Clin Sports Med
· 2024 Jan · PMID 37949516
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Sleep is important for not only general health but also for lowering injury risk and maintaining athletic performance. Sleep disorders are prevalent in athletes, and taking a sleep history, evaluating sleep quality, and...Sleep is important for not only general health but also for lowering injury risk and maintaining athletic performance. Sleep disorders are prevalent in athletes, and taking a sleep history, evaluating sleep quality, and addressing other related factors including mental health are essential in diagnosing and understanding sleep disorders. Other methods such as polysomnography, actigraphy, and sheet sensors can also be used. Treatment options for sleep disorders include sleep hygiene, cognitive behavioral therapy, medication, and addressing contributing factors. For athletes, sleep can also be affected by factors such as travel fatigue and jet lag, which should be taken into consideration.
Clin Sports Med
· 2024 Jan · PMID 37949515
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Disordered eating (DE) and eating disorders (EDs) are more prevalent in athletes than non-athletes, and can cause devastating health and performance consequences. Although they can affect any athlete, DE/EDs are more com...Disordered eating (DE) and eating disorders (EDs) are more prevalent in athletes than non-athletes, and can cause devastating health and performance consequences. Although they can affect any athlete, DE/EDs are more common among women and athletes in lean sports, where there is a perceived competitive advantage to being lean. The sports medicine provider plays a crucial role in screening, diagnosis, and treatment of DE/ED. Treatment should involve a multidisciplinary team with a physician, dietitian, and mental health provider. Preventative efforts should seek to educate athletes and their coaches/support staff and should foster a healthy environment, which deemphasizes weight or body image.
Clin Sports Med
· 2024 Jan · PMID 37949514
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Depressive disorders in athletes are thought to be at least as common as the general population. However, athletes have a unique set of risk factors that can affect the likelihood of developing depression. Screening tool...Depressive disorders in athletes are thought to be at least as common as the general population. However, athletes have a unique set of risk factors that can affect the likelihood of developing depression. Screening tools have been developed specifically for athletes such as the Sport Mental Health Assessment Tool (SMHAT). The management of the depressed athlete should involve an individualized approach, with methods such as counseling, interpersonal therapy, or cognitive behavioral therapy being used. Some may require antidepressant medication. Depressive disorders are also linked to sucidality in athletes, and the team physician and sporting organisation should have a crisis management plan in place for mental health emergencies. Tackling the stigma that remains in sport is a key part to improving mental wellbeing for all athletes.
Reardon CL, Gorczynski P, Hainline B
… +2 more, Hitchcock M, Rice S
Clin Sports Med
· 2024 Jan · PMID 37949513
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Athletes and non-athletes experience many anxiety-related symptoms and disorders at comparable rates. Contributory factors may include pressure to perform, public scrutiny, sporting career dissatisfaction, injury, and ha...Athletes and non-athletes experience many anxiety-related symptoms and disorders at comparable rates. Contributory factors may include pressure to perform, public scrutiny, sporting career dissatisfaction, injury, and harassment and abuse in sport. Anxiety may negatively impact sport performance. Specific types of anxiety may have unique presentations in athletes. It is important to rule out general medical and substance-related causes of anxiety symptoms. Psychotherapy and pharmacology treatment options should be considered, bearing in mind athletes' environmental circumstances and physiologies.
Clin Sports Med
· 2024 Jan · PMID 37949512
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There is growing understanding of the extent of mental health problems, and related mental health needs, among elite athletes. However, far less attention has been paid to mental health among elite coaches and high-perfo...There is growing understanding of the extent of mental health problems, and related mental health needs, among elite athletes. However, far less attention has been paid to mental health among elite coaches and high-performance support staff, the latter including strength and conditioning coaches, physiotherapists, sport psychologists, and other allied health workers in the daily training environment (high-performance support staff are referred to collectively as "entourage" throughout this article). The scarcity of research examining mental health among elite coaches and entourage warrants urgent attention, particularly given these individuals share similar performance demands and role-related stressors as elite athletes. This article reviews the available literature on this topic, including (1) an empirical study conducted by the authors with a sample of coaches and entourage from Australia's national high-performance sport system and (2) a case example to illustrate sport-specific and general risk factors that are likely to impact mental health in elite sporting environments. Avenues for supporting mental health among coaches and entourage are discussed.
Clin Sports Med
· 2024 Jan · PMID 37949511
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This article explores the athlete's relationship with both traditional and social (digital) media and describes athletes' media obligations and the pressures of media attention. It explains the difference in the represen...This article explores the athlete's relationship with both traditional and social (digital) media and describes athletes' media obligations and the pressures of media attention. It explains the difference in the representation of diverse groups, and the potential positive and negative outcomes of the media on an athlete's mental health. The article will review the emergence of social media, its limitless reach, and ways in which it diverges from traditional media coverage of athletic performance. Finally, the article concludes with a discussion of ways that athletes' multidsciplinary medical teams may become advocates for healthy and supportive interactions between athletes and media.
Clin Sports Med
· 2024 Jan · PMID 37949510
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The celebrated side of sports is the high-intensity display of athleticism and competition that draws spectators to the stands, televisions, and streaming services. That version of sports is presented as the hotly contes...The celebrated side of sports is the high-intensity display of athleticism and competition that draws spectators to the stands, televisions, and streaming services. That version of sports is presented as the hotly contested, highly sought-after glory that the competitors sacrifice their time and bodies to pursue. The competitive passion for sport can be observed at every level of sport: from youth sports leagues to elite and professional sports competitions. This chapter will peel back the layers of sports to expose the elements that are not glamorous or celebrated. It will explore the staggering costs under the surface: to athletes, members of the athlete's entourage, and teammates when maltreatment occurs. It will also outline the role of the team physician in providing a safe clinical environment and tools to navigate disclosure and beyond.
Clin Sports Med
· 2024 Jan · PMID 37949509
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Participation in sport can incur a risk of sport-related concussion (SRC). Media representation of SRC is frequently at odds with up-to-date scientific data. Our findings confirm a significant amount of false, confusing,...Participation in sport can incur a risk of sport-related concussion (SRC). Media representation of SRC is frequently at odds with up-to-date scientific data. Our findings confirm a significant amount of false, confusing, or misleading terminology used in reporting on the topic, which is concerning as media is as a major source of SRC information. Individuals have a variable base of knowledge pertaining to this injury, and accurate understanding of SRC does not always correlate to appropriate action. Inaccurate portrayal of SRC media may contribute to the confusion surrounding it. Popular media presents an opportunity to convey evidence-based information on SRC.
Clin Sports Med
· 2024 Jan · PMID 37949508
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ADHD is common among the general population and may be slightly more common among athletes. Diagnosis requires six or more DSM-5-TR symptoms to have been present prior to age 12 and to have an effect on functioning in mu...ADHD is common among the general population and may be slightly more common among athletes. Diagnosis requires six or more DSM-5-TR symptoms to have been present prior to age 12 and to have an effect on functioning in multiple settings. Different sporting organizations have varying requirements for documentation when making a diagnosis. Stimulant medications are the mainstay of treatment; psychosocial interventions, exercise, and non-stimulant medications can serve as adjuncts. Future directions in research on ADHD in sports include determining whether ADHD is overrepresented among the population of elite athletes and parsing out the relationship between ADHD and concussion risk and recovery.
Clin Sports Med
· 2024 Jan · PMID 37949507
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Athletes are incredibly motivated and perpetually pursuing dominance in skill, strength, endurance, and execution-often while balancing many additional responsibilities. Despite the appearance of living fun, luxurious, c...Athletes are incredibly motivated and perpetually pursuing dominance in skill, strength, endurance, and execution-often while balancing many additional responsibilities. Despite the appearance of living fun, luxurious, care-free lifestyles, they are vulnerable to exceptional stressors and the same mental health challenges as the general population. The use of screening tools and assessment guided by a biopsychosocial framework can assist in understanding the factors that contribute to the athlete's mental health status. This can facilitate the development of a targeted management approach to mental health challenges.
McDuff DR, Garvin M, Joy Chang
… +1 more, Thompson D
Clin Sports Med
· 2024 Jan · PMID 37949506
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Sports medicine physicians and athletic trainers regularly encounter athletes who misuse substances that put them at risk for adverse health, social, interpersonal, academic, psychological, and performance effects. The t...Sports medicine physicians and athletic trainers regularly encounter athletes who misuse substances that put them at risk for adverse health, social, interpersonal, academic, psychological, and performance effects. The three most encountered substances are alcohol (binge drinking), cannabis (marijuana), and tobacco/nicotine vaping. Early detection using self-report screening instruments, adverse consequences questionnaires, and urine testing are reviewed. Brief interventions that involve personalized feedback, goal setting, support system involvement, psychoeducation, contingency management, and/or motivational interviewing are highlighted. Lack of response to brief intervention or progression to a substance use disorder should prompt the consideration of referral to a substance specialty level of care.
Clin Sports Med
· 2024 Jan · PMID 37949505
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Though research is inconclusive in being able to determine if young athletes are more or less likely to suffer from mental health disorders compared with their non-athlete peers, there are important psychological conside...Though research is inconclusive in being able to determine if young athletes are more or less likely to suffer from mental health disorders compared with their non-athlete peers, there are important psychological considerations that are unique to the athletic population. This includes depression in the context of overtraining and burnout, performance anxiety, perfectionism, psychological sequalae of concussion, and injury as an independent risk factor for depression, anxiety, post-traumatic stress, and high-risk behaviors. Optimization of mental health care in youth athletes requires continued efforts to improve mental health literacy, decrease stigma, encourage help-seeking behaviors, and advance the routine implementation of effective screening practices.
Gorczynski P, Aron CM, Moore M
… +1 more, Reardon CL
Clin Sports Med
· 2024 Jan · PMID 37949504
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Within elite sport, epidemiological evidence is needed concerning the incidence and prevalence of mental health symptoms and disorders in relation to athlete demographic factors such as (dis)ability, race, ethnicity, sex...Within elite sport, epidemiological evidence is needed concerning the incidence and prevalence of mental health symptoms and disorders in relation to athlete demographic factors such as (dis)ability, race, ethnicity, sexual orientations, and different genders. Mental health promotion campaigns are often based on mental health literacy strategies. Such strategies aim to increase knowledge of mental health symptoms and disorders, address aspects of self- and public stigma, and promote help-seeking behaviors. Sporting organizations need to take responsibility to ensure that policies, practices, and services reflect organizational values concerning mental health. Organizational mental health literacy ensures that information is culturally competent and responsive, easy to find, straightforward, and offers simple, legitimate opportunities to access support.
Gobbell W, Edwards CM, Engel SR
… +1 more, Coyner KJ
Clin Sports Med
· 2023 Oct · PMID 37716734
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Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degene...Sternoclavicular joint instability is a rare complaint in the orthopedic clinic, but patients can experience chronic pain and functional impacts. Causes of instability may be posttraumatic, infectious, autoimmune, degenerative, or secondary to generalized laxity. Conservative treatment is the initial approach to management and involves activity modification, physical therapy, oral nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Surgery is indicated when conservative treatment does not manage symptoms. Figure-of-eight reconstruction techniques provide greatest biomechanical strength but are associated with risk of neurovascular injury. Other reconstruction methods have been shown to mitigate these risks with favorable short-term outcomes.
Clin Sports Med
· 2023 Oct · PMID 37716733
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Injuries to the sternoclavicular (SC) joint are rare, however, when they occur prompt recognition, evaluation, and treatment are crucial. SC joint injuries can occur following high-energy mechanisms such as motor vehicle...Injuries to the sternoclavicular (SC) joint are rare, however, when they occur prompt recognition, evaluation, and treatment are crucial. SC joint injuries can occur following high-energy mechanisms such as motor vehicle collisions and contact sports. Injury to the SC joint can be evaluated with the use of plain radiographs as well as computed tomography. If an injury to the SC joint is suspected, injury to vital mediastinal structures must be evaluated. SC joint dislocations can be treated by either closed reduction or open reduction and stabilization. Many stabilization methods have been described including plate stabilization and ligament reconstruction.
Clin Sports Med
· 2023 Oct · PMID 37716732
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This article reviews techniques and outcomes of surgical fixation for distal clavicle fractures. Near 100% union has been reported for several techniques. The most common are locked plating, coracoclavicular fixation and...This article reviews techniques and outcomes of surgical fixation for distal clavicle fractures. Near 100% union has been reported for several techniques. The most common are locked plating, coracoclavicular fixation and a combination of plating with CC fixation. Hook plates are useful for particular fracture patterns, but there can be complications specific to this implant. Low-profile constructs are favored due to the high rates of symptomatic hardware. Fixation of subacute and chronic injuries can provide reliable functional improvements, but is inferior to acute fixation. Surgery is generally the treatment of choice for displaced fractures in athletes.
Clin Sports Med
· 2023 Oct · PMID 37716731
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Management of distal clavicle fractures depends on a clear understanding of the injury's proximity to the ligamentous attachments joining the clavicle and scapula. Various classification systems have been proposed to gui...Management of distal clavicle fractures depends on a clear understanding of the injury's proximity to the ligamentous attachments joining the clavicle and scapula. Various classification systems have been proposed to guide treatment. Despite this, controversy between operative and nonoperative management remains for certain fracture patterns. Patient-specific factors, concomitant injuries, fracture characteristics (displacement, shortening, and rotation) should all be considered when deciding on treatment. When nonoperative management is indicated, patients should be immobilized in a sling for 2 weeks, followed by gradual range of motion, and strengthening exercises.
Clin Sports Med
· 2023 Oct · PMID 37716730
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Clavicle fractures are a common injury resulting from a high-energy force, such as a fall onto the shoulder, motor vehicle accident, or sporting activity. Although some clavicle fractures may be treated nonoperatively, o...Clavicle fractures are a common injury resulting from a high-energy force, such as a fall onto the shoulder, motor vehicle accident, or sporting activity. Although some clavicle fractures may be treated nonoperatively, operative treatment results in higher union rates and faster return to activity. Here we discuss the operative treatment options for plating of clavicle fractures; specifically, a single plate placed either superiorly or anteriorly or two plates placed orthogonally. Because both techniques provide adequate stability, fracture and patient characteristics should guide the surgical decision making regarding single versus dual plating of clavicle fractures.