Sports Health [JOURNAL]
Sun
200 papers
Steady or Swaying? Assessing the Reliability of the HUMAC Balance System in Athletes With Chronic Low Back Pain.
Ansari S, Sharma S
Sports Health · 2026 · PMID 40376933 · Full text
BACKGROUND: Balance is a fundamental component of athletic performance. Chronic low back pain (CLBP) is a prevalent issue in athletes, impacting performance. Balance assessment plays a crucial role in CLBP rehabilitation...
BACKGROUND: Balance is a fundamental component of athletic performance. Chronic low back pain (CLBP) is a prevalent issue in athletes, impacting performance. Balance assessment plays a crucial role in CLBP rehabilitation. Reliable techniques are essential for balance assessment. The CSMi HUMAC balance system offers promise in this regard. This study aimed to assess the reliability of the HUMAC balance system and to determine the minimal detectable change (MDC) for center of pressure (CoP) indices (sway index [SI], overall stability index [OSI], mediolateral stability index [MLSI], and anteroposterior stability index [APSI]) during squats and limits of stability (LoS) outcomes. HYPOTHESIS: The HUMAC balance system will demonstrate high test-retest reliability, with intraclass correlation coefficients (ICCs) >0.80, when used to assess balance in athletes with CLBP. STUDY DESIGN: Repeated measures design. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 15 athletes (aged 18-30 years) with CLBP were included. The athletes underwent assessment of balance parameters on 2 separate occasions separated by a 1-week interval. Reliability was assessed using ICC, standard error of measurement (SEM), and Bland-Altman plots. RESULTS: Intrarater reliability for all CoP indices during squats and LoS tests showed excellent values (ICC, 0.84-0.98), with no significant systematic bias detected in Bland-Altman plots. CONCLUSION: The HUMAC balance system is a reliable tool for assessing balance in athletes with CLBP. CLINICAL RELEVANCE: The HUMAC balance system demonstrates reliability in assessing balance for athletes with CLBP. This will allow clinicians to monitor changes in balance and potentially track the effectiveness of interventions aimed at improving balance.
Use of the Uninvolved Limb as Comparator When Calculating Return to Sports Hop Test Symmetry After ACL Reconstruction.
Arhos EK, Smith AH, Ito N … +3 more , Risberg MA, Snyder-Mackler L, Silbernagel KG
Sports Health · 2026 · PMID 40317217 · Full text
BACKGROUND: Horizontal hop testing is a reliable measure included in test batteries after anterior cruciate ligament (ACL) reconstruction (ACLR). Hop test results are typically expressed as limb symmetry indexes (LSIs) c...
BACKGROUND: Horizontal hop testing is a reliable measure included in test batteries after anterior cruciate ligament (ACL) reconstruction (ACLR). Hop test results are typically expressed as limb symmetry indexes (LSIs) comparing the involved limb with the uninvolved limb. Using the uninvolved limb as a comparative measure has been questioned due to concerns that performance may be reduced in this limb also and may not be a stable comparison across time, leading to a falsely inflated LSI. Here, we report changes in uninvolved limb hop scores over 5 timepoints after ACLR. HYPOTHESIS: Uninvolved limb hop scores would be similar between preoperative rehabilitation and 2 years after ACLR. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level III. METHODS: Level I and II athletes were enrolled after isolated ACL injury. Participants completed a preoperative hop testing battery after impairment resolution, preoperative rehabilitation, and 6 months, 1 year, and 2 years after ACLR. Linear mixed-effects models were performed separately for each hop and each limb to characterize change in scores over time. Pairwise comparisons for fixed effects of timepoint and estimated marginal means are reported. RESULTS: A total of 182 athletes (25.0 ± 8.8 years, 44% female) were enrolled a mean of 54 days from ACL injury. For each hop, the uninvolved limb hop distance was statistically different from the impairment resolution timepoint only to various follow-up timepoints ( ≤ 0.009). If athletes underwent preoperative rehabilitation, uninvolved limb hop distance was stable throughout the duration of rehabilitation until 2 years, apart from timed hop from 6 months to 2 years ( = 0.04). CONCLUSION: The uninvolved limb is a stable comparison for calculating hop test LSIs as part of return-to-sport decisions. CLINICAL RELEVANCE: These results increase confidence in using symmetry as an outcome and are important for clinicians lacking preinjury hop testing data.
Current State of Baseball Interval Throwing Programs: A Systematic Review of Content, Structure, and Variability of Published Throwing Programs.
Langhans MT, Boos AM, Iyer S … +8 more , Simon KN, Cherny CE, Johnson AJ, Zajac JM, Christoffer DJ, Hellem AR, Finck AN, Camp CL
Sports Health · 2025 Nov · PMID 40298098 · Full text
CONTEXT: There is need for an up-to-date comprehensive review of baseball interval throwing programs in the literature. OBJECTIVE: To (1) understand the origin and basis of interval throwing programs; (2) evaluate the co...
CONTEXT: There is need for an up-to-date comprehensive review of baseball interval throwing programs in the literature. OBJECTIVE: To (1) understand the origin and basis of interval throwing programs; (2) evaluate the content of programs in the peer-reviewed literature including target audience, initiation criteria, throwing specifics, arm care, and performance evaluation metrics; (3) classify these variables as well defined, ambiguous, or missing; and (4) analyze variability in key aspects including starting criteria, length, progression, and completion criteria. DATA SOURCES: Medline, Embase, Cochrane Reviews, Web of Science, and ScopusStudy Selection:The full text of studies, in English, had to be available. Included studies had to contain a complete interval throwing program designed for baseball players. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Initial screening was conducted based on article title and abstract. Full text of the remaining articles was evaluated for fulfillment of inclusion criteria. RESULTS: Nine studies initially met inclusion criteria. The programs' comprehensiveness was poor, with a mean Interval Throwing Program Checklist score of 20 (range 14-23) on a scale of 0 to 30. There were a variety of components, including progressive long toss, weighted ball, and throwing mechanics exercises. The programs identified had significant heterogeneity in duration, intensity, progression, and focus. Overall, there was a significant lack of attempts at validation or formal study of efficacy for published throwing programs. CONCLUSION: Current published interval throwing programs are mostly variations of an original program published many years ago and were based on principles of progressive loading with pain as sign of injury that should be monitored carefully. However, these programs have minimal clinical validation and objective measures to quantify their effectiveness. This work identifies several limitations in the current literature and can serve as a foundation for future development of evidence-based interval throwing programs.
Initiating Testosterone Therapy Without Indication for Treatment of Low Testosterone Is Associated With Higher Risk of Tendon Tear.
Waters TL, Winter JE, Delvadia BP … +4 more , May DS, O'Brien MJ, Savoie FH, Sherman WF
Sports Health · 2025 · PMID 40296344 · Full text
BACKGROUND: Studies have demonstrated an increasing rate of testosterone supplementation in patients who do not meet criteria for testosterone deficiency, but the risks associated with testosterone supplementation are un...
BACKGROUND: Studies have demonstrated an increasing rate of testosterone supplementation in patients who do not meet criteria for testosterone deficiency, but the risks associated with testosterone supplementation are unclear. HYPOTHESIS: Patients initiating testosterone therapy would be diagnosed with significantly more tendon tears and undergo significantly more tendon repairs than matched controls never on testosterone therapy. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Male patients who initiated testosterone therapy within 30 days of a primary care visit and who did not meet criteria for treatment of low testosterone were identified (n = 112,242). Propensity score matching generated a control cohort (n = 448,968) with no history of testosterone therapy and based on several comorbidities at the time of said age-matched primary care visit. Rates of tendon tears and tendon repairs within 1 and 2 years after primary care visit were compared using multivariable logistic regression. RESULTS: Within 1 and 2 years, compared with controls, the testosterone supplementation cohort demonstrated significantly higher rates of rotator cuff tear (odds ratio [OR], 1.35; OR, 1.31), patellar tendon tear (OR, 2.06; OR, 2.14), and any tendon tear (OR, 1.33; OR, 1.31). The testosterone supplementation cohort demonstrated significantly higher rates of quadriceps tendon tears within 1 year (OR, 1.59). Within 1 and 2 years, compared with controls, the testosterone supplementation cohort demonstrated significantly higher rates of rotator cuff repair (OR, 1.28; OR, 1.23), distal biceps tendon repair (OR, 1.65; OR, 1.54), patellar tendon repair (OR, 2.28; OR, 2.18), and any tendon repair (OR, 1.27; OR, 1.23). CONCLUSION: Testosterone supplementation is associated with an increased risk of tendon tears and repairs for at least the first and second year after initiating therapy in patients with no documented laboratory testing. Patients considering testosterone therapy should be counseled on this increased risk of tendon injury.
High-Load Strength Training Reduces Injury Incidence and Injury Burden and Improves Physical Fitness in Young Highly Trained Soccer Players.
Durán-Custodio R, Yanci J, Raya-González J … +2 more , Beato M, Castillo D
Sports Health · 2026 · PMID 40289456 · Full text
BACKGROUND: There is little available information on the reduction of injury incidence and injury burden after strength training programs. This study aimed to analyze the effects of a 12-week high-load strength training...
BACKGROUND: There is little available information on the reduction of injury incidence and injury burden after strength training programs. This study aimed to analyze the effects of a 12-week high-load strength training program on injury incidence, injury burden, and fitness in young, highly trained, soccer players. HYPOTHESIS: It was hypothesized that well-targeted high-load training focused on the gluteal and hamstring musculature could aid in injury prevention and increase physical fitness. STUDY DESIGN: A randomized controlled trial design was applied, which followed the CONSORT Statement. LEVEL OF EVIDENCE: Level 2. METHODS: Twenty players were assigned randomly to the experimental group (EG, n = 10 players), who performed a high-load strength training program, or to the control group (CG, n = 10 players), who performed only their usual soccer training. Injury incidence (injuries per 1000 hours exposure) and injury burden (days of absence per 1000 hours exposure) were recorded during the intervention, as well as the physical fitness attributes before and after the training program. RESULTS: A significant ( < 0.05) lower injury incidence was observed in the EG (CG, 11.34 vs EG, 1.31 injuries per 1000 hours of exposure) and a significant ( < 0.001) lower injury burden in the EG (CG, 304.66 versus EG, 19.72 days of absence per 1000 h of exposure). The analysis of covariance model revealed significant between-group differences favoring the EG, showing significantly greater improvements in jumping, change of direction ability, sprinting, and imbalance strength tests ( < 0.001; effect size, 3.02 to -7.23). CONCLUSION: This study demonstrated the beneficial effects of a 12-week high-load strength training program on injury incidence, injury burden and physical fitness, in highly trained soccer players. CLINICAL RELEVANCE: This study provides positive information for implementing this type of strength training in the daily training sessions of young soccer players for both performance enhancement and injury prevention.
Variability Among Individual Male Runners Influences Cumulative Loading More Than Foot Strike Type.
Ridge ST, Trotter T, Sponbeck JK … +3 more , Johnson AW, Hunter I, Bruening DA
Sports Health · 2026 · PMID 40251769 · Full text
BACKGROUND: Foot strike type affects running mechanics and may influence overuse injury occurrence. Measuring the interaction between cumulative load and foot strike type may provide additional information that could inc...
BACKGROUND: Foot strike type affects running mechanics and may influence overuse injury occurrence. Measuring the interaction between cumulative load and foot strike type may provide additional information that could increase understanding of injury mechanisms. HYPOTHESIS: There will be no differences in cumulative loading between runners using rearfoot strike (RFS) and nonrearfoot strike (NRFS) patterns. NRFS runners will have a greater stride rate. There will be differences in per stride metrics of select lower extremity mechanics. STUDY DESIGN: Observational laboratory study. LEVEL OF EVIDENCE: Level 3. METHODS: Thirty male participants (age, 22.7 ± 2.9 years; height, 1.79 ± 0.07 m; mass, 70.7 ± 7.86 kg; mean ± SD) ran on an instrumented treadmill for 5 km at 3.15 m/s with their preferred foot strike type (14 RFS, 16 NRFS). Stride rate, foot strike angle, loading rate (LR), per stride and per kilometer (cumulative) vertical ground-reaction force (VGRF) impulse, impact peak, absolute peak, knee negative work, and ankle negative work were calculated and compared across time and between groups. RESULTS: Per stride differences were seen for stance time, foot strike angle, and LR (greater for RFS runners, = 0.003). Per stride and cumulative ankle and knee negative work showed significant differences (greater ankle negative work for NRFS runners, < 0.001 [per stride and cumulative], greater knee negative work for RFS runners, = 0.01 per stride, = 0.008 cumulative). CONCLUSION: Ankle and knee loading metrics showed differences in per stride and cumulative metrics between foot strike groups. Individual variability in VGRF loading patterns was more apparent than group distinctions. The common perception that NRFS runners have a higher stride rate was not supported. CLINICAL RELEVANCE: Individual loading patterns, not just foot strike type, and training session characteristics related to cumulative load should be considered when assessing injury risk.
Athletes and Sleep Issues: New Insights Into Translating Laboratory Findings in a Real-World Setting.
Botonis PG, Grammenou M, Toubekis AG
Sports Health · 2025 · PMID 40249165 · Full text
Abstract loading — click title to view on PubMed.
Influence of Resistance Training Variables and the Nordic Hamstring Exercise on Biceps Femoris Architectural Adaptations in Soccer Players: A Systematic Review.
Pecci J, Sañudo B, Ramirez-Campillo R … +1 more , Saez de Villarreal E
Sports Health · 2026 · PMID 40230340 · Full text
CONTEXT: Manipulation of resistance training variables influences the structural and functional adaptations of muscle, having a great impact on sport performance and hamstring injury prevention. OBJECTIVE: To analyze how...
CONTEXT: Manipulation of resistance training variables influences the structural and functional adaptations of muscle, having a great impact on sport performance and hamstring injury prevention. OBJECTIVE: To analyze how the main resistance training variables affect the biceps femoris long head architecture in soccer players. DATA SOURCES: Five databases were searched from inception to January 2024. STUDY SELECTION: Studies that included training intervention groups and measured muscle architecture adaptations before and after the training program in soccer players were included. STUDY DESIGN: Systematic review with meta-analysis. LEVEL OF EVIDENCE: Level 2. DATA EXTRACTION: Muscle thickness, fascicle length, and pennation angle were extracted from included studies as main outcomes. RESULTS: Six studies and 12 training groups (168 participants) were analyzed. The effects of Nordic hamstring exercise (NHE) against soccer interventions, volume of training, and frequency of training as independent variables were analyzed. NHE significantly improved biceps femoris long head fascicle length ( = 0.01). Training twice a week did not show significant differences compared with training once a week. Higher volumes of training (ie, >290 repetitions) in a period of 6 to 12 weeks with 57 repetitions per week demonstrated significant effects. CONCLUSION: NHE lengthens the fascicle, especially if a sufficient volume (ie, >290 repetitions) and 2 days per week are performed. It is still unknown how the programming of some fundamental variables such as intensity, degree of effort, or exercise selection affects the muscle architecture of the biceps femoris long head.
Normalization Methods for Shoulder Strength in Baseball Athletes.
Kennedy SM, Myers NL, Conway JE … +4 more , Garrison JC, Guffey T, Bailey LB, Arnold AJ
Sports Health · 2026 · PMID 40230089 · Full text
BACKGROUND: Arm injuries in baseball continue to rise. Previous studies have confirmed relationships between shoulder strength, injury risk, and performance in baseball athletes. Shoulder strength measures vary considera...
BACKGROUND: Arm injuries in baseball continue to rise. Previous studies have confirmed relationships between shoulder strength, injury risk, and performance in baseball athletes. Shoulder strength measures vary considerably within and among baseball players and are influenced heavily by anthropometric measures. Presently, the normalization of shoulder strength measures has not been tested adequately to meet necessary statistical assumptions. HYPOTHESIS: At least 1 shoulder strength normalization method would meet 2 statistical assumptions: the intercept assumption and correlation assumption. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Isometric shoulder strength was tested in a cohort of uninjured baseball athletes on the dominant limb via handheld dynamometry: external rotation (ER), internal rotation (IR), and scapular plane abduction (SCAP). Five normalization methods were assessed using 2 statistical assumptions to determine the most appropriate normalization method for each shoulder strength measure: first, the regression line between a participant characteristic (body mass, height, ulnar length, and their respective combinations) and the unnormalized strength measure passes through the origin; second, normalizing shoulder strength eliminates its correlation with the participant characteristics. Statistical significance was set a priori at < 0.05. RESULTS: Body mass normalization was the only normalization method that satisfied the intercept and correlation assumptions for ER, IR, and SCAP strength ( > .05). CONCLUSION: Normalizing shoulder ER, IR, and SCAP strength in uninjured baseball athletes using body mass satisfied both statistical assumptions. When clinicians seek to compare shoulder strength in baseball athletes of differing anthropometric make-up, using body mass as the denominator is the most appropriate method for normalization. CLINICAL RELEVANCE: The utilization of a statistically supported shoulder strength normalization method is warranted to account for anthropometric differences when comparing strength between athletes. This study adds a clinically relevant and reproducible method for normalizing isometric shoulder strength in uninjured baseball players.
Biomechanics of Fastpitch Softball Pitching: A Practitioner's Guide.
Friesen KB, Butler LS, Bordelon NM … +4 more , Downs-Talmage JL, Fleisig GS, Ulman S, Oliver GD
Sports Health · 2025 Nov · PMID 40178367 · Full text
CONTEXT: Despite fastpitch softball's growing popularity, there is limited evidence-based guidance to aid practitioners in developing pitching-specific injury prevention and performance enhancement strategies. This comme...
CONTEXT: Despite fastpitch softball's growing popularity, there is limited evidence-based guidance to aid practitioners in developing pitching-specific injury prevention and performance enhancement strategies. This commentary describes the biomechanics across each phase of the softball pitch and provides explanation of common biomechanical errors during the pitch as well as training strategies and exercise recommendations to foster optimal pitcher development. EVIDENCE ACQUISITION: A review of softball pitching biomechanics research available in electronic databases including PubMed, Medline, and EBSCO. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: The 4 primary phases of the windmill softball pitch include the wind-up, stride, acceleration, and follow-through. CONCLUSION: Specific training strategies are recommended to combat the various flaws associated with each phase of the softball pitch. Evaluating body composition, functional characteristics like strength and range of motion of the shoulders, trunk, and hips, as well as assessing energy flow may result in improved performance and minimize risk of injury.
Physical Characteristics Associated With Low Back Pain in Japanese Collegiate Female Rhythmic Gymnasts.
Tsutsui T, Tsukahara Y, Mori J … +10 more , Sakamaki W, Honma Y, Yamamoto R, Fukuda N, Hatsukari A, Ikegami N, Higuchi A, Ikei T, Akiyama E, Torii S
Sports Health · 2025 Nov · PMID 40176305 · Full text
BACKGROUND: Few studies have explored relationships between low back pain (LBP) and physical characteristics (physique, muscle strength, tightness, and flexibility) in female rhythmic gymnasts (RGs). HYPOTHESIS: Due to t...
BACKGROUND: Few studies have explored relationships between low back pain (LBP) and physical characteristics (physique, muscle strength, tightness, and flexibility) in female rhythmic gymnasts (RGs). HYPOTHESIS: Due to their extreme flexibility, modifiable physical factors for LBP in RGs are not related to muscle tightness. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: College female RGs (n = 95) were categorized into LBP and non-LBP groups based on questionnaires and orthopaedic surgeon interview. Physical assessments included whole-body bone mineral content and density, trunk lean body mass, and scoliosis presence by dual-energy X-ray absorptiometry scans, presence of abnormal findings and spine alignment by magnetic resonance imaging scans, hip muscle strength testing (flexion, extension, and abduction), range of motion (ROM), and flexibility testing. LBP and non-LBP groups were compared, and multivariate regression analysis performed. RESULTS: RGs with LBP exhibited significantly longer practice time, lower hip flexion muscle strength on the nondominant side versus dominant side, lower active straight leg raise on the nondominant side versus dominant side, and lower hip external rotation (ER) ROM on the nondominant side versus dominant side. A history of LBP was also associated with current LBP. Multivariate logistic regression analysis revealed that a history of LBP (odds ratio [OR], 6.33; 95% CI, 1.56-25.62), differences in hip flexion strength (OR, 0.96; 95% CI, 1.00-1.08), and differences in hip ER ROM (OR, 1.12; 95% CI, 1.03-1.19) were factors associated with LBP. CONCLUSION: LBP was experienced by 27.3% RGs and associated not only with a history of LBP and a deficit in hip flexor strength on the nondominant side but also a deficit in hip ER ROM on the nondominant side. CLINICAL RELEVANCE: Focusing on hip flexor strength and hip ER ROM on the nondominant side may be of value for LBP rehabilitation and prevention in RGs.
Evaluation of the PhySens as a Wrist-Worn Wearable in Pitch Detection and Biomechanical Workload Estimation.
Greenberg EM, Thomas SJ, Kablan J … +3 more , Condon J, Backstrom E, Lawrence JT
Sports Health · 2025 Nov · PMID 40176298 · Full text
BACKGROUND: The volume and frequency of throwing activity are among the most significant risk factors for developing overuse injuries in youth athletes. Despite introducing systematic guidelines for 'pitch counts,' throw...
BACKGROUND: The volume and frequency of throwing activity are among the most significant risk factors for developing overuse injuries in youth athletes. Despite introducing systematic guidelines for 'pitch counts,' throwing injuries continue to rise. Using technology to create enhanced measures of workload exposure in this unique population of athletes may help generate more effective and personalized injury prevention strategies. HYPOTHESIS: The wrist-worn sensor system (PhySens) will: 1) accurately detect and differentiate throwing activity from other baseball movements, and 2) accurately predict ball velocity, arm slot angle, and elbow valgus torque. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 5. METHODS: Youth pitchers (n = 10) performed a standardized protocol of pitching, field-throwing, and batting. Pitching velocity and biomechanical data were simultaneously captured by the PhySens and traditional 3-dimensional motion capture. The accuracy of the pitching detection algorithm (throw vs batting) was analyzed by comparing truth data with throwing events cataloged by the device. Ball velocity, elbow valgus torque, and arm slot angle predictions were assessed with Pearson correlation coefficients and Bland-Altman plots. RESULTS: A total of 230 events (pitches and bat swings) were analyzed. Pitch detection was excellent, with a sensitivity of 99.4% and specificity 97.9%. Pearson correlations were significant and excellent across all predicted variables, with ball velocity = 0.96, elbow valgus torque = 0.95, and arm slot angle = 0.87. The system demonstrated excellent estimations of ball velocity, elbow valgus torque, and arm slot angle. CONCLUSION: This novel single-sensor wrist worn device was highly accurate in detecting pitching events, predicting ball velocity, and estimating arm slot angle and elbow valgus torque. CLINICAL RELEVANCE: Throwing volume is highly associated with overuse injuries in youth baseball players. Sensor-based measures of workload monitoring can address inherent limitations related to human error and underestimation of true throwing exposure.
Performance of Artificial Intelligence in Addressing Questions Regarding Management of Osteochondritis Dissecans.
Milner JD, Quinn MS, Schmitt P … +8 more , Hall RP, Bokshan S, Petit L, O'Donnell R, Marcaccio SE, DeFroda SF, Tabaddor RR, Owens BD
Sports Health · 2025 Nov · PMID 40170344 · Full text
BACKGROUND: Large language model (LLM)-based artificial intelligence (AI) chatbots, such as ChatGPT and Gemini, have become widespread sources of information. Few studies have evaluated LLM responses to questions about o...
BACKGROUND: Large language model (LLM)-based artificial intelligence (AI) chatbots, such as ChatGPT and Gemini, have become widespread sources of information. Few studies have evaluated LLM responses to questions about orthopaedic conditions, especially osteochondritis dissecans (OCD). HYPOTHESIS: ChatGPT and Gemini will generate accurate responses that align with American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 2. METHODS: LLM prompts were created based on AAOS clinical guidelines on OCD diagnosis and treatment, and responses from ChatGPT and Gemini were collected. Seven fellowship-trained orthopaedic surgeons evaluated LLM responses on a 5-point Likert scale, based on 6 categories: relevance, accuracy, clarity, completeness, evidence-based, and consistency. RESULTS: ChatGPT and Gemini exhibited strong performance across all criteria. ChatGPT mean scores were highest for clarity (4.771 ± 0.141 [mean ± SD]). Gemini scored highest for relevance and accuracy (4.286 ± 0.296, 4.286 ± 0.273). For both LLMs, the lowest scores were for evidence-based responses (ChatGPT, 3.857 ± 0.352; Gemini, 3.743 ± 0.353). For all other categories, ChatGPT mean scores were higher than Gemini scores. The consistency of responses between the 2 LLMs was rated at an overall mean of 3.486 ± 0.371. Inter-rater reliability ranged from 0.4 to 0.67 (mean, 0.59) and was highest (0.67) in the accuracy category and lowest (0.4) in the consistency category. CONCLUSION: LLM performance emphasizes the potential for gathering clinically relevant and accurate answers to questions regarding the diagnosis and treatment of OCD and suggests that ChatGPT may be a better model for this purpose than the Gemini model. Further evaluation of LLM information regarding other orthopaedic procedures and conditions may be necessary before LLMs can be recommended as an accurate source of orthopaedic information. CLINICAL RELEVANCE: Little is known about the ability of AI to provide answers regarding OCD.
Assessing the Predictive Value of Preoperative Knee Function Tests and Self-Report Scores in Anterior Cruciate Ligament Injury Recovery.
Loureiro-Nuno SM, Romero-Morales C, López-López D … +5 more , Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Gómez-Salgado J, Guerra J, Saavedra-García MÁ
Sports Health · 2026 · PMID 40145750 · Full text
BACKGROUND: The ability to identify patients with long-term poor outcomes using clinical and functional information is limited. Identifying prognostic factors to improve long-term outcomes after anterior cruciate ligamen...
BACKGROUND: The ability to identify patients with long-term poor outcomes using clinical and functional information is limited. Identifying prognostic factors to improve long-term outcomes after anterior cruciate ligament (ACL) injury can influence and inform targeted interventions for this population. HYPOTHESIS: Preoperative functional tests and patient-reported outcome measures are predictive of postoperative functional recovery and satisfaction in patients undergoing first-time ACL repair, second-time ACL repair on the same knee, and bilateral ACL repair. STUDY DESIGN: Quasi-experimental prospective study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 88 patients with ACL reconstruction were included. Subjective knee scoring systems and functional performance tests were used for evaluation and analyzed for correlation with results. RESULTS: The first time ACL injury group had lower scores in the various self-report scales: Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Rating Scale, International Knee Documentation Committee (IKDC), and Lower Extremity Functional Scale (LEFS). CONCLUSION: Reduction in self-reported knee function and Y balance test performance after ACL injury are predictive factors for recovery. Estimates exceeded clinically important thresholds. Those who had already undergone surgery had clinically better thresholds, highlighting the assessing these measures when designing presurgical rehabilitation programs.
Sex- and Age-Specific Review of Flag Football Injuries in the United States: A 10-Year Analysis of National Injury Data.
Locke AR, Koehne NH, Yendluri A … +7 more , Laurore C, Obana KK, Tiao J, Saltzman BM, Trofa DP, Li X, Parisien RL
Sports Health · 2025 Nov · PMID 40145666 · Full text
CONTEXT: Flag football is a rapidly growing sport with injuries frequently presenting to emergency departments (EDs). Current literature on flag football lacks mechanisms of injury and any information pertaining to femal...
CONTEXT: Flag football is a rapidly growing sport with injuries frequently presenting to emergency departments (EDs). Current literature on flag football lacks mechanisms of injury and any information pertaining to female athletes. The purpose of this study was to examine demographic-specific injury trends in those playing flag football. EVIDENCE ACQUISITION: The National Electronic Injury Surveillance System (NEISS) was queried for flag football injuries presenting to United States EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury site, diagnosis, and disposition were recorded. NEISS narratives were used to identify mechanisms of injury. National estimates (NEs) were calculated using the NEISS statistical sample weight. Annual injury trends were evaluated by linear regression. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. RESULTS: There were 2508 flag football injuries (NE, 86,443) analyzed from 2013 to 2022; 78.2% were sustained by male athletes. Linear regression analysis revealed no significant trend in annual injuries ( = 0.16) from 2013 to 2022. The most common mechanism of injury was player-player collision (35.7%). The 2 age groups most affected by flag football injuries were middle school-aged (11-13 years) (20.8%) and high school-aged (14-18 years) (23.7%). The area of the body most affected for pediatric (<18 years) groups was the head, while adults most frequently injured their fingers. In addition, the most common mechanism for the pediatric age group was fracture (21.3%), whereas adult age groups most frequently suffered from strain/sprain injuries. CONCLUSION: The number of injuries from flag football identified in this study has not decreased throughout the last decade, aside from 2020 - potentially due to the prevalence of COVID-19. Collisions were the most frequent mechanism of injury across all age groups. Whereas younger athletes frequently sustained head injuries and fractures, older athletes typically sustained strain/sprain injuries and finger injuries.
Application of the British Athletics Muscle Injury Classification in Collegiate Football Athletes: A Retrospective, Observational Study.
Hollabaugh W, Hill T, Davidson C … +5 more , Pennings J, Strasser N, Porras L, Cox C, Fitch R
Sports Health · 2025 Nov · PMID 40145663 · Full text
BACKGROUND: Lower extremity muscle tears are common sports injuries. The British Athletics Muscle Injury Classification (BAMIC) may provide clinical guidance for tears although its value in American football and college...
BACKGROUND: Lower extremity muscle tears are common sports injuries. The British Athletics Muscle Injury Classification (BAMIC) may provide clinical guidance for tears although its value in American football and college athletes is unknown. HYPOTHESIS: Clinical outcomes, specifically time to return to play (RTP) (TRTP), in college American football athletes with activity-related hamstring (HS) and quadriceps (QD) tears will be associated with BAMIC. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: American football college athletes who sustained a HS or QD tear and underwent magnetic resonance imaging within 7 days at 1 institution during the 2023 season were included. TRTP and reinjury rate (RIR) for HS and QD tears classified by BAMIC and injury characteristics were evaluated. RESULTS: Of the 24 HS and 10 QD tears in 21 (17.3%) of 121 athletes (20 ± 1.2 years; 100.0% male), most (60.0%) were BAMIC 2a-3b. Most (89.3%) injuries occurred before the season, and all occurred in practice. Overall median TRTP was 26 days (interquartile range, 17.8-33.0), translating to about 4 weeks missed play. The RIR was 19.0% (4/21). Most (75.0%) reinjuries occurred before RTP. There was no significant relationship between BAMIC and TRTP, although TRTP was less for grade 0 injuries and greater TRTP for injury site "c," albeit with small effect sizes. CONCLUSION: Activity-related HS and QD tears are common in American football college athletes, particularly in preseason and practice. Injured athletes missed about 3 to 4 games, regardless of BAMIC, with 1 in 5 athletes suffering a reinjury. There was no relationship between BAMIC or muscle group and TRTP. CLINICAL RELEVANCE: This appraisal of BAMIC in college and American football athletes highlights the prevalence of muscle tears and the need for prevention. Although BAMIC lacked value in this study, larger studies are needed to evaluate BAMIC in this population.
Preserving Knee Health and Delivering Specialized Care for Active Older Athletes.
Bartsch A, Sherman SL, Tramer J … +2 more , Vel MS, Fredericson M
Sports Health · 2025 Nov · PMID 40145656 · Full text
CONTEXT: Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-...
CONTEXT: Athletes differ from recreational exercisers in many characteristics and often require tailored treatments uniquely adapted to their situations and requirements. This practice is highlighted in young and middle-aged high-performance athletes. However, with advancing age and declining physical performance, age often outweighs athleticism, discounting the existing distinctions. This review focuses on physiological age-related processes in active older athletes and common knee conditions and elucidates the differences in preventing and treating knee injuries from the active adult population. EVIDENCE ACQUISITION: Nonsystematic review with critical appraisal of existing literature. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: Nonsteroidal anti-inflammatory drugs may interfere with the muscle hypertrophy mechanism in older athletes and it may be beneficial to adapt to other pharmacological interventions for knee osteoarthritis (OA). Arthroplasty is not typically compatible with high level sports activities; anterior cruciate ligament reconstruction surgery in the older athlete may be an effective option to improve function and enable return to sport, especially in the absence of OA. Chronic degenerative meniscal injuries can usually be treated conservatively, regardless of subjective mechanical symptoms. Acute traumatic meniscal tears in nonarthritic knees that cause effusions or reproducible mechanical symptoms may yet be considered for repair at any age. Conservative options are more dominant for patella tendinopathy, where platelet-rich plasma may be more effective than the classic extracorporeal shockwave therapy. CONCLUSION: With the increase of the active older athletic population, prevention and injury treatment strategies must be balanced and tailored to their individual needs. Older athletes have various goals and demands in their respective sports, necessitating distinct prevention and treatment strategies.Strength of Recommendation Taxonomy (SORT):B.
Knee Effusion-Synovitis Is Not Associated With Self-Reported Knee Pain in Division I Female Athletes.
Grozier CD, Genoese F, Collins K … +4 more , Parmar A, Tolzman J, Kuenze C, Harkey MS
Sports Health · 2025 Nov · PMID 40145574 · Full text
BACKGROUND: Recent research indicates a potential link between effusion-synovitis and knee pain in athletes. This study investigates the association of knee effusion-synovitis with self-reported knee pain in elite female...
BACKGROUND: Recent research indicates a potential link between effusion-synovitis and knee pain in athletes. This study investigates the association of knee effusion-synovitis with self-reported knee pain in elite female athletes, leveraging ultrasound imaging for effusion-synovitis assessment. HYPOTHESIS: Presence of knee effusion-synovitis is associated with increased self-reported knee pain in Division I female athletes. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 53 NCAA Division I female athletes underwent bilateral knee ultrasound to identify effusion-synovitis. The Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain subscale assessed knee pain. A 1-way analysis of variance compared KOOS pain, symptoms, activities during daily living (ADL), and quality of life (QoL) scores across groups with no, unilateral, and bilateral effusion-synovitis. RESULTS: Among the athletes, 49.1% showed no effusion-synovitis, 26.4% had unilateral, and 24.5% had bilateral effusion-synovitis. There were no differences in self-reported pain scores ( = 0.027; = 0.97), ADL ( = 0.256; = 0.78), or QoL ( = 0.120; = 0.88) between any groups. In addition, the frequency of effusion-synovitis was as follows: for the right limb, Grade 0 = 35 (66%), Grade 1 = 15 (28%), Grade 2 = 1 (2%), and Grade 3 = 2 (4%); for the left limb, Grade 0 = 31 (58%), Grade 1 = 19 (36%), Grade 2 = 3 (6%), and Grade 3 = 0 (0%). CONCLUSION: The presence of effusion-synovitis, irrespective of being unilateral or bilateral, was not associated with self-reported knee pain in elite female athletes. This suggests that lower grades of effusion-synovitis may not significantly impact knee pain. CLINICAL RELEVANCE: The findings of this study challenge existing assumptions about the impact of effusion-synovitis on knee pain in athletes, contributing to the nuanced understanding of knee joint health in sports medicine.
Psychological Distress, Skipped Meals, and Insufficient Sleep, and the Occurrence of Back Pain in Adolescent Female Soccer Players: The Karolinska Football Injury Cohort Study.
Orzali L, Asker M, Weiss N … +5 more , Onell C, Johnson U, Fältström A, Tranaeus U, Skillgate E
Sports Health · 2025 Nov · PMID 40145567 · Full text
BACKGROUND: There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This...
BACKGROUND: There is growing awareness that back pain in adolescent soccer (European football) players is not always related to local tissue damage. Approaches taking into consideration lifestyle factors are needed. This study aimed to investigate the association between psychological distress, skipped meals, and insufficient sleep, and the occurrence of back pain among adolescent female soccer players. HYPOTHESIS: Psychological distress, skipped meals, and insufficient sleep are associated with the occurrence of back pain. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Swedish adolescent female soccer players aged 12 to 17 years, without back pain at baseline, were included. The exposures psychological distress, skipped meals, and insufficient sleep were assessed at baseline. The players were followed for 1 year with a weekly web-based survey, where back pain intensity was measured on a numeric rating scale (NRS) ranging from 0 to 10. The outcome back pain was defined as reporting low back pain and/or upper back/neck pain intensity of ≥4 on the NRS. Multivariable Cox proportional hazard regression analyses were performed to estimate the hazard rate ratio (HRR) with 95% CI for the association between each exposure and the outcome back pain, adjusted for age at baseline and parents' education. RESULTS: In total, 351 players were included, and 141 players reported back pain at some point during the 1-year follow-up. The adjusted HRR for back pain was 1.79 (95% CI, 1.11-2.91) for insufficient sleep, 1.45 (95% CI, 0.97-2.17) for psychological distress, and 0.98 (95% CI, 0.61-1.59) for skipped meals. CONCLUSION: Insufficient sleep and psychological distress are associated with the occurrence of back pain among female adolescent soccer players. CLINICAL RELEVANCE: Our results contribute to the understanding of what may influence the occurrence of back pain in adolescence, offering potential strategies for the prevention of back pain in adolescent female soccer players.
Factors Explaining the Severity of Acute Achilles Tendinopathy Among Runners: A Comprehensive Cross-Sectional Analysis.
Lavallée-Bourget MH, Roy-Bélanger L, García-Arrabé M … +5 more , Laurier X, Tougas A, Dubois B, Bélanger V, Roy JS
Sports Health · 2025 Nov · PMID 40114301 · Full text
BACKGROUND: Achilles tendinopathy (AT) is a prevalent musculoskeletal injury among runners, accounting for approximately 10% of all running-related injuries. AT can result in persistent symptoms and impact the quality of...
BACKGROUND: Achilles tendinopathy (AT) is a prevalent musculoskeletal injury among runners, accounting for approximately 10% of all running-related injuries. AT can result in persistent symptoms and impact the quality of life of runners. The Victorian Institute of Sport Assessment questionnaire (VISA-A) is a widely used self-reported tool for assessing severity of AT. However, the anatomic, biomechanical, psychological, and social factors that influence its score are still poorly understood. The aim of this study is to identify the factors that explain the severity of AT based on the VISA-A score in runners experiencing acute AT. HYPOTHESIS: The VISA-A score will be explained by both biological and psychosocial factors. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: Runners with AT were assessed within 3 months of symptoms onset. The potential explanatory factors assessed included sociodemographic characteristics and medical history, as well as psychosocial, physical, and anatomic (ultrasound imaging) variables. RESULTS: Participants with AT (n = 84) demonstrated moderate impairments, with a mean VISA-A score of 62.8 (SD, 15.1). Three variables emerged as significant factors explaining AT severity: higher level of kinesiophobia and pain catastrophizing, pain during single-leg jumps, and increased cross-sectional Achilles tendon area on ultrasound imaging. These 3 variables had a moderate capacity ( = 0.47) to explain the VISA-A score. CONCLUSION: Pain during single-leg jumps, an increased cross-sectional tendon area assessed by ultrasound, and a high score on kinesiophobia and pain catastrophizing questions are associated with higher VISA scores. CLINICAL RELEVANCE: These findings provide the basis for the development of more tailored interventions to improve the quality of life and function of runners with acute AT.
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