Elite Athletes Research Articles

A Review of Factors for Successful Childbirth and Return to Sport for Female Elite Athletes

An increasing number of elite athletes who experience pregnancy and childbirth during their careers and subsequently return to competitive sports is steadily increasing. While general guidelines for physical activity during and after pregnancy exist for the nonathletes and recreational athletes, there is a lack of evidence-based guidelines for high level competitive athletes. As a result, athletes often return to training without adequate support, and some may even choose to give up pregnancy and parenthood. This review aims to examine the factors that influence the healthy pregnancy and successful return to elite sport among female athletes, based on the experiences of those who have navigated this transition successfully and the research in this area. The studies included in this review emphasize the need for an inclusive sports environment, open and supportive systems, and institutional changes and academic research to enable informed decision-making for pregnant and parenting elite athletes. To ensure sufficient recovery time for elite athletes after childbirth and to develop evidence-based return-to-sport programs, as well as provide clear policies and practices for financial and social support, including childcare, collaboration and support from national governments, sports organizations, and associations is crucial.

Interactions between Stress Levels and Hormonal Responses Related to Sports Performance in Pro Women's Basketball Team.

The testosterone to cortisol ratio (T:C ratio) is a measure of whether elite athletes are recovering from their training. This study described this hormone balance stress in elite women's basketball. (1) Objectives: to analyse the fluctuation of T:C ratio over a 16-week period and explore itis relation to their athletic performance. The participants characteristics were: (height: 177.6 ± 6.4 cm; body mass: 77.808 ± 12.396 kg age: 26.0 ± 5.9 years; and a playing experience of 14.7 ± 2.9 years with 5.0 ± 1.2 years at the elite level. The T:C ratio at Time 1 is: 4.0 ± 2.4 (n = 12); and at Time 2 is: 5.1 ± 4.3 (n = 12). (2) Methods: during 16 weeks of competition, participants underwent analysis of blood samples to assess various biochemical parameters including hormone levels. In addition, their athletic performance was assessed with the following tests: jumping (SJ, CMJ, ABK, DJ); throwing test with a medicine ball (3 kg); Illinois COD agility test; sprint repeatability with change of direction; 20-m speed test without change of direction; and Yo-yo intermittent endurance test IET (II). (3) Results: The main alterations observed were an increase in T levels (1.687%) and a decrease in C levels (-7.634%) between moments, with an improvement (26.366%) in the T:C ratio. Improvements were also observed in some of the tests developed, such as jumping (SJ: 11.5%, p = 0.029; CMJ: 10.5%, p = 0.03; DJ: 13.0%, p = 0.01), upper body strength (MBT: 5.4%, p = 0.03), translation ability (20 m: -1.7%), repeated sprint ability (RSA: -2.2%), as well as intermittent endurance test (Yy (IET): 63.5%, p = 0.01), with significant changes in some of the performance tests. (4) Conclusions: T:C ratio may differ in a manner unrelated to training volume, showing some variation. These results may be attributed to the accumulation of psychophysiological stress during the season.

Motivational determinants of athletes’ self-realisation depending on their professional qualification

BackgroundIn the contemporary era, there is a growing emphasis on understanding the self-realization of personality, encompassing individual-psychological traits, abilities, knowledge, skills, and motivation, extensively studied in psychology. Notably, limited attention has been given to exploring motivational determinants influencing athlete self-realization based on their professional qualifications. This gap is particularly pertinent in Kazakhstan, where significant efforts are directed towards athlete preparation.MethodsEmploying a systemic approach by Bagadirova and Kudinov, the study views athlete self-realization as a multi-level phenomenon with interconnected components. A total of 180 athletes participated, including 60 professionals (average age 23.9), 60 amateurs (average age 31.1), and 60 Paralympians (average age 24.4). The methodological toolkit comprises four diagnostic techniques: E.A. Kalinin’s “Motives of Sports Activities” (MSA) questionnaire, S. Maddi’s resilience test adapted by D.A. Leontiev and E.I. Rasskazova, and S.I. Kudinov’s multidimensional questionnaire on self-realization.ResultsSignificant differences in motivational determinants and self-realization attitudes emerge across athlete groups based on their sports qualifications. Noteworthy aspects include declining in motivation among professional athletes of masters of sports and masters of sports of international class, and rigidity in life resilience among Paralympic athletes. Overall, self-realization levels are not high, with extremely low levels of professional self-realization in all three athlete categories.ConclusionsThe study’s scientific novelty lies in systematically organizing knowledge on fundamental motivational determinants impacting athlete self-realization according to professional qualifications. This research addresses the acute shortage of psychological studies in sports psychology for Kazakhstan, which is still in its early stages. The findings underscore the need for targeted interventions by coaches and sports psychologists to enhance motivation levels, especially among elite athletes, and foster resilience, particularly in Paralympic athletes, ultimately advancing the field in the country.

How the perfectionistic climate of a sports team predicts the athletic performance of elite athletes: a case study of the CUBAL women's basketball team.

In competitive sports, understanding how the perfectionistic climate within teams influences the performance of elite female athletes can provide valuable insights for enhancing coaching practice and athletic achievement. Based on the cognitive appraisal theory of stress, this study constructs a dual-path model using stressors and coping strategies as mediators, referred to as the Perfectionistic Climate on Athletic Performance model (PCPM). The study explores the predictive role of the perfectionistic climate within sports teams on the athletic performance of elite female basketball players. The empirical study the relationships among the variables in the model using a sample of 125 core players from the top-level women's basketball teams in the 24th CUBAL24 tournament in 2022. A Structural Equation Modeling (SEM) analysis was conducted using AMOS 20.0, primarily employing the bias-corrected Bootstrap method to test the dual-path model. The findings reveal double-edged paths towards a perfectionistic climate on athletic performance. In the positive pathway, a perfectionistic climate can positively predict athletic performance through challenge-related sources of stress and positive coping strategies. In the negative pathway, a perfectionistic climate can negatively predict athletic performance through threat-related sources of stress and negative coping strategies. Coaches need to pay attention to athletes' cognitive evaluations of the perfectionistic climate as a source of pressure. By setting challenging goals, coaches can guide athletes to view the perfectionistic climate of the sports team as a source of challenging pressure, thus unleashing their potential. Coaches should actively guide athletes in coping with the pressure brought about by the perfectionistic climate, enhancing their ability to handle stress. This will enable athletes to better adapt to the team's perfectionistic climate and further improve individual and team athletic performance.

The Comparison of Electromyography (EMG) During Blocking in Elite Sepaktakraw Athletes

Background: Blocking is a major indicator of the sepaktakraw game’s results. The analysis of muscle activity involved in blocking provides coaches or amateur athletes with additional information about the importance of muscle groups that influence effective blocking. Objective: This research aimed to compare the maximum voluntary contraction (MVC)during blocking elite sepaktakraw athletes in different muscles. Methods: This research is a cross-sectional study design with fourteen male sepaktakraw athletes (striker position) in the Sepaktakraw Thailand League, aged 20-40 years. All participants completed an informed consent by the ethical committee of Thailand National Sports University (TNSU-SCI 043-2566), and were placed electrodes on five muscle groups, including the rectus abdominis (RA), left rectus femoris (LRF), left gastrocnemius medialis (LGM), right rectus femoris (RRF) and right gastrocnemius medialis (RGM). The collection of blocking is divided into 3 phases: takeoff, flight and landing. Results: The LGM had the highest and was significantly with RA in takeoff phase and landing phase (P0.05), RGM had the highest in flight phase and significantly different with takeoff (p0.05). Moreover, RA during flight and landing significantly differed from takeoff (p0.05). Conclusion: The information this research will help coaches and amateur athletes understanding the blocking in elite athletes. Additionally, they need a specific muscle training program.

Pupil light reflex in young elite athletes: autonomic nervous system activity and viscoelastic properties.

Introduction: The pupil light reflex (photomotor reflex) has a duration of 3.5s and is a highly reproducible measurement. Conventionally, the autonomic nervous system (ANS) activity evaluated by this reflex does not consider the viscoelasticity of the iris muscles. This study aims to detect differences in reflex autonomic activity in a supine position with parameters derived from the Kelvin-Voigt viscoelastic model in two distinct groups of elite athletes. Method: Groups formed using a dendrogram analysis based on basal autonomic activity assessed with heart rate variability. Heart rate variability was measured, and the photomotor reflex was modeled. Results: The model showed a high degree of adjustment to the photomotor reflex (r2 = 0.99 ± 0.01). The impulse 3, an indicator of reflex sympathetic activity, revealed a significantly higher activity (ρ ≤ 0.05) in the [sympa/para]+ group compared to the [sympa/para]⁻ group. This result was further supported by a greater relative total redilation amplitude (ρ ≤ 0.05) and a shorter duration of 75% redilation (ρ ≤ 0.01). Finally, the relative total redilation amplitude exhibited a significant correlation with the linear stiffness constant (ρ ≤ 0.001) and the maximum redilation speed with restoring force (ρ ≤ 0.001). Discussion: These results indicate that (i) the photomotor reflex can detect an alteration of the reflex autonomic activity specific to each of the two branches of the ANS (ii) the viscoelastic properties of the iris muscles play a significant role in the energy storage-restitution mechanisms during the photomotor reflex. This approach could allow athletes to benefit from reduced time spent in the analysis of ANS activity, potentially making it an almost daily and automated process.

Helping athletes to select botanical supplements for the right reasons: A comparison of self-reported reasons for use versus evidence-based supplement claims.

Use of food supplements (FS) by athletes is well characterised but there is little information on 'herbal' or 'botanical' FS beyond 'natural'. This study determined, by questionnaire, whether athletes' main self-reported reason for using FS was reflective of what was written on product labels or, when these claims were unavailable, was in accordance with the scientific literature. In 217 elite (n = 55) and amateur (n = 162) athletes living on the island of Ireland, 71% (n = 153) consumed any kind of FS, with 16% (n = 34) of the entire cohort deemed botanical consumers. 'Protein' (21%, n = 46), 'vitamin D' (17%, n = 37) and 'vitamin C' (15% n = 32) were most consumed with the top reasons for use being 'to support health', 'to prevent illness/for immunity purposes' and 'recovery'. There was generally good agreement between approved nutrition and health claims for such products and athletes' main reported reasons for use. Only the amateur athletes in our pool described using botanical supplements, with reasons for use stated as 'sleep improvement' (21%), 'recovery' (14%), 'supporting health' (12%) and 'energy' (12%), resulting in poor agreement with either approved claims or scientific evidence. Only half of amateur athletes knew if their botanical FS were third-party tested. Athletes and practitioners require guidance to avoid consuming supplements for which there is little scientific evidence, and which may risk being contaminated/fraudulent.

Effects of Chronic Exigencies on Efficacy of Myogenic Engine Among Elite Women

The heart is a myogenic engine of human body which propell the blood to meet the need of working muscles by supplying nutrients, oxygen and clear waste products. The human heart is a myogenic engine which is a hollow organ that will undergo the direct physical stress laid out by the performer when he/she exposed to a regular, panned, systematic and scientific training regimen. The acute and chronic impacts on the structure and functions of hollow myogenic organs leads to a variety of adaptations. The popularly coined statement that either structure decide the function or function decide the structure. This statement is complimentary with each other for any kind of physical stress. The heart will get direct impact, if the same stress in laydown for a prolonged period, then the heart will get certain changes those changes play an important role in deciding the cardiac dynamics like Heart rate at rest (HR), Stroke volume at rest (SV) and cardiac output at rest ( ). Based on these facts in the present study, the investigator would like to enlighten how a planned, systematic, prolonged physical stimulations will put impact on uninterruptedly working myogenic engine of elite athletes. To fulfill the condition of the study an elite woman of (N=15) fifteen each from long distance training, middle distance training, and weight lifting training were chosen as clients. All the volunteered clients had 7 to 9 years of sports age and trained by their respective coaches in their specific sports. The selected criterian parameters are Heart Rate at rest (HR), Stroke Volume at rest (SV) and Cardiac Output at rest ( ) and they were measure by M- Mode Doppler Echocardiography with the support of qualified cardiologist. Finally, the investigator came to an end that elite athletes from three experimental groups, underwent a significant alterations in the dynamics of myogenic engine. The level of significance was set at 0.01 level of assurance. In ordered to find out the significant difference the analysis of variance (ANOVA) was employed. When the ‘F’ ratio is significant, the Scheffe’s post-hock test was used to find the paired mean significant difference, if any, among the groups of chosen parameters.

Neuromechanical proficiency in elite performance decision-making: An event-related potential (ERP) analysis

This research focuses intensively on the neural mechanisms of action selection responses in elite athletes during high-stakes decision-making. It emphasizes the neuromechanical dimensions of these processes, contrasting the responses of expert and novice players within a theoretical framework of neural information processing in high-performance contexts. Utilizing advanced EEG technologies, including event-related potential (ERP) analysis, the study captures a comprehensive view of both behavioral and neurophysiological data. The central aim is to unravel the intricate neural underpinnings that distinguish elite athletes in their decision-making strategies. Key findings highlight: (1) Enhanced accuracy and swifter reaction times in elite athletes during the action selection phase; (2) Significant neurophysiological differences, marked by pronounced N1 peak amplitudes with prolonged latencies, reduced P2 peak amplitudes with stable latencies, decreased P3 peak amplitudes with reduced latencies, and increased average PSW amplitudes. These discoveries significantly advance our understanding of the neural foundations of expert decision-making in high-performance sports. This study not only sheds light on the cognitive and neural dynamics of elite sports performance but also provides a foundation for developing training and performance enhancement techniques in various high-stakes domains.

Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: what did we learn?

ObjectiveA periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed...

PERSONAL QUALITIES AND CAREER LONGEVITY OF ELITE LATVIAN ATHLETES

In recent years, sports psychology researchers have shown a growing interest in exploring various facets of sports careers, career transitions, the personal qualities profile of athletes who achieve peak sports performance, and the existing models and distinctions within career stages. This research aimed to examine the link between the mental qualities and skills and the sports careers of elite Latvian athletes and to seek potential differences dependent on sports career stages, level of qualification, and gender. The research was done among 109 elite athletes from Latvia aged 17 to 40, practicing 19 sports – 71 men and 38 women. For the purposes of the research, the subjects were divided into groups according to two criteria: 1) depending on the different stages of their sports career and 2) depending on the type of development of their sports career. The research methods included: Latvian personality survey (LPA-v3, Perepjolkina et al., 2011); Sports et al. (SMTQ; Sheard et al., 2009), adapted for Latvian conditions by Astaficevs et al. (2020); Psychological Performance Inventory Alternative version (PPI-A; Golby et al., 2007), adapted for Latvian conditions by Astaficevs et al. (2020.); General et al. (GSE; Schwarzer & Jerusalem, 1995), adapted for Latvian conditions by Astaficevs et al. (2020); Psychological Skills Inventory for Sports (PSIS-R5), adapted for Latvian conditions by Fernāte Andra, 2008. The obtained results revealed some differences in the personal profiles of the Latvian athletes depending on the stages and type of their sports careers, level of qualification, and gender. We found higher results along the factors conscientiousness, honesty and modesty, and the lowest results along the factor neuroticism among the elite athletes. We found significantly higher values of the mental skills: anxiety control, concentration, mental preparation, motivation, self-confidence, and control among the men.

A SCIENTIFIC STUDY ON HEART RATE AND MUSCULAR ENDURANCE OF AEROBIC, ANAEROBIC AND COMBINED AEROBIC AND ANAEROBIC ACTIVITIES AMONG ELITE WOMEN

A planned, systematic and chronic training regimen will always leads to significant adaptations on physical and cardiac functions. The heart is an involuntary organ which directly get impact by any systematic training protocol as compared to any other organ of the body, based on this the investigator is throwing a light on how a long distance running training, middle distance running and weight lifting training protocol leads to a significant impact on heart rate at rest and muscular endurance. To fulfill the objectives of the study the investigator has chosen (N=45) elite women volunteered athletes of each (N=15) of long distance running, middle distance running and weight lifting, between 18 to 22 years. All the volunteered elite athletes are trained by their coaches for about 7 to 9 years. The selected criterian parameters are Heart Rate at rest (HR) and Muscular endurance, and they were measure by M- Mode Doppler Echocardiography with the support of qualified cardiologist and bent knee sit-ups (1 min) respectively. The level of significance is set at 0.01 level of assurance. The investigator has concluded that a regular and systematic long distance running, middle distance running and weight lifting training have significantly brought desired changes in heart rate at rest and muscular endurance as compared the normal, healthy, and untrained women reference values. Further, the investigation come to an that the long distance running has significantly lowered heart rate at rest, and significantly enhanced muscular endurance as compared to the middle distance running and weight lifting groups. In ordered to find out the significant difference the analysis of variance (ANOVA) was employed. When the ‘F’ ratio is significant, the Scheffe’s post-hock test was used to find the paired mean significant difference, if any, among the groups of chosen parameters. KEYWORDS: long distance running, middle distance running, weight lifting, heart rate at rest, muscular endurance

Acute Effects of Breath-Hold Conditions on Aerobic Fitness in Elite Rugby Players.

The effects of face immersion and concurrent exercise on the diving reflex evoked by breath-hold (BH) differ, yet little is known about the combined effects of different BH conditions on aerobic fitness in elite athletes. This study aimed to assess the acute effects of various BH conditions on 18 male elite rugby players (age: 23.5 ± 1.8 years; height: 183.3 ± 3.4 cm; body mass: 84.8 ± 8.5 kg) and identify the BH condition eliciting the greatest aerobic fitness activation. Participants underwent five warm-up conditions: baseline regular breathing, dynamic dry BH (DD), static dry BH (SD), wet dynamic BH (WD), and wet static BH (WS). Significant differences (p < 0.05) were found in red blood cells (RBCs), red blood cell volume (RGB), and hematocrit (HCT) pre- and post-warm-up. Peak oxygen uptake (VO2peak) and relative oxygen uptake (VO2/kgpeak) varied significantly across conditions, with BH groups showing notably higher values than the regular breathing group (p < 0.05). Interaction effects of facial immersion and movement conditions were significant for VO2peak, VO2/kgpeak, and the cardiopulmonary optimal point (p < 0.05). Specifically, VO2peak and peak stroke volume (SVpeak) were significantly higher in the DD group compared to that in other conditions. Increases in VO2peak were strongly correlated with changes in RBCs and HCT induced by DD warm-up (r∆RBC = 0.84, r∆HCT = 0.77, p < 0.01). In conclusion, DD BH warm-up appears to optimize subsequent aerobic performance in elite athletes.

Tangled and Bumpy Roads to Gender Equity: Socio-Cultural Insights from Media Stories About Olympic Athletes and Motherhood

With the 2024 Olympic Games touted as reaching gender parity (i.e., same number of female and male athletes participating), media conversations are continuing about elite athlete mothers. Researchers interrogating media stories of Olympic athlete mothers have shown that their sporting journeys are not straightforward due to tensions linked to gender (in)equity. In this paper we use narrative inquiry as a theoretical lens to explore “comeback themes” synthesized from published media studies of Olympic athlete mothers, along with recent examples of media stories of Olympic athlete mothers. We discuss four comeback themes that include: (in)compatible identities, super mums, veteran status/age, and exposing discrimination, and some implications for gender equity. The first three comebacks perpetuate gender ideologies of heteronormative femininity, good motherhood, ageism, and exceptionalism, which downplay equitable support and change. These themes, along with the exposing discrimination theme, also highlight shifting media representations of motherhood and sport whereby stories expose struggles, realities, and/or structural deficits. We reflect on these themes as a “tangled and bumpy road” to gender equity led by athlete mothers’ voices resulting in changes in maternity rights. These comeback themes show gains in gender equity for sportswomen and highlight areas where more work is needed. Future research recommendations include studying mainstream and social media spaces with an intersectional lens to expand understanding of media stories as pedagogical resources to learn more about motherhood, sport, and gender (in)equity.

Multiple domain-general assessments of cognitive functions in elite athletes: Contrasting evidence for the influence of expertise, sport type and sex

Converging evidence has shown that domain-general cognitive abilities, especially executive functions (EF), tend to be superior in sport experts. However, recent studies have questioned this cognitive advantage and found inconsistent findings when comparing sport type and sex. This study aimed to compare the impact of sport expertise, sport type, and sex on various domains of cognitive functions.Two hundred and thirty elite athletes (nFemale = 124, nMale = 106) representing three sport categories (Team [n = 91], Precision-skill dependent [n = 63], and Speed-strength [n = 76] sports) were assessed using a computerized neuropsychological test battery including tests of EF (working memory, inhibition, cognitive flexibility and planning), as well as tests of selective and sustained attention. T-scores and raw values were used to analyze performance through t-tests and ANCOVA with age as covariate.Athletes demonstrated better performance than the normative mean on 5 out of 11 cognitive test variables (p < 0.005). However, their performance fell within the average range when considering the results along a normative scale, except for sustained attention and working memory where they performed just above average (<1 SD). There was a significant main effect of sport category on only one EF variable (p = 0.003). Males performed significantly faster than females on motor reaction time measures of attention and inhibition (all p < 0.001).In this study, the ‘expert advantage’ on domain-general cognitive tests was less prominent when utilizing a normative scale and controlling for age or speed-accuracy trade-offs, except for sustained attention and working-memory. Cognitive functions did not appear to differ meaningfully based on athletes’ sport type or sex.

Prevalence of Specific Mood Profile Clusters among Elite and Youth Athletes at a Brazilian Sports Club.

Those responsible for elite and youth athletes are increasingly aware of the need to balance the quest for superior performance with the need to protect the physical and psychological wellbeing of athletes. As a result, regular assessment of risks to mental health is a common feature in sports organisations. In the present study, the Brazil Mood Scale (BRAMS) was administered to 898 athletes (387 female, 511 male, age range: 12-44 years) at a leading sports club in Rio de Janeiro using either "past week" or "right now" response timeframes. Using seeded k-means cluster analysis, six distinct mood profile clusters were identified, referred to as the iceberg, surface, submerged, shark fin, inverse iceberg, and inverse Everest profiles. The latter three profiles, which are associated with varying degrees of increased risk to mental health, were reported by 238 athletes (26.5%). The prevalence of these three mood clusters varied according to the response timeframe (past week > right now) and the sex of the athletes (female > male). The prevalence of the iceberg profile varied by athlete sex (male > female), and age (12-17 years > 18+ years). Findings supported use of the BRAMS as a screening tool for the risk of psychological issues among athletes in Brazilian sports organisations.

Hip Sideline Emergencies and Hip Injuries in Elite Athletes.

Hip injuries in elite athletes are an increasingly recognized problem and range from chronic overuse injuries, such as adductor strains and labral tears, to acute traumatic injuries such as hip dislocations. In this article, we review common hip pathology experienced by elite athletes and sideline management of emergent hip injuries. Elite athletes are subject to unique physical and mental stresses and therefore must be evaluated and treated in a unique manner. Hip and groin injuries account for approximately 6% of sport injuries overall and 3-15% of all injuries in professional sports. Hip sideline emergencies were rare but can include hip dislocations, subluxations, and avulsion fractures. Hip and groin injuries represent an important subset of injuries which can greatly impact an athlete's ability to perform. Understanding the physiology and types of hip/groin injuries, which athletes are prone to injuries, the impact on recovery time, recurrence risk, and the potential need for surgery aid sports medicine physicians in decision-making.

An Umbrella Review of Body Image Concerns, Disordered Eating, and Eating Disorders in Elite Athletes.

Background/Objectives: Several systematic reviews and meta-analyses have been conducted to date indicating a high prevalence of disordered eating in elite athletes and associated risk factors. However, the substantial time burden associated with locating and comparing these reviews, which are varied in methodology and sampling focus, may be a barrier for informing policy and best practice as well as directing future research. This umbrella review aimed to provide a summary of evidence across published reviews regarding the prevalence and risk factors for disordered eating (including body image concerns and eating disorders) in elite athletes. Methods: Five databases (CINAHL, PsycINFO, MEDLINE, Scopus, and SPORTDiscus) were systematically searched for peer-reviewed systematic reviews and meta-analyses that met the following inclusion criteria: (1) investigated prevalence and risk factors for disordered eating, (2) included a sample of elite athletes, and (3) available in English. The included studies underwent data extraction and risk of bias assessment using the AMSTAR 2. Results: The initial search identified 1828 articles that were screened for title and abstract and then full text, leaving 24 systematic reviews (including 10 meta-analyses). Disordered eating was prevalent across elite athletes, including males and females and across sport type. Elite athletes were at elevated risk for disordered eating and eating disorders but at lower risk for body image concerns versus non-athlete controls. Several risk factors were identified, including female gender, competing in lean sports, and experiencing career changes. Few reviews or meta-analyses examined perceived pressures within the sporting environment, and most had substantial risk of bias concerns. Conclusions: Elite athletes are at risk for the spectrum of disordered eating, and all should be considered for primary prevention and screening. Further research is needed regarding sport-specific versus general pressures and mediators of risk to better inform interventions.

Are Sub-elite Athletes at Higher Risk of Eating Disorders, Exercise Addiction, Depression, and Low Energy Availability Compared With Elite Athletes?

The main objective of this study was to investigate the risk of eating disorders, exercise addiction, depression, and low energy availability (LEA) in Danish female and male elite compared with sub-elite athletes. A cross-sectional study. An online survey. A total of 410 elite athletes (mean age 20.1 years, 51% females) and 206 sub-elite athletes (mean age 21.3 years, 52% females) from 15 different sports.Assessment of Risk Factors: Eating Disorders, exercise addiction, depression, and LEA. The Sick Control, One Stone (6.5 kg), Fat, Food, the Eating Disorder Examination-Questionnaire, the Exercise Addiction Inventory, the Major Depression Inventory, and the Low Energy Availability in Females Questionnaire or the Low Energy Availability in Males Questionnaire. We found that more female sub-elite athletes compared with elite athletes had risk of eating disorders (EDs) (37.4% vs 23.4%; P < 0.012) and the same was found for males (23.2% vs 10.4%; P = 0.005). More athletes with risk of EDs had risk of exercise addiction (12.8 vs 5.4%, P = 0.006), depression (27.3 vs 4.2%, P < 0.001), and LEA (females 55.1 vs 40.7%, P = 0.024, and males 29.4 vs 13.7%, P = 0.036, respectively) compared with athletes without risk of EDs. Sub-elite athletes have a higher risk of eating disorders compared with elite athletes. Regular screening of ED symptoms and associated conditions in elite and especially sub-elite athletes may ensure early identification.

Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment.

To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. Patients with 3-tendon complete tears with greater than 2cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.