dissertation on sports injuries

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Article Contents

Introduction, literature search, physeal injuries and growth disturbance, residual problems after injury in athletes, outcomes of operative management of common sports injuries, conclusions.

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Sport injuries: a review of outcomes

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Nicola Maffulli, Umile Giuseppe Longo, Nikolaos Gougoulias, Dennis Caine, Vincenzo Denaro, Sport injuries: a review of outcomes, British Medical Bulletin , Volume 97, Issue 1, March 2011, Pages 47–80, https://doi.org/10.1093/bmb/ldq026

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Injuries can counter the beneficial aspects related to sports activities if an athlete is unable to continue to participate because of residual effects of injury. We provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries. A systematic computerized literature search was conducted on following databases were accessed: PubMed, Medline, Cochrane, CINAHL and Embase databases. At a young age, injury to the physis can result in limb deformities and leg-length discrepancy. Weight-bearing joints including the hip, knee and ankle are at risk of developing osteoarthritis (OA) in former athletes, after injury or in the presence of malalignment, especially in association with high impact sport. Knee injury is a risk factor for OA. Ankle ligament injuries in athletes result in incomplete recovery (up to 40% at 6 months), and OA in the long term (latency period more than 25 years). Spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Evolution in arthroscopy allows more accurate assessment of hip, ankle, shoulder, elbow and wrist intra-articular post-traumatic pathologies, and possibly more successful management. Few well-conducted studies are available to establish the long-term follow-up of former athletes. To assess whether benefits from sports participation outweigh the risks, future research should involve questionnaires regarding the health-related quality of life in former athletes, to be compared with the general population.

Participation in sports is widespread all over the world, 1 with well-described physical, psychological and social consequences for involved athletes. 2–5 The benefits associated with physical activity in both youth and elderly are well documented. 2 , 6–8 Regular participation in sports is associated with a better quality of life and reduced risk of several diseases, 1 , 9 allowing people involved to improve cardiovascular health. 10 , 11 Both individual and team sports are associated with favourable physical and physiological changes consisting of decreased percentage of body fat 12 and increased muscular strength, endurance and power. 13 , 14 Moreover, regular participation in high-volume impact-loading and running-based sports (such as basketball, gymnastics, tennis, soccer and distance running) is associated with enhanced whole-body and regional bone mineral content and density, 14 , 15 whereas physical inactivity is associated with obesity and coronary heart disease. 16 Sports are associated with several psychological and emotional benefits. 7 , 17 , 18 First of all, there is a strong relationship between the development of positive self-esteem, due to testing of self in a context of sport competition, 19 reduced stress, anxiety and depression. 20 Physical activities also contribute to social development of athletes, prosocial behaviour, fair play and sportspersonship 21 and personal responsibility. 22

Engaging in sports activities has numerous health benefits, but also carries the risk of injury. 7 , 23 , 24 At every age, competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve injuries, caused by direct trauma or repetitive stress. 25–35 Different sports are associated with different patterns and types of injuries, whereas age, gender and type of activity (e.g. competitive versus practice) influence the prevalence of injuries. 7 , 36 , 37

Injuries in children and adolescents, who often tend to focus on high performance in certain disciplines and sports, 24 include susceptibility to growth plate injury, nonlinearity of growth, limited thermoregulatory capacity and maturity-associated variation. 9 In the immature skeleton, growth plate injury is possible 38 and apophysitis is common. The most common sites are at the knee (Osgood-Schlatter lesion), the heel (Sever's lesion) and the elbow. 39 Certain contact sports, such as rugby, for example, are associated with 5.2 injuries per 1000 total athletic exposures in high school children (usually boys). These were more common during competition compared with training and fractures accounted for 16% of these injuries, whereas concussions (15.8%) and ligament sprains (15.7%) were almost as common. 40

Sports trauma commonly affects joints of the extremities (knee, ankle, hip, shoulder, elbow, wrist) or the spine. Knee injuries are among the most common. Knee trauma can result in meniscal and chondral lesions, sometimes in combination with cruciate ligament injuries. 37 Ankle injuries constitute 21% of all sports injuries. 41 Ankle ligament injuries are more commonly (83%) diagnosed as ligament sprains (incomplete tears), and are common in sports such as basketball and volleyball. Ankle injuries occur usually during competition and in the majority of cases, athletes can return to sports within a week. 42 Hip labral injuries have drawn attention in recent years with the advent of hip arthroscopy. 43 , 44 Upper extremity syndromes caused by a single stress or by repetitive microtrauma occur in a variety of sports. Overhead throwing, long-distance swimming, bowling, golf, gymnastics, basketball, volleyball and field events can repetitively stress the hand, wrist, elbow and shoulder. Shoulder and elbow problems are common in the overhead throwing athlete whereas elbow injuries remain often unrecognized in certain sports. 45 Hand and wrist trauma accounts for 3–9% of all athletic injuries. 46 Wrist trauma can affect the triangular fibrocartilage complex 47 or cause scaphoid fractures, 48 whereas overuse problems (e.g. tenosynovitis) are not uncommon. 49 Spinal problems can range from lumbar disc herniation, 39–42 to fatigue fractures of the pars interarticularis, 50 and ‘catastrophic’ cervical spine injuries. 51

Thus, in addition to the beneficial aspects related to sports activities, injuries can counter these if an athlete is unable to continue to participate because of residual effects of injury. Do injuries in children, adolescents and young adults have long-term consequences? What are the outcomes of the most commonly performed surgical procedures? The aim of this review is to provide an updated synthesis of existing clinical evidence of long-term follow-up outcome of sports injuries.

An initial pilot Pubmed search using the keywords ‘sports’, ‘injury’, ‘injuries’, ‘athletes’, ‘outcome’, ‘long term’, was performed. From 1467 abstracts that were retrieved and scanned we identified the thematic topics (types of injury, management, area of the body involved) of the current review, listed below:

Then a more detailed search of PubMed, Medline, Cochrane, CINAHL and Embase databases followed. We used combinations of the keywords: ‘sport’, ‘sports’, ‘youth sports’, ‘young athletes’, ‘former athletes’, ‘children’, ‘skeletally immature’, ‘adolescent’, ‘paediatric’, ‘pediatric’, ‘physeal’, ‘epiphysis’, ‘epiphyseal injuries’, ‘hip’, ‘knee’, ‘ankle’, ‘spine’, ‘spinal’, ‘shoulder’, ‘elbow’, ‘wrist’, ‘football players’, ‘football’, ‘soccer’, ‘tennis’, ‘swimmers’, ‘swimming’, ‘divers’, ‘wrestlers’, ‘wrestling’, ‘cricket’, ‘gymnastics’, ‘skiers’, ‘baseball’, ‘basketball’, ‘osteoarthritis’, ‘former athletes’, ‘strain’, ‘contusion’, ‘distortion’, ‘injury’, ‘injuries’, ‘trauma’, ‘drop out’, ‘dropping out’, ‘attrition’, ‘young’, ‘ youth’, ‘sprain’, ‘ligament’, ‘ACL’, ‘cruciate ligament’, ‘meniscus’, ‘meniscal’, ‘chondral’, ‘labrum’, ‘labral’, ‘reconstruction’, ‘arthroscopy’, ‘throwing’, ‘overhead’, ‘rotator cuff’, ‘TFCC’, ‘scaphoid’, ‘osteoarthritis’, ‘arthritis’, ‘long term’, ‘follow-up’ and ‘athlete’. The most recent search was performed during the second week of November 2009.

Osteoarthritis (OA) in former athletes

Spine problems in former athletes

Knee injury and OA

Ankle ligament injury and OA

Residual upper limb symptoms in the ‘overhead’ athlete

Meniscectomy and oa, meniscal repair in athletes.

Anterior cruciate ligament (ACL) reconstruction and OA

ACL reconstruction in children

Ankle arthroscopy in athletes, hip arthroscopy in athletes.

Operative management of shoulder injuries in athletes (focusing on surgery for instability and labral tears)

Operative management of wrist injuries in athletes (focusing on triquetral fibrocartilage complex, TFCC, injuries and scaphoid fractures)

Given the different types of sports injuries in terms of location in the body, several searches were carried out. The search was limited to articles published in peer-reviewed journals.

From a total of 2596 abstracts that were scanned, 1247 studies were irrelevant to the subject and were excluded. The remaining studies were categorized in the topics identified earlier. We excluded from our investigation case reports, letter to editors and articles not specifically reporting outcomes, as well as ‘kin’ studies (studies reporting on the same patients' population). The most recent study or the study with the longest follow-up was included. In some topics of particular importance, such as the effect of knee injuries (given their frequency), we included long-term studies reporting not only on athletes, but also on the general population (usually in these studies a very high proportion on sports injuries is included). Regarding knee injuries in adults, we included articles with follow-up more than 10 years.

Given the linguistic capabilities of the research team, we considered publications in English, Italian, French, German, Spanish and Portuguese.

A concern regarding children's participation in sports is that the tolerance limits of the physis may be exceeded by the mechanical stresses of sports such as football and hockey or by the repetitive physical loading required in sports such as baseball, gymnastics and distance running. 52 Unfortunately, what is known about the frequency of acute sport-related physeal injuries is derived primarily from case reports and case series data. In a previous systematic review on the frequency and characteristics of sports-related growth plate injuries affecting children and youth, we found that 38.3% of 2157 acute cases were sport related and among these 14.9% were associated with growth disturbance. 24 These injuries were incurred in a variety of sports, although football is the sport most often reported. 53

There are accumulating reports of stress-related physeal injuries affecting young athletes in a variety of sports, including baseball, basketball, climbing, cricket, distance running, American football, soccer, gymnastics, rugby, swimming, tennis. 24 Although most of these stress-related conditions resolved without growth complication during short-term follow-up, there are several reports of stress-related premature partial or complete distal radius physeal closure of young gymnasts. 25–29 These data indicate that sport training, if of sufficient duration and intensity, may precipitate pathological changes of the growth plate and, in extreme cases, produce growth disturbance. 24 , 32

Disturbed physeal growth as a result of injury can result in length discrepancy, angular deformity or altered joint mechanics and may cause significant long-term disability. 33 However, the incidence of long-term health outcome of physeal injuries in children's and youth sports is largely unknown.

Based on the previously selection criteria, 20 studies 54–73 were retained for analysis (Table  1 ). Injury to the physis can result in limb deformities and leg-length discrepancy, the latter being more common after motor vehicle accidents, rather than sports participation.

Evidence on acute physeal injury with subsequent adverse affects on growth.

OA in former athletes

Two studies investigated former top-level female gymnasts for residual symptoms (back pain) and radiographical changes. 74 , 75 Both studies reported no significant differences in back pain between gymnast and control groups; however, the prevalence of radiographical abnormalities was greater in gymnasts than controls in one study. 74

Lower limb weight-bearing joints such as the hip and the knee are at risk of developing OA after injury or in the presence of malalignment, especially in association with high impact sport. 76 Varus alignment was present in 65 knees (81%) in 81 former professional footballers (age 44–70 years), whereas radiographic OA in 45 (56%). 77 Others showed that prevalence of knee OA in soccer players and weight lifters was 26% (eight athletes) and 31% (nine athletes), respectively, whereas it was only 14% in runners (four athletes). 78 By stepwise logistic regression analysis, the increased risk is explained by knee injuries in soccer players and by high body mass in weight lifters. A survey in English former professional soccer players revealed that 47% retired because of an injury. The knee was most commonly involved (46%), followed by the ankle (21%). Of all respondents, 32% had OA in at least one lower limb joint and 80% reported joint pain. 79 Another study examined the incidence of knee and ankle arthritis in injured and uninjured elite football players. The mean time from injury was 25 years. 80 Arthritis was present in 63% of the injured knees and in 33% of the injured ankles, whereas the incidence of arthritis in uninjured players was 26% in the knee and 18% in the ankle. Obviously, it should be kept in mind that radiographic studies can only ascertain the presence of degenerative joint disease, which is just one of the features of OA. Clinical examination is always necessary to clarify the diagnosis, and formulate a management plan.

Ex-footballers also had high prevalence of hip OA (odds ratio: 10.2), 81 whereas in another study the incidence of hip arthritis was 5.6% among former soccer players (mean age: 55 years) compared with 2.8% in an age-matched control group. In 71 elite players it was higher (14%). Female ex-elite athletes (runners, tennis players) were compared with an age-matched population of women, and were found to have higher rates (2–3 fold increase) of radiographic OA (particularly the presence of osteophytes) of the hip and knee. 82 The risk was similar in ex-elite athletes and in a subgroup from the general population who reported long-term sports activity, suggesting that duration rather than frequency of training is important. An older study 83 is runners associated degenerative changes with genu varum and history of injury. A cohort of 27 Swiss long-distance runners was at increased risk of developing ankle arthritis compared with a control group. 84 Similarly elite tennis players were at risk of developing glenohumeral OA, 85 whereas handball players of developing premature hip OA, 86 and former elite volleyball players had marginally increased risk for ankle OA. 87 Interestingly a study that investigated the health-related quality of life (HRQL) in 284 former professional players in the UK found that medical treatment for football-related injuries was a common feature, as was arthritis, with the knee being most commonly affected. Respondents with arthritis reported poorer outcomes in all aspects of HRQL. 88

In summary, OA is more common among former athletes, compared with the general population. The lower limb joints are commonly affected, in association with high impact and injury.

Evidence from follow-up studies on spine of former athletes

Heavy physical work and activity lead to degenerative changes in the spine. Studies on different athletic disciplines and heavy workers have given variable degenerative changes and abnormalities in the lumbar spine. Even though sporting activity is regarded as an important predisposing factor in the development of spinal pathologies, 89–99 there are few studies on the late spinal sequelae of competitive youth sport. Any comparison in terms of back pain between top athletes and the general population is difficult. Experience of pain may be influenced by factors such as susceptibility, motivation and physical activity. Minor pain may be provoked by vigorous body movements that hamper athletic performance, thereby ascribing the pain a greater impact than in the general population. On the other hand, a well-motivated athlete may ignore even severe pain to maintain or improve his/her athletic performance. Also, varying rate/prevalence of osteophytosis has been reported in players associated with various disciplines of sports.

Efforts should be made to understand the aetiology of injuries to the intervertebral discs during athletic performance and thereby prevent them. 74

Based on the previously selection criteria, seven studies 74 , 89 , 98 , 100–103 were retained for analysis (Table  2 ). In summary, spine pathologies are associated more commonly with certain sports (e.g. wresting, heavy-weight lifting, gymnastics, tennis, soccer). Degenerative changes in the athlete's spine can occur, but they are not necessarily associated with clinically relevant symptoms of OA. Therefore, it cannot be determined whether it threatens the athlete's career, or whether it has a worse impact on athletes compared with the general population.

Evidence from follow-up studies on spine of former athletes.

Knee injury and OA in athletes

A population-based case-control study investigated the risk of knee OA with respect to sports activity and previous knee injuries of 825 athletes competing in different sports. They were matched with 825 controls. After confounding factors were adjusted, the sports-related increase risk of OA was explained by knee injuries. 104 Another study leads to the same conclusion: 23 American football high-school players were compared with 11 age-matched controls, 20 years after high-school competition. No significant increase in OA could be demonstrated clinically or radiographically. However, a significant increase in knee joint OA was found in the subgroup of football players who had sustained a knee injury. 105

A cohort of 286 former soccer players (71 elite, 215 non-elite) with a mean age of 55 years was compared with 572 age-matched controls, regarding the prevalence of radiographic features of knee arthritis. Arthritis in elite players, non-elite players and controls was 15%, 4.2% and 1.6%, respectively. In non-elite players, absence of history of knee injury was associated with arthritis prevalence similar to the controls. 106

An interesting study involved a cohort of 19 high-level athletes of the Olympic program of former East Germany. They sustained an ACL tear between 1963 and 1965. None were reconstructed, and all were able to return to sports within 14 weeks. Subsequent meniscectomies were necessary in 15/19 (79%) athletes at 10 years and 18/19 (95%) at 20 years, when in 18 of the 19 knees, arthroscopy was performed, 13 patients (68%) had a grade four chondral lesion. By year 2000 (more than 35 years after ACL rupture), 10/19 knees required a joint replacement. 107

The incidence of radiographic advanced degeneration (Kellgren–Lawrence grade 2 or higher) was 41% in a cohort of 122 Swedish male soccer players (from a total of 154) who consented to radiographic follow-up, 14 years after an ACL rupture. No difference was found between players treated with or without surgery for their ACL rupture. The prevalence of Kellgren–Lawrence grade 2 or higher knee OA was 4% in the uninjured knees. 108

Similar results were evident among Swedish female soccer players who were injured before the age of 20. The prevalence of radiographic OA was 51%, compared with 8% only in the uninjured knee, 12 years later. The presence of symptoms was documented in 63 of 84 (75%) athletes who answered the questionnaire, and was similar ( P = 0.2) in the two management groups (operative versus non-operative). The presence of symptoms did not necessarily correlate with radiographic OA ( P = 0.4). 109

In summary, knee injury is a recognized risk factor for OA. Injured athletes develop OA more commonly than the general population in the long term. Approximately half of the injured knees could have radiographic changes 10–15 years later. It is not clear whether radiographic changes correspond to presence of symptoms.

Ankle ligament injuries and OA in athletes

Ankle sprains are common sporting injuries generally believed to be benign and self-limiting. However, some studies report a significant proportion of patients with ankle sprains having persistent symptoms for months or even years. Nineteen patients with a mean age of 20 years (range: 13–28), who were referred to a sports medicine clinic after an ankle inversion injury, were followed for 29 months (average), and compared with matched controls. Only five (26%) injured patients had recovered fully, whereas 74% had symptoms 1.5–4 years after the injury. Assessments of quality of life using the short form-36 questionnaires revealed a difference in the general health subscale between the two groups, favouring the controls ( P < 0.05). 110

Similar conclusions were drawn from another study, regarding ankle injuries in a young (age range: 17–24 years) athletic population. 111 There were 104 ankle injuries (96 sprains, 7 fractures and 1 contusion), accounting for 23% of all injuries seen. Of the 96 sprains, 4 were predominately medial injuries, 76 lateral and 16 syndesmosis sprains. Although 95% had returned to sports at 6 weeks, 55% reported pain or loss of function. At 6 months, 40% had not fully recovered, reporting residual symptoms. Syndesmosis injuries were associated with prolonged recovery.

The association between ligamentous ankle injuries has been highlighted in a study that, retrospectively, reviewed data from 30 patients (mean age: 59 years, 33 ankles) with ankle osteoarthritis. 112 They found that 55% had a history of sports injuries (33% from soccer), and 85% had a lateral ankle ligament injury. The mean latency time between injury and OA was 34.3 years. The latency period for acute severe injuries was significantly lower (25.7 years), compared with chronic instability (38 years). Varus malalignment and persistent instability were present in 52% of those patients.

In summary, ankle ligamentous injuries in athletes can result in considerable morbidity, residual symptoms and arthritis 25–30 years later.

Shoulder injuries account for 7% of sports injuries and often limit the athlete in his or her ability to continue with their chosen sport. 113 Repetitive overhead throwing imparts high valgus and extension loads to the athlete's shoulder and elbow, often leading to either acute or chronic injury or progressive structural change and long-term problems in the overhead athlete. 45

Schmitt et al . 102 examined 21 elite javelin throwing athletes at an average of 19 years after the end of their high-performance phase (mean age at follow-up was 50 years). Five athletes (24%) complained about transient shoulder pain and three (16%) about elbow pain in their throwing arm affecting activities of daily living. All dominant elbows had advanced degeneration (osteophytes).

Elbow intra-articular lesions are recognized as consequences of repetitive stress and overuse. Shanmugam and Maffulli 9 reported follow-up (mean 3.6 years) of lesions of the articular surface of the elbow joint in a group of 12 gymnasts (six females and six males). This group showed a high frequency of osteochondritic lesions, intra-articular loose bodies and precocious signs of joint ageing. Residual mild pain in the elbow at full extension occurring after activity was present in 10 patients and all patients showed marked loss of elbow extension compared with their first visit.

Glenoid labral tears require repair, and shoulder instability is currently approached operatively more often. A review article found that conservative management of traumatic shoulder dislocations in adolescents was associated with high rates of recurrent instability (up to 100%). Therefore, surgical shoulder stabilization is recommended. The outcomes of surgical management are presented in the next section.

A distinct clinical entity is the ‘little league shoulder’, which is characterized by progressive upper arm pain with throwing and is more commonly seen in male baseball pitchers between ages 11 and 14 years. It is thought to be Salter-Harris type I stress fracture. Activity modification, education to improve throwing mechanics and core muscle training are recommended. It is not known how this condition behaves in the long term, regarding structural damage and development of degenerative changes.

Overhead athletes are plagued by shoulder and elbow injuries or overuse syndromes that can affect their performance and cause degeneration and pain in the long term.

The association between knee OA and meniscectomy has been well documented. In former athletes 114 – 116 it is associated with OA (Table  3 ). Meniscectomy in children and adolescents 117 – 123 has been associated with unfavourable results and radiographic arthritic changes in the long term (Table  4 ). However, radiographic criteria were not always clearly defined. To assess the long-term outcomes of meniscectomy, we also evaluated studies with a minimum follow-up of 10 years in the adult general population 106 , 124 – 129 (Table  5 ). Many of the ‘older’ studies providing the long-term outcomes represent results of open total meniscectomies. The overall message is that radiographic degeneration is common in meniscectomized knees, and patients are at risk of developing OA. The condition of the articular cartilage is a prognostic factor. However, clinical and radiographic findings do not always correlate. Resection should be limited to the torn part of the meniscus.

Menicectomy and osteoarthritis in athletes.

Menicectomy in children and adolescents.

Meniscectomy in adults / general popaltion—long-term outcomes.

Given the long-term problems associated with meniscectomies, preservation of the substance of the meniscus after injury is currently advocated. Based on this concept, arthroscopic meniscal repair techniques have been developed. 125 In the general population, encouraging clinical results with failure rates of 27–30% at 6–7 years follow-up have been reported. 130–132 One study 133 evaluated 45 meniscal repairs in 42 elite athletes followed for an average of 8.5 years. In 83% of them an ACL reconstruction was performed as well. Return to their sport was possible in 81% at an average of 10 months after surgery. They identified 11 failures (24%), seven of which were associated with a new injury. The medial meniscus re-ruptured more frequently compared with the lateral (36.4 versus 5.6%, respectively).

Mintzer et al . 134 retrospectively reviewed the outcome of meniscal repair in 26 young athletes involved in several sports at an average follow-up of 5 years (range: 2–13.5). No failures were reported, with 85% of patients performing high level of sports activities.

In general, the results of meniscal repairs in the general population, as well as in athletes, are encouraging.

ACL reconstruction and OA

Knee injuries can result in ligament ruptures and/or meniscal tears and are recognized as a risk factor of OA. A systematic review on studies published until 2006 135 reported on the prognosis of conservatively managed ACL injuries showed that there was an average reduction of 21% at the level of activities (Tegner score evaluation). ACL reconstruction is therefore a procedure frequently performed in athletic individuals, as they desire to maintain a high level of activities. However, does ACL reconstruction affect the incidence of knee degeneration and symptoms in the long term? We identified three studies 108 , 109 , 136 comparing operative versus non-operative management of ACL ruptures specifically in athletes, in regard to OA.

Two studies from Sweden investigating the prevalence of OA after ACL rupture in male 108 and female 109 soccer players were discussed earlier. Both found no difference in the incidence of radiographic arthritis between surgically and conservatively treated players, more than 10 years after their injury.

A comparative study 136 on high-level athletes with ACL injury showed no statistical difference between the patients treated conservatively or operatively (patella tendon graft) with respect to OA or meniscal lesions of the knee, as well as activity level, objective and subjective functional outcome. The patients who were treated operatively had a significantly better stability of the knee at examination.

Several studies present outcomes of ACL injuries in the general population. A recent systematic review included 31 studies (seven were prospective) reporting radiographic outcomes regarding OA, with more than 10 years follow-up after ACL injury. 137 The prevalence of OA in the injured knee varied from 1 to 100%, whereas in the contralateral knee it was 0–38%. Isolated ACL tears were associated with low OA incidence between 0 and 13%, whereas in the presence of additional meniscal injury, it was 21–48%. Meniscal injury and meniscectomy were the most frequently reported risk factors for OA. The authors scored the quality of the studies and found that studies scoring high reported low incidence of OA. Data extraction indicated that ACL reconstruction as a single factor did not prevent the development of knee OA. 137

There is lack of evidence to support a protective role of reconstructive surgery of the ACL against OA, both in athletes as well as in the general population.

ACL reconstruction in skeletally immature patients is a relatively new trend. 138 The concern is intra-operative epiphysis damage and growth disturbance, a complication which has been avoided in several studies. 139–143

The earliest published study 144 compared non-operative versus operative management of ACL ruptures in 42 skeletally immature athletes (age range: 4–17 years) followed for a mean of 5.3 years. They used a composite knee score based on clinical examination and a patient questionnaire and found superior results in the operatively treated patients. Age and growth plate maturity did not influence results. They recommended ACL reconstruction for active athletic children.

One of the early reports showed that there were no growth disturbances at a mean of 3.3 years after surgery in 9 children, however, with two re-ruptures. Those children could not return to athletic activities. 139

In a series of 57 ACL reconstructions, 15 patients had reached completion of growth when examined at follow-up, none had signs of growth disturbance, whereas clinical scoring was good or excellent in all patients. 142

Another study compared the outcomes of two management strategies in 56 children with ACL ruptures, namely ligament reconstruction in the presence of open physis, or delayed reconstruction after skeletal maturity. The ‘early’ reconstruction group had evidence of less medial meniscal tears (16 versus 41%), and no evidence of growth disturbances, at 27 months mean follow-up. 140

After 1.5–7.5 years follow-up of 19 ACL reconstructions in 20 athletic teenagers (age range: 11.8–15.6 years), all but one had returned to sports, none had tibiofemoral malalignment or a leg-length discrepancy of more than 1 cm, and the modified Lysholm score was 93 out of 95. 143

Finally, 55 children (ages 8 to 16 years, mean 13 years) were followed for a mean of 3.2 years (range: 1–7.5 years) after ACL reconstruction, with no evidence of growth disturbances. Clinical scores showed normal or almost normal values (higher than 90 out of 100 possible points) and 88% of the patients went back to normal or almost normal sports according to the Tegner score. 141

Overall, the clinical results are encouraging and iatrogenic epiphysis damage does not seem to be a problem, possibly because physeal sparing procedures were used. The study designs, however, are inadequate to answer the question of whether early or delayed ACL reconstruction results in the best possible outcome in skeletally immature patients.

Anterior impingement syndrome is a generally accepted diagnosis for a condition characterized by anterior ankle pain with limited and painful dorsiflexion. The cause can be either soft tissue or bony obstruction. Arthroscopic debridement is currently considered a routine procedure, and chondral lesions are now more frequently identified as causes of ankle pain. Few reports specifically in athletes are available 145–149 (Table  6 ). Short-term outcomes only are available. It is not known whether arthritis is a long-term consequence.

Ankle arthroscopy in athletes.

Only recently has the hip received attention as a recognized site of sports injuries, possibly as a result of the evolution of hip arthroscopy which allowed recognition of intra-articular pathology. 150 Acetabular labrum and chondral lesions can be addressed arthroscopically, and patients' satisfaction rates up to 75% have been reported. 44 One study evaluated the outcome of hip arthroscopy in 15 athletes (mean age: 32 years, range: 14–70) followed for 10 years. Nine were recreational athletes, four high school and two intercollegiate athletes. Diagnoses included cartilage lesion (8), labral tear (7), arthritis (5), avascular necrosis (1), loose body (1) and synovitis (1). The median improvement in the modified Harris hip score was 45 points (from 51 preoperatively to 96, on the 100-point scale), with 13 patients (87%) returning to their sport. All five athletes with arthritis eventually underwent total hip arthroplasty at an average of 6 years. 43 Long-term outcomes regarding progression of joint degeneration after traumatic chondral or labral damage are not available.

Operative management of shoulder injuries in athletes

Labral tears require repair, whereas shoulder instability is currently approached operatively more often. Conservative management of traumatic shoulder dislocations in adolescents is associated with high rates of recurrent instability (up to 100%), whereas recurrent dislocations were reported in up to 12%, at an average of 3 years after arthroscopic stabilization. Shoulder dislocations are particularly common in rugby, the characteristic mechanism of injury being tackling, whereas labral tears are common in the ‘overhead’ athlete'. Published results in athletes 151 – 162 (Table  7 ) show that operative stabilization of the shoulder is initially successful, but instability and pain can recur in the long term. Results of arthroscopic techniques in the management of intra-articular pathologies are promising, but long-term outcomes are unknown (Table  7 ).

RCT, randomized controlled trial; VAS, visual analogue scale.

Operative management of elbow injuries in athletes

Elbow ulnar collateral ligament (UCL) insufficiency is one of the frequently recognized injuries in the overhead athlete, as a result of excessive valgus stress. It constitutes a potentially career threatening injury and requires surgical repair. 163 The use of a muscle-splitting approach, avoiding handling of the ulnar nerve, and the use of the docking technique for stabilization is recommended 164 , 165 (Table  8 ). Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for highly motivated athletes. The results of arthroscopic debridement 150 , 166 (Table  7 ) need to be evaluated in the long term.

Operative management of elbow injuries in athletes.

UCL, ulnar collateral ligament.

Operative management of wrist injuries in athletes

A review of the literature shows that 3–9% of all athletic injuries occur in the hand or wrist, and are more common in adolescent athletes than adults. 46 In this article, we focused on TFCC injuries and acute scaphoid fractures in athletes.

TFCC injuries are an increasingly recognized cause of ulnar-sided wrist pain, and can be particularly disabling in the competitive athlete. Advances in wrist arthroscopy made endoscopic debridement and repair of the TFCC possible. McAdams et al . 47 treated arthroscopically TFCC tears in 16 competitive athletes (mean age: 23.4 years). Repair of unstable tears was performed in 11 (69%) and debridement only in 5 (31%). Return to play averaged 3.3 months (range: 3–7 months). The mean duration of follow-up was 2.8 years (range: 2–4.2 years). Clinical scores (mini-DASH and mini-DASH sports module) improved significantly. No long-term outcomes are available.

Operative management of scaphoid fractures in athletes, even if undisplaced, is recommended if early return to sports is desired. One study followed 12 athletes treated operatively for a scaphoid fracture. They were able to return to sports at 6 weeks. At an average follow-up of 2.9 years, 9 of 12 athletes had range of motion equal to the uninjured side, and grip strength was equal to the unaffected side in 10 of 12 athletes. 49

Participation in sports offers potential benefits for individuals of all ages, such as combating obesity and enhancing cardiovascular fitness. 1 On the other hand, negative consequences of musculoskeletal injuries sustained during sports may compromise function in later life, limiting the ability to experience pain-free mobility and engage in fitness-enhancing activity. 167 Increasingly, successful management of sports-related injuries has allowed more athletes to return to participation. The knee is the joint most commonly associated with sports injuries, and therefore is most at risk of developing degenerative changes. It is not clear whether radiographic OA always correlates with symptoms and reduced quality of life. Furthermore, even effective management of meniscal or ACL injury does not reduce the risk of developing subsequent OA. 137 , 168 OA in an injured joint is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcomes involves not only the exact type of injury (e.g. ACL rupture with or without meniscal damage), 137 but also additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. 169

In many of the long-term studies (the majority being retrospective case series), several methodological flaws have to be highlighted. A recent systematic review on OA after ACL injuries 137 suggested that some studies may overestimate the prevalence of long-term OA. The authors in several studies mention that a proportion of the index group of injured athletes were available for follow-up or consented for radiographic examination. One can argue that these patients were the ones with symptoms, therefore the prevalence of OA (after ACL rupture for example) may appear higher than it really is. Presentation of outcomes was not always based on robust criteria. Different clinical scores and radiographic classifications have been used, and therefore results between studies are not directly comparable. In the majority of the studies, it was not clarified whether radiographic appearance correlated with symptoms, and how important these were for the quality of life of the patients. Disabling arthritis requiring intervention may actually be delayed for more than 20–30 years. 107 , 112 Furthermore, long-term studies present outcomes of older techniques, not used any more in clinical practice (e.g. primary ACL repair or total meniscectomy). Evolution in surgical or rehabilitation techniques might have improved outcomes of certain injuries. Therefore, currently known ‘long-term outcomes’ may only reflect the results of techniques used in the past and not what we should expect in the future. Increasing awareness of athletes and trainers, new diagnostic and musculoskeletal imaging modalities, improved surgical and rehabilitation methods, but also analysis of injury patterns in different sports and development of injury prevention strategies might be beneficial to minimize the effects of sports injuries in the years to come.

What is the true incidence of arthritis in the long term? Will it be a disabling condition for the former athlete, in the coming decades? Currently, joint preserving procedures (e.g. microfractures, 145 mosaicplaty, 170 autologous chondrocyte implantation, 171 , 172 realignment osteotomies 173 and implant arthroplasties 174 ) have evolved and allow middle aged or older patients to live without pain and maintain an active life style. Meniscal transplantation shows encouraging results. 175 Should therefore an increased risk for developing musculoskeletal problems prevent children and adults from being active in sports? 176 Do the benefits of participating in sports outweigh the risks?

A survey in Sweden showed that 80% of former track and field athletes with an age range of 50–80 years felt they were in good health, compared with 61% of the referents, despite higher prevalence of hip arthritis in former athletes. Low back disorders were similar in the two groups, shoulder and neck problems were lower in former athletes, and knee arthritis was similar in the two groups. 177

No definite answer can be given to the previously addressed questions, based on available evidence. Future research should involve questionnaires assessing the HRQL in former athletes, to be compared with the general population. 27 , 178–181

Physical injury is an inherent risk in sports participation and, to a certain extent, must be considered an inevitable cost of athletic training and competition. Injury may lead to incomplete recovery and residual symptoms, drop out from sports, and can cause joint degeneration in the long term. Few well-conducted studies are available on the long-term follow-up of former athletes, and, in general, we lack studies reporting on the HRQL to be compared with the general population. Advances in arthroscopic techniques allow operative management of most intra-articular post-traumatic pathologies in the lower and upper limb joints, but long-term outcomes are not available yet. It is important to balance the negative effects of sports injuries with the many social, psychological and health benefits that a serious commitment to sport brings. 9

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Sports injuries in basketball players: a systematic review.

1. Introduction

2. materials and methods, 2.1. search strategy, 2.2. inclusion and exclusion criteria, characteristics of the studies, 4. discussion, 4.1. injuries relative to gender, 4.2. injuries relative to location, 4.3. basketball injuries relative to the position on the court, 4.4. basketball injuries relative to other sports, 5. conclusions, author contributions, conflicts of interest.

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Aksović, N.; Bubanj, S.; Bjelica, B.; Kocić, M.; Lilić, L.; Zelenović, M.; Stanković, D.; Milanović, F.; Pajović, L.; Čaprić, I.; et al. Sports Injuries in Basketball Players: A Systematic Review. Life 2024 , 14 , 898. https://doi.org/10.3390/life14070898

Aksović N, Bubanj S, Bjelica B, Kocić M, Lilić L, Zelenović M, Stanković D, Milanović F, Pajović L, Čaprić I, et al. Sports Injuries in Basketball Players: A Systematic Review. Life . 2024; 14(7):898. https://doi.org/10.3390/life14070898

Aksović, Nikola, Saša Bubanj, Bojan Bjelica, Miodrag Kocić, Ljubiša Lilić, Milan Zelenović, Dušan Stanković, Filip Milanović, Lazar Pajović, Ilma Čaprić, and et al. 2024. "Sports Injuries in Basketball Players: A Systematic Review" Life 14, no. 7: 898. https://doi.org/10.3390/life14070898

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A Qualitative Study of College Athletes’ Experiences of the COVID-19 Pandemic , Carra Johnson

Meeting the Mental Health Needs of Student-Athletes: A Descriptive Study of Practitioners and their Perspectives , William C. Way III

Theses/Dissertations from 2020 2020

A Phenomenological Photovoice Exploration of Female Exercisers’ Experiences of their Body in Fitness Center Environments , Katherine E. Fairhurst

Exploring the Relationship Between Hardiness and Performance in Collegiate Baseball Players , Kevin R. Lou

Using the social ecological model to build a path analysis model of physical activity in a sample of active US college students , Jonathan J. Stewart

"Yo, I Like Your Walk-Up Song": Music Integration in Professional Baseball Gamedays , Seth Swary

Theses/Dissertations from 2019 2019

Stigma, Attitudes, and Intentions to Seek Mental Health Services in College Student-Athletes , Robert C. Hilliard M.S.

Supporting The Injured Athlete: Coaches’ Perspectives On Providing Social Support , Stefanee Opal Maurice

Being Mindful of Perfectionism and Performance Among Athletes in a Judged Sport , Erika D. Van Dyke

Theses/Dissertations from 2018 2018

Competitive Aggressiveness, Anger, and the Experience of Provocation in Collegiate Athletes , Michael E. Berrebi

Functional Movement Screen Composite Scores for Collegiate Field Club Sport Athletes at One University , Daniel Camillone

Exploring the Use of Sport as a Platform for Health Promotion with Youth in Africa: A Scoping Review. , Adam H. Hansell

Use of Four Predictive Screening Variables for Determination of Sacroiliac Joint Dysfunction in Adolescent Soccer Athletes , Brian Hanson

Coaching life skills through sport: An application of the teaching personal and social responsibility model to youth sport in eSwatini , Zenzi Huysmans

Psychosocial Development of Junior Hockey Players , Alexander John Sturges

Theses/Dissertations from 2017 2017

Players' Responses to and Primary Caregivers' Perceptions of Authoritarian and Authoritative Coaching in the Inner-City , Renee Brown

Examining the Impact of a Short-Term Psychological Skills Training Program on Dancers' Coping Skills, Pain Appraisals, and Injuries , Leigh A. Bryant

Changes in Athletes' Anxiety, Anger, and Impulsiveness following Concussion , Megan Byrd

Development of Ethics Education Guidelines for Undergraduate Athletic Training Education Programs , Kaitlynn Cullen

Using a Multi-Omic Approach to Investigate a Diet Intervention in Young Adults at Risk of Disease , Oluremi Ariel Famodu

Approaches to Supervision in Sport Psychology and their Influences on Initial Supervisees' Professional Development , Janaina Lima Fogaca

High School Coaches' Experiences with Openly Lesbian, Gay, and Bisexual Athletes , Meghan K. Halbrook

#Physical Activity: Influencing Parent Behavior Change Through Social Media , Adam Keath

The Effects of an Exercise and Kinesiotape Intervention on Forward HeadRounded Shoulder Posture and Scapular Dyskinesis , Lucas Klawiter

Student-Athletes' Experiences with Racial Microaggressions in Sport: A Foucauldian Discourse Analysis , Sae-Mi Lee

The Effects of a Six Week Lumbopelvic Control and Balance Training Program in High School Basketball Players , Margaret Long

Thrombospondin-1 and Cd47 Mediate Peripheral Microvascular Dysfunction Following Pulmonary Exposure to Multi-Walled Carbon Nanotubes , W. Kyle Mandler

The Investigation of Motor Primitives During Human Reaching Movements and the Quantification of Post-Stroke Motor Impairment , Erienne Virginia Olesh

Theses/Dissertations from 2016 2016

The Effect of Lower Extremity Asymmetries on Low Back and Lower Extremity Pain with Pregnancy , Erica Casto

Do Physical Activity, Sedentary Behaviors, and Nutrition Affect Healthy Weight in Middle School Students in an Appalachian Community? Children's Health Opportunities Involving Coordinated Efforts in Schools (CHOICES) Project , Kibum Cho

How Far is Too Far? Understanding Identity and Overconformity in Collegiate Wrestlers , Ashley M. Coker-Cranney

An Examination of Collegiate Athletes', Undergraduate Sport Science Majors', and Athlete Majors' Intent to Pursue Collegiate Coaching as a Career , Lauren Deckelbaum

A preliminary exploration of the application of self-compassion within the context of sport injury , Zenzi Huysmans

Psychosocial Predictors of Resilience in a Military Sample , Anna-Marie C. Jaeschke

Evaluating the Efficacy of Various Modalities to Improve Arterial Stiffness , Corey Moore

The Influence Over Time of Abdominal Strength Changes on Gluteus Maximus Strength , Taylor M. Opperhauser

Use of a Functional Movement Screening Tool to Determine Injury Risk in Collegiate Acrobatics and Tumbling Athletes , Sara E. Spencer

Adherence to Sport Rehabilitation , Kjersti A. Traaen

Theses/Dissertations from 2015 2015

Surgery and Rehabilitation Treatment Options for Ulnar Collateral Ligament Injuries of the Elbow for Baseball Athletes: A Systematic Review , Amanda M. Damm

What elite men's collegiate tennis coaches look for in recruits and how they assess preferred player characteristics , Brandyn H. Fisher

The Influences of Participation in an Elite Paralympic Military Program on the Self-Identity of Active Duty Service Members with Acquired Disabilities , Lindsay M. Hammond

The Influence of Physical Activity on International Students' Cross-Cultural Adjustment: A Qualitative Longitudinal Study , Shuang Li

Becoming a Mindful Sport Psychology Consultant: Defining, Developing, and Integrating Mindfulness into Practice , Michelle M. McAlarnen

Theses/Dissertations from 2014 2014

Certified Athletic Trainers' Abilities to Identify and Refer Athletes with Psychological Symptoms , Marc L. Cormier

Usage of Evidence Based Medicine Resources in Clinically Practicing Athletic Trainers , Kenneth G. Faldetta

Division I College Student-Athlete Career Situation and Attitudes toward Career Counseling , Adrian J. Ferrera

An Evaluation of State Employees' Preferences for Worksite-based Physical Activity, Nutrition, and Stress Management Programs , Peter Kadushin

The use of joint mobilization on mechanical instability deficits for a lateral ankle sprain: A Systematic Review , Kathleen M. Kerecman

The Effect of a Six Week Functional Training Program on Performance Outcomes in Softball , Zachary M. Mohondro

Sport Psychology "App"lication: NCAA Coaches' Preferences for a Mental Training Mobile App , Raymond F. Prior

"It's not just your dad and it's not just your coach..." The dual-role relationship in female tennis players , Olivier N. Schmid

Stoking the Flames of Wellness: An Exploration of Factors that Influence West Virginia Firefighters' Health Behaviors , Chelsea B. Wooding

Theses/Dissertations from 2013 2013

The Influence of Gender on the Peer Leadership-Cohesion Relationship , Michael E. Berrebi

Stressors and Coping Behaviors of Female Peer Leaders Participating in College Club Sports , Leigh A. Bryant

An Exploration of Master's Degree Field Study and Teacher and Student Behavior in P.E , William J. Davis

An Exploratory Investigation of Baseball Coaches' Attitudes and Experiences With Sport Psychology , Jesse D. Michel

Theses/Dissertations from 2012 2012

Using Concept Mapping to Identify Action Steps for Physical Activity Promotion in Cancer Treatment , Sean J. Fitzpatrick

Theses/Dissertations from 2011 2011

At-Risk Student-Athletes and Academic Achievement: Experiences of Successful and Unsuccessful First Year Collegiate Football Players , Samantha J. Monda

A Survey of Bariatric Surgical Patients' Experiences with Behavioral and Psychological Services , Jessica C. Peacock

A tailored wellness intervention for college students using internet-based technology , Alessandro Quartiroli

Theses/Dissertations from 2010 2010

The effects of a walking intervention on self-efficacy for coping with cancer and quality of life among cancer patients during treatment , Sean J. Fitzpatrick

Validity and reliability of accelerometers for examining vertical jump performance , Ryan M. Ruben

Theses/Dissertations from 2009 2009

The evaluation of a nutrition education and fitness program with a contest component among college students using the RE-AIM framework , Michelle L. Bartlett

An individualized multimodal mental skills intervention for college athletes undergoing injury rehabilitation , Jamie L. Shapiro

The role of emotional intelligence on coach-athlete relationships and motivational climate , Eric E. Steege

Theses/Dissertations from 2008 2008

Effectiveness of an educational intervention on the attitudes toward sport psychology of athletic training students , Damien Clement

Impact of a physical activity intervention for weight loss: A qualitative analysis of participant perceptions and expectations , Jessica Anne Creasy

Leadership and organizational culture transformation in professional sport , Joe Frontiera

Motivation in sport: Bridging historical and contemporary theory through a qualitative approach , Daniel J. Leidl

Theses/Dissertations from 2007 2007

Impact of a tailored intervention on coaches' attitudes and use of sport psychology services , Rebecca Zakrajsek

Theses/Dissertations from 2006 2006

Does physical disability truly create impairment in adjustment to college life? , Jennifer R. Hurst

The transtheoretical model and psychological skills training: Application and implications with elite female athletes , Linda Ann Keeler

Theses/Dissertations from 2005 2005

The role of apoptosis in muscle remodeling , Parco Ming-fai Siu

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Mitigating the Antecedents of Sports-related Injury through Yoga

Gregory d arbo.

School of Graduate Psychology, Pacific University, Hillsboro, OR, USA

Christiane Brems

1 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA

Tamara E Tasker

Injury risk among athletes is an epidemic. The psychological and physical loads imposed on athletes through psychosocial stressors and training regimens significantly increase athletes' injury risk.

This feasibility study assessed whether a 10-week yoga intervention could be implemented successfully and mitigated antecedents of sports injury.

Using a prospective, nonexperimental design, 31 male soccer players attending a college in the Pacific Northwest enrolled in the yoga intervention. The Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) was completed at three time-points before and after the yoga intervention. The RESTQ-Sport scales, identified as strongest predictors for injury, were hypothesized to be mitigated through yoga.

Two stress-related scales were significant in the hypothesized direction: injury and fatigue. The general recovery scale, General Well-Being, was significant at one time-point, but in the opposite direction as hypothesized.

Conclusions:

Positive findings are discussed and explanations for unexpected changes are explored, along with study limitations. Results suggest that yoga can be successfully integrated into the athletic program of soccer players and provisionally support the potential of a yoga intervention to mitigate two significant antecedents of injury, namely, perception of propensity to sustain injury and generalized fatigue.

Introduction

Athletes injure themselves, suffer illness, or endure some form of trauma at a significantly higher rate than nonathletes.[ 1 ] Prevention practices must be developed to mitigate athletes' injury risk. This study aimed to assess the feasibility and preliminary impact of neurophysiological and neurocognitive yoga-based practices[ 2 ] on psychophysical predictors of injury among male college soccer players.

Significant strain is placed on student athletes, ranging from the dangerous contact nature and intense training loads testing limits of physicality to frequent travel and unfamiliar sleeping conditions, all while balancing social activities and academic pursuits. Over a 16-year period (years 1988/1989 through 2003/2004), an 80% increase has been reported in female sports-related injuries and a 20% increase in male sports-related injuries.[ 1 ] Between 2004/2005 and 2008/2009 seasons, 55,000 male NCAA soccer players sustained injuries.[ 3 ] As the number of injuries continues to rise, health professionals are called upon to focus on prevention strategies that mitigate the incidence of sports-related injuries.

To determine possible causes of injury, researchers developed a multicomponent theoretical stress-injury model,[ 4 ] ultimately to inform prevention efforts. Identified were the following antecedents of injury: dysregulating life events, lack of effective coping strategies, sensitivity to stress, and the tendency to appraise situations as stressful. Antecedents in this context mean psychosocial-stress conditions preceding and increasing an athletes' likelihood of sustaining a sports-related injury. These researchers theorized that psychological stress is directly correlated with muscle tension, distractibility, and perceptual narrowing, all of which function to increase injury risk.

In 2001, a second set of researchers developed the Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) to identify biopsychosociocultural antecedents of sports-related injury through assessing athletes' perceived stress and recovery balance.[ 5 ] The theoretical basis for this self-report questionnaire was that biopsychosociocultural stressors can induce a maladaptive psychophysical state that increases athletes' propensity for sports-related injury. Imbedded within the RESTQ-Sport are 19 scales, assessing general and sports-related stress and recovery. Although research has been mixed about which of the 19 RESTQ-Sport scales are the most useful predictors of injury, some agreement has emerged for the following seven scales: Injury, Fatigue, General Well-Being, Physical Recovery, Self-Efficacy, Self-Regulation, Physical Recovery, and Being in Shape.[ 5 , 6 , 7 , 8 , 9 ] These seven scales thus became of primary interest in this feasibility study.

With antecedents of injury defined and a measure identified to assess injury antecedents, the question of how to mitigate these antecedents still needed to be addressed. Considering the multifaceted and challenging nature inherent in being a student athlete, yoga presents itself as a viable intervention. Although developed in 5 th century BCE India, yoga has become the object of much modern research[ 10 ] that has documented its utility in a variety of contexts and with diverse populations. Yoga, as embodied movement that integrates a holistic range of practices (such as ethics, discipline, movement, breath, and meditation), enables practitioners to gain skillful control over viscerosomatic information on and off the mat, the outcome being increased well-being as measured via flexibility and adaptability in functioning.[ 11 , 12 , 13 ]

A holistic yoga practice begins with and is sustained by ethics (moral observances Sanskrit: Yamas and self-discipline Sanskrit: Niyamas ). Through embodiment of the ethical precepts, yoga-athletes' decision-making may engender health-promoting behaviors.[ 14 ] For example, embodied ethics of nonviolence (Sanskrit: Ahimsa ), moderation (Sanskrit: Brahmacharya ), and self-study (Sanskrit: Svadhyaya ) may influence how a yoga-athlete interacts with a stressor, inspiring top-down (i.e., higher-level brain networks) modulation, shifting from emotional reactivity toward skillful executive control.[ 15 ] As yoga practices influence executive control and attentional flexibility,[ 16 ] yoga-athletes may become better adept than non-yoga-athletes at inhibiting negative appraisal, rumination, and emotional reactivity in response to stressors, indirectly downregulating autonomic arousal through limbic inhibitory projections.[ 14 , 17 ] Without adaptively interacting with stressors, psychophysiological strain accumulates, inducing allostatic overload, during which “serious pathophysiology can occur.”[ 18 ]

The physical practice of yoga (Sanskrit: Asana ) further reduces allostatic load through multiple mechanisms. Biomechanical changes in body position (e.g., heart-openers) influence pulmonary ventilation, gas exchange, and cardiovascular function,[ 14 ] positively affect performance measures of flexibility and balance,[ 19 ] attenuate peak muscle soreness,[ 20 ] and more.[ 21 ] Though it remains unclear whether these positive physical changes directly influence athletes' susceptibility to sports-related injury, researchers have correlated high concentrations of blood lactate with physiological strain[ 22 ] and have identified multifaceted physical interventions that include a balance component to reduce ankle and knee injuries.[ 23 ]

Allostatic load may further be mitigated through breathing practices (Sanskrit: Pranayama ) of various forms, such as three-part inhale/exhale, alternate nostril breathing, and forceful expulsion of breath. Supported by polyvagal theory,[ 24 , 25 , 26 ] breath control equips yoga-athletes with direct influence over autonomic arousal through vagal nerve stimulation. With the capacity to volitionally induce an adaptive parasympathetic response through vagal nerve stimulation, yoga-athletes may inhibit a maladaptive, sympathetic-driven response to stress (including muscle tension and pain, inflammation, and vaso- and pulmonary constriction[ 14 ]).

The meditative limbs represent the final limbs of yoga and further reduce allostatic load. Sensory withdrawal (Sanskrit: Pratyahara ), concentration (Sanskrit: Dharana ), meditation (Sanskrit: Dhyana ), and integration (Sanskrit: Samadhi ) represent the deepest layers of yoga, are woven throughout an integrated yoga practice, and may guide yoga-athletes toward interoceptive states of being. Interoception, defined as sensing the body's physiological condition,[ 27 , 28 ] may enable yoga-athletes to detect physiological disturbances[ 29 ] and mitigate allostatic load by replacing maladaptive reactions to stress with adaptive responses.[ 30 ]

This feasibility trial explored whether a multifaceted yoga intervention can be successfully integrated into the athletic experience of soccer players and whether such an intervention can mitigate players' perceptions of psychophysical stress, as monitored by RESTQ-Sport scores. We hypothesized that engagement in a multifaceted, empirically based yoga intervention significantly reduces scores on RESTQ scales Fatigue and Injury, from pre-test to post-test and sustained at follow-up, and significantly increases scale scores on Physical Recovery, Being in Shape, General Well-Being, Self-Efficacy, and Self-Regulation, from pre-test to post-test and sustained at follow-up.

This 10-week feasibility study was approved by the host university's IRB committee. Using a prospective, non-experimental design, pre-, posttest and follow-up measures were used to assess the impact of yoga on student athletes' perception of sports-related recovery and stress. Recruitment began with a flyer advertising free therapeutic yoga for student athletes and was posted at the university's undergraduate campus. The head coach of the Men's Division III Soccer Team contacted the PI to conduct the offered yoga intervention with the entire team ( n = 31). Players were screened for eligibility based on the following criteria: at least 18 years of age; a student athlete, free of acute or chronic physical injury that may hinder or be exacerbated by participation; and willingness to consent to participation, including signing an informed consent form. Athletes who experience preexisting acute or chronic injuries needed approval from team's medical staff prior to participation, communicated to PI by the team's head coach.

Participants

Of 31 soccer players enrolled (M age = 19.58, standard deviation [SD] = 1.12), one player was cut from the team roster and three players were unable to complete the protocol due to having sustained an injury during soccer practice. All participants self-identified as male. The sample was predominantly Caucasian (20, 64.5%), with 1 (3.2%) Native Hawaiian, 2 (6.5%) Latino/Hispanic, 4 (12.9%) Asian American, and 4 (12.9%) multiracial individuals. Current and historical medical problems were endorsed by 14 players (52%; some had multiple problems), including two with concussions (7%), three with back pain (11%), seven with ankle pain (26%), and four with knee pain (15%).

The intervention was an adaption of an original yoga protocol developed by Brems.[ 13 ] The PI was trained on the original yoga protocol, as were the two registered yoga teachers who cofacilitated classes. Protocol adaptation was accomplished by Arbo and Brems and included the following:

• Class material was abbreviated, as maximum session length permitted by the head coach was 45 min
• Presentation of didactics was tailored to sample characteristics. For example, complex philosophical themes were translated into understandable and practical concepts, often supplemented with anecdotes from lead teacher
• Language was adapted to be culturally appropriate for student athletes by eliminating use of imagery and Sanskrit, and using plain language (e.g., from “bring balance and concentration to the pose as a means to find confidence and courage” to “recognize the subtle muscle engagement holding you here”)
• With the heightened risk for injury, adapted protocol postures were low-intensity, fewer in number, and proprioceptive and interoceptive cues were emphasized. These adaptations enabled a slow-paced, deeply introspective class, to ultimately avoid aggravating the preexisting degree of physical strain present in participants
• Classes were shortened to 45 min each.

Classes were composed of 22–27 participants, located in a padded wrestling room, and held immediately after soccer practice on Wednesday mornings (8:00–8:45). Table 1 details specific changes to adapt the protocol for use in the present study. Figure 1 provides the adapted protocol for class 3 as a sample, with Arbo as subject of photos.

Primary protocol features and adaptations for use with athletes

Sample protocol: Session 3

Following approval by the university's Institutional Review Board and in accordance with the Helsinki Declaration, all participants completed paper format pre- and post-test measures; pre-test immediately preceding class 1, post-test immediately following class 10. Follow-up measures were administered via Qualtrix 10 weeks following post-test.

Instrumentation

The Recovery-Stress Questionnaire-Sport (RESTQ-Sport) is a 52-item, self-report, Likert-scale questionnaire (0 = never and 6 = always ), consisting of general and sport-specific stress and recovery scales.[ 5 ] The questionnaire has four dimensions: general stress, general recovery, sports-related stress, and sports-related recovery. All scales tap into the subjective nature of consequences from general and sports-related demands within a 3-day period. General stress items ask questions regarding, for example, feeling overtired (FATIGUE). General recovery items ask questions such as satisfaction with sleep (sleep quality). Sports-related stress items ask questions such as whether muscles felt stiff or tense during performance (injury). Sports-related recovery items ask questions such as perceived ability to achieve peak performance (self-efficacy).

High scores on the 26 stress scales indicate high levels of subjective distress induced by general conditions of life and sports-related conditions. High scores on 26 recovery scales, inversely, indicate a high sense of efficacy in rebounding resources after conditions of stress. Scores for each scale are obtained by taking a mean of all item ratings; mean scores can be compared across time points to observe change. The REST-Q scales have good internal consistency (0.67–0.89) and high test–retest reliability (>0.79).

For the purposes of this study, seven scales were used to test hypotheses: Fatigue, Injury, Physical Recovery, Being in Shape, General Well-Being, Self-Efficacy, and Self-Regulation. The other 12 scales were not considered because research has indicated these 12 scales to not be equally strong predictors of injury.

At posttest only, athletes were asked one open-ended question: “How has your engagement in this opportunity influenced your performance in sports, academics, social life, personal life, etc.?” This question was developed to assess for general impressions after having completed the yoga series. Responses were coded to detect themes that may help underscore or augment quantitative findings.

Statistical analyses

Reference values were defined by the means and SDs of seven RESTQ-Sport stress and recovery scales. As mentioned above, seven of the 19 RESTQ-Sport scales were evaluated (Fatigue, Injury, Physical Recovery, Being in Shape, General Well-Being, Self-Efficacy, and Self-Regulation). These scales are identified as the strongest predictors of injury among soccer players and athletes in general.[ 5 , 6 , 7 , 8 , 9 ] Paired samples t -tests were used to analyze RESTQ-Sport scales to account for attrition from pre-test ( n = 31) to post-test ( n = 27) to follow-up ( n = 19). For each RESTQ-Sport scale, data at pre-test were contrasted against data at post-test and follow-up; data at post-test were contrasted with data at follow-up. Bonferroni adjustment was applied to P value level of significance, resulting in P < 0.007 being considered statistically significant. Effect sizes were calculated using Cohen's et al .[ 31 ] and were classified small (0.20–0.49), medium (0.50–0.79), or large (0.8 or greater).

Recovery-Stress Questionnaire-Sport Stress

Paired samples t - tests were calculated for two scales, comparing means across three time points (pre-, post-test, and follow-up); the results are shown in Table 2 . Positive effect sizes for Injury and Fatigue indicate positive change [i.e., a decrease in mean score from one time point to the next identifies a participant experiencing greater recovery or less stress; Table 2 ]. REST-Q Sport scale, injury, was statistically significant at pre- to post-test ( P = 0.000), sustained at follow-up ( P = 0.000), both with large effect sizes ( d = 1.34; d = 1.71), respectively. REST-Q Sport scale, Fatigue, was also statistically significant at pre- to post-test ( P =0.000), sustained at follow-up ( P < 0.001), and with large effect sizes ( d = 0.85; d = 1.20), respectively.

Recovery-stress questionnaire - sport stress

* P <0.007. Higher scores indicate greater stress. SD: Standard deviation

Recovery-Stress Questionnaire-Sport Recovery

Paired samples t - tests were calculated for five scales, comparing means across three time points (pre-, post-test, and follow-up); the results are shown in Table 3 . Negative effect sizes for self-regulation, self-efficacy, general well-being, being in shape, and physical recovery indicate positive changes [i.e., an increase in mean score from one time point to the next indicates that a participant is experiencing greater recovery or less stress; Table 3 ]. Self-regulation, self-efficacy, physical recovery, and being in shape were not significant; however, Being in Shape did have a P = 0.029 and a small effect size ( d = −0.47). General Well-Being was significant at post-test to follow-up ( P = 0.002), with a medium effect size ( d = 0.53).

Recovery-stress questionnaire - sport recovery

* P <0.007. Higher scores indicate greater adaptability. SD: Standard deviation

This feasibility trial, in which we piloted an adapted version of an evidence-based yoga protocol[ 13 ] with student athletes, had mixed findings. Results suggest the intervention was feasible, as attrition was low and compliance was high. Collaboration with the head coach proved integral, throughout intervention proceedings, for recruitment and retention, which suggests a yoga intervention is best delivered with consideration of the specific circumstances faced by specific soccer or athletic teams. Results regarding RESTQ-Sport scales Injury and Fatigue suggest this yoga intervention was successful in mitigating student athlete's perception of psychophysical stress including fatigue, generalized muscle soreness, and injury proneness. Results pertaining to RESTQ-sport scales self-regulation, self-efficacy, physical recovery, and being in shape scales were not significant. Although Being in Shape scale comparisons did not reach statistical significance, athletes' perception of their physical strength, conditioning, recovery, and energy levels did improve ( P = 0.029; d = −0.47). The general Well-Being scale results suggest athletes perceived their mood and spirits to be worse at follow up (10 weeks post project completion).

A proposed mechanism for change observed among Injury and Fatigue scales is yoga's influence upon perception. REST-Q Sport is inherently subjective, which implies assessment is of perceived stressor impact. An important finding indicated perception as a more salient ingredient in mitigating the stress-injury relationship than in mitigating physical-based stressors.[ 32 ] Our assertion is that participants may have learned interoceptive skills to facilitate activation of high-and low-level brain networks suggested to mediate and moderate stress responses.[ 14 ] Specifically, top-down and bottom-up processing mitigates maladaptive responses to stress (top-down: emotional reactivity, negative appraisal, and rumination; bottom-up: moderation of inflammatory responses, muscle tension, and pain). It is the conjoint cultivation of effective and interactive top-down and bottom-up self-regulation that is a major contributor to yoga's effectiveness[ 11 ] and is proactively applied via the yoga protocol used in this study. Anecdotal data collected through post-test-only, open-ended questions elicited meaningful responses underscoring effects of the piloted intervention on athlete perception of perceived stressor impact. Sample statements included feeling “more relaxed,” and noticing yoga “helped during stress times.” and “.showed me ways to calm down through breathing.” Anecdotal data and injury/fatigue scale changes suggest players' perceived ability to navigate psychophysical stress was influenced by the piloted intervention.

The second proposed mechanism is improvement in range of motion and balance. Although not measured in the present study, prior research[ 19 ] and anecdotal data from participants (e.g., “[I felt] more loose. more flexible… less injury prone”) suggest the included Asana practice may have contributed to change observed in Fatigue and Injury scales.

The RESTQ-Sport recovery scale General Well-Being trended in a statistically significant direction of change counter to what was hypothesized. Although this finding may be counterintuitive and was not predicted, it is not unprecedented in the literature. For a yogi who is new or inexperienced, enhanced recognition of distress can make distress seem more frequent. Higher self-report of perceived stress can result from this enhanced awareness in the short term.[ 33 , 34 ] In addition to stress resulting from increased interoception, uncontrolled environmental factors (e.g., University examinations) may have influenced participant's perceived and self-reported distress.[ 35 ]

Limitations

Feasibility dictated design decisions that may have led to less than optimal intervention quality. First, sampling was neither random nor representative of general athlete populations. Diversity in demographics and type of sport limit generalizations of current research. For example, gender representation was all male and racial composition was largely Caucasian (64.52%), both of which are nonrepresentative of NCAA soccer programs.[ 36 ] Further, no control group was included as recruitment for this study proved extremely difficult. The Head coach and PI mutually agreed all players would participate. Statistical power was limited due to sample size and to attrition from post-test ( n = 27) to follow-up ( n = 19).

Second, restrictive training schedules imposed by the NCAA decreased dose-response, suggested to be imperative in producing desired effect of practicing yoga.[ 37 ] Intervention timing had to be condensed (from 90 to 45 min), an adaptation to the original protocol that may have impeded effectiveness. Location restrictions related to heavy scheduling demands also meant that no yoga props were available. Poses were adapted to using what was available, which included the well-padded floor of the wrestling room and wall space. Not having yoga props was a significant limitation in the present study, as efforts were made to adapt the protocol to the physical limitations of soccer players (e.g., limited range of motion).

The feasibility limitations encountered in this study reflect reality, however. As such, the present study design conditions have strong external validity and likely represent feasibility across most academic departments with little to no funding.

Future considerations and recommendations

More research is needed following similar procedures: Use of multifaceted yoga intervention, collegiate-level student athletes, and RESTQ-Sport.[ 5 ] In such research, environmental and timing aspects of a yoga intervention need to be carefully considered. Weaving yoga into existing activities and schedules may be essential to proper dosing of the intervention (e.g., Asana practice integrated in warm-up practices; Pranayama integrated into drills; Yamas and Niyamas integrated into locker room communication). Findings from this and prior studies suggest this may be time and effort well-spent for sake of college athletes' well-being. Inclusion of a control group, larger sample size, and diversity reflective of NCAA populations would allow for more statistical power and external validity.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgments

We gratefully acknowledge the contributions of the two assistant yoga teachers, Megan Poole and Elisabeth Powell, and the contributions of the other yoga research team members: Elizabeth Alire, Kari Sulenes, Lauren Justice, Anna Gibson, Heather Freeman, Nadezhda Vladagina, Nina Hidalgo, and Dana Dharmakaya Colgan.

This tool prevents injuries for athletes with physical disabilities

Currently, one in ten people in the Netherlands have a movement-related disability, with 21% of them participating in sports. Despite this, little is known about how to prevent injuries and illnesses among this group. This needs to improve, in order to lower the barrier to sports participation, according to  Sietske Luijten , who is completing her PhD with the Tailored Injury Prevention in Adapted Sports (TIPAS) project at Amsterdam UMC.

Friction from prosthesis

In the online tool developed for her PhD research, athletes with physical disabilities fill out a short weekly questionnaire about their status. “For example, are you training less than usual? That could indicate an injury or illness,” explains Sietske. “If something is wrong, additional questions clarify the situation, and the person receives tailored advice. Athletes with a prosthesis may encounter issues at the stump, often due to friction. They then receive advice on how to keep their skin clean.”

The online tool is as comprehensive as possible, covering all complaints. The advice considers the type of sport (sitting or non-sitting) and all types of physical disabilities, divided into five categories: spinal conditions (such as spinal cord injury), limb abnormalities, brain disorders, neuromuscular disorders and restrictions in movement. The tool is designed for all sports levels, from recreational to high performance. 

Though the advice is always tailored, one topic is universal: the balance between strain and capacity. “For someone in a wheelchair, the strain on the shoulders is different from others,” Sietske explains. “The tool provides advice on how to distribute the strain throughout the week. Do you have complaints? Then it might be better to avoid both heavy grocery shopping and sports on the same day, for example.”

Three years of preparation 

It took a lot of work to make the tool as comprehensive as possible, Sietske says. “We spent three years on preparation.” During those three years, she read up on the literature and made an inventory of the problems faced by athletes with physical disabilities in the Netherlands. She discussed injuries and limitations with athletes and medical experts, and finally tested the tool over the course of a sports season. 

Difference of opinion between doctors and athletes 

Interestingly, doctors and athletes view injuries differently. “Medical experts see an injury as physical damage, whereas athletes think more in terms of consequences: if I’m injured, I can’t do my regular activities.” This insight helped translate the tool for athletes – the end users. 

Fewer severe illnesses when you’re more aware

The tool proved effective: athletes using it had fewer injuries. They also experienced fewer severe illnesses, and less often. “Being aware of your physical condition helps with other complaints too,” Sietske suspects. “It keeps you healthier overall. For instance, people with spinal cord injuries are slightly more prone to bladder infections. And if you’re tired and act on it in time, you catch issues earlier.” This is also useful advice for the 4,400 athletes participating in the 2024 Paralympic Games in Paris from 28 August to 8 September.

“Athletes with physical disabilities helped me rethink”

Sietske (1996) has been competing in gymnastics at national level for 20 years. “I’ve had injuries all my life: a severe neck injury and multiple ankle injuries. Helping someone else with this is my drive behind injury prevention.”

The athletes she interviewed not only helped her develop the tool, but also her attitude to sports. “Their perspective on living with a physical disability helps me view my own situation positively.”

The TIPAS project's tool will soon be available on the  Uniek Sporten  (Disabled Sports Fund) platform. Sietske will defend her dissertation at the end of 2024 or the beginning of 2025. 

17 July 2024

Helping athletes with spinal cord injury

22 July 2024

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Injury rates decreased in men's professional football: an 18-year prospective cohort study of almost 12 000 injuries sustained during 1.8 million hours of play

Affiliations.

• 1 Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden [email protected].
• 2 Football Research Group, Linköping University, Linköping, Sweden.
• 3 Center for Health Services Development, Linköping University, Linköping, Sweden.
• 4 Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
• 5 Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway.
• 6 Department of Research, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
• PMID: 33547038
• PMCID: PMC8458074
• DOI: 10.1136/bjsports-2020-103159

Background: The UEFA Elite Club Injury Study is the largest and longest running injury surveillance programme in football.

Objective: To analyse the 18-season time trends in injury rates among male professional football players.

Methods: 3302 players comprising 49 teams (19 countries) were followed from 2000-2001 through 2018-2019. Team medical staff recorded individual player exposure and time-loss injuries.

Results: A total of 11 820 time-loss injuries were recorded during 1 784 281 hours of exposure. Injury incidence fell gradually during the 18-year study period, 3% per season for both training injuries (95% CI 1% to 4% decrease, p=0.002) and match injuries (95% CI 2% to 3% decrease, p<0.001). Ligament injury incidence decreased 5% per season during training (95% CI 3% to 7% decrease, p<0.001) and 4% per season during match play (95% CI 3% to 6% decrease, p<0.001), while the rate of muscle injuries remained constant. The incidence of reinjuries decreased by 5% per season during both training (95% CI 2% to 8% decrease, p=0.001) and matches (95% CI 3% to 7% decrease, p<0.001). Squad availability increased by 0.7% per season for training sessions (95% CI 0.5% to 0.8% increase, p<0.001) and 0.2% per season for matches (95% CI 0.1% to 0.3% increase, p=0.001).

Conclusions: Over 18 years: (1) injury incidence decreased in training and matches, (2) reinjury rates decreased, and (3) player availability for training and match play increased.

Keywords: elite performance; epidemiology; hamstring; injury prevention; soccer.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

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July 23, 2024

Q&A: UW researcher aims to understand common women’s sports injuries

Several common injuries seem to haunt women’s sports. Jenny Robinson, a University of Washington assistant professor of mechanical engineering, is interested in designing better methods to help women athletes train to prevent and recover from injuries. Katherine B. Turner/University of Washington

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Everyone is watching women’s sports. From the record-breaking 19 million viewers of the 2024 NCAA women’s basketball title game to the two sports bars in the Pacific Northwest dedicated to women’s sports , and even new brands dedicated to promoting coverage and investment in women’s sports , female athletes are finally having their moment.

Even though there’s much to celebrate, there are still some huge gaps. Pay is one example, with Caitlin Clark, the top pick in the 2024 WNBA draft, earning just 1% of what the top pick in the NBA draft will be paid . Several common injuries also seem to haunt women’s sports, such as the ACL tears that plagued last year’s Women’s World Cup . An ACL tear is two to eight times more common for women than for men in the same sports.

Jenny Robinson

Jenny Robinson , a University of Washington assistant professor of mechanical engineering, studies differences between how male and female tissues recover after sports injuries. Specifically, Robinson is interested in designing better methods to help female athletes train to prevent and recover from injuries.

With the Paris Olympics Opening Ceremony upcoming on July 26, UW News asked Robinson, who is also the endowed chair in women’s sports medicine and lifetime fitness in the orthopaedics and sports medicine department in the UW School of Medicine, to discuss common injuries for female athletes and how her research field is working to address them.

Let’s talk about ACL tears. We seem to hear about them happening in a variety of sports. Why?

ACL tears are extremely common in activities that require cutting, pivoting, quick turns of directions (high strain rate) and/or high-contact sports. We see this injury often in sports such as soccer, basketball, rugby, downhill skiing and football. I tore my ACL and my lateral meniscus playing soccer when I was 12 years old.

Why is it more common for women to tear their ACL?

There are many possible reasons including anatomical differences that lead to altered biomechanics, differences in tissue structure and properties, and sex hormone differences, including fluctuations that occur in women during the menstrual cycle.

How are ACL tears typically treated?

If the ACL is completely torn, it needs to be reconstructed. One method involves grafting a tendon from another part of the body. For example, using patellar or hamstring tendons are some of the most common options. But this can lead to additional risk for injury at the donor site — I strain my hamstring often because my hamstring tendon was used to repair my ACL tear.

Sometimes the reconstructions are torn again, which requires revision surgery. It’s not career-ending the first time this happens, but any subsequent injuries and/or post-traumatic osteoarthritis can make this career ending.

What makes an injury career-ending for female athletes?

I was just reading up on Olympian Lindsey Vonn ’s total knee replacement this past spring. She’s 39 years old and the typical age range for these types of surgeries is 60 to 70 years old. She’s had so many knee surgeries to treat multiple ACL, MCL and meniscus tears. That is career-ending.

After Jenny Robinson (foreground) tore her ACL and lateral meniscus playing soccer at age 12, the surgeon suggested that she give up the sport, insinuating that it wasn’t a major part of her life and her identity. Jenny Robinson

This is personal for me. When I tore my ACL and meniscus, my orthopedic surgeon told me to stop playing soccer — I was 12 years old — to reduce the risk of additional injuries or post-traumatic osteoarthritis. When I was 16, I went back to the doctor with pain and they confirmed it was post-traumatic osteoarthritis. They told me again to just stop playing soccer, insinuating this wasn’t a major part of my life, a part of my identity, something I could make into a career.

If there has ever been a time to invest in ACL injury prevention, it’s now. For professional athletes, tracking ACL risk is critical for reducing the likelihood of degenerative conditions after acute injuries. These steps ensure athletes have long careers, livelihood and support for their families. Understanding ACL injury risk is also important for non-professionals, youth athletes, parents and coaches as well. It ensures a lifetime of peak physical and mental health.

How does your research focus on female athletes’ recovery from injuries?

We may think we know how women’s bodies operate. But we don’t. Most of the research is based on men’s bodies or bodies of undisclosed sex. Also, much of the research is based on what’s happening at the tissue and joint level without considering how the cells within the tissue are responding based on hormonal and mechanical signaling cues. But changes at the cellular level happen first and then lead to changes at the tissue level.

My research group is trying to determine what cues lead to tissue scarring versus regeneration so that we can develop processes that inhibit scarring and promote regeneration. How do sex hormones and mechanical cues regulate tissue structure and function? What happens to the cells in these tissues when there are different mechanical or hormonal changes?

We need this information to be able to design methods that reduce or prevent injury, provide clearer and more patient-specific surgical and therapy recommendations, and develop techniques to promote functional regeneration and reduce scarring.

Women’s sports are also having a moment in your research field. You’ve been attending multiple conferences that focus on women’s health and engineering. What are these conferences like?

This past summer I have been part of two meetings that bring together professionals in engineering for women’s health — the Engineering Research Visioning Alliance: Transforming Women’s Health Outcomes Through Engineering meeting and the ElevateHER meeting. They are both supported by the National Science Foundation and they aim to define the major questions we need to tackle in the next 50 years, especially around developing strategies to understand female physiology and address conditions that disproportionally impact women.

While I’m in these meetings, my thoughts have gone something like this:

• I’m so happy to be in a room with all these amazing researchers focused on women’s health! I’m pumped to continue working on these major questions
• Wow, there are so many basic questions that we don’t have any clue how to answer
• Oh, but the people in this meeting can figure it all out
• Wait, they don’t know how to approach these questions either
• Ahhh, we have so much to do
• OK, but there is hope because people are working in areas that we previously were clueless about and doing some really impactful research
• Now that we all know each other we can brainstorm and slowly but surely start to tackle these problems

This is a necessary step, and it’s been wonderful being in the same space with people who are all focused on women’s health and how to use engineering design principles and tools to tackle questions.

For more information, contact Robinson at [email protected] .

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Tips for Writing Your Master of Legal Studies Personal Statement

By Miami Law Blog Contributor 07-25-2024

Applying to a Master of Legal Studies (M.L.S.) program is an excellent first step in advancing your legal knowledge in your respective field. Each M.L.S. program sets its own requirements for application and admittance—yet for any graduate-level program, it is common for a personal statement to be required as part of any application.

Read on for practical tips to integrate into your statement, along with common mistakes to avoid.

Understanding the Importance of Your Personal Statement

A personal statement refers to an essay that is typically required as part of a college or graduate program application (most often for advanced degree programs).

The Role of the   Personal Statement   in Your Application

Personal statements give applicants a unique opportunity to share additional information about themselves that may not already be reflected in their academic transcripts, resumes, or other application materials. In advanced degree programs where spots may be limited, a personal statement could make or break an application.

Preparing to Write Your M.L.S. Personal Statement

As you prepare to write your personal statement, there are a few steps that can make the writing process as easy as possible.

Gathering Necessary Information and Resources

Start by collecting any specific information, resources, or documents you may need to write your M.L.S. personal statement accurately. This is especially essential if you plan on referring to your academic transcripts, awards received, or other formal documents in your text.

Identifying Your Unique Qualities and Experiences

Compelling personal statements tend to be ones that communicate an applicant's distinct experiences and qualities. With this in mind, it is useful to set aside time for self-reflection before you start writing. Specifically, consider the personality traits you have that might make you a good fit for the program. In addition, think about any examples of life experiences that you may want to incorporate into your essay.

Tips for a Successful Personal Statement for Legal Studies

As you begin crafting your Master of Legal Studies personal statement, keep in mind some best practices to help your essay stand out from the dozens (or hundreds) of essays your admissions committee will be reading.

Start With an Outline

When writing any kind of important document, it is wise to start with a  detailed outline  that includes your thesis, your main points, and any supporting evidence (such as real-world examples or stories). Once you have a solid outline, you may find it considerably easier to start writing.

Be Authentic and Honest

One of the most crucial characteristics of any successful personal statement is authenticity. While there iss nothing wrong with highlighting your strengths and even bragging a bit, you want to avoid dishonesty or anything that might come off as less than genuine.

Highlight Your Interest in Legal Studies

One of the main reasons many M.L.S. programs require a personal statement is because in the first place, the admissions committee wants to truly get to know applicants and what interests them in a legal studies program. Therefore, it is critical to clearly communicate why you want to pursue an M.L.S. degree, whether it is to expand your knowledge in a specific area or advance your career.

Demonstrate Critical Thinking and Analytical Skills

Completing an M.L.S. program requires a great deal of critical thinking, analytical, and problem-solving skills. You can demonstrate how you possess these skills in your personal statement by sharing specific stories or examples of situations where you have been required to think outside of the box or make an important, calculated decision.

Avoid Common Pitfalls and Cliches

There are certain phrases and tropes that M.L.S. admissions committees have probably seen in personal statements hundreds of times already, so it is ideal to avoid these in your writing. Try to ensure every sentence is truly unique and not something you would find in other essays—or that could be easily upstaged by other applicants. A few examples of content and cliches to avoid could include:

• Discussing legal topics or issues that might be controversial.
• Focusing too much on the external world or other people instead of your own goals and experiences.
• Starting with a quote, statistic, abstract question, or anything else that directs the attention away from you .
• Leaning too heavily into sharing personal hardships (particularly cliches like a sports injury) to prove how you have overcome struggles.
• Pulling from scenarios in the distant past (such as how you learned to be a team player in high school extracurriculars or opening with, “My passion for legal matters began at a young age…”)

Showcase Your Unique Experience

Everybody has something different to bring to the table, but your admissions committee will not understand the scope of your personal experience unless you address it in your personal statement. If you have relevant work experience, a background in legal education, or something else that sets you apart, be sure to weave it into your M.L.S. personal statement.

Emphasize Your Motivation for Pursuing a Master of Legal Studies

People have various motivations for obtaining an M.L.S. degree. Your personal statement is your chance to highlight your own reasons for wanting to pursue this degree. Remember that your reasoning should not be all about  you , so it can be useful to consider how earning your M.L.S. might help others or even contribute to the field as a whole.

Highlight Your Academic Achievements

Even if your academic achievements are already covered in an academic transcript, resume, or other application materials, your M.L.S. personal statement can be an opportunity to succinctly call out anything noteworthy or particularly relevant that might not be immediately apparent in those documents. Ideally, you can connect these achievements to a personal story or anecdote in your essay.

Incorporate Your Future Goals

Take time to reflect on your short- and long-term goals as well as how obtaining an M.L.S. degree may help you pursue those goals. This is something you'll also want to cover in your personal statement, most likely toward the end of the document.

Be Open to Feedback from Peers

One of the best things you can do when creating your personal statement is to get feedback from peers. After you have finished your first draft, do not hesitate to ask family members, mentors, or trusted friends to read through your essay and make comments. This can be an excellent way to gain and incorporate valuable feedback that could strengthen your essay even more.

Take the Time to Proofread

Even with built-in spell checkers in most word processing software today, it is still crucial to actually read through your essay and do your own proofreading before submitting your personal statement. A helpful rule of thumb is to read through the document twice: The first time, read it out loud to check for flow and grammatical errors. The second time,  read it backwards  to better spot typos and misspellings.

Common Mistakes to Avoid

As you work on your personal statement for your M.L.S., you’ll also want to make note of some errors to avoid.

Being Too Vague or Generic

In many cases, your personal statement is your one opportunity to really make your application stand out—so make sure to avoid language that is overly vague or generic. Instead, refer to specific life experiences and the unique qualities you would carry into a graduate-level program.

Overloading on Legal Jargon

As tempting as it may be to flaunt your knowledge of legal jargon in your Master of Legal Studies personal statement, remember that the admissions committee members reading your essay might  not  be in the legal field. With this in mind, it is best to stick with simple language regarding the law. There is nothing wrong with incorporating a few common legal terms here and there, but this is not the time to overdo it with the terminology.

Ignoring the Prompt or Instructions

One of the biggest mistakes applicants make when crafting a personal statement is ignoring the prompt and going in their own direction. Oftentimes, writing prompts will include specific questions to answer or topics to address. Failing to closely adhere to the prompt may demonstrate to your admissions committee that you are not detail-oriented or do not follow directions carefully.

How Long Should My Personal Statement Be?

Generally speaking, most personal statements should be at least a page or 500 words long, but this will all depend on your program's specific guidelines regarding word counts, page limits, spacing, and font sizes.

How Do I Start My Personal Statement?

The best way to start a personal statement is with a "hook," or something that will capture your readers' attention and interest. Many applicants find success beginning their essays with a personal anecdote, a question, or even a surprising fact.

What Topics Should I Avoid in My Personal Statement?

Try to steer clear of any taboo topics that might stir up controversy (e.g., politics and religion), as you never know who might be reading your essay. Additionally, avoid discussing personal struggles that lack a clear, relevant resolution or lesson. Lastly, do not include information that is redundant with skills, accomplishments, or credentials already clearly listed on your resume or transcripts; put a spin on it so you are sharing a personal story, insight, or competency that the reader could not glean from your application elsewhere.

How Can I Make My Personal Statement Stand Out?

There are plenty of ways to set your personal statement apart from other essays, such as incorporating personal anecdotes and experiences while tying them back to your motivation for applying. The more creative yet authentic you remain, the more memorable and compelling your essay will be to the admissions committee reading it.

Ready to Apply for a Master of Legal Studies Program?

Ultimately, writing an M.L.S. personal statement is all about reflecting upon why you are interested in the program and what might set you apart from other applicants. By following the above tips and best practices, you will be in better shape when it comes time to write your personal statement for legal studies.

Are you seeking the right  online Master of Legal Studies  degree program for you? Learn more about the University of Miami School of Law's  online M.L.S. curriculum  with tracks in human resources, cybersecurity, finance, and more—then get started with your online  application  today.

https://admissions.law.miami.edu/academics/mls/

https://admissions.law.miami.edu/academics/mls/curriculum/

https://lifehacker.com/think-backwards-when-proofreading-your-writing-for-spel-1793189994

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Belgium women's basketball guard Julie Allemand to miss 2024 Paris Olympics with injury

The Belgium national women's basketball team will be without one of its star players for the 2024 Paris Olympics .

Guard Julie Allemand will miss all of the Olympics due to injury, the Belgian national team announced Thursday . The details of the injury were not released. She posted a broken heart emoji on social media after the announcement.

💔 — Julie Allemand (@JulieAllemand) July 25, 2024

Allemand is one of two current WNBA players on the Belgium roster, alongside Julie Vanloo. She was traded to the Los Angeles Sparks in the offseason from the Chicago Sky but opted out of the 2024 season and was placed on a full season suspension due to injury. She currently is not listed on the Los Angeles roster.

She recently played for Lyon in France and averaged 10.3 points, 6.5 assists and 4.1 rebounds per game. In two WNBA seasons with the Indiana Fever in 2020 and Sky in 2022, Allemand has averaged 5.8 points, 4.6 assists, 3.1 rebounds. She will be replaced on the national team by Nastja Claessens, who was selected in the third round of the 2024 WNBA Draft by the Washington Mystics .

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It's a devastating injury for Belgium as Allemand was the leader of a team that was expected to give the overwhelming favorite Team USA a challenge for gold. The U.S. is a clear betting favorite to win gold at -1400, according to BetMGM , but Belgium had the fourth-best odds at +2500 alongside Japan.

In February, Belgium played Team USA in the 2024 FIBA Women's Olympic Qualifying Tournaments and nearly pulled off a stunning upset against the stacked American team. Breanna Stewart got a put back layup with three seconds left to win 81-79. Allemand did not play in the contest.

Belgium is in Group C of the Olympics and will begin group play on Monday against Germany.

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Kevin Durant practiced, 'feeling good' with injury, important Team USA basketball scrimmage Thursday

Team USA coach Steve Kerr is confident Kevin Durant will be able to play in the Paris Olympics despite a calf injury that prevented the Phoenix Suns superstar forward from participating in the five exhibition games.

“No,” said Kerr when asked if there is a concern Durant might not be able to play. “He practiced fully (Wednesday). Like I said, the plan is for him to scrimmage (Thursday)."

Kerr confirmed the Suns are having conversations with Team USA regarding Durant’s injury. Going 5-0 in exhibition play with the last two wins over South Sudan and Germany in London coming down to the last minute, Team USA opens Olympic Group C play Sunday against Serbia in France.

“It’s always a collaboration,” Kerr said. "It’s not just our training staff, but Durant is constantly in touch with his people, with the Suns. This is not going to be like us going out and saying, 'Hey, let’s just throw him out there.' This will be a big collaboration.”

Sources informed The Republic last week the Suns weren’t overly concerned with Durant’s injury he suffered a few weeks ago. This was after new Suns coach Mike Budenholzer spoke on the matter at the NBA Summer League in Las Vegas.

“Our medical staff has done a great job of supporting him,” Budenholzer said July 13. “USA Basketball has been great supporting him. Kevin’s a veteran. He knows himself well. We feel confident that he’s in a good place, is being well taken care of and hopeful he’ll be back healthy and ready to play for USA.”

Kerr said Team USA had a non-contact practice Wednesday with a bunch of running and shooting. Durant did “everything” in the practice, Kerr said, but Thursday’s scrimmage will serve as a truer test to the injury.

“The plan is for him to get into the scrimmage and see how he handles that,” Kerr said. “He looked good today and he did everything and got a lot of shots up and told me he’s feeling pretty good.”

"I don't know. I'm going to see how I feel after practice today. Just take it a day at a time." Kevin Durant on if he'll play in either of Team USA's final two exhibition games. He's missed first three with a calf injury. #Suns #TeamUSA #Paris2024 Video credit: @usabasketball https://t.co/yLNNWXKOY1 pic.twitter.com/n7nDm1bUGI — Duane Rankin (@DuaneRankin) July 19, 2024

The concern over Durant’s injury that occurred a few weeks ago goes back to the 2019 Finals when Durant was returning from a calf injury playing for Kerr in Golden State.

Durant suffered a season-ending Achilles injury against the Toronto Raptors and missed the entire 2019-20 season with the Brooklyn Nets. Kerr coached Durant three seasons, winning back-to-back NBA titles (2017, 2018) with Durant winning Finals MVP each year.

Durant is coming off his healthiest NBA season since the Achilles injury. It was his first full season with the Suns; he was traded from Brooklyn to Phoenix in a blockbuster deal right before the 2023 trade deadline.

Playing 75 games in the 2023-24 regular season, Durant averaged 27.1 points, made the All-NBA second team, and is still one of the game’s best players. He'll turn 36 in September.

Looking to win his fourth Olympic gold medal, Durant is the all-time leading scorer for Team USA in Olympic men's basketball competition. He’s been practicing with the national team, dressed for the last two exhibition games in London, but has yet to play for Team USA this summer due to the calf injury.

Have opinions about the current state of the Suns? Reach Suns Insider Duane Rankin at  [email protected]  or contact him at 480-810-5518. Follow him on X, formerly Twitter, at  @DuaneRankin .

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Browns defensive starters Greg Newsome II, Dalvin Tomlinson sidelined from camp with injuries

FILE - Cleveland Browns cornerback Greg Newsome II (0) drops back in coverage during an NFL football game against the New York Jets, Dec. 28, 2023, in Cleveland. Newsome has had surgery on an injured hamstring and tackle Dalvin Tomlinson is scheduled to undergo an arthroscopic procedure on his knee Friday, July 26, 2024. (AP Photo/Kirk Irwin, File)

FILE - Cleveland Browns defensive tackle Dalvin Tomlinson (94) reacts after making a defensive stop during an NFL football game against the Arizona Cardinals, Sunday, Nov. 5, 2023, in Cleveland. Greg Newsome II has had surgery on an injured hamstring and Tomlinson is scheduled to undergo an arthroscopic procedure on his knee Friday, July 26, 2024. (AP Photo/Kirk Irwin, File)

FILE - Cleveland Browns’ Dalvin Tomlinson answers a question following an NFL football practice in Berea, Ohio, June 11, 2024. Tomlinson is scheduled to undergo an arthroscopic procedure on his knee Friday, July 26, 2024. (AP Photo/Sue Ogrocki, file)

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WHITE SULPHUR SPRINGS, W.Va. (AP) — The Cleveland Browns will be without two starters from last year’s top-ranked defense for most of training camp.

Cornerback Greg Newsome II has already had surgery on an injured hamstring, and tackle Dalvin Tomlinson is scheduled to undergo an arthroscopic knee procedure on Friday.

Coach Kevin Stefanski provided medical updates on the two players in his opening remarks after the Browns had their first practice at the Greenbrier Resort. He’s hoping both will be back for the Sept. 8 opener against Dallas.

Newsome was placed on the non-football injury (NFI) list Wednesday while Tomlinson was a surprise addition to the physically-unable-to-perform (PUP) list.

Stefanski said Newsome, who has started 39 games since being drafted by the Browns in the first round in 2021, got hurt working out last week.

“Hopefully have him back for Week 1,” Stefanski said. “But I’ll have more of an update as we get closer.”

The Browns picked up Newsome’s fifth-year option during the offseason.

Stefanski didn’t provide a timeline on Tomlinson, who had a major impact on Cleveland’s defense last season after signing as a free agent with the Browns.

The 30-year-old Tomlinson started 16 games and finished with three sacks, but his presence up front helped free end Myles Garrett, who was the AP NFL Defensive Player of the Year.

AP NFL: https://apnews.com/hub/nfl