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Background: Lateral ankle sprains (LAS) frequently lead to residual soft tissue impairments, often attributed to biomechanical dysfunction during movement. Objective: To compare running biomechanics between adolescent runners with soft tissue pathologies following LAS (injured) and healthy runners (control) and between limbs. Design: Retrospective cohort study. Setting: Hospital‐affiliated sports injury prevention center. Participants: Twenty‐five adolescent runners with a history of LAS and current ankle impingement or tendinopathy (23 female, 2 male; age: 15 ± 2 years; body mass index [BMI]: 19.5 ± 2.5 kg/m2; symptom duration: 1.1 ± 0.9 years), and 23 healthy controls without any LAS history (19 female, 4 male; age: 15 ± 1 years; BMI: 19.2 ± 2.7 kg/m2) were included in this study. Interventions: All participants completed a clinical gait assessment in which they ran at a self‐selected speed on a force‐plate instrumented treadmill, while two video cameras recorded two‐dimensional sagittal and coronal views. Main Outcome Measures: Foot rotation, step width, contact time, and cadence were compared between groups and limbs (involved, uninvolved [or "better" for bilateral cases]) using a multivariate analysis of variance (MANOVA). Rearfoot landing and foot strike type were compared between groups and limbs using a chi‐square analysis. Results: The injured group had significantly increased step width (F = 4.71, p =.04; mean difference [MD] with SE: 1.5 [0.7] cm) compared to controls. The injured groups' involved limb had longer contact time (F = 4.62, p =.03; MDgroup: 12 [7] ms, MDlimb: 22 [11] ms) with more internal foot rotation (F = 14.60, p <.001; MDgroup: 2.2 [1.2] degrees, MDlimb: 4.2 [1.3] degrees) compared to controls and their contralateral limb. There were no significant differences for cadence (F = 2.43, p =.13; MD: 4 [3] steps/min), foot landing (X2 = 1.28, p =.53), or foot strike (X2 = 1.24, p =.54). Conclusions: Spatiotemporal and kinematic running adaptations may predispose young runners with initial LAS to secondary soft tissue dysfunction due to loss of stability from ligamentous structures and an overreliance on myotendinous control. Clinicians may consider targeting these maladaptations during gait‐training interventions. [ABSTRACT FROM AUTHOR]

Background: Exercise‐related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners; however, there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP. Objective: To compare ultrasound‐derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP. Design: Cross‐sectional design. Setting: Hospital‐affiliated sports injury prevention center. Participants: Twenty‐eight adolescent runners with (N = 14) and without ERLLP (N = 14). Interventions: Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures. Main Outcome Measures: Separate repeated measures multivariate analyses of covariance (covariate: gender) were used to compare groups and limbs for mass‐normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles. Results: The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: −0.12–0.49 mm/kg; p range:.002–.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: −3.7–6.4°; p <.001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: −0.14–−0.15 mm/kg; p range:.02–.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: −18; p =.02). Conclusions: Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. The findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening. [ABSTRACT FROM AUTHOR]

Objectives: Several iterations of the Sport Concussion Assessment Tool (SCAT) have been published over the past 16 years. Our goal was to systematically review the literature related to the SCAT and provide recommendations for improving the tool. To achieve this goal, five separate but related searches were conducted and presented herein.Design: Systematic literature review.Data Sources: Medline, Embase, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, SPORTDiscus and PubMed.Eligibility Criteria: Original, empirical, peer-reviewed findings published in English and included sports-related concussion (SRC). Review papers, case studies, editorials and conference proceedings/abstracts were excluded. The age range for the ChildSCAT was 5-12 years and for the Adult SCAT was 13 years and above.Results: Out of 2961 articles screened, a total of 96 articles were included across the five searches. Searches were not mutually exclusive. The final number of articles included in the qualitative synthesis for each search was 21 on Adult SCAT, 32 on ChildSCAT, 21 on sideline, 8 on video/observation and 14 on oculomotor.Summary/conclusions: The SCAT is the most widely accepted and deployable sport concussion assessment and screening tool currently available. There is some degree of support for using the SCAT2/SCAT3 and ChildSCAT3 in the evaluation of SRC, with and without baseline data. The addition of an oculomotor examination seems indicated, although the most valid method for assessing oculomotor function is not clear. Video-observable signs of concussion show promise, but there is insufficient evidence to warrant widespread use at this time. [ABSTRACT FROM AUTHOR]

Aim: To prospectively examine the neurocognitive, postural, dual-task and visual abilities of female Olympic-style boxers before and after participation in a tournament.Methods: Sixty-one females completed the modified Balance Error Scoring System (mBESS), King-Devick test and 3 m timed-up-and-go test in single-task and dual-task conditions. A subset (n=31) completed the CogState computerised neurocognitive test. Initial testing was completed prior to the 2016 Women's World Boxing Championships; each participant repeated the testing protocol within a day of elimination. No participant sustained a concussion. Pretournament and post-tournament performance variables were compared using paired t-tests or Wilcoxon signed-rank tests.Results: Participants completed a mean of 7.5±4.5 rounds of Olympic-style boxing over 2-8 days. Post-tournament scores were significantly lower than pretournament scores for total mBESS (2.2±1.9 errors vs 5.5±2.9 errors, p<0.001, d=1.23) and King-Devick time (14.2±3.9 s vs 18.0±8.3 s, p=0.002, d=0.53). Processing speed was significantly faster after the boxing tournament (maze chase task: 1.39±0.34 correct moves/second vs 1.17±0.44 correct moves/second, p=0.001, d=0.58). No significant changes across time were detected for the other obtained outcome variables.Conclusions: Female boxers demonstrated either improvement or no significant changes in test performance after competing in an Olympic-style boxing tournament, relative to pretournament performance. As many of the test tasks were novel for the boxers, practice effects may have contributed to improved performance. When there is a short time frame between assessments, clinicians should be aware of potential practice effects when using ringside neurological tests. [ABSTRACT FROM AUTHOR]

Background: Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. Purpose: To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. Study Design: Cohort study; Level of evidence, 2. Methods: This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. Results: Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. Conclusion: Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms. [ABSTRACT FROM AUTHOR]

Background: Exercise intolerance is a manifestation of autonomic nervous system (ANS) dysfunction after concussion. Accommodative amplitude (AA) may be a useful clinical proxy for ANS dysfunction since accommodation is controlled by the ciliary muscle, which is innervated by parasympathetic fibers of the ANS. Hypothesis/Purpose: To determine if concussion influences autonomic control of accommodative amplitude (AA) by comparing measurements before and after exercise in adolescent sport-related concussion (SRC). Methods: Secondary analysis of data from a randomized controlled trial of aerobic exercise after adolescent SRC. Accommodation was measured before and after the Buffalo Concussion Treadmill Test (BCTT). Fisher's exact tests were used to compare AA before and after exercise, while Wilcoxon rank sum was used to assess the relationship between AA and time until clinical recovery. Results: 99 participants (64.6% male, median age 15.7 (IQR 14.5, 16.8)) had AA measured before and after the BCTT at the initial post-injury visit (median 6 days (IQR 4, 8)). Abnormal AA, defined using Hofstetter's age-adjusted formula, was present in 43 (43.4%) pre-exercise and in 45 (45.5%) post-exercise. Abnormal pre- and post-exercise AA were significantly associated (p < 0.001). AA improved with exercise for 9 participants (i.e., changed from abnormal to normal) while it worsened with exercise for 11 (i.e. normal to abnormal). Low heart rate threshold (HRt), defined as HR less than 135 bpm at test cessation due to symptom exacerbation, was significantly associated with abnormal post- (p = 0.005) but not pre-exercise AA (p = 0.225). Participants with abnormal post-exercise AA had significantly longer time to clinical recovery (median 20.5 days (IQR 14.5, 32)) than those with normal post-exercise AA (median 14 days (IQR 10.75, 21.75)) (p = 0.008). Conclusion: Abnormal post-exercise AA is associated with delayed recovery after SRC. Adolescents with low exercise tolerance are more likely to have abnormal AA after exercise, suggesting that concussion-related autonomic dysfunction is precipitated by an aerobic exercise stress test. Abnormal AA after exercise may provide prognostic utility in concussion. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates anterior cruciate ligament (ACL) injuries in pediatric athletes presenting to a sports medicine clinic with regard to sex and age and body mass index. Subjects of the study consisted of a randomly selected children 5 to 17 years of age, and aggregated data include demographics, injury mechanism, diagnosis, treatment, previous injury, and organized sports. It was found that girls had a steeper increase of ACL injury/total injury by age than boys.

The article discusses a study that describes and compares differences between males and females in pediatric sports-related injuries. Data was collated and studied on age, sex, height, weight, injury type, location of injury, and sports involvement. It is said that male patients had a higher percentage of injuries to the upper extremity compared with female patients. It is noted that more study is needed to further understand the injury risk in pediatric male and female athletes.

The article focuses on retrospective cross-sectional study conducted to determine the level of sports injuries in children divided into two groups 5-12 years old and 13-17 years old. The results showed that older children suffered more overuse and soft tissue injuries while younger children had more biome injuries and fractures. The upper extremity was main injury region among younger children while hips and spine were common among older children.

Background: Little existing data describe which medical professionals and which medical studies are used to assess sport-related concussions in high school athletes.Purpose: To describe the medical providers and medical studies used when assessing sport-related concussions. To determine the effects of medical provider type on timing of return to play, frequency of imaging, and frequency of neuropsychological testing.Study Design: Descriptive epidemiology study.Methods: All concussions recorded by the High School Reporting Information Online (HS RIO) injury surveillance system during the 2009 to 2010 academic year were included. χ2 analyses were conducted for categorical variables. Fisher exact test was used for nonparametric data. Logistic regression analyses were used when adjusting for potential confounders. Statistical significance was considered for P < .05.Results: The HS RIO recorded 1056 sport-related concussions, representing 14.6% of all injuries. Most (94.4%) concussions were assessed by athletic trainers (ATs), 58.8% by a primary care physician. Few concussions were managed by specialists. The assessment of 21.2% included computed tomography. Computerized neuropsychological testing was used for 41.2%. For 50.1%, a physician decided when to return the athlete to play; for 46.2%, the decision was made by an AT. After adjusting for potential confounders, no associations between timing of return to play and the type of provider (physician vs AT) deciding to return the athlete to play were found.Conclusion: Concussions account for nearly 15% of all sport-related injuries in high school athletes. The timing of return to play after a sport-related concussion is similar regardless of whether the decision to return the athlete to play is made by a physician or an AT. When a medical doctor is involved, most concussions are assessed by primary care physicians as opposed to subspecialists. Computed tomography is obtained during the assessment of 1 of every 5 concussions occurring in high school athletes. [ABSTRACT FROM PUBLISHER]

Background: An estimated 136 000 concussions occur per academic year in high schools alone. The effects of repetitive concussions and the potential for catastrophic injury have made concussion an injury of significant concern for young athletes.Purpose: The objective of this study was to describe the mechanism of injury, symptoms, and management of sport-related concussions using the High School Reporting Information Online (HS RIO) surveillance system.Study Design: Descriptive epidemiology study.Methods: All concussions recorded by HS RIO during the 2008-2009 academic year were included. Analyses were performed using SPSS software. Chi-square analysis was performed for all categorical variables. Statistical significance was considered for P < .05.Results: A total of 544 concussions were recorded. The most common mechanism (76.2%) was contact with another player, usually a head-to-head collision (52.7%). Headache was experienced in 93.4%; 4.6% lost consciousness. Most (83.4%) had resolution of their symptoms within 1 week. Symptoms lasted longer than 1 month in 1.5%. Computerized neuropsychological testing was used in 25.7% of concussions. When neuropsychological testing was used, athletes were less likely to return to play within 1 week than those for whom it was not used (13.6% vs 32.9%; P < .01). Athletes who had neuropsychological testing appeared less likely to return to play on the same day (0.8% vs 4.2%; P = .056). A greater proportion of injured, nonfootball athletes had computerized neuropsychological testing than injured football players (23% vs 32%; P = .02)Conclusion: When computerized neuropsychological testing is used, high school athletes are less likely to be returned to play within 1 week of their injury. Concussed football players are less likely to have computerized neuropsychological testing than those participating in other sports. Loss of consciousness is relatively uncommon among high school athletes who sustain a sport-related concussion. The most common mechanism is contact with another player. Some athletes (1.5%) report symptoms lasting longer than 1 month. [ABSTRACT FROM AUTHOR]

Correct and timely rehabilitation is a vital component of the treatment of sports injuries. The goals of rehabilitation include restoring function, restoring pain-free full range of motion, and achieving full muscle strength and sports endurance. Generally, sports rehabilitation entails a phased approach including progressive exercises and therapeutic modalities to achieve full recovery. This review discusses the rehabilitation of upper extremity, lower extremity, and back injuries. [Copyright &y& Elsevier]

Objective: Investigate the reliability of concussion symptoms captured through ecological momentary assessment (EMA) and compare time with recovery based on 3 definitions of symptomatic recovery and the date of clinical clearance to begin the return-to-play (RTP) process. Design: We used a mobile app with EMA to monitor concussion symptoms as part of a multicenter randomized controlled trial. Setting: Three sports medicine practices. Participants: Patients between 13 and 18 years old with sport-related concussion were prompted to complete the Post-Concussion Symptom Inventory daily over 4 weeks. Interventions: None. Main Outcome Measures: We compared the elapsed days to reaching the 4 outcomes using scatterplots and Kaplan–Meier curves. Results: Among 118 participants, symptoms reported into the app had excellent agreement with symptoms reported at a clinical visit on the same day (intraclass correlation coefficient = 0.97). Most (>50%) participants reached "specific symptom return to preinjury levels," "overall symptom return to preinjury levels," and "current symptom resolution" based on EMA symptom reports between several days and 1 week before achieving "clinical clearance to RTP" determined at a clinical visit, which had 100% sensitivity, but between 56.3% and 78.1% specificity, relative to the app-measured symptom outcomes. Conclusions: Time until symptom recovery varies based on the chosen definition of symptomatic recovery but is a more precise correlate with clinical clearance to begin the RTP process when defining symptom recovery as a return to a preinjury baseline level of symptomatology. Real-time symptom monitoring may be beneficial clinically, allowing providers to assess patients' recovery status and make more timely and remote treatment recommendations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate recovery trajectories among youth athletes with a concussion and healthy controls across different domains using a quantitative and multifaceted protocol. Study design: Prospective repeated measures. Participants: Youth athletes diagnosed with a concussion between the ages of 8 and 18 years were evaluated (1) within 10 days after injury, (2) approximately 3 weeks after injury, and (3) after return-to-play clearance. Control participants completed the same protocol. Setting: Sport concussion clinic. Interventions: N/A. Main outcome measures: Participants underwent a multifaceted protocol that assessed symptoms (postconcussion symptom scale [PCSS]), dual-task gait, event-related potentials (ERPs), and eye tracking. Results: Sixty-seven athletes participated: 36 after concussion (age = 14.0 ± 2.6 years; 44% female) and 31 controls (age = 14.6 ± 2.2 years; 39% female). Concussion symptoms were higher for the concussion group compared with controls at the first (PCSS = 31.7 ± 18.8 vs 1.9 ± 2.9; P < 0.001) and second time points (PCSS = 10.8 ± 11.2 vs 1.8 ± 3.6; P = 0.001) but resolved by the final assessment (PCSS = 1.7 ± 3.6 vs 2.0 ± 3.8; P = 0.46). The concussion group walked slower during dual-task gait than controls at all 3 tests including after return-to-play clearance (0.83 ± 0.19 vs 0.95 ± 0.15 m/s; P = 0.049). There were no between-group differences for ERP connectivity or eye tracking. Those with concussions had a decrease in ERP connectivity recovery over the 3 time points, whereas control participants' scores increased (concussion Δ = -8.7 ± 28.0; control Δ = 13.9 ± 32.2; χ² = 14.1, P = 0.001). Conclusions: Concussion is associated with altered dual-task gait speeds after resolution of concussion symptoms, but ERP and eye tracking measures did not demonstrate between-group differences across time. Some objective approaches to concussion monitoring may support with identifying deficits after concussion, but further work is required to delineate the role of gait, electrophysiological, and eye tracking methods for clinical decision-making. [ABSTRACT FROM AUTHOR]

Objectives: (1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group. Design: A total of 689 patients (20% children 7-12 years of age, 69% adolescents 13-18 years of age, and 11% young adults 19-30 years of age) were seen and diagnosed with a concussion within 21 days after injury. Patients completed the Post-Concussion Symptom Scale (PCSS) and were followed until they no longer required care. Setting: Two specialty care sport concussion clinical practices. Main outcome measures: Overall PCSS score was obtained, as well as severity ratings from somatic, vestibular-ocular, cognitive, sleep, and emotional symptom domains. We also calculated total symptom duration time. Results: No significant main effect of age, or age by sex associations were identified among the symptom domains. Females endorsed a higher somatic symptom severity rating than males (9.8 +/- 6.7 vs 8.1 +/- 6.7; P = 0.03). For patients between 7 and 12 years of age, higher somatic [[beta]-coefficient = 1.57, 95% confidence interval (CI), 1.47-1.67] and cognitive ([beta]-coefficient = 2.50, 95% CI, 2.32-2.68) symptom severities were associated with longer duration of concussion symptoms. Among adolescents, longer total symptom duration was associated with more severe somatic ([beta]-coefficient = 1.25, 95% CI, 0.34-2.15) and vestibular-ocular ([beta]-coefficient = 2.36, 95% CI, 1.49-3.23) symptoms. Conclusions: Within 21 days after concussion, symptom-reporting behavior seems to be similar across the age spectrum, but the relationship between symptom profiles and time to symptom resolution varies by age. Although overall symptom ratings are beneficial in determining clinical pathways, symptom domain use may provide a beneficial method to determine individualized patient care that differs between children and adolescents after concussion. [ABSTRACT FROM AUTHOR]

Prior studies suggest that concussion may lead to an increased risk of a subsequent time-loss sport-related injury, but the mechanisms responsible are unknown. We measured the symptom and dual-task gait outcomes for athletes initially post-concussion and after clinical recovery. Participants then self-reported any additional injuries incurred in the year after their concussion. Forty-two athletes (52% female, mean age = 16.8 ± 3.2 years) completed the study. They underwent a dual-task gait evaluation and symptom inventory within 21 days post-concussion, and again after they were deemed clinically recovered. Approximately one year later, participants documented if they had sustained any subsequent sport-related injuries. The repeated measures analysis of variance (ANOVA) was used to evaluate changes in dual-task gait and symptoms across time and between groups. A significant group*time interaction (p = 0.02) indicated that the group that went on to sustain a subsequent time-loss injury after returning to sports (n = 15) demonstrated significant average walking speed dual-task cost worsening across time (−17.9 ± 9.1% vs. −25.1 ± 12.5%; p = 0.007). In contrast, the group that did not sustain an additional injury walked with consistent dual-task cost values across time (−25.2 ± 9.2% vs. −24.6 ± 8.4%; p = 0.76). Symptoms improved for all participants (main effect of time, p < 0.001; Post-Concussion Symptom Scale [PCSS] = 25.0 ± 16.9 vs. 2.8 ± 7.5; p < 0.001), but did not differ between groups (p = 0.77). Significant dual-task gait cost worsening throughout concussion recovery was associated with time-loss injuries during sports in the year after a concussion. These findings indicate that worsening ability to execute a concurrent gait and cognitive task may relate to the risk of incurring an injury during sports after clinical concussion recovery. [ABSTRACT FROM AUTHOR]

Although growing awareness about the potential long-term deleterious effects of sport-related concussion has led to increased attention to the risks of collision sports, calls to ban these sports, such as American football, might be premature. Collision sports have a relatively high incidence of concussions, but participation in these sports also confers a host of benefits. In addition, the associated risks of participation, including concussion, have not been definitively shown to outweigh the benefits they provide, and the risk-benefit ratio might vary among individuals. The risks of concussion and repetitive concussions associated with collision sports are unknown in the general population and not well characterized even in elite athlete populations. In this article, we discuss current knowledge on sports-related concussion, its neurological consequences, and implications for regulation of the practice of collision sports. [ABSTRACT FROM AUTHOR]