Sports Health [JOURNAL]
Sun
200 papers
Molecular Basis and Practical Applications of Training, Nutrition and Recovery for Maximum Gains in Lean Muscle Mass: A Narrative Review for Optimizing Muscular Hypertrophy.
Vergara Nieto ÁA, Halabi Diaz A, Hernández Millán M … +1 more , Sagredo Oyarzo D
Sports Health · 2026 May · PMID 42099260 · Full text
CONTEXT: Skeletal muscle hypertrophy is a key determinant of strength, athletic performance, and functional capacity across the lifespan, and is clinically relevant to sarcopenia and chronic disease. This review integrat...
CONTEXT: Skeletal muscle hypertrophy is a key determinant of strength, athletic performance, and functional capacity across the lifespan, and is clinically relevant to sarcopenia and chronic disease. This review integrates molecular mechanisms (e.g., mechanotransduction and mTORC1 signaling) with practical training, nutrition, and recovery variables to support evidence-informed hypertrophy programming. EVIDENCE ACQUISITION: Literature was searched in PubMed, Scopus, ScienceDirect, and Google Scholar (January 2010 to March 2024) using Boolean combinations of terms related to hypertrophy, resistance training variables and techniques, protein/macronutrients, sleep, and recovery. Included evidence prioritized randomized controlled trials, systematic reviews/meta-analyses, and mechanistic studies relevant to training, nutrition, and recovery; case reports/editorials and endurance-only or unrelated populations/outcomes were excluded. STUDY DESIGN: Clinical narrative review. LEVEL OF EVIDENCE: Level 4. RESULTS: Hypertrophy is maximized when resistance training provides sufficient mechanical tension and effective fiber recruitment, with weekly volume as a central driver. Practical synthesis supports ~10 to 20 sets per muscle group per week, near-failure efforts (repetitions in reserve ~0-2), and distributing volume across multiple weekly sessions to maintain training quality and recovery. Nutritional support centers on adequate protein intake (≈1.6 g/kg/day; often 1.6-2.2 g/kg/day in trained athletes), with meal distribution (≈3-4 meals/day, ~0.4-0.5 g/kg/meal) as a practical strategy to sustain anabolic signaling. Energy availability and carbohydrate intake support training performance and glycogen-dependent workload (≈3-6 g/kg/day), and a moderate caloric surplus (~200-500 kcal/day) may aid lean mass gain while limiting excess adiposity. Recovery, particularly sleep, modulates hormonal homeostasis and protein metabolism; adequate sleep duration (7-9 h/night) is emphasized as foundational for adaptation. CONCLUSION: An integrative approach to training, nutrition and rest offers the most actionable framework to maximize hypertrophy and strength while managing fatigue and individual recovery capacity.Strength-of-Recommendation Taxonomy (SORT):• Training and Nutritional (SOR A/B): most recommendations are based on Level 1 evidence.• Recovery and rest aspects (SOR B/C): Mechanistic evidence is high. More Level 1 evidence needed with hypertrophy-related outcomes.
Motor Imagery and Action Observation-Based Plyometric Training as a Potential Alternative to Traditional Methods in Female Volleyball Players: A Randomized Controlled Trial.
Yazgan EA, Cavlak U, Kara Kaya B
Sports Health · 2026 May · PMID 42099095 · Full text
BACKGROUND: Plyometric training (PT) improves jump performance, change of direction (CoD), balance, and reaction time (RT) in volleyball. Motor imagery (MI) and action observation (AO) activate motor control networks and...
BACKGROUND: Plyometric training (PT) improves jump performance, change of direction (CoD), balance, and reaction time (RT) in volleyball. Motor imagery (MI) and action observation (AO) activate motor control networks and may induce similar neuromotor adaptations with lower mechanical load. This study compared static and dynamic MI+AO-based PT added to regular volleyball training with traditional PT in female volleyball players. HYPOTHESIS: Static and dynamic MI+AO-based PT would significantly improve RT, jump performance, CoD, and balance, with outcomes comparable with those of traditional PT. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 45 female volleyball players were allocated randomly to static MI+AO (Group A), dynamic MI+AO (Group B), or traditional (Group C) PT. Interventions were performed twice weekly for 8 weeks. RT was assessed using BlazePod; vertical jump test (VJT) and single-leg horizontal jump test (SLHJT) using My Jump 2, CoD via the T-test, and balance with the Y balance test (YBT). RESULTS: At baseline, RT was slower in Group A than in Groups B ( = 0.001) and C ( = 0.004), while other variables were comparable ( > 0.05). All groups demonstrated significant within-group improvements in all outcomes ( < 0.05) with large effect sizes. No between-group differences were found for YBT ( > 0.05). Significant group effects were observed for VJT (η = 0.198), SLHJT-L (η = 0.176), SLHJT-R (η = 0.214), and T-Test performance (η = 0.242) (all < 0.05). VJT improved similarly in Groups B and C, both exceeding Group A. For SLHJT, Group C showed the greatest gains, followed by Group B; both outperformed Group A. CoD improvements were greater in Group C than in Groups A and B. Although RT improved in all groups, analysis of covariance revealed no post-test between-group differences after baseline adjustment. CONCLUSION: MI+AO-based PT appears to be a complementary, load-efficient strategy to support neuromotor performance when mechanical loading must be limited, rather than a substitute for traditional PT. CLINICAL RELEVANCE: This low-risk MI+AO approach may help maintain neuromuscular performance during recovery, rehabilitation, or restricted training periods.
Aligning Self-Perceived Shoulder and Elbow Function With Risk Factors for Shoulder and Elbow Injury in Baseball Athletes.
Smoot WC, Becsey XA, Kazi R … +5 more , Conway JE, Arnold AJ, Garrison JC, Kennedy SM, Myers NL
Sports Health · 2026 · PMID 42099089 · Full text
BACKGROUND: The Kerlan Jobe Orthopaedic Clinical Shoulder and Elbow Score (KJOC) is a responsive outcome for monitoring self-perceived shoulder and elbow function in baseball athletes. While clinically useful, barriers r...
BACKGROUND: The Kerlan Jobe Orthopaedic Clinical Shoulder and Elbow Score (KJOC) is a responsive outcome for monitoring self-perceived shoulder and elbow function in baseball athletes. While clinically useful, barriers regarding its implementation subject the KJOC to limitations. The ability to delineate variables that predict KJOC scores by identifying metrics associated with poor self-perceived function in baseball athletes would prove beneficial. HYPOTHESIS: At least one risk factor for shoulder or elbow injury would significantly explain a portion of the variance in KJOC scores. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 379 baseball athletes completed the KJOC at initial evaluation for either a shoulder or elbow injury. Demographic information and a series of clinical objective measures were collected. A total of 18 variables, most of which have been associated previously with injury risk in baseball athletes, were entered in stepwise fashion into a linear regression. RESULTS: In the final model, 13% of the variance in KJOC scores can be explained by 5 significant predictors. Age explained 6.4%, normalized rotational strength differences explained 1.6% to 2.5%, humeral retrotorsion-corrected glenohumeral internal rotation explained 1.3%, and height explained 0.9% of the total variance in KJOC scores. CONCLUSION: Five variables significantly predicted a portion of the variance in KJOC scores in injured baseball athletes. While the overall variance explained by the model was modest, these findings demonstrate several key demographic and clinical objective measures that may provide meaningful insight into athletes' self-perceived shoulder and elbow function. CLINICAL RELEVANCE: These results support the continued use of patient-reported outcome measures, such as the KJOC, while encouraging the development of objective screening procedures to complement clinical integration. Identifying associated clinical and objective variables that explain self-perceived shoulder and elbow function may allow for improved selection of screening measures for shoulder and elbow injury risk in baseball athletes.
AI-Powered Monitoring of the Acute: Chronic Workload Ratio: Interpretable Injury Risk Prediction in Soccer Players.
Meng D, Wei M, He S … +3 more , Lv Z, Yang G, Wang Z
Sports Health · 2026 · PMID 42099088 · Full text
BACKGROUND: This study proposes a model for monitoring the acute:chronic workload ratio (ACWR). HYPOTHESIS: Historical training data are able to predict a soccer player's future ACWR. STUDY DESIGN: Cross-sectional study....
BACKGROUND: This study proposes a model for monitoring the acute:chronic workload ratio (ACWR). HYPOTHESIS: Historical training data are able to predict a soccer player's future ACWR. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: We propose a timeseries model built upon a Transformer-based foundation model -Tabular Probabilistic Forecasting Network for Time Series-based on historical training data from soccer players, incorporating sensor data (such as Global Positioning System or accelerometers) and athletes' subjective feedback. We leveraged prompt engineering and large language models to enhance the model's predictive capability, extracting previous knowledge-based artificial features from the DeepSeek model. RESULTS: Our model achieved an average mean absolute error of 0.119, an average mean squared error of 0.029, an average root mean square error of 0.149, and an average of 0.564 in ACWR prediction. In addition, in ACWR_RISK prediction, the model achieved an accuracy of 87.12%, precision of 85.91%, recall of 87.12%, and an F1 score of 85.27%. CONCLUSION: Extensive experimental results demonstrate that the model predicts the future injury risk of soccer players effectively, helping players regulate workload fluctuations and maintain their training state and injury risk within an optimal zone. CLINICAL RELEVANCE: The proposed model provides a practical tool for monitoring and predicting athletes' workload dynamics, enabling early identification of elevated injury risk associated with abnormal ACWR fluctuations.
On Lingering Pelvic Floor Musculoskeletal Injuries in the Postpartum Athlete: Are We Adequately Addressing Them?
LaCross J, DeLancey JOL, Masteling M … +2 more , Pipitone F, Ashton-Miller JA
Sports Health · 2026 May · PMID 42087588 · Full text
Although vaginal birth has the highest risk of musculoskeletal injury per hour of exposure of any natural human activity, the resulting injuries often go unrecognized - sometimes for decades. The types of tissues injured...
Although vaginal birth has the highest risk of musculoskeletal injury per hour of exposure of any natural human activity, the resulting injuries often go unrecognized - sometimes for decades. The types of tissues injured during a difficult vaginal birth are similar to those involved in other musculoskeletal injuries. It is not widely appreciated that multiple structures can be injured, including pubic bone stress fractures, injury to the nerve innervating the right or left levator ani (LA) muscle, stretch injuries of the LA muscles themselves, and/or passive tissue stretch injuries to the perineal body (PB), perineal membrane (PM), and endopelvic fascia. Complicating the issue further is the possibility that each structure can be injured to differing extents, and the injuries can occur in a variety of combinations. As a contribution to the existing literature, the relevant information is tabulated for the first time in a pelvic floor musculoskeletal injury classification system, supported by illustrations for easy reference. Because early identification and interventions can help reduce, and even prevent, long-term symptoms, it is important to screen postpartum athletes and refer them to pelvic health specialists when appropriate. This will help benefit these athletes by fostering appropriate interdisciplinary collaboration with their sports medicine care team.
Oral Rehydration Improved Exercise Performance and Decreased Core Temperature and Heartrate Compared With Intravenous Rehydration in Recreationally Active Men.
Sekiguchi Y, Ky AT, Benjamin CL … +4 more , Rolloque JJS, Griswold JA, Kavouras SA, Adams JD
Sports Health · 2026 Apr · PMID 41958221 · Full text
BACKGROUND: The purpose of this study was to examine the effect of oral versus intravenous (IV) rehydration during exercise in the heat on exercise performance and physiological responses. HYPOTHESIS: Oral rehydration wi...
BACKGROUND: The purpose of this study was to examine the effect of oral versus intravenous (IV) rehydration during exercise in the heat on exercise performance and physiological responses. HYPOTHESIS: Oral rehydration will lead to better performance and physiological outcomes. STUDY DESIGN: Cross-over study. LEVEL OF EVIDENCE: Level 2. METHODS: A total of recreational active men (age, 29 ± 12 years; peak oxygen consumption [VO], 49.8 ± 6.6 ml kg min) performed 90 minutes of cycling exercise at 55% watts at VO (WVO) followed by a 12-km time trial in the heat (34.9 ± 0.6°C; 30.3 ± 0.9%; wind speed, 3.4 m sec). Two experimental trials were performed in random order: (1) drank 25 ml of water every 5 minutes (ORAL) and (2) 25 ml of isotonic saline infused intravenously every 5 minutes (IV). Rectal temperature (T) and thirst sensation were measured every 5 minutes. Urine specific gravity (USG) and body mass loss were measured before and after trials. Changes (Δ) were calculated based on the resting value for each trial. RESULTS: Participants started both trials euhydrated (USG < 1.020), and no differences were found in hydration status between ORAL and IV after trials (USG:ORAL, 1.012 ± 0.006; = 0.14; IV, 1.013 ± 0.007; body mass loss: ORAL, 2.4 ± 0.8%; IV, 2.3 ± 0.5%, = 0.68). Thirst levels were higher in IV than ORAL from 20 to 50 minutes ( = 0.03 to 0.05) and after 65 minutes throughout 90 minutes of cycling exercise and the 12-km time trial ( < 0.001 to 0.04. ΔT was also significantly higher in IV after 20 minutes throughout 90 minutes of cycling exercise and a 12-km time trial ( = 0.003 to 0.04). The time trial was significantly faster in ORAL (17.7 ± 4.6 minutes) compared with IV (19.6 ± 6.2 minutes, = 0.05). CONCLUSION: Oral rehydration enhances exercise performance and decreases T and heartrate compared with IV rehydration. CLINICAL RELEVANCE: Oral rehydration might have more benefits than IV in exercise performance and physiological response.
Former Collegiate Athletes' Healthcare Needs During and After Sport Transition: An Exploratory Study.
Reifsteck EJ, Seo Y, Brooks DD … +6 more , Defreese JD, Aldret RL, Borum K, Greco PA, Dortch Diaz MA, Chandran A
Sports Health · 2026 Apr · PMID 41947467 · Full text
BACKGROUND: Student-athletes face unique challenges when transitioning out of collegiate sports, losing access to comprehensive athletic department healthcare services while navigating the critical developmental period o...
BACKGROUND: Student-athletes face unique challenges when transitioning out of collegiate sports, losing access to comprehensive athletic department healthcare services while navigating the critical developmental period of emerging adulthood. PURPOSE: Identify health and wellbeing needs among former student-athletes who have recently transitioned out of college sports to inform targeted healthcare transition strategies. STUDY DESIGN: Mixed-methods design. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 35 former student-athletes (17 women, 18 men) representing diverse backgrounds who participated in their final collegiate competition between 2019 and 2023 completed surveys assessing self-reported measures of health indicators, transition healthcare resources, healthcare engagement, and sport transition planning. A total of 12 former student-athletes participated in focus groups exploring barriers and facilitators in their healthcare transition experience. RESULTS: Participants generally perceived their current health as similar to or improved compared with their collegiate athletic careers (37.1% each), whereas a smaller proportion reported worse health (25.7%). While many participants reported having a general transition plan, most (68.6%) lacked a specific healthcare management plan. Participants cited difficulties with obtaining the care or treatment they needed. Focus groups highlighted a "Performance over People" culture in elite sport in which athletic achievement was prioritized over long-term well-being. "Relational Resources" such as support from family, friends, mentors, and knowledgeable medical professionals were critical for successful sport transition. CONCLUSION: The broader culture of elite sport and the long-term consequences of participation appear to affect how student-athletes understand their health and engage with healthcare as former athletes. Former collegiate athletes experience notable gaps in healthcare support during their transition out of collegiate sports, particularly in accessing holistic care from providers who understand their health needs as former student-athletes. CLINICAL RELEVANCE: Structured healthcare transition planning, specialized provider networks that connect patients to medical professionals with sport-specific expertise, and formal mentorship programs are potential strategies for promoting the physical and mental wellbeing of former student-athletes during and after their transition out of collegiate sport.
Deterioration in Performance Metrics After Acute Achilles Tendon Ruptures in Elite Rugby Union Players: A Retrospective Sports Database Study.
Rubin J, Tham A, Mojica ES … +5 more , Butler JJ, Aratikatla A, Wingo T, Calder JDF, Kennedy JG
Sports Health · 2026 Apr · PMID 41934363 · Full text
BACKGROUND: Acute Achilles tendon ruptures (AATRs) are devastating injuries for athletes, yet outcomes in elite rugby union players remain poorly characterized. HYPOTHESIS: Elite rugby union players who sustain AATRs wil...
BACKGROUND: Acute Achilles tendon ruptures (AATRs) are devastating injuries for athletes, yet outcomes in elite rugby union players remain poorly characterized. HYPOTHESIS: Elite rugby union players who sustain AATRs will demonstrate significantly reduced performance metrics postinjury compared with preinjury levels. STUDY DESIGN: Retrospective case series. LEVEL OF EVIDENCE: Level 4. METHODS: A retrospective review of elite rugby union players who sustained Achilles ruptures from 2013 to 2025 was performed. Data, including player demographics, injury characteristics, and performance metrics, were collected from rugby databases and media reports. A Wilcoxon signed rank test was used to compare pre- and postrupture performance metrics. Effect size was calculated using matched-pairs rank-biserial correlation, with median paired differences and 95% CIs. A value <0.05 was determined as statistically significant. RESULTS: A total of 52 elite rugby union players with a median age of 28 years were identified. Overall, 80.8% of players returned to play (RTP) at a median time of 8.5 months. In the season immediately after injury, games played, tries, tries per game, points, and points per game were all significantly lower than preinjury values (all ≤ 0.003; = -0.49 to -0.61). Across all seasons, games per season, tries per season, tries per game, points per season, and points per game were significantly lower after injury (all < 0.001; = -0.47 to -0.72). CONCLUSION: AATRs in elite rugby union players were associated with significant declines in performance metrics in both the immediate postinjury season and across subsequent seasons. These findings highlight the substantial performance impact of AATRs and support the need for improved position-specific prevention strategies and targeted postinjury rehabilitation protocols. CLINICAL RELEVANCE: Clinicians can use these findings to counsel rugby athletes and teams on prognosis, treatment decisions, and realistic performance expectations after AATRs.
Effects of Sensory Constraints on Sensorimotor Functions in People With Chronic Ankle Instability: A Systematic Review and Meta-analysis.
Hu X, Zeng Z, Ho CY … +2 more , Fong DTP, Yang Y
Sports Health · 2026 Apr · PMID 41934362 · Full text
CONTEXT: Somatosensory dysfunction in people with chronic ankle instability (CAI) has been reported to influence not only peripheral performance but also sensory reweighting of central nervous system. Sensory constraints...
CONTEXT: Somatosensory dysfunction in people with chronic ankle instability (CAI) has been reported to influence not only peripheral performance but also sensory reweighting of central nervous system. Sensory constraints, such as visual or somatosensory perturbations originating from sway surroundings or sway surface, continuously occur during body movements. Dynamically reweighting somatosensory, visual and vestibular cues are crucial for postural stability. However, due to contradictory evidence, it is unclear how sensory constraints affect sensorimotor functions and sensory reweighting ability in individuals with CAI. OBJECTIVE: To examine the impact of sensory constraints on sensorimotor functions, sensory reweighting ability, and the sensory strategy selection of people with CAI during postural control. DATA SOURCES: PubMed, Web of Science, EMBASE, Cochrane, SPORTDiscus, and Medline. STUDY SELECTION: Two authors independently screened article titles, abstracts, and full texts to select peer-reviewed studies exploring sensory constraints on sensorimotor functions in people with CAI and healthy controls. STUDY DESIGN: Meta-analyses of descriptive epidemiological study. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Center-of-pressure, center-of-gravity, and time-to-boundary measures that represent postural stability, and muscle activity amplitude and activation onset time were extracted. RESULTS: A total of 43 articles were included. Compared with healthy controls, the CAI group exhibited static (Hedges's = 0.53) and dynamic (Hedges's = 1.05) deficits with visual constraint, as well as increased medial gastrocnemius activity (Hedges's = 1.02) during unilateral stance with visual constraint. The CAI group showed decreased sensory reweighting during unilateral stance with visual constraint (Hedges's = 0.26) and bilateral stance with visual and somatosensory constraints (Hedges's = 0.45). CONCLUSION: Visual constraint could alter postural control and muscle activation patterns in people with CAI. Sensory reweighting ability of those with CAI may fluctuate based on task and sensory constraints, and visual dominance strategy may help people with CAI modulate posture when visual information is reliable.
Prospective Forecasting of Quadriceps Performance Post-ACLR in Collegiate Athletes.
Knurr KA, Yee R, Deshpande S … +1 more , Cobian DG
Sports Health · 2026 Apr · PMID 41934354 · Full text
BACKGROUND: Accurate prognosis of quadriceps performance postanterior cruciate ligament reconstruction (ACLR) is valuable to clinicians to set expectations and guide interventions. Advanced probabilistic modeling, such a...
BACKGROUND: Accurate prognosis of quadriceps performance postanterior cruciate ligament reconstruction (ACLR) is valuable to clinicians to set expectations and guide interventions. Advanced probabilistic modeling, such as Bayesian frameworks, may enhance recovery forecasting, promoting more personalized clinical decisions. This study aimed to characterize recovery of quadriceps function throughout the initial 14 months post-ACLR in collegiate athletes, and to determine the influence of the number of previous assessments included on the accuracy of the model predictionHypothesis:Predictive performance (as measured by root mean square predictive error) would improve significantly with each assessment added to the model. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 66 Division I collegiate athletes (317 assessments; 35 female athletes) completed serial isometric performance assessments at 1 to 14 months post-ACLR to quantify peak torque (PT) limb symmetry index (LSI), rate of torque development (RTD) LSI, and torque steadiness (TS) of the surgical limb. Bayesian hierarchical B-spline models including graft type and time post-ACLR, with varying degrees of complexity, were compared for PT, RTD, and TS recovery, separately. A novel cross validation design, mimicking the clinical use of this model, assessed the ability to forecast recovery trajectories based on an iterative increase in number of observations using root mean square error (RMSE). RESULTS: The model that allowed the recovery curves' shape to vary by graft type and included athlete-specific random intercepts produced the most accurate predictions, achieving RMSEs of 0.109, 0.173, and 0.536 for predicting PT, RTD, and TS after the first n = 2 assessments. It took at least 10, 12, and 6 months, respectively, on average, to reach the clinical targets utilized for PT (90%), RTD (85%), and TS (0.5% of PT) with 95% certainty. CONCLUSION: Bayesian hierarchical modeling offers a robust and flexible tool for forecasting quadriceps recovery post-ACLR, and demonstrated that RTD took the longest to achieve the clinical targets. CLINICAL RELEVANCE: This predictive modeling approach serves as a "proof-of-concept" and has the potential to better individualize patient recovery trajectories.
Sport-Specific Outcome Measures Improve Clinical Assessment of Shoulder Injury in Swimmers: A Cohort Study of Specific PROMs.
Sousa DN, Velho T, Escaleira R … +6 more , Moedas D, Campos B, Medeiros-Filho JF, Pereira H, Malavolta E, Sevivas N
Sports Health · 2026 Mar · PMID 41914331 · Full text
BACKGROUND: Swimming is among the most widely practiced sports globally. Up to 70% of swimmers report shoulder pain that impairs performance. Patient-reported outcome measures (PROMs) are effective, objective tools for a...
BACKGROUND: Swimming is among the most widely practiced sports globally. Up to 70% of swimmers report shoulder pain that impairs performance. Patient-reported outcome measures (PROMs) are effective, objective tools for assessing such injuries. The aim of this study was to develop and validate swimming-specific adaptations of established shoulder PROMs (ASES-swim and SSV-swim) and compare their psychometric properties and discriminatory ability with generic existing instruments. HYPOTHESIS: Swimming-specific PROMs may more accurately assess shoulder condition in swimmers and monitor recovery, thereby enabling improved evaluation of health status and, ultimately, athletic performance. STUDY DESIGN: Cohort study. METHODS: A total of 167 athletes registered with the Portuguese Swimming Federation (FPN) during the 2023-2024 season were enrolled. Participants were stratified into asymptomatic group (AG = 92) and injured group (IG = 75). Monthly assessments included training characteristics, injury status, and responses to ASES, SSV, SSV-sport, and newly developed ASES-swim and SSV-swim questionnaires over 6 months. RESULTS: SSV-swim correlated strongly with SSV and SSV-sport ( = 0.769, < 0.001 and = 0.857, < 0.001, respectively). ASES-swim scores were highly correlated with ASES scores ( = 0.994, < 0.001). Both SSV-swim and ASES-swim demonstrated higher internal consistency than the nonadapted PROMs (Cronbach alpha = 0.849 and 0.870, respectively). SSV, SSV-sport, and SSV-swim showed moderate discriminatory ability (area under the curve [AUC] = 0.760, 0.809, and 0.851, respectively), whereas ASES and ASES-swim showed excellent discriminatory ability for detecting injury (AUC = 0.967 and 0.970, respectively). CONCLUSION: ASES-swim and SSV-swim are a valid, reliable, and easy to administer tool for the assessment of shoulder injury and recovery in swimmers. Swimming-specific PROMs provide clinically meaningful improvements in shoulder injury assessment accuracy. CLINICAL RELEVANCE: Swimming-specific PROMs provide clinicians with a sensitive and reliable method for assessing shoulder injury in swimmers, enabling more accurate diagnosis and individualized rehabilitation. Further research should investigate sports-specific PROM adaptations to optimize athlete care across disciplines.
The Impact of Psychological and Social Factors on Recovery After ACL Reconstruction.
Malempati M, Siddiqui RN, Lo JE … +3 more , Varieur BM, Rumps MV, Mulcahey MK
Sports Health · 2026 Mar · PMID 41902575 · Full text
BACKGROUND: The purpose of this study was to investigate the impact of demographic, psychological, and social factors on self-reported recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). HYPOTHESIS: Ps...
BACKGROUND: The purpose of this study was to investigate the impact of demographic, psychological, and social factors on self-reported recovery after anterior cruciate ligament (ACL) reconstruction (ACLR). HYPOTHESIS: Psychological and social factors would be associated with lower patient-reported outcome scores (PROMS) after ACLR. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: Retrospective review was conducted of patients who underwent ACLR at a single institution. Recovery was measured by using the PROMIS 10 SF Global Health Physical score, Lysholm Knee score, International Knee Documentation Committee (IKDC) score, and Knee Outcome Survey (KOS) scores. Multivariable linear regression models were developed to predict 6-month PROMIS 10 SF Global Health Physical, Lysholm Knee, IKDC, and KOS scores. Sociodemographic, surgical, and preoperative PROMS with variance inflation factors >5 were removed to minimize collinearity. RESULTS: A total of 67 patients who underwent ACLR between December 2013 to August 2023 were included in this study, with a mean age of 31.1 ± 10.3 years. Smoking history was consistently associated with lower 6-month IKDC (β = -33.5 [-54.0, -13.0], = 0.002), KOS (β = -35.6 [-42.3, -18.4], < 0.001), and Lysholm (β = -27.6 [-45.1, -10.0], = 0.004) scores. White race was associated with lower Lysholm scores (β = -8.0 [-13.1, -3.0], = 0.003). Higher preoperative PROMIS mental health scores were associated with higher KOS (β = 0.4 [0.1, 0.6], = 0.01). Patients with Medicaid reported higher KOS scores (β = 7.2 [2.4, 12.0], = 0.004). CONCLUSION: Several psychosocial and demographic factors may influence recovery after ACL reconstruction. In our study, smoking predicted worse outcomes, while having Medicaid insurance was unexpectedly linked to better self-reported recovery. White race predicted worse outcomes. Mental health findings were contradictory, with high preoperative PROMIS mental health scores, representing current mental health, and a history of depression potentially associated with improved outcomes. CLINICAL RELEVANCE: Identifying psychological and social factors preoperatively can help clinicians better understand which patients may be at risk for lower self-reported outcomes.
Relationship Between Kinesiophobia and Biomechanical, Postural, and Neuromuscular Parameters of the Lower Limbs: A Systematic Review.
García-Castillo J, Benítez-Porres J, García-Romero J … +1 more , Castillo-Domínguez A
Sports Health · 2026 Mar · PMID 41877566 · Full text
CONTEXT: Musculoskeletal injuries are common and often result in behaviors such as kinesiophobia. Kinesiophobia is defined as an irrational fear of movement due to the concern about exacerbating an existing injury or cau...
CONTEXT: Musculoskeletal injuries are common and often result in behaviors such as kinesiophobia. Kinesiophobia is defined as an irrational fear of movement due to the concern about exacerbating an existing injury or causing a new one, which can lead to various changes in posture, neuromuscular function, and biomechanics in affected people. OBJECTIVE: To determine the relationship between kinesiophobia and the biomechanical, postural, and neuromuscular parameters of the lower limbs. DATA SOURCES: A systematic review of the literature from the years 2000 to 2024 was performed using 3 electronic databases: PubMed, Scopus, and Web of Science. STUDY SELECTION: Article selection was conducted by 2 reviewers, initially screening articles by title and abstract, followed by full-text reading, applying eligibility criteria, and assessing methodological quality. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Data were extracted from 10 studies. This systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Study methodology quality was evaluated using the Methodological Index for Non-Randomized Studies scale. RESULTS: Of 1998 studies analyzed, 10 were included in the review. Data were collected on postural control, static and dynamic balance, neuromuscular parameters, and biomechanics. CONCLUSION: Elevated levels of kinesiophobia are associated directly with impaired postural control, neuromuscular alterations, and changes in the biomechanical patterns of the lower limbs during various activities, except during walking.
Review of Current Management of Navicular Stress Fractures in Athletes.
Modica AS, Lucido C, Bitterman AD
Sports Health · 2026 Mar · PMID 41877518 · Full text
CONTEXT: Navicular stress fractures are relatively uncommon injuries seen most frequently in high-level athletes due to repetitive compressive and shearing forces. The tenuous arterial network and central watershed area...
CONTEXT: Navicular stress fractures are relatively uncommon injuries seen most frequently in high-level athletes due to repetitive compressive and shearing forces. The tenuous arterial network and central watershed area predispose the navicular to stress fractures and healing complications. Diagnosing these stress fractures can be difficult for Certified Athletic Trainers due to the ambiguous and insidious nature of these injuries. Identifying risk factors and clinical signs of navicular stress fractures is important to optimally treat these injuries. Intrinsic risk factors include female sex, characteristics of the "female athlete triad," relative energy deficiency in sports, previous foot injury, and dietary insufficiencies. Historically, navicular stress fractures were managed conservatively with 6 weeks of protected nonweightbearing (NWB). Recent literature has found faster return to activity (RTA) and decreased complication rates with operative open reduction internal fixation (ORIF) for treating type 2 and type 3 injuries in high-level athletes. EVIDENCE ACQUISITION: A retrospective review of PubMed/MEDLINE was performed to identify articles. We identified multiple key terms and phrases relevant to the topic being reviewed. In this review, key words include "navicular stress fracture," "athlete," "treatment," "management," "open reduction internal fixation," and "return to activity." Necessary filters or limits were applied to refine our search. STUDY DESIGN: Retrospective review of recent literature exploring the management, and outcomes of navicular stress fractures in athletes. LEVEL OF EVIDENCE: Level 2. METHODS: Articles were screened to identify those with outcomes such as time to RTA and successful RTA after operative or nonoperative management of navicular stress fractures. RESULTS: Recent literature demonstrated potential quicker RTA for operative treatment of type 2 and type 3 navicular stress fractures in the high level athletic population. CONCLUSION: ORIF is a reasonable treatment modality that should be considered with a low threshold in younger athletic patients performing at a high or professional level.Strength-of-Recommendation Taxonomy (SORT):B.
Injuries, Injections, and Internet Forums: A Qualitative Study of Reddit User Perspectives on Peptide Therapy After Orthopaedic Surgery.
Rosenberg AE, Taylor B, Rasquinha RD … +4 more , Khan H, Quinn M, Marcaccio S, Lemme N
Sports Health · 2026 · PMID 41877514 · Full text
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Sleep Duration, Sleep Timing, and Self-Reported Wellbeing in Collegiate Women Volleyball Athletes: A Prospective Study Using a Consumer-Grade Wearable.
Cook JD, Sanfilippo JL, Love JJ … +2 more , Plante DT, Watson AM
Sports Health · 2026 Mar · PMID 41863151 · Full text
BACKGROUND: Previous research assessing sleep health in collegiate athletes has relied predominantly upon self-report measures. This investigation leveraged a modern, consumer-grade wearable device to examine sleep durat...
BACKGROUND: Previous research assessing sleep health in collegiate athletes has relied predominantly upon self-report measures. This investigation leveraged a modern, consumer-grade wearable device to examine sleep duration (SD) and timing across a 5-month window, including both preseason and in-season periods, in a sample of female National Collegiate Athletic Association (NCAA) Division I volleyball athletes. HYPOTHESIS: Shorter SD and earlier waketimes would associate with worse self-reported wellbeing (mood, muscle recovery, and energy). SD would be shorter and waketimes would be earlier during preseason, relative to in-season, as well as on weekdays, relative to weekends. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Data from female NCAA Division I volleyball athletes were collected across a 5-month window. Oura ring measured SD, bedtimes, and waketimes, with wellbeing ratings self-reported each morning. An analytic dataset of 1361 sleep nights from 13 athletes was constructed. Mixed-effects models examined relationships between sleep and wellbeing variables, as well as differences in these variables between preseason versus in-season and weekdays versus weekends. RESULTS: Shorter SD and earlier waketimes were associated significantly with lower self-reported mood and energy. SD was significantly longer in-season, relative to preseason (6.98 ± 0.13 hours) (7.42 ± 0.09 vs 6.98 ± 0.12 hours, < 0.01). Waketimes were significantly later in-season, relative to preseason (08:20 ± 00:08 vs 07:03 ± 00:05, < 0.01), and significantly later on weekends, relative to weekdays (08:18 ± 00:08 vs 07:37 ± 00:07, < 0.01). The shortest SD (6.91 ± 0.13 hours) and earliest waketimes (06:44 ± 00:05) occurred on weekdays during preseason. CONCLUSION: Short SD and early waketimes were associated with lower self-reported mood and energy in collegiate volleyball athletes. Athletes were most vulnerable to insufficient SD on weekdays during the preseason, seemingly as a consequence of earlier waketimes. CLINICAL RELEVANCE: Interventions to facilitate later waketimes, such as delaying early morning training times, may be useful for supporting athlete sleep health and wellbeing.
Psychological Readiness Is Related to Force Production Asymmetry, but Not Biomechanical Asymmetry After Anterior Cruciate Ligament Reconstruction: A Pilot Study.
Crowell MS, Pitt W, Florkiewicz EM … +2 more , Borawski J, Morris JB
Sports Health · 2026 Mar · PMID 41863083 · Full text
BACKGROUND: Reinjury rates and suboptimal outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by reduced psychological readiness to return to sport (RTS) and asymmetries in quadriceps...
BACKGROUND: Reinjury rates and suboptimal outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by reduced psychological readiness to return to sport (RTS) and asymmetries in quadriceps strength and jump-landing biomechanics. HYPOTHESES: ACL-Return to Sport after injury (ACL-RSI) scores, quadriceps performance, and jump landing biomechanics would be significantly associated; the ACLR group would show lower ACL-RSI scores, lower quadriceps peak torque (QuadPT) and rate of torque development (RTD), and different peak knee abduction and extension angles/moments compared with healthy controls; and those with high quadriceps function would have significantly greater ACL-RSI scores than healthy controls. STUDY DESIGN: Case-control. LEVEL OF EVIDENCE: Level 3. METHODS: Military academy cadets cleared for full sports participation after ACLR were compared with matched healthy controls. Psychological readiness was assessed using the ACL-RSI scale. Quadriceps performance was measured by QuadPT and RTD, both expressed as limb symmetry indices (LSIs). Jump-landing biomechanics were analyzed via 3-D motion capture, focusing on peak knee abduction angle/moment LSI and peak knee flexion angle/moment LSI. Pearson's correlations assessed relationships among time since surgery, psychological readiness, quadriceps performance, and biomechanics. RESULTS: This study included 35 participants after ACLR (mean time since surgery, 19.2 ± 9.6 months) and 22 healthy controls. In the ACLR group, ACL-RSI scores were correlated strongly with QuadPT LSI ( = 0.64) and RTD LSI ( = 0.55). No significant correlations were found between the ACL-RSI and jump-landing biomechanics. Participants after ACLR had significantly lower ACL-RSI scores and greater frontal plane biomechanical differences than controls. CONCLUSION: Psychological readiness was related to quadriceps performance but not with jump-landing biomechanics. Participants after ACLR exhibited lower psychological readiness and altered frontal plane biomechanics compared with healthy controls. CLINICAL RELEVANCE: Sports medicine clinicians should address reduced psychological readiness to RTS and jump landing biomechanics symmetry in patients recovering from ACLR.
From Youth Basketball to the NBA: A Matched-Pairs Follow-Up Analysis of Top-Ranked Youth Basketball Players in the USA.
Güllich A, Meisel P, Côté J … +5 more , Malina RM, Brenner JS, Hainline B, Ryan E, DiFiori J
Sports Health · 2026 Mar · PMID 41851950 · Full text
BACKGROUND: Associations of youth sport participation patterns, health, and social-environmental factors with subsequent participation in the National Basketball Association (NBA) have not been investigated systematicall...
BACKGROUND: Associations of youth sport participation patterns, health, and social-environmental factors with subsequent participation in the National Basketball Association (NBA) have not been investigated systematically. Prior studies suggest that high-performing athletes who achieve the world-class level of adult sport engaged in less organized training in their primary sport, participated in more multisport practice and competition, and incurred fewer injuries as youths compared with lower-performing adult national-class athletes. HYPOTHESIS: Players who sign an NBA player contract engaged in less organized basketball, demonstrated more multisport practice, and incurred fewer injuries as youth athletes compared with non-NBA peers. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: Top-ranked male high school basketball players (n = 627, 16.6 ± 1.3 years old) attending invitational events in the United States in 2018 and 2019 completed a questionnaire regarding participation in coach-led and nonorganized basketball and other sports, injuries, academic progress, residence relocation, and scholarship or funding. Of this sample, 40 (6%) signed an NBA player contract by age 22 years. These 40 players were matched by age, birth month, playing position, and national youth player ranking with 40 peers who did not reach the NBA. Matched-pairs analyses included , unpaired tests, tests, and binary-logistic regression (BLR). RESULTS: Youth athletes who later became NBA players reported more organized participation in sports other than basketball until age 14 years (90.0% vs 52.5%), began playing on select teams and focusing exclusively on basketball at older ages (10.7 ± 2.4 vs 9.1 ± 2.5 and 12.9 ± 2.2 vs 9.6 ± 2.5 years), and spent less time in organized and nonorganized basketball than matched non-NBA peers. NBA players also reported fewer severe injuries at ≥14 years (25.0% vs 47.5%) and were less likely to stay back in school, relocate residence, and receive scholarships/funding, respectively. BLR correctly classified 85.0% of NBA and non-NBA players. CONCLUSION: Participation in approximately 2 other sports, later specialization, less coach-led and nonorganized basketball, fewer injuries, and less disruption to academic and home life were characteristic of top-ranked youth players who later played in the NBA. CLINICAL RELEVANCE: This is the first study to investigate youth basketball participation patterns associated with reaching the NBA among top-ranked U.S. high school basketball players.
Low Vitamin D Levels Are Associated With Increased Risk of Musculoskeletal Injuries in Collegiate Athletes.
Frank AM, Joachim MR, Sanfilippo JL … +4 more , Call CJ, Hetzel SJ, Brooks MA, Spiker AM
Sports Health · 2026 · PMID 41782275 · Full text
BACKGROUND: Vitamin (Vit.) D is an essential nutrient that is both synthesized by the body and supplemented via diet. Vit. D deficiency has been found to correlate with an increase in a variety of musculoskeletal injurie...
BACKGROUND: Vitamin (Vit.) D is an essential nutrient that is both synthesized by the body and supplemented via diet. Vit. D deficiency has been found to correlate with an increase in a variety of musculoskeletal injuries. HYPOTHESIS: Lower levels of serum Vit. D would be associated with an increased number of musculoskeletal injuries in collegiate athletes. STUDY DESIGN: Routinely collected data were reviewed for 284 student athletes at a Division I Big10 University. LEVEL OF EVIDENCE: Level 4. METHODS: Serum 25-hydroxyvitamin D (25[OH]D) levels were obtained on athletes via chart review and classified as normal (≥32 ng/ml), insufficient (20-31 ng/ml) and deficient (≤19 ng/ml). Vit. D was analyzed both as a continuous variable and based on the 3-level classification. The odds of injury were estimated with mixed effects logistic regression models. RESULTS: Results showed that 47.2% of athletes were Vit. D insufficient, with 17.6% being deficient. The odds of sustaining an injury at any point during the collection period were 13% higher for each 5 ng/ml decrease in the athlete's Vit. D level (odds ratio [OR], 1.13 (1.00-1.27); = 0.05). There was no significant difference in injury time based upon Vit. D class. There was a significant negative correlation between Vit. D level and max jump height/max jump force (OR, -0.50 (-0.99, -0.02), = 0.04; -0.20 (-0.37, -0.04), = 0.01 respectively), which are clinically insignificant changes. CONCLUSION: Many collegiate athletes had insufficient or deficient Vit. D levels. Our results showed for each 5 ng/ml decrease in an athlete's Vit. D level, there was a 13% increase in odds of injury. Finally, there was no significant association between Vit. D level and athletic performance or injury recovery length. CLINICAL RELEVANCE: Vit. D deficiency and insufficiency is highly prevalent in collegiate athletes.
Injury Prediction in Football: How Artificial Intelligence Is Shaping the Present and Transforming the Future in Africa.
Gaddour M, Nticha I, Mtawaa S … +4 more , Dhahbi W, Chaabene H, Jemni S, Ben Saad H
Sports Health · 2026 · PMID 41764229 · Full text
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