Clinical Journal of Sport Medicine最新文献

Objective: This study aimed to investigate whether flexor digitorum superficialis (FDS) dysfunction could serve as a risk factor of throwing elbow injuries.

Design: This prospective cohort study recruited 31 male college baseball pitchers from June 2022 to May 2023.

Setting: A set of college baseball pitchers of male sex participated in this study and measurements were taken before and after pitching 30 and 50 pitches.

Participants: This study included 31 male college baseball pitchers.

Assessment of risk factors: Using ultrasonography, the presence of an intra-articular ring-down artifact (RDA) was assessed with 4 different conditions: at rest, under gravity valgus load, and under elbow gravity valgus stress with either the contraction of the third and fourth digits or of the second and fifth digits.

Main outcome measures: Each participant threw 50 fastballs at a distance of 18.44 m from the pitcher's plate toward a catcher. These measurements were taken before pitching and after 30 and 50 pitches, and all elbow injuries during the study period resulting in medical evaluation or missed participation were considered as the primary outcome.

Results: Nine pitchers (29%) experienced throwing elbow injuries. Cox regression analysis indicated that the presence of the RDA under valgus stress with FDS contraction involving the second and fifth digits was a significant risk factor for throwing elbow injury (hazard ratio: 5.4; P = 0.018).

Conclusions: Dysfunction in the deep layer of the FDS may serve as a risk factor of throwing elbow injury in college baseball pitchers after throwing 50 pitches.

Level of evidence: Diagnostic, level 2.

Objective: Neurogenic thoracic outlet syndrome (NTOS) is an underrecognized problem causing chronic upper extremity symptoms from brachial plexus compression, often affecting overhead athletes. This study evaluated the utility of ultrasound-guided (USG) diagnostic injections for NTOS.

Design: This was a retrospective chart review.

Setting: This study was conducted at a single institution.

Patients: In total, 203 patients (121 female, 81 male, and 1 nonbinary) with suspected NTOS underwent USG diagnostic blocks. Forty-five were athletes, including 42 overhead athletes.

Intervention: A single sports medicine physician performed USG diagnostic injections targeting the pectoralis minor (PM), anterior and middle scalenes, suprascapular nerve (SSN), or quadrilateral space.

Main outcome measures: Patients reported symptomatic relief >50%.

Results: PM blocks were positive in 125/186 (67%) cases and scalene blocks in 85/130 (65%). SSN and quadrilateral space blocks were positive in 34/76 (44%) and 4/11 (36%), respectively. Among 95 nonathletes receiving both PM and scalene blocks, greatest relief was reported with scalene in 40 (42%) and PM in 31 (32.6%), 8 (8.4%) improved with both, 10 (10.5%) with neither, and 6 unreported (6.3%). Among athletes, 36/42 (85.7%) had positive PM blocks and 13/20 (65%) had positive scalene blocks. SSN and quadrilateral space blocks were positive in 9/14 (64%) and 1/3 (33%), respectively. Of 22 athletes receiving both PM and scalene blocks, 16 (73%) reported greatest relief with PM, 4 (18%) with scalene, and 2 (9%) with neither.

Conclusions: PM blocks produced symptom relief comparable with scalene blocks in the general population and were the most effective diagnostic injection in athletes. These results suggest the PM is a more prominent symptom generator in NTOS than previously recognized, particularly in athletes.

Objective: To identify the independent predictors of mental health and quality of life (QOL) among elite youth soccer athletes.

Design: Cross-sectional observational study.

Setting: Study materials were distributed to the Elite Clubs National League (ECNL) clubs through an online survey.

Participants: 668 adolescent athletes aged 13 to 18 years.

Assessment of risk factors: Independent variables included age, sex, previous week sleep duration, athletic identity (AI), previous injury, and racial/ethnic minority status.

Main outcome measures: Main outcome measures were anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), and QOL (PedsQL). Separate multivariable regression models evaluated independent predictors of each outcome.

Results: Independent predictors of anxiety were age (β = 0.28 ± 0.072, P < 0.001), female sex (β = -1.7±-0.40, P < 0.001), sleep (β = -0.88 ± 0.16, P < 0.001), AI (β = 0.11±-0.034, P = 0.002), and injury (β = 1.2±-0.37, P = 0.001), but not racial/ethnic minority status (β = 0.35 ± 0.39, P = 0.37). Independent predictors of depression included age (β = 0.29 ± 0.070, P < 0.001), female sex (β = -1.4 ± 0.41, P < 0.001), sleep (β = -1.2 ± 0.16, P < 0.001), injury (β = 0.88 ± 0.37, P = 0.019), and racial/ethnic minority status (β = 0.81 ± 0.40, P = 0.004), but not AI (β = 0.049 ± 0.035, P = 0.16). Independent predictors of QOL were age (β = -0.60 ± 0.19, P = 0.001), sleep (β = 2.6 ± 0.43, P < 0.001), injury (β = -3.7 ± 0.98, P < 0.001), and AI (β = -0.22 ± 0.092, P = 0.016), but not sex (β = 1.8 ± 1.1, P = 0.10) or racial/ethnic minority status (β = -1.5 ± 1.0, P = 0.16). In all models, sleep had the greatest relative importance (38%-56%).

Conclusions: Among youth soccer athletes, greater age, female sex, previous injury, and less sleep were independent predictors of anxiety and depression, whereas greater age, previous injury, less sleep, and higher AI predicted lower QOL. Sleep emerged as the strongest modifiable factor, highlighting its importance in psychosocial wellbeing, to the extent that sleep contributes to these outcomes.

Objective: To map and evaluate the implementation of soccer concussion prevention programs and identify barriers and facilitators across all demographics using the RE-AIM framework.

Data source: A scoping review was conducted in accordance with PRISMA-ScR guidelines. The protocol was registered on the Open Science Framework (10.17605/OSF.IO/DBT8M). Studies were eligible if they reported quantitative outcomes of concussion-related programs implemented in soccer settings. Searches were conducted in 6 electronic databases and gray literature, with the search period limited to 2010 to 2025. Data extraction was completed independently by 2 reviewers. Program characteristics and outcomes were mapped to the 5 RE-AIM dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Risk of bias was assessed using the ROBINS-I tool.

Main results: Fourteen studies met inclusion criteria, primarily from the United States (n = 7) and the United Kingdom (n = 4). Interventions focused on concussion education, baseline neurocognitive testing, guideline implementation, and neuromuscular or neck-strengthening exercises. All studies reported Reach, and most demonstrated short-term improvements in knowledge or recognition (Effectiveness). Adoption and Implementation were inconsistently reported, often limited by organizational and resource constraints. Maintenance was the least addressed dimension, with minimal long-term follow-up and no standardized outcomes beyond 6 months. Evidence for reduced concussion incidence was limited.

Conclusions: Concussion programs in soccer seem to produce short-term benefits but remain inadequately evaluated in adoption, implementation, fidelity, and sustainability. Future research should prioritize longitudinal designs and comprehensive RE-AIM reporting to support scalable and sustainable concussion program implementation strategies.

Objectives: To explore the perceptions and attitudes of professional coaches from an English Premier League club toward heading and the Football Association's Heading Guidelines.

Design: This qualitative study used an interpretivist philosophical paradigm. A focus group interview was conducted and analyzed using 6-stage thematic analysis approach.

Setting: A Premier League football club in England.

Patient or participants: Five male professional coaches.

Assessment of risk factor: Related risk of heading in football had been discussed which included safety risks of heading and long-term implications of heading.

Main outcome measures: Coaches' perceptions of heading in football and existing heading guidelines in England.

Results: Three main themes emerged: (1) How bad is heading? Concerns were raised about the risk of heading on neurodegenerative diseases, with coaches questioning the evidence and comparing risks with other sports; (2) How coaching influences heading in football. This theme highlighted the coaches' perceptions on the importance of heading for certain positions and career progression, and the perceived neglect of heading technique development; and (3) How coaches implement the guidelines, with this theme revealing mixed attitudes toward guideline adherence, with suggestions for safer heading practices and concerns about the guidelines' impact on training and games.

Conclusion: Coaches expressed scepticism about the need for Heading Guidelines due to limited evidence on long-term brain health. They emphasized the importance of educating coaches on research evidence as it becomes available, and involving multiple stakeholders in player safety. Effective implementation requires addressing coaches' perceptions and ensuring better communication and education on the guidelines' rationale and benefits. The study highlights the need for improved communication and education to increase buy-in and adoption of Heading Guidelines, considering both coaches' perspectives and the scientific evidence base.

Objective: Bigorexia, or Muscle Dysmorphia, is an increasingly recognized body image disorder among adolescents, characterized by an excessive drive for muscularity and distorted self-perception. Although its psychological dimensions are well described, its cardiovascular implications remain underexplored. This review examines the association between bigorexia-related behaviors and early cardiovascular injury, and proposes a conceptual framework for this evolving phenotype.

Data sources: A comprehensive narrative review was conducted using PubMed, Scopus, and Web of Science. Search terms included "muscle dysmorphia," "bigorexia," "anabolic androgenic steroids," "energy drinks," "high-protein diet," "cardiovascular risk," "left ventricular hypertrophy," "atherosclerosis," "arrhythmia," "adolescents," and "young adults," used individually and in combination.

Main results: Bigorexia is associated with high-risk lifestyle exposures-including anabolic androgenic steroid use, excessive energy drink intake, and high-protein diets-particularly prevalent among adolescent and young adult males in competitive sports and fitness-oriented environments. Their convergence contributes to a distinct cardiovascular phenotype characterized by premature atherosclerosis, pathological left ventricular hypertrophy, endothelial dysfunction, and increased arrhythmogenic risk. Evidence suggests synergistic interactions between these exposures, accelerating vascular aging and myocardial remodeling beyond what each factor produces independently. Behavioral reinforcement and absent screening protocols further amplify risk.

Conclusions: Bigorexia represents not only a psychiatric condition but a potential driver of early cardiovascular disease. Integrating cardiovascular screening into management of at-risk adolescents may enable early detection, risk stratification, and preventive intervention, mitigating long-term cardiovascular morbidity.

Objective: To clarify prevalence patterns, symptomatic rates, and sport-specific risk factors associated with os trigonum, os subfibulare, and os subtibiale in young athletes presenting with ankle pain.

Design: Retrospective cross-sectional study.

Setting: Single-center sports medicine clinic.

Participants: A total of 1167 young athletes (≤22 years) with ankle pain who underwent standardized weight-bearing radiographs.

Independent variables: Accessory ossicle type, age, physeal status, sport category, and sex.

Main outcome measures: Prevalence, symptomatic presentation, and surgical excision.

Results: Accessory ossicles were identified in 361 athletes (30.9%), comprising 406 total ossicles. Os trigonum was most prevalent (21.8%), followed by os subfibulare (9.9%) and os subtibiale (3.2%). Os trigonum was more frequent in athletes with closed physes, whereas os subfibulare and os subtibiale were more frequent in athletes with open physes (all P < 0.05). Among athletes with accessory ossicles, 37 (10.2%) were symptomatic, 73.0% were trauma-related, and 83.8% occurred in cutting/pivoting sports. Cutting/pivoting sports independently predicted symptomatic presentation (Odds ratio 2.41, 95% confidence interval 1.07-5.45; P = 0.034), whereas age, physeal status, and sex were not independently associated.

Conclusions: Accessory ossicles showed distinct prevalence patterns across skeletal maturity groups, but symptomatic presentation was independently associated with cutting/pivoting sports rather than age or skeletal maturity. These findings may help clinicians assess the potential clinical relevance of accessory ossicles identified in young athletes with ankle pain.

Objective: Our study evaluated long-term outcomes of nonoperative treatment of spondylolysis in adolescents and young athletes.

Design: Retrospective case series.

Setting: High-volume sports medicine clinical and research center.

Participants: Spondylolysis patients initially treated nonoperatively (10-25 year old; ≥5 years from diagnosis).

Main outcome measures: We collected self-reported function (Oswestry Disability Index, ODI) and return-to-sport outcomes (for athletes) and compared ODI scores and follow-up between athletes and nonathletes, and between male and female patients.

Results: A total of 150 patients (133 competitive athletes; 108 males; mean age at diagnosis = 16.3 years; mean follow-up time = 8.0 years) were included. Bilateral defects were more common (75%) than unilateral defects (25%), and L5 was the primary affected level (63%). Nonoperative treatment approaches included activity modification (95%), physical therapy (93%), Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) (64%), bracing (38%), and non-NSAID pain medication (23%). The mean ODI score at follow-up was 3.6 (0-100; best score = 0). ODI scores were higher (worse) in female patients versus male patients (P = 0.01), but did not statistically-differ between athletes and nonathletes (P = 0.29). Of competitive athletes, 91% returned to their preinjury sport at the same level or higher. Only 5 patients underwent subsequent back-related surgery after initial nonoperative treatment.

Conclusions: We found excellent long-term outcomes after nonsurgical treatment of spondylolysis in a cohort of adolescents and young adults, including a large proportion of competitive athletes. Our findings underscore that nonsurgical interventions should be the mainstay treatment for spondylolysis in young individuals.

Objective: To investigate the effects of swelling on postural control and patient-reported outcomes in individuals with chronic ankle instability (CAI).

Design: Cross-sectional study.

Setting: Controlled laboratory.

Participants: A total of 60 participants-20 CAI individuals with swelling (swelling), 20 CAI individuals without swelling (nonswelling), and 20 healthy controls (control)-were recruited.

Independent variables: Group (swelling, nonswelling, and control).

Main outcome measures: Participants performed 3 trials of single-leg hop-to-stabilization and single-leg stance tasks, along with patient-reported outcomes. A one-way analysis of variance was used to assess group differences in dynamic and static postural control and patient-reported outcomes.

Results: The swelling group exhibited worse dynamic postural control in vertical stability index and dynamic postural stability index compared with the nonswelling ( P = 0.03, P = 0.04) and control ( P < 0.01 and P < 0.01) groups. The nonswelling group showed similar dynamic postural control with the control group. Swelling ( P < 0.01 and P < 0.01) and nonswelling ( P = 0.01 and P < 0.01) groups showed worse static postural control center of pressure mediolateral velocity and center of pressure anteroposterior velocity compared with the control group. Swelling and nonswelling groups showed differences in patient-reported outcomes about ankle function and instability compared with the control group, but there was no difference in patient-reported outcomes between the swelling and nonswelling groups themselves.

Conclusion: Ankle swelling contributes to altered neuromuscular control, resulting in worse dynamic postural control, but affects neither static postural control nor patient-reported outcomes in CAI individuals.