Sports Health [JOURNAL]
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200 papers
Ten-Year Epidemiology of Concussions in Cirque du Soleil Performers.
Russell JA, Berry M, Richardson T … +1 more , Simon JE
Sports Health · 2026 · PMID 40995848 · Full text
BACKGROUND: Sports concussion receives heavy attention from researchers. Conversely, research devoted to performing arts concussion is scant, despite a variety of head injury opportunities in artistic endeavors and envir...
BACKGROUND: Sports concussion receives heavy attention from researchers. Conversely, research devoted to performing arts concussion is scant, despite a variety of head injury opportunities in artistic endeavors and environments. Circus is a high-energy, high-velocity performing art for which minimal concussion research is available. PURPOSE: Assess via medical records the 10-year concussion incidence in Cirque du Soleil (CdS) performers and the variables surrounding their concussions. STUDY DESIGN: Descriptive epidemiology. LEVEL OF EVIDENCE: Level 5. METHODS: Data were extracted from CdS performers' medical records for 2010 to 2019: sex, age at injury, performance type, artistic discipline, mechanism of injury, performance context, and time-loss from full participation. Yearly artist-exposures for all CdS artists were identified. Data were analyzed for both resident and touring shows. RESULTS: Over 10 years there were 2,733,073 exposures, with 354 concussions sustained among 296 performers. Acrobats were the most commonly concussed (82.8% of all concussions). There were 1.30 concussions per 10,000 artist-exposures. Repeat concussions accounted for 58 concussions (16.4%). Full return to performance occurred at a mean of 35.5 ± 100.3 days. The highest rate of concussions was in 2019 (1.93 per 10,000 artist-exposures); 2010 had the lowest (0.86 per 10,000 artist-exposures). More concussions occurred during performances than training sessions; nearly half (170 of 354) occurred during the first of 2 shows presented nightly. There was no significant difference in overall incidence between resident and touring performers. The most frequent concussion mechanisms were impact with apparatus/equipment (113 of 354) or with another artist (106 of 354). CONCLUSION: The concussion incidence of CdS artists is noteworthy compared with sports concussions. Acrobats sustained the most concussions. Concussions occurred more frequently during performances than during training. CLINICAL RELEVANCE: These new data on performing arts concussions highlight the prevalence and incidence of concussions in circus performers for healthcare professionals who care for them.
The Effect of Photobiomodulation Therapy on Muscle Performance in Volleyball and Football Players: A Meta-Analysis of Randomized Controlled Trials.
Qiu D, He J, Li B … +4 more , Ni P, Zhao Z, Lv R, Li F
Sports Health · 2026 · PMID 40995827 · Full text
CONTEXT: The use of photobiomodulation therapy (PBMT) as an adjunct to improve muscle performance and accelerate recovery in high-level volleyball and football players remains controversial. OBJECTIVE: To determine wheth...
CONTEXT: The use of photobiomodulation therapy (PBMT) as an adjunct to improve muscle performance and accelerate recovery in high-level volleyball and football players remains controversial. OBJECTIVE: To determine whether PBMT improves skeletal muscle performance in ball sports athletes, and whether there are differences in the improvement of skeletal muscle performance by PBMT between volleyballers and footballers. DATA SOURCES: A comprehensive search of the Web of Science, Medline, Scopus, and PubMed databases was conducted through April 10, 2025. STUDY SELECTION: Eligible studies included those explicitly categorized as randomized controlled trials (RCT) of PBMT interventions for high-level volleyballers and/or footballers; 14 studies met the inclusion criteria. STUDY DESIGN: Meta-analysis. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: The primary outcome measures included maximal voluntary contraction force (MVC), number of repetitions, and creatine kinase (CK) levels. Means and standard deviations for each variable of interest were used to calculate standardized mean differences (SMDs). RESULTS: The active laser had no significant effect on MVC (mean difference [MD], 19.67; 95% CI, 7.36 to 31.72; = 0.31)]; however, it significantly increased the number of repetitions (SMD, 0.58; 95% CI, -0.05 to 1.21; = 0.04) and significantly decreased CK levels (MD, -45.37; 95% CI, -55.52 to -35.22; < 0.001). CONCLUSION: PBMT can delay muscle fatigue onset and reduce CK levels in ball sports athletes. The improvement in skeletal muscle performance induced by PBMT showed differences between volleyballers and footballers, as there was a significant increase the number of repetitions in volleyball players, whereas a significant decrease in CK levels was noted in footballers.
Superficial and Deep Gluteal Muscle Activation During Common Therapeutic Exercises: A Muscle Functional Magnetic Resonance Imaging Analysis.
Kim S, Burland JP, Morgan KD … +3 more , DiStefano LJ, Boling MC, Glaviano NR
Sports Health · 2026 · PMID 40977436 · Full text
BACKGROUND: Deep gluteal muscles play an important role in femoral rotation and hip stability, but are often neglected in clinical research. We quantified and compared activation changes of superficial and deep gluteal m...
BACKGROUND: Deep gluteal muscles play an important role in femoral rotation and hip stability, but are often neglected in clinical research. We quantified and compared activation changes of superficial and deep gluteal muscles across 4 common therapeutic exercises: single-leg bridge (BRIDGE), side-lying clamshell (CLAM), side-lying reverse clamshell (R-CLAM), and side-lying hip abduction with external rotation (ABD-ER). HYPOTHESIS: ABD-ER activates both superficial and deep gluteal muscles more effectively than other exercises. STUDY DESIGN: Controlled laboratory study. LEVEL OF EVIDENCE: Level 2. METHODS: Ten healthy, physically active people (5 women and 5 men; age, 27.2 ± 1.9 years; Tegner activity scale, 6.4 ± 0.5) participated. Muscle functional magnetic resonance imaging was conducted before and after 1 set of 40 repetitions of each exercise type. Percent changes in T2 relaxation time in superficial and deep gluteal muscle activation were assessed before and after each exercise using repeated-measures analysis of variance or Friedman test. RESULTS: All muscles showed increased activation after exercise. BRIDGE (11.6%) and ABD-ER (13.2%) activated the gluteus medius more than CLAM (4.5%). ABD-ER activated the tensor fasciae latae (17.8%) and gluteus minimus (18.1%) more than other exercises (2.7% to 7.2%). BRIDGE (13.1%), CLAM (14.5%), and ABD-ER (23.8%) activated the piriformis more than R-CLAM (5.3%). CLAM (24.2%) and ABD-ER (19.5%) activated the obturator internus more than BRIDGE (5.3%) and R-CLAM (7.3%). CLAM and ABD-ER activated the gemellus superior (18.7% and 21.4%, respectively) and gemellus inferior (6.7% and 9.2%, respectively) more than R-CLAM (7.7% and 3.4%, respectively). CONCLUSION: Of the exercises studied, ABD-ER was most effective in activating both superficial and deep gluteal muscles. BRIDGE and CLAM demonstrated selective activation advantages for specific muscles, supporting an individualized approach to exercise selection. CLINICAL RELEVANCE: These insights into gluteal muscle activation changes before and after therapeutic exercises will aid clinical decision-making for exercise prescriptions.
The Evidence Driving Policy for the Implementation of Virtual Rehabilitation Is Riddled With Conflicts of Interest.
Rhon DI, McDevitt A, Magel J … +1 more , Donaldson MB
Sports Health · 2026 · PMID 40977409 · Full text
Abstract loading — click title to view on PubMed.
Concussion Reporting Expectation Screening in the Preparticipation Physical Examination.
Abbott A, Klomhaus AM, Nattiv A … +1 more , Goldman J
Sports Health · 2026 · PMID 40977386 · Full text
BACKGROUND: Studies of National Collegiate Athletic Association (NCAA) athletes have been concerning for rates of athletes reporting playing while symptomatic with a concussion and of athlete nondisclosure of concussion...
BACKGROUND: Studies of National Collegiate Athletic Association (NCAA) athletes have been concerning for rates of athletes reporting playing while symptomatic with a concussion and of athlete nondisclosure of concussion symptoms. PURPOSE/HYPOTHESIS: This study's primary aim was to determine whether application of a brief and validated scale for concussion reporting expectation (CR-E) is an effective screening tool for collegiate athletes. It was hypothesized that 20% of athletes would be considered high risk for nondisclosure of concussion symptoms using this screening tool. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 2B. METHODS: NCAA Division I athletes ( = 358) from 18 teams who presented for preparticipation physical examinations (PPEs) in the 2023 fall season were queried with the CR-E and concussion history questions. The time to complete the CR-E was recorded, and providers recorded whether the screening results warranted additional concussion counseling or education. We report survey responses for all athletes stratified by sex and sport. Power analysis study population was based on NCAA collegiate athletes. RESULTS: The CR-E required an average of 2 minutes for athletes to complete during their PPE. Of 238 of 358 athletes who completed the CR-E questionnaire, 2 in 3 were determined to benefit from concussion education. Overall, athletes felt "neutral" about their agreement on a Likert scale to report concussion symptoms in 4 scenarios described on the CR-E. Water polo, volleyball, women's soccer, gymnastics, and football represented sports with higher rates of counseling, below average agreement to report concussion symptoms for 4 scenarios queried, and most frequent nonreporting histories. CONCLUSION: The CR-E questionnaire represents an impactful screening tool with high utility and feasibility for collegiate athletes. CLINICAL RELEVANCE: Our study supports a brief screening tool to guide concussion counseling for athletes. Based on our data, there appears to be room for improvement in athlete concussion education overall.
Writing a Systematic Review and Meta-analysis: A Step-by-Step Guide.
Dagher D, Khan M
Sports Health · 2025 · PMID 40888799 · Full text
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Development, Validity and Reliability of the Avoidance of Sports Activities Photo Scale (ASAP-Shoulder-Scale) in Athletes With Shoulder Pain.
Turgut E, Dingirdan B, Pakoz B … +3 more , Caylan Gurses K, Haksal PK, de Oliveira AS
Sports Health · 2026 · PMID 40836617 · Full text
BACKGROUND: Fear-avoidance beliefs and kinesiophobia can contribute to shoulder pain-related avoidance behavior. In athletes, symptoms may only become apparent during training and competition. To identify shoulder pain-r...
BACKGROUND: Fear-avoidance beliefs and kinesiophobia can contribute to shoulder pain-related avoidance behavior. In athletes, symptoms may only become apparent during training and competition. To identify shoulder pain-related avoidance behaviors, a standardized screening tool is needed. HYPOTHESIS: Avoidance of Sports Activities Photo Scale (ASAP-Shoulder-Scale) will demonstrate strong psychometric properties. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 162 athletes with shoulder pain were recruited for this study. The ASAP-Shoulder-Scale was developed through an item bank compiled from the International Classification of Functioning, Disability and Health (ICF), with consensus reached by an expert panel. Intraclass correlation coefficients (ICC) were calculated to assess test-retest reliability, along with the standard error of measurement (SEM) and minimal detectable change (MDC). For validation purposes, the Avoidance Daily Activities Photo Scale (ADAP), Shoulder Pain and Disability Index (SPADI), Kerlan-Jobe Orthopaedic-Clinic Shoulder-Elbow Score (KJOC), Tampa Scale for Kinesiophobia (TSK), Pain-Catastrophizing Scale (PCS), and Fear-Avoidance Beliefs Questionnaire (FABQ) were used. RESULTS: A total of 102 preselected activities were evaluated. The scale consisted of 8 activities, with 16 photographic representations that attained 80.0% agreement by the expert panel and demonstrated excellent reliability (ICC, 0.88) with a Cronbach's alpha value of 0.95, a SEM of 20.1 points, and a MDC of 55.8 points. The ASAP-Shoulder-Scale showed significant correlations with ADAP, SPADI, TSK, PCD, and FABQ scores, with correlation coefficients ranging between 0.183 and 0.750 ( < 0.05). CONCLUSION: The ASAP-Shoulder-Scale is a reliable and valid instrument for assessing avoidance behavior in athletes with shoulder pain. CLINICAL RELEVANCE: ASAP-Shoulder-Scale is a novel score to feasibly guide clinicians to monitor avoidance behavior during sports activities. A difference of more than 55.8 points can be accepted as a clinically relevant improvement.
Sports-Related Concussions and Closed Head Injuries in Pediatric Female Soccer Athletes: A 10-year Analysis of National Injury Data.
Yu J, Yendluri A, Javier JV … +7 more , Mohamed KS, Bienstock DM, Darden C, Capotosto S, Gianakos AL, Frank RM, Parisien RL
Sports Health · 2026 · PMID 40836611 · Full text
BACKGROUND: Female athletes are underrepresented in sports injury research, particularly regarding sports-related concussions (SRCs) and closed head injuries (CHIs). This study analyzes injury mechanisms in pediatric fem...
BACKGROUND: Female athletes are underrepresented in sports injury research, particularly regarding sports-related concussions (SRCs) and closed head injuries (CHIs). This study analyzes injury mechanisms in pediatric female soccer players to better address risks in this population. HYPOTHESIS: It was hypothesized that soccer-related SRCs/CHIs in pediatric female players are most commonly caused by ball contact and direct player collisions, with a decrease in incidence over time due to improved safety measuresStudy Design:Descriptive epidemiological. LEVEL OF EVIDENCE: Level 4. METHODS: The National Electronic Injury Surveillance System (NEISS) was queried for soccer-related SRCs/CHIs in girls aged 2 to 18 years from 2014 to 2023. Injury narratives were reviewed to identify mechanisms. National estimates (NEs) were calculated using NEISS statistical weights, and linear regression evaluated trends over time. RESULTS: SRCs/CHIs comprised 16.1% of soccer-related injuries in females aged 2 to 18 years, with 84,519 nationally estimated injuries (2946 NEISS cases). Players aged 14 to 18 years accounted for 63.8% of cases. The most common mechanism was being hit by a soccer ball kicked by another player (35.0%). Player contact, including head-to-head collisions and rough play, caused 25.2% of injuries. For goalies, being kicked or kneed in the head was the leading mechanism (34.6%). A significant decrease in injuries was observed over time ( < 0.05). CONCLUSION: Female pediatric soccer head injuries decreased significantly from 2014 to 2023, with most injuries caused by ball contact or player collisions. These findings support implementing safety initiatives, such as headgear, concussion education, and gameplay modifications, to reduce injury risks based on the mechanisms identified. CLINICAL RELEVANCE: This study highlights the need for safety measures that can be applied broadly across age groups to mitigate soccer-related head injuries in pediatric female athletes.
What Are the Consequences of Hamstring Injuries on Soccer Players' Match Running Performance? A Systematic Review.
Raya-González J, Ponce-Bordón JC, García-Calvo T … +3 more , Polo-Tejada J, Sanabria-Pino B, Lobo-Triviño D
Sports Health · 2026 · PMID 40820639 · Full text
CONTEXT: When soccer players reach high speeds, the hamstring complex is exposed to injury, with sprinting being the mechanism for 70% of injuries suffered in this muscle group. OBJECTIVE: To examine and summarize the im...
CONTEXT: When soccer players reach high speeds, the hamstring complex is exposed to injury, with sprinting being the mechanism for 70% of injuries suffered in this muscle group. OBJECTIVE: To examine and summarize the impact of hamstring injuries on match running performance in elite male soccer players. DATA SOURCES: An electronic database search (Web of Science, Scopus, SportDiscus, and PubMed) was conducted (until December 12, 2023). STUDY SELECTION: Potential studies were searched by using the following keywords: "monitoring," "quantification," "hamstring injuries," "injuries," "recovery," "rehab," and "return to play." The next criteria were also added: professional male soccer, studies reported pre- to postinjury values, included data from matches. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: A total of 4082 papers were reviewed and after 2 screening phases, only 5 papers were selected. RESULTS: A total of 169 hamstring injuries were analyzed (from 18 to 72 in each included study), and a total of 136 matches were included (from 10 to 81 in each included study). This review showed that high-speed running (HSR) distance was the variable reported most frequently. Overall, a decrease in match running performance was found after hamstring injuries compared with baseline values. CONCLUSION: Hamstring injuries impact negatively on soccer players' physical performance, particularly in variables related to HSR. These findings have implications for practitioners regarding the management of player participation after returning to play in terms of volume (ie, minutes), but should be taken with caution due to the limited number of studies included in the present systematic review.
Effect of Hamstring Flexibility Training, Rest, and Retraining on Extensibility and Sagittal Spine Disposition in Dancers: A Randomized Controlled Trial.
Vaquero-Cristóbal R, Cervantes-López-Arza I, Albaladejo-Saura M … +2 more , López-Miñarro PA, Esparza-Ros F
Sports Health · 2026 · PMID 40787838 · Full text
BACKGROUND: Hamstring extensibility is essential for performing several technical movements present in dance. AIM: The aim of this study was to analyze the changes produced by a specific hamstring stretching program, on...
BACKGROUND: Hamstring extensibility is essential for performing several technical movements present in dance. AIM: The aim of this study was to analyze the changes produced by a specific hamstring stretching program, on the hamstring extensibility, sagittal spine curvatures, and pelvic posture during a period of training, rest, and retraining, of female dancers at a High Conservatory of Dance. HYPOTHESIS: The implementation of a stretching program will increase hamstring extensibility and improve sagittal spine disposition of female students of the High Conservatory of Dance. STUDY DESIGN: A randomized controlled trial (RCT) was conducted for a single-blind intervention, including a pretest, retest 1, retest 2, and retest 3, and 2 sample groups. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 57 female dancers (24.63 ± 5.98 years old) completed the study. The experimental group (EG) performed a training period based on hamstring extensibility training for 7 weeks, followed by an 18-day rest period, and a 3-week retraining period. In the training period and retraining period, the EG performed hamstring extensibility training, including 3 sets of 20 seconds of 4 different exercises (240 seconds per session of effective stretching), with a frequency of 4 sessions/week. Hamstring extensibility was measured using the active and passive single leg raise (ASLR and PSLR) tests and the sit-and-reach (SR) test. Sagittal spinal curvatures and pelvic tilt in relaxed standing position, SR, and MacRae and Wright (MW) tests were assessed. The control group (CG) continued with their regular dance training sessions. RESULTS: The EG showed significantly higher scores in the SLR and SR tests ( < 0.01) after training and retraining; a significant increase in the anterior pelvic tilt in the SR and MW tests after the training ( < 0.01); and a significant increase in the thoracic curvature in the MW test after the training ( < 0.01). In general, during the rest period, significant changes were not observed in EG ( > 0.05). Regarding the CG, a significant decrease in the PSLR right leg value was found during the rest period, with a significant increase after the retraining, with just the practice of dance and without performing the stretching intervention ( < 0.01). Furthermore, a greater increase in hamstring extensibility was found in the EG compared with the CG after the training and retraining ( = 0.04 to < 0.01), whereas a greater increase was also found in anterior pelvic tilt in the SR and MW test during the training ( < 0.01). CONCLUSION: A 7-week training period consisting of 4 hamstring extensibility exercises and 3-week retraining period, with an 18-day rest period, effectively improved hamstring extensibility and pelvic tilt in the SR test of female students of the High Conservatory of Dance. CLINICAL RELEVANCE: Incorporating flexibility training could improve the short-term hamstring extensibility of female dancers. This could be an effective tool for dancers whose hamstring extensibility is limiting performance.
Randomized Controlled Trials Evaluating LET and ALL for Anterolateral Rotatory Instability in ACLR Are Fragile: A Systematic Review.
Yendluri A, Gonzalez C, Koehne NH … +8 more , Locke AR, Cuadros A, Kantrowitz DE, Bienstock DM, Alaia MJ, Waterman BR, Li X, Parisien RL
Sports Health · 2026 · PMID 40770846 · Full text
CONTEXT: Lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction have been adopted by some surgeons as augmentations during anterior cruciate ligament reconstruction (ACLR) to improve ante...
CONTEXT: Lateral extra-articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction have been adopted by some surgeons as augmentations during anterior cruciate ligament reconstruction (ACLR) to improve anterolateral rotatory instability. OBJECTIVE: The objective of this study was to assess the statistical robustness of outcomes reported in randomized controlled trials (RCTs) assessing the clinical significance of LET and ALL reconstruction in ACLR. METHODS: PubMed, Embase, and MEDLINE were systematically searched. RCTs published January 1, 2010 to December 31, 2024 assessing LET and ALL reconstruction during ACLR were included. Fragility index (FI) or reverse FI (rFI) was calculated for each outcome, representing the number of event reversals required to alter statistical significance for significant and nonsignificant outcomes, respectively. The fragility quotient (FQ) was determined by dividing the FI or rFI by sample size. LEVEL OF EVIDENCE: Level 1. RESULTS: Of 112 RCTs screened for inclusion, 17 were included for analysis, resulting in 51 total outcomes. The median FI across the 51 outcomes was 4 [interquartile range (IQR), 2-7] with an associated median FQ of 0.031 (IQR, 0.014-0.049). Statistically significant outcomes were more fragile (median FI, 3.5; median FQ, 0.015) than statistically nonsignificant outcomes (median rFI, 5; median FQ, 0.038). In 60.8% of all outcomes (31 of 51), the number of patients lost to follow-up was greater than the outcome's respective FI or rFI. In the 7 RCTs assessing LET, the median FQ was 0.015 (IQR, 0.012-0.042) across 23 outcomes. In the 10 RCTs assessing ALL, the median FQ was 0.035 (IQR, 0.019-0.051) across 28 outcomes. Graft failure, pivot shift, and Lachman/anterior laxity were the most common outcome categories reported, with median FQs of 0.017, 0.035, and 0.048, respectively. CONCLUSION: Outcomes reported in RCTs for LET and ALL reconstruction as augments of ACLR are statistically fragile, emphasizing the need for additional robust and adequately powered RCTs to better understand the impact of anterolateral augmentation on ACLR outcomes.
Fracture Epidemiology in Skateboarding vs. Snowboarding.
Schmidt V, Wadsten M, Brüggemann A … +2 more , Hailer YD, Wolf O
Sports Health · 2025 Jul · PMID 40745953 · Full text
BACKGROUND: Boarding sports, such as skateboarding and snowboarding, are associated with a significant risk of fractures. This study provides a comprehensive overview of the epidemiology, fracture locations, and treatmen...
BACKGROUND: Boarding sports, such as skateboarding and snowboarding, are associated with a significant risk of fractures. This study provides a comprehensive overview of the epidemiology, fracture locations, and treatment approaches for skateboarding and snowboarding-related fractures using data from the Swedish Fracture Register. PURPOSE: To provide a comprehensive overview of the epidemiology, fracture locations, and treatment modalities for fractures incurred during skateboarding and snowboarding. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 4. METHODS: This observational study included all patients registered in the Swedish Fracture Register who sustained fractures while snowboarding or skateboarding from January 2015 to December 2023. Variables studied were age, sex, trauma energy level, seasonal variation, fracture location (body part), and treatment modality. RESULTS: A total of 5155 patients (28% women) with 5446 fractures were included. Adults (≥16 years old) comprised 58% of all patients. The cohort experienced an approximately equal number of fractures from skateboarding (55%) and snowboarding (45%). A greater propensity for high-energy trauma injuries was observed among snowboarders and males. The mean age was similar in both groups, slightly above 20 years. Upper extremity fractures were the most common in both sports. However, discrepancies were noted: lower extremity fractures were more common in skateboarders, whereas injuries to the spine and pelvis were about 8 times more common in snowboarders. Specific injury patterns, such as the "snowboarder's fracture" and "skateboard elbow," appear unique to each sport. CONCLUSION: While skateboarding and snowboarding share similarities, notable differences exist in lower extremity and spinal fractures. Furthermore, specific fracture patterns are characteristic of each sport. Understanding these differences is crucial for developing targeted prevention strategies and improving safety measures.
Effects of Flywheel Leg Curls on Muscle Structure and Function in Athletes with a History of Hamstring Strain Injury: A Randomized Controlled Trial.
Sampietro M, Campana V, Pereira Thiem L … +3 more , Albarenque M, Ribeiro de Oliveira R, Baroni BM
Sports Health · 2026 · PMID 40739858 · Full text
BACKGROUND: Hamstring strain injuries (HSIs) have a high rate of recurrence, highlighting the need for effective tertiary prevention strategies. Flywheel resistance training appears effective in targeting muscular risk f...
BACKGROUND: Hamstring strain injuries (HSIs) have a high rate of recurrence, highlighting the need for effective tertiary prevention strategies. Flywheel resistance training appears effective in targeting muscular risk factors for HSI. HYPOTHESIS: Flywheel leg curls will result in greater improvements in eccentric knee flexor strength and biceps femoris long head (BF) fascicle length compared with conventional leg curls. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: Twenty-six athletes with a history of HSI within the past 18 months participated in an 8-week preventive training program. Athletes were assigned randomly to perform leg curls using either conventional (CON) or flywheel (FLY) equipment. Primary outcomes included eccentric knee flexor strength and BF fascicle length. Secondary outcomes included isometric strength, maximal hip flexion active knee extension (MHFAKE), passive straight leg raise (PSLR), BF muscle thickness, and pennation angle. Reinjury occurrence was monitored over a 6-month period. RESULTS: The FLY group showed significantly greater improvements in eccentric strength (19 ± 19% vs 6 ± 9%; = 0.04) and BF fascicle length (9 ± 8% vs 2 ± 3%; = 0.01) compared with the CON group. The FLY group also exhibited superior gains in isometric strength and flexibility (MHFAKE), whereas the CON group showed a larger increase in BF pennation angle. During follow-up, the CON group sustained 3 reinjuries, whereas the FLY group reported only 1 (reinjury risk ratio 3.0, 95% CI, 0.31-28.9). CONCLUSION: Athletes with a history of HSI who participated in a preventive training program including flywheel leg curls showed greater improvements in knee flexor strength, fascicle length, and flexibility, as well as a lower reinjury occurrence compared with those trained with conventional leg curls. CLINICAL RELEVANCE: Flywheel resistance training offers enhanced muscular adaptations that may reduce the risk of reinjury in athletes with a history of HSI.
VOMS Baseline Versus Postinjury: A Comparison of a Standardized Novel Prototype and a Virtual Reality Application in Sport-Related Concussion.
Pavilionis P, Fenner M, Quigley KG … +5 more , Adhanom IB, Moran RN, Passalacqua M, Szekely B, Murray NG
Sports Health · 2026 · PMID 40739846 · Full text
BACKGROUND: The novel prototype (PRO) or virtual reality (VR) are viable methods of standardization to reduce administration variability during the Vestibular Ocular Motor Screening (VOMS) test. Little is known regarding...
BACKGROUND: The novel prototype (PRO) or virtual reality (VR) are viable methods of standardization to reduce administration variability during the Vestibular Ocular Motor Screening (VOMS) test. Little is known regarding how sport-related concussion (SRC) responds to VOMS in VR. HYPOTHESIS: There will be no difference between PRO and VR total symptom provocation change score (TSPCS), individual subtest symptoms, and near point convergence (NPC) distance within the first 72 hours after SRC. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: At baseline, 394 Division I student-athletes (female, 154; average age, 20.8 ± 1.4 years) completed VOMS using PRO, and 511 (female, 223; average age, 20.9 ± 6.6 years) using VR. Within 72 hours of an SRC, 29 participants (female, 18; 20.6 ± 1.4 years) completed VOMS using PRO and 22 (female, 10; 21.1 ± 1.3 years) using VR. Participants reported subjective symptoms of headache, dizziness, nausea, and fogginess before the test began and after each VOMS subtest in VR. Mann-Whitney tests assessed differences in TSPCS, NPC distance, and subtest symptoms between PRO and VR at baseline and postinjury (PI). Baseline to PI for each modality was also examined. RESULTS: No significant difference was observed for TSPCS (PRO PI, 10.2 ± 11.3; VR PI, 10.5 ± 12.9; = 0.51) and NPC distance (PRO PI, 5.30 ± 6.1 cm; VR PI, 2.80 ± 0.51 cm; = 0.75) for PRO versus VR at PI. This trend continued with all subtests. CONCLUSION: In this Division I collegiate population, symptom provocation during the VOMS in VR is not different than with PRO at PI; however, this comparison was underpowered as no a priori sample size calculation was conducted. CLINICAL RELEVANCE: VR does not provoke additional symptoms PI. VR may be used as a viable method for VOMS test standardization and delivery.
Athletes Who Test Positive on Multiple Domains of the Vestibular-Ocular Motor Screen Take Longer to Return to Play.
Lee BJ, Garrison JC, Goto S … +4 more , Hannon J, Creed K, Blueitt D, Nadolny C
Sports Health · 2026 · PMID 40739841 · Full text
BACKGROUND: The Vestibular-Ocular Motor Screen (VOMS) is a validated tool that is used to assess symptom provocation with vestibular and ocular testing following sport-related concussion (SRC). It is unknown if the invol...
BACKGROUND: The Vestibular-Ocular Motor Screen (VOMS) is a validated tool that is used to assess symptom provocation with vestibular and ocular testing following sport-related concussion (SRC). It is unknown if the involvement of multiple domains on the VOMS effects time to return to play (RTP) following SRC. HYPOTHESIS: Athletes who tested positive on >3 domains of the VOMS would take longer to RTP than athletes who tested positive on ≤3 domains of the VOMS. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 928 athletes were enrolled from a concussion clinic. The median VOMS score was used to divide these athletes into 2 groups, those who tested positive on ≤3 domains (LOW) and those who tested positive on >3 domains (HIGH). Independent -tests were used to assess for differences in time to RTP between groups. A simple linear regression was carried out to assess the influence of positive testing on the VOMS domains at the time of first evaluation on time to RTP. RESULTS: Independent -tests demonstrated a significant difference in time to RTP between the LOW and HIGH groups, with the LOW group returning to play an average of 12.81 days sooner than the HIGH group. The simple linear regression showed that approximately 10.8% of the time to RTP after SRC could be explained by the number of domains that test positive at initial evaluation. CONCLUSION: Athletes who test positive on >3 domains of the VOMS take longer to RTP than athletes who test positive on ≤3 domains of the VOMS at the time of initial evaluation. CLINICAL RELEVANCE: The VOMS may be utilized to help determine which athletes may take longer to RTP based on the number of domains that are affected after SRC.
Are Changes in Thigh Muscle Concentric Strength Associated With Changes in Leg Function After a Youth Sport-Related Knee Injury?
Losciale JM, Le CY, Truong LK … +4 more , Bullock GS, Mitchell CJ, Hunt MA, Whittaker JL
Sports Health · 2026 · PMID 40736040 · Full text
BACKGROUND: Assess the association between changes in injured leg knee extension and flexion strength (peak torque) and self-reported and performance-based measures of leg function after a variety of youth sport-related,...
BACKGROUND: Assess the association between changes in injured leg knee extension and flexion strength (peak torque) and self-reported and performance-based measures of leg function after a variety of youth sport-related, time-loss knee injuries. HYPOTHESIS: There will be a relationship between changes in knee muscle strength and changes in measures of leg function in youth after a sport-related knee injury. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: This was a secondary analysis of the Alberta Youth Prevention of Early Osteoarthritis (PrEOA) Cohort study (Edmonton) that included youth (11-19 years old) who had experienced a medical attention, time-loss, sport-related knee injury in the previous 4 months. Injured leg knee extensor and flexor concentric peak torque (isokinetic; 90 deg/s), triple hop distance, modified Y-balance test (YBT), and Knee injury and Osteoarthritis Outcome Score Sport subscale (KOOS) were assessed at baseline (≤4 months postinjury) and 6 and 12 months later. Adjusted associations between 6- and 12-month change in strength and functional measures were assessed using multivariable regression (95% CI). RESULTS: Based on data from 106 participants (16.2 ± 1.8 years old), a 1 Nm increase in knee extensor strength (6-12 months) was associated with a 0.9 cm (95% CI, -0.5, 2.3) increase in hop distance. Similarly, every 1 Nm increase in knee flexor strength (6-12 months) was associated with a 0.3 cm (95% CI, -1.1, 1.7) increase in hop distance. Across other models, a 1 Nm increase in extensor or flexor strength was associated with a 0- to 0.3-point increase in KOOS score. CONCLUSION: There was minimal-to-no longitudinal relationship between changes in knee extensor or flexor strength and changes in triple hop or YBT performance, or self-reported function within the first year after a youth sport-related knee injury.
Comparison of Upper-Limb Muscle Activation Levels in Different Physical Fitness Exercises Using Dumbbells and Elastic Tubes.
Martín-Ruiz J, Ruiz-Sanchis L, Tamarit Grancha I … +3 more , Gallego Cerveró C, Vicente-Mampel J, Baraja-Vegas L
Sports Health · 2026 · PMID 40734261 · Full text
BACKGROUND: Elastic tubes are used widely in fitness programs because they are lightweight, easy to use, and versatile. However, evidence of their equivalence to other equipment, including dumbbells, remains insufficient...
BACKGROUND: Elastic tubes are used widely in fitness programs because they are lightweight, easy to use, and versatile. However, evidence of their equivalence to other equipment, including dumbbells, remains insufficient. HYPOTHESIS: Elastic tubing and dumbbells do not have equivalent loads, although both equipment generate similar symmetry and muscular synergy. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 2b. METHODS: Thirty physically active people (15 men and 15 women) performed 4 upper-limb exercises (elbow flexion, shoulder abduction, scapular elevation and abduction, and scapular retraction and abduction) with 5 loads (dumbbells ranging from 2 to 6 kg and red, green, blue, black, and silver elastic tubes). RESULTS: Only elbow flexion ( = 0.14 and ≥ 0.99) and shoulder abduction ( = 0.13 and ≥ 0.99) exercises showed load equivalence in men but not in women. Both types of equipment were symmetrical and generated similar synergies when the load was increased, with no sex differences ( = 0.11). Load equivalence was found only in men and in the 2 exercises, suggesting that this equipment was not interchangeable. CONCLUSION: Dumbbell and elastic tube exercises can be executed in a balanced and symmetrical manner, yielding similar synergies considering the involvement of all muscle groups regardless of sex. CLINICAL RELEVANCE: This study analyzed a higher number of exercises performed by both men and women. The results showed that these 2 pieces of equipment cannot be considered interchangeable, as they generate different loads. However, similar efforts are required for symmetry and muscle synergy.
Magnetic Resonance Neurography of Sports-Related Peripheral Nerve Injuries of the Shoulder Region.
Lin Y, Tan ET, Akerman M … +2 more , Colucci PG, Sneag DB
Sports Health · 2026 · PMID 40726051 · Full text
CONTEXT: Although many sports-related injuries in the shoulder region are self-limiting, those involving the peripheral nerves can have a profound adverse effect on an athlete's career. While physical examination and ele...
CONTEXT: Although many sports-related injuries in the shoulder region are self-limiting, those involving the peripheral nerves can have a profound adverse effect on an athlete's career. While physical examination and electrodiagnostic testing are the mainstays for assessing such injuries, peripheral nerve magnetic resonance (MR) imaging, also known as MRN, can play an important and complementary role in helping further characterize injury extent and localization. This review explores the application of MRN in diagnosing and managing sports-related peripheral nerve injuries. EVIDENCE ACQUISITION: A narrative overview of the literature combined with the clinical and research expertise of the authors. STUDY DESIGN: Narrative review. LEVEL OF EVIDENCE: Level 4. RESULTS: MRN helps localize preganglionic and postganglionic traumatic brachial plexus injuries, facilitating the planning of appropriate surgical interventions and determining the extent of nerve injury. MRN may also be used to assess thoracic outlet syndrome, commonly implicated in overhead sports activities. In cases of shoulder dislocation, MRN can depict altered nerve signal intensity and morphology of the axillary nerve that may be stretched. MRN also plays an important role in detecting and guiding the management of iatrogenic nerve-related injuries, and helping define alternative diagnoses, such as Parsonage-Turner syndrome, that might be the culprit in the postsurgical setting. Bone-sensitive and angiography MR pulse sequences can help delineate the spatial relationship among peripheral nerves, osseous structures, and blood vessels. CONCLUSION: MRN is valuable in assessing sports-related traumatic nerve injuries of the shoulder region, as well as newly developed neurological symptoms following shoulder surgery. Specifically, MRN provides a global evaluation of regional muscles and nerves, which and can help localize injury to one or more nerve segments that may be targeted for therapeutic intervention.Strength-of-Recommendation Taxonomy (SORT):Evidence B, level 3.
Can Body Mass Index Values and/or Player Position be Viable Predictors for Exertional Heat Illness in American Football Players?
Cahill OJ, Cooper ER, Grundstein AJ
Sports Health · 2026 · PMID 40717334 · Full text
BACKGROUND: Exertional heat illnesses (EHIs) affect thousands of high school athletes each year. Although there are clear risk patterns for fatal EHIs based on player characteristics, there is less information on these a...
BACKGROUND: Exertional heat illnesses (EHIs) affect thousands of high school athletes each year. Although there are clear risk patterns for fatal EHIs based on player characteristics, there is less information on these associations for nonfatal EHIs. HYPOTHESIS: Prediction of nonfatal EHI risk in American high school football participants can be determined using commonly available data on body mass index (BMI) values and/or player position. STUDY DESIGN: Epidemiological study. LEVEL OF EVIDENCE: Level 3. METHODS: Participants from 22 high schools in the state of Georgia in the United States were used for this study. Player demographics including height, weight, BMI, and player position were considered. EHI occurrences from 2012 to 2014 were recorded and analyzed to determine EHI risk. These data were collected as part of normal practice/competition activities, and the researchers did not interact with the subjects of the study. Therefore, approval from the Institution's Internal Review Board was not required for this investigation. RESULTS: There were 309 EHIs over 163,118 athlete-exposures. The linemen group had over 2.5 to 3 times greater risk of sustaining heat syncope/heat exhaustion (HS/HE) than the backs (relative risk [RR], 2.63; 95% CI, 1.59-4.33) and Specialists (RR, 3.16; 95% CI, 1.52-6.56) groups. Linemen were at lower risk for exercise-associated muscle cramps (EAMCs) compared with backs (RR, 0.63; 95% CI, 0.53-0.76). No differences were found in relative risk among BMI categories. CONCLUSION: Our results indicate that field position is a bigger differentiator in EHI risk than BMI. CLINICAL RELEVANCE: Sports medicine and coaching staff should be educated that American football participants at the linemen position are at greater risk for HS/HE than those at other positions. This supports the use of position-specific training activities to mitigate EHI risk.
Knee Locking and Diagnosis Unlocking: Understanding and Treating the Hypermobile Lateral Meniscus.
Park N, Levitt S, Patel S … +3 more , Katz LD, Jokl P, Medvecky MJ
Sports Health · 2026 · PMID 40696884 · Full text
CONTEXT: Hypermobility of the lateral meniscus is a relatively uncommon condition characterized by excessive, abnormal movement of the lateral meniscus in the knee joint. This literature review and case report aims to pr...
CONTEXT: Hypermobility of the lateral meniscus is a relatively uncommon condition characterized by excessive, abnormal movement of the lateral meniscus in the knee joint. This literature review and case report aims to provide insights into the clinical presentation, diagnosis, and treatment options for peripheral lateral meniscocapsular tears that result in excessive lateral meniscal motion. EVIDENCE ACQUISITION: A narrative review of the literature and the clinical expertise of the authors. STUDY DESIGN: Narrative overview. LEVEL OF EVIDENCE: Level 5. RESULTS: A hypermobile lateral meniscus poses diagnostic challenges due to overlapping symptoms with other knee pathologies. The anatomy of the posterolateral meniscocapsular recess and popliteus hiatus can distort the ability to accurately diagnose tears of the peripheral attachments of the posterior horn of the lateral meniscus. In a primary care practice, recognition of this condition in patients presenting with recurrent mechanical catching or locking episodes, sometimes with a "normal" magnetic resonance imaging (MRI) scan, is crucial to refer to orthopaedics in a timely manner to prevent further damage. Arthroscopic meniscal repair can be an effective treatment option, facilitating a safe return to sports after rehabilitation. CONCLUSION: A hypermobile lateral meniscus and peripheral meniscocapsular tears of the lateral meniscus should be considered in the differential diagnosis of knee pain with recurrent locking episodes, even with an "unremarkable" MRI scan. Timely and accurate diagnosis and appropriate intervention, such as arthroscopic meniscal repair, can lead to better quality of life. Further research is needed to explore long-term outcomes and optimal management strategies for hypermobile lateral meniscal tears.Strength-of-Recommendation Taxonomy (SORT):Level C.
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