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The Association of Sports Specialization and Concussion History on self-reported depressive symptoms and quality of life among high school athletes.

Chou TY, Biese K, Leung W, Bell D, Kaminski T, McGuine T. [published online ahead of print, 2022 Nov 11]. Clin J Sport Med. 2022; doi:10.1097/JSM.0000000000001092

https://journals.lww.com/cjsportsmed/Abstract/9900/The_Association_of_Sport_Specialization_and.61.aspx

Take home message

Sports specialization in high school student-athletes may worsen depressive symptoms and decrease quality of life. History of concussions may not be related to mental health in this population.

Background

As sports participation increases, so do sports specialization and sports-related concussions. Adverse psychosocial outcomes associated with these factors include burnout, depression and reduced quality of life. Although published studies suggest that concussion and sport specialization may be associated with adverse mental health outcomes, no studies exist on student-athletes with either risk factor.

Study aim

The researchers wanted to determine whether sport specialization and concussion history are associated with depressive symptoms and quality of life in high school students.

Methods

The authors recruited student-athletes from 31 high schools in Wisconsin during the 2016-2018 school years. All participants met inclusion criteria by participating in interscholastic sports, enrolling in grades 9–12, and being medically eligible to participate in sports on the day of study recruitment. After meeting these criteria and consenting to participate, researchers collected participant demographic data, including concussion and sports history (participation in one or more sports). Athletic Trainers validate the information provided by the participant. Researchers used the Patient Health Questionnaire-9 to collect data regarding depressive symptoms and the Pediatric Quality of Life 4.0 Scale to assess the participants’ quality of life.

Results

Of the 2,453 athletes, 19% reported a previous concussion and 57% specialized in a sport. Athletes who participated in only one sport reported more depressive symptoms and lower quality of life than their counterparts who played multiple sports. Specifically, single-sport athletes were 50% more likely to report higher depression scores than athletes who played multiple sports in high school. The sports-related concussion was not related to depressive symptoms and quality of life.

Viewpoints

This research adds to the growing body of literature suggesting that sport specialization can lead to negative mental health outcomes for student-athletes. This relationship could explain increased concerns about athletes’ mental health in recent years. This study also adds to the literature that history of concussion is not associated with mental health problems in non-elite athletes. However, this is not intended to downplay the fact that some patients may experience depressive symptoms following a concussion and that we should carefully monitor all patients for mental well-being following an injury. This study is not without limitations. The authors relied on patients’ ability to recall a previous concussion history, raising concerns about the accuracy of one’s memory. The cross-sectional nature of this study also limits the authors’ ability to determine whether sport specialization (playing a single sport) has negative consequences for mental health and quality of life, or whether depressive symptoms make an athlete less often participates in multiple sports. .

Clinical implications

Sports medicine professionals must advocate for diverse sports experiences for youth, adolescent, and teen athletes while ensuring readiness to manage mental health issues in this population. Additionally, these professionals should avoid suggesting that sports-related concussions lead to mental health consequences, including depression.

Questions for discussion

What are your experiences with sports specialization athletics and mental health care? How do you deal with sports specialization in athletics? How does this study change your perspectives regarding sport specialization and concussions in athletics?

related posts

1. We must break the stigma of seeking mental health care among student-athletes
2. Mom and Dad say specialization is important
3. Playing high school football should not lead to impaired cognition or depression

Written by: Cade Watts
Review by: Jeffrey Driban

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Infected and abnormal cells should disappear. And as quickly as possible, before any more damage is done. This is the task of so-called cytotoxic T cells. The question of how these cells fight chronic infections is being investigated by the team around Professor Daniel Pinschewer from the Department of Biomedicine at the University of Basel, in collaboration with several national and international partners.

“These T cells can specialize in two different ways: as a kind of sprinter or as a marathon runner,” Pinschewer explains. “However, the latter can also transform into sprinters at any time in order to eradicate an infection.”

Chronic infections are a special case: the T cells are activated and a strong inflammatory response occurs at the same time. “This tends to ‘shock’ the T cells and develop them into sprinters, which can only intervene effectively in the short term to remove infected cells,” says the virologist. “If all T cells behaved this way, our immune defenses would break down quite quickly.”

Biological messenger counteracts the ‘shock’

This is evident from a study that is now published in the journal Immunity, the researchers investigated how the immune system can nevertheless supply sufficient T cells for the endurance race against chronic infections. According to their results, a biological messenger called interleukin-33 (IL-33) plays a key role. It allows the T cells to remain in their ‘marathon runner’ state. “IL-33 essentially takes away the shock of inflammation,” explains Dr. Anna-Friederike Marx, lead author of the study, explains.

In addition, the biological messenger causes the marathon T cells to multiply, making more endurance runners available to fight the infection. “Thanks to IL-33, there are enough long-term cytotoxic T cells that can still make a final sprint after their marathon,” says Marx.

The findings could help improve the treatment of chronic infections such as hepatitis C. It is conceivable that IL-33 could be administered to support an effective immune response. Thinking along the same lines, IL-33 could be a key to improving cancer immunotherapy, allowing T cells to mount an efficient and long-lasting offensive against tumor cells.

An evaluation of the quality of CPR chest compressions performed on football-equipped and obese simulation manikins.

Longo JA, Lyman KJ, Hanson TA, et. already. Prehosp Emergency Room. 2023 February 3:1-6. doi: 10.1080/10903127.2023.2172494. E-publishing prior to printing.

https://pubmed.ncbi.nlm.nih.gov/36692382/

Take home message

Rescuers provide more superficial CPR chest compressions to obese manikins wearing American Football chest/shoulder pads than to those without equipment or obesity.

Background

Immediate administration of high-quality CPR is a critical part of the cardiac chain of survival. Both body size and protective equipment influence the effectiveness of chest compressions. However, few researchers have examined how protective equipment (e.g., shoulder pads) affects the performance of chest compressions in obese individuals.

Study aim

The researchers conducted a study to assess the quality of CPR chest compressions by a rescuer during four randomized conditions that varied whether the manikin represented someone with obesity or was wearing American football equipment.

Methods

The researchers recruited a convenience sample of 50 first responders with varying levels of education (medical first responder to paramedic). The rescuers then made four resuscitation attempts. Each trial lasted 2 minutes, with a 3-minute break between each trial. Participants completed manikin testing simulating four conditions: (1) traditional manikin without equipment, (2) traditional manikin with American football chest/shoulder pads, (3) obese manikin with American football chest/shoulder pads, and (4) obese manikin without equipment. The researchers measured the effectiveness of the compressions using a Laerdal CPRmeter 2 device, which records compression rate, delivery and depth. During tests without equipment, rescuers had to remove protective equipment before starting chest compressions. This protocol allowed the research team to measure how long it took for a rescuer to remove protective equipment.

Results

The depth of chest compressions suffered when the obese manikin had American Football chest/shoulder pads. Rescuers used more force during chest compressions on the obese manikin without electrodes than in the other three conditions. The mean rate of delivery and number of compressions were similar regardless of excess weight and protective equipment. Regardless of manikin or protective equipment, rescuers only met the recommended compression rate at 40% (obese with electrodes) to 51% (non-obese with electrodes) of compressions and the recommended depth at 7% (obese with electrodes) to 22%. % non-obese with pads) of compressions.

Viewpoints

The hired, trained responders often failed to provide effective chest compressions to simulated patients, especially if they were obese and wearing American football chest/shoulder pads. Therefore, rescuers may benefit from additional training regarding CPR on different body types, with and without protective sports equipment. Furthermore, we need more research to reproduce these results, to look at other types of equipment that may influence the quality of chest compressions, and to investigate the benefit of regular training with on-field scenarios with first responders and athletic trainers.

Clinical implications

Clinicians must consider the patients they treat and how equipment, body types, and other factors can affect the quality of CPR chest compressions. Clinicians may benefit from incorporating bariatric resuscitation exercises into their training.

Questions for discussion

Do you include equipment-specific scenarios or obese manikins in your CPR training? If not, what barriers would you encounter when incorporating exercise models that are obese or in equipment-specific scenarios?

Written by Kyle Harris
Reviewed by Jeffrey Driban

related posts

To delete or not to delete? That’s the question when dealing with resuscitation emergencies in football
Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both In and Out of Hospital: An American Heart Association Consensus Statement
We can do better. Improving the chance of survival after exercise-related sudden cardiac arrest for everyone

Randomized evaluation of CDC HEADS UP concussion education materials for youth sports coaches.

Kroshus E, Zhou H, Ledsky R, Sarmiento K, DePadilla LJ Neurotrauma. January 24, 2023. doi: 10.1089/neu.2022.0504. E-publishing prior to printing. PMID: 36694461.
https://pubmed.ncbi.nlm.nih.gov/36694461/

Take home message

After youth sports coaches were introduced to the Centers for Disease Control and Prevention (CDC) HEADS UP materials for a season, more coaches reported better concussion knowledge and communication with athletes about concussion safety than before the season.

Background

Coaches play a key role in shaping the way athletes learn and report concussions. One of the most prominent and comprehensive forms of concussion education for youth coaches is the CDC HEADS UP program’s online training. Although the educational content has been evaluated, randomized control trials are lacking to assess how the CDC HEADS UP program influences behavioral changes during a sports season.

Study aim

The authors examined youth sports coaches’ communications with youth athletes regarding concussion safety during a sports season in the presence of the CDC HEADS UP program and a typical education strategy.

Methods

The authors randomized 75 YMCA chapters in 15 regional associations (764 youth sports coaches) to receive the CDC HEADS UP training or control (their typical teaching strategy). The coaches answered demographic questions such as sex, the sport they coach and history of concussion claims. The CDC youth sports materials consist of four main components: 1) an online training module completed before the start of the season, 2) additional resources (stickers, poster, fact sheet), 3) 8 weekly CDC Heads-up messages for coaches to relay the athletes, and 4) guidance on how local organizations can integrate HEADS UP resources and messages with existing YMCA values. The coaches completed surveys before and after a competitive season. The authors then assessed communication behavior with three questions:

1. “Have you met your athletes?” (Yes No)
2. “Have you reviewed the YMCA rules regarding concussion safety with your athletes?” (Yes No),
3. “How many times have you talked informally with athletes on your team about concussion safety?” (never/occasionally/often).

The authors also evaluated communication intention by rating how likely they are to hold a team meeting to talk formally or informally about concussion safety. They also evaluated concussion identification (knowledge of signs/symptoms), concussion management (likelihood to return an athlete to sport), and exposure to concussion information without intervention (app, TV/movie, website information) .

Results

A total of 537 coaches (82% male, 93% coached high-contact sports, 20% concussion diagnosed) completed pre-season surveys (432 in intervention, 105 in control) and completed 411 post-season surveys (295 in intervention). . , 116 under control). Unfortunately, only 184 coaches completed the pre- and post-season surveys (148 during the intervention, 36 during the control). Overall, demographics were similar between groups, although coaches in the intervention group were more likely to coach a high-contact sport.

After coaches were introduced to the HEADS UP program, more coaches communicated with athletes about concussion safety than before the season. Those in the control group may also have more coaches communicating with athletes, but most likely this improvement was less than in the Heads Up group. Concussion knowledge and communication intent were greater at season’s end among coaches who received the HEADS UP program. The authors did not observe this improvement among coaches in the control group.

Viewpoints

The CDC HEADS UP program is the most widely used concussion program in the United States. The program has important content and increases a coach’s knowledge immediately after completion of the program. This study suggests that the program can also improve communication and knowledge over a season. To know for sure, however, we need a large randomized trial comparing changes in communication behavior and knowledge over a season between a group of coaches who completed the HEADS UP program and another group who received regular training. Understanding how well the HEADS UP program performs in the real world can help us determine if any additional educational materials are needed during the season. In the meantime, this research provides further support for the CDC Heads UP youth sports materials.

Clinical implications

Clinicians should encourage youth sports organizations to adopt and adapt the CDC HEADS UP program. If a doctor is concerned about the effectiveness of the material, he can supplement the material with his resources.

Questions for discussion

Do you use CDC Heads Up Materials to train your student-athletes to be coaches? If so, have you seen similar results in communication and knowledge? If not, what do you use for your concussion education?

related posts

1. Improving Concussion Education: Consensus from the NCAA Department of Defense Mind Matters Research and Education Grand Challenge
2. Peer-led concussion education can improve concussion knowledge and reporting behavior
3. Concussion education videos. Viewing once does not help with Info Stick
4. Coaches are provided with information about concussions with a five-minute fact sheet
5. Concussion knowledge is getting better, but concussion reporting is getting worse
6. Better attitudes can improve reporting habits
7. Center for Concussion Education and Research – Peer Concussion Education

Written by Jane McDevitt
Reviewed by Jeffrey Driban

Many promising athletes have had their careers ruined by injuries. One thing that almost all athletic events have in common is high loads for a short period of time, such as jumping, throwing and running. This leads to overuse injuries such as groin pain and sore shoulders, but also to sudden injuries such as ankle sprains and hamstring tears.

Jenny Jacobsson is a physiotherapist and visiting researcher at the Athletics Research Center of Linköping University. She has worked for many years as a medical coordinator for the Swedish national athletics team and has seen the impact of injuries on athletes.

“Before the 2008 Beijing Olympics, we saw a lot of injuries in our national team and tried to find out why. At the time, no research had been done into the incidence of injuries in track and field athletes. But we wanted to know what was happening among our elite. athletes aged 16 and over, including adult elite athletes,” says Jenny Jacobsson.

The research into injuries in Swedish athletics showed that one of the main causes of injuries was previous injuries. This means that the earlier an athlete is injured in their career, the more likely they are to be injured later and more often. But the causes of injuries in youth sports are a complex issue, involving everything from training amount and load to equipment and even sleep.

Together with her colleagues at the Athletics Research Center, Jenny Jacobsson has developed a digital health platform with information for parents and youth coaches about adolescent growth and how it is influenced by training, with a focus on track and field athletes aged 12-15.

To investigate whether this type of platform can prevent injuries, the researchers conducted a study in which 21 athletics clubs with athletes aged 12 to 15 were randomized into two groups: an intervention group and a control group. During the preseason, the parents and coaches of the intervention group were given access to the digital information platform for four months, which was not accessible to outsiders at the time (but is now accessible to everyone). They were also regularly encouraged to log in and explore its content.

The researchers noted that the clubs that accessed the information showed significantly lower injury incidence and took twice as long for the first injury to occur. Moreover, the effect was greater at large clubs. The results, published in the British Journal of Sports Medicine, could point the way to more injury-free athletics.

“We have not investigated the mechanism that leads to change, but we see that digital information works when it comes to injury prevention. If coaches and parents learn to recognize the problems, it is possible to reduce the training burden in time. Medically speaking, we do know.” what happens in growing bodies, but spreading the information to those who could benefit from it has been a challenge. This platform can bridge that gap,” says Jenny Jacobsson.

The research was funded by the Swedish Research Council for Sports Sciences (Centrum för idrottsforskning).

Meniscus procedures do not increase with delayed ACL reconstruction and rehabilitation: results from a randomized controlled trial.

van der Graaff SJA, Reijman M, van Es EM, Bierma-Zeinstra SMA, Verhaar JAN, Meuffels DE. The British Journal of Sports Medicine, 2023; 57:78-82.

Full text freely available

Take home message

People who initially receive rehabilitation with optional delayed anterior cruciate ligament (ACL) reconstruction are at a similar risk for meniscal surgery than those treated with early ACL reconstruction.

Background

Nonoperative treatment for ACL rupture is a viable option for many patients. However, some physicians have expressed concern that nonoperative treatment of ACL rupture or delayed ACL reconstruction may increase the risk of meniscal injury.

Study aim

van der Graaff and colleagues completed a secondary analysis of data from the COMPARE trial to evaluate whether treating ACL rupture with a delayed reconstruction option leads to more meniscal procedures than early ACL reconstruction.

Methods

The authors used data collected from the COMPARE study. The study included people who had suffered an acute ACL rupture in the previous two months. Eight-five participants randomly received early ACL reconstruction (within six weeks of study enrollment). Eighty-two participants were randomly assigned to receive nonoperative treatment with optional delayed ACL reconstruction. All participants in the non-operative group received at least three months of supervised physiotherapy. After 3 months of structured physiotherapy, participants could opt for ACL reconstruction. The authors recorded whether someone had undergone a meniscal procedure during ACL reconstruction or other surgery. In addition, all participants underwent a baseline MRI, which the research team assessed for signs of a meniscus tear.

Results

Half of the participants who started in the nonoperative group elected to undergo ACL reconstruction during the two-year follow-up period. At baseline, approximately 41% of participants had a meniscus tear, regardless of group. Approximately 30% of knees underwent a meniscal procedure during ACL reconstruction, regardless of whether it was early or delayed reconstruction. After reconstruction, 5% of knees required a new meniscal procedure, regardless of group. These subsequent surgeries were due to new trauma or knee complaints, but there was always a meniscus that the authors noted was damaged in the original ACL reconstruction. Approximately 10% of participants who never underwent ACL reconstruction underwent separate meniscal surgery.

Viewpoints

This study makes it clear that someone who attempts non-operative treatment is not at greater risk for a new meniscal injury than someone who receives early ACL reconstruction. These results are consistent with the results of the KANON study, which found similar rates of meniscal surgery over a five-year period after people were randomly assigned to early or optionally delayed ACL reconstruction.

Clinical implications

Clinicians should be aware that initially attempting non-operative treatment in someone with an ACL injury will not increase the risk of a meniscus tear requiring surgery. Educating patients about the pros and cons of delaying ACL reconstruction can help a patient better evaluate their options after an ACL rupture and allow them to choose the option that best suits their lifestyle.

Questions for discussion

How soon after an ACL injury do you discuss surgery as a possible outcome with your patients? Do you also discuss the options for patients to be treated non-operatively?

Written by Kyle Harris
Reviewed by Jeffrey Driban

related posts

Why patients treated nonoperatively after an ACL injury decide to undergo surgery
Who gets a blood clot after ACL reconstruction?
Does sex influence the psychological willingness to return to sports after ACL reconstruction?
What happens in the family, stays in the family: inheriting the risk of ACL tears
People with ACL reconstruction are five times more likely to need a knee replacement later

Published in the magazine Frontiers in public healthThe study is the first large-scale study to examine the benefits of attending any type of live sporting event.

The research, conducted by academics from Anglia Ruskin University’s School of Psychology and Sport Science, used data from 7,209 adults aged 16 to 85, living in England, who took part in the Taking Part Survey, which was carried out commissioned by the UK government’s Department for Digital. , Culture, Media and Sports.

It found that attending live sporting events results in higher scores on two key measures of subjective well-being – life satisfaction and a sense of ‘life worth living’ – and lower levels of loneliness.

These results are significant because previous studies have shown that higher life satisfaction scores are associated with fewer life-limiting conditions and better physical health, successful aging and lower mortality rates.

The new research also shows that attending live sporting events leads to an increase in people’s sense that ‘life is worth living’, and that the magnitude of this increase is comparable to that of finding work.

Many initiatives are currently promoting the benefits of physical participation in sport, but the researchers believe that watching live sporting events could also provide an accessible and effective public health tool to improve wellbeing and reduce loneliness.

Lead author Dr. Helen Keyes, head of the School of Psychology and Sport Science at Anglia Ruskin University (ARU), said: “Previous research has focused on specific sports or small populations, such as students in the United States. first research into the benefits of attending a sporting event for an adult population, and therefore our findings could be useful for shaping future public health strategies, such as offering lower ticket prices for certain groups.

“The live events covered by the research ranged from free amateur events, such as watching village sports teams, through to Premier League football matches. Therefore, further research should be carried out to see whether these benefits are more apparent for elite sport. , or are more closely linked to the support of a specific team.

“However, we do know that watching live sport of all kinds provides many opportunities for social interaction and this helps forge group identity and belonging, which in turn alleviates loneliness and increases levels of well-being.”

Provision of concussion information by coaches and attendance of athletic trainers: Findings from the 2021 YouthStyles Survey

Daugherty J, Waltzman D, Sarmiento KJ Athl Trein. January 16, 2023. doi: 10.4085/1062-6050-0454.22. E-publishing prior to printing. PMID: 36645830.

Full text freely available

Take home message

More than 40% of adolescents participating in sports reported that their coach had not provided them with concussion information in the past year. This lack of communication may be linked to a lack of access to athletic trainers during games and practices.

Background

Coaches can provide concussion education and make a positive impact by translating concussion knowledge into healthy behaviors, such as reporting suspected concussions. Coaches who complete concussion training and relay that information to their athletes positively impact an athlete’s perspective on concussions. However, it is unknown how often coaches discuss concussion education with the athletes and whether the presence of an athletic trainer helps with better communication between coach and athlete.

Study aim

The authors used survey data to examine how often coaches provided concussion safety information to their athletes and whether this varied based on the presence of athletic trainers at games and practices.

Methods

In June 2021, adolescents living with Ipsos Knowledge Panel member parents were invited to complete the annual YouthStyle Web-based survey. Approximately 48% of invited adolescents completed survey questions about history of concussions, information about concussion safety, how concerned they think their coach is about concussion safety, and the frequency of athletic trainers at games and practices in the past year . The authors took statistical steps to ensure that the data represented adolescents across the United States.

Results

Of the 829 adolescents, 39% reported having participated in sports in the past twelve months: 1) only in school sports (19%), 2) only in sports competitions (13%), or both (7%). The most commonly reported sports were basketball and football. Nearly half (47%) of youth athletes reported that their coach discussed concussions. Additionally, 32% reported receiving a handout, and 23% said their coach had sent them an email or had them watch a video in the past 12 months. Overall, 58% of adolescent athletes reported that their coach discussed or provided information about concussions. More youth athletes who participated in school sports (65%) reported receiving this information, compared to athletes who only participated in non-school sports competitions (39%). About half of youth athletes indicate that they have an athletic trainer during training (55%) or competitions (55%). Youth athletes who participated in school sports were more likely to report having access to athletic trainers (72%) than those who participated on non-school sports teams (49%). Of youth athletes who always/sometimes had an athletic trainer, 63% reported that the coach talked to them about concussions, compared to 24% of youth athletes who rarely or never had access to athletic trainers.

Viewpoints

Four in 10 athletes report that their coaches do not discuss concussions or provide concussion information. The authors found that access to an athletic trainer can improve communication between coaches and youth athletes. It would be interesting to know if the athletic trainer increases the amount of communication as they provide resources for the coaches to share with athletes. It would be helpful to understand how athletic trainers can improve a coach’s concussion communication with athletes. Furthermore, this study focused on whether the coach provided information, and not on the quality of that information. It would be interesting to know how well the education worked. Coaches without access to athletic trainers may provide concussion information to the athletes, but the athlete does not remember it because it was not helpful.

Clinical implications

We must encourage coaches to consistently educate athletes about concussions to improve reporting behavior among youth athletes. In addition, sports trainers have a positive influence on communication between coach and youth. So when we encourage administrators to hire full-time athletic trainers, we can remind them that athletic trainers can help coaches better communicate about concussions and other injuries with their athletes.

Questions for discussion

Are you trying to get coaches to talk to the athletes about concussions? If so, have you seen better results in communication, knowledge and reporting behavior?

related posts

1. Improving Concussion Education: Consensus from the NCAA Department of Defense Mind Matters Research and Education Grand Challenge
2. CDC Heads Up program increases concussion knowledge and injury communication
3. Peer-led concussion education can improve concussion knowledge and reporting behavior
4. Concussion education videos. Viewing once does not help with Info Stick
5. Coaches are provided with information about concussions with a five-minute fact sheet
6. Concussion knowledge is getting better, but concussion reporting is getting worse
7. Better attitudes can improve reporting habits
8. Center for Concussion Education and Research – Peer Concussion Education

Written by Jane McDevitt
Reviewed by Jeffrey Driban

Foot muscles are generally categorized as intrinsic or extrinsic muscles. While intrinsic muscles originate and insert into the foot, extrinsic muscles originate in the lower leg and insert into the foot through the ankle. Both muscle groups help stabilize the medial (inner) longitudinal arch of the foot. Although some studies have linked muscle swelling caused by long-distance running to lowering of the longitudinal arch, associating this with intrinsic and extrinsic muscle damage has thus far been challenging.

Now, a new study examines the damaging effects of running a full marathon on the intrinsic and extrinsic foot muscles, and its association with changes in the longitudinal arch of the foot. The research team was led by Professor Mako Fukano from Shibaura Institute of Technology (SIT) and also included Kento Nakagawa from Waseda University, Ayako Higashihara and Takayuki Inami from Keio University, and Takaya Narita from Toin University of Yokohama. Their findings were published online on April 27, 2023 in Scandinavian journal for medicine and science in sports.

The study recruited 22 college runners from athletic clubs who ran at least 2-3 times a week and had registered for a full marathon race at the Mount Fuji International Marathon in either 2019 or 2021. The researchers first assessed magnetic resonance imaging (MRI) based transverse relaxation time (T₂), as an indicator of muscle damage, for the participants’ intrinsic and extrinsic foot muscles at four intervals: before the marathon, and 1, 3 and 8 days after running the full marathon. T₂ is defined as the time required for the transverse magnetization vector in an MRI to decay to approximately 37% of its initial value, and is influenced by tissue-specific characteristics.

The intrinsic muscles studied included the abductor hallucis (ABH), flexor digitorum brevis (FDB) and quadratus plantae (QP) and the extrinsic muscles included the flexor digitorum longus (FDL), tibialis posterior (TP) and flexor hallucis longus (FHL). ). ). The researchers also determined longitudinal arch height via three-dimensional analysis of foot posture for 10 of these participants at the same time intervals as the T₂ MRI to determine changes in the height of the longitudinal arch of the foot.

When comparing with the values ​​of T₂ before the marathon, the researchers noted that the T₂ the values ​​of QP, FDL, TP and FHL increased significantly one day after the marathon and varied during the observation period. Furthermore, they also found that the increase in T₂ of TP persisted three days after the marathon. However, they did not observe a major difference in T₂ for ABH and FDB. The team found no significant changes in toe flexor strength in any of the participants. Interestingly, they also noted that the arc height ratio statistically decreased from before the marathon to 1 and 3 days after the race, and this change could be correlated with T₂ changes in FDL and FHL.

“These results indicate that the damage and recovery response after a full marathon differs between different foot muscles. For our research participants, all three extrinsic muscles and only one intrinsic muscle showed damage after marathon running, suggesting that extrinsic muscles could be more susceptible to marathon-induced damage than the intrinsic damage,” explains Prof. Fukano. This striking damage to the extrinsic foot muscles reflects the high pressure exerted by the ankle joint during long-distance running, compared to the rest of the foot – something other studies have also shown. Because QP is attached to FDL and/or FHL, it may also have a secondary function in running in addition to the extrinsic foot muscles, making it the only intrinsic foot muscle damaged by marathon running. Furthermore, the correlation between FDL and FHL and longitudinal arch height indicates that marathon-induced damage to these extrinsic muscles could be a factor in reducing arch height.

“As more people now run for fitness, our findings can provide runners and sports professionals with insights into planning better recovery strategies that target muscle fatigue and damage to prevent running-related injuries and also improve runners’ fitness,” concludes Prof. Fukano.

Higher concussion rates following COVID-19 infection in high school athletes.

Bullock GS, Emery CA, Nelson VR, etc. al, Br J Sports Med2023; [epub ahead of print]. two: 10.1136/brjsports-2022-106436.

Full text freely available

Take home message

Athletes who tested positive for a COVID-19 infection were more likely to suffer a concussion within 60 days of recovering from the infection than athletes who did not contract COVID-19.

Background

COVID-19 affects the respiratory, cardiovascular and nervous systems. In some cases, COVID-19 can lead to long-term consequences (e.g. impaired cognition). It is currently unknown whether COVID-19 infection affects the risk of sports-related concussions.

Study aim

Bullock and colleagues completed a prospective cohort study to compare concussion rates between high school athletes who recently tested positive for COVID-19 and those who did not.

Methods

The authors recruited athletes from high schools in six states. A certified athletic trainer recorded all cases of COVID-19 infection or concussion. If an athlete reported COVID-like symptoms or had an elevated temperature during a daily screening, the athletic trainer administered a COVID test. The research team also recorded when an athlete participated in a training or competition. The authors focused on the number of concussions within 60 days after an athlete returned to play following a COVID-19 infection. All data was recorded in the Players Health Rehab system, including demographic information, sports and illness data for all athletes.

Results

A total of 72,522 athletes participated in high school sports at the affected school during the 2020-2021 school year. Of these athletes, 430 had COVID-19 infections. Of the athletes with a COVID-19 infection, 32 had a concussion, and 1,241 athletes without COVID-19 had a concussion. An athlete with a history of COVID-19 was approximately 3 times more likely to suffer a concussion within 60 days of returning to play than an athlete without COVID-19.

Viewpoints

Overall, the authors found that prior COVID-19 infection increased the risk of concussion during the first 60 days after recovery from COVID-19. Therefore, the effects of a COVID-19 infection may linger after returning to play. Knowing whether this applies to other sports-related injuries would be interesting. Additionally, learning why these athletes are at greater risk for concussion (e.g., deconditioning, persistent symptoms) can help us develop prevention strategies and make informed decisions about when and how to release an athlete to play following a COVID-19 infection.

Clinical implications

Doctors should explain to patients with COVID-19 that they may experience lingering effects that predispose them to concussion. We need to help the patient make an informed decision about when to return to play after COVID-19 infection. Once an athlete returns, doctors should monitor these patients for concussions.

Questions for discussion

What other measures have you implemented in your clinical practice to monitor athletes after COVID-19 infection? Is a COVID-19 infection something you are currently documenting?

Written by Kyle Harris
Reviewed by Jeffrey Driban

related posts

COVID recovery may require injury prevention training!
Use of cardiovascular magnetic resonance (CMR) imaging for return to athletic activities after COVID-19 infection: an expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR)
Adapted physical activity in subjects and athletes recovering from Covid-19: a position statement of the Società Italiana Scienze Motorie e Sportive
Cardiopulmonary Considerations for High School Athletes During the COVID-19 Pandemic: Update to the NFHS-AMSSM Guidelines