Sports Health [JOURNAL]
Sun
200 papers
Adaptation of Muscles With Different Physiological Properties to Resistance Training With and Without Bloodflow Restriction.
Cidrais M, Teodósio C, Correia JM … +4 more , Vila-Chã C, Pezarat-Correia P, Bruno PM, Mendonca GV
Sports Health · 2026 Jul · PMID 42396840 · Full text
BACKGROUND: Low-load bloodflow-restricted (BFR) resistance training (LLBFR-RT) has been shown to elicit muscular hypertrophy comparable with high-load resistance training (HL-RT). We aimed to explore the differential imp...
BACKGROUND: Low-load bloodflow-restricted (BFR) resistance training (LLBFR-RT) has been shown to elicit muscular hypertrophy comparable with high-load resistance training (HL-RT). We aimed to explore the differential impact of LLBFR-RT and HL-RT on hypertrophy of the triceps surae. HYPOTHESIS: LLBFR-RT would be more effective than HL-RT for soleus muscle hypertrophy. In addition, it was hypothesized that HL-RT would be more effective than LLBFR-RT for the hypertrophy of both gastrocnemii. STUDY DESIGN: An active controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 28 healthy adults were assigned randomly to 2 unilateral plantar-flexion training regimens: HL-RT (75% of 1-repetition maximum [1RM], 4 sets, 10 repetitions) and LLBFR-RT (20% of 1RM, 4 sets, 30+15+15+15 repetitions). Maximal voluntary isometric contractions (MVIC), 1RM, and panoramic ultrasound assessments of the triceps surae were obtained pre- as well and post-4 weeks of intervention (5 sessions per week). RESULTS: MVIC and 1RM improved statistically from pre- to post-training ( < 0.05), and this occurred similarly between interventions (gains of ~20% to 30%). Both regimens were similarly effective for the hypertrophy of the soleus muscle (gains of ~12% to 15%). Conversely, the lateral gastrocnemius only responded to HL-RT (gains of ~12%; < 0.05 vs 4% with LLBFR-RT), and the medial gastrocnemius did not manifest statistical changes with either training regimen. CONCLUSION: HL-RT is more effective for eliciting size gains in the lateral gastrocnemius (muscle with a mixed fiber type composition) over a period of high-frequency training. The soleus (muscle with predominant oxidative fibers) adapts to both training regimens in a similar fashion. CLINICAL RELEVANCE: High-frequency plantar-flexion exercise with HL-RT (5 days per week) is preferable to LLBFR-RT when aiming to elicit plantar-flexor strength gains accompanied by more comprehensive hypertrophy of the triceps surae muscle.
Therapeutic Exercises Induce Distinct Regional Activation Patterns of the Fibularis Longus Muscle in People With Chronic Ankle Instability.
Mendez-Rebolledo G, López-Ramírez R, Rondón-Pérez N … +2 more , Martinez-Valdes E, Guzmán-Venegas R
Sports Health · 2026 Jun · PMID 42358100 · Full text
BACKGROUND: Chronic ankle instability (CAI) is common in athletic populations and is associated with recurrent sprains and impaired performance. Recent evidence shows that fibularis longus has distinct anterior and poste...
BACKGROUND: Chronic ankle instability (CAI) is common in athletic populations and is associated with recurrent sprains and impaired performance. Recent evidence shows that fibularis longus has distinct anterior and posterior regions and that, during isometric eversion, people with CAI display a reduced relative contribution of the posterior region. This muscle is typically trained with band-resisted eversion in supine (BES) and BOSU-based exercises (seated and single-leg eversion, BOSU-Sit and BOSU-SL, respectively), yet it is unknown whether these specific tasks correct or perpetuate regional activation deficits. HYPOTHESIS: As exercise demands increased from BES to BOSU-based tasks, fibularis longus activation would be differentially modulated and people with CAI would exhibit a greater anterior shift of the activation barycenter together with a reduced relative contribution of the posterior region, particularly during the BOSU-based tasks. STUDY DESIGN: Descriptive laboratory study. LEVEL OF EVIDENCE: Level 5. METHODS: A total of 40 physically active adults (CAI, n = 20; no-CAI, n = 20) performed 3 exercises: BES, BOSU-Sit, and BOSU-SL. High-density surface electromyography recorded fibularis longus activation using a 64-electrode grid. Root mean square was computed for anterior and posterior regions, and the activation barycenter was calculated along the -axis (anteroposterior) and -axis (cephalocaudal). RESULTS: In CAI, both BOSU exercises shifted the -axis barycenter anteriorly relative to BES (BOSU-Sit, = 0.01; BOSU-SL, = 0.01). BES was the only exercise in which people with CAI exhibited greater posterior-region activation than controls ( = 0.003). In contrast, BOSU-SL produced an anterior-dominant pattern, with greater anterior-region activation than the posterior region ( = 0.04) and lower posterior-region activation than BES ( = 0.008). CONCLUSION: Therapeutic exercises commonly grouped as "fibular strengthening" are not neuromuscularly equivalent. In this acute task comparison, BES was associated with a more posterior barycenter and greater posterior-region activation in CAI, whereas BOSU-based tasks primarily activated the anterior region.
When to Start Plyometric Training After Anterior Cruciate Ligament Reconstruction? A Systematic Review of Randomized Clinical Trials.
Alabbad M, Nuhmani S, Muaidi Q
Sports Health · 2026 Jun · PMID 42358085 · Full text
CONTEXT: Injury to the anterior cruciate ligament (ACL) causes substantial long-term disabilities for athletes. Exercise methods like plyometrics have been considered ideal due to their neuromuscular and motor control be...
CONTEXT: Injury to the anterior cruciate ligament (ACL) causes substantial long-term disabilities for athletes. Exercise methods like plyometrics have been considered ideal due to their neuromuscular and motor control benefits. OBJECTIVE: This systematic review aims to provide practitioners with criteria for starting to perform plyometric training exercise (PTE) after ACL reconstruction (ACLR). DATA SOURCES: A review of relevant literature was conducted using PubMed, Cochrane Library, and PEDro. STUDY SELECTION: Based on a set of criteria, only relevant randomized controlled trials were included in the study from inception to March 18, 2026. STUDY DESIGN: Systematic review of randomized clinical trials. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: An appropriate form was developed and tested for collecting data from the literature to answer the current question. As part of the risk of bias assessment, an updated version of the Cochrane tool was used, and the GRADE approach was applied. RESULTS: Of the studies' outcomes, 63% raised some concerns about bias. Across 16 studies, 685 participants (70% men, 30% women) were included, with a mean age of 25.23 years. PTE began on average after 13.50 weeks post-ACLR as reported in 14 studies. A number of criteria were considered when starting PTE, including clinical, strength, performance, biomechanics, and patient-reported outcomes. CONCLUSION: Programs of plyometric training have been reported to start on average 13.50 weeks after ACLR. There is still a need to conduct more research to establish the validity of the proposed assessment criteria to start plyometric exercises in a safe manner. This study's findings may enable PTE to be implemented more practically in ACL rehabilitation programs, which reduces the gap between research and practice.
Effects of Concurrent Strength and Aerobic Exercise Training on Cognitive Health in Adults With Physiological or Neurocognitive Disorders: Systematic Review With Meta-analysis of Randomized Controlled Trials.
Zhang M, Yan R, Lou L … +4 more , Wu K, Bian J, Li D, Sun J
Sports Health · 2026 Jun · PMID 42358083 · Full text
CONTEXT: This study aimed to evaluate the effects of concurrent strength and aerobic exercise training (CET) on cognitive function in middle-aged and older adults with physiological conditions (e.g., type 2 diabetes, met...
CONTEXT: This study aimed to evaluate the effects of concurrent strength and aerobic exercise training (CET) on cognitive function in middle-aged and older adults with physiological conditions (e.g., type 2 diabetes, metabolic syndrome, cardiovascular disease, chronic obstructive pulmonary disease, frailty, fibromyalgia) or neurocognitive disorders (e.g., mild cognitive impairment, dementia, Alzheimer's disease [AD]). EVIDENCE ACQUISITION: Two independent reviewers conducted a systematic search of PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, SPORTDiscus, CNKI, WanFang, and Google Scholar from inception to July 2024. Randomized controlled trials (RCTs) examining CET (≥4 weeks) in clinical populations, reporting global cognition via validated tools (e.g., Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA]). Non-RCTs, acute interventions, healthy populations, and lack of control were excluded. Two reviewers performed study selection, data extraction, and risk of bias assessment independently using the Cochrane Risk-of-Bias 2.0 tool; discrepancies were resolved by a third reviewer. Standardized mean differences (SMD) with 95% CI were calculated using random-effects models. STUDY DESIGN: Systematic review and meta-analysis. LEVEL OF EVIDENCE: Level II. RESULTS: A total of 22 RCTs involving 3463 participants (age range, 43.9-92.1 years; 48% female) were included. Of these, 714 participants had physiological disorders (e.g., diabetes, fibromyalgia, frailty) and 2442 had neurocognitive disorders (e.g., dementia, AD). CET significantly improved global cognitive function compared with controls (SMD = 0.34; 95% CI, 0.18 to 0.50; < 0.001; = 67%). Subgroup analyses demonstrated significant improvements in both physiological disorders (SMD = 0.29; 95% CI, 0.09 to 0.49; < 0.01) and neurocognitive disorders (SMD = 0.37; 95% CI, 0.14 to 0.55; < 0.01). No publication bias was detected (Egger's test = 0.62). CONCLUSION: CET is an effective nonpharmacological intervention for enhancing cognitive health in middle-aged and older adults with physiological or neurocognitive disorders.Strength-of-Recommendation Taxonomy (SORT):Moderate.
Physical Therapy for Sport-Related Concussion: A Network Meta-analysis and Systematic Review.
Li H, Yang J, Zhang Y … +2 more , Qu C, Hu S
Sports Health · 2026 Jun · PMID 42358080 · Full text
CONTEXT: The effectiveness and optimal exercise-based physical therapy interventions for sport-related concussion (SRC) remain controversial, and a systematic synthesis of the evidence is lacking. OBJECTIVE: To conduct a...
CONTEXT: The effectiveness and optimal exercise-based physical therapy interventions for sport-related concussion (SRC) remain controversial, and a systematic synthesis of the evidence is lacking. OBJECTIVE: To conduct a network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating exercise-based physical therapy interventions for SRC recovery and provide best-practice recommendations. DATA SOURCES: MEDLINE (PubMed), Web of Science, and Cochrane databases were searched from inception through December 2024. STUDY SELECTION: RCTs assessing exercise-based physical therapy interventions for SRC that reported symptom or recovery outcomes were included. Animal studies, observational studies, and studies with nonextractable data were excluded. All records were screened independently and blindly by 2 reviewers. STUDY DESIGN: NMA using a random-effects model. Study quality was assessed with the Cochrane Risk of Bias tool (PROSPERO registration: CRD420251011941). LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Two reviewers independently extracted data. Outcomes included clinical recovery time and symptom- or scale-based measures. RESULTS: A total of 20 RCTs with 1320 participants (age, 12 to 60 years; 57% female) reporting acute or persistent SRC were included; details on sport types and levels were limited. Interventions comprised subthreshold aerobic exercise protocol (SAEP), usual care exercise protocol (UCEP), multidisciplinary interventions, stretching, strict rest, vestibular rehabilitation therapy (VRT), and combined VRT plus SAEP. Multidisciplinary interventions achieved the greatest improvements (standardized mean difference [SMD] = -2.06; = 0.002), followed by combined VRT plus SAEP and VRT alone. Subgroup analyses showed similar patterns: multidisciplinary interventions were most effective in participants <30 years old (SMD = -2.42) and in patients with persistent symptoms (SMD = -2.999). Risk of bias was low in 13 studies, moderate in 3, and high in 4. CONCLUSION: Multidisciplinary interventions and the combination of VBT and SAEP are the most effective treatments for SRC recovery, particularly for patients with persistent symptoms and for those <30 years.
Functional Shoulder Adaptations and Attack Form in High School Volleyball Players: Sex Differences in Range of Motion, Strength, and Dynamic Stability.
Mizoguchi Y, Suzuki K, Hasegawa S … +3 more , Shimada N, Hall T, Akasaka K
Sports Health · 2026 Jun · PMID 42343223 · Full text
BACKGROUND: Shoulder function asymmetries are common in adolescent volleyball players, yet evidence beyond glenohumeral range of motion (ROM) is limited, and few studies jointly examine sex and attack form. HYPOTHESIS: S...
BACKGROUND: Shoulder function asymmetries are common in adolescent volleyball players, yet evidence beyond glenohumeral range of motion (ROM) is limited, and few studies jointly examine sex and attack form. HYPOTHESIS: Shoulder asymmetries would differ by attack form, with bow-and-arrow hitters showing greater dominant-nondominant internal rotation (IR) strength and dynamic-stability asymmetry than straight-arm hitters. Second, we expected typical dominant-arm ROM and strength adaptations and greater strength and stability in boys than girls. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: We evaluated 108 high school volleyball players (49 boys, 59 girls). Bilateral shoulder ROM, isometric strength, joint position sense, acromiohumeral distance, and dynamic stability (upper quarter Y-balance test [UQYBT]) were assessed. Asymmetry was defined as dominant minus nondominant. Exploratory logistic regression examined associations between attack form (straight vs bow-and-arrow/circular) and shoulder asymmetry, with an additional exploratory female-only subgroup analysis. RESULTS: Both sexes showed marked dominant-side adaptations: reduced IR ROM (boys -20.3°, girls -17.6°; both < 0.001) and increased external rotation (ER) ROM (boys 11.7°, girls 7.7°; both < 0.001), with decreased total rotational motion. Boys had higher normalized IR and ER strength ( < 0.001) and superior UQYBT performance ( < 0.001), except inferolateral. In exploratory logistic regression, greater IR strength asymmetry (odds ratio [OR], 1.18; 95% CI, 1.01-1.40; = 0.04) and smaller inferolateral reach asymmetry (OR, 0.92; 95% CI, 0.86-0.98; = 0.01) were associated with using a bow-and-arrow/circular swing; however, no significant attack-form differences were observed in the exploratory female-only subgroup analysis. CONCLUSION: Characteristic overhead-shoulder profiles - IR loss, ER gain, and preserved ER/IR ratios - are already present in high school volleyball players. Associations between attack form and shoulder asymmetry should be interpreted cautiously and considered exploratory. CLINICAL RELEVANCE: Clinicians may monitor IR ROM, strength balance, and upper-quarter stability to characterize shoulder function in adolescent volleyball players and to identify extreme or symptomatic asymmetries that may warrant individualized conditioning.
The Indirect Contact ACL Injury Cascade: Why Current Prevention Falls Short.
Myslinski T, Kiely J, Gabbett T … +1 more , Park G
Sports Health · 2026 Jun · PMID 42343207 · Full text
Abstract loading — click title to view on PubMed.
Is the 10% Asymmetry Threshold Important in Team Handball? Interlimb Asymmetry and Threshold-Based Performance Analysis in Lower-Limb Functional Tests.
Akgün S
Sports Health · 2026 Jun · PMID 42343192 · Full text
BACKGROUND: Asymmetry in unilateral functional performance may affect both performance outcomes and injury risk in elite athletes. Understanding the relationship between asymmetry ratios and performance parameters in han...
BACKGROUND: Asymmetry in unilateral functional performance may affect both performance outcomes and injury risk in elite athletes. Understanding the relationship between asymmetry ratios and performance parameters in handball players can inform training and monitoring strategies. This study aimed to investigate the relationship between asymmetry ratios obtained from unilateral functional performance tests in elite male handball players and to determine the effect of a 10% asymmetry threshold on performance outcomes. HYPOTHESIS: Asymmetry ratios above 10% in lower extremity functional tests negatively influence performance outcomes in elite male handball players. STUDY DESIGN: Cross-sectional study with randomized measurements. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 41 elite male handball players (age, 20.98 ± 2.15 years; height, 185.90 ± 7.58 cm; weight, 92.61 ± 14.72 kg; body mass index, 26.76 ± 3.52 kg/m; training experience, 11.27 ± 3.45 years) participated voluntarily. Lower extremity strength was evaluated using vertical jump (VJ), counter movement jump (CMJ), and 5 single-leg hop tests (SLHTs): single hop for distance (SH), triple hop (TH), crossover hop (CH), medial side triple hop (MSTH), and 90° medial rotation hop (MRH). Dynamic balance was assessed via the Y balance test (YBT). Participants were classified according to a 10% asymmetry threshold for comparison. RESULTS: Moderate positive correlations were observed between asymmetry ratios in certain multidirectional jump tests and dynamic balance parameters ( < 0.05). Significant differences between the left and right sides were observed in the VJ, CMJ, SH, TH, MRH, and anterior (ANT) scores ( < 0.05). Participants within the <10% asymmetry threshold outperformed the >10% group across all tests. Notably, effect sizes were large (d = 0.85-2.62) for VJ, CMJ, SH, MRH, ANT, and posteromedial scores ( < 0.05). CONCLUSION: A 10% strength asymmetry ratio represents a critical reference point in elite male handball players. Systematic monitoring of asymmetry ratios is important not only for injury prevention but also for optimizing performance outcomes. CLINICAL RELEVANCE: Identifying and correcting strength asymmetry, and maintaining them below the 10% threshold, can improve performance and reduce the risk of injury in elite handball athletes.
Prehabilitation for Patients Undergoing Anterior Cruciate Ligament Reconstruction Reduces Kinesiophobia Levels at 1-Year Postoperation.
Ho SWL, Nah MFK, Lim OTR … +4 more , Zhang X, T J, Jin Tan LT, Lee KT
Sports Health · 2026 Jun · PMID 42339880 · Full text
BACKGROUND: Anterior cruciate ligament (ACL) injuries are the most common knee ligament injuries and ACL reconstruction (ACLR) is often required to restore stability and facilitate return-to-sport. However, kinesiophobia...
BACKGROUND: Anterior cruciate ligament (ACL) injuries are the most common knee ligament injuries and ACL reconstruction (ACLR) is often required to restore stability and facilitate return-to-sport. However, kinesiophobia-fear of movement due to risk of reinjury-is prevalent post-ACLR (62% to 78%) and linked to poor return-to-sport outcomes despite good physical recovery. HYPOTHESIS: Patient, injury, surgery, and rehabilitation factors can be associated with elevated kinesiophobia in patients undergoing primary ACLR. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A retrospective review was conducted using data from a tertiary acute hospital's ACL registry between June 1, 2019 and June 1, 2023. Included were patients aged 18 years to 60 years undergoing primary ACLR. Exclusions were revision ACLR, multiligament injuries, and incomplete 1-year dataset. Demographics, injury/surgery/rehabilitation factors and patient-reported outcomes were measured preoperatively, and at 6 months and 1 year. Tampa Scale of Kinesiophobia-17 (TSK-17, with ≥37 indicating elevated kinesiophobia), was recorded preoperatively and 1 year postoperatively. Multivariate regression was used to identify predictors of elevated 1-year kinesiophobia. RESULTS: Data from 200 patients were analyzed (8 excluded due to incomplete data). Baseline TSK-17 was 38.6 ± 5.6, improving to 32.6 ± 7.6 at 1 year ( < 0.001), with 59% showing elevated kinesiophobia at baseline and 29% at 1 year. The average TSK-17 reduction was 6.1 ± 8.6, meeting the minimal clinically important difference (MCID) level. Prehabilitation was attended by 106 patients (55.21%), with a median of 1 session (range 0-10). Elevated 1-year kinesiophobia was associated significantly with higher baseline TSK-17 scores (odds ratio [OR], 2.004; 95% CI, 1.013-3.968; = 0.05) and inversely associated with attending ≥1 prehabilitation session (OR, 0.513; 95% CI, 0.264-0.997; = 0.05). CONCLUSION: Prehabilitation before ACLR should be standard-of-care, to reduce risk of elevated kinesiophobia at 1-year. CLINICAL RELEVANCE: High baseline kinesiophobia predicts sustained elevated 1-year kinesiophobia, hence assessment (TSK-17 scores) and early intervention targeting kinesiophobia should be included in preoperative ACLR protocols.
Sex Differences in Pacing Profile and Reliability in a 4-km Cycling Time Trial.
Marinho AH, Schamne JC, Hasegawa JS … +5 more , Cavalcante VHV, Gonçalves F, Bertuzzi R, Lima-Silva AE, Cristina-Souza G
Sports Health · 2026 Jun · PMID 42339847 · Full text
BACKGROUND: Sex differences in pacing profile and day-to-day variability have been underexplored. Therefore, this study investigated potential sex differences in pacing profile, risk-taking behavior, and pacing reliabili...
BACKGROUND: Sex differences in pacing profile and day-to-day variability have been underexplored. Therefore, this study investigated potential sex differences in pacing profile, risk-taking behavior, and pacing reliability during a 4-km cycling time trial. HYPOTHESIS: Men and women present similar pacing and assume similar risk of premature trial interruption during a 4-km cycling time trial. In addition, it was hypothesized that men and women might present comparable performance and pacing reliability. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: A total of 32 cyclists (16 men and 16 women) performed 2 4-km cycling time trials on separate days. Power output and ratings of perceived exertion were recorded during the trials. To quantify the risk of premature time-trial interruption, the hazard score was calculated as the product of the rating of perceived exertion and the remaining distance. RESULTS: There were no sex differences in power output distribution or hazard score during the 4-km cycling time trial ( > 0.05), with both men and women presenting a "U-shaped" pacing profile. In addition, men and women exhibited similar endurance performance reliability between trials ( > 0.05). However, the day-to-day coefficient of variation for power output distribution ranged from 3.5% to 7.2% in women and from 1.9% to 6.3% in men, indicating slightly greater day-to-day variability in the pacing profile for women. CONCLUSION: Men and women exhibit similar pacing profiles, risk-taking behavior, and endurance performance reliability during a 4-km cycling time trial. However, women seem to demonstrate greater day-to-day pacing profile variability than men. CLINICAL RELEVANCE: The present findings provide insights that enable more accurate monitoring and prescription of training protocols in female cyclists.
Jugular Venous Compression Collar for Prevention of Brain Injury due to Repetitive Head Impact and Concussion in Sport: A Scoping Review.
Weber I, Whelan BM, Bruce JM … +1 more , Harmon KG
Sports Health · 2026 Jun · PMID 42339815 · Full text
CONTEXT: There is significant interest in jugular venous compression (JVC) devices from multiple parties, including sports physicians, athletic trainers, athletes, and parents. OBJECTIVE: To examine the effects of JVC on...
CONTEXT: There is significant interest in jugular venous compression (JVC) devices from multiple parties, including sports physicians, athletic trainers, athletes, and parents. OBJECTIVE: To examine the effects of JVC on repetitive head impacts and evaluate their effectiveness in reducing brain injury and concussion risk in sport. DATA SOURCES: Embase, Cochrane Central Register of Controlled Trials, CINAHL Plus, SPORTDiscus, Web of Science Core Collection - SCI-EXPANDED, SSCI, AHCI, ESCI, American Psychological Association, PsycInfo, WHO International Clinical Trials Registry Platform (ICTRP), ProQuest Dissertations and Theses Citation Index (Web of Science), Europe PMC, and PubMed. STUDY SELECTION: Full-text, peer-reviewed manuscripts of primary research, published between 2010 and 2024. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 5. DATA EXTRACTION: A total of 22 articles met the inclusion criteria. These articles were categorized into 4 groups: animal models (n = 4), biomechanics in humans (n = 4), evidence in athletes (n = 11), and evidence in Special Weapons and Tactics Breacher Training (SWAT) (n = 3). Several of the athlete articles used the same cohort of athletes. RESULTS: There was no difference in concussion rates in athletes between collared and noncollared groups during a season, while evidence from animal and tactical populations was limited to mechanistic and imaging outcomes. In both athletes and SWAT personnel, there were no clinically significant differences in neurocognitive performance between groups. There are statistically significant imaging changes between collared and noncollared groups; however, the imaging changes were not consistent and are of uncertain clinical significance. Furthermore, 6 out of 11 studies in athletes are currently under investigation. The available evidence supports that JVC can increase intracranial pressure, but it remains unknown if this results in any clinically meaningful benefit. CONCLUSION: Although no adverse outcomes are reported with collar use, current research does not support the effectiveness of JVC collars for concussion reduction and use for mitigation of repetitive head impact. Additional studies from diverse research teams with independent funding sources are required.
The Effects of Visual Training on Balance and Functional Recovery After Lower Extremity Injuries: A Systematic Review and Meta-analysis.
Liu K, Qiu J, Shi A … +1 more , Guo Y
Sports Health · 2026 Jun · PMID 42249596 · Full text
CONTEXT: Visual training (VT) is used increasingly in sports rehabilitation to enhance visuomotor integration after lower extremity injuries. However, its effectiveness in improving balance and functional recovery remain...
CONTEXT: Visual training (VT) is used increasingly in sports rehabilitation to enhance visuomotor integration after lower extremity injuries. However, its effectiveness in improving balance and functional recovery remains unclear, with inconsistent findings across studies. OBJECTIVE: To determine whether VT improves balance control and functional recovery in people with lower extremity injuries compared with standard rehabilitation or other active controls. DATA SOURCES: Eight databases (PubMed, Web of Science, Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Cochrane Library) were searched from inception to September 17, 2025. STUDY SELECTION: Randomized controlled trials (RCTs) evaluating VT as the primary intervention and reporting balance- or function-related outcomes were included. Of 1186 records screened, 18 RCTs (n = 707) met eligibility criteria. STUDY DESIGN: Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE: Level 1. DATA EXTRACTION: Data on participant characteristics, intervention protocols, balance outcomes (static and dynamic), and functional outcomes (subjective function, physical function, sport performance) were extracted. RESULTS: VT improved static balance significantly (standardized mean difference [SMD] = 0.46; 95% CI, 0.10-0.81; = 0.01) and dynamic balance (SMD = 0.88; 95% CI, 0.31-1.44; = 0.002). No significant effects were found for subjective functional recovery, physical function, or sport performance. Larger effects were observed in men, chronic ankle instability populations, and with stroboscopic VT. CONCLUSION: VT may provide meaningful benefits for balance rehabilitation after lower extremity injuries, especially for dynamic balance. However, it does not enhance subjective function, physical function, or sport performance significantly. Despite its potential as an adjunct to rehabilitation, overall certainty of evidence is very low, highlighting the need for high-quality RCTs with standardized protocols.
Child and Adolescent Athletes at Greatest Risk of Concussions and Closed Head Injuries in Male Ice Hockey: A 20-Year Analysis of National Injury Data.
Valdivia LM, Jain C, Koehne NH … +7 more , Yendluri A, White CA, Namiri N, Forsh DA, Waterman BR, Li X, Parisien RL
Sports Health · 2026 Jun · PMID 42246478 · Full text
CONTEXT: Ice hockey is a fast-paced and physically demanding collision sport that carries a high risk of injury, especially concussions and closed head injuries (CHIs). The purpose of this study was to evaluate the frequ...
CONTEXT: Ice hockey is a fast-paced and physically demanding collision sport that carries a high risk of injury, especially concussions and closed head injuries (CHIs). The purpose of this study was to evaluate the frequency, trends, and mechanisms of injury of concussions and CHIs sustained by male ice hockey players in the United States (US). EVIDENCE ACQUISITION: Concussions and CHIs sustained playing male ice hockey presenting to US emergency departments from January 1, 2004 to December 31, 2023 were queried using the National Electronic Injury Surveillance System (NEISS). For each injury, patient demographics, disposition, and mechanism of injury were recorded. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression modeling. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. RESULTS: A total of 62,070 concussions and CHIs occurred during the study period. From 2004 to 2023, overall injury incidence increased ( = 0.06). From 2004 to 2012, there was a significant increase in concussion and CHI incidence ( < 0.001) followed by a plateau after 2013. The age group affected most commonly was adolescents (ages 13-19 years) (52.3%, NE = 32,455). The top 3 mechanisms were head-to-ice contact (28.6%, NE = 17,741), head-to-boards contact (22.8%, NE = 14,123), and head-to-player contact (15.4%, NE = 9575). Head-to-ice contact was the most common mechanism in children (33.6%, NE = 5960). Head-to-player reached its highest rate in young adults (21.3%, NE = 1567). Falls initiated 33.9% of all concussions and CHIs. The hospitalization rate across the study was 3.4%. CONCLUSION: Concussions and CHIs sustained from male ice hockey demonstrated a 290% increase from 2004 to 2023, with the child and adolescent populations at greatest risk and head-to-ice contact representing the most common injury mechanism. Focused injury awareness, educational prevention programs, and potential rule changes are essential to decrease the rising incidence of concussions and CHIs in this at-risk patient population.Strength-of-Recommendation Taxonomy (SORT):C-level recommendation.
Nonsurgical Anterior Cruciate Ligament Rehabilitation: A Scoping Review of Exercise Descriptors and Return-to-Sport Outcomes.
Ghezzi S, Pichero R, Cioeta M … +3 more , Gokeler A, Giovannico G, Tortoli E
Sports Health · 2026 Jun · PMID 42233492 · Full text
CONTEXT: Anterior cruciate ligament (ACL) injuries are common in athletes, especially in pivoting sports. While surgical reconstruction is standard, nonsurgical management remains a viable option for selected patients. H...
CONTEXT: Anterior cruciate ligament (ACL) injuries are common in athletes, especially in pivoting sports. While surgical reconstruction is standard, nonsurgical management remains a viable option for selected patients. However, limited guidance exists on effective rehabilitation protocols for this population. The purpose of this review was to identify and summarize the rehabilitation strategies used in nonsurgical management for patients with ACL deficiency (ACL-D), with particular attention to exercise-based components. EVIDENCE ACQUISITION: Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, studies were included based on the PCC framework, focusing on athletes aged >14 years with ACL injuries undergoing nonsurgical management. Four databases (MEDLINE, EMBASE, CINAHL, PEDro) were searched up to June 2024, with additional manual screening. Two reviewers independently screened and extracted data. A narrative synthesis was conducted, and exercises were categorized using established frameworks. Inter-rater reliability was assessed using Cohen's kappa. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 4. RESULTS: A total of 14 studies involving 570 athletes (aged 14-57 years) were included. Of these, 53% completed rehabilitation without surgery, and 30% returned to sport. Protocols varied significantly, with a mean duration of 12 ± 8 weeks. Interventions focused on strength (48%), neuromuscular control (10%), and sport-specific exercises (25%). Patient-reported outcome measures were used in 71% of studies. Associated injuries were reported in 33% of studies and negatively influenced return to sport (RTS) outcomes. CONCLUSION: Notable inconsistencies in nonsurgical management of ACL-D protocols and exercise descriptors limit comparability and the development of standardized guidelines. Short rehabilitation duration may partly explain the low RTS rate (30% of the original cohort) and the high reinjury rate (28%). Structured, progressive programs focusing on strength, neuromuscular training, and psychological readiness may be important to improve outcomes.
The Insufficient Anterior Cruciate Ligament: Reframing the Understanding of Noncontact ACL Injuries.
Souryal TO
Sports Health · 2026 May · PMID 42200574 · Full text
Abstract loading — click title to view on PubMed.
The Effect of Scapular-Focused Exercise With or Without Electromyography Biofeedback in High-School Baseball Pitchers With Shoulder Impingement Syndrome: A Randomized Controlled Trial.
Chung WY, Lee Y
Sports Health · 2026 · PMID 42157602 · Full text
BACKGROUND: Exercise therapy using electromyography biofeedback (EB) is applied widely for pitchers with shoulder impingement syndrome (SIS). However, few studies have targeted adolescent athletes and evaluated various f...
BACKGROUND: Exercise therapy using electromyography biofeedback (EB) is applied widely for pitchers with shoulder impingement syndrome (SIS). However, few studies have targeted adolescent athletes and evaluated various functional outcomes. HYPOTHESIS: Scapular-focused exercise (SFE) with EB would lead to greater improvements in muscle activity, strength, function, and pain compared with SFE alone. STUDY DESIGN: Randomized controlled trial. LEVEL OF EVIDENCE: Level 2. METHODS: A total of 36 high-school baseball pitchers diagnosed with SIS were assigned randomly to either the SFE+EB group (n = 18) or the SFE group (n = 18), while 9 were excluded before analysis. Both groups participated in a 4-week intervention (3 sessions per week, 60 minutes per session). The SFE+EB group received real-time visual feedback using surface electromyography targeting the upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and serratus anterior (SA). The SFE group received verbal and tactile feedback from a physical therapist. Pre- and postintervention assessments included muscle activity, strength, Shoulder Pain and Disability Index, and Numeric Pain Rating Scale. RESULTS: No significant differences were found in baseline characteristics between groups except for glenohumeral internal rotation deficit. The SFE+EB group showed significantly greater improvements in MT activity at 90° (13.14 ± 7.38) compared with the SFE group (7.48 ± 6.62) ( < 0.05). Within-group analysis demonstrated significant increase in UT activity in the SFE+EB group at 60°, whereas MT, LT, SA activity, and UT:MT, UT:LT, and UT:SA ratios improved in both groups. Furthermore, LT and SA muscle strength, along with function and pain scores showed similar changes across groups after the intervention. CONCLUSION: SFE with EB significantly enhances MT activation and symptom relief in high-school baseball pitchers with SIS. In addition, therapist-guided SFE without EB also yields clinically meaningful improvements. CLINICAL RELEVANCE: EB may optimize scapular muscle activation. However, individualized therapist feedback remains an effective and accessible alternative for injury prevention and rehabilitation in young athletes.
Optimizing Conditioning Activities for Postactivation Performance Enhancement: A Framework for Practitioners.
Fontanetti G, Boullosa D, Lima L
Sports Health · 2026 May · PMID 42136134 · Full text
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Quadriceps Strength Correlations and Biomechanical Differences During the Single-Leg Squat Test With Posterior Versus Neutral Standardization After ACL Reconstruction.
Solie BS, Eggleston G, Greufe Schwery N … +2 more , Ogbonnaya U, Larson CM
Sports Health · 2026 May · PMID 42136133 · Full text
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), the single-leg squat test (SLST) may be included in an initial/baseline performance testing battery. During the SLST, the position of the nonstance limb...
BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), the single-leg squat test (SLST) may be included in an initial/baseline performance testing battery. During the SLST, the position of the nonstance limb is known to affect the biomechanics/kinematics of the test, making SLST standardization important for comparing outcomes after ACLR. HYPOTHESIS: The position of the nonstance limb during the SLST will influence the correlation between peak knee flexion limb-symmetry index (LSI) and quadriceps strength LSI, and affect lower extremity biomechanics during the SLST. STUDY DESIGN: Biomechanical cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 66 athletes completed quadriceps strength and single-leg squat testing 5 to 7 months after ACLR. Based on their nonstance limb position during the SLST, athletes were placed in either a posterior standardization (PS) or neutral standardization (NS) group for biomechanical analyses. Correlations between peak knee flexion LSI during the SLST and quadriceps strength LSI were investigated, and between- and within-group analyses of lower extremity joint biomechanics were completed. RESULTS: Performing the SLST with PS produced a medium correlation between peak knee flexion LSI and quadriceps strength LSI ( = 0.37, = 0.14), whereas NS produced a small correlation ( = 0.27, = 0.07). In both groups, the surgical limb showed significantly less peak knee flexion (PS; = 0.02) (NS; = 0.03) and knee moment-contribution (PS; = 0.04) (NS; = 0.0001), as well as significantly more hip moment-contribution (PS; = 0.03) (NS; = 0.0001). Surgical limb change in anterior center of pressure was significantly greater with NS relative to PS (P = 0.03), and nonsurgical limb ankle moment-contribution was significantly greater with PS relative to NS (P = 0.02). CONCLUSION: Although surgical limb knee moment contribution is reduced significantly in both groups after ACLR, peak knee flexion LSI may be a better indicator of quadriceps strength LSI during the SLST with PS than with NS. CLINICAL RELEVANCE: After ACLR, single-leg squatting with PS may be preferred for knee-specific performance testing and as an exercise regression for horizontal hopping, whereas NS may be preferred as an exercise regression for vertical hopping. Strength-of-Recommendation Taxonomy (SORT): B-level recommendation (biomechanical, Level 3 cohort study).
Lipid Profiles in Elite and Collegiate Athletes: A Scoping Review.
Farrington L, Key C, Denton Z … +3 more , van den Anker S, Vopat B, Vopat L
Sports Health · 2026 May · PMID 42124530 · Full text
CONTEXT: The effects of regular physical activity and its influence on lipid metabolism is well established. However, the extent to which elite and collegiate athletes exhibit distinct lipid profiles remains an area of o...
CONTEXT: The effects of regular physical activity and its influence on lipid metabolism is well established. However, the extent to which elite and collegiate athletes exhibit distinct lipid profiles remains an area of ongoing research. OBJECTIVE: To map the literature on lipid profiles in collegiate and elite athletes, summarize variations by sex, sport, and competitive level, and identify gaps to guide future research. DATA SOURCES: A comprehensive search of PubMed, Cochrane, and SPORTDiscus identified English-language studies on lipid profiles in professional and collegiate athletes, published between January 2010 and January 2025. STUDY SELECTION: Studies were screened and selected in Rayyan. STUDY DESIGN: Scoping review. LEVEL OF EVIDENCE: Level 4, scoping review of Level 1-3 studies. DATA EXTRACTION: Lipid values along with factors associated with variation across athlete populations were extracted. RESULTS: A total of 31 studies met inclusion criteria, representing 5921 athletes (3271 men, 2650 women; mean age, 24.3 years). Most cohorts were male (84%) and elite-level (77%), whereas women were not represented in many of the sports. High-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC) were reported most consistently. Mean lipid values included HDL 59.3 ± 14.0 mg/dl, LDL 94.3 ± 20.4 mg/dl, TC 168.0 ± 19.8 mg/dl, triglycerides (TG) 86.8 ± 28.4 mg/dl, and VLDL 38.2 ± 29.5 mg/dl. Female athletes showed higher HDL and lower LDL and TG than male athletes. Elite athletes reported higher HDL, TC, and TG, and minimal differences in LDL, compared with collegiate athletes. Lipid levels varied by sport and sex. Female runners reported the highest (73.5 mg/dl) and female soccer players the lowest (37.7 mg/dl) HDL, and judo athletes showed the highest LDL (139.4 mg/dl) and TG (143.6 mg/dl). CONCLUSION: Lipid profiles among elite and collegiate athletes vary considerably by sex, sport, and competition level. Standardized, sex-balanced studies are needed to clarify the role of lipid metabolism in athlete health, cardiovascular risk, and performance. Further research is needed using rigorous, standardized, and sex-balanced methodologies to clarify the impact of lipid profiles on athlete health and performance, and to guide evidence-based strategies for cardiovascular risk assessment and management in athletic populations.
Mismatch Between Physical and Psychological Outcomes at Return to Sport After ACL Reconstruction and the Association With Second ACL Injury Risk: A Cohort Study.
Piussi R, Lindskog J, Högberg J … +6 more , Hamrin Senorski R, Thomeé R, Buckthorpe M, Della Villa F, Samuelsson K, Hamrin Senorski E
Sports Health · 2026 May · PMID 42116545 · Full text
BACKGROUND: The purpose of this study was to investigate whether a mismatch between physical function and psychological outcomes at return to preinjury level of sport (RTS) after anterior cruciate ligament (ACL) reconstr...
BACKGROUND: The purpose of this study was to investigate whether a mismatch between physical function and psychological outcomes at return to preinjury level of sport (RTS) after anterior cruciate ligament (ACL) reconstruction is associated with the risk of a second ACL injury. HYPOTHESIS: A mismatch between physical function and psychological outcomes at RTS increases second ACL injury riskStudy Design:Prospective cohort (registry). LEVEL OF EVIDENCE: Level 3. METHODS: Patients registered in a local rehabilitation specific registry with ACL reconstruction, aged 15 to 40 years, who reported a preinjury Tegner level ≥6, and completed muscle function tests and patient reported outcome measures (PROs) at RTS were included. Patients were categorized into 4 our groups: (1) high physical function and high PROs (High-High), (2) low physical function and low PROs (Low-Low), (3) high physical function and low PROs (High-Low), and (4) low physical function and high PROs (Low-High). Cox regression analysis and Kaplan-Meier survival estimates were used to assess the association between group classification and second ACL injury risk within 1 year of RTS. RESULTS: A cohort of 380 patients from was included. Within 1 year of RTS, 34 (8.9%) patients sustained a second ACL injury. The second ACL injury rate was highest in the Low-High group (19.2%). However, no statistically significant difference in hazard ratios for second ACL injury was observed. CONCLUSION: A "mismatch" that consists of high muscle function and low psychological status, or low muscle function and high psychological status does not appear to affect the occurrence of second ACL injury after ACL reconstruction. CLINICAL RELEVANCE: Clinicians should be cautious not to rely solely on results from muscle function tests and PROs to clear patients for unrestricted sports participation.
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