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ObjectivesTo evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence.MethodsWe conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16–26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes.Results269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16–26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful.ConclusionThe IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes.Trial registration numberNTR7698.

Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinicians and policy-makers implement results in practice. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and its accompanying Explanation and Elaboration document provide general reporting examples for systematic reviews of healthcare interventions. However, implementation guidance for sport and exercise medicine, musculoskeletal rehabilitation, and sports science does not exist. The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address this problem. Nineteen content experts collaborated with three methods experts to identify examples of exemplary reporting in systematic reviews in sport and exercise medicine (including physical activity), musculoskeletal rehabilitation (including physiotherapy), and sports science, for each of the PRISMA 2020 Statement items. PERSiST aims to help: (1) systematic reviewers improve the transparency and reporting of systematic reviews and (2) journal editors and peer reviewers make informed decisions about systematic review reporting quality.

The importance of physical activity during childhood and adolescence has come to light, with an increase in sports-related acute traumatic and overuse injuries as a major disadvantage. A solid understanding of the physiology of the growing skeleton, together with knowledge about age- and sex-related differences in the occurrence of acute traumatic and overuse injuries is necessary. Every musculoskeletal radiologist should also be familiar with the appearances of these injuries on different imaging modalities. This review focuses on all these aspects concerning acute traumatic and overuse injuries among children and adolescents.

ObjectivesTo systematically develop an injury prevention programme in judo and test its feasibility: Injury Prevention and Performance Optimization Netherlands (IPPON) intervention.MethodsWe used the five-step Knowledge Transfer Scheme (KTS) guidelines. In the first two steps, we described the injury problem in judo and showed possibilities to reduce the injury rates. In the third step, the Knowledge Transfer Group (KTG) translated this information into actions in judo practice. Expert meetings and practical sessions were held. In the fourth step, we developed the injury prevention programme and evaluated its feasibility in judo practice in a pilot study. As a final step, we will evaluate the injury prevention programme on its effectiveness to reduce injuries.ResultsIn the first two steps, information collected indicated the need for reducing judo injuries due to high incidence rates. Injury prevention programmes have shown to be effective in reducing injuries in other sports. For judo, no injury prevention programme has yet been systematically developed. In the third step, the KTG reached consensus about the content: a trainer-based warm-up programme with dynamic exercises focusing on the shoulder, knee and ankle. In the fourth step, the intervention was developed. All exercises were approved in the pilot study. Based on the pilot study’s results, the IPPON intervention was extended and has become suitable for the final step.ConclusionWe developed the IPPON intervention using the systematic guidance of the KTS. This trainer-based programme focuses on the prevention of shoulder, knee and ankle injuries in judo and consists of 36 exercises classified in three categories: (1) flexibility and agility, (2) balance and coordination and (3) strength and stability. The effectiveness and feasibility of the intervention on injury reduction among judo athletes will be conducted in a randomised controlled trial.

BackgroundClinical decision-making around intramuscular tendon injuries of the hamstrings is a controversial topic in sports medicine. For this injury, MRI at return to play (RTP) might improve RTP decision-making; however, no studies have investigated this.ObjectiveOur objectives were to describe MRI characteristics at RTP, to evaluate healing and to examine the association of MRI characteristics at RTP with reinjury for clinically recovered hamstring intramuscular tendon injuries.MethodsWe included 41 athletes with hamstring intramuscular tendon injuries and an MRI at baseline and RTP. For both MRIs, we used a standardised scoring form that included intramuscular tendon injury characteristics. We recorded reinjuries during 1-year follow-up.ResultsAt RTP, 56% of the intramuscular tendons showed a partial or complete thickness tendon discontinuity. Regarding healing from injury to RTP, 18 of 34 (44% overall) partial-thickness tendon discontinuities became continuous and 6 out of 7 (15% overall) complete thickness tendon discontinuities became partial-thickness tendon discontinuities. Waviness decreased from 61% to 12%, and 88% of tendons became thickened. We recorded eight (20%) reinjuries within 1 year. Intramuscular tendon characteristics at RTP between participants with or without a reinjury were similar.ConclusionComplete resolution of an intramuscular tendon injury on MRI is not necessary for clinically successful RTP. From injury to RTP, the intramuscular tendon displayed signs of healing. Intramuscular tendon characteristics of those with or without a reinjury were similar.

The quantity of clinical information (scientific articles, videos, podcasts, and so on) available, and ways to access this information are increasing exponentially—far more rapidly than one can differentiate valuable information (signal) from non-useful or even misleading information (noise).1 Your job is to select information that is both accurate and useful, and to convert it into knowledge to make a quality decision. Making a quality decision in practice should involve three key steps: (1) systematically searching and assessing the quality of published literature, (2) combining quality research evidence with quality clinical evidence, and (3) considering the feasibility of use in the practical setting. When reviewing the research evidence, you might choose to consult systematic reviews (SRs)—expected to be a high-quality and comprehensive summary of the body of research regarding a particular intervention, technique, procedure or technology. However, while you might expect that a SR is accurate, remember that the glittering thing is not always gold.2 Some poorly conducted SRs use complex data pooling to synthesise articles with high risk of bias, creating a publication with a tantalising title while the results and discussion/conclusion are misleading and confusing.2 The number of SRs being produced is growing rapidly, but many of these are redundant, misleading or unnecessary.3 This raises the question: How do you make sense of conflicting SR research evidence? How do you know which one to trust? You are the team clinician and your star player sustains a time-loss injury—tendinopathy, hamstring strain, shoulder dislocation, ACL rupture—the injury specifics are not important here. But what is important is what you do next. How do you gather and synthesise quality information to help the player make an informed choice about treatment? You are not short of information to help inform a decision, but how do you make sense of it? What should …

KLINISCHE BEFUNDE SIND DER BILDGEBUNG VON HAMSTRING-VERLETZUNGEN UBERLEGEN Bildgebende Masnahmen fugen der klinischen Befundung bei Hamstring-Verletzungen nur wenig relevante Informationen zu. Bei der Vorhersage der Verletzungsdauer sollten sich Sportphysios daher in erster Linie auf ihre Untersuchungen verlassen. Dabei helfen konnen mehrere evidenzbasierte Tests.

One of the challenges of working in professional sport is the constant pressure to be innovative, to adopt new strategies, techniques and technologies to gain that all important competitive advantage. Players, managers and chief executive officers feel the pressure to perform and win matches—often this manifests as a perception of needing to accumulate all those marginal gains possible and fear of missing out, that is, another team has a cryotherapy chamber, so we should too, even if it may not be effective. The medical and performance team feel pressure to provide these so-called ‘one-percenters’ that players and managers and even the Board can obsessively chase. In this process, practitioners often come up against charismatic forces hawking the next silver bullet, magic potion or black box that will claim to win games, improve performance, enhance recovery and predict injury or talent. There is also the fact that …

Arm movements after perturbations like tripping over an obstacle have been suggested to be aspecific startle responses, serve a protective function or contribute to balance recovery. This study aimed at determining if and how arm movements play a functional role in balance recovery after a perturbation. We tripped young subjects using an obstacle that suddenly appeared from the floor at exactly mid-swing. We measured arm muscle EMG, quantified body rotations after tripping, and established the effects of arm movements by calculating how the body would have rotated without arms. Strong asymmetric shoulder muscle responses were observed within 100 ms after trip initiation. Significantly faster and larger responses were found in the contralateral arm abductors on the non-tripped (right) side. Mean amplitudes were larger in the ipsilateral retroflexors and contralateral anteflexors. The resulting asymmetric arm movements had a small effect on body rotation in the sagittal and frontal planes, but substantially affected the body orientation in the transverse plane. With the enlargement of the ongoing arm swing, the arms contributed to balance recovery by postponing the transfer of arm angular momentum to the trunk. This resulted in an axial rotation of the lower segments of the body towards the non-tripped side, which increases the length of the recovery step in the sagittal plane, and therefore facilitates braking the impending fall. © 2009 Springer-Verlag.

Infographic: 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern