Sports Health [JOURNAL]
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200 papers
The Epidemiology of Pickleball Injuries Presenting to US Emergency Departments.
McMillan P, Lake LP, Burkhart A … +3 more , Reddy E, Hale IC, Grawe BM
Sports Health · 2026 · PMID 40653665 · Full text
BACKGROUND: The popularity of pickleball as a recreational and competitive sport has increased dramatically over the last decade in the United States. HYPOTHESIS: To evaluate trends in pickleball injury rates and specifi...
BACKGROUND: The popularity of pickleball as a recreational and competitive sport has increased dramatically over the last decade in the United States. HYPOTHESIS: To evaluate trends in pickleball injury rates and specific injury characteristics. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: The National Electronic Injury Surveillance System database was queried from 2014 to 2023 for national weighted injury estimates and injury characteristics from recreational pickleball players presenting to US emergency departments. RESULTS: Annual national estimates of pickleball-related injuries increased significantly ( < .001) from 2014 (1313; CI, 550-2078) to 2023 (24,461; CI, 3837-45,086). A transient 19.3% reduction in injury rates occurred in 2020, coinciding with the COVID-19 pandemic. Most injuries affected people aged 60 to 79 years, with nearly equal sex distribution (51.2% men vs 48.8% women). Most patients were discharged, although 5 deaths due to cardiac arrest were reported. Women had higher odds of upper extremity injuries (odds ratio [OR], 1.66), hand/wrist injuries (OR, 3.22), and fractures (OR 3.03). Men experienced more lower extremity injuries (OR, 1.71), trunk injuries (OR, 1.28), lacerations (OR, 1.71) and strains/sprains (OR, 1.87). Women were more likely to fall (OR, 2.08), while men were more often hit (OR, 1.92) or overexerted themselves (OR, 1.89). Older adults, aged 60 to 79 years, had increased odds of wrist/hand injuries (OR, 1.47) and fractures (OR, 1.75), with falls being 2.10 times more likely in this cohort. People aged 40 to 59 years had higher odds of lower extremity injuries (OR, 2.09), whereas those <19 years had higher odds of dislocation (OR, 5.25), head injury (OR, 1.95), and laceration (OR, 2.83). CONCLUSION: Pickleball injuries affect predominantly older adults, with distinct sex and age-related patterns. CLINICAL RELEVANCE: There is a need for age and sex-specific injury prevention strategies to enhance safety in pickleball participation.
Biometric Changes up to 1 Year After Bilateral Hip Arthroscopy in Division I Collegiate Athletes.
Steiner Q, Walczak BE, Sanfilippo J … +3 more , Joachim MR, Haraldsdottir K, Watson AM
Sports Health · 2026 · PMID 40635206 · Full text
BACKGROUND: Patients undergoing bilateral hip arthroscopy for femoroacetabular impingement (FAI) require weightbearing restrictions that, combined with surgery, may influence muscle mass and bone mineral density (BMD). H...
BACKGROUND: Patients undergoing bilateral hip arthroscopy for femoroacetabular impingement (FAI) require weightbearing restrictions that, combined with surgery, may influence muscle mass and bone mineral density (BMD). HYPOTHESIS: After bilateral hip arthroscopy, patients will exhibit changes in biometric data. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: National Collegiate Athletic Association (NCAA) Division I collegiate athletes undergoing bilateral hip arthroscopy surgery had a dual energy x-ray absorptiometry (DXA) scan preoperatively and at 3, 6, or 12 months postoperatively. Linear mixed effects models assessed change in total body and leg lean and fat mass, and pelvic, spine, and total leg BMD at each timepoint relative to baseline. RESULTS: Significant decreases (n = 18 athletes) in pelvic BMD were seen at baseline (1.40g/cm; [95% CI, 1.30, 1.51]); 3 months (1.33g/cm [1.23, 1.43]; < 0.001), and 6 months (1.33g/cm [1.22, 1.43]; < 0.001), and spine BMD at 6 months postoperatively (1.43g/cm [1.30, 1.52]; 1.38g/cm; [1.29, 1.47]; = 0.02). Lower extremity and total body fat mass were increased at 3 months (6881 g; [4932, 8829]; 7757 g [5801, 9713]; < 0.01), (19,565 g; [13130, 25999]; 21,467 g; [15012, 27922]; = 0.02), whereas total body lean mass was decreased at 3 months (66,736 g; [58,265, 75,207]; 64,978 g; [56,492, 73,464]; = 0.04). Results at 12 months were not significantly different from baseline. CONCLUSION: In NCAA Division I collegiate athletes who underwent bilateral hip arthroscopy for FAI, pelvic and spine BMD was decreased up to 6 months after surgery when compared with presurgery measurements, but no decrease was observed after 1 year. Clinicians should be aware of the potential implications of decreased bone mass up to 12 months postsurgery. CLINICAL RELEVANCE: Understanding changes in body composition and BMD postoperatively may help to guide rehabilitation management and injury risk assessment.
Validity of the King Devick Test for Acute Diagnosis of Concussion in NCAA Division I Athletes.
Harmon KG, Whelan BM, Aukerman DF … +6 more , Poddar SK, DeLeo A, Elkington HA, Garruppo G, Holliday M, Hwang CE
Sports Health · 2026 · PMID 40625038 · Full text
BACKGROUND: The King-Devick (KD) test is a timed rapid number naming test used for the acute diagnosis of concussion. HYPOTHESIS: The KD test will be more sensitive, but less specific, than other commonly used objective...
BACKGROUND: The King-Devick (KD) test is a timed rapid number naming test used for the acute diagnosis of concussion. HYPOTHESIS: The KD test will be more sensitive, but less specific, than other commonly used objective tests for concussion. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 4. METHODS: National Collegiate Athletic Association Division I college athletes completed baseline testing for the KD. When an athlete presented acutely with suspected concussion from July 1, 2020 to December 31, 2022 (sideline/within 48 hours) the test was repeated. If a concussion was diagnosed, a control matched on comorbid conditions, sex/gender, team, season, and baseline test time was identified to test. RESULTS: Baseline and postinjury data were collected for 97 concussed and 97 matched control athletes. In total, 44% of concussions occurred in female athletes, with most concussion occurring in football 37 (38%), women's volleyball 14 (14%), and softball 6 (6%). The KD test had fair test-retest reliability at 0.72 (95% CI, 0.61-0.80). The sensitivity and specificity of the test for any increase in time compared with baseline was 81% and 56%, with a positive predictive value of 65% and negative predictive value of 75%. The AUC was also fair at 0.75 (0.68-0.82). There was no significant difference in accuracy of the KD taken at different times points (immediate, 2-8 hours, 8-24 hours, 24-48 hours). CONCLUSION: The KD is more sensitive, but less specific, than other commonly used objective tests for concussion. Understanding the psychometric properties of the KD can help with the diagnosis of concussion. CLINICAL RELEVANCE: The KD may be a good initial screening tool to prompt further evaluation or allow return to play without further evaluation. Further study in other populations is needed.
Movement Rate and Brain-Muscle Coupling in Male Footballers With and Without Hamstring Injury History.
Correia JP, Grilo H, Witvrouw E … +2 more , Vaz JR, Freitas SR
Sports Health · 2026 · PMID 40625028 · Full text
BACKGROUND: High-speed actions constitute an important mechanism of hamstring strain injuries (HSIs) in football. These actions have a strong supraspinal base, and changes in brain activity have been noted in other muscu...
BACKGROUND: High-speed actions constitute an important mechanism of hamstring strain injuries (HSIs) in football. These actions have a strong supraspinal base, and changes in brain activity have been noted in other musculoskeletal injuries; however, there is a lack of information about changes in brain-muscle coupling in footballers with HSI history. Therefore, this study aimed to determine whether movement speed and brain-muscle activity differ between players with and without HSI history during a high-speed knee movement task. HYPOTHESIS: Footballers with previous HSI will show decreased knee movement rate and associated neurophysiological inhibition. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 108 male footballers (39 with HSI history) performed a maximum-speed knee flexion-extension task over eight 10-second blocks. During this task, brain and muscle activity of knee flexors and extensors were recorded using electroencephalography (EEG) and electromyography (EMG), respectively, and the movement rate was measured. RESULTS: Footballers with HSI history moved at a higher rate in the first half of the task. This was accompanied by higher theta and decreasing alpha EEG activity, lower rectus femoris and biceps femoris activity, and less flexor-extensor co-contraction. Conversely, there were no differences in corticomuscular coherence (CMC) between groups, but the biceps femoris showed a significantly lower CMC than all other muscles. CONCLUSION: The task was able to differentiate players with and without HSI history; in addition, those with previous HSI showed EEG activity patterns associated with increased task load and use of attentional resources for sensorimotor integration. EMG findings indicated players with HSI history were able to perform better despite showing overall reduced activity, especially in the rectus femoris and biceps femoris. CLINICAL RELEVANCE: Neurocognitive factors may be involved in HSIs and persist even after rehabilitation, suggesting the relevance of including these factors in rehabilitation.
Sleep: A Game Changer for Youth Athlete Wellbeing.
Tate T, Main LC, Roberts S … +1 more , Bruce L
Sports Health · 2026 · PMID 40625023 · Full text
BACKGROUND: Youth athletes may have reduced opportunities for sufficient sleep, and often report poor mental health and wellbeing. HYPOTHESIS: Most youth athletes obtain less than recommended duration and quality of slee...
BACKGROUND: Youth athletes may have reduced opportunities for sufficient sleep, and often report poor mental health and wellbeing. HYPOTHESIS: Most youth athletes obtain less than recommended duration and quality of sleep, with associated reduced wellbeing. STUDY DESIGN: Prospective observational study. LEVEL OF EVIDENCE: Level 3. METHODS: Sleep was monitored in 98 youth athletes (15.19 ± 2.08 years) for 8 consecutive weeks. Wellbeing was self-reported weekly using the Multicomponent Training Distress Scale (MTDS) and the Short Recovery Stress Scale (SRSS). RESULTS: Adolescent athletes averaged 7.0 (±1.1) hours sleep per night, but did not meet recommended daily sleep duration (ie, ≥8 hours) on >80% of nights studied. Significant sleep disturbances were detected in 40% of participants. Total sleep time measured via actigraphy was associated negatively with MTDS depression (all values given as [β; CI)] (-0.50; -0.95-0.05), stress (-0.78; -1.23-0.33) and sleep disturbance (-0.62; -0.97-0.27) subscales and overall score (-2.57; -4.27-0.87), and the SRSS stress subscale (-0.82; -1.50-0.15) ( < 0.05). Subjective sleep quality measured via sleep diaries was associated positively with all MTDS scores including depression (0.85; 0.50-1.19), sleep disturbance (1.04; 0.72-1.35), and physical symptom (0.60; 0.13-1.08) subscales, and the SRSS stress subscale (1.67; 0.91-2.43), and negatively with SRSS recovery subscale (-1.02; -1.64-0.41). Fatigue ratings before bed and upon awakening were associated positively with all MTDS subscales and the SRSS stress subscale (1.23; 0.74-1.71) (1.26; 0.79-1.74) ( < 0.05). CONCLUSION: Many adolescent athletes do not meet current sleep recommendations, and inadequate duration and/or quality of sleep in this population is associated with poorer self-reported wellbeing. CLINICAL RELEVANCE: Education surrounding sleep in youth athletes should emphasize the importance of adequate sleep, alongside the maintenance of regular sleeping patterns to promote wellbeing and mental health.
The Influence of Limb Dominance on Performance-Based Outcomes After ACL Reconstruction.
Hodges J, Bruce Leicht AS, Thompson XD … +6 more , Werner BC, Diduch DR, Brockmeier SF, Gwathmey FW, Miller MD, Hart JM
Sports Health · 2026 · PMID 40551484 · Full text
BACKGROUND: Considering limb dominance (LD) may be valuable when utilizing limb symmetry index (LSI) when assessing patients after anterior cruciate ligament reconstruction (ACLR). HYPOTHESIS: Patients will have better p...
BACKGROUND: Considering limb dominance (LD) may be valuable when utilizing limb symmetry index (LSI) when assessing patients after anterior cruciate ligament reconstruction (ACLR). HYPOTHESIS: Patients will have better performance-based outcomes when index ACLR occurred on the dominant limb (DL) compared with the nondominant limb (NDL). STUDY DESIGN: Observational cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 279 patients (49.1% female, 20.83 ± 5.23 years; 48% DL surgery) completed a laboratory visit (7.65 ± 1.65 months post-ACLR) assessing LD influence on knee extension and flexion peak torque, center of pressure (COP) distance and velocity, and hop performance. LD was defined as the preferred limb to kick a soccer ball. LSI variables were converted to indicator variables and categorized as "Pass" or "Fail" based on LSI ≥ 90%. RESULTS: Patient LD and isometric knee extension LSI Pass status were significantly associated (χ = 10.09; = 0.001). No additional associations were found between LD and other LSI Pass status variables ( > 0.05). Patients with DL ACLR demonstrated more symmetric knee extension peak torque ( < 0.001, = 0.42) and 6-meter hop ( = 0.02, = 0.25) outcomes; NDL was more symmetric during COP distance tests ( = 0.03, = 0.40). No differences were observed between LD and raw strength or balance measures ( > 0.05). Patients with ACLR on their NDL jumped farther on their contralateral limb for triple-hop ( = 0.03, = 0.23) but not single-hop ( > 0.05) distance. CONCLUSION: LD appears to influence isometric knee LSI in patients post-ACLR; patients with surgery on their DL achieved higher symmetry and a greater rate of LSI Pass success for knee extension strength. CLINICAL RELEVANCE: Addressing differences in recovery patterns between DL and NDL may improve rehabilitation precision and guide return-to-activity timelines after ACLR.
Bigger Than Ever.
Wojtys EM
Sports Health · 2025 Jul · PMID 40540431 · Full text
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Effectiveness of Percutaneous Needle Tenotomy for Tendinopathies: Response.
Maag L, Linder S, Hackett L … +5 more , Mitchkash M, Farley T, Lamar D, Fisher N, Burnham B
Sports Health · 2025 Jul · PMID 40540430 · Full text
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Return to Sport After Reverse Shoulder Arthroplasty: A Systematic Review.
Singh A, Cho V, Abdel Khalik H … +3 more , Dagher D, Sheth U, Khan M
Sports Health · 2026 · PMID 40538058 · Full text
CONTEXT: Reverse shoulder arthroplasties (RSAs) have become significantly more common in recent decades, and shoulder arthroplasties are increasingly performed on younger, active patient populations. However, the body of...
CONTEXT: Reverse shoulder arthroplasties (RSAs) have become significantly more common in recent decades, and shoulder arthroplasties are increasingly performed on younger, active patient populations. However, the body of evidence evaluating return to sport after RSA is limited. OBJECTIVE: To evaluate the rates of return to sport after RSA as well as patient-reported outcomes for pain and function. DATA SOURCES: A comprehensive search of MEDLINE, EMBASE, and CENTRAL identified studies from inception through October 10, 2023. STUDY SELECTION: Studies evaluating return to sport after RSA in adult patients (>18 years) were included. Reviews, meta-analyses, non-English language, and studies that did not report return to sport data were excluded. Outcomes included rates of return to sport at any level, and at the same level or higher, as well as patient-reported outcomes. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: A descriptive analysis of the included studies was performed. RESULTS: A total of 19 studies (3092 patients) were included. Mean patient age was 72.5 years, and most (58.8%) were female. The mean rate of return to sport at any level was 85.1% (95% CI, 84.6-85.6). The mean rate of return to the same level or higher was 69.5% (95% CI, 67.6-71.4). The mean decrease in visual analog scale pain score was 1.97, whereas ASES and CMS scores increased 64.0 and 35.5 points, respectively. All changes in patient-reported outcomes exceeded the minimal clinically important difference. CONCLUSION: This review demonstrates a high rate of return to sport after RSA, with a substantial portion of patients maintaining or exceeding their preoperative activity level. Clinically meaningful improvements in pain and function were also observed. Limitations include the predominantly retrospective study design and the high mean patient age, necessitating further research on generalizability and long-term outcomes, particularly in younger populations.
Rethinking Lower Extremity Limb Dominance: A Comparison of Performance-Based and Self-Selected Measures.
Leung A, Dyke J, Zarzycki R … +3 more , Lawrence JT, Ganley T, Greenberg E
Sports Health · 2026 · PMID 40517289 · Full text
BACKGROUND: Limb dominance implies preferential or asymmetrical performance between limbs. There is currently no consensus regarding limb dominance definition for the lower extremity. Previous work described several meth...
BACKGROUND: Limb dominance implies preferential or asymmetrical performance between limbs. There is currently no consensus regarding limb dominance definition for the lower extremity. Previous work described several methods of subjective reporting for lower extremity limb dominance; however, the correlation between objective performance and subjective perception of limb dominance is poorly understood, particularly among adolescent athletes. The purpose of this study was to test the agreement between objective performance and self-selected limb dominance in 3 different single-leg hopping tasks. HYPOTHESIS: There will be a positive association between self-selected limb dominance and objective performance. STUDY DESIGN: Cross-sectional cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Self-selected limb dominance was determined by asking, "Which leg would you use to kick a ball as far as you could?" Participants performed a series of single-leg hops, and 3-trial means of the single hop (SH), timed hop (TH), and vertical hop (VH) were used for analysis. Paired samples test or Wilcoxon-signed rank test identified differences in limb performance for each hop test. Chi-square analysis evaluated associations between self-selected limb dominance and objective performance. RESULTS: A total of 352 healthy youth athletes (55% male; mean age, 11.1 ± 1.7 years) participated. There was a small statistically significant difference between limbs on all hop tests. Chi-square analysis revealed no associations ( > 0.05) between self-selected limb dominance and objective performance across all hop test constructs. CONCLUSION: A single limb performed better on all hop tests by a small and not clinically relevant difference. Perceived limb dominance did not predict performance regardless of hopping task. CLINICAL RELEVANCE: Symmetrical performance on the SH, TH, and VH is normal in uninjured athletes. When returning injured athletes to sport, clinicians should aim for restoring hop test symmetry regardless of whether the injured limb is the perceived dominant limb.
Association of Loading Asymmetry During Squatting With Loading Asymmetry During Drop Jump After ACL Reconstruction: Implications for Rehabilitation Progression.
Popovich JM, Tsai LC, Brito M … +2 more , Xerogeanes JW, Lyle MA
Sports Health · 2026 · PMID 40517288 · Full text
BACKGROUND: Biomechanical asymmetries after anterior cruciate ligament reconstruction (ACLR) may be amplified and perpetuated by progressing athletes to higher-demand tasks despite impairments in lower-demand tasks. HYPO...
BACKGROUND: Biomechanical asymmetries after anterior cruciate ligament reconstruction (ACLR) may be amplified and perpetuated by progressing athletes to higher-demand tasks despite impairments in lower-demand tasks. HYPOTHESES: (1) Between-limb asymmetries in limb loading and joint kinetics will be greater during the higher-demand drop jump compared with squatting. (2) Asymmetries in limb loading and joint kinetics during squatting will be associated with asymmetries during drop jump. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 22 (11 female) participants after primary ACLR (6.4 ± 0.5 months) performed bilateral squat and drop jump tasks. Vertical ground-reaction force (vGRF), knee and hip extensor net joint moments (NJMs), hip/knee mean NJM ratio, and limb symmetry index (LSI) were calculated during the eccentric phase. Comparisons between limbs and across tasks were analyzed using 2-way repeated measures analyses of variance. Pearson's correlations assessed associations between vGRF and NJM LSIs, and hip/knee NJM ratios across tasks. RESULTS: Mean vGRF LSI and knee NJM LSI were significantly more asymmetric during drop jump compared with squatting (79.7 ± 14.9 vs 90.0 ± 11.0%, < 0.001 and 55.8 ± 17.6 vs 66.4 ± 25.6%, = 0.02, respectively). Mean vGRF LSI ( = 0.58; = 0.004) and knee NJM LSI ( = 0.61; = 0.002) were moderately correlated between tasks. The hip/knee ratio for the ACLR limb correlated strongly between tasks ( = 0.69; < 0.001); nonsurgical limb: r = 0.39; P = 0.07). CONCLUSION: Underloading and reduced functional use of the ACLR knee were amplified during the drop jump compared with squatting. Limb mechanics during lower-demand squatting are informative of performance during drop jump. CLINICAL RELEVANCE: Criterion-based rehabilitation guidelines may benefit from requiring symmetry in lower-demand tasks before progressing to higher-level activities to optimize recovery and reduce risk of reinjury.
Relationship Between Patients' Self-Reported Injury Mechanism and MRI Outcomes in Hamstring Muscle Injury: A Prospective Cohort Study on 71 Patients.
Grange S, Reurink G, Croisille P … +1 more , Edouard P
Sports Health · 2026 · PMID 40506866 · Full text
BACKGROUND: Hamstring muscle injury (HMI) is the most common injury in sports that require sprints and accelerations. Different HMI subtypes have been described according to the muscle, location, tissue, and severity of...
BACKGROUND: Hamstring muscle injury (HMI) is the most common injury in sports that require sprints and accelerations. Different HMI subtypes have been described according to the muscle, location, tissue, and severity of the injury. It is of interest to determine whether these subtypes are related to a particular clinical injury mechanism. HYPOTHESIS: There would be an association between the muscle involved and the injury mechanism. STUDY DESIGN: Prospective, multicenter, observational cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: All patients underwent postinjury magnetic resonance imaging (MRI) and were assessed for their mechanism of injury using a survey. Statistical analyses used chi squared test and analysis of variance. RESULTS: A total of 71 patients were included in the present study. MRI scans were performed within 7.5 ± 4.9 days of injury. There was no significant association between the HMI mechanism and the injured muscle (χ = 6.86; = 0.34), or with proximo-distal position (χ = 20.28; = 0.16). There was a significant association between HMI mechanism and HMI grade (χ = 23.7; < 0.001) and the HMI volume (F(3,67) = 5.223; = 0.003) with significant higher severity and higher volume in stretching than in running mechanisms ( = 0.002). CONCLUSION: We showed an association between HMI mechanism and MRI scan grade and volume, with significant higher injury grade and larger volume in stretching mechanism. CLINICAL RELEVANCE: These differences, depending on the mechanism of injury, may lead to changes in clinical practice.
Monitoring Internal and External Training Loads in Female Artistic Roller Skating: A Longitudinal Study.
Rebelo A, Martinho DV, Pires IG … +2 more , Lima R, Nakamura FY
Sports Health · 2025 Nov · PMID 40485175 · Full text
BACKGROUND: Artistic roller skating is a sport that involves high physical demands, particularly in the free skating discipline, where jumps are critical. Managing training loads is essential for optimizing performance a...
BACKGROUND: Artistic roller skating is a sport that involves high physical demands, particularly in the free skating discipline, where jumps are critical. Managing training loads is essential for optimizing performance and preventing injuries. HYPOTHESIS: To investigate the internal and external training loads of female artistic roller skating athletes and to analyze the relationships between these loads components. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 15 female artistic roller skating athletes were monitored over a 4-week mesocycle leading up to the National Championship. Internal training load (ITL) was measured using the session rating of perceived exertion (sRPE), whereas external training load (ETL) was assessed with an inertial measurement unit capturing jumps and energy. Repeated measures analysis of variance (RMANOVA) and correlation analysis were conducted. RESULTS: The RMANOVA revealed significant differences in monotony and strain of ITL, as well as in the monotony of jumps and energy. Significant correlations were found between ITL and ETL metrics, with higher sRPE and daily ITL associated with increased jumps and energy. CONCLUSION: The findings highlight the interrelationships between internal and external load metrics, with higher perceived exertion and daily training loads associated with increased external workload, particularly in jump frequency and energy. In addition, training monotony and strain fluctuated across microcycles, with notable increases observed as the competition approached. These results emphasize the importance of systematically monitoring both internal and external training loads, including monotony and strain, to better understand workload dynamics and guide training adjustments. CLINICAL RELEVANCE: The findings provide practical insights for coaches on how to balance training intensity and volume to enhance performance and prevent overtraining and injuries.
Effectiveness of Percutaneous Needle Tenotomy for Tendinopathies: Letter to the Editor.
Rhim HC, Tsitsilianos N, Makovitch S
Sports Health · 2025 Jul · PMID 40476615 · Full text
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Match Demands and Perceived Exertion of Cerebral Palsy Soccer National Team Players.
Wartner D, Cost R, Andersen JC … +1 more , Oliva-Lozano JM
Sports Health · 2026 · PMID 40444803 · Full text
BACKGROUND: The aims of this study were to analyze match demands and perceptual responses of cerebral palsy soccer national team players. Specifically, to identify whether variations in match demands exist between playin...
BACKGROUND: The aims of this study were to analyze match demands and perceptual responses of cerebral palsy soccer national team players. Specifically, to identify whether variations in match demands exist between playing positions and between halves. HYPOTHESIS: Differences between playing positions exist and match demands differ from first to second half. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: An observational, longitudinal study was conducted over the 2022-2023 season. Electronic performance and tracking systems collected physical output, whereas perceptual responses were collected through ratings of perceived exertion postmatch. RESULTS: Playing position significantly affected all variables ( = 4.05-73.31; < .001; η = 0.20-0.82). Midfielders had the greatest average physical output in all variables, except for high-intensity accelerations per minute (forwards = ~0.19 count/min) and maximum velocity (full-backs = ~28.87 km/h). Match half had no significant effect on any variable ( = 0.00-1.38; > .05; η = 0.00-0.02), except for distance per minute, which was usually greater in the first half than second half ( = 7.15; = .01; η = 0.10). Regarding perceptual response, playing position had a significant effect, with goalkeepers having significantly lower ratings of perceived exertion compared with the other positions ( < .05). CONCLUSION: Playing position significantly affected all variables, with goalkeepers showing the lowest demands, followed by central defenders. Midfielders had the highest physical output across most variables, except for high-intensity accelerations per minute (forwards) and maximum velocity (full-backs). Match half had no significant effect on any variable, except for distance per minute. CLINICAL RELEVANCE: Understanding match demands and positional differences in cerebral palsy soccer helps coaches plan tailored training sessions and drills to meet specific physical outputs. This knowledge supports training periodization, optimal player performance, and recovery. Insights into physical challenges for each position assist in scouting and adjusting training intensity.
Motor Learning of Knee Joint Kinematics in Patients Within the First Year After ACL Reconstruction.
Arhos EK, Wood JM, Grävare Silbernagel K … +1 more , Morton SM
Sports Health · 2026 · PMID 40444800 · Full text
BACKGROUND: Undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) does not normalize the asymmetric knee biomechanics during gait that are related to the later development of post-traumatic osteoarthritis. AC...
BACKGROUND: Undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) does not normalize the asymmetric knee biomechanics during gait that are related to the later development of post-traumatic osteoarthritis. ACL rupture and reconstruction have negative neuromuscular implications, disrupting knee joint afferent inputs that may be essential for central nervous system adaptability and motor learning. Here, we examined the ability of patients after ACLR to adapt knee joint biomechanics using a split-belt treadmill locomotor learning paradigm compared with uninjured controls. HYPOTHESIS: Patients after ACLR will be able to adapt and retain their knee joint mechanics, but to a lesser extent than controls. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level III. METHODS: We examined neuromuscular adaptations (ie, motor learning) using an evidence-based split-belt treadmill adaptation paradigm in 15 patients (20.8 ± 3.5 years old, 9 female), 3 to 9 months after ACLR and 15 control patients. During adaptation, the 2 treadmill belts were split (ie, moving at different speeds) to induce motor learning of new knee joint kinematic patterns. Three-dimensional motion capture was used to record joint kinematics and assess adaptation of knee flexion and extension angles. We also measured quadriceps strength, knee joint proprioception, and other markers of ACLR recovery. RESULTS: After ACLR, patients showed flexibility in motor patterns for peak knee flexion and extension angles. Our data showed no difference between patients after ACLR and uninjured controls in the extent of adaptation of either kinematic variable. CONCLUSION: These data suggest that knee kinematics are malleable during rehabilitation, and demonstrate adaptability in the nervous system for knee joint angles during gait. CLINICAL RELEVANCE: Current clinical interventions and evidence-based rehabilitation programs have not been successful in restoring gait mechanics. The current work indicates motor learning-based approaches can modify knee joint kinematics and therefore may be worthy of consideration in future interventions to address poor gait mechanics after ACLR.
Return to Long-Distance Running After Hip Arthroscopy for Femoroacetabular Impingement.
Marom N, Olsen RJ, Burger J … +4 more , Dooley MS, Ranawat AH, Kelly BT, Nawabi DH
Sports Health · 2026 · PMID 40444798 · Full text
BACKGROUND: Arthroscopic hip surgery for femoroacetabular impingement syndrome (FAIS) has high rates of return to sport; however, patient return to long-distance running is unclear. HYPOTHESES: (1) Long-distance runners...
BACKGROUND: Arthroscopic hip surgery for femoroacetabular impingement syndrome (FAIS) has high rates of return to sport; however, patient return to long-distance running is unclear. HYPOTHESES: (1) Long-distance runners undergoing arthroscopic hip surgery for FAIS are a distinctive subgroup in terms of demographics, hip injury characteristics, and running metrics. (2) Most patients will return to general running but a lower proportion return to long-distance running after arthroscopic hip surgery. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: An institutional hip preservation registry was reviewed retrospectively for long-distance runners (half marathons, marathons) who underwent primary hip arthroscopies for FAIS between March 2008 and January 2018. Patient demographics, injury characteristics, and clinical and radiographic findings were recorded. Multivariable logistic regression analysis identified potential risk factors for not returning to long-distance running. RESULTS: Sixty-eight (78 hips) long-distance runners (mean patient age, 37.8 ± 8.9 years; 38 (56%) female; mean weekly running mileage before injury, 34.5 ± 16.9 miles) were included. Overall, 50 runners (74%) returned to any running, of which 25 (50%) returned to long-distance running, completing half/full marathons races after surgery. Most common reasons for not returning to running were pain or discomfort (50%) followed by fear of reinjury (22%), and additional different injuries (22%). Multivariable logistic regression analysis revealed female runners (odds ratio, 0.2; CI, 0.0-0.9; = 0.03) were less likely to return to long-distance running. CONCLUSION: Most (74%) long distance runners returned to running after hip arthroscopic treatment for FAIS; however, only 37% returned to long-distance running. Satisfaction from surgery was not necessarily associated with return to running. Female long-distance runners were less likely to return to long-distance running after surgery. CLINICAL RELEVANCE: Study findings provide helpful context for clinicians counseling patients with symptomatic FAIS who are considering hip arthroscopy and are concerned about return to long-distance running.
The Search for the Holy Grail in Running Biomechanics: Is There an Ideal Movement Profile for Minimizing Mechanical Overload?
Leporace G, Guadagnin EC, Carpes FP … +4 more , Gustafson J, Gonzalez FF, Chahla J, Metsavaht L
Sports Health · 2026 · PMID 40395032 · Full text
BACKGROUND: Running biomechanics can influence injury risk, but whether the combined effect of different biomechanical factors can be identified by individual running profiles remains unclear. Here, we identified distinc...
BACKGROUND: Running biomechanics can influence injury risk, but whether the combined effect of different biomechanical factors can be identified by individual running profiles remains unclear. Here, we identified distinct biomechanical profiles among healthy runners, examined lower limb mechanical load characteristics, and evaluated potential implications for injury risk. HYPOTHESIS: Multiple factors would serve as a common denominator allowing identification of specific patterns. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 2. METHODS: Step cadence, stance time, vertical oscillation, duty factor, vertical stiffness, peak ground reaction force (GRF), and anteroposterior, lateral, and vertical smoothness were determined from 3-dimensional kinematic data from 79 healthy runners using a treadmill at 2.92 m/s. Principal component analysis, self-organizing maps, and K-means clustering techniques delineated distinct biomechanical running profiles. Mutual information analysis, Kruskal-Wallis, and Pearson's Chi-squared tests were conducted. RESULTS: Five biomechanical profiles (P1-P5) demonstrated different running mechanical characteristics: P1 exhibited low cumulative and peak mechanical load due to a combination of high duty factor, low step cadence, and longer stance time; P2 showed characteristics associated with the lowest peak mechanical load due to reduced peak GRF and greater smoothness; P3 and P5 showed contrasting running patterns, but maintained moderate smoothness and peak GRF; and P4 exhibited the highest peak mechanical load, driven by high GRF, low duty factor, and high vertical oscillation. CONCLUSION: The 5 profiles appear to be associated with different lower limb load patterns, highlighting previously unrecognized connections between biomechanical variables during running. Some variables contribute to increased peak and cumulative load, whereas others help reduce it, underscoring the complex interplay of biomechanical factors in running. CLINICAL RELEVANCE: Identifying distinct running profiles can help clinicians better understand individual variations in mechanical load and injury risk, thus informing targeted interventions, such as personalized training adjustments or rehabilitation programs, to prevent injuries and enhance performance in runners.
Exploring the Influence of Quadriceps Peak Torque and Rate of Torque Development on Running Mechanics After Anterior Cruciate Ligament Reconstruction.
Gohil AM, Hawk GS, Johnson DL … +2 more , Fry CS, Noehren B
Sports Health · 2026 · PMID 40388121 · Full text
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), chronic changes in knee joint biomechanics during higher level tasks, such as running, may negatively impact long-term knee joint health. Among the fact...
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), chronic changes in knee joint biomechanics during higher level tasks, such as running, may negatively impact long-term knee joint health. Among the factors that contribute to these chronic changes, the influence of quadriceps strength on knee joint biomechanics during running is not well understood. HYPOTHESIS: Higher involved limb quadriceps strength (peak torque and rate of torque development [RTD]) and limb symmetry index (LSI) will be positively associated with greater peak knee flexion angle and peak knee extensor moment during running. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Peak knee extensor moment and peak knee flexion angle were analyzed during the stance phase of running, 6 months following ACLR (n = 26; 18 female participants; age, 19 ± 5.0 years). Involved limb quadriceps strength and LSI were calculated for peak torque and RTD. Linear regression models were used to analyze the relationship between involved limb and LSI values of quadriceps peak torque and RTD to peak knee flexion angle and peak knee extensor moment. RESULTS: Quadriceps peak torque ( = 0.37; < .01) and RTD ( = 0.31, < .01) each had a positive relationship to peak knee extensor moment, but not peak knee flexion angle. Quadriceps peak torque and RTD LSI were not associated with peak knee flexion angle or peak knee extensor moment ( > .20). CONCLUSION: Quadriceps peak torque and RTD are positively associated with running kinetics 6 months after ACLR. Peak torque and RTD LSI were not associated with running mechanics after ACLR. CLINICAL RELEVANCE: Quadriceps peak torque and rate of torque development are positively associated with running mechanics after ACLR. Clinicians should consider objective assessments of quadriceps strength before initiating running after ACLR.
Asymmetry in Limb Stiffness, Joint Power, and Joint Work During Landing in Anterior Cruciate Ligament Reconstruction Patients.
Teater MA, Schmitt D, Powell DW … +1 more , Queen RM
Sports Health · 2026 · PMID 40387877 · Full text
BACKGROUND: Kinetic and kinematic side-to-side limb asymmetries can increase after anterior cruciate ligament reconstruction (ACLR). Limb stiffness asymmetry has not been previously explored. HYPOTHESIS: Athletes with AC...
BACKGROUND: Kinetic and kinematic side-to-side limb asymmetries can increase after anterior cruciate ligament reconstruction (ACLR). Limb stiffness asymmetry has not been previously explored. HYPOTHESIS: Athletes with ACLR will exhibit greater asymmetry in limb stiffness, peak eccentric joint power, and eccentric joint work compared with asymptomatic controls during landing. STUDY DESIGN: Case-control study. LEVEL OF EVIDENCE: Level 4. METHODS: Forty athletes with 5.9 ± 1.4 months removed from ACLR and 40 asymptomatic athletes completed 7 stop-jumps (SJs) during a single session. Three-dimensional motion capture and ground-reaction force data were collected during landing. Normalized symmetry index values for limb stiffness, peak eccentric joint power, and eccentric joint work of athletes with bone-patellar tendon-bone (BPTB) grafts, athletes with hamstring grafts, and control athletes were compared. RESULTS: Athletes with ACLR had greater knee power Athletes with ACLR had greater knee power (BPTB, 29.1 ± 17.6; hamstring, 27.3 ± 14.1; Control, 14.2 ± 10.7; < 0.01) and knee work (BPTB, 35.2 ± 21.5; hamstring, 32.1 ± 18.4; Control, 14.9 ± 10.1; < 0.01) asymmetries than control athletes. Athletes with BPTB grafts and hamstring grafts both displayed larger knee power and work asymmetries compared with control athletes (P < 0.01 for each comparison), with no differences between graft types (P = 0.90 and = 0.80, respectively). No between-group differences were found in limb stiffness (BPTB, 16.2 ± 10.8; hamstring, 13.5 ± 9.83; Control, 13.9 ± 9.33; = 0.63), ankle power (BPTB, 16.5 ± 11.4; hamstring, 14.4 ± 13.0; Control, 18.3 ± 14.0; = 0.55), ankle work (BPTB, 20.9 ± 13.0; hamstring, 17.4 ± 14.9; Control, 18.4 ± 12.8; = 0.69), hip power (BPTB, 17.6 ± 12.8; hamstring, 19.5 ± 11.3; Control, 13.3 ± 9.08; = 0.09), or hip work (BPTB, 17.2 ± 13.9; hamstring, 24.6 ± 14.1; Control, 16.2 ± 11.7; = 0.06) asymmetries. CONCLUSION: Athletes with ACLR use asymmetric landing strategies that favor their nonsurgical limb, resulting in greater knee power and knee work asymmetries compared with controls. No between-group asymmetry differences in limb stiffness, ankle power and work, and hip power and work were found. CLINICAL RELEVANCE: After 5.9 ± 1.4 months removed from ACLR surgery, athletes favor their nonsurgical limb at the knee, risking further injury. While limb stiffness asymmetry was not different between groups, the groups appeared to modulate limb stiffness differently between limbs to produce similar asymmetry values.
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