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Since the United States’ first woman began medical school less than two centuries ago, medicine has become increasingly gender diverse. Women now make up the current majority of medical students and are predominant in fields such as pediatrics, obstetrics and gynecology, child and adolescent psychiatry and neonatal-perinatal medicine. Despite this progress, representation of women in many medical subspecialties, such as orthopaedic surgery sports medicine and primary care sports medicine is still consistent with historic origins of gender inequality. In 2018, women made up only 5.3% of orthopaedic surgeons and 12.1% of orthopaedic surgery sports medicine residents and fellows. Similarly, data from 2019 suggest 27.2% of family medicine sports medicine physicians are women. Female representation in positions of leadership within these subspecialties highlight further inequalities. Through current initiatives to provide early exposure and mentorship to prospective residency applicants, there have been small advances in diversifying these fields. However, these advances have been largely inadequate for women of minority and marginalized groups. Adequate female representation is paramount to gain the benefits field diversification presents, including accessible representation, provider advocacy, prioritization of women’s health, mentorship, and diverse thought and innovation. By simultaneously analyzing the historic barriers facing women in operative and nonoperative fields of sports medicine, and the benefits of gender diversity for patient care, we can recommend actions necessary in promoting gender diversity moving forward.

Airborne murine coronavirus was assessed for its sensitivity to the vapors of chemicals commonly used to disinfect indoor surfaces. As a model for the chemical sensitivity of airborne SARS-CoV-2, the infectious potential of airborne Mouse Hepatitis Virus (MHV) was tracked in the presence of the following pure chemical vapors, each of which was below its permissible exposure limit (PEL) as regulated by the US National Institute of Occupational Safety and Health (NIOSH): < 50 ppmv for glycol; < 1ppmv for HOCl; and, < 1ppmv for H2O2. Along with its growth media, infectious MHV was aerosolized in a particle size distribution between 0.5 μm and 3.2 μm into a sealed, dark, 9 m3 chamber maintained at 220C and 60% RH, including levels of chemical vapors maintained below their respective PELs. As judged by the TCID50 of airborne MHV collected by condensation, this airborne virus was rapidly inactivated by HOCl vapor, incurring an average of 99% infectious potential loss after 16 ± 4 minutes exposure to ≤0.2 ppmv HOCl. Airborne MHV responded with a 99% loss of infectious potential in 38 ± 10 minutes of exposure to ≤0.9 ppmv H2O2; and, a 99% loss of infectious potential in 33 ± 15 minutes when exposed to a gas-phase dipropylene glycol blend ≤20 ppmv as TVOC. The juxtaposition of quantitative RT-PCR and TCID50 responses suggest that even low levels of gas-phase HOCl exposures can damage the genome of airborne coronavirus in relatively short time frames (c.a. < 5 mins).

To present a synthesis of recent literature regarding the risk factors and management for MTSS. Risk factors include female sex, prior history of MTSS, less running experience, female athlete triad/RED-S, higher BMI, smoking, and biomechanical abnormalities. Management includes activity modification, gait retraining, orthotics, medications, and, very rarely, surgery. MTSS is an overuse injury commonly seen in runners. The pathophysiology remains disputed, and diagnosis is often determined from clinical presentation alone. For unclear reasons, women are at increased risk for development of MTSS. Other risk factors include increased BMI, prior history of MTSS, less running experience, smoking, presence of at least one component of the female athlete triad/RED-S, and biomechanical abnormalities. Treatment often includes cessation of high-impact activity, gait retraining, neuromuscular training, and orthotics. In rare circumstances, surgery may be considered. Identifying risk factors is important for prevention and individualized management.

BACKGROUND Bone stress injury (BSI) in youth runners is clinically important during times of skeletal growth and is not well studied. OBJECTIVE To evaluate the prevalence, anatomical distribution, and factors associated with running-related BSI in boy and girl middle school runners. DESIGN Retrospective cross-sectional study. SETTING Online survey distributed to middle school runners. METHODS Survey evaluated BSI history, age, grade, height, weight, eating behaviors, menstrual function, exercise training, and other health characteristics. MAIN OUTCOME MEASUREMENTS Prevalence and characteristics associated with history of BSI, stratified by cortical-rich (eg, tibia) and trabecular-rich (pelvis and femoral neck) locations. PARTICIPANTS 2107 runners (n = 1250 boys, n = 857 girls), age 13.2 ± 0.9 years. RESULTS One hundred five (4.7%) runners reported a history of 132 BSIs, with higher prevalence in girls than boys (6.7% vs 3.8%, p = .004). The most common location was the tibia (n = 51). Most trabecular-rich BSIs (n = 16, 94% total) were sustained by girls (pelvis: n = 6; femoral neck: n = 6; sacrum: n = 4). In girls, consuming

Runners and coaches are often interested in identifying the "ideal" running form to reduce the risk of injury and improve performance. While differences in pelvis and hip motion have been reported among adolescent female and male long-distance runners of different stages of physical maturation, the influence of sex and/or maturation on temporal-spatial parameters is unknown for adolescent runners. Adolescent runners of different stages of physical maturation (pre-, mid-, post-pubertal) completed an overground running analysis at a self-selected speed. We performed 2 × 3 ANCOVAs (covariate = running speed) to compare temporal-spatial parameters among sex and maturation groups. Pre-adolescents ran with higher cadences and shorter step lengths than mid- (

Stress injuries to the bone and physis of the knee are common in the active adolescent patient and can be broken down into bone stress injuries (BSIs) and chronic physeal stress injuries. BSIs result from prolonged, repetitive bone loading, whereas chronic physeal stress injuries develop from repetitive loading to the apophysis or epiphysis. Most stress injuries of the knee resolve with relative rest but will occasionally need surgical intervention in more severe cases. Early and accurate identification is paramount for optimal management and to avoid long-term consequences.

The Male Athlete Triad is a medical syndrome most common in adolescent and young adult male athletes in sports that emphasize a lean physique, especially endurance and weight-class athletes. The 3 interrelated conditions of the Male Athlete Triad occur on spectrums of energy deficiency/low energy availability (EA), suppression of the hypothalamic-pituitary-gonadal axis, and impaired bone health, ranging from optimal health to clinically relevant outcomes of energy deficiency/low EA with or without disordered eating or eating disorder, functional hypogonadotropic hypogonadism, and osteoporosis or low bone mineral density with or without bone stress injury (BSI). Because of the importance of bone mass acquisition and health concerns in adolescence, screening is recommended during this time period in the at-risk male athlete. Diagnosis of the Male Athlete Triad is best accomplished by a multidisciplinary medical team. Clearance and return-to-play guidelines are recommended to optimize prevention and treatment. Evidence-based risk assessment protocols for the male athlete at risk for the Male Athlete Triad have been shown to be predictive for BSI and impaired bone health and should be encouraged. Improving energetic status through optimal fueling is the mainstay of treatment. A Roundtable on the Male Athlete Triad was convened by the Female and Male Athlete Triad Coalition in conjunction with the 64th Annual Meeting of the American College of Sports Medicine in Denver, Colorado, in May of 2017. In this second article, the latest clinical research to support current models of screening, diagnosis, and management for at-risk male athlete is reviewed with evidence-based recommendations.

Measuring clinically relevant opioid-related problems in health care systems is challenging due to the lack of standard definitions and coding practices. Well-defined, opioid-related health problems (ORHPs) would improve prevalence estimates and evaluation of clinical interventions, crisis response, and prevention activities. We sought to estimate prevalence of opioid use disorder (OUD), opioid misuse, and opioid poisoning among inpatients at a large, safety net, health care institution.Our study included events documented in the electronic health records (EHRs) among hospitalized patients at Denver Health Medical Center during January 1, 2017 to December 31, 2018. Multiple EHR markers (ie, opioid-related diagnostic codes, clinical assessment, laboratory results, and free-text documentation) were used to develop diagnosis-based and extended definitions for OUD, opioid misuse, and opioid poisoning. We used these definitions to estimate number of hospitalized patients with these conditions.During a 2-year study period, 715 unique patients were identified solely using opioid-related diagnostic codes; OUD codes accounted for the largest proportion (499/715, 69.8%). Extended definitions identified an additional 973 unique patients (~136% increase), which includes 155/973 (15.9%) who were identified by a clinical assessment marker, 1/973 (0.1%) by a laboratory test marker, and 817/973 (84.0%) by a clinical documentation marker.Solely using diagnostic codes to estimate prevalence of clinically relevant ORHPs missed most patients with ORHPs. More inclusive estimates were generated using additional EHR markers. Improved methods to estimate ORHPs among a health care system's patients would more fully estimate organizational and economic burden to more efficiently allocate resources and ensure capacity to provide clinical services.

Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.

Background: Bone stress injury (BSI) is a common reason for missed practices and competitions in elite track and field runners. Hypothesis: It was hypothesized that, after accounting for medical risk factors, higher plantar loading during running, walking, and athletic movements would predict the risk of future BSI in elite collegiate runners. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 39 elite collegiate runners (24 male, 15 female) were evaluated during the 2014-2015 academic year to determine the degree to which plantar pressure data and medical history (including Female and Male Athlete Triad risk factors) could predict subsequent BSI. Runners completed athletic movements while plantar pressures and contact areas in 7 key areas of the foot were recorded, and the measurements were reported overall and by specific foot area. Regression models were constructed to determine factors related to incident BSI. Results: Twenty-one runners (12 male, 9 female) sustained ≥1 incident BSI during the study period. Four regression models incorporating both plantar pressure measurements and medical risk factors were able to predict the subsequent occurrence of (A) BSIs in female runners, (B) BSIs in male runners, (C) multiple BSIs in either male or female runners, and (D) foot BSIs in female runners. Model A used maximum mean pressure (MMP) under the first metatarsal during a jump takeoff and only misclassified 1 female with no BSI. Model B used increased impulses under the hindfoot and second through fifth distal metatarsals while walking, and under the lesser toes during a cutting task, correctly categorizing 83.3% of male runners. Model C used higher medial midfoot peak pressure during a shuttle run and triad cumulative risk scores and correctly categorized 93.3% of runners who did not incur multiple BSIs and 66.7% of those who did. Model D included lower hindfoot impulses in the shuttle run and higher first metatarsal MMP during treadmill walking to correctly predict the subsequent occurrence of a foot BSI for 75% of women and 100% without. Conclusion: The models collectively suggested that higher plantar pressure may contribute to risk for BSI.

Bone stress injury (BSI) of the tibia, a spectrum of impairments that include conditions commonly referred to as medial tibial stress syndrome (MTSS), tibial stress reaction, and tibial stress fracture, is relatively common in athletes of various ages and levels of competition. While simple rest from the offending activities remains the primary method of treatment, identification of nutritional, hormonal, and biomechanical risk factors is crucial to prevent persistent or recurrent injury. Perhaps the most basic and important mechanical risk factor, especially in those with chronic or recurrent injury, may be abnormalities in gait and ankle flexibility, which can range from subtle to severe. While magnetic resonance imaging-based (MRI) injury grading can provide a framework for expected healing time, treatment must be individualized and evolution of a patient’s symptoms should guide the progression to return to sport after a prescribed period of rest. The vast majority of tibial BSIs can be managed nonoperatively and surgery is largely reserved for those who have undergone exhaustive conservative management without success, those with multiple recurrences, or high-level competitive athletes with the most severe grades of injury. The current review aims to highlight current concepts in the treatment of tibial BSI, with a particular focus on the high-risk population of adolescent athletes.

The health benefits of regular recreational physical activity are well known in reducing secondary health consequences of a sedentary lifestyle in the general population. However, individuals with physical disabilities participate less frequently in recreational activity compared with those without disabilities. Although evidence on the impact of recreational physical activity on quality of life in this population is in its infancy, regular recreational and sports activity participation has shown to have a positive association with improvements in quality of life, life satisfaction, community reintegration, mood, and employment in those with disabilities. Facilitators of participating in adaptive sports include a desire to improve social support, physical fitness, health, and fun. Unfortunately, those with disabilities face numerous barriers to participate in adaptive sports including accessibility, transportation, awareness, finances, and physical and cognitive impairments. Further studies are needed to investigate facilitators and barriers to participating in adaptive sports to capitalize on the physical and psychosocial benefits of regular recreational activity. The aim of this article is to review the available literature on the effects of adaptive sports participation on quality of life.

PURPOSE OF REVIEW: This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. RECENT FINDINGS: Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. SUMMARY: Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.

Objectives: To describe demographic and presenting clinical characteristics, diagnostic features, treatment approaches, and clinical outcomes of adolescent tarsal navicular BSI’s. Methods: A retrospective chart review of patients with tarsal navicular BSIs was performed at eight academic centers. Diagnosis was confirmed by radiologic imaging in all cases. The following variables were collected utilizing a REDCap database and analyzed with basic descriptive and comparative statistics: age, sex, primary sport, physical exam (PE) findings, diagnostic imaging modality, treatment modalities, surgical technique (when applicable), time of protected weight-bearing, time to running, and time to return to sport. Results: 110 patients (mean age: 14.7 years +/-2.7 years; 65% female) met inclusion criteria, 103 (94%) of whom reported a primary sport, most commonly cross country/track and field (33%) and gymnastics/dance (27%). Common PE findings included navicular tenderness (96%), pain with walking (89%), and pain with resisted inversion (55%). Both x-ray and MRI were obtained in the majority of patients (91%), while CT was obtained for 30%. A radiologically detectable fracture line was present in 44%, most commonly on the dorsal navicular cortex. Non-operative treatment was successful in 85% of patients, consisting of protective boot (79%) or cast (21%). Operative treatment was pursued for 15% of patients, with 73% treated with open reduction internal fixation and 27% undergoing percutaneous screw fixation. All operative patients underwent fixation with either 1 (50%) or 2 screws (50%). Bone grafting was performed in 5 patients (31%). Significant differences between non-operative and operative cohorts included presence of fracture line (38% vs. 88%, PConclusions: Adolescent tarsal navicular BSIs occur most commonly in sports involving repetitive loading, such as cross country, track and field, gymnastics, and dance. The most common PE findings are navicular tenderness to palpation, pain with walking, and pain with resisted inversion. Patients that ultimately require surgical treatment were more likely to have a radiologic fracture line, prolonged return to weightbearing, running and sport than those successfully treated non-operatively. [Table: see text][Table: see text]

OBJECTIVE To identify the prevalence of male and female athlete triad risk factors in ultramarathon runners and explore associations between sex hormones and bone mineral density (BMD). DESIGN Multiyear cross-sectional study. SETTING One hundred-mile ultramarathon. PARTICIPANTS Competing runners were recruited in 2018 and 2019. ASSESSMENT OF RISK FACTORS Participants completed a survey assessing eating behaviors, menstrual history, and injury history; dual-energy x-ray absorptiometry for BMD; and laboratory evaluation of sex hormones, vitamin D, and ferritin (2019 cohort only). MAIN OUTCOME MEASURE A Triad Cumulative Risk Assessment Score was calculated for each participant. RESULTS One hundred twenty-three runners participated (83 males and 40 females, mean age 46.2 and 41.8 years, respectively). 44.5% of men and 62.5% of women had elevated risk for disordered eating. 37.5% of women reported a history of bone stress injury (BSI) and 16.7% had BMD Z scores

The Male Athlete Triad is a syndrome of 3 interrelated conditions most common in adolescent and young adult male endurance and weight-class athletes and includes the clinically relevant outcomes of (1) energy deficiency/low energy availability (EA) with or without disordered eating/eating disorders, (2) functional hypothalamic hypogonadism, and (3) osteoporosis or low bone mineral density with or without bone stress injury (BSI). The causal role of low EA in the modulation of reproductive function and skeletal health in the male athlete reinforces the notion that skeletal health and reproductive outcomes are the primary clinical concerns. At present, the specific intermediate subclinical outcomes are less clearly defined in male athletes than those in female athletes and are represented as subtle alterations in the hypothalamic-pituitary-gonadal axis and increased risk for BSI. The degree of energy deficiency/low EA associated with such alterations remains unclear. However, available data suggest a more severe energy deficiency/low EA state is needed to affect reproductive and skeletal health in the Male Athlete Triad than in the Female Athlete Triad. Additional research is needed to further clarify and quantify this association. The Female and Male Athlete Triad Coalition Consensus Statements include evidence statements developed after a roundtable of experts held in conjunction with the American College of Sports Medicine 64th Annual Meeting in Denver, Colorado, in 2017 and are in 2 parts-Part I: Definition and Scientific Basis and Part 2: The Male Athlete Triad: Diagnosis, Treatment, and Return-to-Play. In this first article, we discuss the scientific evidence to support the Male Athlete Triad model.

Bone stress injuries (BSIs) of the pelvis and sacrum comprise only 1–7% of all BSIs and can be challenging to diagnose and manage. These BSIs are often missed since they are difficult to diagnose on plain radiographs, their presenting symptoms are often vague and can be easily mistaken for other diagnoses. For this reason, advanced imaging is often required for diagnosis. Pelvic BSIs are medium-risk, meaning that they have a low likelihood of progressing to complete fracture or non-union, but should still be treated with caution. These BSIs tend to require a much longer treatment period prior to return to full activity. This chapter focuses on BSIs in the pubic rami, ilium, acetabular roof, and sacrum, in addition to osteitis pubis, including epidemiology, common presentation, diagnosis, and management recommendations.

Barrack, MT, Fredericson, M, Dizon, F, Tenforde, AS, Kim, BY, Kraus, E, Kussman, A, Singh, S, and Nattiv, A. Dietary supplement use according to sex and Triad risk factors in collegiate endurance runners. J Strength Cond Res 35(2): 404-410, 2021-This cross-sectional study evaluated the prevalence in the use of dietary supplements among elite collegiate runners among 2 NCAA Division I cross-country teams. At the start of each season from 2015 to 2017, male and female endurance runners were recruited to complete baseline study measures; the final sample included 135 (male n = 65, female n = 70) runners. Runners completed a health survey, web-based nutrition survey, and Triad risk assessment. The prevalence of dietary supplement use and Triad risk factors, including disordered eating, low bone mass, amenorrhea (in women), low body mass index, and stress fracture history, was assessed. A total of 78.5% (n = 106) runners reported taking 1 or more supplements on ≥4 days per week over the past month, 48% (n = 65) reported use of ≥3 supplements. Products used with highest frequency included multivitamin/minerals 46.7% (n = 63), iron 46.7% (n = 63), vitamin D 34.1% (n = 46), and calcium 33.3% (n = 45). More women, compared with men, used iron (61.4 vs. 30.8%, p < 0.001) and calcium (41.4 vs. 24.6%, p = 0.04); men exhibited higher use of amino acids and beta-alanine (6.2 vs. 0%, p = 0.04). Runners with bone stress injury (BSI) history, vs. no previous BSI, reported more frequent use of ≥3 supplements (61.5 vs. 32.8%, p = 0.001), vitamin D (49.2 vs. 19.4%, p < 0.001), and calcium (47.7 vs. 19.4%, p = 0.001). Low bone mineral density was also associated with higher use of vitamin D and calcium. Most runners reported regular use of 1 or more supplements, with patterns of use varying based on sex, history of BSI, and bone mass.

Background: The female athlete triad (Triad) has been associated with increased risk of bone stress injury (BSI) in certain populations. Purpose: The purpose of this study is to evaluate the prevalence of Triad risk factors and identify hormonal and extrinsic factors that may influence Triad risk in high school (HS) distance runners. Methods: Thirty-nine female HS distance runners completed a questionnaire, which included disordered eating (DE)/eating disorder (ED), menstrual irregularities, BSI history, and height/weight. Serum labs were obtained, including ferritin, 25-hydroxyvitamin D, estradiol, insulin-like growth factor, and free T3. Runners completed dual-energy x-ray absorptiometry to measure bone mineral density (BMD) using Z-scores that are age, sex and ethnicity-matched. Body fat percentage was also obtained. A risk score was then calculated using energy availability (EA), body mass index (BMI), age of menarche, oligomenorrhea, BMD, and history of BSI. The statistical model used was Spearman correlation coefficient. P-values

Background: Increased neck strength may be a protective factor for reducing concussions in youth athletes. However, little research exists regarding validated neck strength training methods among this demographic. Purpose: To determine whether a 7-week neck strength training period is sufficient to achieve significant gains in neck strength and size amongst high school football players. Additionally, to assess if increased neck strength influences concussion outcomes. Methods: This study enrolled 54 male high school football players, ages 14-17, in a 7-week strength training protocol in which neck exercises were incorporated into preseason strength and conditioning workouts (figure 1). Pre- and post-neck strength was assessed in four directions: forward flexion (FF), extension (EXT), right lateral flexion (RLF) and left lateral flexion (LLF). Strength was measured as maximal isometric head pressure applied into a pre-inflated sphygmomanometer cuff (figure 2). Concussion totals from the subsequent 2018 season were compared with totals from the 2017 and 2016 seasons per data obtained from the team’s athletic trainer. Results: Fifty athletes in total were analyzed; 4/54 athletes did not complete final testing due to scheduling conflicts. A two sample t-test of neck circumferences revealed a statistically significant increase of 0.37 cm from pre- to post-neck strength training (p=0.0025, figure 3). Single sample strength t-test analysis (corrected for cuff pre-inflation) demonstrated a statistically significant post-test strength increase of 19.8% (FF), 11.0% (EX), 18.8% (RLF), and 18.0% (LLF) (pConclusion This study demonstrates that increases in neck size and strength can be achieved amongst high school athletes using easily implemented training methods during a 7-week preseason training period. The additional observation of reduced concussion outcomes is not conclusive, though these initial results are promising. Additional research is needed to investigate the potential of neck strengthening in modifying concussion risk. Funding provided by the Stanford Medical Scholars Fellowship Program [Figure: see text][Figure: see text][Figure: see text]

Background: The Female Athlete Triad (Triad) is the interrelationship of low energy availability, reproductive irregularities, and low bone mineral density. It is theorized that mental health illness can both contribute to and result from low energy availability. Limited data exists that describes the relationship between the Female Athlete Triad and mental health symptoms. Hypothesis/Purpose: The purpose of this study was to investigate the relationship between the Triad and mental health illness, specifically depression and anxiety symptoms, in high school athletes. Methods: This was a cross-sectional survey study of high school athletes distributed via social media with responses accepted from 12/30/20 – 2/15/21. Data was collected including age, sex, training history, menstrual history, history of bone stress injuries, and eating behaviors. The Female Athlete Triad Coalition Consensus Statement Cumulative Risk Assessment Tool was used to score athletes (range: 0-10 points) and to classify them as low-, moderate-, or high-risk for Female Athlete Triad. Mental health was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress Depression and Anxiety short form questionnaires. Mental health scores were scored as none, mild, moderate, or severe self-reported depressive or anxious symptoms. Ordinal logistic regressions were performed. Results: There were 78 self-reported female high school participants (mean age = 16). Depression symptoms were reported in 74% of participants (19% mild, 40% moderate, 15% severe). Anxiety symptoms were reported in 64% of participants (18% mild, 26% moderate, 21% severe). Triad risk assessment responses categorized participants as 45% low risk, 41% moderate risk, and 14% high risk of developing the Triad. Depression symptoms were significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.245 (1.004 – 1.544) ( p = .0462). Anxiety symptoms were also significantly associated with increasing Triad risk assessment score: Odds Ratio (per 1 point Triad risk score) = 1.264 (1.020 – 1.567) ( p = .0319). Conclusion: Anxiety and depression symptoms were both significantly associated with increasing Triad risk scores in this preliminary cross-sectional study. Notably, this study is limited by sampling bias. Further research is needed to explore the relationship between mental health illness and the Female Athlete Triad.

Violence researchers have highlighted a need to understand connections between campus characteristics and violent victimization among students. Responding to those calls, we systematically reviewed research examining the characteristics of secondary and post-secondary educational settings associated with sexual violence and related victimization experiences, including dating/intimate partner violence, stalking, bullying, hate crimes, and crime more broadly. We screened 1124 quantitative and qualitative records, 43 of which met the inclusion criteria for this systematic review. Evidence emerged for institution demographics, institution type, institution climate, institution financial characteristics, and educational characteristics being related to various forms of victimization; institution setting (urban vs. rural) was not associated with victimization. Additionally, evidence was observed for institution location and size/density. Some factors, including institution type and campus demographics, operated differently for different forms of victimization. We highlight limitations of existing data, including variability in the measurement of victimization outcomes, lack of power to detect differences at the campus level, and challenges of creating a database on victimization that contains campus identifiers. We also reinforce calls for more intersectional research, both in terms of the types of victimization experienced by students as well as in the disproportionate impact victimization may have on students with marginalized identities.

Bone stress injuries are common in military personnel and athletes. The delayed diagnosis of a bone stress injury can lead to a more severe injury that requires a longer period of treatment. The early detection of bone stress injuries is a central part of management. Currently, the reference standard for detecting bone stress injuries is magnetic resonance imaging. However, the expanding use of point-of-care ultrasonography (US) may enable the early detection of bone stress injuries in the clinical setting. In this article, we review the US detection of bone stress injuries, as well as discuss the rationale for the use of US in the diagnosis of these injuries.

There appears a linear relationship between small increases in running speed and cardiovascular health benefits. Encouraging or coaching recreational runners to increase their running speed to derive these health benefits might be more effective if their joint level kinematic and kinetic strategy was understood. The aim of this investigation was to compare the peak sagittal plane motions, moments, and powers of the hip, knee and ankle at 85%, 100%, 115% and 130% of self-selected running speed. Overground running data were collected in 12 recreational runners (6 women, 6 men) with a full body marker set using a 12-camera Vicon MX system with an AMTI force plate. Kinematics and kinetics were analyzed with Vicon Nexus software. Participants chose to run at 2.6 ± 0.5 m/s (85%); 3.0 ± 0.5 m/s (100%); 3.3 ± 0.5 m/s (115%); and 3.7 ± 0.5 m/s (130%); these four speeds approximately correspond to 6:24-, 5:33-, 5:03-, and 4:30-min kilometer running paces. Running speed had a significant effect (P 0.05) on peak kinematic and kinetic variables of the hips, knees and ankles, with peak sagittal hip moments invariant (P 0.54) and the peak sagittal ankle power generation (P 0.0001) the most highly responsive variable. The timing of the peak sagittal extensor moments and powers at the hip, knee and ankle were distributed across stance in a sequential manner. This study shows that running speed affects lower limb joint kinematics and kinetics and suggests that specific intersegmental kinetic strategies might exist across the narrow range of running speeds.

Foot injuries account for 10% to 20% of all running injuries, and ankle injuries account for 15% of all sports injuries. In running, the foot serves as the link between the ground and the kinetic chain of the lower limb and trunk to enable forward propulsion. Excessive stress or abnormalities in biomechanical stress can predispose runners to overuse and traumatic injury. This chapter provides a framework for approaching the differential diagnosis of foot and ankle injuries in runners and outlines evidence-based medicine to prevent, evaluate, and manage injury. Within this framework, common running injuries are highlighted and grouped based on structure. We cover tendon, ligament/fascia, nerve, and bone disorders. A more comprehensive analysis is devoted to Achilles tendinopathy, plantar fasciopathy, and acute lateral ankle sprain due to their commonality in runners. Multidisciplinary and evidence-based clinical care can enable most runners to make a successful return to sport following conservative treatment.

Bone stress injuries (BSIs) occur when bone is no longer able to withstand repetitive, mechanical loading. BSIs are common in elite and recreational runners. The 1-year prospective incidence of BSI in competitive cross-country and track-and-field athletes is as high as 21%. Early identification and proper management of BSI may prevent progression of injury down the pathology continuum on magnetic resonance imaging. BSI may represent a systemic deficit in metabolic or hormonal status. Screening for the Female Athlete Triad and parallel male Triad can help prevent BSI or BSI recurrence. This chapter uses evidence-based medicine to highlight the pathophysiology, risk factors, clinical evaluation, and management of common BSIs in runners. Within this framework, BSIs are grouped by high-, moderate-, and low-risk anatomic sites based on healing properties. With evidence-based management and proper rehabilitation principles, most runners can return to play with conservative treatment.

Background: A multidisciplinary approach is an intrinsic part of the sports medicine management process as providers, therapists and athletic trainers frequently interact to deliver optimal care to athletes both in clinic and on the sideline. Establishing effective communication and engaging athletes in the decision making process as treatment plans are developed may help increase compliance and improve health outcomes. Gender preference of patients for their providers has been found to influence patient satisfaction and health outcomes but has not been studied in depth. Purpose: The purpose of this study was to systematically review the literature to identify and characterize young athletes’ gender preferences for their sports medicine providers. Methods: This review was conducted according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses Group (PRISMA) guidelines. Pubmed, Embase, CINAHL and PsycInfo databases were searched utilizing MeSH terms, with results limited to English-language publications from the year 1945 to present day. The investigators assessed study eligibility independently and limited to studies that had quantitative outcome measures related to gender preference and participants ≤ 22 years of age. The Appraisal Tool for Cross-Sectional Studies (AXIS) was utilized to assess studies for bias. Results: Six cross-sectional studies met the eligibility criteria. Across studies, there were a total of 2,159 participants with mean ages ranging from 14.7 to 21.0 years. Of the five studies that reported the gender of participants, 50.6% were female. Participants were more likely to have a preference for a gender-concordant sports medicine provider when their chief complaint was related to their genital region and/or their sexual health. Participants of both genders favored a female provider when the health issue pertained to behavioral and/or psychosocial health, such as depression. Female athletes preferred a female provider when the issue was related to body image and/or disordered eating. For strength and conditioning coaches, male athletes reported a strong preference for male providers, but female athletes did not express a gender preference. Two of the studies’ quality was categorized as “good” by the AXIS criteria and four were “fair”. Conclusions: Young athletes’ gender preference for their sports medicine providers is situation-dependent. However, there is a paucity of studies examining gender provider preferences in pediatric athletes. Further studies are necessary to address this void in the literature as this may impact health outcomes.

Background: Investigations of the female athlete triad (Triad) in high school athletes have found that 36% had low energy availability, 54% had menstrual abnormalities, and 16% had low bone mineral density (BMD). Limited data are available showing the prevalence of these risk factors in high school distance runners or regarding best practice on screening for the Triad in the adolescent population. Purpose: To (1) evaluate the prevalence of Triad risk factors and iron supplementation in high school distance runners and (2) pilot a screening tool for Triad risk score. Study Design: Descriptive epidemiology study. Methods: The study population included female high school athletes who participated in cross-country/track. Participants completed a survey including questions regarding dietary habits, menstrual history, and bone stress injury (BSI) history. They then underwent evaluation of 25-hydroxyvitamin D, free triiodothyronine (T3), and dual-energy x-ray absorptiometry scan to measure body fat and BMD through use of age-, sex-, and ethnicity-matched Z scores. Triad scores were calculated. Relationships were analyzed using Spearman correlation coefficient. Results: There were 38 study participants (mean age, 16.9 years). Average body mass index was 19.8 kg/m2. Disordered eating or eating disorders were reported in 76.3% of runners; in addition, 23.7% reported delayed menarche, 45.9% had a history of amenorrhea or oligomenorrhea, 42.1% had low BMD ( Z score < –1.0), and 15.8% reported prior BSI. Low free T3 was significantly associated with higher Triad risk scores ( r S = –0.36; P = .028). More than 42% of athletes were supplementing iron. Conclusion: The prevalence of Triad risk factors in high school distance runners was high. Free T3 was inversely associated with Triad score, which may serve as an indicator of low energy availability. Nearly half of the athletes were using iron supplementation.

ObjectivesBone stress injuries (BSI) are common in runners of both sexes. The purpose of this study was to determine if a modified Female Athlete Triad Cumulative Risk Assessment tool would predict BSI in male distance runners.Methods156 male runners at two collegiate programmes were studied using mixed retrospective and prospective design for a total of 7 years. Point values were assigned using risk assessment categories including low energy availability, low body mass index (BMI), low bone mineral density (BMD) and prior BSI. The outcome was subsequent development of BSI. Statistical models used a mixed effects Poisson regression model with pResults42/156 runners (27%) sustained 61 BSIs over an average 1.9 years of follow-up. In the baseline risk factor model, each 1 point increase in prior BSI score was associated with a 57% increased risk for prospective BSI (p=0.0042) and each 1 point increase in cumulative risk score was associated with a 37% increase in prospective BSI risk (p=0.0079). In the longitudinal model, each 1 point increase in cumulative risk score was associated with a 27% increase in prospective BSI risk (p=0.05). BMI (rate ratio (RR)=1.91, p=0.11) and BMD (RR=1.58, p=0.19) risk scores were not associated with BSI.ConclusionA modified cumulative risk assessment tool may help identify male runners at elevated risk for BSI. Identifying risk factors may guide treatment and prevention strategies.