Sports Health-A Multidisciplinary Approach最新文献

Background: Neuromuscular training (NMT) improves biomechanical risk factors associated with anterior cruciate ligament (ACL) injury yet has failed to abate increasing ACL injury rates at scale. This study assessed sport-specific sensorimotor adaptations resulting from a NMT protocol with additive real-time sensorimotor augmented biofeedback (augmented NMT [aNMT] or sham aNMT) in a standardized drop vertical jump (DVJ) task and in ecologically valid sport-specific tasks performed in a simulated virtual reality (VR) environment.

Hypothesis: Both training groups will display beneficial biomechanical changes in the standard DVJ, but aNMT will have greater transfer to the VR sport-specific scenario. Biomechanical improvements in DVJ will vary by sport, while improvements in VR sport-specific scenarios will not vary by sport.

Study design: Prospective longitudinal randomized placebo-controlled trial.

Level of evidence: Level 1.

Methods: A total of 271 adolescent female soccer, basketball, and volleyball athletes performed 6 weeks of preseason NMT with additive aNMT or sham aNMT. Three-dimensional biomechanics were assessed at pre-/post-training that included DVJs and sport-specific VR tasks. Pre-/post-training standardized delta scores for both tasks were computed for hip and knee angles and external joint moments. Hierarchical clustering and chi-square analyses (omnibus and within each sport) assessed sport by intervention interactions for biomechanical transfer to both tasks.

Results: Hierarchical clustering identified 3 DVJ clusters, 2 of which (N = 243) demonstrated beneficial pre-/post-training changes. A small proportion (10%) of athletes classified in a maladaptive cluster that consisted predominantly of aNMT participants, while sham aNMT made up a greater proportion of a beneficial adaptive cluster (χ² = 6.06; P = 0.05). For the sport-specific VR task, 2 statistical clusters were identified, both characterized primarily by improved hip flexion angles regardless of sport.

Conclusion: Beneficial effects of aNMT and sham aNMT on the DVJ were observed in most participants, with aNMT accounting for a greater proportion of players exhibiting maladaptive DVJ changes. VR scenarios revealed consistently beneficial changes in landing biomechanics in all participants.

Clinical relevance: Sport-specific VR tasks may assess more nuanced levels of movement complexity than traditional laboratory-based tasks and provide a complementary approach to evaluate biomechanical adaptations resulting from NMT.

Background: Training load is widely recognized as an important contributor to injury occurrence in sport; however, athletes exposed to similar workloads may differ in their ability to tolerate and recover from training demands.

Hypothesis: Injury occurrence in competitive athletes is hypothesized to be more strongly associated with the interaction between training load and recovery status than with training-load magnitude alone, and reductions in recovery status are expected to precede injury onset.

Study design: Retrospective longitudinal observational study.

Level of evidence: Level 3.

Methods: A retrospective longitudinal dataset comprising 15,420 monitored training sessions from 156 competitive athletes was analyzed. Training load was quantified using session-based workload measures derived from training intensity and duration. Recovery status was evaluated using a composite indicator derived from sleep quality, perceived recovery, fatigue, and stress-related measures. Injury outcomes were examined using generalized estimating equation logistic regression models to account for repeated observations within athletes.

Results: Higher training loads were associated with greater injury occurrence (odds ratio [OR], 1.15; 95% CI, 1.02-1.30), whereas higher recovery status was associated with lower injury odds (OR, 0.97; 95% CI, 0.97-0.98). The association between training load and injury occurrence was more pronounced among athletes with impaired recovery, while comparable workloads showed weaker associations when recovery status was moderate or high. Recovery levels declined across the sessions preceding injury onset, with the largest reductions observed during the final sessions before injury.

Conclusion: Injury occurrence in competitive athletes appears to be more closely associated with the interaction between training load and recovery status than with training-load magnitude alone. Monitoring recovery alongside training load may help practitioners identify periods of increased injury vulnerability and adjust workloads according to changes in athlete recovery status.

Clinical relevance: Evaluating recovery status alongside training load may help practitioners identify short-term periods of increased injury vulnerability and guide context-sensitive adjustments to training demands in competitive athletes.

Context: Ankle injuries are common in athletes and can significantly impair postural stability. Balance deficits may vary with the type of injury and the specific biomechanical demands of the sport.

Objective: To evaluate systematically how different types of ankle injuries affect postural stability in athletes by classifying and comparing findings across distinct sport archetypes (eg, multidirectional, linear, balance-focused) to identify sport-specific impairments.

Data sources: A search was conducted in PubMed, Scopus, Embase, and Web of Science from inception up to August 31, 2025, for observational studies assessing postural stability in athletes with ankle injuries.

Study selection: Studies published in any language were included if they assessed postural stability in athletes with ankle injuries. Data were extracted independently by 2 authors, and any disagreements were resolved through discussion. Study quality was assessed using Joanna Briggs Institute checklists (cross-sectional: 8-item; cohort: 11-item; case-control: 10-item). Reporting quality was evaluated using the STROBE checklist.

Study design: Systematic review.

Level of evidence: Level 1.

Data extraction: Data were extracted on static and dynamic balance (DB), including postural sway, center of pressure, stabilization times, and reach distances in the Star Excursion Balance Test (SEBT) and Y Balance Test (YBT).

Results: A total of 59 studies involving 4848 participants were included. Most participants were youth (61%, aged 19-29 years) and adolescent (32%, aged 12-18 years) athletes, with a limited focus on female-only cohorts (6.7% of studies). Athletes with ankle injuries showed deficits in static and DB, with chronic ankle instability (CAI) causing persistent impairments in stabilization times and reduced reach in the SEBT/YBT. Pivoting sports (eg, soccer, basketball) exhibited greater balance deficits than endurance or balance-focused sports.

Conclusion: Ankle injuries, particularly CAI, result in significant balance impairments, necessitating sport-specific rehabilitation addressing both distal and proximal neuromuscular control. Static tests may underestimate functional deficits.

Background: Chronic ankle instability (CAI) can induce contralateral limb deficits, influencing interlimb asymmetry during athletic tasks. Understanding the magnitude, direction, and individual thresholds of these asymmetries is critical for effective rehabilitation and performance monitoring.

Hypothesis: CAI-induced contralateral limb deficits significantly influence the magnitude and direction of interlimb asymmetry in jumping and change-of-direction-speed (CODS) tasks.

Study design: Cross-sectional study.

Level of evidence: Level 3.

Methods: Male elite soccer players with (n = 32) and without (n = 38) CAI performed single-leg hop (SLH), single-leg triple hop, modified-505 (Mod505), and 90°-changes-of-direction tests.

Results: Paired-sample t tests revealed small-to-moderate differences between dominant and nondominant limbs in both groups (P < 0.05), moderate-to-large differences between injured and contralateral uninjured limbs (P < 0.05), large differences between injured and matched limbs of healthy players (P < 0.05), and small nonsignificant differences between contralateral uninjured and matched limbs of healthy players (P > 0.05). Independent-sample t test revealed asymmetries were significantly higher in all tests (P < 0.05) except for SLH (P > 0.05) in players with CAI. Kappa coefficient showed substantial-to-perfect agreements for players with CAI (κ = 0.71-1.00), and moderate-to-substantial agreements for healthy players (κ = 0.51-0.73), indicating asymmetries favored same limb. Agreement percentages for similar identifications of asymmetry patterns based on individual thresholds derived from intralimb variability revealed that injured players adopted similar patterns in CODS (81.25%), while healthy players adopted similar patterns between SLH and mod505 (76.32%).

Conclusion: CAI-induced contralateral limb deficits influenced magnitude and direction of asymmetry, potentially underestimating asymmetry. Asymmetry consistently favors the same limb due to injury and functional similarities; thresholds derived from intralimb variability identify real asymmetry.

Clinical relevance: These findings highlight the importance of considering contralateral limb deficits when interpreting interlimb asymmetries in players with CAI. Rehabilitation programs should address these deficits to optimize performance and reduce injury risk.

Context: Somatosensory dysfunction in people with chronic ankle instability (CAI) has been reported to influence not only peripheral performance but also sensory reweighting of central nervous system. Sensory constraints, such as visual or somatosensory perturbations originating from sway surroundings or sway surface, continuously occur during body movements. Dynamically reweighting somatosensory, visual and vestibular cues are crucial for postural stability. However, due to contradictory evidence, it is unclear how sensory constraints affect sensorimotor functions and sensory reweighting ability in individuals with CAI.

Objective: To examine the impact of sensory constraints on sensorimotor functions, sensory reweighting ability, and the sensory strategy selection of people with CAI during postural control.

Data sources: PubMed, Web of Science, EMBASE, Cochrane, SPORTDiscus, and Medline.

Study selection: Two authors independently screened article titles, abstracts, and full texts to select peer-reviewed studies exploring sensory constraints on sensorimotor functions in people with CAI and healthy controls.

Study design: Meta-analyses of descriptive epidemiological study.

Level of evidence: Level 4.

Data extraction: Center-of-pressure, center-of-gravity, and time-to-boundary measures that represent postural stability, and muscle activity amplitude and activation onset time were extracted.

Results: A total of 43 articles were included. Compared with healthy controls, the CAI group exhibited static (Hedges's g = 0.53) and dynamic (Hedges's g = 1.05) deficits with visual constraint, as well as increased medial gastrocnemius activity (Hedges's g = 1.02) during unilateral stance with visual constraint. The CAI group showed decreased sensory reweighting during unilateral stance with visual constraint (Hedges's g = 0.26) and bilateral stance with visual and somatosensory constraints (Hedges's g = 0.45).

Conclusion: Visual constraint could alter postural control and muscle activation patterns in people with CAI. Sensory reweighting ability of those with CAI may fluctuate based on task and sensory constraints, and visual dominance strategy may help people with CAI modulate posture when visual information is reliable.

Background: Boarding sports, such as skateboarding and snowboarding, are associated with a significant risk of fractures. This study provides a comprehensive overview of the epidemiology, fracture locations, and treatment approaches for skateboarding and snowboarding-related fractures using data from the Swedish Fracture Register.

Purpose: To provide a comprehensive overview of the epidemiology, fracture locations, and treatment modalities for fractures incurred during skateboarding and snowboarding.

Study design: Descriptive epidemiology study.

Level of evidence: Level 4.

Methods: This observational study included all patients registered in the Swedish Fracture Register who sustained fractures while snowboarding or skateboarding from January 2015 to December 2023. Variables studied were age, sex, trauma energy level, seasonal variation, fracture location (body part), and treatment modality.

Results: A total of 5155 patients (28% women) with 5446 fractures were included. Adults (≥16 years old) comprised 58% of all patients. The cohort experienced an approximately equal number of fractures from skateboarding (55%) and snowboarding (45%). A greater propensity for high-energy trauma injuries was observed among snowboarders and males. The mean age was similar in both groups, slightly above 20 years. Upper extremity fractures were the most common in both sports. However, discrepancies were noted: lower extremity fractures were more common in skateboarders, whereas injuries to the spine and pelvis were about 8 times more common in snowboarders. Specific injury patterns, such as the "snowboarder's fracture" and "skateboard elbow," appear unique to each sport.

Conclusion: While skateboarding and snowboarding share similarities, notable differences exist in lower extremity and spinal fractures. Furthermore, specific fracture patterns are characteristic of each sport. Understanding these differences is crucial for developing targeted prevention strategies and improving safety measures.

Background: Blood flow restriction (BFR) training effectively improves strength in muscles directly subjected to occlusion. Secondary effects on distal and contralateral muscles remain underexplored.

Hypothesis: A walking training program plus BFR applied to the upper thigh enhances muscle strength in distal muscles of the lower leg.

Study design: Nonrandomized controlled clinical trial with a within-subject approach.

Level of evidence: Level 1.

Methods: A total of 20 male and 12 female adults (31.1 ± 9.5 years) with ≥10% strength asymmetry in knee extensors completed 3 weekly sessions over 12 weeks. A cuff inflated at 90% of total occlusion pressure was applied to the weaker limb (exercised segment [ES]); the stronger limb served as control segment (CS). Outcomes assessed pre- and postintervention included ankle plantarflexor and dorsiflexor strength and muscle thickness (MT) (medial gastrocnemius [MG] and tibialis anterior [TA]) using isometric testing and ultrasound.

Results: Strength gains were identified after training in the ES and CS for the MG and TA muscles (P < 0.005 pre-to-post comparisons). In the ES, the plantarflexor and dorsiflexor torque increased from 85.6 N·m to 111.7 N·m and from 34.5 N·m to 39.6 N·m, respectively. In the CS, torque increased from 93.1 N·m to 110.5 N·m (plantarflexors) and from 35.5 N·m to 40.3 N·m (dorsiflexors). Relative improvements were greater in the ES (plantarflexor, +30.4%; dorsiflexor, +14.8%) than the CS (plantarflexor, +18.7%; TA, +13.6%), although no interactions were observed (P > 0.05). MT showed nonsignificant variation (P > 0.05). In the ES, the MG changed from 1.93 cm to 2.04 cm and TA from 2.06 cm to 2.33 cm. In the CS, the MG remained stable (1.99 cm to 2.02 cm), and TA varied from 2.12 cm to 2.35 cm.

Conclusion: Walking combined with BFR targeting the upper thigh improves strength in distal muscles of the lower leg, with notable gains in both the occluded and contralateral segments. Neural adaptations likely account for the observed strength increases.

Clinical relevance: BFR walking is an effective, low-impact intervention to enhance lower-limb muscle strength, with potential applications in rehabilitation and training for people with asymmetry or muscle weakness.

Background: Swimming is among the most widely practiced sports globally. Up to 70% of swimmers report shoulder pain that impairs performance. Patient-reported outcome measures (PROMs) are effective, objective tools for assessing such injuries. The aim of this study was to develop and validate swimming-specific adaptations of established shoulder PROMs (ASES-swim and SSV-swim) and compare their psychometric properties and discriminatory ability with generic existing instruments.

Hypothesis: Swimming-specific PROMs may more accurately assess shoulder condition in swimmers and monitor recovery, thereby enabling improved evaluation of health status and, ultimately, athletic performance.

Study design: Cohort study.

Methods: A total of 167 athletes registered with the Portuguese Swimming Federation (FPN) during the 2023-2024 season were enrolled. Participants were stratified into asymptomatic group (AG = 92) and injured group (IG = 75). Monthly assessments included training characteristics, injury status, and responses to ASES, SSV, SSV-sport, and newly developed ASES-swim and SSV-swim questionnaires over 6 months.

Results: SSV-swim correlated strongly with SSV and SSV-sport (r = 0.769, P < 0.001 and r = 0.857, P < 0.001, respectively). ASES-swim scores were highly correlated with ASES scores (r = 0.994, P < 0.001). Both SSV-swim and ASES-swim demonstrated higher internal consistency than the nonadapted PROMs (Cronbach alpha = 0.849 and 0.870, respectively). SSV, SSV-sport, and SSV-swim showed moderate discriminatory ability (area under the curve [AUC] = 0.760, 0.809, and 0.851, respectively), whereas ASES and ASES-swim showed excellent discriminatory ability for detecting injury (AUC = 0.967 and 0.970, respectively).

Conclusion: ASES-swim and SSV-swim are a valid, reliable, and easy to administer tool for the assessment of shoulder injury and recovery in swimmers. Swimming-specific PROMs provide clinically meaningful improvements in shoulder injury assessment accuracy.

Clinical relevance: Swimming-specific PROMs provide clinicians with a sensitive and reliable method for assessing shoulder injury in swimmers, enabling more accurate diagnosis and individualized rehabilitation. Further research should investigate sports-specific PROM adaptations to optimize athlete care across disciplines.

Background: After anterior cruciate ligament reconstruction (ACLR), the single-leg squat test (SLST) may be included in an initial/baseline performance testing battery. During the SLST, the position of the nonstance limb is known to affect the biomechanics/kinematics of the test, making SLST standardization important for comparing outcomes after ACLR.

Hypothesis: The position of the nonstance limb during the SLST will influence the correlation between peak knee flexion limb-symmetry index (LSI) and quadriceps strength LSI, and affect lower extremity biomechanics during the SLST.

Study design: Biomechanical cohort study.

Level of evidence: Level 3.

Methods: A total of 66 athletes completed quadriceps strength and single-leg squat testing 5 to 7 months after ACLR. Based on their nonstance limb position during the SLST, athletes were placed in either a posterior standardization (PS) or neutral standardization (NS) group for biomechanical analyses. Correlations between peak knee flexion LSI during the SLST and quadriceps strength LSI were investigated, and between- and within-group analyses of lower extremity joint biomechanics were completed.

Results: Performing the SLST with PS produced a medium correlation between peak knee flexion LSI and quadriceps strength LSI (R = 0.37, R² = 0.14), whereas NS produced a small correlation (R = 0.27, R² = 0.07). In both groups, the surgical limb showed significantly less peak knee flexion (PS; P = 0.02) (NS; P = 0.03) and knee moment-contribution (PS; P = 0.04) (NS; P = 0.0001), as well as significantly more hip moment-contribution (PS; P = 0.03) (NS; P = 0.0001). Surgical limb change in anterior center of pressure was significantly greater with NS relative to PS (P = 0.03), and nonsurgical limb ankle moment-contribution was significantly greater with PS relative to NS (P = 0.02).

Conclusion: Although surgical limb knee moment contribution is reduced significantly in both groups after ACLR, peak knee flexion LSI may be a better indicator of quadriceps strength LSI during the SLST with PS than with NS.

Clinical relevance: After ACLR, single-leg squatting with PS may be preferred for knee-specific performance testing and as an exercise regression for horizontal hopping, whereas NS may be preferred as an exercise regression for vertical hopping. Strength-of-Recommendation Taxonomy (SORT): B-level recommendation (biomechanical, Level 3 cohort study).

Context: Anterior cruciate ligament (ACL) injuries are common in athletes, especially in pivoting sports. While surgical reconstruction is standard, nonsurgical management remains a viable option for selected patients. However, limited guidance exists on effective rehabilitation protocols for this population. The purpose of this review was to identify and summarize the rehabilitation strategies used in nonsurgical management for patients with ACL deficiency (ACL-D), with particular attention to exercise-based components.

Evidence acquisition: Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, studies were included based on the PCC framework, focusing on athletes aged >14 years with ACL injuries undergoing nonsurgical management. Four databases (MEDLINE, EMBASE, CINAHL, PEDro) were searched up to June 2024, with additional manual screening. Two reviewers independently screened and extracted data. A narrative synthesis was conducted, and exercises were categorized using established frameworks. Inter-rater reliability was assessed using Cohen's kappa.

Study design: Scoping review.

Level of evidence: Level 4.

Results: A total of 14 studies involving 570 athletes (aged 14-57 years) were included. Of these, 53% completed rehabilitation without surgery, and 30% returned to sport. Protocols varied significantly, with a mean duration of 12 ± 8 weeks. Interventions focused on strength (48%), neuromuscular control (10%), and sport-specific exercises (25%). Patient-reported outcome measures were used in 71% of studies. Associated injuries were reported in 33% of studies and negatively influenced return to sport (RTS) outcomes.

Conclusion: Notable inconsistencies in nonsurgical management of ACL-D protocols and exercise descriptors limit comparability and the development of standardized guidelines. Short rehabilitation duration may partly explain the low RTS rate (30% of the original cohort) and the high reinjury rate (28%). Structured, progressive programs focusing on strength, neuromuscular training, and psychological readiness may be important to improve outcomes.