Sports Physicians Research Articles

Finger injuries in athletes

Hand injuries in sportives are becoming increasingly common, accounting for approximately 25% of all sports-related injuries. The recent growing popularity for sports such as climbing, which even became an Olympic discipline in 2022, is increasing hand and finger injuries in the active population. Some sports are more prone to typical hand and finger injuries. These injuries need to be treated quickly and correctly, to enable the athlete to receive optimal treatment followed by appropriate rehabilitation, in order to return to his or her sport in the best possible conditions. We have chosen to highlight five of these specific pathologies to help general practitioners and sports physicians to make an accurate diagnosis and manage or refer these injuries as best as possible.

Arrhythmias and sudden cardiac death in athletes

This case-based review provides an overview of the most relevant supraventricular and ventricular arrhythmias in athletes, elucidating their connections with intensive exercise and sports and the risk of sudden cardiac arrest. It highlights typical symptoms and key diagnostic characteristics of these arrhythmias. Additionally, it discusses potential treatment strategies, aligning them with the latest guidelines and recommendations. It aims to enhance sports physicians’ understanding of arrhythmias in athletes and to provide practical guidance on their management.

Non-dominant leading wrist injuries in Indian professional cricketers

Cricket is a popular sport played worldwide, immensely popular in India, with a high prevalence of wrist and hand injuries varying from 11% to 13%. Among batsmen, the injury rates are higher in the non-dominant leading wrist. These injuries affect the ligaments, bones, triangular fibrocartilage complex, tendons, and neurovascular structures predominantly on the palmar and ulnar aspect of the wrist and occur due to the force vectors transmitted to the wrist during the bat swing. Specific injuries can be explained by the biomechanics of this double grip sport, and its force vector knowledge of these injuries can enable the sports physician to diagnose early and effectively treat the athlete, improving their performance and outcome. The main intent of this article is to review the biomechanics and clinical presentation of the most common injuries in the non-dominant or leading wrist of cricketers.

Premier Highland dancer sports injuries

Objective: The objective of this paper is to document sports injuries in premier Highland dancers. Highland dance originated in Scotland and is a relatively unknown sport to physiatrists and sports physicians. It is not the same as Irish dance performed in tap shoes but has some similarities to ballet with regard to the turnout of the leg in the first position. Methods: An Institutional Review Board approved, prospective, telephone survey was conducted to document demographics, area, type, and age of injury in premier Highland dancers. Results: A total of 22 premier Highland dancers met the inclusion criteria for the study. In the hip region, injuries included apophysitis at the anterior superior iliac spine. In the knee region, knee effusions, shin splints, and hairline stress fractures of the tibia were reported. In addition, less common injuries in sports, such as tibialis anterior strain and plantaris tendon partial rupture, were noted. In the ankle/foot region, sprains and tears of anterior tibiofibular, calcaneofibular, posterior talofibular ankle ligaments, and plantar fasciitis were observed, as well as fractured metatarsals in the foot and degenerative arthritis. Conclusion: Injuries resulting from improper alignment in “turnout” (external rotation at the hip) and overuse syndromes from intense and long hours of training to reach national and international competitive premier level were observed. Uncommon injuries, such as tibialis anterior strain and plantaris tendon partial rupture, were also noted that were unique to the jumping and heel/toe maneuvers performed in this sport.

High prevalence of low bone mineral density but normal trabecular bone score in Norwegian elite Para athletes.

Low bone mineral density (BMD) increases the risk of bone stress injuries (BSI) and is one of several clinical concerns in Para athlete sports medicine. However, whether bone microarchitecture is altered in Para athletes is not known. We aimed to investigate BMD, bone microarchitecture and incidence of bone stress injuries in Norwegian elite Para athletes. In this cross-sectional study in Para athletes, Dual energy x-ray absorptiometry (iDXA, Lunar, GE Health Care) derived areal BMD, trabecular bone score (TBS), a surrogate marker for bone microarchitecture, and body composition (body weight (BW), lean body mass (LBM), fat mass (FM), fat percentage) were investigated and compared between ambulant and non-ambulant athletes. Also, the association between BMD, TBS and body composition variables was investigated. Incidence of BSI was assessed with a questionnaire and confirmed by a sports physician in a clinical interview. BMD Z-score <-1 was defined as low and ≤-2 as osteoporotic. TBS ≥ 1.31 was normal, 1.23-1.31 intermediate and <1.23 low. Among 38 athletes (26 ± 6 yrs, 14 females), BMD Z-score was low in 19 athletes, and osteoporotic in 11 athletes' lumbar spine (LS) or femoral neck (FN). BMD was lower in non-ambulant vs. ambulant athletes both in LS (1.13 ± 0.19 vs. 1.25 ± 0.14 g/cm2, p = 0.030) and FN (0.90 ± 0.15 vs. 1.07 ± 0.16 g/cm2, p = 0.003). TBS was normal for all athletes. BMD Z-score in LS was positively associated with TBS (r = 0.408, p = 0.013), body weight (r = 0.326, p = 0.046) and lean body mass (r = 0.414, p = 0.010), but not with fat mass or fat percentage. None of the athletes reported any BSI. Half of the Norwegian elite Para athletes had low BMD, and 29% had BMD Z-score <-2 suggesting osteoporosis. Non-ambulant athletes were more prone to low BMD than ambulant athletes. However, despite high prevalence of low BMD, TBS was normal in all athletes, and BSI was absent in this young population.

Major clinical outcomes of metabolism and sports physiology: a systematic review

Introduction: In the sports medicine setting, many of the established positive health benefits of exercise have been documented by historic discoveries in the field of exercise physiology. Mitochondrial function is critical in regulating all three of the classic physiological factors that limit endurance performance. Objective: It was to carry out a systematic review to present the main information on exercise physiology in the light of mitochondrial redox activities in sports performance, as well as the guidelines of sports medicine in this regard. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from August to September 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles dated from 2008 to 2023. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 200 articles were found, and of the 77 articles were evaluated in full and 32 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 37 studies with a high risk of bias and 78 studies that did not meet GRADE. It was concluded that sports physicians may seek to use an increasing number of non-invasive techniques to study muscle metabolic functioning, answering how mitochondrial networks interact with O2 kinetics, how to remodel mitochondrial networks to increase performance, and how training affects the interaction between glycogen/lipid storage site and mitochondrial networks. Physiological and psychological demands during training and competition generate fatigue and reduce an athlete's sport-specific performance capacity. The magnitude of this decrease depends on several characteristics of the exercise stimulus, such as type, duration, and intensity, as well as on individual characteristics, such as physical conditioning, profile, and fatigue resistance. Recent evidence suggests that exercise-induced reactive species are essential upstream signals for the activation of redox-sensitive transcription factors and the induction of exercise-associated gene expression. Free radicals and oxidative stress are increasingly included in major reviews of exercise physiology as regulators of responses and adaptations.

Training and professional practice of the Sports Physician in Mexico

Training and professional practice of the Sports Physician in Mexico

Sports psychiatry clinical curriculum for sports and exercise medicine fellows in one Canadian university

Abstract: Introduction: Athletes can experience the same mental illnesses as the general population. Sports create additional circumstances that can influence the mental health of its participants. Sport and Exercise Medicine (SEM) physicians are often on the front lines of providing medical assessment and treatment to athletes for a variety of presenting complaints. Enhancing the knowledge base and clinical approach of Sport and Exercise Medicine physicians for assessment and management of mental health challenges in athletes can assist in early identification, assessment, treatment initiation, or referral to a sports psychiatrist. Providing SEM trainees with formal clinical exposure to Sports Psychiatry can better equip them for their future practice. This article describes a formalized clinical rotation in Sports Psychiatry for SEM Fellows in one Canadian university. Methods: In collaboration with the SEM Fellowship program, a formal Sports Psychiatry rotation was created to ensure every Fellow had exposure to mental health assessment and management of athletes appropriate to what would be expected of SEM physicians. Results: A four-week curriculum which included direct clinical assessment, treatment initiation, follow up, and presentation of case-based mental health topics appropriate for SEM physicians. This program was reviewed during accreditation as part of the Enhanced Skills curriculum of the postgraduate Family Medicine program at McMaster University in 2023. Conclusion: An integrated Sports Psychiatry rotation during a SEM Fellowship provides an opportunity for future SEM physicians to have exposure to a clinical population of athletes with mental health concerns to develop tools for assessment, management, and collaborative care.

Emerging Quantitative Imaging Techniques in Sports Medicine.

This article describes recent advances in quantitative imaging of musculoskeletal extremity sports injuries, citing the existing literature evidence and what additional evidence is needed to make such techniques applicable to clinical practice. Compositional and functional MRI techniques including T2 mapping, diffusion tensor imaging, and sodium imaging as well as contrast-enhanced US have been applied to quantify pathophysiologic processes and biochemical compositions of muscles, tendons, ligaments, and cartilage. Dual-energy and/or spectral CT has shown potential, particularly for the evaluation of osseous and ligamentous injury (eg, creation of quantitative bone marrow edema maps), which is not possible with standard single-energy CT. Recent advances in US technology such as shear-wave elastography or US tissue characterization as well as MR elastography enable the quantification of mechanical, elastic, and physical properties of tissues in muscle and tendon injuries. The future role of novel imaging techniques such as photon-counting CT remains to be established. Eventual prediction of return to play (ie, the time needed for the injury to heal sufficiently so that the athlete can get back to playing their sport) and estimation of risk of repeat injury is desirable to help guide sports physicians in the treatment of their patients. Additional values of quantitative analyses, as opposed to routine qualitative analyses, still must be established using prospective longitudinal studies with larger sample sizes.

Effect of testosterone in young ice-hockey players on hematological, biochemical parameters and the level of physical performance

Ice-hockey combines intense physical activity at high speed with elements of power struggle. Testosterone is the main anabolic hormone, an increase in which during adolescence is associated with faster growth, increased muscle mass, physical strength, and increased overall and aerobic performance. Thus, it is interesting to study the effect of different testosterone levels on metabolic parameters and physical performance of young ice-hockey players.Objective: to compare hematological and biochemical parameters, as well as exercise performance in young ice-hockey players, depending on the testosterone level.Materials and methods: the study included 100 young ice-hockey players aged 15–17 years (average age 15.3 ± 1.1 years). The study group included 25 young ice-hockey players with an increased level of total blood testosterone (&gt; 27.5 nmol/l). The control group included 75 young athletes with normal testosterone levels. All athletes included in the study underwent the PWC 170 test to assess physical performance. Assessment of hematological parameters included hemoglobin (HGB), hematocrit, red blood cell, mean corpuscular volume (MCV), mean concentration hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). β-crosslaps, myoglobin and creatine phosphokinase (CPK) activity were measured to assess the functional state of muscle and bone tissue.Results: A comparative assessment of the CBC in young ice-hockey players did not reveal significant differences depending on the level of serum testosterone level. Tolerance to physical activity in the study groups also did not differ. Young ice-hockey players with increased testosterone levels showed lower β-crosslaps values compared to the control group. The values of other biomarkers of the functional activity of muscle tissue did not depend on the level of testosterone levels.Conclusion: Increased serum testosterone level in the range from 27.5 to 40 nmol/l, detected in young ice-hockey players aged 15–17 years, is not associated with a change in hematological and biochemical parameters. High total testosterone levels do not improve physical performance. It is necessary to continue studies to assess the dynamics of the serum testosterone in young ice-hockey players to clarify the long-term effects of androgens on the metabolic and functional indicators of young athletes. Increasing serum testosterone levels in athletes is subject to wide discussion in the community of sports physicians and endocrinologists.

The role of physical activity in obesity: let's actively manage obesity

Obesity, physical inactivity and sedentary behaviour are major public health concerns. A complex interaction of many factors leads to obesity, which requires an individualised multicomponent management strategy. As new interventions become available to help individuals manage obesity, it is essential that physical activity remains a core part of the approach. Here, we summarise current evidence regarding the benefits of physical activity as part of a management strategy of obesity. Additionally, we discuss current methods for increasing physical activity levels in individuals with obesity and outline the role of sport and exercise medicine physicians as part of the multidisciplinary team.

Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment.

Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards.

A suggested universal protocol for dental examination in sports.

The athletes of any sport and level submit their bodies to constant exercise. Any given pathology can increase the risk of injury, illness, or even reduced performance. The medical examination is valuable in diagnosing existing health problems and preventing medical issues that might compromise the athlete's overall health when exercising. The stomatognathic system is not an exemption, as oral pathologies, including dental caries and periodontal diseases, are found in high incidence in sports. The need for accurate and detailed dental examination in sports leaded dentists from the European Association for Sports Dentistry and the Academy for Sports Dentistry to elaborate a universal dental examination in sports protocol that can record the overall oral health of the athlete, including the teeth, periodontium, and musculoskeletal screening, for all athletes. The outcome of this stomatognathic examination allows sports physicians and professionals other than dentists to have a complete image of the individual oral health condition of any given athlete, and it allows the dentists to efficiently screen and prevent pathologies, as well as to advise on the eligibility to practice sports from the oral health perspective.

Introducing Australia's clinical care standard for low back pain.

Introducing Australia's clinical care standard for low back pain.

Autopsy and sudden death.

Our story dates back in the late 70s, when a series of juvenile sudden death (SD) occurred in the Veneto region, north east of Italy. A successful application for a prospective study on young people dying suddenly (<35-year-old, sudden infant death syndrome excluded) was submitted to the regional health authorities, thus implementing a network of collaboration with local anatomic and forensic pathologists, to collect all such events and to gather demographic data. The project is still in progress, and since then, we studied hundreds of consecutive juvenile SD cases, allowing to identify the culprit diseases in the various organs and cardiac structures (aorta, coronary arteries, myocardium, valves, and conduction system). The long-standing Veneto region experience clearly shows that autopsy still plays a pivotal role in the study and prevention of SD and should be carried out regularly. With time, the investigation of SD moved from the classic post-mortem study to molecular autopsy, especially in cases of SD with structurally normal heart. Sudden death prevention in the young has to be faced by an interdisciplinary team, including pathologists, cardiologists, sport physicians, and geneticists, the clinicopathologic correlation method still being the polar star. The game in the fight against SD is still played in the anatomical theatre, the place where 'death enjoys to save lives'.

The awareness of injury prevention programmes is insufficient among French- and German-speaking sports medicine communities in Europe.

Evaluate the current state of sports injury prevention perception, knowledge and practice among sports medicine professionals located in Western Europe and involved in injury prevention. Members of two different sports medicine organizations (GOTS and ReFORM) were invited to complete a web-based questionnaire (in German and in French, respectively) addressing perception, knowledge and implementation of sports injury prevention through 22 questions. 766 participants from a dozen of countries completed the survey. Among them, 43% were surgeons, 23% sport physicians and 18% physiotherapists working mainly in France (38%), Germany (23%) and Belgium (10%). The sample rated the importance of injury prevention as "high" or "very high" in a majority of cases (91%), but only 54% reported to be aware of specific injury prevention programmes. The French-speaking world was characterized by lower levels of reported knowledge, unfamiliarity with existing prevention programmes and less weekly time spent on prevention as compared to their German-speaking counterparts. Injury prevention barriers reported by the respondents included mainly insufficient expertise, absence of staff support from sports organizations and lack of time. There is a lack of awareness regarding injury prevention concepts among sports medicine professionals of the European French- and German-speaking world. This gap varied according to the professional occupation and working country. Relevant future paths for improvement include specific efforts to build awareness around sports injury prevention. Level IV.

Shoulder muscle imbalance as a risk factor for shoulder injury in elite badminton players: A prospective study

ObjectivesTo assess the impact of preseason shoulder testing on the risk of significant shoulder injury (SSI) in elite badminton players. DesignProspective cohort study. SettingSecondary care, academic medical center. ParticipantsNineteen elite badminton players (19.37 ± 4.79 years, n = 13 males). Main outcome measuresAt preseason, they had shoulder examination tests including the table-to-acromion distance and the glenohumeral rotation range of motion. The glenohumeral internal rotation deficit (GIRD) was calculated. Isokinetic internal and external rotator shoulder muscle strength was tested at 60°/s (concentric and eccentric modes) and 240°/s (concentric mode). Bilateral strength ratio (non-dominant:dominant) and unilateral agonist:antagonist conventional and functional ratios (FR: eccentric-to-concentric) were calculated. ResultsDuring the follow-up time of 38 weeks, SSIs were assessed by an experienced sport physician and 42% of the participants sustained at least one SSI at their dominant side. The preseason GIRD and FR at 240°/s (FR240) were independently associated with SSIs (G2 = 6.28, p = .012 and G2 = 6.23, p = .013, respectively). FR240 < 0.69 (odds ratio = 28.0) and GIRD> 14° (odds ratio = 36.14) were predictors for SSIs. ConclusionsLower functional deceleration ratio and greater GIRD are associated with a higher risk of SSI at the dominant side in elite badminton players.

Maladaptive versus Adaptative Cardiovascular Phenotype in Response to Exercise Training: Expert Opinion of the Evidence

Sports physicians, physiologists, cardiologists, and researchers indistinctly use the terms “cardiac maladaptation,” “maladaptive cardiac remodeling” and/or “hypertrophy,” “adverse cardiac remodeling,” and “maladaptive cardiovascular (CV) phenotype/system” to describe pathophysiological responses to chronic and/or high-intensity exercise (i.e., extreme exercise). These terms may be somewhat vague and ambiguous, suggesting a lack of clarity about these mal/adaptations. There is a need to standardize which acute and/or chronic CV responses to exercise training may be considered physiological and which pathological. We aim to present a compilation of CV exercise-induced modifications from a morphological, structural, and electrical perspective that we consider CV maladaptation.

Imaging in Sports Medicine

Muscular, soft tissue, and bony injuries are common among athletes. Different imaging modalities can be used to assess these patients depending on the type of injury and the expert opinion. Multiple imaging modalities are used to diagnose, investigate, and decide an appropriate medical or surgical treatment. Among the modalities that are used, magnetic resonance imaging and ultrasound (US) are commonly used to illustrate soft tissue injuries. Radiographs are cheap and are commonly used. The British Athletic Muscle Injury Classification is a grading system used for muscle injuries and can be used to predict the time it takes for a player to return fully. Tendons and ligaments are graded from 1 to 3, and the Fredericson grading system is used to classify bony injuries. Many of the common sports injuries are graded using these grading systems. Good communication and collaboration among sports physicians, surgeons, and radiologists are essential to adequate injury management in athletes. Appropriate choice of imaging modalities, classification systems, and a knowledge of common sports injuries can facilitate this.

Glucocorticoids Accelerate Erythropoiesis in Healthy Humans-Should the Use in Sports Be Reevaluated?

The World Anti-Doping Agency prohibits glucocorticoid administration in competition but not in periods out of competition. Glucocorticoid usage is controversial as it may improve performance, albeit debated. A hitherto undescribed but performance-relevant effect of glucocorticoids in healthy humans is accelerated erythropoiesis. We investigated whether a glucocorticoid injection accelerates erythropoiesis, increases total hemoglobin mass, and improves exercise performance. In a counterbalanced, randomized, double-blinded, placebo-controlled crossover design (3 months washout), 10 well-trained males (peak oxygen uptake, 60 ± 3 mL O 2 ·min -1 ·kg -1 ) were injected with 40 mg triamcinolone acetonide (glucocorticoid group) or saline (placebo group) in the gluteal muscles. Venous blood samples collected before and 7-10 h, 1, 3, 7, 14, and 21 d after treatment were analyzed for hemoglobin concentration and reticulocyte percentage. Hemoglobin mass and mean power output in a 450-kcal time trial were measured before as well as 1 and 3 wk after treatment. A higher reticulocyte percentage was evident 3 d (19% ± 30%, P < 0.05) and 7 d (48% ± 38%, P < 0.001) after glucocorticoid administration, compared with placebo, whereas hemoglobin concentration was similar between groups. Additionally, hemoglobin mass was higher ( P < 0.05) 7 d (glucocorticoid, 886 ± 104 g; placebo, 872 ± 103 g) and 21 d (glucocorticoid, 879 ± 111 g; placebo, 866 ± 103 g) after glucocorticoid administration compared with placebo. Mean power output was similar between groups 7 d (glucocorticoid, 278 ± 64 W; placebo, 275 ± 62 W) and 21 d (glucocorticoid, 274 ± 62 W; placebo, 275 ± 60 W) after treatment. Intramuscular injection of 40 mg triamcinolone acetonide accelerates erythropoiesis and increases hemoglobin mass but does not improve aerobic exercise performance in the present study. The results are important for sport physicians administering glucocorticoids and prompt a reconsideration of glucocorticoid usage in sport.