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Objective To describe the injury mechanism and its association with magnetic resonance imaging (MRI) injury findings in acute rectus femoris injuries. Design Combined retrospective and prospective descriptive injury study. Retrospective cohort from January 2010 to October 2013 and prospective cohort from October 2013 to January 2019. Setting Specialized sports medicine hospital. Participants Male professional football players older than 18 years playing in a national football league, referred for injury assessment within 7 days after an acute rectus femoris injury, with a positive finding on MRI. Independent variables Rectus femoris muscle injury MRI findings in relation to injury mechanism in male football players. Main outcome measures Rectus femoris injury mechanism (kicking, sprinting, and others), MRI injury location, and grade. Results There were 105 injuries in total, with 60 (57.1%) and 45 (42.8%) injuries from the retrospective and prospective cohorts, respectively. Kicking was the injury mechanism in 57 (54.3%) of all acute rectus femoris injuries, sprinting represented 32 (30.4%), and 16 (15.2%) were classified as others. There were 20 (19.05%) free tendon, 67 (63.8%) myotendinous junction and/or intramuscular tendon, and 18 (17.1%) peripheral myofascial located injuries. All free tendon injuries were related to kicking and graded as a complete tear of at least one of the tendons in 15/20 (75.0%) cases. Conclusions Kicking seems to be an important mechanism related to complete ruptures and injuries occurring at the proximal free tendon. Sprinting was the other most common mechanism but was never associated with injury to the proximal free tendon.

ObjectivesThis study assessed knowledge, beliefs and practices of elite female footballers regarding injury prevention.MethodsA survey was sent to players participating in the FIFA Women’s World Cup France 2019. Questions covered three injury prevention domains: (1) knowledge; (2) attitudes and beliefs; (3) prevention practices in domestic clubs. Additionally, ACL injury history was assessed.ResultsOut of 552 players, 196 women responded (35.5%). More than 80% of these considered injury risk to be moderate or high. Players listed knee, ankle, thigh, head and groin as the most important injuries in women’s football. The most important risk factors identified were low muscle strength, followed by poor pitch quality, playing on artificial turf, too much training, reduced recovery and hard tackles. In these elite players, 15% did not have any permanent medical staff in their domestic clubs, yet more than 75% had received injury prevention advice and more than 80% performed injury prevention exercises in their clubs. Players identified the two most important implementation barriers as player motivation and coach attitude. Two-thirds of players used the FIFA 11+ programme in their clubs.ConclusionsThis diverse group of elite players demonstrated good knowledge of risk level and injury types in women’s football. Of the risk factors emphasised by players, there was only one intrinsic risk factor (strength), but several factors out of their control (pitch quality and type, training volume and hard tackles). Still players had positive attitudes and beliefs regarding injury prevention exercises and indicated a high level of implementation, despite a lack of medical support.

This study aimed to determine if sleep quality and psychological factors were associated with time to meet the discharge criteria to return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) among athletes. A cohort-study design included 89 athletes following ACL-R. Each participant completed a battery of questionnaires at 6 different time points: within 3 days of injury occurrence and at post-surgery (1.5 m, 3 m, 4.5 m, 6 m and when discharge criteria were met). Assessment included sleep quality and quantity, symptoms of depression, anxiety, stress, psychological readiness to RTS and fear of re-injury. The primary outcome was the time needed to meet all discharge criteria to RTS. Sleep parameters and psychological factors were not associated with time to meet the discharge criteria to RTS. However, athletes that had lower scores of anxiety (OR 1.2 (95% CI 1.0, 1.3) and insomnia (OR 1.2 (95% CI 1.0, 1.3) at baseline were more likely to meet the RTS discharge criteria. Athletes with better sleep quality at 3m, 4.5m and 6m were more likely to meet the RTS discharge criteria OR 1.3 (95% CI 1.1, 1.7), 2.0 (95% CI 1.1–3.4) and 1.4 (95% CI 1.0, 1.9) respectively. Sleep quality and psychological factors were not associated with time to meet the discharge criteria to RTS but impacted whether athletes adhered and completed their rehabilitation program or not. Monitoring sleep quality and psychological factors of athletes before and following ACL-R surgery is important to identify athletes who could have difficulties in adhering to and completing their rehabilitation program to RTS.

Context Arbitrary asymmetry thresholds are regularly used in professional soccer athletes, notwithstanding the sparse literature available to examine their prevalence. Objective To establish normative and positional asymmetry values for commonly used screening tests and investigate their relationships with jumping performance. Design Cross-sectional study. Setting Elite soccer screening. Patients or Other Participants A total of 203 professional male soccer players. Main Outcome Measure(s) Bilateral and unilateral jumping; range of motion; and hamstrings (HAM), quadriceps (QUAD), and hip-adductor and -abductor strength tests were used to quantify asymmetry. Players were divided into 4 quartiles (Q1–Q4) based on the magnitude of their asymmetry for each test. Single composite scores were also developed to group tests by range of motion and HAM, QUAD, hip-adduction, and hip-abduction strength, and differences in jump performance were examined among players in each quartile. Results Large variability (range = 5.2%–14.5%) was evident in asymmetry scores across the different tests and physical qualities. Forwards displayed greater asymmetry in concentric quadriceps and eccentric hip-abduction strength (P < .05). The HAM and QUAD composite scores indicated that Q4 players' jumps were shorter than those in other quartiles during a single-legged countermovement jump and 10-second hop (P < .05). No decrements in unilateral jump performance were shown among players in each quartile for range of motion or hip-adduction and -abduction strength, and no composite measures of asymmetry affected bilateral jump performance. Conclusions No single asymmetry threshold was present for all tests; the outcomes were task, variable, and population specific. Larger asymmetries in HAM and QUAD strength appeared to be detrimental to unilateral jump performance.

In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3–1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1–1.4]) and hip/groin (RR 1.9 [95% CI 1.3–2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1–3.2]; youths RR 1.5 [95% CI 1.26–1.67]; professionals RR 1.3 [95% CI 1.14–1.46]). Both males (RR 1.5 [95% CI 1.33–1.68)] and females (RR 1.5 [95% CI 1.14–1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.

Objectives: Examine growth and maturation trends in dynamic balance using the anterior reach Y-Balance test, and its utility as an injury risk screening tool. \ud Design: Cross sectional and prospective cohort.\ud Setting: Elite male youth soccer players.\ud Participants: 346 players grouped as pre, circa or post peak height velocity (PHV). \ud Main outcome measures: Pre-season anterior reach absolute and relative Y-Balance test scores and seasonal prospective lower extremity injury monitoring.\ud Results: Absolute reach distances were greatest post-PHV (p < 0.05). Relative to leg length, pre-PHV achieved the highest scores and increased between-limb differences. Significant associations between injury and anterior reach scores were present in pre (OR: 0.94, CI: 0.91 - 0.98, p < 0.05) and circa-PHV (OR: 1.05, 95% CI: 1.05 – 1.10, p < 0.05). Increased age (OR: 1.49, 95% CI: 1.04 – 2.13, p < 0.05) and height (OR: 1.06, 95% CI: .99 – 1.13, p = 0.82) were risk factors post-PHV. No differences in injury occurrence were shown between players with absolute reach difference > 4 cm in any group.\ud Conclusions: Anterior reach scores increased injury risk, but associations were small and inconsistent. The Y-Balance should be used with caution as a screening tool in this cohort.

Introduction: Physeal injuries have been overlooked in epidemiological research in youth sports. Our prospective study investigated the incidence, severity, and burden of physeal injuries in a youth elite football academy. Methods: In total, 551 youth male football players from under-9 to under-19 were included and observed over four consecutive seasons. Injuries involving the physis were diagnosed and recorded according to type, location, and diagnosis. Injury incidence (II), severity (days lost), and injury burden (IB) were calculated per squad per season (25 players/squad). Results: There were 307 physeal injuries: 262 apophyseal (85%), 26 physeal (9%), 2 epiphyseal (1%), and 17 other physeal injuries (5%) with 80% (n=245) causing time-loss. The overall mean incidence of time-loss physeal injuries was 6 injuries/squad-season, leading to a total of 157 days lost/squad-season. The U-16s had the highest burden with 444 days lost per squad-season [median: 20 (95% CI: 12–30) days; II: 10 (95% CI: 7.3.1–13.4)]. Apophyseal injuries of the hip–pelvis resulted in the greatest burden [median: 13 (95% CI: 10–17); II: 2.5 (95% CI: 2.1–3.0)]. Peak apophyseal injury incidence per body parts occurred in U-11 for foot–ankle (II: 2.4; 95% CI: 1.0–4.9), U-14 for knee (II: 4.5; 95% CI: 2.7–7.1), and U-17 for hip–pelvis (II: 6.4; 95% CI: 4.2–9.3). Conclusion: Physeal injuries accounted for a quarter of all-time loss with the largest injury burden in U-16. Most physeal injuries involved the lower limb and affected the apophysis. Physeal and apophyseal injuries incidence, burden, and pattern vary substantially depending on age. Hip–pelvic apophyseal injuries accounted for the largest injury burden.

Background: Groin pain is a high incidence and prevalence injury in multidirectional field sports such as soccer, ice hockey, rugby and Australian football codes. Long-standing adductor-related groin pain is a persistent clinical condition and a frequent complaint in athletes involved in sports that require multiplanar movement patterns (change of direction, high-speed sprinting and kicking). To date, the lack of rehabilitation guidelines and return-to-play criteria makes this clinical entity difficult to manage. The aim of the present Delphi was to define, based on expert opinion and practical experience, the criteria used in clinical practice to establish a safe return-to-play in multidirectional sports in athletes suffering from long-standing adductor-related groin pain. Methods: 40 experts were invited to fill a 3-Round Delphi questionnaire. In round 1, open-ended and closed questions about 9 different sections (palpation, flexibility, strength, patient-reported outcome measures, imaging, intersegmental control, performance tests, sport-specific skills, training load) were proposed to investigate return to play evaluation criteria used by each expert. Responses were analysed and coded to produce round 2 questionnaire that investigated only the sections and the items that reached the cut-off value (≥70%). Round 3 questionnaire was based on sections and items that reached cut-off value in previous rounds and experts rated their agreement for return to play criteria with a 5-point Likert Scale. Descriptive statistics enabled interpretation of consensus.Results: High participation rate (80%) and response rate across the 3 rounds (100%) were recorded. 6 sections reached positive consensus in round 1, 1 section reached negative consensus. In round 2 positive consensus was confirmed only for 3 sections and negative consensus for 1 section. In round 3, positive agreement was established for strength (3 items), performance tests (3 items) and sport-specific skills (2 items) sections. Negative consensus was confirmed for imaging section.Conclusion: Despite most of items did not reach cut-off values, a solid positive consensus between experts was reached for strength, performance tests and sport-specific skills sections and a solid negative consensus was obtained for imaging section. These findings could be a useful practical tool for clinicians in the return-to-play continuum.

Background Subjective monitoring of rate of perceived exertion is common practice in many sports. Typically, the information is used to understand the training load and at times modify forthcoming sessions. Identifying the relationship between the athlete and coach’s interpretation of training would likely further benefit understanding load management. The aim of this systematic review was to evaluate the relationship between coaches’ rating of intended exertion (RIE) and/or rating of observed exertion (ROE) and athletes’ reported rating of perceived exertion (RPE). Methods The review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a search of Medline, Google Scholar, Science Direct, SPORTDiscus, and Web of Science databases. We assessed the correlation between coach-reported RIE and/or ROE and RPE. Assessment for risk of bias was undertaken using the Quality Appraisal for Reliability Studies (QAREL) checklist. Inclusion criteria were (1) male and/or female individuals, (2) individual and/or team sport active participants, and (3) original research article published in the English language. Results Data from 19 articles were found to meet the eligibility criteria. A random effect meta-analysis based on 11 studies demonstrated a positive association of player vs. coach rating of RIE (r = 0.62 [95% CI 0.5 to 0.7], p < 0.001). The pooled correlation from 7 studies of player vs. coach rating on ROE was r = 0.64 95% CI (0.5 to 0.7), p < 0.001. Conclusion There was a moderate to high association between coach RIE and/or ROE and athlete-reported RPE and this association seems to be influenced by many factors. The suggestions we present in this review are based on imploring practitioners to consider a multi-modal approach and the implications of monitoring when using RPE. Trial Registration CRD42020193387

ObjectiveInvestigate the incidence and burden of injuries by age group in youth football (soccer) academy players during four consecutive seasons.MethodsAll injuries that caused time-loss or required medical attention (as per consensus definitions) were prospectively recorded in 551 youth football players from under 9 years to under 19 years. Injury incidence (II) and burden (IB) were calculated as number of injuries per squad season (s-s), as well as for type, location and age groups.ResultsA total of 2204 injuries were recorded. 40% (n=882) required medical attention and 60% (n=1322) caused time-loss. The total time-loss was 25 034 days. A squad of 25 players sustained an average of 30 time-loss injuries (TLI) per s-s with an IB of 574 days lost per s-s. Compared with the other age groups, U-16 players had the highest TLI incidence per s-s (95% CI lower-upper): II= 59 (52 to 67); IB=992 days; (963 to 1022) and U-18 players had the greatest burden per s-s: II= 42.1 (36.1 to 49.1); IB= 1408 days (1373 to 1444). Across the cohort of players, contusions (II=7.7/s-s), sprains (II=4.9/s-s) and growth-related injuries (II=4.3/s-s) were the most common TLI. Meniscus/cartilage injuries had the greatest injury severity (95% CI lower-upper): II= 0.4 (0.3 to 0.7), IB= 73 days (22 to 181). The burden (95% CI lower-upper) of physeal fractures (II= 0.8; 0.6 to 1.2; IB= 58 days; 33 to 78) was double than non-physeal fractures.SummaryAt this youth football academy, each squad of 25 players averaged 30 injuries per season which resulted in 574 days lost. The highest incidence of TLI occurred in under-16 players, while the highest IB occurred in under-18 players.

There is evidence that a number of medical conditions and co-morbidities are associated with obesity in young children. This review explored whether there is evidence of associations with other conditions or co-morbidities. Observational studies of young children (mean age < 10 years) were identified using electronic searches of five databases (MEDLINE, Embase, CINAHL, AMED and SPORTDiscus). Of 27 028 studies screened, 41 (comprising 44 comparisons) met the inclusion criteria. These studies provided data on five distinct diseases/conditions: asthma (n = 16), vitamin D deficiency (n = 10), iron deficiency (n = 10), allergies (n = 4) and flat-footedness (n = 4). Thirty-two studies were appropriate for meta-analysis using random-effects models, and revealed obesity was significantly associated with having asthma (OR 1.5, 95% CI 1.3-1.7), vitamin D deficiency (OR 1.9, 95% CI 1.4-2.5) and iron deficiency (OR 2.1, 95% CI 1.4-3.2). Heterogeneity (I2 ) ranged from 57% to 61%. Narrative synthesis was conducted for all studies. There was no evidence of a consistent association between obesity in young children and eczema, dermatitis or rhinitis due to the low number of studies. However, there was an association with flat-footedness. These results have implications for health policy and practice and families. Further research leading to a greater understanding of the associations identified in this review is suggested.

BackgroundThe 9+ screening battery test consists of 11 tests to assess limitations in functional movement.AimTo examine the association of the 9+ with lower extremity injuries and to identify a cut-off point to predict injury risk.MethodsProfessional male football players in Qatar from 14 teams completed the 9+ at the beginning of the 2013/2014 and 2014/2015 seasons. Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff during these seasons. Univariate and multivariate Cox regression analyses were used to calculate HR and 95% CI. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity and identify the optimal cut-off point for risk assessment.Results362 players completed the 9+ and had injury and exposure registration. There were 526 injuries among 203 players (56.1%) during the two seasons; injuries to the thigh were the most frequent. There was no association between 9+ total score and the risk of lower extremity injuries (HR 1.02, 95% CI 0.99 to 1.05, p=0.13), even after adjusting for other risk factors in a multivariate analysis (HR 1.01, 95% CI 0.98 to 1.04, p=0.37). ROC curve analysis revealed an area under the curve of 0.48, and there was no cut-off point that distinguished injured from non-injured players.ConclusionThe 9+ was not associated with lower extremity injury, and it was no better than chance for distinguishing between injured and uninjured players. Therefore, the 9+ test cannot be recommended as an injury prediction tool in this population.

BackgroundThe association between bone mineral density (BMD) and serum25-hydroxyvitamin D (25(OH)D) concentration is weak, particularly in certain races (eg, BlackAfrican vs Caucasian) and in athletic populations. We aimed to examine if bioavailable vitamin D rather than serum 25(OH)D was related to markers of bone health within a racially diverse athletic population.MethodsIn 604 male athletes (Arab (n=327), Asian (n=48), Black (n=108), Caucasian (n=53) and Hispanic (n=68)), we measured total 25(OH)D, vitamin D-binding protein and BMD by DXA. Bioavailable vitamin D was calculated using the free hormone hypothesis.ResultsFrom 604 athletes, 21.5% (n=130) demonstrated severe 25(OH)D deficiency, 37.1% (n=224) deficiency, 26% (n=157) insufficiency and 15.4% (n=93) sufficiency. Serum 25(OH)D concentrations were not associated with BMD at any site. After adjusting for age and race, bioavailable vitamin D was associated with BMD (spine, neck and hip). Mean serum vitamin D binding protein concentrations were not associated with 25(OH)D concentrations (p=0.392).ConclusionRegardless of age or race, bioavailable vitamin D and not serum 25(OH)D was associated with BMD in a racially diverse athletic population. If vitamin D screening is warranted, clinicians should use appropriate assays to calculate vitamin D binding protein and bioavailable vitamin D levels concentrations than serum 25(OH)D. In turn, prophylactic vitamin D supplementation to ‘correct’ insufficient athletes should not be based on serum 25(OH)D measures.

Background/AimGroin injury epidemiology has not previously been examined in an entire professional football league. We recorded and characterised time loss groin injuries sustained in the Qatar Stars League.MethodsMale players were observed prospectively from July 2013 to June 2015. Time loss injuries, individual training and match play exposure were recorded by club doctors using standardised surveillance methods. Groin injury incidence per 1000 playing hours was calculated, and descriptive statistics used to determine the prevalence and characteristics of groin injuries. The Doha agreement classification system was used to categorise all groin injuries.Results606 footballers from 17 clubs were included, with 206/1145 (18%) time loss groin injuries sustained by 150 players, at an incidence of 1.0/1000 hours (95% CI 0.9 to 1.1). At a club level, 21% (IQR 10%–28%) of players experienced groin injuries each season and 6.6 (IQR 2.9–9.1) injuries were sustained per club per season. Of the 206 injuries, 16% were minimal (1–3 days), 25% mild (4–7 days), 41% moderate (8–28 days) and 18% severe (>28 days), with a median absence of 10 days/injury (IQR 5–22 days). The median days lost due to groin injury per club was 85 days per season (IQR 35–215 days). Adductor-related groin pain was the most common entity (68%) followed by iliopsoas (12%) and pubic-related (9%) groin pain.ConclusionGroin pain caused time loss for one in five players each season. Adductor-related groin pain comprised 2/3 of all groin injuries. Improving treatment outcomes and preventing adductor-related groin pain has the potential to improve player availability in professional football.

Study Design: Cross-sectional Observational Cohort Study. Level of Evidence: 3.Objectives: Document kicking loads of professional soccer players in match play, and describe differences in velocity-...

Introduction: Selection of younger athletes for advanced training in elite sport is assumed to be based on identification of innate talent. Previous researchers have identified relative age effects to influence these selection processes; however, maturation status and skeletal age effects, which have the potential to be a greater influence, have not been widely examined.Methods: Skeletal age (categorising athletes as: early maturing, on time, or late maturing via wrist and hand X-ray and Fels classification) and birth quarter are documented for 472 boys from Elite Youth football academies and compared to reference normative data to assess their effect on academy selection.Results: It is seen that maturation status has a much stronger influence – approximately 10-fold – on selection with a systematic over-representation of early maturing athletes in elite football academies, an effect that increases with age.Conclusions: Our results demonstrate that athletes are being chosen in large by their matur...

The present investigation was carried out to examine the incidence and pattern of injuries in adolescent multisport athletes from youth sports academy. Injury data were prospectively collected from 166 athletes during the seasons from 2009 to 2014. A total of 643 injuries were identified, 559 (87.0%) were time-loss injuries. The overall injury incidence was 5.5 (95% confidence interval CI: 5.1-6.0), the incidence of time-loss injuries was 4.8 (95% CI: 4.4-5.2), the incidence of growth conditions was 1.2 (95% CI: 1.0-1.4) and incidence of serious injuries was 0.6 (95% CI: 0.5-0.8) per 1000 h of exposure. The prevalence of overuse injuries was 50.3%. Growth conditions represented 20.0%. Most of the injuries (67.0%) involved the lower extremities, and both foot and ankle were the most predominant injured body parts (22.0%). Knee injuries were mostly from overuse (50 vs. 23, p = .02), whereas foot and ankle injuries resulted from an acute mechanism (94 vs. 31, p .0001). Minor and moderate injuries accounted for 87.0%. Muscle, tendon and osteochondrosis injuries accounted for 52.0% of all injuries. Comparing groups, squash sport was having the highest injury incidence (8.5 injuries per athlete). Higher exposure was associated with greater overuse relative risk (RR = 1.03, 95% CI: 1.01-1.014, p .001). In conclusion, the results of this study identified a high incidence of injuries in this youth sports population. Striking was the prevalence of overuse injuries of 50%, which suggests the need for injury prevention protocols for adolescent highly trained athletes.

The present study examined the effects of religion and spirituality practices and beliefs on emotional and psychological outcomes among professional athlete with anterior cruciate ligaments (ACL) injury. Methods: A sample of professional athletes (n = 50) with ACL injury and prior to surgery participated in this study. Participants completed Brief Cope Inventory (BCI) and Depression Anxiety & Stress Scale (DASS 21). From the responses to specific items related to religion and spirituality, participants were classified as high or low in religious/spiritual belief (RSH or RSL respectively); and as high and low in their praying/meditation practice (PMH or PML respectively). Results: RSH participants reported better scores on overall coping 8.3 ± 11.4, acceptance 6.7 ± 1.7, self-distraction 6.2 ± 1.8, use of emotional support 6.9 ± 1.5. Reduced depression 10.6 ± 13.0, anxiety 14.0 ± 18.6 and stress 8.6 ± 14.2 compared to RSL (p ≤ 0.05). PMH group had better scores on overall coping 84.0 ± 11.8 and use of emotional support 6.9 ± 1.6 compared to PML P = 0.004 and P = 0.007 respectively. Conclusion: The results of this study suggest that belief and practice of religion/spirituality play a central role in the processes of reconstructing the coping strategies and reducing depression, anxiety and stress.

Injuries are common in elite adolescent athletics, but few studies have addressed risk factors for injury. Growth and maturation are potential risk factors in this population; however, the current body of literature is both inconclusive and considered at high risk of bias. The aim of this study was therefore to examine whether growth rate, maturity status, and maturity tempo are associated with injury risk in an elite sports academy. Anthropometric, skeletal maturity and injury data collected prospectively over four seasons (117 athlete-seasons) were included in the analyses. Growth rate for stature was associated with greater risk of bone (incidence rate ratio (IRR): 1.5 per one standard deviation increase above the mean; 95% CI: 1.1-1.9) and growth plate injuries (IRR: 2.1; 1.5-3.1). Growth rate for leg length was associated with greater overall injury risk (IRR: 1.3; 1.0-1.7) as well as the risk of bone (IRR: 1.4; 1.0-1.9) and growth plate injuries (IRR: 2.1; 1.4-3.0). Athletes with greater skeletal maturity, expressed as skeletal age (IRR: 0.6 per year; 0.5-0.9) and percentage of predicted mature height (IRR: 0.8 per percent increase; 0.7-1.0), were less prone to growth plate injuries. Rate of change in skeletal age was associated with an increased risk of bone injuries (IRR: 1.5; 1.0-2.3). The results of this study suggest that rapid growth in stature and leg length, skeletal maturity status, and maturity tempo represent risk factors for certain injury types in adolescent athletics.

Background The Nine Plus screening battery test (9+) is a functional movement test intended to identify limitations in fundamental movement patterns predisposing athletes to injury. However, the interseason variability is unknown. Aim To examine the variability of the 9+ test between 2 consecutive seasons in professional male football players. Methods Asymptomatic Qatar Star League players (n= 220) completed the 9+ at the beginning of the 2013 and 2014 seasons. Time-loss injuries in training and matches were obtained from the Aspetar Injury and Illness Surveillance Program. No intervention was initiated between test occasions. Results A significant increase in the mean total score of 1.6 points (95% CI 1.0 to 2.2, p

Background: A hamstring strain injury (HSI) has become the most common noncontact injury in soccer. Isokinetic muscle strength deficits are considered a risk factor for HSIs. However, underpowered studies with small sample sizes unable to determine small associations have led to inconclusive results regarding the role of isokinetic strength and strength testing in HSIs. Purpose: To examine whether differences in isokinetic strength measures of knee flexion and extension represent risk factors for hamstring injuries in a large cohort of professional soccer players in an adequately powered study design. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 614 professional soccer players from 14 teams underwent isokinetic strength testing during preseason screening. Testing consisted of concentric knee flexion and extension at 60 deg/s and 300 deg/s and eccentric knee extension at 60 deg/s. A clustered multiple logistic regression analysis was used to identify variables associated with the risk of HSIs. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity. Results: Of the 614 players, 190 suffered an HSI during the 4 seasons. Quadriceps concentric strength at 60 deg/s (odds ratio [OR], 1.41; 95% CI, 1.03-1.92; P = .03) and hamstring eccentric strength at 60 deg/s (OR, 1.37; 95% CI, 1.01-1.85; P = .04) adjusted for bodyweight were independently associated with the risk of injuries. The absolute differences between the injured and uninjured players were 6.9 N·m and 9.1 N·m, with small effect sizes ( d < 0.2). The ROC analyses showed an area under the curve of 0.54 and 0.56 for quadriceps concentric strength and hamstring eccentric strength, respectively, indicating a failed combined sensitivity and specificity of the 2 strength variables identified in the logistic regression models. Conclusion: This study identified small absolute strength differences and a wide overlap of the absolute strength measurements at the group level. The small associations between lower hamstring eccentric strength and lower quadriceps concentric strength with HSIs can only be considered as weak risk factors. The identification of these risk factors still does not allow the identification of individual players at risk. The use of isokinetic testing to determine the association between strength differences and HSIs is not supported.

The workplace is an ideal setting to implement an effective health-promoting program. Insufficient information exists regarding the motivators and barriers to physical activity among working adults in Qatar. Therefore, this study aimed to identify the motivators and barriers to physical activity among adults in a healthcare setting. This cross-sectional study was conducted in an orthopaedic and sports medicine hospital. The participants were Qatari and non-Qatari adult staff (n = 100), who were recruited by word of mouth. They filled out self-administered questionnaires consisting of questions on age, gender, nationality, medical conditions, and the motivators (external, health/medical, and engagement) and barriers (personal, perceptual, and time constraint) to participating in physical activity. The characteristics of participants were: Age (

Background: Hamstring injuries remain a significant injury burden in sports such as soccer that involve high-speed running. It has repeatedly been identified as the most common noncontact injury in elite male soccer, representing 12% of all injuries. As the incidence of hamstring injuries remains high, investigations are aimed at better understanding how to prevent hamstring injuries. Stretching to improve flexibility is commonly used in elite-level sports, but risk factor studies have reported contradicting results, leading to unclear conclusions regarding flexibility as a risk factor for hamstring injuries. Purpose: To investigate the association of lower limb flexibility with the risk of hamstring injuries in professional soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: All teams (n = 18) eligible to compete in the premier soccer league in Qatar (Qatar Stars League [QSL]) underwent a comprehensive musculoskeletal assessment during their annual periodic health evaluation at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar. Variables included passive knee extension and ankle dorsiflexion range of motion. A clustered multivariate Cox regression analysis was used to identify associations with the risk of hamstring injuries. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity. Results: A total of 438 unique players (72.4% of all QSL players) competed for 601 player-seasons (148 players competed both seasons) and sustained 78 hamstring injuries. Passive knee extension range of motion (hazard ratio [HR], 0.97 [95% CI, 0.95-0.99]; P = .008) and ankle dorsiflexion range of motion (HR, 0.93 [95% CI, 0.88-0.99]; P = .02) were independently associated with the injury risk. The absolute differences between the injured and uninjured players were 1.8° and 1.4 cm, respectively, with small effect sizes ( d < 0.2). The ROC curve analyses showed an area under the curve of 0.52 for passive knee extension and 0.61 for ankle dorsiflexion, indicating failed to poor combined sensitivity and specificity of the 2 strength variables identified in the multivariate Cox regression analysis. Conclusion: This study identified deficits in passive hamstring and ankle dorsiflexion range of motion as weak risk factors for a hamstring injury. These findings have little clinical value in predicting the risk of future hamstring injuries, and test results must therefore be interpreted cautiously in athletic screening.

Background: Musculoskeletal hip/groin screening tests are commonly performed to detect at-risk individuals. Bony hip morphology is considered a potential intrinsic risk factor but has not been examined prospectively. Purpose: To evaluate the association between intrinsic risk factors identified from musculoskeletal and radiographic screening tests and hip/groin injuries leading to time loss from training and/or match play in professional male soccer players. Study Design: Prospective cohort study; Level of evidence, 2. Methods: Male professional soccer players, aged ≥18 years, underwent screening specific for hip/groin pain during 2 consecutive seasons of the Qatar Stars League. The screening battery included pain provocation, range of motion, and strength tests as well as a hip radiographic examination. The radiographic examination included an anteroposterior pelvic view and 45° Dunn view, with bony hip morphology determined using quantitative methods. Time-loss (≥1 day) hip/groin injuries and individual player exposure (training and match play) were recorded prospectively, and injuries were categorized as adductor-related, inguinal-related, iliopsoas-related, pubic-related, or hip-related groin pain, or “other,” as recommended in the Doha agreement. We calculated hazard ratios (HRs) from univariate and multivariate Cox regression models to assess the relationship between potential risk factors and hip/groin injuries. Results: There were 438 players, completing 609 player seasons, and 113 hip/groin injuries that met the criteria for inclusion, with 85 injuries categorized as adductor-related. The proportion of players with bony morphological variants was the following: cam, 71%; pincer, 5%; and acetabular dysplasia, 13%. Previous hip/groin injuries (HR, 1.8; 95% CI, 1.2-2.7) and eccentric adduction strength were associated with the risk of hip/groin injuries. Higher (>1 SD above the mean) than normal eccentric adduction strength was associated with an increased risk for all hip/groin injuries (HR, 1.6; 95% CI, 1.0-2.5). Lower (Conclusion: Previous groin injuries and eccentric adduction strength were associated with the risk of groin injuries. However, these associations were not strong enough to identify an “at-risk” individual, and therefore, musculoskeletal screening tests were not useful to dictate individualized prevention strategies. Bony hip morphology was not associated with the risk of groin injuries.

Background: Lower extremity muscle strength tests are commonly used to screen for injury risk in professional soccer. However, there is limited evidence on the ability of such tests in predicting future injuries. Purpose: To examine the association between hip and thigh muscle strength and the risk of lower extremity injuries in professional male soccer players. Study Design: Case-control study; Level of evidence, 3. Methods: Professional male soccer players from 14 teams in Qatar underwent a comprehensive strength assessment at the beginning of the 2013/2014 and 2014/2015 seasons. Testing consisted of concentric and eccentric quadriceps and hamstring isokinetic peak torques, eccentric hip adduction and abduction forces, and bilateral isometric adductor force (squeeze test at 45°). Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff throughout each season. Univariate and multivariate Cox regression analyses were used to calculate hazard ratios (HRs) with 95% CIs. Results: In total, 369 players completed all strength tests and had registered injury and exposure data. Of these, 206 players (55.8%) suffered 538 lower extremity injuries during the 2 seasons; acute muscle injuries were the most frequent. Of the 20 strength measures examined, greater quadriceps concentric peak torque at 300 deg/s (HR, 1.005 [95% CI, 1.00-1.01]; P = .037) was the only strength measure identified as significantly associated with a risk of lower extremity injuries in multivariate analysis. Greater quadriceps concentric peak torque at 60 deg/s (HR, 1.004 [95% CI, 1.00-1.01]; P = .026) was associated with the risk of overuse injuries, and greater bilateral adductor strength adjusted for body weight (HR, 0.75 [95% CI, 0.57-0.97; P = .032) was associated with a lower risk for any knee injury. Receiver operating characteristic curve analyses indicated poor predictive ability of the significant strength variables (area under the curve, 0.45-0.56). Conclusion: There was a weak association with the risk of lower extremity injuries for 2 strength variables: greater quadriceps concentric muscle strength at (1) high and (2) low speeds. These associations were too small to identify an “at-risk” player. Therefore, strength testing, as performed in the present study, cannot be recommended as a screening test to predict injuries in professional male soccer.

Objective. To examine the association between obesity and cognitive function in healthy premenopausal women. Methods. From a cohort of 220 women, 98 were randomly selected that provided complete data. Body composition was examined by dual-energy X-ray scan. All participants completed the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess cognitive performance in three domains: attention, memory, and planning executive function. The Reaction Time (RTI) test was used to assess motor and mental response speeds; the Stockings of Cambridge (SOC) test was used to assess planning executive function. For memory assessment, the Delayed Match to Sample (DMS), Pattern Recognition Memory (PRM), and Spatial Span (SSP) tests were used to assess forced choice recognition memory, visual pattern recognition memory, and working memory capacity, respectively. Results. 36 (36.7%) were morbidly obese, 22 (22.4%) obese, and 23 (23.5%) overweight. Performance on RTI and SOC planning ability were not associated with body mass index (BMI). DMS mean time to correct response, when stimulus is visible or immediately hidden (0 ms delay), was higher by 785 ± 302 ms (milliseconds) (p=0.011) and 587 ± 259 ms (p=0.026) in morbidly obese women compared to normal weight women. Memory span length was significantly lower in overweight (5.5 ± 1.3, p=0.008) and obese women (5.6 ± 1.6, p=0.007) compared to normal weight (6.7 ± 0.9). DEXA-assessed body fat (%) showed similar associations as BMI, and latency to correct response on DMS and PRM was positively correlated with percentage of body fat, but not with VO2 max. Conclusion. In otherwise healthy premenopausal women, obesity did not impact accuracy on cognitive tasks related to attention, memory, or planning executive function, but morbid obesity was associated with higher latency to correct response on memory-specific tasks and lower memory span length.

This study assessed selected measures of cognitive function in trained cyclists who observed daylight fasting during Ramadan. Eleven cyclists volunteered to participate (age: 21.6±4.8 years, VO 2 max: 57.7±5.6 ml • kg-1 • min-1) and were followed for 2 months. Cognitive function (Cambridge Neuropsychological Test Automated Battery (CANTAB), Reaction Time index (RTI) and Rapid Visual Information Processing (RVP) tests) and sleep architecture (ambulatory EEG) were assessed: before Ramadan (BR), in the 1st week (RA1) and 4th week of Ramadan (RA4), and 2 weeks post-Ramadan (PR). Both cognitive tests were performed twice per day: before and after Ramadan at 8-10 a.m. and 4-6 p.m., and during Ramadan at 4-6 p.m. and 0-2 a.m., respectively. Training load (TL) by the rating of perceived exertion (RPE) method and wellness (Hooper index) were measured daily. If the TL increased over the study period, this variable was stable during Ramadan. The perceived fatigue and delayed onset muscle soreness (DOMS) increased at RA4. Sleep patterns and architecture showed clear disturbances, with significant increases in the number of awakenings and light sleep durations during Ramadan (RA1 and RA4), together with decreased durations of deep and REM sleep stages at PR. RTI (simple and multiple reaction index) reaction and movement times did not vary over the study period. The RVP test showed reduced false alarms during Ramadan, suggesting reduced impulsivity. Overall accuracy significantly increased at RA1, RA4 and PR compared to baseline. At RA4, the accuracy was higher at 0-2 a.m. compared to 4-6 p.m. Despite the observed disturbances in sleep architecture, Ramadan fasting did not negatively impact the cognitive performance of trained cyclists from the Middle East.

Background Intermittent fasting during the month of Ramadan, although not obligatory, is commonly practiced by Muslim children. Objective Our aim was to describe the effects of Ramadan fasting on various physiological and neurobehavioral measures in preteen and teenaged boys. Design We conduced a prospective cohort study during Ramadan, observed from August 9 to September 11, 2010. Participants Eighteen healthy Muslim boys (mean age±standard deviation 12.6±1.5 years) were recruited and assessed before, during (1st and 4th weeks), and after Ramadan. Subjects were classified as preteens (aged 9 to 12 years) or teens (aged 13 to 15 years). Intervention On each clinic visit, participants completed a match-to-sample test, a spatial planning and working memory task, and a working memory capacity test using the Cambridge Neuropsychological Test Automated Battery. Participants were also assessed for their sleep patterns, daily energy expenditure, and dietary intake. Body composition was determined using a dual-energy x-ray scan. Complete blood count, lipid profile analysis, and iron indices were conducted. Main outcome measures We measured morphologic, metabolic, and neurobehavioral parameters. Statistical analyses A linear mixed model was used to assess changes in outcome measures. Post hoc pairwise comparisons were performed as necessary with Bonferroni adjustment. Results Within 1 week of fasting, there was a drop in body fat only in preteens ( P =0.001). Reported fat ( P =0.004) and protein intake ( P =0.037) was higher during Ramadan, but energy expenditure did not change. By the end of Ramadan, there was a significant reduction in hemoglobin (mean±standard error −0.48±0.4 mmol/L) and serum iron (−25.7±31.8 μg/dL [−4.6±5.7 μmol/L]) levels. During week 4, total sleep duration decreased by 1.8 hours. At week 4, performance on the spatial planning and working memory task and working memory capacity test increased significantly ( P =0.002), while match-to-sample test performance declined in preteens only ( P =0.045). Conclusions Ramadan fasting was associated with significant changes in body composition, dietary intake, and sleep patterns. Reductions in attention and iron indices were observed in preteens only.

Understanding soccer players’ match-related fatigue and recovery profiles likely helps with developing conditioning programs that increase team performance and reduce injuries and illnesses. In order to improve match recovery (the return-to-play process and ergogenic interventions) it is also pivotal to determine if match simulation protocols and actual match-play lead to similar responses. (1) To thoroughly describe the development of fatigue during actual soccer match play and its recovery time course in terms of physiological, neuromuscular, technical, biochemical and perceptual responses, and (2) to determine similarities of recovery responses between actual competition (11 vs. 11) and match simulations. A first screening phase consisted of a systematic search on PubMed (MEDLINE) and SportDiscus databases until March 2016. Inclusion criteria were: longitudinal study with soccer players; match or validated protocol; duration > 45 min; and published in English. A total of 77 eligible studies (n = 1105) were used to compute 1196 effect sizes (ES). Half-time assessments revealed small to large alterations in immunological parameters (e.g. leukocytes, ES = 1.9), a moderate decrement in insulin concentration (ES = − 0.9) and a small to moderate impairment in lower-limb muscle function (ES = − 0.5 to − 0.7) and physical performance measures (e.g. linear sprint, ES = − 0.3 to − 1.0). All the systematically analyzed fatigue-related markers were substantially altered at post-match. Hamstrings force production capacity (ES = − 0.7), physical performance (2–4%, ES = 0.3−0.5), creatine kinase (CK, ES = 0.4), well-being (ES = 0.2−0.4) and delayed onset muscle soreness (DOMS, ES = 0.6–1.3) remained substantially impaired at G + 72 h. Compared to simulation protocols, 11 vs. 11 match format (CK, ES = 1.8) induced a greater magnitude of change in muscle damage (i.e. CK, ES = 1.8 vs. 0.7), inflammatory (IL-6, ES = 2.6 vs. 1.1) and immunological markers and DOMS (ES = 1.5 vs. 0.7) than simulation protocols at post-assessments. Neuromuscular performances at post-match did not differ between protocols. While some parameters are fully recovered (e.g. hormonal and technical), our systematic review shows that a period of 72 h post-match play is not long enough to completely restore homeostatic balance (e.g. muscle damage, physical and well-being status). The extent of the recovery period post-soccer game cannot consist of a ‘one size fits all approach’. Additionally, the ‘real match’ (11 vs. 11 format) likely induces greater magnitudes of perceptual (DOMS) and biochemical alterations (e.g. muscle damage), while neuromuscular alterations were essentially similar. Overall, coaches must adjust the structure and content of the training sessions during the 72-h post-match intervention to effectively manage the training load within this time-frame.

Fowler, PM, Murray, A, Farooq, A, Lumley, N, and Taylor, L. Subjective and objective responses to two rugby sevens world series competitions. J Strength Cond Res 33(4): 1043-1055, 2019-The purpose was to examine the utility of subjective and objective measures of player preparedness, interpreted at both group level and individual level, during 2 consecutive competitions of the World Rugby Sevens Series (WRSS). Subjective (sleep, energy, and muscle soreness ratings) and objective (heart rate [HR] at rest [HRREST] and in response to submaximal exercise [HREX]) measures were obtained from 16 male rugby 7s players from 1 team for 3 consecutive days (D1-3) at home (HOME) and on arrival at 4 tournament (T1-4) locations (T1-New Zealand; T2-USA; T3-Hong Kong; and T4-Tokyo) across 2 WRSS competitions (2 tournaments per competition) separated by 1 month. At a group level, energy ratings were significantly lower in T2 and T4 compared with HOME, and on D1 T2 compared with D1 T1 (p ≤ 0.05). Greatest variability in subjective ratings was observed during T1 and T3 at an individual level, particularly for sleep quality. Although at a group level HRREST and HREX significantly decreased in T1-4 compared with HOME (p ≤ 0.05), there was only a ∼50% agreement between the direction of change in HR indices at an individual level. Results from this study suggest that relocation between tournaments within WRSS competitions disrupts player preparedness measures to the largest degree. Hence, this period could be targeted by practitioners with appropriate recovery and/or sleep-promoting interventions or modulation of match-/training-load. Moreover, subjective rather than objective measures seem to be of greater use to inform player preparedness decision making, particularly at an individual level compared with a group level.

The purpose was to assess sleep patterns, quantity and quality in adolescent (16.2 ± 1.2 yr) Middle Eastern academy soccer players (n = 20) and the influence of an intermission upon these characteristics. On a 17-day training camp (located one time zone west of home) including three discrete matches, sleep was assessed pre- (PRE) and post-match (POST) via wrist actigraphy. Retrospective actigraphy analysis identified sleep characteristics, including if players experienced a sleep intermission (YES) or not (NO) proximal to dawn, and bedtime (hh:mm), get-up time (hh:mm), time in bed (h), sleep duration (h) and sleep efficiency (%). Within YES two bouts were identified (BOUT1 and BOUT2). No differences were seen between PRE and POST, nor between BOUT1 and BOUT2 (p .05). Overall players did not meet National Sleep Foundation (NSF) guidelines (7:04 ± 1:16 h vs. recommended 8-10 h for 14-17 yr). Sleep duration was significantly reduced (∼ -13% or -1:06) in YES compared to NO (6:33 ± 1:05 vs. 7:29 ± 1:17, p .01). Despite players in YES waking earlier due to an intermission, they did not compensate for this with a later wake time, rising significantly earlier compared to NO (09:40 ± 00:38 vs. 10:13 ± 00:40, p .05). These players on average do not obtain sufficient sleep durations relative to NSF guidelines, with decrements increased by an intermission proximal to dawn. High inter- and intra-individual variance in the players sleep characteristics indicates the need for individualized sleep education strategies and interventions to promote appropriate sleep.

Objective: The aim of this study was to assess the effects of 3-day Islamic intermittent fasting (3d-IF) on cognitive performance and serum levels of neurotrophic factors (brain-derived neurotrophic factor [BDNF] and vascular endothelial growth factor [VEGF]) before and after repeated sprints. Methods: Twenty-one physically active male Muslims (29.8 5.9 years, exercising 4 1.5 times/week) were randomly assigned to one of 2 experimental sessions: the control or nonfasting session (CS) or the fasting session (FS). These 2 sessions occurred 7 days apart in a counterbalanced crossover design. In both conditions, the test was performed at the same time of day, approximately hour before sunset. In the FS, the test occurred on the third day of the 3d-IF and involved the participants' performance of the following: (a) two series of 5 maximal 5-second sprints and (b) 2 cognitive tasks: One Touch Stockings (OTS) and reaction time (simple and complex RTI). Results: In both conditions, the participants' reaction times during the RTI test were similar at the pre- and mid-exercise points, but postexercise, simple and complex reaction times were higher in FS compared to CS (p = 0.045, effect size [ES] = 0.21 and p = 0.006, ES = 0.41, respectively). However, OTS performance and serum levels of neurotrophic factors were not influenced by the 3d-IF. Conclusion: Simple and complex reaction times during the RTI test were negatively affected by the 3d-IF after 2 bouts of intensive repeated sprints. Scopus

Background Hamstring injuries remain prevalent across a number of professional sports. In football, the incidence has even increased by 4% per year at the Champions League level over the last decade. The role of muscle strength or strength ratios and their association with risk of hamstring injury remain restricted by small sample sizes and inconclusive results. Purpose The purpose of this study is to identify risk factors for hamstring injury in professional football players in an adequately powered, prospective cohort study. Using both established (isokinetic) and novel (eccentric hamstring test device) measures of muscle strength, we aimed to investigate the relationship between these strength characteristics over the entire range of motion with risk of hamstring injury. Methods All teams (n=18) eligible to compete in the premier football league in Qatar underwent a comprehensive strength assessment during their annual periodic health evaluation at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar. Variables included isokinetic strength, Nordic hamstring exercise strength and dynamic hamstring: quadriceps ratios. Results Of the 413 players included (68.2% of all league players), 66 suffered a hamstring injury over the two seasons. Only isokinetic quadriceps concentric at 300°/s (adjusted for bodyweight) was associated with risk of hamstring injury when considered categorically. Age, body mass and playing position were also associated with risk of hamstring injury. None of the other 23 strength variables examined were found to be associated with hamstring injury. Conclusion The clinical value of isolated strength testing is limited, and its use in musculoskeletal screening to predict future hamstring injury is unfounded.

AimTo describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete’s heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.DesignSystematic review with meta-analysis.Data sourcesSix electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.Inclusion criteria(1) Male and/or female competitive athletes, (2) participants aged 6–18 years, (3) original research article published in English language.ResultsData from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes ConclusionsThe paediatric athlete’s heart undergoes significant remodelling both before and during ‘maturational years’. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.

Vitamin D (25(OH)D) deficiency has associations with bowl/colon cancer, arthritis, diabetes, and cardiovascular disease. Many athletes are vitamin D deficient, yet no studies have examined the association between 25(OH)D status and cardiac structure and function in healthy athletes.A total of 506 national-level athletes [football (50%), handball (23%), volleyball (16%), and basketball (11%)] and 244 control participants presented for precompetition medical assessment. Controls were healthy individuals registered with a sporting federation undertaking2 h of exercise per week.All individuals undertook a physical examination, 12-lead electrocardiogram, echocardiogram, and serum 25(OH)D evaluation.From 506 athletes and 244 controls, 23 and 12.3% demonstrated 25(OH)D sufficiency (30 ng/ml), 30 and 23.4% insufficiency (20-30 ng/ml), 37.2 and 48.8% deficiency (10-20 ng/ml), and 11 and 15.6% severe deficiency (10 ng/ml). Severely 25(OH)D-deficient athletes present significantly (p 0.05) smaller aortic root and left atria diameters, intraventricular septum diameter (IVSd), left ventricular diameter during diastole (LVIDd), left ventricular mass (LVM), left ventricular volume during diastole (LVvolD), and right atrial (RA) area than insufficient and sufficient athletes. Furthermore, following logarithmic transformation adjusting 25(OH)D for age, body surface area, ethnicity, and athletic participation, positive associations were observed between 25(OH)D and IVSd, LVIDd, posterior wall thickness during diastole, LVM, and LVvolD in athletes but not in the control participants.Severely 25(OH)D-deficient athletes present significantly smaller cardiac structural parameters than insufficient and sufficient athletes. Future research should investigate the precise mechanism(s) causing cardiac hypertrophy with increases in serum 25(OH)D in healthy athletes.

Clinical oral health examination of 187 UK professional footballers revealed that oral health was poor (37% players had active dental caries, 53% dental erosion and 5% moderate–severe irreversible periodontal disease). Importantly, 20% reported that it impacted on their quality of life and 7% on their training and/or performance.1 Consequently, a call of action for oral health screening was recently issued in this journal to help improve the oral health of athletes.2 Aspetar Orthopaedic Sports Medicine Hospital (Doha, Qatar) accepted this call by investing in a sports dentistry department. Following the ethical approval, 1245 individuals (91.7% male) presented at our facility for dental screening, of whom 56.5% were Arab, 29.6% Black, 7.9% White and 6.8% Asian. All individuals were registered with the Qatar Olympic Committee (QOC) and were invited for dental screening via Qatar’s National Sports Medicine Programme. Informed consent was provided by all individuals, with parents/guardians providing for those individuals aged under 18 years. Athletes (n=1079; age 21.7±6.8 years) were defined as a QOC registered individual who undertook regular exercise or training (≥6 hours/week) for …

Objectives: To investigate the incidence, characteristics and patterns of football injuries at club level in Qatar. Design: Prospective cohort study. Methods: Data were prospectively collected from the first division football league clubs in Qatar, in accordance with the international consensus statement on football injury epidemiology. An injury was defined as any physical complaint sustained during football activity resulting in the inability to participate fully in the next training or match. Individual injuries and exposure of each player were recorded by the medical staff of each team over one season. Results: A total of 217 injuries were recorded, with an injury rate during matches of 14.5/1000 h (95% CI: 11.6-18.0) compared with 4.4/1000 h during training sessions (95% CI: 3.7-5.2). More than one third of all injuries were muscle strains (36.4%). Hamstring strains (54.4% of all muscle strains) exhibited a higher incidence than all other injury types (p < 0.001). The thigh was the most frequent injury location (41.9%, p < 0.001). Re-injuries (15% of total injuries) were mainly comprised of muscle strains associated with a higher severity compared with new injuries. Conclusions: Despite the different environmental, social and cultural setting, our findings are comparable with previous data from a European club football, confirming the previous finding at national team level that there are no regional peculiarities of football injuries in this part of the Asiatic continent. The relatively high overuse injury incidence rate and the high recurrence rate for (severe) thigh muscle strains, especially during games, warrants prevention strategies.

To assess and compare the intra-and interrater reliability of three different MRI grading and classification systems after acute hamstring injury. Methods: Male athletes (n = 40) with clinical diagnosis of acute hamstring injury and MRI

Summary Aim To investigate the impact of intermittent Ramadan fasting on the ability of children to perform repeated sprints. Methods and results Eighteen children performed 6 × 15 m sprints (15 s rest) before, during (1st and 4th week) and after (2 and 4 weeks) Ramadan. Compared to baseline, total sprint times lengthened 4 weeks into Ramadan and remained elevated 2 weeks post-Ramadan. Initial sprint performance and sprint decrement score did not change. Conclusions Repeated sprinting performance was compromised towards the end of the Ramadan month in children and this effect persisted for 2 weeks, while fatigue resistance was not affected.

Background MRI is frequently used in addition to clinical evaluation for predicting time to return to sport (RTS) after acute hamstring injury. However, the additional value of MRI to patient history taking and clinical examination remains unknown and is debated. Aim To prospectively investigate the predictive value of patient history and clinical examination at baseline alone and the additional predictive value of MRI findings for time to RTS using multivariate analysis while controlling for treatment confounders. Methods Male athletes (N=180) with acute onset posterior thigh pain underwent standardised patient history, clinical and MRI examinations within 5 days, and time to RTS was registered. A general linear model was constructed to assess the associations between RTS and the potential baseline predictors. A manual backward stepwise technique was used to keep treatment variables fixed. Results In the first multiple regression model including only patient history and clinical examination, maximum pain score (visual analogue scale, VAS), forced to stop within 5 min, length of hamstring tenderness and painful resisted knee flexion (90°), showed independent associations with RTS and the final model explained 29% of the total variance in time to RTS. By adding MRI variables in the second multiple regression model, maximum pain score (VAS), forced to stop within 5 min, length of hamstring tenderness and overall radiological grading, showed independent associations and the adjusted R 2 increased from 0.290 to 0.318. Thus, additional MRI explained 2.8% of the variance in RTS. Summary There was a wide variation in time to RTS and the additional predictive value of MRI was negligible compared with baseline patient history taking and clinical examinations alone. Thus, clinicians cannot provide an accurate time to RTS just after an acute hamstring injury. This study provides no rationale for routine MRI after acute hamstring injury. Trial registration number ClinicalTrials.gov Identifier: NCT01812564.

Background To evaluate the efficacy of a single platelet-rich plasma (PRP) injection in reducing the return to sport duration in male athletes, following an acute hamstring injury. Methods A randomised, three-arm (double-blind for the injection arms), parallel-group trial, in which 90 professional athletes with MRI positive hamstring injuries were randomised to injection with PRP-intervention, platelet-poor plasma (PPP-control) or no injection. All received an intensive standardised rehabilitation programme. The primary outcome measure was time to return to play, with secondary measures including reinjury rate after 2 and 6 months. Results The adjusted HR for the PRP group compared with the PPP group was 2.29 (95% CI 1.30 to 4.04) p=0.004; for the PRP group compared with the no injection group 1.48 (95% CI 0.869 to 2.520) p=0.15, and for the PPP group compared with the no injection group 1.57 (95% CI 0.88 to −2.80) p=0.13. The adjusted difference for time to return to sports between the PRP and PPP groups was −5.7 days (95% CI −10.1 to −1.4) p=0.01; between the PRP and no injection groups −2.9 days (95% CI −7.2 to 1.4) p=0.189 and between the PPP and no injection groups 2.8 days (95% CI −1.6 to 7.2) p=0.210. There was no significant difference for the secondary outcome measures. No adverse effects were reported. Conclusions Our findings indicate that there is no benefit of a single PRP injection over intensive rehabilitation in athletes who have sustained acute, MRI positive hamstring injuries. Intensive physiotherapy led rehabilitation remains the primary means of ensuring an optimal return to sport following muscle injury. Trial registration number ClinicalTrials.gov Identifier: NCT01812564.

Objective: The aim of this study was to determine the prevalence of low back pain (LBP) in a primary care setting population and examine its association with the symptoms of depression and somatization. Methods: This is a cross-sectional study, utilising a survey carried out in primary health care clinics (PHCs) in Al-Ain, United Arab Emirates (UAE). A multistage stratified sampling design was used and a representative sample of 1304 UAE nationals aged 18–65 years who attended PHC clinics for any reason were included and 1103 (84.5%) subjects agreed to participate and responded to the questionnaire during a period from June 2001 to January 2002. A specially designed questionnaire with three parts was used for the data collection: socio-demographic information of the studied subjects, modified version of the Roland-Morris scale for evaluating back-related functional disability and SCL-90 R for depression and somatization subscales was used to assess depressive and somatic symptoms. Results: Of the total number of subjects surveyed (1103), 586 (53.1%) were men and 517 (46.9%) women. The mean age was 34.9 ± 13.4 years for men and 33.5 ± 11.8 years for women. The prevalence of LBP in the studied subjects was 64.7% (95% CI, 60.7–68.5] with 46.7% among men and 53.3% among women. There were a significant differences between the subjects with LBP and without LBP with respect to gender (P < 0.001), body mass index (BMI) (P < 0.001), occupational status (P < 0.001) and living environment (P = 0.016). Functional disability was higher in patients with LBP. Young patients in aged 15–34 years, patients with preparatory/secondary educational level and students showed higher depressive symptoms. A similar pattern was found in patients with somatic symptoms. Factor analysis revealed a strong association between depression and somatization in LBP patients. Conclusions: Functional disability was higher in with LBP. Furthermore, symptoms of depression and somatization are prevalent among LBP patients. Wiley Online Library

Adequate vitamin D (25(OH)D) is required to maintain good bone health, yet many athletes are 25(OH)D deficient. This study sought to examine the relation between serum 25(OH)D and measures of bone health (bone mineral density (BMD) and T-score) in an ethnically diverse athletic population.Nine hundred and fifty male athletes presented for precompetition medical assessment in our facility. An additional 436 individuals registered with a Qatari sporting federation (such as sailing, archery, shooting, bowling) but exercising2 h·wk were used as control population. There were 30 Asian, 242 Black African, 235 Caucasian, 491 from Gulf Cooperation Countries, 336 Middle Eastern, and 52 Persian participants. All individuals undertook bone densitometry and body composition analysis by dual-energy x-ray absorptiometry and serum 25(OH)D evaluation.From 950 athletes, 17.5% demonstrated severe deficiency, 39.2% demonstrated deficiency, 24.5% demonstrated insufficiency, and 18.8% demonstrated sufficiency, compared with 436 controls, 25.9% of whom demonstrated severe deficiency, 46.3% demonstrated deficiency, 19.0% demonstrated insufficiency, and 8.7% demonstrated sufficiency. No athlete presented with a T-score suggestive of osteoporosis (-2.5 SD) or osteopenia (-1.0 SD) at hip total. After adjustment for age, anthropometry, ethnicity, and athletic participation, there was no association between 25(OH)D and any BMD and T-score at any site within athletes. African and Caucasian athletes present with greater (P0.05) BMD and T-scores at the spine, neck, and hip total than those of Asian, Gulf Cooperation Countries, Middle Eastern, and Persian ethnicities. Athletes participating in high-impact sports present with higher measures (P0.05) of bone health than control participants regardless of 25(OH)D status.There is no association between 25(OH)D and BMD and T-score for any site within male athletes after adjusting for age, ethnicity, and sporting participation.

The objective of this study was to determine the effect of hyperthermic environment in combination with exercise on the plasma concentration of interleukin-1ra (IL-1ra), interleukin-6 (IL-6) and C-...

Introduction: The aim of the present study is to identify clinical, laboratory and radiological factors that can predict which patients may develop cholangitis. Methods: This is a retrospective case-control study based on patients admitted to Hamad Hospital from June'06 to November'10 with a diagnosis of AC secondary to CBD stones. The control group included patients with obstructive lithiasic jaundice not complicated by cholangitis. Both groups were compared and analysed with respect to demographics, previous medical/surgical history, laboratory investigations and surgical/endoscopic procedures. Results: The study comprised of 112 patients of 24 different nationalities. 53 patients presented with AC and 59 were admitted for management of obstructive jaundice. Although Asians had a greater prevalence of cholangitis (57.4%) compared to Middle Easterners (35.7%) and Africans (33.3%), this was not statistically significant (P=0.066). Laboratory tests significantly correlated to AC were leukocytosis (P