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Organized sports participation among children aged 6–17 years: United States, 2020

Black LI, Terlizzi EP, Vahratian A. National Center for Health Statistics (US). Publication date: 08/11/2022. Series: data overview; No. 441

https://stacks.cdc.gov/view/cdc/119026

Take home message

Sports participation was lower among racial and ethnic minority children, children whose parents had lower education or income, children living in counties with greater social vulnerability, and children living in the southern United States.

Background

Youth participation in sports is associated with better physical fitness and mental health. Understanding the differences in sports participation can help inform strategies to promote active lifestyles among children and adolescents, which positively impacts their physical and mental health.

Study aim

Black and colleagues completed an analysis of data from the 2020 National Health Interview Survey to describe disparities in sports participation in the United States.

Methods

The authors analyzed data from the 2020 National Health Interview Survey. This survey is a nationally representative household survey conducted throughout the year. Parents reported whether their child participated in a sports team or club or took sports lessons at school or in the community in the previous 12 months. The authors then collected data on household income as a percentage of the federal poverty level, race and Hispanic origin, geographic region (Northeast US, Midwest US, Southern US, or Western US), social vulnerability of a county, and urbanicity ( urban region). -national classification) of a province.

Results

About half (54%) of children aged 6 to 17 have played sports in the past twelve months (boys: 56%; girls: 52%). The authors reported: “Participation levels were lower among children from racial and ethnic minority groups, children whose parents had lower levels of education and family income, children living in counties with greater social vulnerability, and children living in the South.”

Viewpoints

The results of this letter provide a surprising snapshot of sports participation in the United States. While it is established that early sports participation can have a positive impact on an individual, significant differences still exist. These findings indicate that sports participation is strongly associated with socioeconomic status. Ultimately, a higher socio-economic status can ensure children’s access to sports. This is particularly reflected in the fact that lower parental education, lower parental income and lower geographical area of ​​social vulnerability are all associated with lower participation. These findings complement data from the Athletic Training Locations and Services Database, which shows that these communities also have less access to athletic training services.

This data provided a unique snapshot of 2020, when many sports shut down in the spring due to the COVID-19 pandemic. The survey asked about sports participation over the past year, so it is unclear whether the pandemic could influence these results. Furthermore, not every community is recovering from the pandemic in the same way. The authors acknowledge that it will be essential to replicate these analyzes with data from the 2022 survey to better understand patterns of sports participation after many of the restrictions associated with the pandemic are relaxed/removed.

Clinical implications

Sports medicine professionals should advocate for increased access to sports through local recreation organizations, schools, and other organizations. In regions with high social vulnerability, we should encourage policymakers that investments in youth sports and physical activity can help improve community health.

Questions for discussion

What can we do as doctors to positively influence participation in team sports?

Written by: Kyle Harris
Review by: Jeffrey Driban

related posts

Asian Pacific Society of Cardiology Consensus Recommendations for Pre-Participation Screening in Young Competitive Athletes
A lasting impression: youth sports participation and healthy habits as adults
Previous participation in collision sports is associated with reduced quality of life
Lower socioeconomic status is associated with less access to athletic training services

by Adam Halseth PT, DPT, SCS | Northeast Scottsdale

Tennis elbow or golfer’s elbow is an uncommon condition. It just has an impact about 1 to 3 percent of adults every year. But your chances of developing it increase as you get older. Although the name suggests it is a condition exclusive to these sports, it is possible to develop tennis or golfer’s elbow even if you have never played either game in your life.

Below you will find important information about this painful condition, including why it occurs, how to determine if you have the condition, and what treatment options are available.

Understanding tennis/golfer’s elbow

Tennis/golfer’s elbow is one of the most common causes of elbow pain. It is often persistent and painful enough to warrant physical therapy and/or a doctor’s visit. This condition occurs when the tendons that connect your forearm to the outside of the elbow bone become swollen and inflamed.

If this happens, it can lead to microscopic tears in the muscles and tendons. These tears can cause a lot of pain, even though they are very small.

Usually people don’t experience these symptoms unless they do a lot of repetitive movements. While the general population is not highly likely to experience this pain, as many as half of all players will experience it at some point in their lives.

What causes tennis/golfer’s elbow?

If you’re wondering what the causes are, the answer is: a lot of things! As mentioned, tennis/golfer’s elbow usually occurs as a result of repetitive movements of the elbow joint. Besides tennis and golf, some other activities that can lead to elbow pain and discomfort include:

• Screens
• Squash
• Weightlifting
• Racketball
• Rake
• Typing
• To paint
• Carpentry
• To knit
• Gardening
• Swimming

Did some of the items in the list above surprise you? Fortunately, there are things you can do to reduce the chance of developing elbow pain or minimize symptoms if you already have it. Keep reading to learn more.

5 Symptoms of tennis/golfer’s elbow

Are you experiencing elbow pain that makes you wonder if you have tennis/golfer’s elbow or something else? Although a doctor or therapist should be consulted to make the most accurate diagnosis, these are five common symptoms:

1. Discomfort when you lift something
2. Weakness in your hand or forearm when making a fist or grabbing something
3. Recurring pain just below the bend in your elbow (on the outside of your forearm)
4. Pain that radiates from the elbow to the wrist
5. Discomfort when turning the forearm (for example, when opening a jar or a door)

As you can see, the primary symptom is pain in the elbow area. Conditions that mimic tennis elbow include:

• Radiocapitellar arthritis
• Osteochondritis dissecans
• Intra-articular plica
• Rotational instability

A visit to your PT can help rule out these conditions if you are unsure whether you have tennis/golfer’s elbow or another condition.

Prevention techniques

The best way to prevent developing this condition is to avoid doing repetitive movements too often. If you play a sport or other activity that requires repetitive use of your arm and muscles, make sure you take regular breaks. Stretch the muscles of your arms during your breaks.

It is also important to warm up the muscles of your arms before doing any physical activity that requires the use of your elbows and/or arms. When the muscles are warm, they can stretch and contract more easily without causing injury.

Once you’ve finished a sporting event or workout and stretched your arm muscles, consider applying ice to your elbows if you feel heat or inflammation in those areas. If you already have symptoms of tennis elbow despite your best efforts, consider getting physical therapy.

Physiotherapy treatment options

Physical therapy can help improve the flexibility and strength of your forearm muscles, making you less likely to develop tennis elbow. Physical therapy can also facilitate healing and reduce pain by stimulating blood flow to the affected tendons and muscles. Blood contains oxygen, which the muscles need to heal and function optimally.

Six common physical therapy treatment options recommended for tennis elbow:

1. Muscle stimulation
2. Ultrasound
3. Ice massage
4. Braces and tape to support the affected area
5. Specialized stretches and exercises
6. Nonsteroidal anti-inflammatory drugs

During your recovery from tennis/golfer’s elbow, it is important not to rush things. If you push your body before it is ready and your condition has healed enough, you can set yourself back. Before returning to your previous activity level, make sure that you can grasp objects without pain and that your elbow no longer looks or feels swollen. When you can bend and move your affected elbow without difficulty or discomfort, you can resume your normal activities.

Get your quality of life back

If you are ready to get your life back and fully recover from the symptoms of your tennis/golfer’s elbow, we are here to help. Contact Foothills Sports Medicine Physical Therapy today request your appointment.

Attendees

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.