Sports Health [JOURNAL]
Sun
200 papers
A Systematic Review of the Star Excursion Balance Test to Define Clinically Meaningful Psychometric Values.
Zhang Y, Pei S, Martin RL
Sports Health · 2026 · PMID 41320880 · Full text
CONTEXT: The Star Excursion Balance Test (SEBT) is recognized for simultaneously assessing strength, range of motion (ROM), balance, neuromuscular control, and functional performance of the lower extremity. Although ther...
CONTEXT: The Star Excursion Balance Test (SEBT) is recognized for simultaneously assessing strength, range of motion (ROM), balance, neuromuscular control, and functional performance of the lower extremity. Although there is evidence to support the SEBT, a contemporary systematic review to define its clinically relevant psychometric properties is needed. OBJECTIVE: To define clinically relevant psychometric values for the SEBT. DATA SOURCES: PubMed, Embase, Medline, CINAHL, SPORTDiscus, and Scopus databases were searched from database inception through November 2023. STUDY SELECTION: Clinical studies reporting reliability, validity, and responsiveness of SEBT were included. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Intra-class correlation coefficient (ICC), minimal detectable difference (MDD), minimal detectable change (MDC), evidence of validity, and minimal clinically important difference (MCID) values were recorded. RESULTS: Out of 3982 identified studies, a total of 102 were included; 20 studies of reliability found the SEBT to have ICC values ranging from 0.51 to 0.99. Out of these 20 studies, 5 reported MDC or MDD values in an injured population. Based on these studies, a standardized protocol for SEBT was compiled. A total of 81 studies of validity found that the SEBT could differentiate reaching distances between healthy people and those with lower extremity injuries with correlations with patient-report outcome measure, functional performance test, muscle strength, muscle activation, ROM, and motor strategies. One study of responsiveness identified MCID values of 4.2 cm to 10.9 cm for SEBT in the 2 weeks after anterior cruciate ligament reconstruction. CONCLUSION: The reliability, validity, and responsiveness with MDD, MDC, and MCID values for the SEBT can be used in clinical practice.
Tennis 10+ Warm-Up and Cool-Down Program: A 1-Year Longitudinal Analysis of Compliance and Injury Rates in Adult Recreational Tennis Players.
Render A, Mullins M, Avant L … +3 more , Shenvi N, Tran T, Jayanthi N
Sports Health · 2026 · PMID 41305878 · Full text
BACKGROUND: Injury prevalence among adult recreational tennis players may be >50%, involving injuries to upper extremity, lower extremity, and trunk. No standardized on-court warm-up/cool-down program has demonstrated im...
BACKGROUND: Injury prevalence among adult recreational tennis players may be >50%, involving injuries to upper extremity, lower extremity, and trunk. No standardized on-court warm-up/cool-down program has demonstrated improved compliance and injury reduction in this population. HYPOTHESIS: Compliance with the Tennis 10+ warm-up/cool-down program in adult recreational tennis players will improve over time. High compliance with Tennis 10+ will show reduced injury rates versus low compliance over the 1-year study period. STUDY DESIGN: Longitudinal cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Adult recreational tennis players actively participating in a tennis league and/or competitive tennis were included. Level of compliance by time, injury rate, injury type, sex, and age were assessed at baseline, and at 3, 6, 9, and 12 months. Association between variables was assessed by a 2-sample test or chi-squared statistical test. RESULTS: A total of 317 adult recreational tennis players (age, 18-75 years [mean, 48]) completed enrollment. Compliance levels improved significantly over time ( = 0.01). Men ( = 0.02) and players aged 39 to 50 years ( < 0.01) showed a significantly higher level of compliance over time. There were no differences in injury rates between low and high compliance groups, except at 12 months, when high compliance was associated with a significant decrease in injury frequency and overuse injuries ( = 0.01). CONCLUSION: Compliance with the Tennis 10+ warm-up/cool-down program improved from baseline, especially with men and people aged 39 to 50 years. High compliance with Tennis 10+ was not associated with lower overall injury rates, except lower overuse injury rates at 12 months. CLINICAL RELEVANCE: Tennis 10+ can be implemented as an on-court method before and after tennis play to effectively reduce barriers to warm-up/cool-down in adult recreational tennis players. Further study is necessary to identify the significance of injury reduction with program compliance.
Noncompleted Matches in Professional Women's Tennis (1975-2024): Epidemiology, Trends, and Associated Factors of Walkovers and Defaults.
Peña V, Baiget E, Pluim BM … +1 more , Casals M
Sports Health · 2026 · PMID 41272923 · Full text
BACKGROUND: Walkovers (WOs) and Defaults are significant occurrences in professional tennis, leading to uncompleted matches. WOs typically result from injuries, illnesses, or unforeseen circumstances, while Defaults stem...
BACKGROUND: Walkovers (WOs) and Defaults are significant occurrences in professional tennis, leading to uncompleted matches. WOs typically result from injuries, illnesses, or unforeseen circumstances, while Defaults stem from code of conduct violations. Understanding their epidemiology is essential for optimizing competition structure and injury prevention strategies. HYPOTHESES: The incidence of WOs in Women's Tennis Association (WTA) tournaments increases over time. Both WOs and Defaults are associated with competition-related factors. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 706,816 singles matches from WTA tournaments between 1975 and 2024 were analyzed. To assess the occurrence of WOs and Defaults, potential associated factors were analyzed using absolute and relative epidemiological measures. RESULTS: The overall incidence of WOs was 5.3 per 1000 matches (95% CI, 5.13-5.47), with a slight increase observed in recent years. The WTA Tour recorded the highest incidence (incidence proportion [IP], 5.62; 95% CI, 5.28-5.98). WOs were most frequent in qualifying rounds (IP, 8.09; 95% CI, 7.66-8.55), final rounds (IP, 7.22; 95% CI, 6.75-7.73), and on carpet courts (IP, 7.21; 95% CI, 6.39-8.11). Defaults were extremely rare, with an overall incidence of 0.15 per 1000 matches (95% CI, 0.12-0.18). The highest Default incidence was recorded in qualifying rounds (IP, 0.20; 95% CI, 0.14-0.28) and was most frequent on hard courts (IP, 0.17; 95% CI, 0.13-0.22). CONCLUSION: Competitive structure and playing surface play a role in the occurrence of WOs and Defaults. These findings underscore the importance of injury prevention strategies, fair play policies, and player support systems to minimize disruptions in competition. CLINICAL RELEVANCE: Understanding the epidemiology of WOs and Defaults can help inform injury prevention strategies, optimize tournament formats, and guide policy development to reduce uncompleted matches in the WTA.
Early Sport Specialization and Intense Training in Junior Tennis Players: A Sport-Specific Review.
Thurber L, Kantrowitz DE, Wang KC … +2 more , Jayanthi N, Colvin A
Sports Health · 2026 · PMID 41272920 · Full text
CONTEXT: Early sports participation can provide significant physical, psychosocial, and mental benefits for young athletes. Sports engagement can be via sport sampling or sport specialization. Sport specialization is oft...
CONTEXT: Early sports participation can provide significant physical, psychosocial, and mental benefits for young athletes. Sports engagement can be via sport sampling or sport specialization. Sport specialization is often encouraged by parents and coaches as it is perceived as a mechanism for achieving elite level play, particularly in tennis. EVIDENCE ACQUISITION: A search on PubMed, Google Scholar, and Science Direct was conducted for pertinent peer-reviewed studies on sport specialization and overuse injuries in youth athletics and junior tennis using key terms including "junior tennis," "youth sports," "sport specialization," and "overuse injury." STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 5. RESULTS: Early sport specialization leads to increased injury risk, decreased athletic career longevity, and higher incidence of burnout without demonstrating significant benefits in terms of improving peak sports performance or the likelihood of reaching elite play. CONCLUSION: Youth athletes should avoid specializing in a single sport before age 12, avoid training more hours per week than their age in years, and limit training to 16 hours per week maximum. Specific to tennis, junior players should be at least 12 years old for tournament play, compete in no more than 2 tournaments per month or 12 per year, engage in a maximum of 12 hours per week of organized tennis, a minimum of 2 hours per week of injury prevention training, and consider another off-season sport. Injury may be more likely with early sport specialization, early intense training (before middle or late adolescence) and annual match volume (>40 matches annually). Finally, we provide novel recommendations for safe volumes of training, matches, and tournaments for junior tennis players based on their age and level of play.Strength-of-Recommendation Taxonomy (SORT):B - recommendations based on inconsistent or limited-quality patient-oriented evidence.
Utilization of Rehabilitation Visits and Functional Testing After Anterior Cruciate Ligament Reconstruction.
Chmielewski TL, Lange AJ, Shervheim C … +3 more , Bouche M, Yungtum W, Cooper C
Sports Health · 2026 · PMID 41272494 · Full text
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction guidelines recommend delaying return to sport until 9 months postsurgery and using functional testing to inform clinical decision-making. HYPOTHESIS: Regular re...
BACKGROUND: Anterior cruciate ligament (ACL) reconstruction guidelines recommend delaying return to sport until 9 months postsurgery and using functional testing to inform clinical decision-making. HYPOTHESIS: Regular rehabilitation visits would continue up to 9 months postsurgery, and most patients would receive functional testing. STUDY DESIGN: Retrospective study. LEVEL OF EVIDENCE: Level 4. METHODS: Electronic medical records were reviewed for 338 patients, aged 14 to 21 years, who participated in sports preinjury and had primary ACL reconstruction between January 2017 and December 2018. Of these, 124 patients had all rehabilitation in-system. Rehabilitation visits and time to end of rehabilitation were examined through 12 months postsurgery. The proportion of patients who participated in return-to-sport training, received functional testing, and remained active in rehabilitation up to 9 months postsurgery was calculated. RESULTS: Of the total rehabilitation visits, 58.9% occurred in the first 3 months postsurgery. The mean time to end of rehabilitation was 7 months postsurgery. One-third of the patients participated in return-to-sport training, and 72.6% received at least 1 functional test. About 40% of patients were active in rehabilitation up to 9 months postsurgery but visit frequency (<2 times per month) was lower than in return-to-sport training (2 sessions per week). CONCLUSION: Over half of the rehabilitation visits were received in the early phase, and more than half of patients completed rehabilitation before 9 months postsurgery. Return-to-sport training facilitated regular visits in the late phase. About one-quarter of patients had rehabilitation progression without functional testing. CLINICAL RELEVANCE: Study findings illuminate late phase rehabilitation visits and functional testing as potential areas of care delivery to improve for better return-to-sport outcomes after ACL reconstruction.
Asymmetry Should Be Considered the Norm, Not the Exception: Neuromuscular Asymmetries in Knee Flexors and Extensor Assessed Through a Multimetric Approach.
D'Emanuele S, Boccia G, Marcantonio A … +4 more , Massagrande C, Ghiotto L, Schena F, Tarperi C
Sports Health · 2026 · PMID 41272473 · Full text
BACKGROUND: The level of interlimb asymmetry varies significantly across outcome measures, resulting in poor agreement in categorizing participants as (a)symmetric. Several researchers have discussed the need for an indi...
BACKGROUND: The level of interlimb asymmetry varies significantly across outcome measures, resulting in poor agreement in categorizing participants as (a)symmetric. Several researchers have discussed the need for an individual approach to data analysis and the need to perform multiple tests. HYPOTHESIS: Limb dominance does not consistently influence muscle function, and the direction of asymmetry may show low consistency across different muscle groups and across the various metrics applied to the same muscles. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 71 subjects visited the laboratory once to undergo assessments for knee extensors (KEs) and knee flexors (KFs) separately for the dominant and nondominant limbs. Maximal voluntary force (MVF), rate of force development (RFD) at various time intervals (50, 100, 150 ms) and at its peak (RFD), and RFD-scaling factor (RFD-SF) were obtained. Approximate entropy (ApEn), coefficient of variation, and detrended fluctuation analysis (DFAα) of force signal were also calculated during sustained submaximal contractions. Analyses of variance or Wilcoxon signed-rank test assessed differences in each metric between muscle groups and limbs. Kappa coefficients (κ) were calculated to determine the level of agreement for the direction of asymmetry. RESULTS: Except for RFD (d = 0.305) and RFD-SF (r = 0.280) for KF, no differences between dominant and nondominant limb were observed. All κ values were null, slight or fair (all κ ≤ 0.23). CONCLUSION: The dominant limb is not necessarily stronger than the nondominant limb. The direction of asymmetry varies depending on the metric and muscle considered. Our findings corroborate that asymmetries are ubiquitous in physical performance with neuromuscular asymmetries observed in 75% of subjects. CLINICAL RELEVANCE: These findings highlight the necessity of comprehensive assessment across a multimetrics approach, identifying imbalances and tailoring personalized programs to address performance asymmetries effectively.
Association Between Eccentric and Isometric Shoulder Rotation Strength, Shoulder Range of Motion and Injury Incidence in the Shoulder in Adolescent Competitive Tennis Players: The SMASH Cohort Study.
Johansson F, Batt M, Ellenbecker T … +1 more , Skillgate E
Sports Health · 2026 · PMID 41272459 · Full text
BACKGROUND: For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few s...
BACKGROUND: For competitive adolescent athletes, injury avoidance is a challenge, and causes of injury are complex and multifactorial. Despite an incidence of 8.2 shoulder injuries per 1,000 hours of tennis played, few studies have investigated the association between shoulder strength, range of motion (ROM), and injury. HYPOTHESIS: Eccentric and isometric shoulder muscle strength and/or shoulder ROM are associated with new shoulder complaints and/or injuries. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: At baseline 301 adolescent competitive tennis players aged 13 to 19 years completed a questionnaire, were assessed with a shoulder protocol for strength and ROM and followed weekly (for shoulder complaint/injury) for 52 consecutive weeks. Outcomes were a first incidence of a tennis-related shoulder complaint or injury in the dominant arm, defined as a sum score of ≥20 or ≥40, respectively, on the Oslo Overuse Injury Questionnaire. Two cohorts were created for Cox regression analyses, adjusted for age, sex, and playing level: (1) shoulder complaints (n = 204), and (2) shoulder injuries (n = 252). RESULTS: The most definitive adjusted associations were a hazard rate ratio (HRR) of 1.3 (95% CI 1.0-1.8) for a shoulder complaint in eccentric external rotation (eccER) strength, and a HRR for shoulder injuries of 1.4 (95% CI 1.0-1.9) in isometric internal rotation (IIR) strength in the 90-90 position, and 1.5 (95% CI 1.1-2.0) in eccER normalized to body mass. CONCLUSION: Higher values of eccER shoulder strength, IIR strength at the 90-90 position, and eccER shoulder strength normalized to body mass, were associated with shoulder complaints/injuries in adolescent competitive tennis players. CLINICAL RELEVANCE: Incorporating a training program that takes volume and intensity into account in the daily oncourt sessions, to build resilience through a well-planned, long-term training and competition plan to minimize shoulder injury risk may be of importance.
Effect of Travel on Sleep Patterns and Athletic Performance in Female Professional Tennis Players: A Retrospective Cohort Study Utilizing WHOOP 3.0 Tracking.
Maynard JR, Nadwodny JP, Hung CM … +4 more , Punj M, Almodovar-Frau D, Teune B, Stroia KA
Sports Health · 2026 · PMID 41272436 · Full text
BACKGROUND: Sleep is vital for an athlete's recovery, physical and mental health, and athletic performance. The impact on circadian rhythm from long-distance travel across multiple time zones has not been studied using w...
BACKGROUND: Sleep is vital for an athlete's recovery, physical and mental health, and athletic performance. The impact on circadian rhythm from long-distance travel across multiple time zones has not been studied using wearable technology in female professional tennis players. HYPOTHESIS: Travel between time zones in female professional tennis players leads to circadian desynchronization, causing disruption in sleep patterns, changes in physiologic parameters, and decreased athletic performance. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 52 female professional tennis players consented to wear, and share the data of, WHOOP 3.0 while traveling and competing on the Women's Tennis Association (WTA) Tour. Linear mixed models examined the relationship between (1) travel and sleep/recovery and (2) sleep/recovery and match performance. RESULTS: Sleep duration without travel averaged 437 minutes (436.8 ± 2.8). On the first night after travel, for every hour time zone difference (TZD) traveled regardless of direction, players slept 11 minutes less (-11.3 ± 0.96; < 0.05). Eastward travel further reduced sleep (-24.5 ± 4.2; < 0.05), while westward travel increased sleep duration (+30.0 ± 4.2; < 0.05). These effects were reduced on the subsequent 2 nights. CONCLUSION: Sleep duration reduction was most prominent on the first night after travel, particularly with eastward travel, but improved on subsequent nights. The number of time zones crossed predictably increases the vulnerability for insufficient sleep duration, whereby a 2-hour TZD easterly, and 4-hour TZD westerly, reduces sleep duration <7 hours on the first night. No significant correlation was found between sleep disruption and competition performance in our female professional tennis population. CLINICAL RELEVANCE: The findings suggest that professional tennis players should, and generally do, arrive at competition locations with enough time to resynchronize their circadian rhythm to the destination time zone; particularly if traveling eastward.
The Combination of Motor Imagery and Breathing Optimizes the Performance of the Serve in Skilled Tennis Players.
Robin N, Carien R, Bonnin T … +2 more , Michineau L, Dominique L
Sports Health · 2026 · PMID 41263400 · Full text
BACKGROUND: Tennis players frequently use motor imagery (MI) to improve serve accuracy and efficiency. Moreover, breathing, such as forced expiration, can improve serving speed. HYPOTHESIS: A combination of MI before act...
BACKGROUND: Tennis players frequently use motor imagery (MI) to improve serve accuracy and efficiency. Moreover, breathing, such as forced expiration, can improve serving speed. HYPOTHESIS: A combination of MI before action and breathing during movement would increase serve performance in skilled tennis players. STUDY DESIGN: Nonrandomized, repeated-measures design. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 20 tennis players (mean age, 24.2 years; SD = 5.9), with between 9 and 18 years of regular practice, completed 4 experimental counterbalanced sessions: Control (no instruction), Breathing (inhalation while throwing the ball and forced expiration while hitting), Imagery (external visual mental simulation before serving), and Imagery + Breathing (combination of both). Each session included the completion of 10 first-serves in an actual match condition. The speed, percentage of success, accuracy, and efficiency scores served as performance indicators and dependent variables. RESULTS: Compared with the Control condition, Imagery significantly improved accuracy and percentage of success, and Breathing increased speed of the serves. Participants had significantly better performances in the Imagery + Breathing condition than in the Control condition; better serving speed than in the Imagery condition; and higher accuracy, efficiency, and percentage of success than in the Breathing condition. CONCLUSION: The combination of MI plus breathing resulted in an overall improvement in serve performance. CLINICAL RELEVANCE: Tennis coaches and practitioners should integrate MI interventions and breathing practice during training and matches.
Validity and Reliability of the Single Leg Bridge Test and Handheld Dynamometer for Assessing Knee Flexor Strength After Anterior Cruciate Ligament Reconstruction.
Rodrigues CAS, Albano TR, Queiroz JHM … +3 more , Souza CCC, Lima POP, Almeida GPL
Sports Health · 2026 · PMID 41254948 · Full text
BACKGROUND: The isokinetic dynamometer is the "gold standard" equipment for assessing muscle strength after anterior cruciate ligament reconstruction (ACLR); however, its high cost limits its use in clinical practice. Th...
BACKGROUND: The isokinetic dynamometer is the "gold standard" equipment for assessing muscle strength after anterior cruciate ligament reconstruction (ACLR); however, its high cost limits its use in clinical practice. The hand-held dynamometer (HHD) and performance-based tests are alternative methods. HYPOTHESIS: The single leg bridge test (SLBT) and HHD are reliable and valid for assessing knee flexor strength compared with isokinetic dynamometer and knee-specific patient-reported outcomes after ACLR. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 127 participants with ACLR ≥6 months previously were evaluated using the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) questionnaire, the SLBT, the HHD, and the isokinetic dynamometer. RESULTS: The SLBT showed good test/retest reliability in both limbs (intraclass correlation coefficient [ICC] = 0.85-0.87), moderate-to-good criterion validity with an isokinetic dynamometer ( = 0.53), and moderate-to-good construct validity with IKDC and ACL-RSI ( = 0.42 and 0.43). An HHD showed good test/retest reliability (ICC = 0.85-0.89), moderate-to-good criterion validity with an isokinetic dynamometer ( = 0.42), and none-to-weak construct validity with IKDC and ACL-RSI ( = 0.07 and 0.23). The limb symmetry index (LSI) of the SLBT and HHD showed weak validity with the isokinetic dynamometer ( = 0.23 and 0.24). CONCLUSION: Compared with the isokinetic dynamometer, the SLBT and HHD showed good reliability and moderate-to-good validity. However, the LSIs showed weak correlations with the gold standard. CLINICAL RELEVANCE: When isokinetic testing is not possible, clinicians can use SLBT and HHD to assess knee flexor muscle strength in patients after ACLR. However, we do not recommend using the LSI of the SLBT and HHD for clinical decision making.
Associations Between Patient-Reported Outcomes and Dual-Task Jump Performance After ACL Reconstruction: Analyses by Sex.
Lövgren A, Strong A, Markström JL
Sports Health · 2026 · PMID 41254946 · Full text
BACKGROUND: Subjective patient-reported outcome measures (PROMs) and physical performance tests are important tools for assessing rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the associ...
BACKGROUND: Subjective patient-reported outcome measures (PROMs) and physical performance tests are important tools for assessing rehabilitation after anterior cruciate ligament reconstruction (ACLR). However, the associations and interrelationships between PROMs and dual-task jump performance, and sex-specific differences among patients with ACLR remain unclear. HYPOTHESIS: Associations exist between PROMs and dual-task jump performance, and do not differ between men and women with ACLR. STUDY DESIGN: Controlled laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 44 sports-active people with ACLR (50% men; mean [SD] 25.4 [16.0] months postsurgery) completed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale, and a dual-task drop vertical jump test. The test incorporated cognitive challenges targeting short-term memory, attention, fast decision-making, and inhibitory control. Dual-task performance was quantified as the percentage of correctly completed memory and motor trials. Associations were analyzed using partial correlations, controlling for time post-ACLR. RESULTS: Across all participants, no significant correlations were observed between dual-task performance and ACL-RSI or IKDC-SKF scores ( = 0.02-0.14; = 0.37-0.92). Women demonstrated positive correlations ( = 0.39-0.40; = 0.07-0.08) with both PROMs, suggesting a potential association, although shallow linear slopes, whereas men showed negative, nonsignificant correlations ( = -0.10 to -0.36; = 0.11-0.65). A high and significant correlation was found between ACL-RSI and IKDC-SKF scores among women ( = 0.76; < 0.01) but not men ( = 0.36; = 0.11). CONCLUSION: After ACLR, ACL-RSI and IKDC-SKF scores were not significantly associated with dual-task jump performance. However, women showed greater consistency between the 2 PROMs than men. CLINICAL RELEVANCE: The ACL-RSI, IKDC-SKF, and dual-task jump performance capture distinct aspects of recovery, potentially reflecting different biopsychosocial constructs, highlighting the importance of considering sex-specific factors in post-ACLR rehabilitation and assessment.
Validation of an Upper Extremity Physical Performance Test Battery in Competitive Adult Tennis Players.
Stubbe J, Borms D, Vandenbosch D … +1 more , Cools AM
Sports Health · 2026 · PMID 41178676 · Full text
BACKGROUND: Upper extremity physical performance tests are used frequently to assess upper limb performance in overhead athletes such as tennis players. Recently, it has been suggested that a test battery rather than ind...
BACKGROUND: Upper extremity physical performance tests are used frequently to assess upper limb performance in overhead athletes such as tennis players. Recently, it has been suggested that a test battery rather than individual tests should be used to increase construct validity. So far, no test battery consisting of analytical tests, as well as physical performance tests, has been validated in a population of adult tennis players, correlating results with serve performance. HYPOTHESIS: The test battery will show a strong correlation with serve velocity and a limited correlation with serve accuracy. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 69 tennis players underwent a serve performance test, including velocity and accuracy measurements. They next completed a test battery consisting of strength tests (hand grip and shoulder strength), shoulder range of motion (ROM) tests and upper extremity physical performance tests. The physical performance test assessment included the closed kinetic chain upper extremity stability test, seated single-arm shot-put test, upper limb rotation test, and shoulder endurance test. The correlation between the test battery and serve velocity and accuracy was assessed through linear regression. Backward regression was used to identify the most significant variables. RESULTS: A strong correlation was found between the test battery and serve velocity. The test battery explained 58.5% of the variance in serve velocity. Exploratory backward regression showed that the closed kinetic chain upper extremity stability test and shoulder internal rotation strength explained 59.3% of the variance. There was no significant correlation between the test battery and serve accuracy. CONCLUSION: The test battery, including physical performance tests, strength, and ROM measurements, demonstrates strong construct validity for serve velocity. CLINICAL RELEVANCE: This test battery provides an on-field, easy, and efficient method of assessing athletes. Clinicians may use this test battery to evaluate healthy adult tennis players.
Workload and Enjoyment Perception in Small-Sided Soccer Games: A Systematic Review of Studies in Untrained Children and Adolescents.
Gómez-Álvarez N, Federico-Tuccelli L, SanMartín-Godoy P … +5 more , Vieyra-Fuenzalida M, Hermosilla-Palma F, Reyes-Amigo T, Oliveira J, Fonseca H
Sports Health · 2026 · PMID 41171044 · Full text
CONTEXT: Small-sided soccer games (SSSG) have been proposed as a strategy to promote the health of children and adolescents. Understanding training loads has a strong influence on program effectiveness. OBJECTIVE: This s...
CONTEXT: Small-sided soccer games (SSSG) have been proposed as a strategy to promote the health of children and adolescents. Understanding training loads has a strong influence on program effectiveness. OBJECTIVE: This systematic review aimed to describe the training load and perception of enjoyment during SSSG in untrained children and adolescents. DATA SOURCES: A systematic search on PubMed, Web of Science, Scopus, and Scielo databases was performed. STUDY SELECTION: Experimental or observational studies conducted in untrained children or adolescents (6 to 18 years) that analyzed internal loads, external loads, or perceived enjoyment during 1 or more SSSG were included. STUDY DESIGN: Systematic review following PRISMA guidelines. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Information on publication type, participants, SSSG characteristics, and main results of the internal and external load and perceived enjoyment was extracted. RESULTS: A total of 15 articles (n = 539 participants, aged 8-18 years) were included. Twenty-one SSSG designs were identified, and the format used most was 3v3. Heartrate (HR) (range 71%-88% of maximum HR) and rate of perceived exertion (range 3-7 of 10 or 12-15 of 20) were the primary measures of internal load, while distance traveled, average speed, and number of accelerations were used to assess external load. Perceived enjoyment was reported using mainly the 16-item PACES or 18-item PACES scale (59.14 or 88.67, respectively). The structural aspects of the game were evaluated in 6 studies, suggesting that the number of players, pitch size, man-marking, and restricting the type of locomotion may affect workload. Contextual factors, such as verbal motivation or sex, can also influence workload. CONCLUSION: SSSG is associated with moderate-to-vigorous intensity exercise and high enjoyment perception. Workload can be affected by structural (number of players, pitch size, man-marking) and contextual factors (verbal encouragement, sex composition), although evidence is still limited.
ADHD Is Associated With Increased Rates of Postoperative Complications and Revision Surgery After ACL Reconstruction.
Sasaki J, Fuller SI, Kocan J … +4 more , Yunke A, Pavlesen S, Del Prince C, MacFarlane AJ
Sports Health · 2026 · PMID 41163560 · Full text
BACKGROUND: Anterior cruciate ligament (ACL) tears represent half of all knee injuries and are often treated surgically through ACL reconstruction. Recent attention has focused on mental health factors as potential modif...
BACKGROUND: Anterior cruciate ligament (ACL) tears represent half of all knee injuries and are often treated surgically through ACL reconstruction. Recent attention has focused on mental health factors as potential modifiable risk factors in ACL reconstruction outcomes. However, no studies have looked at ACL reconstruction outcomes in patients with attention-deficit/hyperactivity disorder (ADHD). This study aimed to assess the effect of ADHD on 3-month, 6-month, and 3-year complications in patients undergoing ACL reconstruction. HYPOTHESIS: There will be increased rates of complications in ADHD patients, compared with non-ADHD patients, after ACL reconstruction. STUDY DESIGN: Retrospective case-control study. LEVEL OF EVIDENCE: Level 3. METHODS: We queried TriNetX, a global research database, to analyze patients who underwent an ACL reconstruction surgery and divided them into ADHD and non-ADHD cohorts. We examined outcomes from 1 day to 3 months, 1 day to 6 months, and 6 months to 3 years postoperatively. For the 1-day to 3-month and 6-month outcomes, we examined arthrofibrosis, infection, wound complications, revision surgery, emergency department visits, and readmission. We examined arthrofibrosis, chronic instability, and revision surgery between 6 months and 3 years. Cohorts were propensity score matched. RESULTS: In the 1-day to 3-month and 6-month cohorts, ADHD patients were found to have a significantly increased risk of requiring revision surgery, having wound complications, and experiencing hospital readmission compared with the non-ADHD group. ADHD patients were also more likely to return to the emergency department within 6 months. At 3 years follow-up, there were no differences between cohorts. CONCLUSION: This study demonstrates that patients with ADHD who undergo ACL reconstruction are at increased risk of early revision surgery, wound complications, and hospital readmission. CLINICAL RELEVANCE: These findings can be useful to healthcare professionals to help reduce the risk of complications in ADHD patients undergoing ACL reconstruction by tailoring postoperative rehabilitation protocols.
Quantitative T2* With Ultrashort Time-to-Echo MRI Differentiates Tendonitis Severity in Lateral Epicondylitis.
Tan AH, Lowe A, Potter HG
Sports Health · 2026 · PMID 41163497 · Full text
BACKGROUND: Lateral epicondylitis (LE), or tennis elbow, severely affects elbow mobility due to degeneration of and injury to the extensor carpi radialis brevis (ECRB) tendon. Conventional magnetic resonance imaging (MRI...
BACKGROUND: Lateral epicondylitis (LE), or tennis elbow, severely affects elbow mobility due to degeneration of and injury to the extensor carpi radialis brevis (ECRB) tendon. Conventional magnetic resonance imaging (MRI), although relied upon to determine LE severity, is a qualitative measure of tendon degeneration. Novel quantitative T2*-mapping using ultrashort time-to-echo (UTE) assesses the collagen component of the tendon and could provide a more objective assessment of tendon pathology. HYPOTHESIS: UTE T2* values differentiate LE severity grades and correlate with conventional MRI signal. STUDY DESIGN: Prospective and cross-sectional. LEVEL OF EVIDENCE: Level 3. METHODS: UTE T2* MRI was acquired in 30 patients (11 female/19 male; age, 48.7 ± 13.8 years) with elbow pain at a field strength of 3 T. The ECRB tendon and muscle were segmented to obtain mean T2* values and conventional proton-density MRI signal. Elbows were grouped by a qualitative radiologic grading scale of increasing LE severity (0, no degeneration; 1, degeneration; 2, partial tear; 3, full-thickness tear). T2* and PD values were compared between groups using Wilcoxon rank-sum tests and against each other with Spearman's rank correlation. RESULTS: Mean T2* was significantly higher in partially torn tendon (15.3 ms) versus normal and degenerated tendon (7.70 ms, < 0.01). Mean T2* was also higher in partially torn tendon (15.3 ms) versus degenerated tendon (8.32 ms, = 0.04). The correlation coefficient between T2* and PD was moderate at = 0.624 ( < 0.01). CONCLUSION: T2* differentiates between tendon severity grades and may provide additional information to conventional MRI scan assessment for increased sensitivity to tendon changes in LE. CLINICAL RELEVANCE: T2* UTE may detect early changes in LE as a quantitative basis for making objective return-to-play or treatment decisions.
Isn't It Time to Stop Pretending Ligament Reconstructions Are "Anatomic"?
Williams A, Borque K
Sports Health · 2025 Nov · PMID 41147861 · Full text
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Daily Step Count 2 Years After Anterior Cruciate Ligament Reconstruction and Associations With Cartilage Health and Knee Symptoms and Function.
Øiestad BE, Williams AA, Titchenal MR … +2 more , Lutz AM, Chu CR
Sports Health · 2026 · PMID 41123174 · Full text
BACKGROUND: People suffering anterior cruciate ligament (ACL) injuries are at increased risk for development of osteoarthritis (OA). This study investigated associations between daily step count, cartilage degeneration a...
BACKGROUND: People suffering anterior cruciate ligament (ACL) injuries are at increased risk for development of osteoarthritis (OA). This study investigated associations between daily step count, cartilage degeneration and patient-reported outcomes 2 years after ACL reconstruction (ACLR). HYPOTHESIS: Daily step count is associated with cartilage health and patient-reported knee symptoms and function 2 years after ACLR. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 4. METHODS: We analyzed data from 34 patients (18 female), aged 33.4 ± 10.8 years with stable knees recruited from the community 2 years after primary ACLR. Mean daily step count was measured using an activity tracker (FitBit) over a 7-day collection period. Cartilage morphology on magnetic resonance imaging (MRI) was graded across multiple joint areas. Knee symptoms and function were assessed by the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales pain, symptoms, activity of daily living (ADL), sport/recreation (sport/rec), and knee-related quality of life (QoL) using published thresholds for patient acceptable symptom state (PASS). Analyses were adjusted for age, sex, and body mass index. RESULTS: The mean (SD) daily step count was 9276 (3199). At least 1 cartilage abnormality was present on morphological MRI in 20% of ACLR knees. The mean (SD) KOOS values were: pain 94 (7), symptoms 92 (8), ADL 91 (10), function in sport/rec 85 (14), and knee-related QoL 56 (22). Failure to achieve PASS rates were 76% for ADL; 59% for QoL, 18% for pain, 35% for sport/rec, and 0% for symptoms. CONCLUSION: Daily step count was not associated with cartilage health or knee symptoms and function 2 years after ACLR. However, a high proportion of participants with reported unacceptable ADL and QoL 2 years after ACLR. CLINICAL RELEVANCE: The proportion with unacceptable PASS for ADL and QoL in participants with stable knees after ACLR indicates a need to optimize rehabilitation and improve post-ACLR recovery.
Effects of Physical Exercise on Whole-Body Bone Mineral Density in Adolescents: A Systematic Review and Meta-analysis.
Li Y, Saibon JB, Mo W … +1 more , Xu J
Sports Health · 2026 · PMID 41123070 · Full text
CONTEXT: Adolescence is a critical period for bone development, and physical exercise has been recognized as a key factor in promoting bone health. Whole-body bone mineral density (BMD) serves as a vital indicator of bon...
CONTEXT: Adolescence is a critical period for bone development, and physical exercise has been recognized as a key factor in promoting bone health. Whole-body bone mineral density (BMD) serves as a vital indicator of bone strength and future fracture risk. OBJECTIVE: To systematically review and perform a meta-analysis of the effects of physical exercise on whole-body BMD in adolescents, identifying types of exercise beneficial for bone health. DATA SOURCES: A comprehensive search was conducted across databases including Web of Science, PubMed, Embase, EBSCOhost, Cochrane, and Scopus to identify relevant studies published between 1991 and 2025. STUDY SELECTION: Studies were selected based on predefined inclusion criteria that focused on adolescents, physical exercise, and whole-body BMD outcomes. A total of 12 studies involving 1845 participants met the criteria for inclusion. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Data were extracted using the Cochrane Handbook guidelines, and meta-analysis was conducted using Review Manager software. Publication bias was assessed using a funnel plot. RESULTS: Physical exercise increased whole-body BMD significantly in adolescents (pooled effect size of mean difference, 0.06; 95% CI, 0.04, 0.09; < 0.001). Physical exercise significantly improved whole-body BMD in both male and female adolescents, but the effect was more pronounced in boys ( < 0.001) compared with girls ( = 0.002). High-impact and weightbearing exercises, such as basketball, soccer, ice hockey, and boxing, significantly enhanced whole-body BMD in adolescents, whereas nonweightbearing exercises, such as swimming, had a weaker effect on BMD improvement. Judo showed no significant effect. CONCLUSION: Physical exercise, particularly high-impact sports, significantly enhances whole-body BMD in adolescents, especially in boys. These findings highlight the importance of incorporating effective physical activities into adolescent physical education to promote optimal bone health.
Assessment of Landing Stability in Patients After Anterior Cruciate Ligament Injury and Reconstruction: A Systematic Review and Meta-analysis.
Chen Y, Zheng S, Yu L … +4 more , Xue X, Wang Z, Sun Y, Hua Y
Sports Health · 2026 · PMID 41017646 · Full text
CONTEXT: Dynamic postural control deficits are prevalent in people with anterior cruciate ligament injury (ACLI) or reconstruction (ACLR). Time to stabilization (TTS) and the dynamic postural stability index (DPSI) are u...
CONTEXT: Dynamic postural control deficits are prevalent in people with anterior cruciate ligament injury (ACLI) or reconstruction (ACLR). Time to stabilization (TTS) and the dynamic postural stability index (DPSI) are used to assess dynamic postural stability during a jump-landing task. However, results vary on whether landing stability can adequately demonstrate dynamic postural deficits in patients with ACLI and ACLR. OBJECTIVE: To (1) describe common methods and parameters for determining TTS and DPSI, and (2) identify the differences in TTS and DPSI across different jump-landing tasks and directions between the ACLI or ACLR and control groups. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, Scopus, CINAHL, and SPORTDiscus were searched for articles from conception until March 2024. STUDY SELECTION: Clinical studies assessing dynamic postural stability between patients with ACLI and ACLR and controls were included. Eleven articles were included in the analysis. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: The following information was extracted from included articles: demographic data, sample size, methodology, landing stability test outcomes, and calculation methods of outcomes. Different jump tasks were explored, and meta-analyses were conducted on the landing stability test outcomes. RESULTS: In forward jump-landing tasks, knees affected by ACLI or ACLR needed more time than controls to achieve stabilization, showing a moderate effect in the anteroposterior direction (based on 2 studies, 47 affected knees versus 44 healthy knees; standardized mean difference [SMD] = 0.438), and a large effect in the vertical direction (based on 3 studies, 77 affected knees versus 74 healthy knees; SMD = 0.656). CONCLUSION: These findings demonstrate impaired dynamic stability in ACLI/ACLR patients, highlighting the importance of TTS as an effective measure for assessing landing stability.
A Video Analysis of Suspected Injuries and Suspected Concussions in Elite Ladies Gaelic Football Matches.
Porter L, West SW, Behan S … +1 more , O'Connor S
Sports Health · 2026 · PMID 40996851 · Full text
BACKGROUND: Previous research shows that injuries are prevalent in ladies Gaelic football. However, little is known about how these injuries occur (ie, the mechanism of injury). In addition, there are limited data on inj...
BACKGROUND: Previous research shows that injuries are prevalent in ladies Gaelic football. However, little is known about how these injuries occur (ie, the mechanism of injury). In addition, there are limited data on injuries sustained during elite-level matches. Concussions are also a key concern, yet research has examined solely self-reported suspected concussions, and it remains unclear how potential concussions are identified and managed during matches. OBJECTIVE: To establish the incidence, characteristics, and management of suspected injuries and concussions in elite ladies Gaelic football matches. DESIGN: Cross-sectional video analysis study. LEVEL OF EVIDENCE: Level 3. METHODS: A video coding framework was developed based on similar published studies and validated by 5 Gaelic football-specific raters. One research assistant coded all matches from the 2022 season, and an experienced referee also reviewed foul play events. RESULTS: There were 829 suspected injuries (suspected injury rate [IR], 229.0 per 1000 hours; 95% CI, 214.0-245.2; 6.9 suspected injuries per match) and 162 suspected concussions (IR, 44.8 per 1000 hours; 95% CI, 38.4-52.2; 1.4 per match) recorded in 120 matches. Most suspected injuries received onfield medical attention (84.0%); however, just 13.6% of suspected concussions were removed from play. The tackle accounted for the most suspected injuries (40.2%), player-to-player contact (68.2%) was the most common mechanism, and the head/neck (38.1%) was the body location injured most frequently. Foul play concerned 53.2% of suspected injuries, with 76.7% of fouls concerning the tackle. CONCLUSION: The nonremoval of suspected concussions and the frequency of tackle-related suspected injuries and foul play warrants attention. CLINICAL RELEVANCE: Developing and implementing injury prevention programs, concussion management strategies, and education for all knowledge users may contribute to a safer playing environment.
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