.2% (p <0.05) of players believed they knew what to do and who to contact if they experienced a concussion. <h3>Conclusions</h3> To our understanding, this is the first nationwide investigation among US quidditch players in the United States on concussion symptomology and preparedness. Compared to other collision sports, player understanding of symptoms is similar, but these results also indicate that quidditch players have a sense of urgency in being prepared to manage a concussion. <h3>Author(s) Disclosures</h3> The authors of this study do not have any disclosures or conflicts to report.

Predicting Rugby League Tackle Outcomes Using Strength and Power Principal Components.

Tackling is a fundamental skill in collision sports such as rugby league. Given the complexity of tackling and multitude of strength and power variables available for analysis, this study aimed to predict tackle outcomes in professional rugby league based on strength and power principal components (PCs). Twenty-eight rugby league players participated in this study. Maximal strength was assessed via 1 repetition maximum on the back squat, bench press, and bench pull. Lower-body vertical and horizontal power were evaluated using a countermovement jump and standing broad jump. A postmatch analysis of 5 National Rugby League matches was conducted to examine tackling outcomes. PC analysis was performed on the strength and power assessments. The first PCs were retained in each analysis, and a series of Spearman rank-order correlations were conducted between the tackle outcomes and the retained PCs. The PCs significantly related to tackle outcomes were included in the multiple regression analyses to estimate their effect on tackle outcomes. Strength PC was a significant predictor of play-the-ball speed in attack, accounting for 54% of the variance. Countermovement jump PC was a significant predictor of postcontact meters, explaining 19% of the variance. These findings demonstrate that a range of tackle outcomes may be predicted from strength and power components. The coaching staff may choose to develop programs and testing designed to focus on these components, which may further develop players' tackle outcomes during competition.

Prevalence of hormonal contraceptive use and reported side effects of the menstrual cycle and hormonal contraceptive use in powerlifting and rugby

ABSTRACT OBJECTIVES The prevalence of hormonal contraceptive (HC) use and the associated symptomology of use or non-use are under-studied in athletic populations, and in particular, in strength and collision sports. This study aimed to investigate the prevalence of hormonal contraceptive use and reported side effects of the menstrual cycle and hormonal contraceptive use in powerlifters and rugby players. METHODS Competitive female powerlifters and rugby players (aged ≥18 y), representing a strength and a collision sport respectively, completed an anonymous online questionnaire for the purpose of assessing self-reported prevalence of HC use, and symptoms of the menstrual cycle and HC use. Athletes were categorized by sport (powerlifters, n=149; rugby players, n=135) in order to conduct a stratified analysis. For open-ended questions, a content analysis was conducted to categorize responses, and frequency analyses were performed. RESULTS Current HC use was reported by 51.1% of athletes, with similar prevalence for the two sports (powerlifting, 48.3% vs. rugby, 54.1%, P=0.34). Side effects of the menstrual cycle were reported in 83.5% of non-HC users, with the most common being unspecified cramping (42.4%), headache/migraine (24.5%), and fatigue (24.5%). Side effects were reported in 40.0% of HC users, with the most common being mood changes (17.9%), stomach pain (8.3%) and headaches/migraines (6.9%). CONCLUSION A large proportion of HC users and non-users in this study experience negative side effects of HC use and the menstrual cycle, respectively. The symptoms experienced by both groups are wide-ranging, with a high degree of variation between individuals. The negative side-effects experienced by HC users and non-users may have an influence on athletic performance, and this requires future investigation.

Normalized Brain Tissue-Level Evaluation of Volumetric Changes of Youth Athletes Participating in Collision Sports.

Observations of short-term changes in the neural health of youth athletes participating in collision sports (e.g., football and soccer) have highlighted a need to explore potential structural alterations in brain tissue volumes for these persons. Studies have shown biochemical, vascular, functional connectivity, and white matter diffusivity changes in the brain physiology of these athletes that are strongly correlated with repetitive head acceleration exposure. Here, research is presented that highlights regional anatomical volumetric measures that change longitudinally with accrued subconcussive trauma. A novel pipeline is introduced that provides simplified data analysis on standard-space template to quantify group-level longitudinal volumetric changes within these populations. For both sports, results highlight incremental relative regional volumetric changes in the subcortical cerebrospinal fluid that are strongly correlated with head exposure events greater than a 50-G threshold at the short-term post-season assessment. Moreover, longitudinal regional gray matter volumes are observed to decrease with time, only returning to baseline/pre-participation levels after sufficient (5–6 months) rest from collision-based exposure. These temporal structural volumetric alterations are significantly different from normal aging observed in sex- and age-matched controls participating in non-collision sports. Future work involves modeling repetitive head exposure thresholds with multi-modal image analysis and understanding the underlying physiological reason. A possible pathophysiological pathway is presented, highlighting the probable metabolic regulatory mechanisms. Continual participation in collision-based activities may represent a risk wherein recovery cannot occur. Even when present, the degree of the eventual recovery remains to be explored, but has strong implications for the well-being of collision-sport participants.

Bone Health in Pediatric Fracture Patients: A DEXA Study

Vitamin D deficiency is widespread in children and is associated with increased fracture severity. Previous studies have shown mixed results on the impact of vitamin D supplementation on bone health parameters measured on dual-energy x-ray absorptiometry (DEXA) scan. This is the first longitudinal DEXA study in a pediatric fracture population. Pediatric fracture patients with vitamin D levels below 20 ng/mL were counseled to take vitamin D and calcium per a serum-based protocol. Patients underwent baseline DEXA within the initial 12 weeks post fracture and had follow-up scans at 6 and 12 months. 48 patients were enrolled, 32 patients completed two DEXA scans, and 19 completed three DEXA scans. There was a significant increase in lumbar spine BMC, TBLH BMD, and TBLH BMC between DEXA 1 and 2 (p 0.001). A positive trend in DEXA parameters is suggested between DEXA 1 and DEXA 3. Height adjusted z-scores (HAZ) were calculated which showed no statistical significance, p-values > 0.05. In this group, there are no significant changes in TBLH, BMC or BMD z-scores one year after fracturing despite vitamin D and calcium supplementation. This suggests that children returning to collision sports may be at continued risk for refracture and future studies are needed.

Effects of Cumulative Years of Contact/Collision Sports on Neuropsychological Outcomes

To determine the relationship between prolonged exposure to repetitive head impacts (RHI) through contact sports, as assessed by cumulative years contact sport participation, and quality of life outcomes in current/former contact sport athletes. Cumulative lifetime RHI exposure may be a more meaningful measure than age of first exposure to contact sports to assess effects of RHI on neurologic function, however effects on young adults remain mixed. Twenty-one physically active current/former contact sport athletes (35.0 ± 12.2 years, 66.7% male) completed an online questionnaire. To assess quality of life and psychological status, participants completed the Apathy Evaluation Scale-Self Rated (AES-S), Short Form 12 (SF-12), Satisfaction with Life Survey (SWLS), and Sport Concussion Assessment Tool 5 (SCAT5) Symptoms. Participants self-reported years of organized contact sport history (16.9 ± 10.5 years, range: 1-45) along with covariates (sex, LD/ADHD, age, concussion history). Generalized linear models were used to examine the association between cumulative years contact sport and psychological outcomes, while controlling for covariates. Cumulative years contact sports was a significant positive predictor of better apathy ratings (p = 0.038) and SWLS (p = 0.001). For every year increase, there was an associated 1.1% reduction in AES-S and 1.6% improvement in SWLS. Cumulative years was not a significant predictor of SF-12 Mental Component Summary (p = 0.113), SF-12 Physical Component Summary (p = 0.289), or symptoms (p = 0.237). Cumulative years of contact sport history was associated with better patient reported outcomes in current/former contact/collision sport athletes. This provides insight into later life effects of prolonged RHI exposure on neuropsychological outcomes in a more diverse subject pool outside of retired football players. Long-term neurologic effects remain to be elucidated, however, in early adulthood collision sports have positive mental health outcomes.

Age-Related Trajectories of Brain Structure-Function Coupling in Female Roller Derby Athletes.

Contact and collision sports are believed to accelerate brain aging. Postmortem studies of the human brain have implicated tau deposition in and around the perivascular space as a biomarker of an as yet poorly understood neurodegenerative process. Relatively little is known about the effects that collision sport participation has on the age-related trajectories of macroscale brain structure and function, particularly in female athletes. Diffusion MRI and resting-state functional MRI were obtained from female collision sport athletes (n = 19 roller derby (RD) players; 23–45 years old) and female control participants (n = 14; 20–49 years old) to quantify structural coupling (SC) and decoupling (SD). The novel and interesting finding is that RD athletes, but not controls, exhibited increasing SC with age in two association networks: the frontoparietal network, important for cognitive control, and default-mode network, a task-negative network (permuted p = 0.0006). Age-related increases in SC were also observed in sensorimotor networks (RD, controls) and age-related increases in SD were observed in association networks (controls) (permuted p ≤ 0.0001). These distinct patterns suggest that competing in RD results in compressed neuronal timescales in critical networks as a function of age and encourages the broader study of female athlete brains across the lifespan.

Clinical outcomes of Gaelic Athletic Association athletes after surgical stabilization in the setting of anterior shoulder instability

BackgroundGaelic Athletic Association (GAA) games are collision sports played at an amateur level, which represent the most popular sports played on the island of Ireland. Each year, many GAA players in Ireland require surgical stabilization with either arthroscopic Bankart repair (ABR) or open Latarjet (OL) procedures in the setting of anterior shoulder instability. The purpose of this study was to evaluate the clinical outcomes, recurrence, and return to play (RTP) in athletes who play GAA games having undergone surgical stabilization with either ABR or OL procedures in the setting of anterior shoulder instability.MethodsA retrospective review of all patients with anterior shoulder instability whom had stabilization with either ABR or OL under a single surgeon between 2012 and 2018 was performed. Patients who were athletes partaking in GAA sports were followed up by chart review and telephone survey to assess their clinical outcomes including satisfaction, pain as measured on the visual analog scale score, the Subjective Shoulder Value, recurrence, complications, and revision surgeries. In addition, RTP rates, time to RTP, level of RTP, and Shoulder Instability–Return to Sport after Injury scores were evaluated.ResultsA total of 200 GAA athletes (194 males) with a mean age of 23.9 ± 6.1 years with mean follow-up of 50.4 ± 24 months were included in this study. A total of 98.1% patients were satisfied with their procedure at the latest follow-up, with an overall recurrence rate of 5%. A total of 6.5% of athletes required revision surgery, of whom 4% required revision stabilization (all of whom had recurrence). The overall rate of RTP was 88% at mean 6.0 ± 1.7 months postoperatively, with 75% of athletes returning at the same or higher levels than their preinjury level. There were no significant differences for all outcome measures analyzed between patients who had ABR or OL procedures.ConclusionGAA athletes with anterior shoulder instability treated with either ABR or OL procedures report excellent clinical outcomes at medium-term follow-up, with high satisfaction rates, excellent functional outcomes, and high rates of RTP. Furthermore, this cohort demonstrates low rates of recurrence after stabilization with few requiring revision surgery.

Competitive trait anxiety and general self-esteem of athletes according to the sport type and gender

Traditionally, anxiety has been interpreted as a negative emotional state characterized by nervousness, worry, fret, uncertainty and vague fear which could have an adverse effect on sports achievement. On the other hand, sport type and its specific nature and demands, may also be connected with the level of state and trait anxiety. This study aimed to investigate potential differences in the competitive trait anxiety level and general self-esteem according to gender in sports of different contact level. The sample consisted of 1024 (590 males and 434 females) young athletes. Independent variables were sport contact level (non-contact, contact and collision sports) and gender. Dependent variables were measured by the adjusted versions of Sport Competition Anxiety Test and Rosenberg Self-Esteem Scale. Basic descriptive statistics was calculated for all the groups, and the differences between them were established using χ² test and MANOVA. The results suggest significant differences in trait competitive anxiety per sport type, gender and their interaction, and no differences in the general self-esteem level. The current study reveals that not only the intensity but also the intergroup relationship of a sport contact level (non-contact, contact and collision sports) is gender determined. These findings are important in psycho-diagnostic procedure and choosing appropriate coping strategies for athletes.

Same name, same game, but is it different? An investigation of female rugby union match events in Canadian Varsity players

Rugby Union is team-based collision sport with increasing global popularity, particularly in the women's game. Despite this, there is currently no evidence demonstrating the frequency of match events outside of the international game. Therefore, the aim of this study is to outline the frequency and distribution of match events in non-international female rugby union to both outline the demands placed on players and to assess the patterns of play for future injury prevention strategies. Forty-eight games from three seasons of varsity rugby were coded and rates of events per match were calculated. Average ball in play percentage was 51%. The tackle was the most frequent contact match event [280.0 (95% CIs: 270.2-289.7)] while passes were the most frequent non-contact match events [323.2 (95% CIs: 311.8-334.5)]. The distribution of events across match quarter was largely consistent and neither the fixture type, nor the season was consistently associated with differences in match event count per game. This study provides the first analysis of match events outside of international game and provides a useful reference for coaches in preparation of players as well as comparable data for the women's game when informing decision making on injury prevention.

Development of a Machine-Learning-Based Classifier for the Identification of Head and Body Impacts in Elite Level Australian Rules Football Players.

Background: Exposure to thousands of head and body impacts during a career in contact and collision sports may contribute to current or later life issues related to brain health. Wearable technology enables the measurement of impact exposure. The validation of impact detection is required for accurate exposure monitoring. In this study, we present a method of automatic identification (classification) of head and body impacts using an instrumented mouthguard, video-verified impacts, and machine-learning algorithms.Methods: Time series data were collected via the Nexus A9 mouthguard from 60 elite level men (mean age = 26.33; SD = 3.79) and four women (mean age = 25.50; SD = 5.91) from the Australian Rules Football players from eight clubs, participating in 119 games during the 2020 season. Ground truth data labeling on the captures used in this machine learning study was performed through the analysis of game footage by two expert video reviewers using SportCode and Catapult Vision. The visual labeling process occurred independently of the mouthguard time series data. True positive captures (captures where the reviewer directly observed contact between the mouthguard wearer and another player, the ball, or the ground) were defined as hits. Spectral and convolutional kernel based features were extracted from time series data. Performances of untuned classification algorithms from scikit-learn in addition to XGBoost were assessed to select the best performing baseline method for tuning.Results: Based on performance, XGBoost was selected as the classifier algorithm for tuning. A total of 13,712 video verified captures were collected and used to train and validate the classifier. True positive detection ranged from 94.67% in the Test set to 100% in the hold out set. True negatives ranged from 95.65 to 96.83% in the test and rest sets, respectively.Discussion and conclusion: This study suggests the potential for high performing impact classification models to be used for Australian Rules Football and highlights the importance of frequencies <150 Hz for the identification of these impacts.

Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes.

Shoulder instability is a relatively common injury especially in the young athletic population and its surgical management continues to remain a controversial topic in sports medicine orthopedics. Anterior instability is the most common type encountered and is estimated to have an incidence rate of 0.08 per 1000 person–years in the general population; however, this figure is likely higher in the young athletic population. While in recent practice, arthroscopic surgery has become the new gold standard for management, reported failure rates as high as 26% and high recurrence rates in specific subpopulations such as young men in high collision sports have led to the consideration of alternative open procedures such as open Bankart repair, Latarjet, capsular shift, and glenoid bone grafting. These procedures may be preferred in specific patient subgroups such as young athletes involved in contact sports and those with Hill–Sachs defects and multidirectional instability, with postoperative recurrence rates of instability as low as 10%. The purpose of this review is to provide an overview of different open surgical techniques in the management of shoulder instability and summarize patient outcomes including recurrence rates for shoulder instability, return to sport, range of motion (ROM), muscle strength, and complications either individually by procedure or in comparison with other techniques, with special focus on their impact in the athletic population.

Cognitions That Support Concussion Reporting in Collegiate Athletes: An Analysis of a Worksheet Activity.

Sports related concussions continue to be a public health concern and improving reporting behavior a focus of educational programs. While educational programs have addressed changes in knowledge of concussion symptoms, it has been challenging to design educational programs which have lasting effects on reporting behavior. The current analysis describes an intervention in which thoughts about reporting behavior are actively written down in a worksheet exercise to "pre-arm" athletes with cognitions designed to enhance reporting behavior prior to the injury event. A total of 503 male and female college athletes participating in collision (football, field hockey, ice hockey, lacrosse, and soccer) and contact sports (baseball, basketball, and softball) from 7 colleges/universities competing across all three NCAA divisions provided data collected during a randomized trial of a peer concussion education program. Qualitative analysis revealed 10 themes that would improve reporting including short-term benefits, faster recover, safe and healthy return to play, reporting helps the team, reporting protects the brain, risk aversion, long-term benefits, coach will be supportive, teammates will be supportive and understanding, and academic performance will be affected. Athletes had awareness of key risks involved in concussions and understood both short- and long-term consequences. These findings have important implications for understanding how to change athletes' thoughts about reporting concussions.