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British Journal of Sports Medicine current issue - Recent Educational Updates

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Neurocognitive enriched rehabilitation at #sportfisio2024
<p>The Swiss Sports Physiotherapy Association (SSPA) will hold its 22nd annual conference on 8 November 2024 at the Bernexpo, Bern, capital of Switzerland and home of this event since 2005.</p> <p>The goal of SSPA has always been to organise a high-quality scientific congress featuring international high-profile speakers. We invite you to relive all our conferences (since 2013) on our own YouTube channel (<A HREF="https://www.youtube.com/channel/UCMYW4Yv3IXeANv-uD3R0FYA">https://www.youtube.com/channel/UCMYW4Yv3IXeANv-uD3R0FYA</A>), a free educational resource for the sports physiotherapy (PT) and medicine community.</p> <sec id="s1"><st>SSPA news</st> <p>The SSPA, founded in 2002 as a non-profit organisation, has been a member society of BJSM since 2011. Back in 2015, the SSPA organised the 1st World Congress of Sports Physical Therapy (WCSPT) of the International Federation of Sports Physical Therapy. The event took place in Bern and attracted over 800 participants form numerous countries worldwide. This June 2024, our colleagues of the Norwegian Sports PT society will host...


The days of generalised joint hypermobility assessment in all patients with ACL injury are here
<p>Second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACL-R) is a dreaded potential complication to both patients and healthcare professionals.<cross-ref type="bib" refid="R1">1</cross-ref> Research conducted throughout the 2010s has helped identify factors influencing second ACL injury risk after ACL-R and the multifactorial causes of second ACL injury are now well established, with patient anatomy, surgical factors and components of the rehabilitation process each playing essential roles.<cross-ref type="bib" refid="R2">2</cross-ref> Despite the wealth of existing knowledge, additional contributors to second ACL injury may be overlooked due to the focus on complex interactions between a subset of risk factors. To avoid missing the forest for the trees, we cannot afford to overlook more straightforward reasons that lead to second ACL injuries. Generalised joint hypermobility (GJH) is one such contributor to the increased risk of reinjury after primary ACL injury. This editorial presents the rationale for an assessment of GJH in all patients...


Social media impact on athlete mental health: #RealityCheck
<sec id="s1"><st>#RealityCheck</st> <p>Global social media use rates have nearly tripled<cross-ref type="bib" refid="R1">1</cross-ref> with 95% of 13&ndash;27-year-olds using YouTube and other platforms such as TikTok (67%), Instagram (62%) and Snapchat (59%) and 35% of users doing so &lsquo;almost constantly&rsquo;.<cross-ref type="bib" refid="R2">2</cross-ref> 95% of teens have access to a smartphone, and 97% use the internet daily.<cross-ref type="bib" refid="R2">2</cross-ref> The US Surgeon General<cross-ref type="bib" refid="R3">3</cross-ref> and the American Psychological Association<cross-ref type="bib" refid="R4">4</cross-ref> have voiced considerable concern about the potential negative impact of social media on youth and adolescent mental health, calling it &lsquo;an urgent public health issue&rsquo;.<cross-ref type="bib" refid="R3">3</cross-ref></p> <p>Although the literature on mental health and social media use has increased, minimal research exists on young and/or elite athletes, leaving many important questions unanswered. What are the positive and negative mental health effects of social media on athletes? Are there opportunities to use social media to increase mental health literacy, destigmatise mental...


Preventing hip osteoarthritis in athletes: is it really a mission impossible?
<p>Hip osteoarthritis (OA) in athletes is important to acknowledge, with early hip OA associated with elite-level high joint impact sports, such as football, ice hockey and handball.<cross-ref type="bib" refid="R1">1</cross-ref> Current management of hip OA is largely reactive (when OA disease is established and irreversible). Identifying athletes at risk of, or with early-stage hip OA, may improve treatment success and reduce disease burden. Clinicians and researchers need to understand the natural history of OA in active populations, risk factors for early hip OA and whether OA in athletes can be prevented. In this editorial, focussing on elite athletes, we aim to describe the natural history of hip OA, consider the role of primary cam morphology in hip OA development and provide clinical and research recommendations for the prevention of hip OA.</p> <sec id="s1"><st>The natural history of hip OA in athletes</st> <p>Understanding the natural history of hip OA across the lifespan...


What should be included in an Olympic Sports International Federations pregnancy and postpartum policy and guidance?
<p>Many women have to choose between having children and their athletic career.<cross-ref type="bib" refid="R1">1</cross-ref> However, times are changing, and some elite female athletes are continuing to compete during pregnancy and the postpartum period (2 years following childbirth).<cross-ref type="bib" refid="R1">1 2</cross-ref><cross-ref type="bib" refid="R2"></cross-ref> Pregnant athletes should be encouraged, when medically safe, to exercise throughout their pregnancy and the postpartum period due to the health gains for both the mother and unborn child, similar to the non-athletic population.<cross-ref type="bib" refid="R3">3</cross-ref> Appropriately, there are concerns about the safety of some exercise forms and durations during pregnancy and the postpartum period, especially for elite athletes who may have unique training demands and high-performance goals.<cross-ref type="bib" refid="R3">3</cross-ref></p> <p>At the beginning of 2016, the IOC produced a five-part consensus statement on exercise during pregnancy and the postpartum period, with systematic reviews on each area.<cross-ref type="bib" refid="R2">2 4&ndash;9</cross-ref><cross-ref type="bib" refid="R4"></cross-ref><cross-ref type="bib" refid="R5"></cross-ref><cross-ref type="bib" refid="R6"></cross-ref><cross-ref type="bib" refid="R7"></cross-ref><cross-ref...


Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study
<sec><st>Objective</st> <p>To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period.</p> </sec> <sec><st>Methods</st> <p>Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018&ndash;2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR<FONT FACE="arial,helvetica">x</FONT>mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models.</p> </sec> <sec><st>Results</st> <p>Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0&ndash;3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013).</p> </sec> <sec><st>Conclusion</st> <p>Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.</p> </sec>


'Considering the reality, I am very lucky: how professional players and staff perceive injury prevention and performance protection in womens football
<sec><st>Objective</st> <p>To explore the beliefs and perceptions of professional female footballers and staff regarding injury prevention and performance protection in professional women&rsquo;s football.</p> </sec> <sec><st>Methods</st> <p>This qualitative study applied semistructured interviews with 18 participants from 3 top-tier teams from 2 countries (Portugal and England) and 4 nationalities, including 2 physiotherapists, 5 players, 3 team doctors, 2 head coaches, 3 strength and conditioning coaches, 2 managers, and 1 head of performance. Data analysis applied constant comparison analysis, using principles of grounded theory. There were no major differences in the perspectives of players and staff, and the findings are presented together.</p> </sec> <sec><st>Results</st> <p>Identifying and reporting injuries and recognising potential injury risk factors were mentioned to influence the prevention of injury. Participants stated that the growth and evolution of women&rsquo;s football could influence injury risk. Before reaching the professional level, exposure to potential risk factors, such as lack of recovery, limited awareness and opportunities for prevention (eg, preventive exercises and load management strategies), was believed to impact players&rsquo; injury risk. Players further described their experiences and the &lsquo;bumpy road&rsquo; to becoming a professional player, their current context and potential future improvements for women&rsquo;s football regarding injury prevention and performance protection.</p> </sec> <sec><st>Conclusion</st> <p>Professional female football players face different injury risks during different moments of their careers. According to elite players and staff, amateur and semiprofessionals have limited resources and lack injury prevention strategies. Professional players and staff perceived the current preventive measures as good and relied on the value of individualised care and a multidisciplinary approach. In the future, more resources and structured injury prevention strategies are needed in youth and non-professional levels of women&rsquo;s football to reduce injury risk and allow more players to reach their maximal performance.</p> </sec>


Pelvic floor muscle training in female functional fitness exercisers: an assessor-blinded randomised controlled trial
<sec><st>Objective</st> <p>Stress urinary incontinence (SUI) is common among females during functional fitness training, such as CrossFit. The aim of this study was to assess the effect of pelvic floor muscle training (PFMT) on SUI in female functional fitness exercisers.</p> </sec> <sec><st>Methods</st> <p>This was an assessor-blinded randomised controlled trial with a PFMT group (n=22) and a control group (n=25). The PFMT group followed a 16-week home-training programme with 3 sets of 8&ndash;12 maximum pelvic floor muscle (PFM) contractions daily and weekly follow-up/reminders by phone. The primary outcome was change in a total score of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). The secondary outcomes were perceived change of symptoms of SUI, change of PFM strength measured by vaginal manometry and symptoms of anal incontinence (AI) and pelvic organ prolapse (POP).</p> </sec> <sec><st>Results</st> <p>47 women, mean age of 33.5 years (SD: 8.1), participated. At 16 weeks, there was a mean difference between groups of &ndash;1.4 (95% CI: &ndash;2.6 to &ndash;0.2) in the change of the ICIQ-UI-SF score in favour of the PFMT group. The PFMT group completed a mean of 70% (SD: 23) of the prescribed protocol. 64% in the PFMT group versus 8% in the control group reported improved symptoms of SUI (p&lt;0.001, relative risk: 7.96, 95% CI, 2.03 to 31.19). There were no group differences in the change of PFM strength or AI/POP symptoms.</p> </sec> <sec><st>Conclusion</st> <p>A 16-week home-training programme of the PFM led to improvements in SUI in female functional fitness exercisers. However, PFM strength and AI and POP symptoms did not improve significantly in the PFMT group compared with the control group.</p> </sec>


Socioeconomic deprivation and racialised disparities in competitive athletes with sudden cardiac arrest from the USA
<sec><st>Objective</st> <p>To explore the association of socioeconomic deprivation and racialised outcomes in competitive athletes with sudden cardiac arrest (SCA) in the USA.</p> </sec> <sec><st>Methods</st> <p>SCA cases from the National Center for Catastrophic Sports Injury Research (July 2014 to June 2021) were included. We matched Area Deprivation Index (ADI) scores (17 metrics to grade socioeconomic conditions) to the 9-digit zip codes for each athlete&rsquo;s home address. ADI is scored 1&ndash;100 with higher scores indicating greater neighbourhood socioeconomic deprivation. Analysis of variance was used to assess differences in mean ADI by racial groups. Tukey post hoc testing was used for pairwise comparisons.</p> </sec> <sec><st>Results</st> <p>391 cases of SCA in competitive athletes (85.4% male; 16.9% collegiate, 68% high school, 10.7% middle school, 4.3% youth) were identified via active surveillance. 79 cases were excluded due to missing data (19 race, 60 ADI). Of 312 cases with complete data, 171 (54.8%) were white, 110 (35.3%) black and 31 (9.9%) other race. The mean ADI was 40.20 (95% CI 36.64, 43.86) in white athletes, 57.88 (95% CI 52.65, 63.11) in black athletes and 40.77 (95% CI 30.69, 50.86) in other race athletes. Mean ADI was higher in black versus white athletes (mean difference 17.68, 95% CI 10.25, 25.12; p=0.0036) and black versus other race athletes (mean difference 17.11, 95% CI 4.74, 29.47; p&lt;0.0001).</p> </sec> <sec><st>Conclusions</st> <p>Black athletes with SCA come from areas with higher neighbourhood socioeconomic deprivation than white or other race athletes with SCA. Our findings suggest that socioeconomic deprivation may be associated with racialised disparities in athletes with SCA.</p> </sec>


No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury
<sec><st>Objective</st> <p>We aimed to determine hip and lower-leg muscle strength in people after ACL injury compared with an uninjured control group (between people) and the uninjured contralateral limb (between limbs).</p> </sec> <sec><st>Design</st> <p>Systematic review with meta-analysis.</p> </sec> <sec><st>Data sources</st> <p>MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and SportDiscus to 28 February 2023.</p> </sec> <sec><st>Eligibility criteria</st> <p>Primary ACL injury with mean age 18&ndash;40 years at time of injury. Studies had to measure hip and/or lower-leg muscle strength quantitatively (eg, dynamometer) and report muscle strength for the ACL-injured limb compared with: (i) an uninjured control group and/or (ii) the uninjured contralateral limb. Risk of bias was assessed according to Cochrane Collaboration domains.</p> </sec> <sec><st>Results</st> <p>Twenty-eight studies were included (n=23 measured strength &le;12 months post-ACL reconstruction). Most examined hip abduction (16 studies), hip extension (12 studies) and hip external rotation (7 studies) strength. We found no meaningful difference in muscle strength between people or between limbs for hip abduction, extension, internal rotation, flexion or ankle plantarflexion, dorsiflexion (estimates ranged from &ndash;9% to +9% of comparator). The only non-zero differences identified were in hip adduction (24% stronger on ACL limb (95% CI 8% to 42%)) and hip external rotation strength (12% deficit on ACL limb (95% CI 6% to 18%)) compared with uninjured controls at follow-ups &gt;12 months, however both results stemmed from only two studies. Certainty of evidence was very low for all outcomes and comparisons, and drawn primarily from the first year post-ACL reconstruction.</p> </sec> <sec><st>Conclusion</st> <p>Our results do not show widespread or substantial muscle weakness of the hip and lower-leg muscles after ACL injury, contrasting deficits of 10%&ndash;20% commonly reported for knee extensors and flexors. As it is unclear if deficits in hip and lower-leg muscle strength resolve with appropriate rehabilitation or no postinjury or postoperative weakness occurs, individualised assessment should guide training of hip and lower-leg strength following ACL injury.</p> </sec> <sec><st>PROSPERO registration number</st> <p>CRD42020216793.</p> </sec>


Infographic. Return to activity/sport postpartum: a summary of current recommendations
<p>With increased participation in sport by female athletes, there has been a concomitant rise in the number of female athletes aiming to return to activity (RTA) and/or return to sport (RTS) postpartum. However, almost one in two female participants stops exercising/playing sport due to pelvic floor symptoms.<cross-ref type="bib" refid="R1">1</cross-ref> Additionally, a lack of female athlete-specific research and clinical practice guidelines make it difficult for both athletes and clinicians to navigate a safe and successful RTA/RTS.<cross-ref type="bib" refid="R2">2</cross-ref> Furthermore, female athletes have specific biological, sociocultural and environmental considerations that could impact sport and health outcomes.<cross-ref type="bib" refid="R3">3</cross-ref></p> <p>A recent scoping review was undertaken to evaluate recommendations for RTA/RTS postpartum.<cross-ref type="bib" refid="R4">4</cross-ref> We concluded that while some recommendations exist,<cross-ref type="bib" refid="R5">5&ndash;7</cross-ref><cross-ref type="bib" refid="R6"></cross-ref><cross-ref type="bib" refid="R7"></cross-ref> evidence informed guidelines are needed to improve physical activity levels and RTA/RTS for postpartum females.<cross-ref type="bib" refid="R4">4</cross-ref> This infographic aims to summarise the results of the...


Exercise, digital health and chronic disease: feasibility, effectiveness and utilisation (PhD Academy Award)
<sec id="s1"><st>What did I do?</st> <p>My thesis investigated the feasibility, effectiveness and utilisation of digital health physical activity/exercise interventions in chronic disease cohorts. Contemporary literature was reviewed for applicable digital health interventions,<cross-ref type="bib" refid="R1">1</cross-ref> a feasibility randomised controlled trial was undertaken to evaluate the feasibility of a patient-centred digital health exercise and diet intervention for people living with kidney and liver disease in tertiary care,<cross-ref type="bib" refid="R2">2 3</cross-ref><cross-ref type="bib" refid="R3"></cross-ref> and the utilisation of telehealth exercise physiology (EP) services in Australia was examined.<cross-ref type="bib" refid="R4">4</cross-ref></p> </sec> <sec id="s2"><st>Why did I do it?</st> <p>Only 25% of all Australian adults aged 18&ndash;64 years meet physical activity and muscle strengthening guidelines.<cross-ref type="bib" refid="R5">5</cross-ref> This observation is compounded for people living with complex multimorbid chronic conditions, such as kidney or liver disease, where clinical state has a profound effect on physical activity level. Novel approaches to exercise delivery are warranted in these patient...