Snooze it or Lose it: Understanding Sleep Disturbance and Injuries in Soccer and Basketball Student-Athletes.

OBJECTIVES: To assess the sleep characteristics of collegiate soccer and basketball student-athletes and explore the associations between sleep and injury risk. DESIGN: Cohort study. SETTING: NCAA D1 and NAIA Tier 1. PARTICIPANTS: One hundred eighty-one collegiate soccer and basketball student-athletes (42% female; mean age: 20.0 ± 1.7 years). INDEPENDENT VARIABLES: Questionnaires were administered during the 2020/2021 and 2021/2022 preseason, collecting demographic, injury history, medical history, and sleep information, including sleep difficulty category scores of 0 to 4 (none), 5 to 7 (mild), and ≥8 (moderate/severe) and other sleep disturbance measures derived from the Athlete Sleep Screening Questionnaire (ASSQ), including insufficient sleep duration (<7 hours of sleep) and poor subjective sleep quality. MAIN OUTCOME MEASURES: All-complaint knee and ankle injuries. RESULTS: According to the ASSQ, 25.4% (95% confidence interval [CI], 17.9-34.3) of the student-athletes had mild sleep difficulty and 12.7% (95% CI, 7.3-20.1) had moderate/severe sleep difficulty. 36.1% (95% CI, 29.1-43.6) had insufficient sleep duration. 17.1% (95% CI, 11.7-23.7) were not satisfied with the quality of their sleep (poor sleep quality), and 13.8% (95% CI, 9.1-19.7) had an "eveningness" chronotype. Based on multivariable logistic regression models, student-athletes with poor sleep quality had significantly higher odds for injury (OR: 2.2, 95% CI, 1.04-4.79, P = 0.039). CONCLUSIONS: Clinically relevant dysfunctional sleep patterns are prevalent among collegiate soccer and basketball student-athletes. Poor sleep quality was significantly associated with injury risk among student-athletes. Findings suggest a substantial sleep problem in collegiate soccer and basketball student-athletes and warrant that student-athletes are regularly screened and timely interventions applied.

Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review.

OBJECTIVE: To evaluate best practices for neuromuscular training (NMT) injury prevention warm-up programme dissemination and implementation (D&I) in youth team sports, including characteristics, contextual predictors and D&I strategy effectiveness. DESIGN: Systematic review. DATA SOURCES: Seven databases were searched. ELIGIBILITY: The literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. INCLUSION CRITERIA: participation in a team sport, ≥70% youth participants (<19 years), D&I outcomes with/without NMT-related D&I strategies. The risk of bias was assessed using the Downs & Black checklist. RESULTS: Of 8334 identified papers, 68 were included. Sport participants included boys, girls and coaches. Top sports were soccer, basketball and rugby. Study designs included randomised controlled trials (RCTs) (29.4%), cross-sectional (23.5%) and quasi-experimental studies (13.2%). The median Downs & Black score was 14/33. Injury prevention effectiveness (vs efficacy) was rarely (8.3%) prioritised across the RCTs evaluating NMT programmes. Two RCTs (2.9%) used Type 2/3 hybrid approaches to investigate D&I strategies. 19 studies (31.6%) used D&I frameworks/models. Top barriers were time restrictions, lack of buy-in/support and limited benefit awareness. Top facilitators were comprehensive workshops and resource accessibility. Common D&I strategies included Workshops with supplementary Resources (WR; n=24) and Workshops with Resources plus in-season Personnel support (WRP; n=14). WR (70%) and WRP (64%) were similar in potential D&I effect. WR and WRP had similar injury reduction (36-72%) with higher adherence showing greater effectiveness. CONCLUSIONS: Workshops including supplementary resources supported the success of NMT programme implementation, however, few studies examined effectiveness. High-quality D&I studies are needed to optimise the translation of NMT programmes into routine practice in youth sport.

Injury severity at the time of sport-related ankle sprain is associated with symptoms and quality of life in young adults after 3-15 years.

BACKGROUND: Ankle sprains are the most common sports-related injuries. Individuals with time-loss ankle sprains often experience residual symptoms and chronic ankle instability years after injury. Up to 90% of post-traumatic ankle osteoarthritis cases are associated with severe ankle sprain. This study aimed to examine whether ankle injury severity sustained during youth sports participation is associated with ankle symptoms and function. MATERIALS AND METHODS: Cohort study included 50 young adults (mean age, 23 years) with a 3-to 15-year history of a youth-sport related 'significant ankle sprain' (SAS). The primary independent variable was injury severity, which was captured in the index SAS injury details through interviews. SAS was defined as ligament and other intra/extra-articular structure injuries that disrupted youth sport participation, at least 3 days of time loss, and required medical consultation. Severe SAS was defined as SAS involving >28 days of time loss, and non-severe SAS only involved ankle ligaments and/or with ≤28 days of time loss. The Foot and Ankle Outcome Score questionnaire was used to assess ankle symptoms and function. Descriptive statistics and multivariable linear regression models were used to examine the association between SAS severity and outcomes, with sex and time since injury as covariates. RESULTS: Compared to participants with non-severe SAS, participants with a history of severe SAS demonstrated significantly poorer outcomes in symptoms [-18.4 (99% CI: -32.2 to -4.6)], pain [-10.1 (99% CI: -19.2 to -1.1)] and QoL [-17.1 (99% CI: -33.1 to -1.1)] in multivariable linear regression models. CONCLUSIONS: Severe ankle sprain with a loss of > 4 weeks from sports participation at the time of injury is independently associated with poorer ankle symptoms, pain, and ankle-related quality of life after 3-15 years. Secondary prevention measures are needed in individuals with a history of severe ankle sprains to mitigate the potential health consequences.

Who Does Not Respond to Injury Prevention Warm-up Programs? A Secondary Analysis of Trial Data From Neuromuscular Training Programs in Youth Basketball, Soccer, and Physical Education.

OBJECTIVES: To identify factors associated with nonresponse to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. METHODS: This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of 4 randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education. Youth who were exposed to NMT and who sustained an injury during the study were considered nonresponders. Odds ratios (ORs) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/physical education). RESULTS: A total of 1793 youth were included. Youth with a history of injury in the previous year had higher odds (OR = 1.64; 95% CI: 1.14, 2.37) of injury during the study, and females were more likely (OR = 1.67; 95% CI: 1.21, 2.31) to sustain an injury than males who were participating in NMT. Age was not associated with the odds of sustaining an injury (OR = 1.10; 95% CI: 0.93, 1.30). Soccer players benefited most from greater adherence, with 81% lower odds of injury (OR = 0.19; 95% CI: 0.06, 0.57) when completing 3 NMT sessions a week compared with 1 session per week. CONCLUSION: Factors associated with nonresponse to an NMT warm-up program were female sex, history of injury during the previous 12 months, and lower weekly NMT session adherence in some sports (soccer). J Orthop Sports Phys Ther 2023;53(2):94-102. Epub: 9 December 2022. doi:10.2519/jospt.2022.11526.

Is Cumulative Load Associated with Injuries in Youth Team Sport? A Systematic Review.

BACKGROUND: High cumulative external and internal load may predispose athletes to increased risk for injury across a variety of sports, competition levels, and age groups. However, evidence of an association between cumulative load and injury in youth sport remains inconclusive. The objective of this study was to determine the current evidence for cumulative load and injury risk relationships in youth team sport through a systematic review of the existing literature. METHODS: A systematic review of the literature was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Literature searches were conducted in PubMed, Web of Science, SCOPUS, and CINAHL for relevant articles published between January 2010 and April 2021. The authors conducted independent review and quality assessment of the eligible studies. Eleven articles evaluating youth (less than 18 years old) team sport were included for qualitative synthesis. RESULTS: Fifty-nine percent (n = 39/66) of the relationships assessed revealed an association between cumulative load and injury across the team sports studied, including the presence of load-injury associations in 84% (n = 16/19) of assessments in youth soccer. Of those relationships where an association was present, 79% (n = 31/39) were positive associations between cumulative load and injury. Risk of bias assessment scores ranged from three to six out of seven possible (median = 5) for cohort studies and from four to seven out of 10 possible (median = 5.5) for cross-sectional studies. CONCLUSIONS: There is some evidence for a positive association between load and injury in youth team sport. Youth soccer was the most studied team sport, and a substantial number of positive load-injury associations were reported. Current evidence lacks consistency in the measures and metrics used in defining load-injury relationships. Trial Registration PRISMA ID - CRD42020203622.

Absence of Injury Is Not Absence of Pain: Prevalence of Preseason Musculoskeletal Pain and Associated Factors in Collegiate Soccer and Basketball Student Athletes.

Unlike musculoskeletal (MSK) injuries, MSK pain is rarely studied in athletes. In this study, we examined the prevalence of preseason MSK pain in apparently healthy collegiate soccer and basketball players and its relationship with previous injuries (1-year history), among other factors. Ninety-seven eligible student athletes (mean age: 20.1 (SD: 1.6) years; 43% male; 53% soccer players) completed a baseline questionnaire comprising questions related to demographics, medical and 1-year injury history and any current MSK pain and the corresponding body location. The overall prevalence of preseason MSK pain was 26% (95% CI: 17-36%) and it did not differ by sex or sport. The back (6.2%) and knee (5.2%) regions were reported to be the most frequently affected body parts for preseason MSK pain. Athletes with a previous injury and with perception of incomplete healing had 3.5-fold higher odds (OR: 3.50; 95% CI: 1.28-9.36) of baseline MSK pain compared with those without a previous injury. One in four collegiate soccer and basketball players had preseason MSK pain. Collegiate sports medicine professionals should consider conducting routine preseason evaluations of MSK pain in their athletes and initiate appropriate interventions for the prevention of MSK pain and its potential consequences among athletes.

Location of anterior knee pain affects load tolerance in isometric single leg knee extension.

OBJECTIVES: To investigate relationships between load tolerance of single leg isometric knee extension and athlete reported knee pain location and severity during the single leg decline squat. DESIGN: Cross-sectional study. METHODS: 175 college basketball athletes (99 women, 76 men) in Alberta, Canada participated at the start of the 2018-19 season. Knee pain location (dichotomized into focal/diffuse pain), and severity (numerical rating scale 0-10) were collected during the single leg decline squat. Athletes completed a standardized single leg isometric knee extension to determine load tolerance (defined by pain or reduced form). A quantile regression model was used to examine the association between load tolerance and pain location adjusting for sex, years played, body mass index and team. RESULTS: Athletes with diffuse pain had a significantly lower median load tolerance (-0.89 kg) than athletes without pain (95% confidence interval [-1.49, -0.29]; p = 0.003). Athletes with focal pain tolerated similar median loads (-0.42 kg) to those without pain (95% confidence interval [-1.17, 0.33]; p = 0.26). Higher knee pain severity was associated with a non-linear but consistent reduction in load tolerance (p < 0.001). CONCLUSIONS: Athlete-reported knee pain location during the single leg decline squat influenced load tolerance to isometric knee extension. Athletes with focal pain tolerated similar isometric loads to their pain free teammates. Clinicians should consider load selection of isometric knee extension for athletes with diffuse pain given their lower load tolerance. Future research should consider reporting pain location in addition to pain severity to differentiate clinical presentations and response to exercise.

The "SHRed Injuries Basketball" Neuromuscular Training Warm-up Program Reduces Ankle and Knee Injury Rates by 36% in Youth Basketball.

OBJECTIVE: To evaluate the effectiveness of a neuromuscular training warm-up prevention program, Surveillance in High school and community sport to Reduce (SHRed) Injuries Basketball, for reducing all-complaint ankle and knee injuries in youth basketball players. DESIGN: Quasi-experimental study. METHODS: High school/club basketball teams (male and female players aged 11-18 years) in Calgary, Canada participated in 2016-2017 (control; season 1) and 2017-2018 (intervention; season 2). The control season included a standard-of-practice warm-up. In season 2, a SHRed Injuries Basketball coach workshop was completed by participating team coaches. Teams were randomized by school/club to an unsupervised or a supervised (weekly supervision by study personnel) implementation of the coach-delivered SHRed Injuries Basketball program. The 10-minute SHRed Injuries Basketball program included 13 exercises (ie, aerobic, agility, strength, balance). All-complaint ankle and knee injuries were collected weekly using validated injury surveillance. Multilevel, multivariable Poisson regression analyses (considering important covariates, clustering by team and individual, and offset by exposure hours) estimated incidence rate ratios (IRRs) by intervention group (season 1 versus season 2) and secondarily considered the control versus completion of the SHRed Injuries Basketball program, unsupervised and supervised. RESULTS: Sixty-three teams (n = 502 players) participated in season 1 and 31 teams (n = 307 players: 143 unsupervised, 164 supervised) participated in season 2. The SHRed Injuries Basketball program was protective against all-complaint knee and ankle injuries (IRR = 0.64; 95% confidence interval [CI]: 0.51, 0.79). Unsupervised (IRR = 0.62; 95% CI: 0.47, 0.83) and supervised (IRR = 0.64; 95% CI: 0.49, 0.85) implementations of the SHRed Injuries Basketball program had similar protective effects. CONCLUSION: The SHRed Injuries Basketball program was associated with a 36% lower rate of ankle and knee injuries. Neuromuscular training warm-ups are recommended as the minimal standard of practice for injury prevention in youth basketball. J Orthop Sports Phys Ther 2022;52(1):40-48. doi:10.2519/jospt.2022.10959.

Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review.

OBJECTIVE: To determine whether high or low adiposity is associated with youth sport-related injury. DATA SOURCES: Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury. MAIN RESULTS: Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation. CONCLUSIONS: Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.

Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold?

BACKGROUND: This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury. METHODS: A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function. RESULTS: We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes. CONCLUSION: At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis. LEVEL OF EVIDENCE: Level III, historical cohort study.

Prevalence and Pain Distribution of Anterior Knee Pain in Collegiate Basketball Players.

CONTEXT: Causes of anterior knee pain (AKP) in jumping athletes include patellofemoral pain and patellar tendinopathy. The differential diagnosis of AKP is challenging, with variations in clinical presentations. No previous research has used pain location to describe AKP in basketball players. OBJECTIVE: To (1) describe the prevalence and pain distribution of AKP in collegiate basketball players and (2) report the prevalence of focal inferior pole pain using 2 outcome measures. DESIGN: Cross-sectional study. SETTING: University and collegiate basketball facilities in Alberta, Canada. PATIENTS OR OTHER PARTICIPANTS: A total of 242 collegiate basketball athletes (138 women, 104 men). MAIN OUTCOME MEASURE(S): The single-legged decline squat test (SLDS) was used to capture pain location via pain mapping (dichotomized as focal or diffuse) and pain severity (numeric rating scale). The Oslo Sports Trauma Research Centre Knee questionnaire (OSTRC-Knee) and adapted version for patellar tendinopathy (OSTRC-Patellar Tendinopathy Questionnaire [OSTRC-P]) were used to report the prevalence of AKP and patellar tendinopathy, respectively. Focal inferior pole pain during the SLDS was used to classify patellar tendinopathy. RESULTS: Of the 242 players, 146 (60%) reported pain with the SLDS (unilateral = 64 [26%]; bilateral = 82 [34%]). A total of 101 (43%) described knee pain using the OSTRC-Knee. Pain mapping captured the variability in pain locations. Diffuse pain was more prevalent (left, 70%; right, 72%) than focal pain (left, 30%; right, 28%). Low prevalence of patellar tendinopathy was noted using the OSTRC-P (n = 21, 8.7%) and inferior pole pain during the SLDS (n = 25, 10.3%). CONCLUSIONS: Diffuse AKP was common in Canadian basketball players; however, pain mapped to the inferior pole of the patella was not common. Few players reported tendinopathy using the OSTRC-P, suggesting that patellar tendinopathy was not a primary knee pain presentation in this jumping cohort. Pain location, rather than the presence or severity of pain alone, may better describe the clinical presentation of AKP in jumping athletes.

The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study.

This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11-18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7-22.7%), 23.2% (95% CI: 18.6-28.2%) in males and 12.5% (95% CI: 8.3-17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7-6.4%), 4.1% (95% CI: 2.2-7.0%) in males and 4.5% (95% CI: 2.1-8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10-4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58-16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.

Return to sport decisions after an acute lateral ankle sprain injury: introducing the PAASS framework-an international multidisciplinary consensus.

BACKGROUND: Despite being the most commonly incurred sports injury with a high recurrence rate, there are no guidelines to inform return to sport (RTS) decisions following acute lateral ankle sprain injuries. We aimed to develop a list of assessment items to address this gap. METHODS: We used a three-round Delphi survey approach to develop consensus of opinion among 155 globally diverse health professionals working in elite field or court sports. This involved surveys that were structured in question format with both closed-response and open-response options. We asked panellists to indicate their agreement about whether or not assessment items should support the RTS decision after an acute lateral ankle sprain injury. The second and third round surveys included quantitative and qualitative feedback from the previous round. We defined a priori consensus being reached at >70% agree or disagree responses. RESULTS: Sixteen assessment items reached consensus to be included in the RTS decision after an acute lateral ankle sprain injury. They were mapped to five domains with 98% panellist agreement-PAASS: Pain (during sport participation and over the last 24 hours), Ankle impairments (range of motion; muscle strength, endurance and power), Athlete perception (perceived ankle confidence/reassurance and stability; psychological readiness), Sensorimotor control (proprioception; dynamic postural control/balance), Sport/functional performance (hopping, jumping and agility; sport-specific drills; ability to complete a full training session). CONCLUSION: Expert opinion indicated that pain severity, ankle impairments, sensorimotor control, athlete perception/readiness and sport/functional performance should be assessed to inform the RTS decision following an acute lateral ankle sprain injury. TRIAL REGISTRATION NUMBER: ACTRN12619000522112.

Evaluating Methods for Imputing Missing Data from Longitudinal Monitoring of Athlete Workload.

Missing data can influence calculations of accumulated athlete workload. The objectives were to identify the best single imputation methods and examine workload trends using multiple imputation. External (jumps per hour) and internal (rating of perceived exertion; RPE) workload were recorded for 93 (45 females, 48 males) high school basketball players throughout a season. Recorded data were simulated as missing and imputed using ten imputation methods based on the context of the individual, team and session. Both single imputation and machine learning methods were used to impute the simulated missing data. The difference between the imputed data and the actual workload values was computed as root mean squared error (RMSE). A generalized estimating equation determined the effect of imputation method on RMSE. Multiple imputation of the original dataset, with all known and actual missing workload data, was used to examine trends in longitudinal workload data. Following multiple imputation, a Pearson correlation evaluated the longitudinal association between jump count and sRPE over the season. A single imputation method based on the specific context of the session for which data are missing (team mean) was only outperformed by methods that combine information about the session and the individual (machine learning models). There was a significant and strong association between jump count and sRPE in the original data and imputed datasets using multiple imputation. The amount and nature of the missing data should be considered when choosing a method for single imputation of workload data in youth basketball. Multiple imputation using several predictor variables in a regression model can be used for analyses where workload is accumulated across an entire season.

Magnitude, Frequency, and Accumulation: Workload Among Injured and Uninjured Youth Basketball Players.

Overuse injuries are common in basketball. Wearable technology enables the workload to be monitored in sport settings. However, workload-injury models lack a biological basis both in the metrics recorded and how workload is accumulated. We introduce a new metric for monitoring workload: weighted jump height, where each jump height is weighted to represent the expected effect of the jump magnitude on damage to the tendon. The objectives of this study were to use principal components analysis to identify distinct modes of variation in all workload metrics accumulated over 1, 2, 3, and 4 weeks and to examine differences among the modes of variation in workload metrics between participants before the injury and uninjured participants. Forty-nine youth basketball players participated in their typical basketball practices and games, and lower extremity injuries were classified as patellar or Achilles tendinopathy, other overuse, or acute. An inertial measurement unit recorded the number and height of all jumps, and session rating of perceived exertion was recorded. The previous 1-, 2-, 3-, and 4-week workloads of jump count, jump height, weighted jump height, and session rating of perceived exertion were summed for each participant-week. Principal components analysis explained the variance in the accumulated workload variables. Using the retained principal components, the difference between the workload of injured participants in the week before the injury and the mean workload of uninjured participants was described for patellar or Achilles tendinopathy, overuse lower extremity injury, and any lower extremity injury. Participants with patellar or Achilles tendinopathy and overuse lower extremity injuries had a low workload magnitude for all variables in the 1, 2, 3, and 4 weeks before injury compared with the weeks before no injury. Participants with overuse lower extremity injuries and any lower extremity injury had a high previous 1-week workload for all variables along with a low previous 3- and 4-week jump count, jump height, and weighted jump height before injury compared with the weeks before no injury. Weighted jump height represents the cumulative damage experienced by tissues due to repetitive loads. Injured youth basketball athletes had a low previous 3- and 4-week workloads coupled with a high previous 1-week workload.

Warm-Ups and Coaches' Perceptions: Searching for Clues to Improve Injury Prevention in Youth Basketball.

Introduction: Regular use of neuromuscular training (NMT) warm-up programs improves performance and prevents injuries. However, low level of adoption of these programs remains a problem. Understanding the current warm-ups in youth basketball and coaches' perceptions on injury prevention can guide the design of superior implementation strategies. This study describes warm-ups in youth basketball and coaches' injury prevention-related knowledge, attitudes, beliefs, and information sources. Methods: Youth basketball coaches (n = 50) completed a preseason questionnaire. The questionnaire covered warm-up length, use of aerobic/agility/balance/strength/other exercises in the warm-up, injury-related knowledge, attitudes, beliefs, and sources of information. Results: Typical warm-up duration was ≤ 10 min (48.0% of coaches, 95% CI: ±13.8%). All coaches included aerobic exercises in their warm-up. Agility, strength, and balance exercises were utilized by 80.0% (95% CI: ±11.7%), 70.7% (95% CI: ±13.6%), and 26.8% (95% CI: ±13.6%) of coaches, respectively. Most coaches agreed to some extent that basketball injuries are preventable (94%) and that participating in a NMT warm-up program would reduce player's risk of injury (92%). Other coaches were identified as the most common source of information on warm-ups and injury prevention. Discussion: Coaches use parts of effective NMT warm-up programs, but balance exercises are not well adopted. Considering the level of evidence supporting the importance of balance exercises in injury prevention, it is crucial to improve the implementation of NMT warm-up programs in youth basketball, for example, through educational courses. As fellow coaches were identified as the most important source of information, coaches' role in knowledge translation should be emphasized.

Dissemination and implementation research in sports and exercise medicine and sports physical therapy: translating evidence to practice and policy.

Knowledge from research evidence is wasted unless it is applied. While the scientific evidence base for many sports and exercise medicine and sports physical therapy interventions is robust, real-world implementation and evolution to scale remains an ongoing challenge. Dissemination and implementation research is important to generate evidence-informed, cost-effective and context-specific strategies for implementation partners and stakeholders to effectively apply and sustain the best research evidence in public health and clinical practice. However, this field of inquiry remains underexplored in sports and exercise medicine and sports physical therapy. Most intervention studies in sports and exercise medicine and sports physical therapy are terminated at the efficacy trial stage without considerations for best practices for translation to community and clinical settings. Lack of context-specific dissemination and implementation strategies to drive the translation of evidence-based interventions results in poor execution of, and attrition from, interventions, and this is associated with suboptimal outcomes and increased healthcare costs. Theory-driven quality research informing the successful dissemination and implementation of evidence-based interventions is needed to address lingering evidence-to-practice gaps. Dissemination and implementation research completes the final stage in the research-to-practice pipeline. It seeks to close evidence-to-practice gaps, thereby ensuring speedy application of research evidence to achieve desired public health outcomes while making more efficient use of limited resources. This review introduces sports and exercise medicine and sports physical therapy researchers and stakeholders to key concepts and principles in dissemination and implementation research.