Hans-Wilhelm Mueller-Wohlfahrt, Lutz Haensel, Kai Mithoefer
et al.
Objective To provide a clear terminology and classification of muscle injuries in order to facilitate effective communication among medical practitioners and development of systematic treatment strategies. Methods Thirty native English-speaking scientists and team doctors of national and first division professional sports teams were asked to complete a questionnaire on muscle injuries to evaluate the currently used terminology of athletic muscle injury. In addition, a consensus meeting of international sports medicine experts was established to develop practical and scientific definitions of muscle injuries as well as a new and comprehensive classification system. Results The response rate of the survey was 63%. The responses confirmed the marked variability in the use of the terminology relating to muscle injury, with the most obvious inconsistencies for the term strain. In the consensus meeting, practical and systematic terms were defined and established. In addition, a new comprehensive classification system was developed, which differentiates between four types: functional muscle disorders (type 1: overexertion-related and type 2: neuromuscular muscle disorders) describing disorders without macroscopic evidence of fibre tear and structural muscle injuries (type 3: partial tears and type 4: (sub)total tears/tendinous avulsions) with macroscopic evidence of fibre tear, that is, structural damage. Subclassifications are presented for each type. Conclusions A consistent English terminology as well as a comprehensive classification system for athletic muscle injuries which is proven in the daily practice are presented. This will help to improve clarity of communication for diagnostic and therapeutic purposes and can serve as the basis for future comparative studies to address the continued lack of systematic information on muscle injuries in the literature. What are the new things Consensus definitions of the terminology which is used in the field of muscle injuries as well as a new comprehensive classification system which clearly defines types of athletic muscle injuries. Level of evidence Expert opinion, Level V.
Objectives To develop an assessment and recognition tool to identify elite athletes at risk for mental health symptoms and disorders. Methods We conducted narrative and systematic reviews about mental health symptoms and disorders in active and former elite athletes. The views of active and former elite athletes (N=360) on mental health symptoms in elite sports were retrieved through an electronic questionnaire. Our group identified the objective(s), target group(s) and approach of the mental health tools. For the assessment tool, we undertook a modified Delphi consensus process and used existing validated screening instruments. Both tools were compiled during two 2-day meeting. We also explored the appropriateness and preliminary reliability and validity of the assessment tool. Sport Mental Health Assessment Tool 1 and Sport Mental Health Recognition Tool 1 The International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) was developed for sports medicine physicians and other licensed/registered health professionals to assess elite athletes (defined as professional, Olympic, Paralympic or collegiate level; aged 16 years and older) potentially at risk for or already experiencing mental health symptoms and disorders. The SMHAT-1 consists of: (i) triage with an athlete-specific screening tool, (ii) six subsequent disorder-specific screening tools and (iii) a clinical assessment (and related management) by a sports medicine physician or licensed/registered mental health professional (eg, psychiatrist and psychologist). The International Olympic Committee Sport Mental Health Recognition Tool 1 (SMHRT-1) was developed for athletes and their entourage (eg, friends, fellow athletes, family and coaches). Conclusion The SMHAT-1 and SMHRT-1 enable that mental health symptoms and disorders in elite athletes are recognised earlier than they otherwise would. These tools should facilitate the timely referral of those athletes in need for appropriate support and treatment.
The convergence of semiconductor technology, physiology, and predictive health analytics from wearable devices has advanced its clinical and translational utility for sports. The detection and subsequent application of metrics pertinent to and indicative of the physical performance, physiological status, biochemical composition, and mental alertness of the athlete has been shown to reduce the risk of injuries and improve performance and has enabled the development of athlete-centered protocols and treatment plans by team physicians and trainers. Our discussions in this review include commercially available devices, as well as those described in scientific literature to provide an understanding of wearable sensors for sports medicine. The primary objective of this paper is to provide a comprehensive review of the applications of wearable technology for assessing the biomechanical and physiological parameters of the athlete. A secondary objective of this paper is to identify collaborative research opportunities among academic research groups, sports medicine health clinics, and sports team performance programs to further the utility of this technology to assist in the return-to-play for athletes across various sporting domains. A companion paper discusses the use of wearables to monitor the biochemical profile and mental acuity of the athlete.
Several sports have published consensus statements on methods and reporting of epidemiological studies concerning injuries and illnesses with football (soccer) producing one of the first guidelines. This football-specific consensus statement was published in 2006 and required an update to align with scientific developments in the field. The International Olympic Committee (IOC) recently released a sports-generic consensus statement outlining methods for recording and reporting epidemiological data on injury and illness in sport and encouraged the development of sport-specific extensions. The Fédération Internationale de Football Association Medical Scientific Advisory Board established a panel of 16 football medicine and/or science experts, two players and one coach. With a foundation in the IOC consensus statement, the panel performed literature reviews on each included subtopic and performed two rounds of voting prior to and during a 2-day consensus meeting. The panel agreed on 40 of 75 pre-meeting and 21 of 44 meeting voting statements, respectively. The methodology and definitions presented in this comprehensive football-specific extension should ensure more consistent study designs, data collection procedures and use of nomenclature in future epidemiological studies of football injuries and illnesses regardless of setting. It should facilitate comparisons across studies and pooling of data.
# Background
Neuromuscular and kinematic peculiarities in the lower extremities between the sexes could influence the way the posterior kinetic chain interacts during exercises and sprinting, potentially altering hamstring strengthening exercise selection.
# Purpose
This study compared sex-differences in four exercises (the rocker, perpetuum mobile fast and slow [PMfast and PMslow] and the Nordic Hamstring exercise) on their potential to simulate sprint-like muscle activity and kinematics.
# Methods
Muscle activity of the posterior kinetic chain (biceps femoris [BFlh], semitendinosus [ST], gluteus maximus [GMax] and gastrocnemius medialis [GCM]) was measured with surface electromyography (sEMG) during each exercise and treadmill running at 75% of the individual maximal sprint velocity. sEMG data was normalized to maximal sprinting. 3D-motion capture was employed to assess hip and knee angles.
# Results
Eight male and 12 female athletes were included (age: 22.4 years ± 3.1; body mass: 61.0 kg ± 7.1; height: 1.67 m ± 0.07). Peak (MD: 31, p= 0.003, [95%CI: 14-48], SMD: 1.1) and average hamstring activity (MD: 16, p< 0.001, [95%CI: 8-24], SMD: 1.4) was greater in females for every examined task. A sex and muscle interaction showed that females displayed significantly greater peak (MD: 39, p=0.002, [95%CI: 21-60], SMD: 1.3) and mean activity (MD: 20, p< 0.001, [95%CI: 12-29], SMD: 1.5) for ST but not BFlh. Joint angles of peak muscle activity showed significantly greater hip angles during the PMfast in females (MD: 30°, p= 0.014, [95%CI: 15-46°], SMD: 2.1) and an overall significantly smaller knee flexion angle for the ST compared to the BFlh (MD: 7°, p= 0.02, [95%CI: 1-12°], SMD: 0.4). Neither hamstring elongation stress nor muscle selectivity showed significant sex differences.
# Discussion
Aside from overall display of greater hamstring, specifically ST activity in all tasks for females, only minor kinematic and no synergist muscle sex-differences were found. Further research exploring sex-specific hamstring neuromuscular strategies is needed.
# Level of evidence
3b
Sulistyorini Anita, Izzalqurny Tomy Rizky, Utomo Muhammad Andry Prio
et al.
The 2021 eruption of Mount Semeru caused 61 deaths and the displacement of thousands people, exposed major shortcomings in community preparedness. One key factor contributing to these gaps is the limited availability of educational media that is accessible and relevant to the local context. This study addresses this issue by developing and validating a digital educational platform that was co-designed with local residents. The research offers two main novelties. Firstly, it combines comprehensive volcanic and geological information with practical preparedness guidelines that are presented on website. Secondly, the participatory co-design approach involving the local community contrasts with the usual top-down approach to disaster ICT initiatives. An educational website was produced and iteratively tested for feasibility with 34 individuals directly affected by the Semeru eruption, guided by a research and development (R&D) framework. Initial small-group testing (n = 10) yielded a 70% feasibility score, prompting significant revisions. Subsequent large-group testing (n = 24) demonstrated increased feasibility of over 92%, classifying the final product as ’highly feasible’. This research delivers a validated, context-specific digital tool that bridges the gap between government mitigation plans and grassroots needs, positioning the website as both a product and a model for interventions that strengthen community resilience.
Yannick Rau, Thomas Huynh, Karl-Heinz Frosch
et al.
Abstract Background Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial could be made so far. Plate osteosynthesis appears to gain in importance. We aim to give insight into the more recent trends and developments as well as establish the epidemiology of patella fractures in Germany by analysing treatment and epidemiological data from a national database. Methods Anonymised data was retrieved form a national database. In the period of 2006 to 2020, all patients with patella fractures as defined in ICD-10 GM as their main diagnosis, who were treated in a German hospital were included. Patients were divided into subgroups based on gender and age. Age groups were created in 10-year intervals from 20 years old up to 80 years old with one group each encompassing all those above the age of 80 years old and below 20 years old and younger. Linear regression was performed were possible to determine statistical significance of possible trends. Results A total of 151,435 patellar fractures were reported. 95,221 surgical interventions were performed. Women were about 1.5 times more likely to suffer from patella fracture than men. The relative number of surgical interventions rose from about 50% in 2006 to 75% in 2020. Most surgical interventions are performed in those over the age of 50. The incidence of complex fractures and plate osteosynthesis has significantly increased throughout the analysed period. Conclusions We found a clear trend for surgical treatment in Germany with an increase in surgical procedures. We could also show that this ratio is age-related, making it more likely for younger patients in the age groups from 0 to 70 years old to receive surgical treatment for their patella fracture.
Osteosarcoma (OS) is a type of bone cancer that is derived from primitive mesenchymal cells typically affecting children and young adults. The current standard of treatment is a combination of neoadjuvant chemotherapy and surgical resection of the cancerous bone. Post-resection challenges in bone regeneration arise. To determine the appropriate amount of bone to be removed, preoperative imaging techniques such as bone and CT scans are employed. To prevent local recurrence, the current standard of care suggests maintaining bony and soft tissue margins from 3 to 7 cm beyond the tumor. The amount of bone removed in an OS patient leaves too large of a deficit for bone to form on its own and requires reconstruction with metal implants or allografts. Both methods require the bone to heal, either to the implant or across the allograft junction, often in the setting of marrow-killing chemotherapy. Therefore, the issue of bone regeneration within the surgically resected margins remains an important challenge for the patient, family, and treating providers. Mesenchymal stem/stromal cells (MSCs) are potential agents for enhancing bone regeneration post tumor resection. MSCs, used with scaffolds and growth factors, show promise in fostering bone regeneration in OS cases. We spotlight two MSC types—bone marrow-derived (BM-MSCs) and adipose tissue-derived (ASCs)—highlighting their bone regrowth facilitation and immunomodulatory effects on immune cells like macrophages and T cells, enhancing therapeutic outcomes. The objective of this review is two-fold: review work demonstrating any ability of MSCs to target the deranged immune system in the OS microenvironment, and synthesize the available literature on the use of MSCs as a therapeutic option for stimulating bone regrowth in OS patients post bone resection. When it comes to repairing bone defects, both MB-MSCs and ASCs hold great potential for stimulating bone regeneration. Research has showcased their effectiveness in reconstructing bone defects while maintaining a non-tumorigenic role following wide resection of bone tumors, underscoring their capability to enhance bone healing and regeneration following tumor excisions.
This study aimed to analyze within- and between-player variations of peak speed and sprinting actions occurring in small-sided games (SSGs: 1v1 and 5v5). The study followed a cohort study design. Twenty male youth soccer players (age: 17 years old) from the same team were observed over four consecutive weeks. Each week, the players participated in two sessions (day one and day two) during which SSGs were applied. The 1 vs. 1 format was employed with four repetitions of thirty seconds interspaced with two-minute rest intervals, while the 5 vs. 5 format with four repetitions of four minutes and two-minute rest intervals between them. The players were monitored during all training sessions with the Polar Team Pro. The peak speed attained in each game, and the number of sprints were extracted as the primary outcomes. The between-player variability revealed a lower coefficient of variations for peak speed in the 1 vs. 1 (13.9%) and 5 vs. 5 (10.9%) formats than for sprints (1 v 1: 64.7%; 5 v 5: 65.5%). Considering the within-player variability, it was observed that sprints were more variable (1 vs. 1: 62.1%; 5 v 5: 65.7%) than peak speed (1 vs. 1: 16.4%; 5 v 5: 14.0%). The between-session analysis revealed that during week 1 (day 1), peak speed was significantly higher than during week 3 (day 1) in the 1 vs. 1 format (+3.0 km/h; p = 0.031; d = 1.296). Moreover, peak speed during week 3 (day 2) was considerably lower than during week 1 (–5.9 km/h; p 0.05). However, on day two, the sprint was substantially higher during week one than during week four in the 5 vs. 5 format (+5.40 n; p = 0.002; d = 2.571). In conclusion, this study revealed that peak speed presents lower within- and between-player variability than the number of sprints. Considering these two measures, there are no considerable variations between the weeks. Coaches should consider identifying strategies to stabilize the stimulus regarding the number of sprints if this represents one of the targets for employing SSGs.