Sports Health [JOURNAL]
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200 papers
The Effect of Muscle-Damaging Exercise in the Heat on Sleep.
Keefe MS, Dunn RA, Appell CR … +4 more , Jiwan NC, Luk HY, Rolloque JS, Sekiguchi Y
Sports Health · 2026 · PMID 41749466 · Full text
BACKGROUND: Sleep is negatively affected by muscle-damaging exercise, but it remains unknown whether hot environmental conditions further affect sleep. HYPOTHESIS: Sleep quality would decline, but sleep quantity would be...
BACKGROUND: Sleep is negatively affected by muscle-damaging exercise, but it remains unknown whether hot environmental conditions further affect sleep. HYPOTHESIS: Sleep quality would decline, but sleep quantity would be longer after experiencing both heat exposure and EIMD. STUDY DESIGN: Crossover study. LEVEL OF EVIDENCE: Level 3. METHODS: In a randomized, counterbalanced order, 10 healthy males (mean ± SD: age, 23 ± 3 years; body mass, 78.7 ± 11.5 kg; height, 176.9 ± 5 cm; lactate threshold [LT], 9.7 ± 1.0 km h) performed 30 min of downhill running (DHR) at -10% gradient at the LT in control (ambient temperature [], 20°C; relative humidity [RH], 20%) and hot conditions (, 35°C; RH, 40%). Seven days later, participants performed a flat 45-min run in the heat at LT. Sleep parameters were collected from a wearable device the night after DHR, the following 6 nights, and the night of the 45-min flat run. Differences in sleep parameters between conditions following DHR, the subsequent 6 nights, and the night of the 45-min run were analyzed using repeated measures analysis of variance (ANOVA). RESULTS: Following DHR, total sleep time (6.7 ± 0.7 h vs 5.2 ± 1.8 h; = 0.040), rapid eye movement (REM; 1.7 ± 0.6 h vs 1.2 ± 0.7 h; = 0.046), and slow-wave sleep (SWS; 1.6 ± 0.4 h vs 1.2 ± 0.5 h; = 0.015) were greater in the hot condition. However, REM% and SWS% did not differ ( > 0.05), indicating increases reflected longer sleep duration rather than altered architecture. Sleep efficiency, light sleep, resting heart rate, heart rate variability, and respiratory rate were also unchanged ( > 0.05). No differences were observed across the subsequent 6 nights or after the flat run ( > 0.05). CONCLUSION: Sleep duration increased on the night after muscle-damaging exercise in hot conditions, with greater REM and SWS reflecting longer sleep rather than altered architecture. CLINICAL RELEVANCE: Individuals from various populations, including athletes, military, occupational workers, and the general public may participate in exercise under heat stress, requiring awareness of potential sleep disturbances following exercise in hot conditions.
Effects of Blood Flow Restriction Walking on Distal and Contralateral Lower Limb Muscles: A Nonrandomized Clinical Trial With a Within-Subject Approach.
Cutisque LP, Silveira CC, Morozowski FW … +2 more , Moreira NB, Rodacki ALF
Sports Health · 2026 Feb · PMID 41711049 · Full text
BACKGROUND: Blood flow restriction (BFR) training effectively improves strength in muscles directly subjected to occlusion. Secondary effects on distal and contralateral muscles remain underexplored. HYPOTHESIS: A walkin...
BACKGROUND: Blood flow restriction (BFR) training effectively improves strength in muscles directly subjected to occlusion. Secondary effects on distal and contralateral muscles remain underexplored. HYPOTHESIS: A walking training program plus BFR applied to the upper thigh enhances muscle strength in distal muscles of the lower leg. STUDY DESIGN: Nonrandomized controlled clinical trial with a within-subject approach. LEVEL OF EVIDENCE: Level 1. METHODS: A total of 20 male and 12 female adults (31.1 ± 9.5 years) with ≥10% strength asymmetry in knee extensors completed 3 weekly sessions over 12 weeks. A cuff inflated at 90% of total occlusion pressure was applied to the weaker limb (exercised segment [ES]); the stronger limb served as control segment (CS). Outcomes assessed pre- and postintervention included ankle plantarflexor and dorsiflexor strength and muscle thickness (MT) (medial gastrocnemius [MG] and tibialis anterior [TA]) using isometric testing and ultrasound. RESULTS: Strength gains were identified after training in the ES and CS for the MG and TA muscles ( < 0.005 pre-to-post comparisons). In the ES, the plantarflexor and dorsiflexor torque increased from 85.6 N·m to 111.7 N·m and from 34.5 N·m to 39.6 N·m, respectively. In the CS, torque increased from 93.1 N·m to 110.5 N·m (plantarflexors) and from 35.5 N·m to 40.3 N·m (dorsiflexors). Relative improvements were greater in the ES (plantarflexor, +30.4%; dorsiflexor, +14.8%) than the CS (plantarflexor, +18.7%; TA, +13.6%), although no interactions were observed ( > 0.05). MT showed nonsignificant variation ( > 0.05). In the ES, the MG changed from 1.93 cm to 2.04 cm and TA from 2.06 cm to 2.33 cm. In the CS, the MG remained stable (1.99 cm to 2.02 cm), and TA varied from 2.12 cm to 2.35 cm. CONCLUSION: Walking combined with BFR targeting the upper thigh improves strength in distal muscles of the lower leg, with notable gains in both the occluded and contralateral segments. Neural adaptations likely account for the observed strength increases. CLINICAL RELEVANCE: BFR walking is an effective, low-impact intervention to enhance lower-limb muscle strength, with potential applications in rehabilitation and training for people with asymmetry or muscle weakness.
Analyzing the Relationship Between Aggression, Rule Violations, and Head Contact Events in Canadian Competitive Minor Bodychecking Hockey.
McFaul CS, Krbavac BP, Cutler J … +2 more , Hoshizaki TB, Robidoux MA
Sports Health · 2026 · PMID 41703967 · Full text
BACKGROUND: Hockey is an immensely popular sport in Canada, especially among youth participants. Despite evidence on the rates and risk of head injuries, especially in bodychecking contexts, little research has explored...
BACKGROUND: Hockey is an immensely popular sport in Canada, especially among youth participants. Despite evidence on the rates and risk of head injuries, especially in bodychecking contexts, little research has explored how and why injury occurs in gameplay through video observational methods. OBJECTIVE: To understand whether head contact (HC) events occur in youth bodychecking hockey as a result of play execution according to the rules, or result from violent and/or aggressive play. STUDY DESIGN: Descriptive observational video analysis. METHODS: Verified head impact data from bodychecking minor hockey in Eastern Ontario at AA/AAA levels were used. In total, 249 verified head impacts were available for analysis across 48 under-15 (U15) and under-18 (U18) games. A comprehensive video analysis of head impacts was conducted to identify whether play was: (1) penalty vs no penalty; and (2) aggressive vs nonaggressive. Penalties were evaluated based on rule definition through video analysis, rather than the referee's call on the ice. Similarly, 4 contextual definitions for aggressive/nonaggressive gameplay behaviors were established for analysis. RESULTS: Amongst the highest levels in U15 and U18 bodychecking hockey, our results demonstrate that most HC events (~68%) were the outcome of nonaggressive play and within the rules of the sport (~67%). CONCLUSION: Key findings from this study identify that HC events are mainly a result of legal and nonaggressive hockey gameplay. While the rules do penalize aggressive play, these same rules do not prevent HC from occurring in bodychecking hockey. RELEVANCE: This study adds to existing knowledge by identifying contextual factors related to potential injury events (HC) through video analysis in youth bodychecking hockey. This explains why injuries may happen, and assists in shifting research efforts towards injury prevention rather than simply documenting rates.
Which Criteria Are Used to Clear Athletes to Return to Sport After Achilles Tendon Repair? A Scoping Review.
Busà MF, Zago M, Buckthorpe M … +2 more , Esposito F, Della Villa F
Sports Health · 2026 · PMID 41703942 · Full text
CONTEXT: Achilles tendon (AT) rupture is a devastating and potentially career-ending injury. Compared with other severe lower extremity injuries, such as anterior cruciate ligament reconstruction, it is associated with l...
CONTEXT: Achilles tendon (AT) rupture is a devastating and potentially career-ending injury. Compared with other severe lower extremity injuries, such as anterior cruciate ligament reconstruction, it is associated with lower return to sport (RTS) rates, longer absence from training and competition, reduced sport-specific performance in the 2 years after rupture, shorter career length, and persistent long-term functional deficits. Therefore, better knowledge of the RTS criteria after AT rupture may support the optimization of rehabilitation outcomes and improve long-term RTS success. OBJECTIVE: The purposes of this scoping review were to (1) map the scientific evidence regarding criteria used to clear patients to RTS after surgical AT repair, and (2) describe the predominant outcome measurements reported in the literature. DATA SOURCES: Web of Science, Scopus, and MEDLINE databases. STUDY SELECTION: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework, including English-language studies published from 1995 to 2022 on "athletes" or "sportive patients" who underwent surgical AT repair. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 3. RESULTS: Of 589 studies identified, 34 met the inclusion criteria: 3% were randomized controlled trials, 50% were case series, and 47% were cohort studies. None defined an outcome measurement as a criterion to RTS. The main outcomes were timeframe from surgery to RTS (53%), ankle range of motion (47%), Achilles Tendon Rupture Score (47%), calf circumference (44%), and heel-rise test (44%). CONCLUSION: None of the 34 studies defined an outcome measurements as criteria for RTS. The main measurements focused on the early rehabilitation stage, with limited standardization and a lack of assessment for the mid- and late stages of rehabilitation. Defining RTS criteria after AT repair may help optimize rehabilitation and the RTS process.
Interlimb Asymmetry in Elite Soccer Players During Jumping and Change-of-Direction Tasks: Emphasizing Chronic Ankle Instability-Induced Contralateral Limb Deficit.
Ziaei M, Bishop C, Esmaeili H … +1 more , Zolaktaf V
Sports Health · 2026 Feb · PMID 41703927 · Full text
BACKGROUND: Chronic ankle instability (CAI) can induce contralateral limb deficits, influencing interlimb asymmetry during athletic tasks. Understanding the magnitude, direction, and individual thresholds of these asymme...
BACKGROUND: Chronic ankle instability (CAI) can induce contralateral limb deficits, influencing interlimb asymmetry during athletic tasks. Understanding the magnitude, direction, and individual thresholds of these asymmetries is critical for effective rehabilitation and performance monitoring. HYPOTHESIS: CAI-induced contralateral limb deficits significantly influence the magnitude and direction of interlimb asymmetry in jumping and change-of-direction-speed (CODS) tasks. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Male elite soccer players with (n = 32) and without (n = 38) CAI performed single-leg hop (SLH), single-leg triple hop, modified-505 (Mod505), and 90°-changes-of-direction tests. RESULTS: Paired-sample tests revealed small-to-moderate differences between dominant and nondominant limbs in both groups ( < 0.05), moderate-to-large differences between injured and contralateral uninjured limbs ( < 0.05), large differences between injured and matched limbs of healthy players ( < 0.05), and small nonsignificant differences between contralateral uninjured and matched limbs of healthy players ( > 0.05). Independent-sample test revealed asymmetries were significantly higher in all tests ( < 0.05) except for SLH ( > 0.05) in players with CAI. Kappa coefficient showed substantial-to-perfect agreements for players with CAI (κ = 0.71-1.00), and moderate-to-substantial agreements for healthy players (κ = 0.51-0.73), indicating asymmetries favored same limb. Agreement percentages for similar identifications of asymmetry patterns based on individual thresholds derived from intralimb variability revealed that injured players adopted similar patterns in CODS (81.25%), while healthy players adopted similar patterns between SLH and mod505 (76.32%). CONCLUSION: CAI-induced contralateral limb deficits influenced magnitude and direction of asymmetry, potentially underestimating asymmetry. Asymmetry consistently favors the same limb due to injury and functional similarities; thresholds derived from intralimb variability identify real asymmetry. CLINICAL RELEVANCE: These findings highlight the importance of considering contralateral limb deficits when interpreting interlimb asymmetries in players with CAI. Rehabilitation programs should address these deficits to optimize performance and reduce injury risk.
Bench-Press Performed With a Velocity- and Tempo-Based Approach: Are There Differences in Volume Load, Time Under Tension, and Metabolic Demands?
Fitas A, Miras-Moreno S, Oliveira JH … +4 more , Cidrais M, Pezarat-Correia P, Schoenfeld BJ, Mendonca GV
Sports Health · 2026 · PMID 41673807 · Full text
BACKGROUND: Velocity-based training (VBT) is a resistance training approach that uses lifting velocity to determine training load and track strength progress. This study determined the impact of a VBT versus a tempo-base...
BACKGROUND: Velocity-based training (VBT) is a resistance training approach that uses lifting velocity to determine training load and track strength progress. This study determined the impact of a VBT versus a tempo-based training (TBT) approach on volume load and time under tension during a single set of submaximal bench press performed to failure. HYPOTHESIS: VBT would result in larger volume load and similar time under tension as TBT. STUDY DESIGN: Randomized-crossover design. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 14 healthy men (24.1 ± 5.8 years) performed free-weight bench-press exercise at low intensities (12%, 16%, 20%, and 24% of 1-repetition maximum [1RM]) with oxygen uptake (O) measurements. O was then extrapolated to a set performed at 70% 1RM to failure and the accumulated O deficit was calculated together with the relative energy contribution of aerobic and anaerobic metabolism. Mechanical data were collected with a linear encoder. RESULTS: Despite the lack of differences between conditions for total time under tension ( > 0.05), VBT achieved a higher volume load at set failure ( < 0.05). Moreover, the VBT condition resulted in a larger total O from set initiation to termination ( < 0.01). Conversely, the accumulated O deficit did not differ between conditions ( > 0.05). Compared with TBT, VBT elicited a higher relative contribution of aerobic energy (VBT, ~41%; TBT, 33%) and a lower relative contribution of anaerobic energy (VBT, ~59; TBT, 67%) during exercise ( < 0.01). CONCLUSION: VBT is an effective strategy to enhance volume load during bench-press performed to failure at 70% 1RM. This effect occurs without compromising time under tension. These findings are associated with a higher contribution of aerobic energy supply to exercise. CLINICAL RELEVANCE: VBT may be beneficial for athletes aiming to maximize volume load in response to resistance exercise.
Neuroimaging Analysis of Patients With Anterior Cruciate Ligament Reconstruction: Pain-Driven Inhibition of Return to Sports.
Zhang Y, Xue X, Yang G … +4 more , Wang H, Lu R, Wang H, Hua Y
Sports Health · 2026 · PMID 41648995 · Full text
BACKGROUND: Fear of pain and reinjury significantly hinders return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). However, the neural basis of this psychological barrier remains unclear. HYPOTHES...
BACKGROUND: Fear of pain and reinjury significantly hinders return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR). However, the neural basis of this psychological barrier remains unclear. HYPOTHESIS: ACLR patients will exhibit structural and functional brain changes in regions related to pain and emotion, influencing their psychological readiness to RTS. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: We recruited 36 ACLR patients and 36 healthy controls, collecting visual analog scale (VAS) scores for knee pain, Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scores, and structural and functional magnetic resonance imaging data. RESULTS: Significant smaller gray matter (GM) volume was observed in the thalamus (effect size, -0.813), periaqueductal gray (PAG) (effect size, -0.737), and prefrontal cortex (PFC) (effect size, -0.690) in ACLR patients. We also found weakened functional connectivity between the PAG and the anterior cingulate cortex (ACC). GM volume in the thalamus was correlated positively with ACL-RSI scores ( = 0.362). Notably, the effect of VAS scores on ACL-RSI was mediated by the reduced FC between PAG and ACC (direct effect, -2.071, indirect effect, -0.826). CONCLUSION: This study reveals that the psychological readiness to RTS after ACLR may be due to peripheral nociceptive input causing changes in pain-related brain structures and functions. CLINICAL RELEVANCE: Recognizing these neuropsychological changes may guide comprehensive rehabilitation strategies post-ACLR, emphasizing the need for interventions targeting central neural mechanisms alongside physical recovery.
Posterior Knee TGCT (Formerly PVNS) Masquerading as a Popliteal Lesion: Combined Arthroscopic Synovectomy and Posterior Open Excision With 8-Year Disease-Free Follow-Up.
Kougioumtzis I, Papageorgiou P, Kanakis D … +6 more , Ververidis N, Tottas S, Gravvanis N, Iliopoulos E, Drosos G, Stamatis A
Sports Health · 2026 · PMID 41634530 · Full text
Tenosynovial giant cell tumor (TGCT), formerly pigmented villonodular synovitis (PVNS), may extend into the popliteal fossa and mimic a Baker cyst, complicating diagnosis and operative planning. A 53-year-old former endu...
Tenosynovial giant cell tumor (TGCT), formerly pigmented villonodular synovitis (PVNS), may extend into the popliteal fossa and mimic a Baker cyst, complicating diagnosis and operative planning. A 53-year-old former endurance runner presented with posterior knee pain, swelling, intermittent locking, and a palpable popliteal mass. Examination demonstrated effusion and limited range of motion; weightbearing radiographs showed mild osteoarthritic change with effusion, and magnetic resonance imaging (MRI) revealed synovial hypertrophy with low T2 signal suggestive of hemosiderin deposition. Arthroscopic synovectomy via 4 anterior and 2 posterior portals was performed; histology confirmed diffuse, nonmalignant TGCT. Given persistent posterior disease, a staged posterior open approach (lazy-S incision) enabled en bloc excision of the extra-articular component. Adjuvant radiosynoviorthesis (intra-articular yttrium-90) was administered. At 8-year follow-up, there was no clinical or radiographic evidence of disease. This case emphasizes MRI recognition of hemosiderin-related low T2 signal, the value of combining arthroscopic synovectomy with posterior open excision in diffuse disease with popliteal extension, and selective use of adjuvant radiosynoviorthesis for durability.
Testosterone-Optimizing Strategies in Athletes.
Lazarev A, Pujalte GGA, Philibert C … +5 more , Meek SE, Broderick GA, Zapp DG, Mayo MR, Hackney AC
Sports Health · 2026 · PMID 41630126 · Full text
CONTEXT: Testosterone is a steroid hormone produced primarily in the testes in men and ovaries in women, playing crucial roles in androgenic, anabolic, and psychological functions, including muscle growth, bone formation...
CONTEXT: Testosterone is a steroid hormone produced primarily in the testes in men and ovaries in women, playing crucial roles in androgenic, anabolic, and psychological functions, including muscle growth, bone formation, erythropoiesis, risk-taking, and aggression, making it important for athletes. Sports performance is linked closely to testosterone level, prompting athletes to explore legal and illegal ways to boost testosterone. This review examines testosterone physiology and legal strategies for optimizing testosterone levels in athletes, as well as their practical applications. EVIDENCE ACQUISITION: Database search. STUDY DESIGN: Narrative review. LEVEL OF EVIDENCE: Level 5. RESULTS: Maintaining healthy testosterone levels requires energy balance and optimal nutrition with adequate macronutrients and micronutrients, especially for athletes prone to dieting and food restriction. Testosterone boosters are marketed widely but lack strong evidence for efficacy and may pose risks. While some substances show promise, further research is needed. Sleep is critical as testosterone secretion is linked to the rapid eye movement phase, highlighting the need for proper sleep hygiene and addressing sleep disorders. Moderate-to-high intensity free-weight resistance exercises are most effective for increasing testosterone, while the effects of sexual activity remain unclear. Endocrine-disrupting chemicals can lower testosterone levels and should be avoided. While cold-water immersion may decrease testosterone, sauna bathing appears to be neutral. Radiofrequency electromagnetic radiation from modern electronic devices may harm the hypothalamic-pituitary-gonadal axis, warranting limited use. Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs and acetaminophen, may decrease testosterone levels, suggesting cautious use. Seasonal changes in testosterone levels require further study. Testosterone-optimizing strategies excluding banned substances may aid in treating functional low testosterone or reducing harm in anabolic-androgenic steroid users. CONCLUSION: Educating athletes on safe and effective strategies to increase testosterone is crucial, with ongoing research needed to explore additional methods.Strength-of-Recommendation Taxonomy:B.
Relationship Between Sport Specialization and Short-Term Health-Related Quality of Life in Youth Athletes After Injury.
Stover D, Verma R, DeMaio E … +6 more , Render A, Shenvi N, Easley KA, Stracciolini A, Jayanthi N, LaBella C
Sports Health · 2026 Feb · PMID 41629770 · Full text
BACKGROUND: Researchers have examined associations between sport specialization and injury. However, no studies have investigated associations between sport specialization and health-related quality of life (HRQoL) after...
BACKGROUND: Researchers have examined associations between sport specialization and injury. However, no studies have investigated associations between sport specialization and health-related quality of life (HRQoL) after injury. HYPOTHESIS: Among injured youth athletes, level of sport specialization is not associated with differences in HRQoL approximately 1 month after sport-related injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: A multicenter, cross-sectional study was performed at 3 primary care sports medicine clinics. Eligible 8- to 18-year-old athletes who presented for musculoskeletal injury or concussion were enrolled. At the initial clinic visit, patients completed the Player Development Survey (PDS) to determine sport specialization level. Approximately 1 month after enrollment, patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) to determine HRQoL measures. RESULTS: Of 720 athletes invited to participate, 336 (age, 14.2 ± 2.4 years) completed the PDS and PROMIS surveys; 22% were highly specialized, 39% were moderately specialized, and 39% were low specialized athletes. Overall, there were no differences in HRQoL scores across the 3 levels of sport specialization. In subgroup analysis based on sex, female HRQoL scores were worse than male HRQoL scores irrespective of sport specialization level in 3 categories: pain interference (mean difference between female and male scores [± SEM] = 2.3 ± 1.1; = 0.04), depression/sadness (2.9 ± 1.1; = 0.01), and anxiety/fear (2.8 ± 1.2; = 0.02). CONCLUSION: Higher level of sport specialization is not associated with worse HRQoL approximately 1 month after sport-related injury. Female athletes have worse short-term HRQoL after an injury irrespective of sport specialization level. While sex differences were statistically significant, the magnitude of differences was small. CLINICAL RELEVANCE: Sport specialization is not associated with differences in HRQoL after injury. Injured female athletes may need closer monitoring due to possibly worse short-term HRQoL, but further investigation is needed.
The Impact of Ankle Injuries on Postural Stability and Balance Control Among Athletes: A Systematic Review.
Gasavi Nezhad Z, Arazpour M
Sports Health · 2026 Feb · PMID 41622590 · Full text
CONTEXT: Ankle injuries are common in athletes and can significantly impair postural stability. Balance deficits may vary with the type of injury and the specific biomechanical demands of the sport. OBJECTIVE: To evaluat...
CONTEXT: Ankle injuries are common in athletes and can significantly impair postural stability. Balance deficits may vary with the type of injury and the specific biomechanical demands of the sport. OBJECTIVE: To evaluate systematically how different types of ankle injuries affect postural stability in athletes by classifying and comparing findings across distinct sport archetypes (eg, multidirectional, linear, balance-focused) to identify sport-specific impairments. DATA SOURCES: A search was conducted in PubMed, Scopus, Embase, and Web of Science from inception up to August 31, 2025, for observational studies assessing postural stability in athletes with ankle injuries. STUDY SELECTION: Studies published in any language were included if they assessed postural stability in athletes with ankle injuries. Data were extracted independently by 2 authors, and any disagreements were resolved through discussion. Study quality was assessed using Joanna Briggs Institute checklists (cross-sectional: 8-item; cohort: 11-item; case-control: 10-item). Reporting quality was evaluated using the STROBE checklist. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Data were extracted on static and dynamic balance (DB), including postural sway, center of pressure, stabilization times, and reach distances in the Star Excursion Balance Test (SEBT) and Y Balance Test (YBT). RESULTS: A total of 59 studies involving 4848 participants were included. Most participants were youth (61%, aged 19-29 years) and adolescent (32%, aged 12-18 years) athletes, with a limited focus on female-only cohorts (6.7% of studies). Athletes with ankle injuries showed deficits in static and DB, with chronic ankle instability (CAI) causing persistent impairments in stabilization times and reduced reach in the SEBT/YBT. Pivoting sports (eg, soccer, basketball) exhibited greater balance deficits than endurance or balance-focused sports. CONCLUSION: Ankle injuries, particularly CAI, result in significant balance impairments, necessitating sport-specific rehabilitation addressing both distal and proximal neuromuscular control. Static tests may underestimate functional deficits.
Injuries in Sail GP Season 4.
Fallon T, Rousselon H, Deakin J … +2 more , Fernandez M, Heron N
Sports Health · 2026 · PMID 41603119 · Full text
This infographic summarizes the first prospective injury and illness surveillance study in Sail Grand Prix (SailGP) during Season 4 (2023-2024). Monitoring 100 professional athletes across 4919.84 sailing hours, the stud...
This infographic summarizes the first prospective injury and illness surveillance study in Sail Grand Prix (SailGP) during Season 4 (2023-2024). Monitoring 100 professional athletes across 4919.84 sailing hours, the study found an overall injury rate of 9.96 per 1000 hours-higher during racing (11.89) and particularly during foiling activities (26.52). Lower limb injuries, especially to the ankle and knee, were most common, with grinders showing the highest positional injury incidence. Illness, mainly respiratory in nature, occurred at 5.14 per 1000 hours. These findings highlight the physical demands and health risks of elite foiling, informing targeted prevention, conditioning, and safety strategies in SailGP.
Prognostic Value of Conventional Ultrasound and MRI Features for Clinical Outcomes in Athletes With Patellar Tendinopathy After Exercise Therapy.
Deng J, Breda SJ, Fang Y … +3 more , Eygendaal D, de Vos RJ, Oei EHG
Sports Health · 2026 · PMID 41588720 · Full text
BACKGROUND: Structural abnormalities assessed with conventional ultrasound (US) or magnetic resonance imaging (MRI) are associated with the risk of developing patellar tendinopathy (PT). However, their prognostic value f...
BACKGROUND: Structural abnormalities assessed with conventional ultrasound (US) or magnetic resonance imaging (MRI) are associated with the risk of developing patellar tendinopathy (PT). However, their prognostic value for athletes with PT performing exercise therapy remains unclear. HYPOTHESIS: Baseline imaging features could be associated with changes in pain and disability over 24 weeks in athletes with PT after exercise treatment. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level II. METHODS: Athletes with PT were randomly allocated to 2 different programs of exercise therapy for 24 weeks. Imaging features at baseline included patellar tendon thickness, intratendinous calcifications, patellar erosions, and Doppler flow on US, as well as tendon fiber disruption, infrapatellar fat pad (IFP) edema, bone marrow edema, and deep infrapatellar bursitis on MRI scan. Clinical outcomes were measured at baseline, and at 12- and 24-week follow-up, using the visual analog scale after single-leg squat (VAS-SLDS) for pain on loading, and Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire for disability. Linear mixed-effects models, incorporating interaction terms tested using likelihood ratio tests, evaluated the prognostic value of baseline imaging features. RESULTS: Of 76 included athletes (58 male, 18 female; average age, 24 ± 4 years), abnormal US features were identified in 26% to 78% of cases. Among 72 MRI scans analyzed, abnormal features were demonstrated in 43% to 81% of cases. No significant associations were identified between individual imaging features and 24-week changes in VAS-SLDS or VISA-P scores (all > 0.10), or between the total number of imaging abnormalities and clinical outcomes (all > 0.50). CONCLUSION: There was no evidence of an association between baseline abnormalities assessed using conventional US or MRI and 24-week changes in pain or disability among athletes with PT undergoing exercise therapy. CLINICAL RELEVANCE: Healthcare professionals should avoid relying on conventional imaging findings to predict prognosis.
A 25-Year Analysis of Athlete Mortality in the United States: Causes, Trends, and the Role of Resource Disparities.
Dayal D, Harrell M, Rahaman C … +4 more , Berta C, Manush A, Casp A, Momaya A
Sports Health · 2026 Jan · PMID 41572729 · Full text
BACKGROUND: Despite advancements in preparticipation physical examinations and cardiovascular evaluations, sport-related mortality persists. This study assesses athlete mortality over 25 years, stratifying data by sport,...
BACKGROUND: Despite advancements in preparticipation physical examinations and cardiovascular evaluations, sport-related mortality persists. This study assesses athlete mortality over 25 years, stratifying data by sport, state, cause of death, socioeconomic factors, and age. HYPOTHESIS: Most athlete mortality would be due to sudden cardiac death (SCD) and occurred in contact sports in low-resource communities. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: A retrospective search of athlete deaths occurring during games or practice from 1999 to 2024 was conducted using an online search engine (https://www.google.com/). Inclusion criteria required deaths to be related directly to athletic activity. Unrelated cases were excluded. The socioeconomic status of athletes was determined through the area deprivation index (ADI). Poisson regression was used to compare mortality rates with respect to sport type and region. RESULTS: A total of 593 athlete deaths were recorded, with a mean age of 16.2 years (range, 5-43). Most deaths occurred in male athletes (92%), at the high school level (70%), and during football participation (65%). Cardiovascular events were the leading cause of death (51%), followed by neurological causes (18%), and exertional heat stroke (11%). Mortality was highest during practice (69%) and was significantly more frequent in rural areas ( < 0.001). States with the highest mortality rates had an average national ADI of 67.8, indicating moderate socioeconomic deprivation, while states with the lowest mortality rates had an average ADI of 43.8. Exertional heat stroke accounted for 87.5% of deaths in football and was most prevalent in the South Atlantic region ( < 0.001). CONCLUSION: Football had the highest rate of all-cause athlete mortality, driven by cardiovascular events, traumatic brain injuries, and exertional heat stroke. Mortality was disproportionately higher in rural areas during practice. CLINICAL RELEVANCE: Higher mortality rates correlated positively with greater socioeconomic deprivation, as indicated by ADI values.
What Do Upper-Extremity Physical Performance Tests Measure? Insights From a Descriptive Electromyographical Study.
Borms D, Stubbe J, Horsley I … +1 more , Declève P
Sports Health · 2026 · PMID 41572425 · Full text
BACKGROUND: Physical performance tests (PPTs) require athletes to complete a physical activity essential to their sports performance. Evaluating associated electromyographical requirements enables clinicians to select ap...
BACKGROUND: Physical performance tests (PPTs) require athletes to complete a physical activity essential to their sports performance. Evaluating associated electromyographical requirements enables clinicians to select appropriate tests for their athletes' specific needs. HYPOTHESIS: Shoulder muscle activity differs between tests. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 4. METHODS: Thirty asymptomatic overhead athletes (17 women, 13 men; mean age, 20.3 ± 1.7 years) performed 4 upper-extremity PPTs: Y-balance test-upper quarter (YBT-UQ), closed kinetic chain upper extremity stability test (CKCUEST), upper limb rotation test (ULRT), and shoulder endurance test (SET). Surface electromyography, expressed as a percentage of the maximal isometric voluntary contraction, was used to measure muscle activity in upper, middle, and lower trapezius, serratus anterior, infraspinatus, and posterior deltoid on both sides. Only the supporting arm (ie, in closed chain) was considered for analysis. RESULTS: During the YBT-UQ, serratus anterior and infraspinatus activity was highest during all reach directions. Serratus anterior showed the highest activity when supporting the medial and inferolateral reach (range, 72.7-95%). The infraspinatus was most active when supporting the superolateral reach (range, 92-129.2%). During the CKCUEST, all muscles were moderate to highly active, with the serratus anterior (range, 77.5-78.8%) and infraspinatus (range, 64.1-64.7%) being most active. All muscles demonstrated moderate-to-high activity during the ULRT, with the highest activity in posterior deltoid, infraspinatus, and serratus anterior. For the SET, muscle activity progressively increased with increasing speed. CONCLUSION: Serratus anterior and infraspinatus activity was high across all tests, with the greatest activity during the YBT-UQ and CKCUEST. The ULRT elicited the highest posterior deltoid activity. CLINICAL RELEVANCE: Our findings offer clinicians specific electromyographical insights, facilitating appropriate test selection for screening and return to sport.
Mapping the Existing Return-to-Sport Criteria After Pectoralis Major Tendon Injury in Different Sports: A Scoping Review for Getting Back to the Game.
Sharma S, Whiteley R, Rani B … +3 more , Sartori S, Sharma H, Gabbett TJ
Sports Health · 2026 · PMID 41568786 · Full text
CONTEXT: It is estimated that only 50% of athletes who sustain pectoralis major tendon injuries return to sport (RTS) despite successful treatment. This limited RTS rate may be due to absence of standardized RTS criteria...
CONTEXT: It is estimated that only 50% of athletes who sustain pectoralis major tendon injuries return to sport (RTS) despite successful treatment. This limited RTS rate may be due to absence of standardized RTS criteria for such patients. Evidence suggests a significant heterogeneity in RTS guidance across various studies, leading to inconsistency in clinical advice. OBJECTIVE: To examine the existing RTS criteria used in pectoralis major tendon injury in different sporting populations. DATA SOURCES: A comprehensive literature search with defined keywords was conducted in electronic databases including PubMed, Scopus, EBSCO (via CINAHL complete), Web of Science, Embase, and grey literature (e.g., Opengrey.com) to include studies published from inception until May 2024. STUDY SELECTION: Studies investigating the RTS outcome after pectoralis major injury managed surgically and/or conservatively in various sporting athletes were included. All studies included were in English language. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Details of population age, sex, type of sports, injury mechanism (contact/noncontact), management technique, rehabilitation protocol, outcomes assessed, RTS criteria used, mean RTS duration, number of athletes returned to play, athletes reaching preinjury performance level, and re-injury rate were extracted. RESULTS: The literature search identified 1707 studies; 39 studies were included for the final review. A total of 1129 injured athletes (1 female were recorded from the included studies with a mean age of 30.1 years. Regarding RTS criteria, no established criterion for this injury exists in the literature. Strength assessment, range of motion, functional outcomes, and pain were the measures used most in clearing the athlete to continue sport. CONCLUSION: Despite the increasing number of athletes sustaining this injury, current evidence reports marked variability in RTS recommendations, with no universally accepted or validated criteria identified. Therefore, for now, both objective and subjective parameters should be used to aid RTS decision making.
Knee Injury in Competitive Brazilian Jiu Jitsu Athletes: Implications for Training.
Piekarski M, Kreiswirth E, Barber Foss K … +3 more , Jimenez ML, Myer GD, Montalvo AM
Sports Health · 2026 · PMID 41549501 · Full text
BACKGROUND: The "heel hook" is a debilitating, high-percentage submission move in Brazilian jiu jitsu. While evidence suggests that the heel hook can result in severe ligamentous damage to the knee and/or ankle, definiti...
BACKGROUND: The "heel hook" is a debilitating, high-percentage submission move in Brazilian jiu jitsu. While evidence suggests that the heel hook can result in severe ligamentous damage to the knee and/or ankle, definitive data on injuries from this technique are lacking. The purpose of this study was to assess the safety of the heel hook by comparing the incidence of knee and ankle injuries in International Brazilian Jiu Jitsu Federation (IBJJF) competitions where the move was permitted versus banned. HYPOTHESIS: Knee and ankle injury incidence will be higher in those exposed to the heel hook relative to those not exposed to the heel hook during competition. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 4. METHODS: Using data from 303 adult (<30 years old) and 455 masters (≥30 years old) division brown and black belt IBJJF competitors from 2021, and 164 adult brown and black belt competitors from 2009, we calculated injury frequencies, incidence rates per 1000 matches, and incidence rate ratios resulting from submission holds, emphasizing the heel hook. RESULTS: In 2021 (heel-hook-legal), knee injury incidence rate in exposed competitors was 26.5 per 1000 matches, while knee injury incidence rate in unexposed competitors was 2.2 per 1000 matches (relative risk [RR], 12.0; 95% CI, 1.5, 96.1; < 0.001). There was no significant difference in ankle injury incidence in exposed (19.8 injuries per 1000 matches) versus unexposed (8.8 injuries per 1000 matches) competitors. There were no significant differences in ankle or knee injury incidence when comparing injury rates between athletes in 2009 and 2021. CONCLUSION: Our findings indicate the heel hook significantly increased risk of knee injury. CLINICAL RELEVANCE: Competitive BJJ athletes should engage in skill training to mitigate knee injury risk.
Developing a Repetition-Based Inter-Set Rest Adjustment Method in Resistance Training.
Zhang X, Chen Z, Li H … +3 more , Weakley J, Li Z, García-Ramos A
Sports Health · 2026 · PMID 41549493 · Full text
BACKGROUND: This study aimed to develop an objective, repetition-based method for inter-set rest adjustment in resistance training (RT), addressing limitations of fixed and self-selected intervals. HYPOTHESIS: The adjust...
BACKGROUND: This study aimed to develop an objective, repetition-based method for inter-set rest adjustment in resistance training (RT), addressing limitations of fixed and self-selected intervals. HYPOTHESIS: The adjustable protocol would yield greater repetition volume, higher velocity, and lower fatigue than the fixed protocol, with reduced time cost compared with the self-selected protocol. STUDY DESIGN: Crossover randomized trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 20 young adults completed 3 RT protocols in randomized order: fixed, self-selected, and adjustable. Each protocol involved 5 sets of bench press and bench pull at approximately 75% 1 repetition maximal, performed close to failure. The protocols differed in inter-set rest strategy: fixed (3-minute rest), self-selected (participant-determined), and adjustable (based on previous set repetition count). RESULTS: Our findings indicated that the self-selected and adjustable protocols resulted in significantly greater repetition volume compared with the fixed protocol ( = 7.0; = 0.003). Although the self-selected and adjustable protocols exhibited significantly higher fastest set velocity than the fixed protocol ( = 3.5, = 0.04), the practical difference was only 0.01 m/s. In addition, no significant main effects of protocol were observed in mean set velocity, blood lactate concentration, or perceived exertion ( = 1.1-2.4; = 0.10-0.58). In terms of time efficiency, the fixed protocol was the most efficient, followed by the adjustable protocol, with the self-selected protocol being the least efficient. CONCLUSION: People using the adjustable protocol achieved greater repetition volume without increased metabolic stress or perceived exertion compared with the fixed 3-minute rest. Although the adjustable protocol sacrifices some time efficiency compared with the fixed protocol, it remains more efficient than the self-selected approach. CLINICAL RELEVANCE: The repetition-based inter-set rest adjustment approach can serve as a feasible alternative to both fixed and self-selected inter-set rest approaches in RT.
A Biomechanical Analysis of Lead Hip Flexion in Professional Baseball Pitchers.
Manzi J, Dowling B, Chow J … +6 more , Brusalis CM, Kew ME, Bharam S, Gulotta LV, Dines JS, Carr JB
Sports Health · 2026 · PMID 41549491 · Full text
BACKGROUND: Deficits in passive range of motion (ROM) and strength of the lead hip during the pitch among professional baseball pitchers are associated with increased injury risk to the core, groin, and throwing shoulder...
BACKGROUND: Deficits in passive range of motion (ROM) and strength of the lead hip during the pitch among professional baseball pitchers are associated with increased injury risk to the core, groin, and throwing shoulder. HYPOTHESIS: A positive, linear relationship will link lead hip flexion at maximum shoulder external rotation (MER) with pitch velocity. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: Professional pitchers were divided into Low (<85°, n = 122), Moderate (85-95°, n = 137), and High (>95°, n = 80) groups based on lead hip flexion at MER, and pitched fastballs while using 3-dimensional motion capture (480 Hz). RESULTS: Pitchers in the Low, Moderate, and High groups did not significantly differ in age ( = 0.16), weight ( = 0.08), height ( = 0.36), or throwing hand ( = 0.54). Low pitchers had significantly less MER compared with High pitchers ( = 0.04); shorter stride length than Moderate and High pitchers ( < 0.001); greater lead knee extension velocity than High pitchers ( = 0.007); and less lead knee flexion at ball release than Moderate and High pitchers ( < 0.001). Low pitchers had greater shoulder anterior force, elbow anterior force, and elbow flexion torque compared with Moderate pitchers. Lead hip flexion at MER was not predictive in group ( = 0.89) or univariate analysis ( = 0.43) for ball velocity. CONCLUSION: This study provides normative values for lead hip flexion angles throughout the pitch. Pitchers with moderate lead hip flexion at MER demonstrated significantly less shoulder anterior force, elbow anterior force, and elbow flexion torque compared with other groups, with no significant relationship with biomechanical efficiency or ball velocity. CLINICAL RELEVANCE: Pitchers appear to benefit from maintaining lead hip flexion within an appropriate range at MER, near 90°, as either too much or too little can be disadventagous.
Metabolic Workup for Bone Stress Injury: A Practical Approach for Evaluating Bone Health in Athletes.
Nye NS, Kasper K, Hoang TD … +6 more , Gee S, McClung JP, Crutchfield A, Childress M, Tenforde AS, Boden B
Sports Health · 2026 · PMID 41549475 · Full text
CONTEXT: This review synthesizes current literature regarding metabolic aspects of athlete bone health and incorporates evidence-based recommendations into a clinician-friendly algorithm. EVIDENCE ACQUISITION: Published...
CONTEXT: This review synthesizes current literature regarding metabolic aspects of athlete bone health and incorporates evidence-based recommendations into a clinician-friendly algorithm. EVIDENCE ACQUISITION: Published manuscripts listed in PubMed between 1993 and 2024 were reviewed. Relevant terms including keywords and section titles of manuscripts were searched, and relevant studies identified. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 1-3. RESULTS: A metabolic workup is often appropriate in the context of an athlete with bone stress injury (BSI) but varies based on clinical scenario. Evidence supports that all athletes with BSI be considered for a minimum workup including 25-hydroxyvitamin D (SORT A), complete blood count (CBC) (SORT B), and an iron panel with ferritin (SORT B). Athletes with features of low energy availability, including ≥2 Triad risk factors (low body mass index, abnormal uterine bleeding), or with multiple features of relative energy deficiency in sport require an initial strategy to correct energy availability (increased energy intake and/or decreased training load) and should be considered for dual-energy x-ray absorptiometry (DXA) (SORT A) and additional laboratory testing. If there is persistent clinical concern, a comprehensive laboratory evaluation should be considered, and varies based on athlete sex and clinical context. People with recurrent or multiple BSI or requiring surgical fixation also warrant detailed, stepwise testing for underlying causes (SORT C). A reasonable strategy starts with a focused workup for more common conditions (eg, CBC, complete metabolic panel, iron panel, 25-OH vitamin D, DXA) and may expand based on initial findings and clinical suspicion. CONCLUSION: Existing evidence supports optimizing nutrition and further evaluation for factors influencing bone health for all athletes with BSI. More extensive workup is required in athletes with multiple features of low energy availability, multiple/recurrent BSI, BSI requiring surgical fixation, and signs/symptoms of an underlying medical disorder.Strength-of-Recommendation Taxonomy (SORT):A, B, C.
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