Perspectives of Ballet Dancers on Causes of Their Injuries and Implementation of Injury Preventive Measures by Ballet Teachers and Masters.

OBJECTIVES: Ballet dancers have a high injury risk. We aimed to gain insight into the causes for acute and overuse injuries in ballet dancers and the level of implementation of injury prevention by ballet teachers/masters, as perceived by dancers. METHODS: An international cross-sectional online-survey was based on the Fit-to-Dance Questionnaire and literature. Adult amateur, pre-professional, and professional ballet dancers reported the perceived causes of their injuries sustained in the previous 2 years. Multiple answers per injury were possible. Also, dancers rated the level of implementation of measures to prevent injury by their ballet teachers and ballet masters based on 21 items using a 5-point Likert scale. Causes were analyzed per-injury as well as per-dancer. RESULTS: 188 ballet ensembles and 51 dance organizations were contacted, from which 192 ballet dancers (mean age 27 ±7.8 yrs, 83% females) responded. 119 dancers (62%) reported 203 acute and 164 (85%) reported 469 overuse injuries. Fatigue was the most frequently perceived cause for acute injuries in the per-injury (n=89, 43.8%) and per-dancer analysis (n=63, 32.8%). For overuse injuries, pressure from the teacher/master was most frequently perceived as cause in the per-injury analysis (n=240, 51.2%), specifically in pre-/professional dancers (n=233, 61.3%). In the per-dancer analysis, fatigue/overtraining scored highest for overuse injuries (n=107; 55.7%). Other causes were previous/repetitive injuries (acute-per-injury 26.1%, acute-per-dancer 22.4%; overuse-per-injury 46.3%, overuse-per-dancer 53.1%) or erroneous dance technique (acute-per-injury 24.6%, acute-per-dancer 21.9%; overuse-per-injury 47.8%, overuse-per-dancer 45.3%). With regard to perceived level of implementation of injury preventive measures by ballet teachers/masters to prevent musculoskeletal injuries, 2 items received high ratings, 12 moderate ratings and 6 low ratings. CONCLUSIONS: Fatigue and pressure accounted for the majority of perceived causes for injuries. Perceived support by ballet teachers/masters regarding injury prevention was moderate to low. Future research should focus on the awareness, attitudes, and the important role of ballet teachers/masters for injury prevention in dancers.

[Ultrasound in sports traumatology]. / Ultraschall in der Sporttraumatologie.

Ultrasound (US) has numerous applications in sports traumatology. The technical progress of mobile US devices has led to increasing use of ultrasound as a primary diagnostic tool. New applications such as elastography and 3 D vascularization are used for special indications.The purpose of this review is to present the current status of ultrasound in the diagnosis of sports injuries and sport traumatology including established applications and new technical advances. US is presented both in its comparison to other imaging modalities and as a sole diagnostic tool.US can be used for initial diagnosis to improve the clinical examination and for intensive shortterm follow-up imaging. The main areas of application are currently the diagnosis of acute muscle and tendon injuries as well as overuse injuries. In particular, the exclusion of structural muscle injuries can be adequately ensured with US in the majority of anatomical regions. The recently published guideline on fracture ultrasound has strengthened the clinical evidence in this area, especially in comparison to conventional radiography and in the development of algorithms and standards. The increasing use of mobile ultrasound equipment with adequate image quality makes US a location-independent modality that can also be used at training sites or during road games.

Overuse injury and affects in competitive sport: A prospective longitudinal study.

Overuse injuries, which have a high prevalence in sport, are suggested to result in different affective responses in comparison to traumatic injuries. Affects may also reciprocally act as risk factors for overuse injury. The aim of this study was to examine the associations between overuse injury and affects within a longitudinal follow-up design. Competitive athletes (N = 149) of various sports and levels of competition completed the Positive and Negative Affect Schedule (PANAS) and the Oslo Sports Trauma Research Centre Overuse injury questionnaire (OSTRC-O) once a week over 10 consecutive weeks. Bivariate unconditional latent curve model analyses with structured residuals were performed to evaluate the associations within and across weeks between OSTRC-O severity score and affects. Results indicated that OSTRC-O severity score and positive affects (PA) had a statistically significant negative within-week relation (r = -24.51, 95% CI = [-33.9, -15.1], p < 0.001). Higher scores of overuse injury were significantly related to lower levels of PA across weeks (ß = -0.02, 95% CI = [-0.04, -0.001], p = 0.044), while the reciprocal effect of PA on overuse injury was not significant (ß = -0.13, 95% CI = [-0.52, 0.26], p = 0.51). No statistically significant association was observed between OSTRC-O severity score and negative affects, neither within nor across weeks. Our findings suggest that overuse injury may have adverse psychological consequences on the long run through lessened PA and address the need for providing sustainable psychological support focusing upon such PA when working with athletes experiencing overuse injury.

Youth Athletes With Sever's Disease Exhibit Altered Achilles Tendon Ultrasound Characteristics: A Retrospective Case-Control Study.

OBJECTIVES: Calcaneal apophysitis (Sever's disease) is an overuse condition caused by repetitive traction stress to the calcaneal apophysis. Whether Achilles tendon morphology is altered in this young patient population remains unknown. Therefore, we aimed to identify differences in Achilles tendon morphology between youth athletes diagnosed with calcaneal apophysitis and healthy controls. METHODS: This retrospective chart review included 46 patients (n = 23 Sever's disease, 15F/8M, 12.4 ± 2.3 years old) and (n = 23 healthy controls, 13F/10M, 15.9 ± 1.5 years old) who sought care in a Children's Hospital Sports Medicine/Orthopedics Department between 2012 and 2022. We measured ultrasound-derived degree of tendon thickening, Achilles tendon thickness (cm), and cross-sectional area (CSA [cm2]). Separate multivariate analyses of covariance (MANCOVAs) were used to compare degree of thickening, mass-normalized Achilles tendon thickness, and CSA between participant groups, covarying for age. Cohen's d effect sizes were used to assess the magnitude of mean differences and standard error (MDSE) between groups. RESULTS: Young athletes with Sever's disease had a significantly greater degree of tendon thickening with a large effect compared with healthy controls (MDSE: 0.07 [0.01] mm P < .001, d = 1.39). Achilles tendon thickness and CSA did not statistically differ between groups; however, the magnitude of between-group differences for these measures (MDSE: 0.18 [0.05] cm, MDSE: 0.27 [0.07] cm2, respectively) were moderate. CONCLUSIONS: Our findings demonstrate previously unrecognized differences in Achilles tendon morphology between young athletes with clinically diagnosed Sever's disease and healthy controls. Our study supports incorporating diagnostic ultrasound as part of a comprehensive examination to ensure appropriate diagnosis and clinical management for adolescents with heel pain.

Development and validation of an overuse injury questionnaire for youth athletes: The Youth Overuse Injury Questionnaire.

OBJECTIVE: To develop and validate the Youth Overuse Injury Questionnaire (YOvIQ). DESIGN: A cross-sectional study. SETTING: Online platforms. PARTICIPANTS: Two content experts (in sports injury epidemiology and in sports science and medicine) and seven end-users (youth volleyball athletes) provided feedback during development of the YOvIQ. 227 competitive youth athletes across 14 different sports assessed the psychometric properties of the YOvIQ. MAIN OUTCOME MEASURES: Participants completed both YOvIQ and the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O2) for anatomical areas of the shoulder, elbow, lower back, knee, and ankle/foot. Validity was assessed via convergent validity. Reliability was assessed using internal consistency estimation and interclass correlation coefficient. RESULTS: Following feedback from content experts, examples and quantitative symbolization were added to the options in YOvIQ, with positive feedback from end-users. Convergent validity between YOvIQ and the OSTRC-O2 was demonstrated with non-significant differences (P ≥ .05) and significant correlations (P < 0.001) for prevalence and severity scores. YOvIQ demonstrated internal consistency for prevalence (Cronbach's alpha coefficient >0.70) and moderate-to-good reliability for severity scores (ICC: 0.51 to 0.88) for shoulder, lower back, and knee. CONCLUSIONS: The YOvIQ is a valid and reliable instrument to identify overuse injuries to the shoulder, lower back, and knee in youth athletes.

Bone health and the masters runner.

Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.

Profiling injuries sustained following implementation of a progressive load carriage program in United States marine corps recruit training.

BACKGROUND: Load carriage tasks during United States Marine Corps (USMC) recruit training can cause injury. Load carriage conditioning, if optimized, can reduce injury risk. OBJECTIVE: To compare injuries sustained by USMC recruits following participation in either the Original Load Carriage (OLC) program or a Modified Load Carriage (MLC) program. METHODS: Retrospective musculoskeletal injury data were drawn from the USMC San Diego Sports Medicine injury database for recruits completing the OLC (n = 2,363) and MLC (n = 681) programs. Data were expressed as descriptive statistics and a population estimate of the OLC:MLC relative risk ratio (RR) was calculated. RESULTS: The proportion of injuries sustained in the MLC cohort (n = 268; 39% : OLC cohort, n = 1,372 : 58%) was lower, as was the RR (0.68, 95% CI 0.61- 0.75). The leading nature of injury for both cohorts was sprains and strains (OLC n = 396, 29%; MLC n = 66; 25%). Stress reactions were proportionally higher in MLC (n = 17, 6%; OLC n = 4, 0.3%), while stress fractures were proportionately lower (MLC n = 9, 3%; OLC n = 114, 8%). Overuse injuries were lower in MLC (- 7%). The knee, lower leg, ankle, and foot were the top four bodily sites of injuries and the Small Unit Leadership Evaluation (SULE), Crucible, overuse-nonspecific, running, and conditioning hikes were within the top five most common events causing injury. The prevalence rates of moderate severity injury were similar (MLC = 23%; OLC = 24%), although MLC presented both a higher proportion and prevalence of severe injuries (MLC = 6%; OLC = 3%, respectively). CONCLUSION: A periodized load carriage program concurrently increased exposure to load carriage hikes while reducing injuries both during the load carriage hikes and overall.

Exercise Dependency and Overuse Injuries in Attention Deficit Hyperactivity Disorder.

ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is a common condition, but current medications have limitations, pushing a drive for alternative approaches. Different exercise-focused approaches have shown promise, but concern has also been raised about individuals with ADHD showing greater risk of addiction, including exercise dependency. Using an online survey, we examined current exercise practices, including exercise dependency and the presence of overuse injury, which could result from overexercising, in 114 adults with ADHD. We found that most were regularly exercising. None were classified as exercise dependent, but 38.9% were deemed symptomatic nondependent. Hyperactive-impulsive symptoms were a predictor of the level of exercise withdrawal experienced, and the co-occurrence of autism spectrum disorder was associated with greater risk of overuse injuries. The data indicate that ADHD may confer some greater risk of exercise dependency, aligning with previous studies investigating other addictions and suggesting further research is critical.

A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players.

BACKGROUND: There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes. HYPOTHESIS: Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 4. METHODS: An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups. RESULTS: A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01). CONCLUSION: While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points). CLINICAL RELEVANCE: This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.

Overuse Injuries, Overtraining, and Burnout in Young Athletes.

Sports participation can have tremendous physical and mental health benefits for children. Properly implemented progressive training programs can yield a broad range of beneficial physiologic adaptations, but imbalances of training load and recovery can have important negative consequences. Overuse injuries, for example, can result from repetitive stress without sufficient recovery that leads to accumulated musculoskeletal damage. In addition, extended periods of increased training loads that exceed the intervening recovery can have systemic consequences such as overtraining syndrome, which results in decreased performance, increased injury and illness risk, and derangement of endocrine, neurologic, cardiovascular, and psychological systems. Burnout represents one of the primary reasons for attrition in youth sports. Broadly defined as physical or mental exhaustion and a reduced sense of accomplishment that leads to devaluation of sport, burnout represents a direct threat to the goal of lifelong physical activity and the wide-ranging health benefits that it provides. This clinical report is intended to provide pediatricians with information regarding the risk factors, diagnosis, management, and prevention of these conditions to assist in the identification of at-risk children, the treatment of young athletes, and the guidance of families in the promotion of safe and healthy sport participation.

Injury Patterns in Highly Specialized Youth Athletes: A Comparison of 2 Pathways to Specialization.

CONTEXT: Sport specialization, commonly defined as intensive year-round training in a single sport to the exclusion of other sports, has been associated with an increased risk for overuse injury. Two pathways to becoming highly specialized are recognized: (1) having only ever played 1 sport (exclusive highly specialized) and (2) quitting other sports to focus on a single sport (evolved highly specialized). Understanding the differences in injury patterns between these groups of highly specialized athletes will inform the development of injury-prevention strategies. OBJECTIVE: To compare the distribution of injury types (acute, overuse, serious overuse) among evolved highly specialized athletes, exclusive highly specialized athletes, and low-moderately specialized athletes. DESIGN: Cross-sectional study. SETTING: Tertiary care pediatric sports medicine clinic between January 2015 and April 2019. PATIENTS OR OTHER PARTICIPANTS: A total of 1171 patients (age = 12.01-17.83 years, 59.8% female) who played ≥1 organized sports, presented with a sport-related injury, and completed a sports participation survey. MAIN OUTCOME MEASURE(S): Distribution of injury types (acute, overuse, serious overuse). RESULTS: The percentage of injuries due to overuse was similar between the exclusive and evolved highly specialized athletes (59.2% versus 53.9%; P = .28). Compared with low-moderately specialized athletes, exclusive and evolved highly specialized athletes had a higher percentage of overuse injuries (45.3% versus 59.2% and 53.9%, respectively; P = .001). Multivariate analysis of the highly specialized groups revealed sport type to be a significant predictor of a higher percentage of injuries due to overuse, with individual-sport athletes having increased odds of sustaining an overuse injury compared with team-sport athletes (odds ratio = 1.95; 95% CI = 1.17, 3.24). CONCLUSIONS: The distribution of injury types was similar between evolved and exclusive highly specialized youth athletes, with both groups having a higher percentage of injuries due to overuse compared with low-moderately specialized athletes. Among highly specialized athletes, playing an individual sport was associated with a higher proportion of overuse injuries compared with playing a team sport.

Knee, Low Back, and Shoulder Problems Among University and Professional Volleyball Players: Playing With Pain.

CONTEXT: The knee, low back, and shoulder account for most overuse injuries in volleyball. Previous researchers have used methodology that did not examine the extent of injury burden and effect on performance. OBJECTIVE: To develop a more accurate and complete understanding regarding the weekly prevalence and burden of knee, low back, and shoulder problems within the highest levels of men's volleyball, including the role that preseason complaints, match participation, player position, team, and age have on complaints. DESIGN: Descriptive epidemiology study. SETTING: Professional volleyball clubs and the National Collegiate Athletic Association Division I program. PATIENTS OR OTHER PARTICIPANTS: A total of 75 male volleyball players, representing 4 teams playing in their country's respective premier league (Japan, Qatar, Turkey, and the United States), participated over a 3-season period. MAIN OUTCOME MEASURE(S): Players completed a weekly questionnaire (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire) reporting pain related to their sport and the extent to which knee, low back, and shoulder problems affected participation, training volume, and performance. Problems leading to moderate or severe reductions in training volume or performance or the inability to participate were considered substantial problems. RESULTS: The mean weekly prevalence of knee, low back, and shoulder problems based on 102 player-seasons was 31% (95% CI = 28%, 34%), 21% (95% CI = 18%, 23%), and 19% (95% CI = 18%, 21%), respectively. Most players (93%, 95/102 player-seasons) reported some level of knee (79%, n = 81/102 player-seasons), low back (71%, n = 72/102 player-seasons), or shoulder (67%, n = 68/102 player-seasons) complaints during the season. Most players (58%, n = 59/102 player-seasons) experienced at least 1 episode of substantial problems affecting the knee (33%, n = 34/102 player-seasons), low back (27%, n = 28/102 player-seasons), or shoulder (27%, n = 28/102 player-seasons). Players with preseason complaints had more in-season complaints than teammates without preseason problems (mean weekly prevalence: knee, 42% versus 8%, t49 = -18.726, P < .001; low back, 34% versus 6%, t32 = -12.025, P < .001; shoulder, 38% versus 8%, t30 = -10.650, P < .001). CONCLUSION: Nearly all included elite male volleyball players experienced knee, low back, or shoulder problems, and most had at least 1 bout that substantially reduced training participation or sport performance. These findings suggest that knee, low back, and shoulder problems result in greater injury burden than previously reported.

Developing the Singapore youth shoulder overuse injury prevention program.

OBJECTIVES: To develop the Singapore Youth Shoulder Overuse Injury Prevention Program specifically for competitive overhead youth athletes in Singapore. DESIGN: Two-round online Delphi technique with experts and a feasibility assessment questionnaire with youth athletes who represented end-users. SETTING: Volleyball for youth athletes. PARTICIPANTS: Experts were recruited through purposive sampling based on their knowledge and experience. Youth athletes were recruited though a volleyball club. MAIN OUTCOME MEASURES: The main outcome measure was the level of consensus on the proposed (1) exercise program for the overhead youth athletes, (2) education program regarding overuse injuries for coaches of overhead youth athletes, and (3) education program regarding overuse injuries for overhead youth athletes. Consensus was set at 75% agreement in this study. RESULTS: Eighteen experts completed the two Delphi rounds with 100% response rate. Consensus was achieved for the exercise program and both education programs. Twelve youth athletes completed the feasibility assessment questionnaire and found the exercises to be feasible in terms of usefulness, practical use, instructions, duration, and ease of execution. CONCLUSION: Consensus was reached for the Singapore Youth Shoulder Overuse Injury Prevention Program, and feasibility of execution by end-users was successfully determined.

Gene expression of Postn and FGF7 in canine chordae tendineae and their effects on flexor tenocyte biology.

Chordae tendineae, referred to as heart tendinous cords, act as tendons connecting the papillary muscles to the valves in the heart. Their role is analogous to tendons in the musculoskeletal system. Despite being exposed to millions of cyclic tensile stretches over a human's lifetime, chordae tendineae rarely suffer from overuse injuries. On the other hand, musculoskeletal tendinopathy is very common and remains challenging in clinical treatment. The objective of this study was to investigate the mechanism behind the remarkable durability and resistance to overuse injuries of chordae tendineae, as well as to explore their effects on flexor tenocyte biology. The messenger RNA expression profiles of chordae tendineae were analyzed using RNA sequencing and verified by quantitative reverse transcription polymerase chain reaction  and immunohistochemistry. Interestingly, we found that periostin (Postn) and fibroblast growth factor 7 (FGF7) were expressed at significantly higher levels in chordae tendineae, compared to flexor tendons. We further treated flexor tenocytes in vitro with periostin and FGF7 to examine their effects on the proliferation, migration, apoptosis, and tendon-related gene expression of flexor tenocytes. The results displayed enhanced cell proliferation ability at an early stage and an antiapoptotic effect on tenocytes, while treated with periostin and/or FGF7 proteins. Furthermore, there was a trend of promoted tenocyte migration capability. These findings indicated that Postn and FGF7 may represent novel cytokines to target flexor tendon healing. Clinical significance: The preliminary discovery leads to a novel idea for treating tendinopathy in the musculoskeletal system using specific molecules identified from chordae tendineae.

Occurrence of injuries and illnesses in athletes with a physical impairment; a forty-week prospective cohort study.

OBJECTIVES: Currently, the knowledge about the epidemiology of sport-related health problems of athletes with a physical impairment is limited. Therefore, this study aims to describe the prevalence, incidence and severity of sport-related health problems of athletes with a physical impairment in the Netherlands over a one sport season. DESIGN: Prospective cohort study. METHODS: Athletes (n = 99) with a physical impairment participated in this study. After completing a baseline questionnaire, athletes started a 40-week health monitoring period, during which they completed the Dutch translation of the OSTRC Questionnaire on Health Problems every week. Based on the reported information, injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport and the total burden were calculated. RESULTS: A total of 368 health problems were reported by 95 athletes. These health problems consisted of 258 injuries and 110 illnesses. The average weekly prevalence of health problems was 48.0 %; for injuries 34.6 %, and illnesses 13.4 %. Differences were found when considering injury severity, with the highest severity scores for athletes with a limb deficiency. Furthermore, recreational athletes reported the highest injury severity scores, followed by athletes who competed nationally and athletes who competed internationally. CONCLUSIONS: Data from this study show a high average weekly prevalence of health problems, and differences amongst various impairment categories and sport levels when considering the severity of injuries. These results add to the knowledge regarding sport-related health problem epidemiology in this population, indicating that impairment category and sport level should be taken into account when developing injury prevention strategies.

The Effects of Injury Type on Health-Related Quality of Life in Youth Athletes: A Cross-Sectional Analysis.

OBJECTIVE: The relationship between health-related quality of life (HRQoL) and injury type has not been analyzed for young athletes. We hypothesized that there would be no difference in HRQoL between injured athletes, injured nonathletes, and normative data for healthy youth (NDHY) or among athletes with acute, overuse, or concussion injuries. DESIGN: Cross-sectional clinical cohort. SETTING: Primary care sports medicine clinics at 3 academic institutions. PARTICIPANTS: Patients aged 8 to 18 years presenting with injury. INDEPENDENT VARIABLES: Injury type and athletic participation. MAIN OUTCOME MEASURES: Health-related quality of life measured 1 month after injury through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 v2.0 assessed pain interference, peer relationships, depression, fatigue, anxiety, and mobility. One-way analysis of variance was performed with P values of <0.05 considered significant. Concussion Learning Assessment and School Survey (CLASS) evaluated academic performance. RESULTS: Three hundred fifty-seven patients (36% male), with average age of 14.2 years, completed HRQoL and CLASS surveys following injury. There were 196 overuse injuries (55%), 119 acute injuries (33%), and 42 concussions (12%). Ninety-four percent were athletes. Six percent were nonathletes; 90.5% of concussed patients reported grades worsening. Concussed athletes reported more fatigue (P = 0.008) compared with other injury types but no worse than NDHY. Athletes with overuse injuries had lower mobility (P = 0.005) than other injury types and NDHY. Patients with lower HRQoL were female, older age, or required surgery. No other domains had significant differences by injury type nor did HRQoL differ between the athletes, nonathletes, and NDHY. CONCLUSIONS: With the exception of injuries requiring surgery, HRQoL of injured young athletes was similar to NDHY in most domains.

Injuries and Factors Associated with Injuries Among U.S. Army Band Musicians.

The Department of Defense is the largest employer of full-time musicians. In the U.S. military, many musicians experience unique occupational exposures such as extended periods of standing, sitting, and marching for rehearsals and performances, static and non-neutral postures, and a variety of repetitive motions while playing instruments. These exposures are in addition to physical training and fitness standards required of U.S. Army soldiers. METHODS: An electronic survey was administered to active-duty U.S. Army Band musicians. The survey collected demographics, personal characteristics, Army Physical Fitness Test performance, occupational demands, health behaviors, and injuries from October 2017 to December 2018. Survey responses were combined with medical and physical fitness performance records. Descriptive statistics were reported and factors associated with injuries were investigated. RESULTS: There were 465 Army Band members in this population, with approximately half (49%) completing the survey. Most survey respondents (81%) reported an injury in the past year, which they predominantly attributed to overuse (54%). Leading reported activities resulting in injury included running for physical training (21%), repetitive movements while playing an instrument (11%), and standing while playing (11%). A majority of survey respondents (60%) also had a medical encounter for an injury. Factors significantly associated with injury among men were lower aerobic fitness and higher body fat percentage; additional unadjusted factors associated with injury among all Army Band soldiers included female sex, older age, and longer periods of marching and standing while playing. CONCLUSIONS: Injury prevention initiatives for Army Band musicians should focus on the reduction of overuse and repetitive motion injuries. Suggested prevention strategies include balanced physical training, ergonomic adjustments, rehearsal breaks, and leadership support for injury prevention efforts.

The effectiveness of telehealth gait retraining in addition to standard physical therapy treatment for overuse knee injuries in soldiers: a protocol for a randomized clinical trial.

INTRODUCTION: Running is the most common cardiovascular exercise in the military. However, there is a high incidence of running-related overuse injuries that reduces military readiness. Gait retraining is a common intervention to treat running-related injuries, but the high cost of equipment and lack of clinician expertise and availability reduces utilization. Gait retraining intervention in a telehealth format might improve feasibility. The purpose of this randomized clinical trial is to determine the effectiveness of a telehealth gait retraining intervention on pain, self-reported function, and biomechanical risk factors for injury in service members who present to a Military Health System physical therapy clinic with an overuse knee injury. METHODS: This is a parallel, two-arm, single-blind randomized clinical trial. The two independent variables are intervention (2 levels: telehealth gait retraining intervention with standard of care or only standard of care) and time (3 levels: baseline, 10 weeks or post-intervention, 14 weeks). Participants between the ages of 18 to 60 years will be included if they report knee pain during and/or after running to be anywhere from a 3 to a 7 on the numerical pain rating scale and demonstrate a rearfoot strike pattern. The primary dependent variables are as follows: (1) pain (worst pain during and/or after running) and (2) foot strike pattern (conversion rate from rearfoot to non-rearfoot foot strike pattern during running). Secondary outcomes include patient self-reported function and running biomechanics. DISCUSSION: The effectiveness of a telehealth gait retraining intervention to reduce pain and modify foot strike pattern is not known. The results of this study may help determine the effectiveness and feasibility of a telehealth gait retraining intervention to reduce pain, change foot strike, improve function, and improve running gait biomechanics. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04269473 . Registered 05 February 2020.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB).

INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density. METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up. ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications. TRIAL REGISTRATION NUMBER: NCT05587270.

Blocking CCN2 Reduces Established Palmar Neuromuscular Fibrosis and Improves Function Following Repetitive Overuse Injury.

The matricellular protein cell communication factor 2/connective tissue growth factor (CCN2/CTGF) is critical to development of neuromuscular fibrosis. Here, we tested whether anti-CCN2 antibody treatment will reduce established forepaw fibro-degenerative changes and improve function in a rat model of overuse injury. Adult female rats performed a high repetition high force (HRHF) task for 18 weeks. Tissues were collected from one subset after 18 wks (HRHF-Untreated). Two subsets were provided 6 wks of rest with concurrent treatment with anti-CCN2 (HRHF-Rest/anti-CCN2) or IgG (HRHF-Rest/IgG). Results were compared to IgG-treated Controls. Forepaw muscle fibrosis, neural fibrosis and entheseal damage were increased in HRHF-Untreated rats, compared to Controls, and changes were ameliorated in HRHF-Rest/anti-CCN2 rats. Anti-CCN2 treatment also reduced phosphorylated-ß-catenin (pro-fibrotic protein) in muscles and distal bone/entheses complex, and increased CCN3 (anti-fibrotic) in the same tissues, compared to HRHF-Untreated rats. Grip strength declines and mechanical sensitivity observed in HRHF-Untreated improved with rest; grip strength improved further in HRHF-Rest/anti-CCN2. Grip strength declines correlated with muscle fibrosis, entheseal damage, extraneural fibrosis, and decreased nerve conduction velocity, while enhanced mechanical sensitivity (a pain-related behavior) correlated with extraneural fibrosis. These studies demonstrate that blocking CCN2 signaling reduces established forepaw neuromuscular fibrosis and entheseal damage, which improves forepaw function, following overuse injury.