Category: Knee ligaments

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The required sample size was calculated using G*Power (version 3.1, University of Düsseldorf, Germany) [21]. The a priori power analysis was calculated with an assumed power of 0.90, an alpha level of 0.01 and an effect size of Cohen’s f = 0.26 for pulmonary diffusion capacity (TL) [10]. The analysis showed that a total sample size of N=60 would be sufficient to detect a significant interaction effect by time. Accordingly, 80 participants were enrolled to account for possible dropouts due to injuries.

Eighty healthy prepubertal boys, aged 6 to 10 years, with normal lung volumes and regular flow-volume curves and no history of cardiovascular disease or allergies, volunteered to participate in the study. A respiratory functional examination was performed by a physician, including a health questionnaire to screen the participants’ medical history. The boys were randomly divided into two groups:

• The football group (SG, n = 40) participated in four weekly football sessions of 75 minutes each over a period of 28 weeks.

• The control group (CG, n = 40) matched to the SG in terms of age, body weight and height, participated only in regular physical education classes without any other extracurricular sports activities.

All participating boys went to the same school near the football training center. After providing written and verbal information about the risks and benefits of the study, written informed consent to participate in the study was obtained from all study participants and their parents or legal guardians before the start of the study. The ethics committee of Sousse Medical University (Tunisia) approved the study. The study was conducted in accordance with the latest version of the Declaration of Helsinki. The physical characteristics of the study participants at the time of inclusion are listed in Table 1.

Procedures

Baseline (Trial 1) anthropometric data (body height to the nearest 0.1 cm and body weight to the nearest 100 g) were collected using standard stadiometers (Seca™, Hamburg, Germany) and scales (Tefal, France). Maximum oxygen consumption (VO₂max) and maximum aerobic power (MAP) were determined using standard protocols, with the extensive testing performed on a bicycle ergometer (Monark cycle). The bicycle ergometer was chosen for safety reasons, because the participants are boys aged 6 to 10 years and the treadmill is also more stressful. Participants cycled unloaded at 60-65 revolutions/min (rpm) for the first minute, after which the work rate was increased every minute according to the Cooper and Weiler-Ravell procedure. [22] to VO₂the maximum had been reached. The examiners who performed the exercise test were blinded to group assignment.

Oxygen consumption (VO₂) and carbon dioxide (VCO₂) production were determined using a calibrated metabolic measurement system (MedGraphics CPX St Paul, MN, USA). The transfer of nitric oxide (NO) and carbon monoxide (CO) was measured simultaneously during a single breathing maneuver using an automated device (Medisoft, Dinant, Namur, Belgium), according to the latest ERS guidelines [23]. Each participant completed three validated transfer measurements [9, 10]: two at rest (before exercise) and one at the end of the maximum exercise test. After the test, the participants remained seated on the bicycle ergometer. An investigator attached the nose clip and mouthpiece to initiate the breathing maneuver under the experimenter’s guidance. Participants were informed about the importance of test standardization to achieve better test reproducibility. The validity of the test was visually checked by examining the trace showing the volume changes during the maneuver. In other words, the computer-generated trace should have no pause during the rapid inhalation, be flat during the breath-hold, and be continuous during the exhalation. The test was considered valid if these criteria were met. All participants were given three introductory trials to practice the maneuvers.

DM and Vc were determined from TL_NO and T.L_CO values ​​as previously described by Dridi et al. [9]. Since the reactivity of NO and hemoglobin was considered very high and its inverse was negligible, TL_NO was considered equivalent to DM_NO. DM_CO was determined using the coefficient of proportionality (a) and the DM values ​​of the two gases (aDM_NO = aDM_CO = 1.97) according to “Graham’s law.

Same tests (maximum O₂ consumption, maximum aerobic power and NO/CO transfer) were repeated 28 weeks later (Test 2). All tests and effort measurements were performed on the same equipment, calibrated using identical methods, and measured using identical laboratory techniques for the initial and follow-up tests.

Football training program

The training period was spread over 28 weeks (from October to April) (Table 2), with training taking place in four weekly sessions (between 5:00 PM and 6:15 PM on Tuesday, Wednesday, Friday and Sunday) (Table 3). During this time, only friendly matches were scheduled. Each training session included a 15-minute warm-up, followed by 20 minutes of physical work (jumping, wrapping, running) and 30 minutes of basic technical training (dribbling, juggling, passing, technical circuit), supplemented with active stretching exercises.

The SG was exposed to seven months (i.e. 28 consecutive weeks) of systematic football training with three sessions per week. The training sessions were carried out on a synthetic football field and were led by three professional coaches. During the first 6 weeks, the coaches emphasized training physical fitness components such as endurance, linear speed and speed of change of direction, coordination including balance to provide a foundation for subsequent football-specific training. From weeks 7 to 12, the exercise program mainly included football-specific technical exercises (passing, dribbling, ball control, etc.).

From weeks 13 to 18, the coaches ensured the development of motor skills such as movement coordination, speed, joint flexibility, basic endurance through circuits, slaloms, races, jumps, etc. From weeks 19 to 28, the coaches focused on technical and tactical aspects of training including ball possession, recovering the ball, transition… and proposing simple situations of reduced squads by limiting the opposition (3 × 2; 4 × 3; 5 × 4…) in addition to fun games and small games (3 × 3 ; 4 × 4; 5 × 5 in small to medium-sized places 12 × 20 m; 16 × 24 m; 25 × 35 m). The last 10 weeks were reserved for technical development, maintenance of physical qualities and tactical placement (mainly in player position). The model applied by the coaches followed the model proposed by the Tunisian Football Federation.

Exercise intensity was regulated and monitored using smartwatches (H.Tang, Model F6, China) that allowed monitoring heart rate during continuous running (i.e. 50–70% of maximum heart rate [HRmax]), high-intensity interval training (i.e. 90-100% of HRmax), specific football training with and without the ball, tactical training, technical training, small matches and aerobic training. In addition, a football match was scheduled every week on Sunday. The participating team played against other regional clubs, using a 7 × 7 format on a relatively small field (30 ≠ 40 m). The match lasted 15 minutes at halftime. SG played 20 matches during the experimental period.

The participating boys were part of the same football training center in the city of Sousse (Tunisia). Nine of the forty children played football in a private training center before the start of the study (maximum two years). All other participants started playing football when they entered the study. During the same period, CG attended a one-hour weekly physical education course at their primary school, the content of which was fundamentally playful and based on educational games. Boys did not participate in any other physical training activities during the study. The children in both groups completed all aspects of the training programs. The participation rate in training for the experimental group (e.g. the football group) was 91%. No test- or training-related injuries occurred during the study.

static analysis

All results are presented as means and standard deviations (SDs) after the normality distribution of the data was assessed and confirmed using the Shapiro-Wilk test. The intraclass correlation coefficient (ICC) and the coefficients of variation (CV) were used to determine the consistency of the measurements and their variation (test-retest reliability). Based on the 95% CI of the ICC estimate, values ​​less than 0.5, between 0.5 and 0.75, between 0.75 and 0.9 and greater than 0.90 were indicative of poor, moderate, good, respectively. and excellent agreement. Differences within and between groups were calculated using a two-way analysis of variance (ANOVA) for repeated measures. Bonferroni adjusted post hoc tests were calculated to assess any significant interactions by time period. Partial eta squared (η²p) are taken from the ANOVA output and Cohen’s d effect sizes (d) are calculated to quantify meaningful differences in the data [24, 25] with demarcations of trivial (<0.2), small (0.2–0.59), moderate (0.60–1.19), large (1.2–1.99) and very large (≥ 2, 0).

Pearson correlations were used to examine the relationship between variables. The magnitude of the correlations was determined using the modified scale proposed by Hopkins (2009). [26]. A stepwise multiple regression analysis was used to determine the best predictive independent variables. We attempted to use a stepwise regression between the VO₂max, MAP) and the lung parameters (TL_NOTL_COVA, Vc, DM).

All statistical analyzes were calculated using SPSS for Windows, version 16.0 (SPSS Inc., Chicago, IL, USA).

The researchers looked for links between the self-reported screen time of more than 700 children aged 8 to 16 in the first 7 to 10 days after an injury, and the symptoms they and their caregivers reported over the next six months.

The children whose concussion symptoms resolved the quickest had used a moderate amount of screen time. “We call this the ‘Goldilocks’ group because it appears that spending too little or too much time on screens is not ideal for concussion recovery,” said Dr. Molly Cairncross, an assistant professor at Simon Fraser University who conducted the study while working as a postdoctoral researcher with Associate Professor Dr. Noah Silverberg in UBC’s psychology department. “Our findings show that the blanket recommendation to avoid smartphones, computers and televisions as much as possible may not be best for children.”

The study was part of a larger concussion project called Advancing Concussion Assessment in Pediatrics (A-CAP), led by psychology professor Dr. Keith Yeates at the University of Calgary and funded by the Canadian Institutes of Health Research. The data came from participants aged 8 to 16 who had suffered a concussion or orthopedic injury, such as a sprained ankle or a broken arm, and sought care at one of five emergency departments in Canada.

The purpose of including children with orthopedic injuries was to compare their recovery with the concussion group.

Patients in the concussion group tended to have relatively worse symptoms than their counterparts with orthopedic injuries inside in the concussion group, it was not simply a matter of symptoms worsening with increasing screen time. Children with minimal screen time also recovered more slowly.

“Children use smartphones and computers to stay connected with peers, so removing those screens completely can lead to feelings of disconnection, loneliness and not having social support,” said Dr. Cairncross. “These things are likely to have a negative impact on children’s mental health, which can make recovery take longer.”

The UBC/Cagary study differed from another study conducted in the US last year in that it tracked screen time and recovery over a longer period of time. The previous study found that screen time slowed recovery, but screen use was only measured in the first 48 hours and symptoms only for 10 days.

The longer timeline led to another interesting finding, described by Dr. Silverberg:

“The amount of time spent in front of screens during the early recovery period made little difference to long-term health outcomes.” he said. “After 30 days, children with a concussion or other type of injury reported similar symptoms regardless of their early screen use.”

The researchers also noted that screen time appeared to have less influence on symptoms than other factors such as the patient’s gender, age, sleep habits, physical activity, or pre-existing symptoms.

“Screen time didn’t make much of a difference compared to several other factors that we know can affect concussion recovery,” said Dr. Yeates. “Encouraging concussion patients to get good sleep and gradually engage in light physical activity will likely do much more for their recovery than keeping them off their smartphones.”

Ultimately, the findings suggest that blanket restrictions on screen time may not be helpful for children and adolescents with concussions. Instead, the researchers suggest using the same approach as with other activities, namely moderation. If symptoms flare up, screen time can always be limited.

Underrepresentation of female athletes in research informing influential consensus and position statements on concussion: a review and synthesis of evidence

D’Lauro C, Jones ER, Swope LM, Anderson MN, Broglio S, Schmidt JD. Br J Sports Med. July 18, 2022: bjsports-2021-105045. doi: 10.1136/bjsports-2021-105045.

Full text freely available

Take home message

Female athletes are underrepresented in the data used to inform concussion consensus and position papers.

Background

Medical professionals rely on concussion consensus and position statements to design their diagnosis and treatment protocols. These papers are based on evidence suggesting that men and women have similar presentations and recoveries; However, there may be clinically meaningful differences in concussion risk, presentation, and recovery among male, female, transgender, and non-binary athletes. Although this disparity is recognized, it remains unclear whether a gender imbalance in concussion research influences concussion consensus and position statements.

Study aim

The authors evaluated the three influential consensus and position papers to quantify the composition of the research data for clinical practice among female athletes.

Methods

The authors conducted a PubMed search in August 2021 using the terms “concussion position statement” and “concussion consensus statement.” The English language was the only limitation. The authors selected the International Conference on Concussion in Sport (ICCS, 2017), the National Athletic Training Association (NATA) Concussion Position Statement (2014), and the American Medical Society for Sports Medicine (AMSSM) Concussion Position Statement (2019). They selected these statements based on citation patterns, the publication of updated versions, and research into the use of these documents by physicians. The authors counted the total number of male and female participants in each study cited in the three documents that recorded or implied gender information. If the original authors failed to clearly state the ratio for sex or gender, the current authors excluded that study.

Results

Across all three statements, 375 citations were reviewed, including 171 articles with relevant gender and sex information (93 from NATA, 17 from ICCS and 68 from AMSSM). Eighteen were cited in two of the statements, while all three cited zero. Overall, the studies were ~80% male (NATA 80%, ICCS 88%, and AMSSM 79% male). Only two manuscripts contained an all-female sample, while 69 manuscripts contained an all-male sample.

Viewpoints

The information doctors receive about concussion care relies heavily on data among men. This is alarming because medical professionals rely on these expert-curated documents to guide their clinical decisions; however, the scientific evidence fails to adequately represent female and non-binary athletes. This disparity can lead to unequal treatment of these athletes who sustain a concussion. For example, men and women differ in responses to medications, substance abuse, and risk factors for other health problems. Therefore, this could indicate that female and non-binary athletes respond differently than men to concussion, both on a physiological and psychosocial level. It would be interesting to see if this trend also occurs in other consensus and position statements. Additionally, it would be helpful if future statements clearly describe how well the evidence represents the intended patient population (e.g., sex, gender, race/ethnicity).

Clinical implications

Consensus and position statements should be a starting point and not a shortcut. Medical professionals should seek research beyond consensus and position statements to guide their concussion practices toward female and non-binary athletes. Additionally, when educating a female or non-binary athlete about what to expect after a concussion, we should seek out relevant research or explain to the patient that their personal experience may differ from what they find online or hear from professionals who rely solely on consensus. or position statements.

Questions for discussion

Do you mainly get your medical data from position statements? Have you noticed any differences between gender, race/ethnicity, or gender? If so, what have you done to fill the knowledge gaps in the position statements?

related posts

1. Comparison of three new concussion guidelines
2. Do sex and contraception affect recovery from a concussion?
3. A Closer Look at Concussions 2016-202: Increasing Prevalence and Gender Differences
4. Bottom line: what role do age and gender play after a concussion?

Written by: Jane McDevitt
Review by: Jeffrey Driban

Cardiomyopathy, a form of heart disease in the heart muscle, is a genetic condition in which the walls of the heart chambers no longer develop as they normally would, and can take many forms. This can lead to collapses on the field or affect the heart’s ability to pump blood around the body.

For one in twenty healthy adolescent athletes, training alone leads to changes in the appearance of the heart during ultrasound. This means that diagnosing a cardiomyopathy can often be difficult, and being told that a disease is even suspected can lead to a huge amount of psychological distress, often preventing them from participating in training and matches until a clear decision has been made.

In this major international study, more than 400 youth athletes from the Manchester United Youth Academy, Football Club Barcelona and the Qatar Aspire Academy were screened using new and non-invasive ultrasound techniques. These techniques, already used in the clinical diagnosis of patients, are an important step forward in the development of a new route for screening for cardiomyopathy in athletes. The team now hopes the new techniques will reduce the number of false diagnoses, potentially saving the NHS time and resources in providing follow-up tests to rule out the condition and prevent health problems.

Professor Craig Williams, Director of the Children’s Health & Exercise Research Center at the University of Exeter said: “Our results demonstrate the power of new ultrasound techniques in screening athletes suspected of having cardiomyopathy but who are otherwise completely healthy. .. The difference this makes is the more accurate diagnosis of cardiomyopathy, especially in young athletes, better protecting the athletes of tomorrow.”

Dan Dorobantu, PhD student in cardiology at the University of Exeter, added: “When screening athletes we often saw changes that could be due to disease, but equally to the way the heart adapts to training. Reaching a clear conclusion may involve more testing, follow-up visits and significant stress for the athletes. Any new technology that can help us better diagnose these cases would lead to improvements in the screening and care we provide to our athletes. “

Exercise-induced heat illness: policy adoption and influence on contextual factors reported by athletic administrators

Scarneo-Miller SE, Adams WM, Coleman KA, Lopez RM. Sports Health. Mar 5, 2023: 19417381231155107. doi: 10.1177/19417381231155107. E-publishing prior to printing. PMID: 36872595.

https://journals.sagepub.com/doi/10.1177/19417381231155107

Take home message

Most high school athletic administrators reported having a written heat illness policy in place, but they were often missing key components. The presence of an athletic trainer helped create a written policy that included more components.

Background

Sports administrators play an important role in policy acceptance. Policy measures such as addressing acute heat illness are critical as improper management can lead to poor outcomes. Unfortunately, we know little about the factors that promote and hinder the implementation of heat illness policies.

Study aim

The authors surveyed high school athletic administrators in the United States to describe the adoption of exertional heat illness policies and to examine factors that influence the adoption of these policies.

Methods

During the 2018-2019 academic school year, the research team emailed nearly 7,000 athletic administrators inviting them to complete a questionnaire asking about 1) demographics, 2) exercise-related illness policies, 3) monitoring and modification of written policy, and 4) enablers and barriers to policy development. The researchers used the precautionary adoption process model to assess an athletics administrator’s willingness to adopt policies. The adoption model is based on 8 phases, from not being aware to maintaining a written policy for more than 6 months.

Results

Of 466 athletics administrators (~48 years old, 82% male, 77% worked in the field for more than 15 years), 78% reported having a written policy on the prevention and treatment of exertional heat illness. Only 6% adopted all eleven essential elements of an exertional heat illness policy. Almost half of the managers indicated that they adopted fewer than 5 essential elements.

Older athletics administrators, those who had previously dealt with heat illness, or those with an athletic trainer on their staff were more likely to have a written policy. Additionally, state mandates and having a medical professional were the most commonly cited facilitators for adopting policies on exertional illness prevention and use of a rectal thermometer. Similarly, the most commonly reported barrier to comprehensive heat illness management was the lack of a full-time athletic trainer (11). Administrators also recognized budget constraints that limited the use of a cold water immersion pool (23%), and the top barriers to using a rectal thermometer were discomfort using the thermometer (32%), parent/guardian resistance (30 %), resistance from parents/guardians (30%). coaches (30%) and liability issues (27%).

Viewpoints

Nearly 80% of athletics administrators surveyed reported that they had a written policy on exertional heat illness. Few integrated or were aware of all the necessary components to meet best clinical practices. The authors found that access to athletic training services was associated with better adoption of exercise health policies. This finding is consistent with it being an athletic trainer who would implement such a policy. It’s worth recognizing that only 7% of administrators contacted completed the survey. Therefore, these results may not accurately reflect what is happening in high schools across the country. One possibility is that people more interested in policy or heat illness completed the survey. So these results may show us the best-case scenario for written policies (78%) that include all components (6%) – which is a worrying sign.

Clinical implications

Encouraging state mandates and schools to hire athletic trainers can ensure that there are written policies to address heat illness. Clinicians may also want to consider strategies to educate coaches and parents/guardians about the reasons for this policy, such as rectal thermometers and cold water plunge pools.

Questions for discussion

Are you having trouble adding rectal temperature to your exercise heat illness protocol? Do you communicate with your athletics administrator regarding the approval, implementation and annual review/practice of your emergency policy?

related posts

1. Management of exertional heat stroke still leaves something to be desired
2. A little more education about heat stroke due to exertion could go a long way
3. Clinical Pearl: prevention and treatment of exertional heat stroke
4. Tag us! What do coaches know about heat stroke during exertion and the role of the athletic trainer?
5. Follow guidelines to prevent exertional heat illness? Let’s reconsider these guidelines

Written by Jane McDevitt
Reviewed by Jeffrey Driban

New research at women’s football clubs in six European countries shows that information about the menstrual cycle, hormonal contraception and pregnancy is seriously lacking.

The research, led by academics from Staffordshire University, involved more than 1,100 players, coaches and managers from grassroots to top-level clubs in Bulgaria, England, Finland, France, Poland and Spain. It examined policy, perceptions and understanding through an online survey and a series of focus groups.

Dr. Jacky Forsyth, Associate Professor of Exercise Physiology, explains: “The topic of ovarian hormones and their effects on training and performance, beyond pregnancy and postpartum, appears to have received little attention within any formal coaching training.

“In sports, these topics also come with varying degrees of stigmatization and silence, as well as being a barrier to gender equality. To tackle this, we wanted to gather best practice across Europe to learn which clubs are doing well, what is effective and what can be improved.

“Despite some good practice in individual clubs in different countries, there was limited knowledge and understanding of how training, performance and health are affected. Knowledge was generally left to the individual without support from governing bodies or coach training providers.”

69% of all participants said there was ‘no at all’ menstrual cycle education offered in their clubs, and while some clubs tracked players’ menstrual cycles, this was varied and inconsistent.

Approaching coaches about the menstrual cycle was identified as difficult for some players, with the barrier being that ‘the female game is still predominantly coached by men’ and that ‘men won’t understand’. Because of this, some players supported each other, keeping it between us girls rather than approaching their coaches.

Similarly, 77% of respondents reported no education about hormonal contraception and 64% no education about pregnancy. Furthermore, only 5% were aware of the club’s policy on pregnancy, maternity leave, maternity and care responsibilities/childcare.

Recommendations emerging from the study include hiring more female coaches and formalizing coach training to include research on the menstrual cycle, hormonal contraception and pregnancy, to encourage open dialogue between coaches and athletes. The research will also directly impact teaching on Staffordshire University’s Sport and Exercise courses.

Co-author Dr. Alex Blackett said: “These findings shed light on the fact that football training and education continues to be focused on the men’s games. The development of women’s football seems to be superficial at the moment and underneath there is still a lot more to be done.

“The willingness to have open discussions is so important because, as our article suggests, there is still a stigma attached to some of these issues. Although it is good that there is solidarity and that players support each other, we sometimes notice that pseudoscience principles are perpetuated and that is why it is important that the right information and support comes from the top.”

The study was part of the European Women in Sport (E-WinS) project which is funded by the Erasmus+ Sport program and brings together experts from nine universities and sports organisations.

The Staffordshire University team will now work directly with football clubs in Great Britain to put some of their findings into practice. E-WinS project partners are producing toolkits that will be available online for free.

In 2022, Chelsea FC Women became the first football club in the world to tailor training to players’ menstrual cycles and England women’s manager Sarina Wiegman introduced menstrual tracking apps ahead of the team’s win at the 2022 European Women’s Football Championship.

More recently, the women’s teams of Stoke City and West Bromwich Albion announced a switch to colored shorts with their home kit, as players raised concerns about wearing white during their periods.

Dr. Forsyth added: “Initially it’s about creating awareness that the menstrual cycle is not just about PMT and getting moody and bloated. Variations in ovarian hormone levels occur throughout the lifespan, so understanding their effects is important for the advancement of women’s football.

“Something as simple as tracking players’ menstrual cycles can make a big difference. For example, performance can be optimized in certain phases of the menstrual cycle and training can be adapted to prevent injuries and muscle soreness.

“Coaches need to have knowledge of issues specific to women and I hope this will be included in the FA coaching awards as it is clearly needed.”

“Menstrual cycle, hormonal contraception and pregnancy in women’s football: perceptions of players, coaches and managers” is published in the Sports in society log.

Masculinity, optimism, and perceived stakeholder pressure influence concussion prevention intentions and behaviors in college students and athletes.

Weber Rawlins ML, Welch Bacon CE, Tomporowski P, Gay JL, Bierema L, Schmidt JD. J Am Coll Health. 2022 Sep 9:1-7. doi: 10.1080/07448481.2022.2115300. E-publishing prior to printing.

https://pubmed.ncbi.nlm.nih.gov/36084227/

Take home message

Student-athletes with a pessimistic view of concussion risk have higher intentions to report symptoms or a concussion.

Background

Doctors rely on student-athletes to report a possible concussion to ensure proper diagnosis and treatment. We can optimize education efforts to improve concussion reporting with a better understanding of the barriers to concussion reporting. Three emerging areas that may influence messaging are masculinity (qualities traditionally associated with men), optimism (thinking that bad things are less likely to happen to the person than others), and perceived pressure from stakeholders (e.g., coaches, teammates).

Study aim

Weber Rawlins and colleagues completed a survey study to determine how masculinity, optimism, and perceived pressure from others were related to reporting intentions and behavior.

Methods

Student-athletes from three universities in the southeastern US used online survey software to complete five tools that assessed key factors:

1. masculinity (winning, emotional control, risk taking, violence, power over women, playboy, self-reliance, primacy of sports and heterosexual self-presentation)
2. optimism bias
3. perceived pressure (from coaches, teammates, parents/guardians, sports medicine professionals, athlete administrators, and sports fans)
4. concussion and symptom reporting intentions (summarized as reporter or non-reporter)
5. concussion and symptom reporting behavior (summarized as reporter or non-reporter)

Results

A total of 313 respondents completed all parts of the survey, and 369 respondents completed at least one part of the survey. A student-athlete was less likely to report symptoms or a concussion if he was not a pessimist (neutral or optimist). Furthermore, they were less likely to report symptoms if they reported higher levels of masculinity in two domains: “playboy” and “heterosexual self-preservation.” In terms of intent to report concussions, someone with higher scores for “primacy of the sport” and “pressure from athletic administration” was less likely to report it.

Viewpoints

Interestingly, the most consistent result was that someone who was neutral or less likely to experience bad events than someone else was less likely to report symptoms or a concussion. Based on this finding, the authors suggest that “educational efforts should emphasize the realistic risk that student-athletes have for sustaining a concussion in sport or developing long-term health consequences as a result of that concussion.” The authors also reported predictors of reporting behavior during the previous year. These analyzes led to different results than what we reported above. One explanation is that reporting intentions and actual behavior do not match. However, it is difficult to compare these results because only 10-20% of participants had symptoms or a concussion to report (or not report) in the previous year. Therefore, the different results could be a fluke, or this subset of people may be unique to the remaining 80-90% of participants without concussions or symptoms in the previous year. It will be interesting to see if future studies with a larger group of people with symptoms or concussions in the previous year yield similar results.

Clinical implications

Clinicians should encourage timely reporting of concussions and provide realistic estimates of a student-athlete’s risk for concussion and the consequences of a concussion.

Questions for discussion

What strategies have you used to educate stakeholders about the dangers of not reporting concussions? Have you found these efforts to be successful? Why or why not?

Written by: Kyle Harris
Review by: Jeffrey Driban

related posts

Better posture can improve concussion reporting habits
Concussion knowledge is getting better, but is reporting getting worse?
Knowledge of concussions does not translate into healthy reporting habits
Differences in symptom reporting between male and female athletes before and after concussion

New research from Edith Cowan University (ECU) has shown that one type of muscle contraction is most effective at increasing muscle strength and size – and instead of lifting weights, the focus should be on lowering them.

The team, which also included researchers from Niigata University and Nishi Kyushu University in Japan and Londrina State University in Brazil, had groups of people perform three different types of dumbbell curl exercises and measured the results.

It turned out that those who only lowered a weight saw the same improvements as those who increased and decreased their weight – despite only performing half the number of repetitions.

Professor Ken Nosaka from ECU said the results reinforce previous research showing that a focus on “eccentric” muscle contractions – where activated muscles are lengthened – is more important for increasing the strength and size of muscles, rather than volume.

“We already know that just one eccentric muscle contraction per day can increase muscle strength if performed five days a week – even if it only lasts three seconds per day – but concentric (lifting a weight) or isometric muscle contraction (holding a weight) does not produce such an effect,” said Professor Nosaka.

“This latest study shows that we can be much more efficient in the time we spend training and still see significant results by focusing on eccentric muscle contractions.

“In the case of a dumbbell curl, many people may believe that the lifting action provides the most benefit, or at least some benefit, but we found that concentric muscle contractions contributed little to the training effects.”

Crunching the numbers

The study consisted of three groups that performed dumbbell curls twice a week for five weeks, plus a control group that did nothing.

Of the training groups, one group performed exclusively eccentric muscle contractions (lowering weight), another performed exclusively concentric muscle contractions (lifting weight), and another performed both concentric and eccentric muscle contractions (alternating lifting and lowering weight).

All three saw improvements in concentric strength, but this was the only improvement for the concentric-only group.

The eccentric-only and concentric-eccentric groups also saw significant improvements in isometric (static) strength and eccentric strength.

Most interestingly, despite the eccentric-only group doing half as many reps as those who lifted and lowered weights, the gains in strength were very similar and the eccentric-only group also saw greater improvement in muscle thickness , an indicator of muscle hypertrophy: 7.2 percent compared to the 5.4 percent of the concentric-eccentric group.

“Understanding the benefits of eccentric training can allow people to spend their time exercising more efficiently,” said Professor Nosaka.

“With the small amount of daily exercise needed to see results, people don’t necessarily need to go to the gym — they can incorporate eccentric exercises into their daily routine.”

Putting it into practice

So how can we use this knowledge in the gym?

When using a barbell, Professor Nosaka recommends using two hands to assist with the concentric phase (lifting weight), before using one arm for the eccentric phase (lowering weight), when performing:

• Biceps curls
• Overhead extension
• Front elevation
• Shoulder press

Using leg weight machines, Professor Nosaka recommends using the same concentric/eccentric technique when performing:

• Knee extensions
• Leg curls
• Calf goes up

Taking care of bodies in the home

Luckily, Professor Nosaka says you don’t need gym weights to apply the same principles to a workout and has come up with some simple exercises you can do at home.

During the exercises, feel the contracting muscles being gradually stretched from the beginning to the end of the range of motion.

After each eccentric muscle contraction, minimize the effort to return to the starting position (i.e. concentric muscle contraction).

Repeat 10 times for each exercise.

Chair sitting: From a semi-squat position, slowly sit down on a chair for three seconds (narrower and wider positions will create different effects). If this becomes easy, try sitting with one leg.

Chair recline: Sit on the front of a chair to create space between your back and the backrest and slowly lean back for three seconds (arms can be crossed on the chest or held at the back of the head).

Uneven squat: Stand behind a chair, lean to one side to put more weight on one leg, then squat down for three seconds.

Heel down: Still behind a chair, lean forward and lift your heels. Then lift one leg off the ground and lower the heel of the other leg for three seconds.

Wall kiss: Lean against a wall with both arms fully extended. Slowly bend the elbow joint for three seconds until your face comes close to the wall.

Forward lunge: Place one leg in front of the other and bend the knees deeper for three seconds.

‘Comparison between concentric only, eccentric only and concentric-eccentric resistance training of the elbow flexors for their effects on muscle strength and hypertrophy’ was published in the European Journal of Applied Physiology.

Early psychological symptoms predict concussion recovery time in middle and high school athletes.

[ PMC gratis artikel ][ PubMed ]Wilmoth K, Tan A, Tarkenton T, Rossetti HC, Hynan LS, Didehbani N, Miller SM, Bell KR, Cullum CM. J Clin Exp Neuropsychol. 2022 May;44(4):251-257. doi: 10.1080/13803395.2022.2118676. Epub 8 Sep 2022. PMID:36073744.

Full text not freely available

Take home message

Middle and high school athletes who reported more concussion symptoms and sleep problems, as well as post-traumatic memory loss, were more likely to have long-term recovery than peers without these concerns. Additionally, depressive symptoms can help identify men at risk for a prolonged recovery.

Background

Recovery from a concussion is quite variable. Therefore, determining risk factors for long-term recovery is essential to provide appropriate patient care to reduce this risk. Several risk factors for prolonged post-injury recovery have been identified (e.g., emotional symptoms, sleep disturbances). However, these factors have not been well established in college athletes.

Study aim

The authors analyzed clinical data from middle and high school athletes to investigate whether post-concussion psychological factors and sleep symptoms predict long-term recovery.

Methods

The authors recruited 393 high school students (~15 years old; 45% female) to complete 3 surveys within 14 days of injury (~6 days of injury), which is part of a larger study through Con Tex. completed the 3 questionnaires during their clinical evaluation: 1. 7-item Generalized Anxiety Disorder Scale (GAD-7), which screened for anxiety; 2. The eight-item patient questionnaire (PHQ-8) to assess whether depression is present; and 3. The Pittsburg Sleep Quality Index (PSQI) to evaluate sleep quality. The authors located the provider’s documented date of symptom resolution through a medical record review.

Results

A total of 17% (n=66) needed more than 30 days to recover. The authors found that post-traumatic memory loss, worse concussion scores, and poorer sleep quality predicted longer concussion recovery. In women, only more severe concussion symptoms predicted longer recovery. In men, on the other hand, greater depression and post-traumatic memory loss are related to long-term recovery.

Viewpoints

Someone with more severe symptoms or poor sleep quality within the first two weeks after a concussion may have a greater chance of long-term recovery from the concussion. However, the authors found that there were different predictors when they looked at sex. Women with greater symptom severity were more likely to have a long recovery. At the same time, men were more likely to have a long recovery if they had worse depression symptoms or post-traumatic memory loss. It is worth noting that although sleep, anxiety and depressive symptoms were predictive factors, the overall scores were low, indicating that they were unlikely to experience high levels of anxiety, depression or sleep disturbance.

Clinical implications

Medical professionals should screen patients after a concussion for signs of anxiety, depression, or sleep disturbance, because even subtle signs can increase the likelihood of long-term recovery. These assessments can help identify problems early and lead to a more targeted concussion plan.

Questions for discussion

Have you noticed any specific predictors associated with your athlete’s recovery? How do you incorporate concussion risk into your concussion education/management/basic protocol?

related posts

1. Wake-up call for collegiate athletes’ sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness
2. A few more hours of sleep, my baseline for your athletes
3. Typical versus prolonged recovery time and predictors after concussion in high school and college athletes
4. In patients who report persistent symptoms after a concussion, groups of symptoms occur together

Written by: Jane McDevitt
Review by: Jeffrey Driban

Although the popularity of professional women’s football has increased in many countries, highlighted by England’s recent victory at the 2022 UEFA European Women’s Football Championships, the technology and equipment are still largely designed for men’s football. Strikingly, a recent study found only 32 published scientific articles on technology in women’s football.

Kat Okholm Kryger and colleagues – including England women’s national football team captain Leah Williamson – asked ten questions to highlight the minimal progress that has been made in elite women’s football technology, and the barriers that still exist to tailor-made making equipment available to female players. The authors discuss why tailor-made technology for female footballers is necessary and highlight that although women have different physical needs than men, equipment such as football boots and balls are still designed for men rather than women. These issues can both increase the risk of injury from ill-fitting shoes, and reduce performance due to the proportionately greater effort required to kick the ball compared to men.

Additionally, the authors report that many female soccer players feel uncomfortable wearing soccer shorts (which are typically white) due to concerns about possible menstrual leaks. Professional female footballers are also often required to wear specific sports bras provided by kit sponsors, rather than the optimal sports bra for their body type. This can also reduce performance and lead to discomfort while running and turning.

The authors note that manufacturers are recognizing the lack of development in women’s football technology and that there is a positive shift towards women-specific products. However, progress is limited by the lack of existing research, and concerted efforts are needed to address key gaps in understanding the needs of female footballers.