Neurocognitive function and musculoskeletal injury risk in sports:A systematic review

ObjectivesA variety of modifiable risk factors has been suggested to predict musculoskeletal injury in sports. Screening paradigms and exercise-based prevention programs, so far, frequently focused on physical parameters such as strength, balance or flexibility. However, less is known with regard to the impact of brain function. We investigated the relation between cognition and the occurrence of injury in athletes.DesignSystematic review.MethodsDatabase searches using Pubmed, Web of Science and Google Scholar returned nine cohort and case-control studies, which almost exclusively examined college athletes engaging in open skill sports. Methodological quality, rated by means of a modified Downs and Black checklist, was moderate (12/17 points).ResultsSeven out of the nine included studies suggested that lower-order cognitive function (i.e. visuomotor reaction time) is systematically associated with the occurrence of injury. No paper examined the impact of executive function.ConclusionsDespite initial evidence pointing towards a potentially injury-predictive role of lower-order cognitive function, several issues including the use of more variable populations and outcomes remain to be addressed before definitive recommendations for clinicians can be made.     

The impact of stretching on sports injury risk: a systematic review of the literature

PURPOSE: We conducted a systematic review to assess the evidence for the effectiveness of stretching as a tool to prevent injuries in sports and to make recommendations for research and prevention. METHODS: Without language limitations, we searched electronic data bases, including MEDLINE (1966-2002), Current Contents (1997-2002), Biomedical Collection (1993-1999), the Cochrane Library, and SPORTDiscus, and then identified citations from papers retrieved and contacted experts in the field. Meta-analysis was limited to randomized trials or cohort studies for interventions that included stretching. Studies were excluded that lacked controls, in which stretching could not be assessed independently, or where studies did not include subjects in sporting or fitness activities. All articles were screened initially by one author. Six of 361 identified articles compared stretching with other methods to prevent injury. Data were abstracted by one author and then reviewed independently by three others. Data quality was assessed independently by three authors using a previously standardized instrument, and reviewers met to reconcile substantive differences in interpretation. We calculated weighted pooled odds ratios based on an intention-to-treat analysis as well as subgroup analyses by quality score and study design. RESULTS: Stretching was not significantly associated with a reduction in total injuries (OR = 0.93, CI 0.78-1.11) and similar findings were seen in the subgroup analyses. CONCLUSION: There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes. Further research, especially well-conducted randomized controlled trials, is urgently needed to determine the proper role of stretching in sports.     

The association between early specialization and performance level with injury and illness risk in youth elite athletes

A trend is observed towards more specialized training and selection into talent programs at an early age for youth athletes. Little is known how this might influence the risk of illness and injury. The aim of the study was to assess whether, in a group of youth elite athletes, those specializing early or performing best were at increased risk of incurring injury or illness after entering a specialized Sport Academy High School program. We enrolled 259 16‐year‐old elite athletes. They completed a baseline web‐based questionnaire covering their age at specialization, single‐ versus multi‐sport involvement during the previous 2 years and current performance level (rated by themselves and their coach). Subsequently, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems was used to self‐report injuries and illnesses weekly for 26 weeks from October to May. In this specialized Sport Academy High School program, 39% of the athletes reported early specialization (at 12 years or younger). However, early specialization did not increase the risk of injury or illness during the 26 weeks, nor did being a single‐sport athlete the previous two years increase this risk. The best performing athletes at the time of enrollment were not at greater risk of becoming injured or ill during the 26 weeks. In conclusion, in a group of youth elite athletes entering a specialized Sport Academy High School program neither early single‐sport specialization nor performance level appears to represent risk factors for injury or illness after enrollment.     

Strategies to prevent injury in adolescent sport: a systematic review

This systematic review set out to identify randomised controlled trials and controlled intervention studies that evaluated the effectiveness of preventive strategies in adolescent sport and to draw conclusions on the strength of the evidence. A literature search in seven databases (Medline, SportDiscus, EMBASE, CINAHL, PEDro, Cochrane Review and DARE) was carried out using four keywords: adolescent, sport, injury and prevention (expanded to capture any relevant literature). Assessment of 154 papers found 12 studies eligible for inclusion. It can be concluded that injury prevention strategies that focus on preseason conditioning, functional training, education, balance and sport-specific skills, which should be continued throughout the sporting season, are effective. The evidence for the effectiveness of protective equipment in injury prevention is inconclusive and requires further assessment.     

Epidemiology of ankle and foot overuse injuries in sports: A systematic review

Studies regarding ankle and foot overuse injuries are quite diverse in research methodology, data reporting, and outcomes. The aims of this systematic review were to analyze the methodology of published studies regarding ankle and foot overuse injuries in different sports disciplines and to summarize epidemiological data of ankle and foot overuse injuries. Four electronic databases, PubMed (MEDLINE), EMBASE, CINAHL, and SPORTDiscus^® were systematically searched up to June 2011. A total of 89 articles on 23 sports disciplines were included in this review. Soccer, running, and gymnastics were the most frequently studied sports. Achilles tendinopathy, plantar fasciitis, and stress fracture were the most frequently studied injuries. Study design and reporting methods were heterogeneous. Most studies suffered from a weak methodology and poor reporting. The most common weaknesses were lack of a clear case definition, describing assessment procedures and reporting sample characteristics. Due to methodological heterogeneity of studies, inter‐sports and intra‐sports comparisons and meta‐analysis were not possible. Methodology of most studies on incidence and prevalence of ankle and foot overuse injuries is insufficient. Based on the results, we recommend authors to clearly define cases, describe assessment procedures and report sample characteristics adequately.     

Specialization patterns across various youth sports and relationship to injury risk

Objectives: Current trends among young athletes towards earlier specialization age and year-round training on multiple teams has raised concern for increased injury risk. Our previous analyses showed higher risk for injury in highly specialized young athletes. The goal of this research was to determine whether sports specialization and injury patterns vary by sports type.

Methods: In this clinical case-control study, injured athletes (aged 7–18 years) were recruited from sports medicine clinics and compared to similarly aged uninjured athletes recruited from primary care clinics. Participants completed a survey reporting age, gender, sport type, specialization patterns, and details regarding sports-related injuries in the previous 6 months. Clinical diagnoses were collected from patients’ medical records. Injuries were classified as acute, overuse, or serious overuse.

Results: Of 1,190 athletes enrolled, 26% (313) were single-sport specialized (reported participation in one sport and trained >8 months/year). Sports with the highest proportion of single-sport specialized athletes were tennis (46.7%), gymnastics (30.1%), and dance (26.3%). Single-sport specialized athletes in individual sports started specializing at a younger age (11.2 ± 2.4 vs. 12.0 ± 2.7, p = 0.05) and reported higher training volumes (11.8 vs. 10.3 h/week, p = 0.04) than those in team sports. Sports with the youngest specialization age were gymnastics (8.9 ± 1.7), dance (10.8 ± 3.0), and soccer (10.9 ± 2.4). Single-sport specialized athletes in individual sports accounted for a higher proportion of overuse injuries (44.3% vs 32.2%, OR = 1.67, p = 0.037) and serious overuse injuries (23.4% vs 11.6%, OR = 2.38, p = 0.011), but a lower proportion of acute injuries (28.8% vs 13.8%, OR = 0.37, p = 0.001) compared to single-sport specialized athletes involved in team sports.

Conclusions: Athletes in individual sports may be more likely to specialize in a single sport than team sport athletes. Single-sport specialized athletes in individual sports also reported higher training volumes and greater rates of overuse injuries than single-sport specialized athletes in team sports.     

Amputees and sports: a systematic review

Amputation of a limb may have a negative impact on the psychological and physical well-being, mobility and social life of individuals with limb amputations. Participation in sports and/or regular physical activity has a positive effect on the above mentioned areas in able-bodied individuals. Data concerning participation in sports or regular physical activity together with its benefits and risks for individuals with limb amputations are scarce. No systematic review exists that addresses a wide range of outcomes such as biomechanics, cardiopulmonary function, psychology, sport participation and sport injuries. Therefore, the aim of this article is to systematically review the literature about individuals with limb amputations and sport participation. MEDLINE (PubMed), EMBASE, CINAHL? and SportDiscus? were searched without time or language restrictions using free text words and MeSH terms. The last search date was 31 March 2010. Books, internet sites and references of included papers were checked for papers relevant to the topic under review. Papers were included if the research topic concerned sports and a minimum of ten individuals with limb amputations were part of the study population. Papers were excluded if they included individuals with amputations of body parts other than upper or lower limbs or more distal than the wrist or ankle, or if they consisted of case reports, narrative reviews, books, notes or letters to the editor. Title, abstract and full-text assessments were performed by two independent observers following a list of preset criteria. Of the 3689 papers originally identified, 47 were included in the review. Most of the included studies were older than 10 years and had cross-sectional designs. Study participants were generally younger and often had more traumatic amputations than the general population of individuals with limb amputations. Heterogeneity in population characteristics, intervention types and main outcomes made data pooling impossible. In general, sports were associated with a beneficial effect on the cardiopulmonary system, psychological well-being, social reintegration and physical functioning. Younger individuals with unilateral transtibial amputations achieve better athletic performance and encounter fewer problems when participating in sports compared with older individuals with bilateral transfemoral amputations. Regardless of their amputation level, individuals with limb amputations participate in a wide range of recreational activities. The majority of them were not aware of the sport facilities in their area and were not informed about available recreational activities. Sport prosthetic devices were used mostly by competitive athletes. For football, the injury rate and pattern of the players with an amputation were similar to those of able-bodied players. Individuals with limb amputations appear to benefit both physically and psychologically from participation in sports and/or regular physical activity. Therefore, sports should be included in rehabilitation programmes, and individuals with limb amputations should be encouraged to pursue a physically active life following hospital discharge.     

The prevention of shin splints in sports: a systematic review of literature.

PURPOSE: To review the published and unpublished evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and offer evidence-based recommendations to coaches, athletes, and researchers. METHODS: We searched electronic data bases without language restriction, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 199 citations identified, we emphasized results of the four reports that compared methods to prevent shin splints. We assessed the methodologic quality of these reports by using a standardized instrument. RESULTS: The use of shock-absorbent insoles, foam heel pads, heel cord stretching, alternative footwear, as well as graduated running programs among military recruits have undergone assessment in controlled trials. There is no strong support for any of these interventions, and each of the four controlled trials is limited methodologically. Median quality scores in these four studies ranged from 29 to 47, and serious flaws in study design, control of bias, and statistical methods were identified. CONCLUSION: Our review yielded little objective evidence to support widespread use of any existing interventions to prevent shin splints. The most encouraging evidence for effective prevention of shin splints involves the use of shock-absorbing insoles. However, serious flaws in study design and implementation constrain the work in this field thus far. A rigorously implemented research program is critically needed to address this common sports medicine problem.     

Sailing and sports medicine: a literature review

Sailing medicine has been mainly addressed by healthcare professionals who happen to sail. Although there has been an increase in the number of studies of various aspects of sailing over the last 15 years, efforts to advance evidence based knowledge of sailing and sports medicine face unique obstacles. Recent interest in research by groups such as Olympic and America's Cup teams has produced beneficial changes.     

The Elbow and Tennis,Part 1: An Analysis of Players With and Without Pain

After studylng 2,633 average tennis players, the authors offer some surprlslng new ideas about the factors that may contribute to elbow pain.     

Extended reality in musculoskeletal rehabilitation and injury prevention - A systematic review

ObjectiveUnlike in neurological patient populations, the effects of Extended Reality within the context of sports medicine have rarely been studied. This systematic review was conducted to investigate the value of Extended Realty-assisted rehabilitation and injury prevention strategies on injury rehabilitation and prevention outcomes.MethodsPubMed and Web of Science databases were consulted. The search strategy consisted of the terms Virtual Reality (Intervention), rehabilitation and injury prevention (Outcome) and healthy athletes or athletes with a musculoskeletal sports injury (Population). After eligibility and Risk of Bias screening, ten articles were included. Risk of Bias analysis resulted in a level of evidence varying between C (three articles), B (six articles) and A2 (one article) scores.ResultsExtended Reality was found to provide an added value for both sports injury prevention and rehabilitation outcomes. It particularly provides clinicians with the opportunity to address the underlying biomechanical risk profile for common sports injuries, allowing the athletes to train protective movement patterns more effectively.ConclusionMore large-scale high-quality prospective research is needed in order to determine whether Extended Reality-assisted therapy is superior to conventional therapy in sports rehabilitation and injury prevention circles with strong conclusive evidence.     

Prevention of knee injuries in sports. A systematic review of the literature

AIM: We reviewed evidence regarding risk factors associated with incidence of knee injuries both to assess the effectiveness of prevention strategies, and to offer evidence-based recommendations to physicians, coaches, trainers, athletes, and researchers. METHODS: We searched electronic data bases without language restriction for the years 1966 - September 1, 2001, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 328 citations identified, we emphasized the results from the 13 reports that compared alternative methods to prevent knee injury and assessed the methodologic quality of these reports using a standardized instrument. RESULTS: Five studies addressed the effectiveness of bracing in football players; these studies showed no consistent evidence of benefit. Two studies comparing alternative cleat designs and a controlled study testing the effects of adjustments in the ski boot/binding system were difficult to interpret because of inadequate reporting of methodology. Six prospective studies that addressed the impact of conditioning and training showed promise of proprioception and neuromuscular training for protection against knee injury. We identified serious flaws in study design, control of bias, and statistical methods; the median quality scores ranged from 11 to 56 (out of 100). CONCLUSION: Structured training programs that emphasize neuromuscular and proprioceptive training offer encouraging evidence for the prevention of knee injuries. However, flaws in study design and implementation have limited the effectiveness of work in this field. A rigorously implemented research program is needed to address this critically important sports medicine problem.     

The prevention of ankle sprains in sports. A systematic review of the literature

To assess the published evidence on the effectiveness of various approaches to the prevention of ankle sprains in athletes, we used textbooks, journals, and experts in the field of sports medicine to identify citations. We identified 113 studies reporting the risk of ankle sprains in sports, methods to provide support, the effect of these interventions on performance, and comparison of prevention efforts. The most common risk factor for ankle sprain in sports is history of a previous sprain. Ten citations of studies involving athletes in basketball, football, soccer, or volleyball compared alternative methods of prevention. Methods tested included wrapping the ankle with tape or cloth, orthoses, high-top shoes, or some combination of these methods. Most studies indicate that appropriately applied braces, tape, or orthoses do not adversely affect performance. Based on our review, we recommend that athletes with a sprained ankle complete supervised rehabilitation before returning to practice or competition, and those athletes suffering a moderate or severe sprain should wear an appropriate orthosis for at least 6 months. Both coaches and players must assume responsibility for prevention of injuries in sports. Methodologic limitations of published studies suggested several areas for future research.     

Infectious disease outbreaks in competitive sports: a review of the literature

Recent outbreaks of infectious diseases in athletes in competitive sports have stimulated considerable interest. The environments in which these athletes compete, practice, receive therapy for injuries, and travel, both domestically and internationally, provide varied opportunities for the transmission of infectious organisms. The purpose of this medical literature review is to identify the agents most commonly reported in the medical literature as responsible for infectious disease outbreaks in specific sports and their modes of transmission and to guide targeted prevention efforts. A literature review of English-language articles in medical publications that reported outbreaks of infectious diseases in competitive athletes was conducted in PubMed MEDLINE from 1966 through May 2005. Outbreaks that were solely food borne were excluded. Fifty-nine reports of infectious disease outbreaks in competitive sports were identified in the published medical literature. Herpes simplex virus infections appear to be common among wrestlers and rugby players, with no single strain responsible for the outbreaks. Methicillin-resistant Staphylococcus aureus was responsible for several recent outbreaks of soft tissue and skin infections among collegiate and professional athletes. The most common mode of transmission in outbreaks was direct, person-to-person (primarily skin-to-skin) contact. Blood-borne exposure was implicated in 2 confirmed outbreaks of hepatitis. Airborne and vector transmissions were rarely reported. This review provides an overview of infectious disease outbreaks thought to be either serious enough or unusual enough to report. Appropriate surveillance of the frequency of infections will allow sports medicine staff to identify outbreaks quickly and take necessary measures to contain further transmission and prevent future outbreaks.     

Association between training volume and lower extremity overuse injuries in young female athletes: implications for early sports specialization

Background: Recent studies indicated greater risk of overuse injuries among young female athletes than their male counterparts. However, few studies have focused on female athletes and the effect of single-sport participation on lower extremity overuse injuries.

Objective: The objective of this study is to identify an independent risk variable for lower extremity overuse injuries based on status of sport participations (single- and multisports) in young female athletes.

Methods: In this cross-sectional study, 12–18-year-old female athletes were asked to complete electronic questionnaires describing their current sport participation and previous injury history. Range of motion (ROM), muscular strength, and performance parameters were measured at the time of completion of electronic questionnaires. Potential risk variables were compared between single- and multisport athletes and entered into a logistic regression model. Adjusted odds ratio (aOR), 95% confidence intervals (95% CIs), and p values were recorded to find an association with increased likelihood of lower extremity overuse injuries.

Results: The study cohort comprised 236 female young athletes (single-sport athletes: N = 60, multisport athletes: N = 176). A few variables including age, BMI, weekly hours of training for a sport, knee ROM, ankle ROM, and knee extensor strength were identified as potential risk variables. A logistic regression analysis showed an independent association between increased weekly hours of training for a sport and greater likelihood of histories of lower extremity overuse injuries (aOR = 1.091, 95% CIs: 1.007–1.183, p = .034).

Conclusion: Although status of single- or multisports participation was not a significant risk variable, increased training volume was found to be an independent contributing factor for greater likelihood of lower extremity overuse injury histories in 12–18 years female athletes. The current study identified that single-sport athletes trained nearly twice as many hours per week when compared to multisport athletes, which may explain an underlying mechanism of sports specialization.     

Quantifying the risk of sports injury: a systematic review of activity-specific rates for children under 16 years of age

Injuries caused by sports and other forms of physical activity in young children constitute a significant public health burden. It is important to quantify this risk to ensure that the benefits of sport participation are not outweighed by the potential harms. This review summarises the literature reporting exposure-based injury rates for various forms of physical activity in children aged 15 years and younger. Forty eight studies were found, of which 27 reported injury rates per hourly based exposure measured and 21 reported injury rates according to some other measure. Fourteen different sports and activities were covered, mostly team ball sports, with soccer being the most widely studied. Injury definition and the method of ascertaining and measuring injuries differed between studies, which created a large variation in reported injury rates that did not necessarily represent actual differences in injury risk between activities. The highest hourly based injury rates were reported for ice hockey, and the lowest were for soccer, although the range of injury rates for both of these activities was wide. Very few studies have investigated sports-related injuries in children younger than 8 years or in unorganised sports situations.