Welcome back to your academic home: AMSSM special issue

Correspondence to Dr Christina L Master, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA;masterc@chop.edu As with many life events marked in relation to March 2020 when COVID-19 became a global pandemic, the publication of this year’s American Medical Society for Sports Medicine (AMSSM) special issue of the British Journal of Sports Medicine corresponds with the 2-year mark of this pandemic. During that time, AMSSM members (similar to our colleagues around the world) have learnt to navigate the ever-changing challenges of practising medicine, caring for sports teams, conducting research, advocating for healthy communities, and educating the next generation of sports and exercise medicine physicians during a pandemic. Concussion Read an important study examining the diagnostic utility of common sideline concussion assessments, some new and some old, and determine for yourself what is the best use of your time and effort in the evaluation of concussion. ( see page 144 ) Sports cardiology Review survival rates and find out which socioeconomic factors influence outcomes from exercise-related sudden cardiac arrest in high school athletes in the USA. ( see page 138 ) Explore the novel association between race and maladaptive concentric left ventricular hypertrophy in American-style football athletes. ( see page 151 ) Hear the heart-warming story of how Dr Joseph Marek and his team make a difference for young athletes through Young Hearts for Life with over a quarter-million cardiac screening tests completed and counting. ( see page 173 ) Mental health Recognise the important intersection of sports, mental health and the media, and learn how you can more effectively advocate for your athletes. ( see page 123 ) Embrace an important call to action to recognise and prevent vicarious and secondary traumatic stress in sport from athlete abuse. ( see page 119 ) Musculoskeletal ultrasound Familiarise yourself with the AMSSM Sports Ultrasound Curriculum for Sports Medicine Fellowships to be the most up-to-date on this important facet of training and clinical practice. ( see page 127 ) Transgender Learn how you can be a better ally and promote the health and well-being of your transgender athletes. ( see page 125 ) Regenerative medicine Build your evidence base for the responsible use of regenerative medicine and orthobiologics in sports medicine with highlights from the AMSSM Position Statement. ( see page 121 ) COVID-19 Be reassured that the risk of SARS-CoV-2 transmission from on-field player contacts in football (soccer) is very low. ( see page 158 ) The theme of this year’s AMSSM Annual Meeting is ‘Welcome Home’, which reminds us how fortunate we are to have academic homes within AMSSM and British Journal of Sports Medicine.

Increased Incidence of Injury Among Runners With COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) affects multiple organ systems. Whether and how COVID-19 affects the musculoskeletal system remains unknown. We aim to assess the association between COVID-19 and risk of injury. HYPOTHESIS: Runners who report having COVID-19 also report a higher incidence of injury. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 4. METHODS: An electronic survey was distributed from July through September 2020, by New York Road Runners, ASICS North America, race medical directors, and through social media. Inclusion criteria were runners 18 years or older who had participated in ≥1 race (running or triathlon) in 2019. RESULTS: A total of 1947 runners participated and met inclusion criteria. Average age was 45.0 (SD, 12.2) years and 56.5% were women. A total of 123 (6.3%) runners self-reported having COVID-19; 100 (81%) reported their diagnosis was from a laboratory test (polymerase chain reaction or antibody) and 23 reported being diagnosed by a medical professional without confirmatory laboratory testing. Since March 2020, 427 (21.9%) reported an injury that prevented running for at least 1 week, including 38 of 123 (30.9%) who self-reported having COVID-19 and 389 of 1435 (21.3%) who did not report having COVID-19 (P = 0.01). After adjusting for age, sex, the number of races in 2019, and running patterns before March 2020, runners who self-reported a diagnosis of COVID-19 had a higher incidence of injury compared with those who did not (odds ratio, 1.66; 95% CI, 1.11-2.48; P = 0.01). CONCLUSION: Injuries were more often self-reported by runners with laboratory-confirmed or clinically diagnosed COVID-19 compared with those who did not report COVID-19. Given the limitations of the study, any direct role of COVID-19 in the pathophysiology of injuries among runners remains unclear. CLINICAL RELEVANCE: Direct and indirect musculoskeletal sequelae of COVID-19 should be further investigated, including the risk of exercise- and sports-related injury after COVID-19.

Running races during the COVID-19 pandemic: a 2020 survey of the running community.

OBJECTIVES: To survey runners and triathletes about their willingness to resume in-person racing during the COVID-19 pandemic, health concerns related to mass races and changes in running patterns since the start of the pandemic. DESIGN: An electronic survey was distributed from 15 July to 1 September 2020 to runners and triathletes by New York Road Runners, ASICS North America, and race medical directors, and through social media. PARTICIPANTS: Runners and triathletes 18 years of age or older who participated in at least one race in 2019. RESULTS: A total of 2278 surveys were received. Not all participants answered every question; the denominator represents the number of responses to each question. Most participants were from the USA (1620/1940, 83.5%), of which over half were from New York (812/1475, 55.1%). Regarding when respondents would feel comfortable returning to in-person racing, the most frequent response was 'Whenever local laws allow, but only if there are sufficient precautions' (954/2173, 43.9%), followed by 'Not until there is a vaccine' (540/2173, 24.9%). The most common concerns about in-person races were crowded starting corrals (1802/2084, 86.5%), the number of COVID-19 cases in the race location (1585/2084, 76.1%) and the number of participants (1517/2084, 72.8%). Comparing running patterns before the pandemic to Summer 2020, the mean weekly mileage decreased from 25.5 (SD 15.4) miles to 22.7 (16.2) miles (p<0.001). CONCLUSION: Most runners are willing to return to racing when local laws allow, though as of Summer 2020, many desired certain precautions to feel comfortable.

Clinician Well-being during a Pandemic: Practices to Boost Resilience and Life Satisfaction.

The role of the sports medicine physician has been challenged in several ways during the COVID-19 pandemic, potentially eroding a sense of well-being. Four universal human needs related to flourishing and a sense of life satisfaction are the framework we use to examine the effects of a pandemic on sports medicine clinicians. We offer two evidence-based practices to promote well-being and resilience within each of the four universal needs.

Considerations for Return to Exercise Following Mild-to-Moderate COVID-19 in the Recreational Athlete.

The COVID-19 pandemic has resulted in significant morbidity and mortality around the world. The spectrum of COVID-19 is broad, from clinical disease requiring intensive medical care to less severe symptoms that are treated with supportive care. The majority of COVID-19 cases fall into the mild-to-moderate category, with symptoms lasting less than 6 weeks. Nevertheless, the morbidity from COVID-19 is significant and can affect multiple body systems, most frequently the cardiac, pulmonary, hematologic, musculoskeletal, and gastrointestinal systems. For patients who wish to return to exercise after mild-to-moderate COVID-19, the wide range of disease expression presents a challenge for clinicians seeking to offer counsel. This literature review on return to activity following mild to moderate COVID-19 in the recreational athlete includes evidence-based considerations and recommendations for clinicians in guiding the safest return to activity.

Musculoskeletal Consequences of COVID-19.

Coronavirus disease 2019 (COVID-19) is an emerging pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the majority of patients who become infected with SARS-CoV-2 are asymptomatic or have mild symptoms, some patients develop severe symptoms that can permanently detract from their quality of life. SARS-CoV-2 is closely related to SARS-CoV-1, which causes severe acute respiratory syndrome (SARS). Both viruses infect the respiratory system, and there are direct and indirect effects of this infection on multiple organ systems, including the musculoskeletal system. Epidemiological data from the SARS pandemic of 2002 to 2004 identified myalgias, muscle dysfunction, osteoporosis, and osteonecrosis as common sequelae in patients with moderate and severe forms of this disease. Early studies have indicated that there is also considerable musculoskeletal dysfunction in some patients with COVID-19, although long-term follow-up studies have not yet been conducted. The purpose of this article was to summarize the known musculoskeletal pathologies in patients with SARS or COVID-19 and to combine this with computational modeling and biochemical signaling studies to predict musculoskeletal cellular targets and long-term consequences of the SARS-CoV-2 infection.