Sports Medicine Practitioners Research Articles

A SPORTS CONCUSSION BASELINE IMPLEMENTED AT THE CONCLUSION OF A COLLEGIATE ATHLETE'S CAREER

As concussion diagnosis persists as a major clinical challenge for sports medicine practitioners, there has been a heightened emphasis on concussion baselines. This has led to an increase in computerized neuro-psychological baselines that are initiated at the beginning of an athlete’s career and administered again upon a suspected concussion. However, their utility and reliability have been called into scrutiny. As the brain health of athletes rightly remains a key priority, there have been no studies positing a concussion baseline as part of an athlete’s exit health physical to document their brain health after their athletic career. The purpose of this report is to present a noncomputerized, objective, neurologically supported concussion baseline that can be used to document athletes’ brain health at the end of their careers. A total of 31 division-1 male collegiate football players were assessed using this baseline, and their data was reported.

Collective Weakness Is Associated With Time to Mortality in Americans.

McGrath, R, McGrath, BM, Jurivich, D, Knutson, P, Mastrud, M, Singh, B, and Tomkinson, GR. Collective weakness is associated with time to mortality in Americans. J Strength Cond Res 38(7): e398-e404, 2024-Using new weakness cutpoints individually may help estimate time to mortality, but their collective use could improve value. We sought to determine the associations of (a) each absolute and body size normalized cut point and (b) collective weakness on time to mortality in Americans. The analytic sample included 14,178 subjects aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. Date of death was confirmed from the National Death Index. Handgrip dynamometry measured handgrip strength (HGS). Men were categorized as weak if their HGS was <35.5 kg (absolute), <0.45 kg·kg -1 (body mass normalized), or <1.05 kg·kg -1 ·m -2 (body mass index [BMI] normalized). Women were classified as weak if their HGS was <20.0 kg, <0.337 kg·kg -1 , or <0.79 kg·kg -1 ·m -2 . Collective weakness categorized persons as below 1, 2, or all 3 cutpoints. Cox proportional hazard regression models were used for analyses. Subject values below each absolute and normalized cutpoint for the 3 weakness parameters had a higher hazard ratio for early all-cause mortality: 1.45 (95% confidence interval [CI]: 1.36-1.55) for absolute weakness, 1.39 (CI: 1.30-1.49) for BMI normalized weakness, and 1.33 (CI: 1.24-1.43) for body mass normalized weakness. Those below 1, 2, or all 3 weakness cut points had a 1.37 (CI: 1.26-1.50), 1.47 (CI: 1.35-1.61), and 1.69 (CI: 1.55-1.84) higher hazard for mortality, respectively. Weakness determined by a composite measure of absolute and body size adjusted strength capacity provides robust prediction of time to mortality, thus potentially informing sports medicine and health practitioner discussions about the importance of muscle strength during aging.

Knee Joint Preservation in Tactical Athletes: A Comprehensive Approach Based upon Lesion Location and Restoration of the Osteochondral Unit.

The unique physical demands of tactical athletes put immense stress on the knee joint, making these individuals susceptible to injury. In order to ensure operational readiness, management options must restore and preserve the native architecture and minimize downtime, while optimizing functionality. Osteochondral lesions (OCL) of the knee have long been acknowledged as significant sources of knee pain and functional deficits. The management of OCL is predicated on certain injury characteristics, including lesion location and the extent of subchondral disease. Techniques such as marrow stimulation, allograft and autologous chondrocyte implantation are examined in detail, with a focus on their application and suitability in tactical athlete populations. Moreover, the restoration of the osteochondral unit (OCU) is highlighted as a central aspect of knee joint preservation. The discussion encompasses the biomechanical considerations and outcomes associated with various cartilage restoration techniques. Factors influencing procedure selection, including lesion size, location, and patient-specific variables, are thoroughly examined. Additionally, the review underscores the critical role of post-operative rehabilitation and conditioning programs in optimizing outcomes. Strengthening the surrounding musculature, enhancing joint stability, and refining movement patterns are paramount in facilitating the successful integration of preservation procedures. This narrative review aims to provide a comprehensive resource for surgeons, engineers, and sports medicine practitioners engaged in the care of tactical athletes and the field of cartilage restoration. The integration of advanced preservation techniques and tailored rehabilitation protocols offers a promising avenue for sustaining knee joint health and function in this demanding population.

Coaches’ experiences of performance support teams

Supporting high-level performance is increasingly seen as a team game, reflected in the growth in support services. Coaches and management must work effectively with various practitioners to deliver the required support to athletes. To date, how coaches experience these support teams has yet to be explored. Accordingly, we utilized a qualitative research design with semistructured interviews to examine coach-consumers’ perceptions of more or less effective practice. Eight high-level coaches were recruited, and data was analyzed using reflexive thematic analysis. Key themes generated included the make-up and conduct of high-performing teams, prioritizing coach–practitioner relationships, and professional development considerations for both coaches and practitioners. Data suggest that practitioners are seen as playing a crucial role in elite sports performance, and coaches generally have a positive view of the contributions of sports science teams. Notably, however, several challenges were identified, including communication issues, conflicts over the allocation of resources, recruitment of, and the need for sports scientists to understand the demands of sports and the coaching process. Findings have practical implications for support teams and coaches working in high-performance sports; specifically, in the recruitment and development of sports science and medicine practitioners and coaches.

Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine.

There is no consensus among sports medicine surgeons in North America on postoperative rehabilitation strategy after meniscus repair. Various meniscal tear types may necessitate a unique range of motion (ROM) and weightbearing rehabilitation protocol. To assess the current landscape of how sports medicine practitioners in the American Orthopedic Society for Sports Medicine (AOSSM) rehabilitate patients after the repair of varying meniscal tears. Cross-sectional study. A survey was distributed to 2973 AOSSM members by email. Participants reviewed arthroscopic images and brief patient history from 6 deidentified cases of meniscus repair-in cases 1 to 3, the tears retained hoop integrity (more stable repair), and in cases 4 to 6, the tear patterns represented a loss of hoop integrity. Cases were shuffled before the presentation. For each case, providers were asked at what postoperative time point they would permit (1) partial weightbearing (PWB), (2) full weightbearing (FWB), (3) full ROM, and (4) ROM allowed immediately after surgery. In total, 451 surveys were completed (15.2% response). The times to PWB and FWB in cases 1 to 3 (median, 0 and 4 weeks, respectively) were significantly lower than those in cases 4 to 6 (median, 4 and 6 weeks, respectively) (P < .001). In tears with retained hoop integrity, the median time to PWB was immediately after surgery, whereas in tears without hoop integrity, the median time to PWB was at 4 weeks postoperatively. Similarly, the median time to FWB in each tear with retained hoop integrity was 4 weeks after surgery, while it was 6 weeks in each tear without hoop integrity. However, regardless of tear type, most providers (67.1%) allowed 0° to 90° of ROM immediately after surgery and allowed full ROM at 6 weeks. Most providers (83.3%) braced the knee after repair regardless of hoop integrity and utilized synovial rasping/trephination with notch microfracture-a much lower proportion of providers utilized biologic augmentation (9%). Sports medicine practitioners in the AOSSM rehabilitated meniscal tears differently based on hoop integrity, with loss of hoop stresses triggering a more conservative approach. A majority braced and utilized in situ adjuncts for biological healing, while a minority added extrinsic biologics.

Epidemiology of Injuries in Men's Professional and Amateur Football (Part I).

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men's football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players.

Inter-Professional and Methodological Agreement in Using the Cutting Movement Assessment Score (CMAS)

Background: The cutting movement assessment score (CMAS) provides a qualitative assessment of the side-step cutting (S-SC) technique. Previous research has been undertaken primarily by biomechanists experienced with S-SC evaluations. Little is known about the agreement between various sports science and medicine practitioners to ascertain whether the tool can be used effectively by different practitioners in the field. Currently, the CMAS uses three camera views (CVS) to undertake the evaluation, and it would be worthwhile to know whether the CMAS can be effectively conducted with fewer camera views to improve clinical utility. Therefore, the aim of the study was to examine the inter-rater agreement between different sports science and medicine practitioners and agreement between using different CVS to evaluate the S-SC technique using the CMAS. Methods: Video data were collected from 12 male rugby union players performing a 45° S-SC manoeuvre toward both the left and right directions. Five different sports science and medicine practitioners evaluated footage from three cameras of one left and one right trial from each player using the CMAS. Twelve different trials were also evaluated by the sports rehabilitator using single and multiple CVS. Agreements (percentage; Kappa coefficients (K)) between different practitioners and configurations of the CVS were explored. Results: Good to excellent inter-rater agreements were found between all practitioners for total score (K = 0.63–0.84), with moderate to excellent inter-rater agreements observed across all items of the CMAS (K = 0.5–1.0). Excellent agreement was found between using three CVS vs. two CVS that included at least a sagittal view (K = 0.96–0.97). Lower agreement (K = 0.83) was found between angle-frontal views with three CVS. Conclusions: The CMAS can be used effectively by various practitioners to evaluate the movement quality of S-SC. The use of two CVS that include at least a sagittal plane view would suffice to evaluate the S-SC technique against the CMAS.

Sports Medicine and the Pelvic Floor.

The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.

Advancing feminist innovation in sport studies: A transdisciplinary dialogue on gender, health and wellbeing.

Athlete health and wellbeing requires a holistic, multidimensional approach to understanding, supporting, and treating individual athletes. Building more supportive, inclusive, and equitable environments for the health and wellbeing of women and gender expansive people further requires gender-responsive approaches that promote broader cultural change. Feminist sport and exercise medicine practitioners, sports scientists, and social science researchers are increasingly coming together in their efforts to do this work. However, working across disciplines inevitably includes an array of ontological, epistemological, and political challenges. In this paper, we offer a curated 'dialogue' with a group of feminist scholars engaged in research and practice across disciplines, bringing them together to discuss some of the most pressing gendered issues in sport today (i.e., ACL injury, concussion, menstruation in sport, mental health, gender categories). In so doing, we amplify the voices of those working (empirically and clinically) at the disciplinary intersections of gender, sport and health, and learn about some of the current and future possibilities for transdisciplinary innovations and strategies for building (responsiveness to) cultural change.

Biomechanical Characteristics of Scapular and Glenohumeral Movements during Pitching Motion in Injury-prone College Baseball Pitchers.

The coordination of glenohumeral (GH) and scapular movements is central to the injury prevention of baseball pitchers. However, there is no objective data establishing the direct relationship between pitching injuries and associated GH and scapular movements. Therefore, this study demonstrated the biomechanical differences in the scapular and GH movements during pitching between injury-prone pitchers and healthy college baseball pitchers. A total of 30 collegiate baseball pitchers were classified into two groups according to their injury status: injury-prone group (n = 15) and control group (n = 15). We obtained pitching motion data using three-dimensional motion analysis technique. The horizontal abduction angles of the GH joint during cocking and acceleration phases were considerably greater in the injury-prone pitchers (19.0° at stride foot contact [SFC], -4.0° at maximum external rotation [MER], and -0.3° at ball release) than those in healthy controls (11.7° at SFC, -10.0° at MER, and -6.9° at ball release). Additionally, in the cocking phase, the amount of angular change in the scapular external rotation (ER) was significantly smaller in the injury-prone group than that in the control group (mean difference, -13.0). These results suggest that the injury-prone pitchers have less internal rotation of the scapula and a more horizontal abduction of the GH joint during the cocking and acceleration phases. Therefore, sports medicine practitioners may need to pay considerable attention to the coordination of scapular and GH horizontal movements during pitching for prevention of shoulder injuries.

Rope Jumping Strength Monitoring on Smart Devices via Passive Acoustic Sensing.

Rope jumping, as a fitness exercise recommended by many sports medicine practitioners, can improve cardiorespiratory capacity and physical coordination. Existing rope jump monitoring systems have limitations in terms of convenience, comfort, and exercise intensity evaluation. This paper presents a rope jump monitoring system using passive acoustic sensing. Our system exploits the off-the-shelf smartphone and headphones to capture the user's rope-jumping sound and breathing sound after exercise. Given the captured acoustic data, the system uses a short-time energy-based approach and the high correlation between rope jumping cycles to detect the rope-jumping sound frames, then applies a dual-threshold endpoint detection algorithm to calculate the number of rope jumps. Finally, our system performs regression predictions of exercise intensity based on features extracted from the jumping speed and the mel spectrograms of the user's breathing sound. The significant advantage of the system lies in the solution of the problem of poorly characterized mel spectrograms. We employ an attentive mechanism-based GAN to generate optimized breathing sound mel spectrograms and apply domain adversarial adaptive in the network to improve the migration capability of the system. Through extensive experiments, our system achieves (on average) 0.32 and 2.3% error rates for the rope jumping count and exercise intensity evaluation, respectively.

Use of Blood Flow Restriction Training Between North American Sports Medicine Practitioners: A Questionnaire-Based Survey

<h3>Research Objectives</h3> To profile current clinical application of blood flow restriction (BFR) training among active sports medicine practitioners in North America using an online questionnaire. To compare responses to position stand recommendations regarding BFR training methodology. <h3>Design</h3> Survey distributed through August and September of 2021. <h3>Setting</h3> Online. <h3>Participants</h3> Convenience sample of 72 clinicians actively practicing in the United States (n=67) and Canada (n=5) were included. Experience applying or prescribing BFR training was required. Individuals unfamiliar with written English were excluded. The survey link was distributed electronically through professional organizations, email list servs, and social media. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Demographics (profession, practice setting, years of experience), type of equipment, treatment parameters, observed side effects, and personal opinions on the efficacy and value of BFR training. <h3>Results</h3> Athletictrainers (48.6%) and physical therapists (41.7%) primarily completed the survey. Automatic inflated cuffs and KAATSU airbands were the most common units employed. Parameters varied between respondents for exercise prescription (e.g. load and volume) and occlusion settings. Populations for BFR implementation ranged from injured (93.1%) and post-surgery cases (88.4%) to healthy individuals for performance enhancement (9.4%). Respondents primarily followed position statement recommendations with individualized pressure selections specific to blood pressure for resistance (80.9%) and aerobic BFR (69.6%) modes. Side effects reported included delayed onset muscle soreness (66.2%), inability to continue treatment due to pain (28%), numbness (22.5%), and cold feeling in the extremity (19.7%). Physical therapists indicated higher confidence in safety (t= -2.291, p=0.026), understanding of practice recommendations (t= -2.615, p=0.011) and theoretical principles (t=-3.056, p=0.004) compared with athletic trainers. <h3>Conclusions</h3> BFR is a common modality in contemporary sports medicine settings. Variations in BFR application is evident in devices, exercise and occlusion parameters selected, and side effects observed. Practitioners appear to be compliant with practice recommendations regarding the adoption of individualized pressure prescription. <h3>Author(s) Disclosures</h3> N/A.

Barriers and Facilitators of Research in Pediatric Sports Medicine Practitioners: A Survey of the PRiSM Society.

Barriers and facilitators to research in sports medicine (SM) by physicians and allied health (AH) professions such as physical therapists and athletic trainers are understudied. The purpose of this research was to examine and compare research barriers, facilitators, and other research related facets including interests, comfort, knowledge, and resources among SM physicians and AH practitioners. Cross-sectional survey. The survey was sent to Pediatric Research in Sports Medicine (PRiSM) members. The survey was designed to ask respondents to identify their top barrier and facilitator to conducting research. Research interest (binary), self-rated comfort reading research articles (0-100 scale), self-rated knowledge conducting research independently (0-100 scale), and available research resources were evaluated. Descriptive statistics, chi-square, and t-tests were used to compare the responses between SM physicians and AH practitioners. The value of p<0.05 was set as a statistically significant criterion. The response rate was 35.7% (N=100). For both SM physicians and AH practitioners, the greatest research barrier was a lack of time. However, the leading research facilitators differed in the two professions. The top research facilitator for SM physicians was availability of research personnel, while availability of research mentoring was selected as a prime facilitator by AH practitioners. There were no differences in research interest between SM physicians (87.0%) and AH practitioners (95.5%, p=0.267). However, self-rated comfort reading research articles was higher in SM physicians (75.6±20.6) than AH practitioners (60.6±28.3, p=0.018). There were no differences in self-rated knowledge conducting research independently between SM physicians (70.2±18.6) and AH practitioners (63.4±24.6, p=0.163). Lack of time was the top research barrier for both SM physicians and AH practitioners. Regarding research facilitators, having available time was the main facilitator for SM physicians while availability of mentoring was the leading facilitator in AH practitioners. 3.

Can exercise attenuate the negative effects of long COVID syndrome on brain health?

The impetus for many governments globally to treat the novel coronavirus (COVID-19) as an endemic warrant more research into the prevention, and management of long COVID syndrome (LCS). Whilst the data on LCS remains scarce, reports suggest a large proportion of recovered individuals will experience ongoing neuropsychological symptoms, even with mild disease severity. The pathophysiology underlying LCS is multifaceted. Evidence suggests that altered inflammatory, neurotrophic, and neurotransmitter pathways within the brain contribute to neuropsychological symptoms reported following COVID-19. Exercise or regular physical activity has long been shown to have positive effects on brain health and cognition through exerting positive effects on inflammatory markers, neurotransmitters, and neurotropic factors analogous to the neurophysiological pathways proposed to be disrupted by COVID-19 infection. Thus, exercise may serve as an important lifestyle behavior in the management of LCS. In this opinion article, we present the evidence to support the positive role of exercise in the management of cognitive symptom that manifest with LCS and discuss important considerations and interactions with cardiorespiratory and exercise tolerance complications that often present for individuals experiencing LCS. We highlight the need for more research and training of sports medicine practitioners and clinical exercise physiologists in the management of LCS with exercise and call for further research to understand the optimal dose-responses and exercise prescription guidelines for cognitive benefits and minimizing other complications.

Shoulder Injuries in Professional Baseball Batters: Analysis of 3,414 Injuries Over an 8-Year Period

PurposeTo characterize the shoulder injuries experienced by baseball batters and position players (nonpitchers); to quantify the outcomes of these injuries with respect to time out of play, recurrence, and surgery rates; and to identify any injury patterns that are associated with worse outcomes.MethodsBetween 2011 and 2017, all Major League Baseball (MLB) and Minor League Baseball (MiLB) players who sustained shoulder injuries were identified using the MLB Health and Injury Tracking System (HITS). Injuries were included if they were sustained during baseball activity, resulted in at least 1 day missed (DM), and occurred in position players (nonpitchers).ResultsOver the study period, a total of 3,414 shoulder injuries occurred in batters, resulting in a sum of 68,808 DM and a mean of 22 DM per injury. Most injuries were a result of acute trauma (n = 2125; 62.2%) with throwing as the predominant activity (n = 1292; 38%). Rotator cuff strain/tears was the most common diagnosis (n = 790; 23.1%), and SLAP tears had the highest season-ending rate (35.3%) and need for surgery (45.1%). There was a lower frequency of surgery (6.2% vs 9.2%; P = .002) and reinjury (2.03% vs 3.62%; P = .007) in the throwing shoulder vs the nonthrowing shoulder. There was an increased frequency of surgery for the front versus the back batting shoulder (8.2% vs 6.2%; P = .031) with similar DM (20.7 vs 22.2; P = .333) and return to play rates (94.0% vs 92.2%; P = .135).ConclusionsDuring the 7-season study period, there were a total of 3,414 shoulder injuries that resulted in nearly 70,000 days of out of play in professional baseball position players/batters (nonpitchers). Although pitchers were intentionally excluded from the analysis, throwing was still the most common mechanism of injury, and rotator cuff injuries were the most common injury. Labral tears were the most likely injury to be season ending and require surgery.Clinical RelevanceThis study is meant to help determine characteristics of shoulder injuries that occur in non-pitchers by focusing on professional baseball batters and position players. This information could be helpful to sports medicine practitioners and shoulder specialists to better prognosticate injury recovery.

Psychological Interventions Can Reduce Injury Risk in Athletes: A Critically Appraised Topic.

Clinical Scenario: Injury prevention programs are becoming standard practice for reducing sports-related injuries, but most programs focus on musculoskeletal elements. Psychological factors can be strong predictors of sports-related injuries and there is recent evidence that suggests psychological interventions can be effective at reducing injury risk. It is unclear if injury prevention programs that focus on psychological factors are an important inclusion for athletic trainers/therapists. Athletes can be exposed to different psychological factors based on sport type including team or individual sports, which can increase their risk of injury. While psychological interventions can reduce injuries by addressing psychological symptoms, it is unclear if the interventions are effective for at-risk athletes in addition to athletes who are not suffering from any psychological factors. Currently, there are no guidelines or recommendations for athletic trainers/therapists to address psychological factors with the purpose of injury prevention. Clinical Question: Are psychological intervention programs effective in reducing sports-related injury risk and are they clinically relevant to athletic trainers/therapists for implementation in all settings? Summary of Findings: The authors searched the literature for studies investigating the use of psychological intervention programs to reduce sports-related injuries in an athletic population. The search returned 6 possible papers (2 systematic reviews without meta-analysis, 1 systematic review with a meta-analysis, 2 meta-analyses, and 1 randomized control trial not included in the systematic reviews). The authors narrowed our appraisal to one systematic review and one randomized controlled trial. The review contained all the studies from the previous review papers including 3 studies which performed screening procedures. The collection of evidence demonstrates positive effects associated with implementing psychological intervention techniques to reduce sports injury rates in all athletes; at-risk athletes, not at-risk athletes, and individual and team-sport athletes. Bottom Line: There is sufficient evidence supporting the use of a psychological-based intervention by athletic trainers/therapists to effectively reduce the number of injury occurrences in the athletic population. Direct comparisons of effectiveness between team and individual sports was not conducted in the research, but a substantial representation of both sport types existed. The current evidence includes a variety of athletic populations, at-risk and not at-risk, different sport types, and competition levels. Athletic trainers/therapists should consider the integration of psychological disciplines in current injury prevention practices to address the psychological concerns which put athletes at additional risk for injury. Strength of Recommendation: Grade B evidence exists to support the use of psychological intervention strategies in a well-developed injury prevention plan. Sports medicine practitioners can help athletes reduce stress, increase mindfulness, and be more aware of mental health practices which helps reduce injury risk.

Utilisation of performance markers to establish the effectiveness of cold-water immersion as a recovery modality in elite football.

Optimal strategies for recovery following training and competition in elite athletes presents ongoing debate. The effects of cold-water immersion (CWI) compared to passive recovery (PR) though a triad of performance measures after fatiguing exercise within a normal micro-cycle, during mid-competitive training cycle, in elite male footballers were investigated. Twenty-four elite footballers (age 20.58 ± 2.55 years; height 179.9 ± 5.6 cm; weight 75.7 ± 7.5 kg; body fat 6.2 ± 1.7%) were randomly assigned to CWI or PR following a fatiguing training session. Objective measures included eccentric hamstring strength, isometric adductor strength, hamstring flexibility and skin surface temperature (Tsk). Subjective measures included overall wellbeing. Data were collected at match day+3, immediately post-training, immediately post-intervention and 24 hrs post-intervention. Physiological, biomechanical and psychological measures displayed significant main effects for timepoint for eccentric hamstring strength, Tsk, overall wellbeing, sleep, fatigue, stress and group for eccentric hamstring strength, Tsk and sleep (groups combined). Group responses identified significant effects for timepoint for CWI and PR, for eccentric hamstring strength peak force, sleep, fatigue, and muscle soreness for CWI. Significant differences were displayed for eccentric hamstring strength (immediately post-intervention and immediately post-training) for peak force and between CWI and PR eccentric hamstring strength immediately post-intervention. Linear regression for individual analysis demonstrated greater recovery in peak torque and force for CWI. CWI may be useful to ameliorate potential deficits in eccentric hamstring strength that optimise readiness to train/play in elite football settings. Multiple measures and individual analysis of recovery responses provides sports medicine and performance practitioners with direction on the application of modified approaches to recovery strategies, within mid-competitive season training cycles.

Doping and the Sports Physician’s Role – The Swiss Experience

Sports physicians who take care of both leisure and elite athletes tend to be confronted with doping practices in various facets. The authors of this article aimed to examine attitudes, knowledge and experiences regarding doping practices and anti-doping resources in a specially trained population of board-certified Swiss sport and exercise physicians using a questionnaire. Swiss sports medicine practitioners identified doping as a significant health problem both in leisure, as well as in elite sports. Furthermore, consumption of non-prohibited available medication such as painkillers reveal to be a relevant health issue. Almost 90% of sports medicine specialists in Switzerland advocate for educating athletes (leisure and elite) on adverse side effects of prohibited and non-prohibited drugs in sports. For the purpose of improving the education of current and future Swiss sports physicians, this study sheds light on the knowledge, experiences and attitudes about illicit artificial performance enhancement, as well as the identification of preferred anti-doping resources.

What Doping has Taught Us – A Call for the Implementation of Bioethics in Sports Medicine Education

In this issue, we present the results of a survey named “Doping and the Sports Physician’s Role – The Swiss Experience”, in which the primary aim was to get an impression of the current situation among the community of Swiss sports medicine practitioners in terms of experiences and attitudes towards “doping” in sport. The purpose of this study was solely descriptive and explicitly not designed for declaring neither the opinion of the society of “Sports &amp; Exercise Medicine Switzerland» (SEMS), nor the view of “Swiss Sport Integrity”.

Deceleration Training in Team Sports: Another Potential \u2018Vaccine\u2019 for Sports-Related Injury?

High-intensity horizontal decelerations occur frequently in team sports and are typically performed to facilitate a reduction in momentum preceding a change of direction manoeuvre or following a sprinting action. The mechanical underpinnings of horizontal deceleration are unique compared to other high-intensity locomotive patterns (e.g., acceleration, maximal sprinting speed), and are characterised by a ground reaction force profile of high impact peaks and loading rates. The high mechanical loading conditions observed when performing rapid horizontal decelerations can lead to tissue damage and neuromuscular fatigue, which may diminish co-ordinative proficiency and an individual’s ability to skilfully dissipate braking loads. Furthermore, repetitive long-term deceleration loading cycles if not managed appropriately may propagate damage accumulation and offer an explanation for chronic aetiological consequences of the ‘mechanical fatigue failure’ phenomenon. Training strategies should look to enhance an athlete’s ability to skilfully dissipate braking loads, develop mechanically robust musculoskeletal structures, and ensure frequent high-intensity horizontal deceleration exposure in order to accustom individuals to the potentially damaging effects of intense decelerations that athletes will frequently perform in competition. Given the apparent importance of horizontal decelerations, in this Current Opinion article we provide considerations for sport science and medicine practitioners around the assessment, training and monitoring of horizontal deceleration. We feel these considerations could lead to new developments in injury-mitigation and physical development strategies in team sports.