Research Articles (Sports Medicine)

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Building the future of exercise oncology : current status of international workforce development and integration into standard cancer care
(Oxford University Press, 2025-09) Wonders, Karen Y.; Kennedy, Mary A.; Capozzi, Lauren C.; Lei, Yao; Pillay, Lervasen; Azevedo Voltarelli, Fabrício; Wiskemann, Joachim; Campbell, Anna M.
The complex requirements of people with cancer can impact the provision of safe, effective, evidence-based exercise prescription. Consequently, a range of essential competencies are required from the exercise oncology workforce. There is a global need for a standardized approach to the development of this workforce. By defining, standardizing, and training the workforce in essential competencies, this will enable various professionals to safely and effectively screen, access, design, and deliver appropriate exercise programs. Therefore, this is also a call for a global collaboration on the development of the exercise oncology workforce with special attention to assisting low- or middle-income countries with their increasing cancer burden and unique challenges, which may require unique context-specific strategies. The building of an appropriate internationally standardized workforce is essential in the provision of physical activity and exercise options as part of standard cancer care.
Consensus on the descriptors, definitions, and reporting methods for heading in football studies : a Delphi study
(Public Library of Science, 2025-07) Peek, Kerry; Ross, Andrew G.; Williamson, Paula R.; Georgieva, Julia; Andersen, Thor Einar; Meyer, Tim; Gouttebarge, Vincent; Dahlen, Sara; Clarke, Mike; Serner, Andreas
Heading in football (soccer) is a complex skill involving deliberate head-to-ball contact, which may pose short-, medium-, and long-term risk to player brain health. However, understanding header exposure during matches and training sessions, as well as comparing header incidence between studies is currently challenging given the lack of standardisation in descriptors, definitions, and reporting methods. This Delphi study aimed to establish a consensus on the descriptors, definitions, and reporting methods for heading in football research to improve consistency and quality. The study involved 167 participants from diverse football-related backgrounds including coaches, players, medical personnel, and researchers, with consensus achieved to include 27 descriptors in minimum reporting criteria for heading in football research. An additional 27 descriptors were also defined for inclusion in an expanded framework. The operational definition of a header was standardised as “a head-to-ball contact where the player makes a deliberate movement to redirect the trajectory of the ball using their head.” The consensus framework provides a standardised approach to heading in football research to enhance data quality and comparability across studies. Improved header incidence data quality has the potential to contribute significantly to our understanding of the risks associated with heading in football to inform future research and practice guidelines.
Health and performance challenges in the era of human enhancement : insights from sport medicine professionals
(Springer, 2025-10) Hu, Ke; Schneider, Christian; Hutchinson, Mark R.; Ergen, Emin; Geistlinger, Michael; Killoughery, Iain; Braumann, Klaus-Michael; Lazzoli, Jose Kawazoe; Seto, Jane; Bigard, Xavier; Debruyne, Andre; Jegier, Anna; Papadopoulou, Theodora; Manonelles, Pedro; Arroyo, Francisco; Ghrairi, Mourad; Cintron, Ana V.; Zupet, Petra; Leitao, Marcelo Bichels; Kayikci, Umutcan; Kopile, Daniel Arkader; Pigozzi, Fabio; Fossati, Chiara; Di Gianfrancesco, Alessia; Di Luigi, Luigi; Stafrace, Kirill Micallef; Ionescu, Anca; Wolfarth, Bernd; Ergun, Metin; Roberts, William O.; Natsis, Konstantinos; Tooth, Camille; Rozenstoka, Sandra; Casajus, Jose Antonio; Muniz-Pardos, Borja; Nahon, Roberto Lohn; Shroff, Malav; Xie, Minhao; Constantinou, Demitri; Janse van Rensburg, Dina Christina; Ulkar, Buelent; Jowett, Andrew; Badtieva, Victoriya; Kaux, Jean-Francois; Baumgartl, Peter; Papaellina, Clea Hadjistephanou; Steinacker, Juergen; Motta-Pensabene, Julio; Reer, Ruediger; Bachl, Norbert; Migliorini, Sergio; Zahar, Maher; Stuart, Mark; Bilzon, James; Massazza, Giuseppe; Di Pietro, Bruno; Hassan, Khaled Massoud; Drummond, Felix Albuquerque; Fincoeur, Bertrand; Petroczi, Andrea; Pitsiladis, Yannis
BACKGROUND : In the pursuit of sporting success, some elite athletes prioritise peak performance over long-term health, frequently resulting in significant and enduring health consequences. The Enhanced Games (TEG) position themselves as a bold experiment in transhumanism, advocating for the use of performance-enhancing drugs (PEDs), including methods banned by World Anti-Doping Agency (WADA), to push the boundaries of human athletic potential. OBJECTIVES : The aim of this study is to explore the perspectives of sport physicians, sport scientists, physiotherapists and other allied healthcare professionals on treating and supporting “enhanced athletes”, with the view of informing future guidelines. METHODS : Participants were invited via email and personal contacts within sport medicine communities to complete a brief anonymous survey via QuestionPro™. Descriptive statistics were performed using Excel™ and RStudio™. RESULTS : A total of 323 healthcare professionals responded (82% were sport physicians), among whom 74% expressed a willingness to treat acute lesions and/or chronic diseases in “enhanced athletes”. In comparison, a considerable minority (30%) expressed support for assisting athletes in their use of PEDs and methods under medically supervised conditions, with high consistency across professional roles. A relatively high readiness was observed in sport physicians treating acute (77% versus 58%; p < 0.01) and chronic (75% versus 63%; p = 0.11) diseases for “enhanced athletes”. As far as WADA rules and/or national anti-doping laws apply, this support presupposes compliance with the code and the respective national laws to protect physicians from serious professional, legal and personal consequences. CONCLUSION : The preliminary findings align with the broader goal of fostering a sport culture that values both peak performance and the short- and long-term health of all participants. These results emphasise the necessity of implementing professional guidelines and comprehensive support systems designed to safeguard the long-term well-being of all athletes and underscore the urgent need for further research into the impact of TEG on sport and its community.
Can we trust them? An expert evaluation of large language models to provide sleep and jet lag recommendations for athletes
(Springer Nature, 2025) Vitale, Jacopo; McCall, Alan; Cina, Andrea; Janse van Rensburg, Dina Christina; Halson, Shona
BACKGROUND : With the increasing use of artificial intelligence in healthcare and sports science, large language models (LLMs) are being explored as tools for delivering personalized, evidence-based guidance to athletes. OBJECTIVE : This study evaluated the capabilities of LLMs (ChatGPT-3.5, ChatGPT-4, and Google Bard) to deliver evidence-based advice on sleep and jet lag for athletes. METHODS : Conducted in two phases between January and June 2024, the study first identified ten frequently asked questions on these topics with input from experts and LLMs. In the second phase, 20 experts (mean age 43.9 ± 9.0 years; ten females, ten males) assessed LLM responses using Google Forms surveys administered at two intervals (T1 and T2). Inter-rater reliability was evaluated using Fleiss' Kappa, and intra-rater agreement using the Jaccard Similarity Index (JSI), and content validity through the content validity ratio (CVR). Differences among LLMs were analyzed using Friedman and Chi-square tests. RESULTS : Experts’ response rates were high (100% at T1 and 95% at T2). Inter-rater reliability was minimal (Fleiss' Kappa: 0.21–0.39), while intra-rater agreement was high, with 53% of experts achieving a JSI ≥ 0.75. ChatGPT-4 had the highest CVR for sleep (0.67) and was the only model with a valid CVR for jet lag (0.68). Google Bard showed the lowest CVR for jet lag (0%), with significant differences compared to ChatGPT-3.5 (p = 0.0073) and ChatGPT-4 (p < 0.0001). Reasons for inappropriate responses varied significantly for jet lag (p < 0.0001), with Google Bard criticized for insufficient information and frequent errors. ChatGPT-4 outperformed other models overall. CONCLUSIONS : This study highlights the potential of LLMs, particularly ChatGPT-4, to provide evidence-based advice on sleep but underscores the need for improved accuracy and validation for jet lag recommendations.
Exploring eccentric hamstring strength : peak force, torque, and impulse metrics in elite academy soccer players
(Routledge, 2025) Tondelli, Eduardo; Tomaghelli, Luciano; Tedesco, Franco; Feroldi, Alejo; Herbella, Juan; Baldjian, Agustin; Van Dyk, Nicol
This study aimed to characterize eccentric strength metrics and the bilateral asymmetry index of the knee flexor muscles across different categories in elite academy soccer players. Also, explore correlations between the metrics with demographic characteristics. With a cross-sectional design, data were collected over two weeks during the mid-year break of the 2023 season. Eccentric muscle strength was assessed with the Nordic Hamstring Exercise (NHE) with the NordBord®. One hundred thirty-two male elite academy soccer players between 13 and 20 years old (16.3 ± 2.2 years; body mass (BM): 68.8 ± 6.5 kg; height: 174 ± 7 cm) competing in the Argentinian Football League participated. Metrics included were relative and absolute peak force (PF), peak torque (PT), and eccentric impulse (EI). Bilateral asymmetry index (BAI) was calculated for each metric. Eccentric PF, PT, and EI significantly increased with age. BAI decreased from the U17 category onward. Moderate correlations were observed between PF and PT with BM (r = 0.45, p < .001, 95% CI: 0.31–0.58; and r = 0.54, p < .001, 95% CI: 0.41–0.65, respectively), and PF with body mass index (BMI) (r = 0.37, p < .001, 95% CI: 0.22–0.51). EI had weaker correlations with BM (r = 0.12, p < .1665, 95% CI: –0.061–0.3). PF and PT peaked at the U17 and declined in older categories. To conclude, this study found higher eccentric hamstring strength values in elite youth soccer players than previously reported. PF showed moderate correlation with BMI, while EI had weak correlations with BM. Significant age-related variations in BAI were observed, particularly in younger players.
International Tennis Federation (ITF), Women's Tennis Association (WTA), and Association of Tennis Professionals (ATP) expert group statement on nutrition in high-performance tennis. Current evidence to inform practical recommendations and guide future research
(Human Kinetics, 2025-08) Vicente-Salar, Néstor; Crespo, Celda Miguel; Pluim, Babette M.; Fernández-Fernández, Jaime; Stroia, Kathleen; Ellenbecker, Todd; Sanz, David; Del Coso, Juan; Moreno-Pérez, Victor; Hainline, Brian; López-Samanes, Álvaro; LaRoche, Jessica; Parker-Simmons, Susie; Van Reijen, Miriam; Reid, Machar; Duffield, Rob; Girard, Olivier; Love, Page; Broad, Elizabeth; Halson, Shona; Ruiz-Cotorro, Angel; Sanz-Quinto, Santiago; Ruiz-Cotorro, Ángel Jr; Sánchez Pay, Alejandro; Burke Louise M.
The sport of tennis involves unique nutritional demands for the physical and technical aspects of match play and training, as well as the nutritional challenges associated with extensive travel and a lengthy competition calendar. An expert group assembled by The International Tennis Federation, the Women's Tennis Association, and the Association of Tennis Professionals has produced a scientific review of current evidence to inform practical recommendations for high-performance tennis. The narrative summary considers the diversity within the tennis community, including male and female players, youth players, and wheelchair players. The Expert Group Statement addresses nine specific topics: (a) introduction to tennis; (b) physiological characteristics of tennis training and match play; (c) training nutrition; (d) body composition, low energy availability, and relative energy deficiency in sport; (e) match-day nutrition; (f) dietary supplements for tennis performance; (g) environmental and travel issues; (h) nutrition guidelines during periods of illness and injury rehabilitation; and (i) special population groups. The statement advocates for an evidence-based approach to nutrition in high-performance tennis and emphasizes a "food first" philosophy, prioritizing food over supplements to meet nutrient requirements effectively. In recognition of the benefits of sound nutrition, strategies in supporting health and performance over a player's career, academies, national federations, and international organizations are encouraged to engage professionals with appropriate nutrition-related qualifications and professional registrations to support players effectively.
Sex, training variables, history of chronic disease, and chronic injury are risk factors associated with a history of exercise-associated muscle cramping in 10,973 ultramarathon race entrants : a safer XXXVIII study
(Edizioni Minerva Medica S.p.A., 2024-09) MacMillan, Candice; Sewry, Nicola Ann; Schwellnus, Martin Peter; Boulter, Jeremy; Dyer, Marlise; Jordaan, Esme; candice.macmillan@up.ac.za
BACKGROUND : The prevalence of a history of exercise-associated muscle cramping (hEAMC) among ultramarathon runners is high. While the Comrades is one of the most popular mass community-based participation ultramarathons (90 km) globally, research on the epidemiology, clinical characteristics, and risk factors of entrants' lifetime hEAMC are scarce. This research aimed to describe the epidemiology, clinical characteristics, and risk factors of hEAMC among Comrades Marathon entrants. METHODS : This was a retrospective, cross-sectional study in which 10973 race entrants of the 2022 Comrades Marathon participated. Entrants completed a prerace medical screening questionnaire that included questions related to the lifetime prevalence (%; 95% CI), severity, treatment and risk factors (demographics, training/racing variables, chronic disease/allergies, injury) for EAMC. RESULTS : One thousand five hundred eighty-two entrants reported hEAMC in their lifetime (14.4%; 95% CI: 13.77-15.09). There was a significantly (P<0.01) higher prevalence of male (16.10%; 95% CI:15.34-16.90) than female (8.31%; 95% CI: 7.27-9.50) entrants with hEAMC (PR=1.94; 95% CI:1.68-2.23). The prevalence of hEAMC was highest in entrants with a: 1) 1 disease increase in composite disease score (PR=1.31; 95% CI:1.25-1.39); 2) history of collapse (PR=1.87; 95% CI 1.47-2.38); 3) past chronic musculoskeletal (MSK) injury (PR=1.71; 95% CI 1.50-1.94); and 4) MSK injury in the previous 12 months (PR=2.38;95% CI: 2.05-2.77). Training-related risk factors included an increase of 10 km weekly running distance (PR=0.97; 95% CI:0.95-0.99) and a training pace increase of 1min/ km (slower) (PR=1.07; 95% CI:1.03-1.12). CONCLUSIONS : Future research should investigate the causal relationship between risk factors identified and hEAMC in ultramarathon runners. Findings from this study could assist in effective anticipation and adequate planning for treating EAMC encounters during community-based mass participation events.
International Olympic Committee consensus-driven guidelines for athlete mental health support at sporting events
(BMJ Publishing Group, 2025) Mountjoy, Margo; Sloan, Scott; Ali-Zada, Msomah; Bindra, Abhinav; Blauwet, Cheri; Budgett, Richard; Burrows, Kirsty; Currie, Alan; Engebretsen, Lars; Erdener, Ugur; Massey, Andrew; McDuff, David; Moran, Jane; Purcell, Rosemary; Putukian, Margot; Thornton, Jane S.; Viseras, Gloria; Fear, Joanna; Gouttebarge, Vincent
Event-related mental health problems among elite athletes are prevalent. However, empirical details on the development and implementation of a comprehensive mental health support programme at international sporting events are lacking. Therefore, this paper aims to provide consensus-driven, evidence-based recommendations to guide such a development and implementation. An 8-stage process based on the RAND-UCLA Appropriateness Method was adopted to collate and synthesise the available literature on this topic, to identify gaps in the scientific evidence and to enlist expert experience from a multidisciplinary expert panel to fill these gaps. Within such a process, the existing scientific literature was explored while experts (including athletes) were consulted to reach consensus on the recommendations. Accordingly, a robust pre-event plan is required to ensure the successful implementation of a comprehensive mental health programme during sport events, focussing on promotion, prevention, treatment and recovery. During sporting events, according to the defined pre-event plan, various activities targeting athletes, coaches, the entourage, officials or fans should be implemented: for example, educational programmes to decrease stigma, raise awareness and support help-seeking, a mental fitness area for decompression and relaxation, inperson mental health services provided by qualified mental health professionals with sport-specific as well as trauma-informed and violence-informed skills and mental health surveillance in parallel with the existing injury and illness surveillance programmes. Post event, a thorough evaluation of the implemented activities should be conducted while surveillance data should be analysed to identify areas requiring future targeted intervention(s). Also, particular attention should be given to postevent mental health support including the use of decompression interventions to support adjustment, emotional processing and reintegration.
The prevalence, size, and anatomic location of cartilage and osteochondral lesions in athletes with an acute ligamentous ankle injury
(Sage, 2025-07) Baltes, Thomas P.A.; Dalansi, Feriel; Al-Naimi, Maryam R.; Bordalo, Marcelo; Holtzhausen, Louis; Whiteley, Rod; Cardinale, Marco; D'Hooghe, Pieter; Kerkhoffs, Gino M.M.J.; Tol, Johannes L.
BACKGROUND : In athletes with an acute ligamentous ankle injury, cartilage and osteochondral lesions ([O]CLs) have been reported in 8% using 1.5-T magnetic resonance imaging (MRI). Visualization of cartilage injuries improves with the use of higher field strengths. PURPOSE : To evaluate the prevalence, size, and anatomic location of (O)CLs in athletes with an acute ligamentous ankle injury using 3-T MRI, as well as to determine the association of (O)CLs with injury of (1) the lateral ankle ligaments and (2) anterior syndesmosis. STUDY DESIGN : Cohort study; Level of evidence, 3. METHODS : For this prospective cohort study, all acute ligamentous ankle injuries in athletes (≥18 years of age) evaluated in the outpatient department of a specialized orthopaedic and sports medicine hospital within 7 days after injury were assed for eligibility. Acute ankle injuries were excluded if 3-T MRI could not be obtained within 10 days after injury or if imaging demonstrated a frank fracture. A musculoskeletal radiologist assessed MRI scans for the presence, location, and size of (O)CLs. Morphology was graded using the modified Berndt and Harty score, Griffith MRI score, and International Cartilage Regeneration & Joint Preservation Society score. In addition, injuries of the lateral ankle ligaments and anterior syndesmosis were graded. A multivariate logistic regression analysis was performed to evaluate the association between (O)CLs and injury of the (1) lateral ankle ligaments and (2) anterior syndesmosis. RESULTS : Between September 2016 and February 2020, 171 acute ankle injuries in 166 athletes were included in this study. The overall prevalence of (O)CLs was 14%. (O)CLs of the talus and tibia were observed in 24 (14%) and 9 (5%) acute ankle injuries, respectively. Of 33 (O)CLs, 28 (85%) were classified as cartilage lesions. Lateral ligament injury was observed in 73% of acute ankle injuries, and anterior syndesmosis injury in 38%. Multivariate logistic regression analysis did not show significantly higher odds of (O)CLs in the presence of anterior syndesmosis injury (OR, 2.16; 95% CI, 0.90-5.16). CONCLUSION : In athletes with an acute ligamentous ankle injury, a prevalence for (O)CLs of 14% was established using 3-T MRI. The majority were cartilage lesions. No statistically significant association was established between (O)CLs and lateral ligament or syndesmosis injury was established.
Protecting respiratory health of athletes : an Olympic challenge
(Elsevier, 2024-07) Hull, James H.; Clemm, Hege; Backer, Vibeke; Koehle, Michael; Mountjoy, Margo; Schwellnus, Martin Peter; Olin, J. Tod
The summer of 2024 will be remembered in part for the XXXIII Olympic and Paralympic Games in Paris, France. The Games provide a platform to highlight the value of sporting participation and remind us of the widespread health benefits of regular exercise, including for cardiovascular, metabolic, mental, and respiratory health
International perspectives on exercise oncology : current state, challenges, and opportunities for future development
(Oxford University Press, 2025-09) Luo, Hao; Bergerot, Paulo Gustavo; Galvão, Daniel A.; Jeon, Justin Y.; Mustian, Karen Michelle; Newton, Robert U.; Pillay, Lervasen; Wiskemann, Joachim; Schmitz, Kathryn H.
Exercise oncology has emerged as a distinctive area of research and clinical practice. To obtain a global overview of this field, we summarize viewpoints from experts across 6 continents on (1) the scope of exercise oncology research and programs, (2) the availability of reimbursement for cancer exercise services, and (3) pathways and initiatives for developing the exercise oncology workforce. From an international perspective, the field of exercise oncology has progressed substantially; however, gains made to date are uneven, with general underdevelopment in Africa, Asia, and South and Central America. In addition, the availability of cancer exercise services continues to fall short of the increasing demand worldwide. With the upcoming formation of the International Society of Exercise Oncology, we suggest leveraging coordinated efforts from the global exercise oncology community to optimize research capacity, enhance workforce development, and expand the delivery of exercise services to advance the field across the world.
Trail running safety : a review of serious adverse events reported in online news articles
(Sage, 2025-09) Viljoen, Carel Thomas; Da Cruz, Monique; Matlala, Kgame; Groves, Megan; Du Toit, Kaylin; Fourie, Loria; Silva, Bruno; Scheer, Volker; MacMillan, Candice; Janse van Rensburg, Dina Christina; carel.viljoen@up.ac.za
Trail running is an endurance sport that entails running outdoors on natural terrain. Scientific literature provides minimal information on serious adverse events that occur during trail running. The objectives of this review were to identify and summarize the available information published in online worldwide news articles and to categorize the results in fatal, missing, and catastrophic events in trail running. Over a 14-wk period, online news articles were searched using Google Advanced Search and DuckDuckGo for reports on serious adverse events during trail running. Data were extracted and summarized from online news articles that met the inclusion criteria. Ninety-four online news articles reported on 127 runners involved in serious adverse events during trail running. Among the serious adverse events reported in this review, 82% (n = 104) were fatal trail running events; 29% (n = 37) were related to missing events, of which 54% (n = 20) of the missing events resulted in death; and 6% (n = 6) were catastrophic injuries. Most runners were males (73%) aged 16 to 75 y (41.5 ± 12.6 y). The most common intrinsic causes of death were cardiac arrest (58%) and collapse (38%), whereas the most common extrinsic causes of death were cold weather resulting in potential hypothermia (40%) and blunt trauma following falling/slipping (25%). Almost half the runners who went missing (41%) were found. The 6 runners involved in catastrophic events (6%) suffered severe burn wounds, brain damage, and frostbite. Serious adverse events in trail running seem to be rare. This review reports multiple serious adverse events during trail running. Although these events are rare, they highlight the need for further research and improved reporting. These findings can assist in developing future prevention strategies for trail running events and guide medical staff during race-day medical planning.
Are recommended tackle techniques associated with superior performance outcomes? A retrospective video analysis study of elite women’s rugby union
(Routledge, 2024) Dane, Kathryn; West, Stephen; Simms, Ciaran; Sharief, Hendricks; Van Dyk, Nicol; Connors, Will; Ventresque, Anthony; Wilson, Fiona
This cross-sectional study aims to identify the situational characteristics, ball-carrier technical variables, and Tackle Ready recommended techniques associated with performance outcomes in elite women’s Rugby Union. Using retrospective video analysis, 43 tackler and ball-carrier technical characteristics for 1500 tackle events in the 2022–23 Women’s Six Nations Championship were assessed, considering match situation and performance outcomes. Rate ratio (RR) was determined using propensity rates. Effective tackles were associated with match situations involving two defenders, forwards tackling forwards, defensive teams moving forwards, and tackles initiated closer to attackers at ball reception. Seven out of the 22 coded Tackle Ready techniques were significantly associated with superior performance outcomes. Techniques associated with the greatest likelihood of effective tackle outcome included wrap and clamp (RR 46.8) and ear to body (RR 20.9). Tackles made to the hip and leg of the ball-carrier increased the risk of missed tackles. This study provides the first analysis of tackle characteristics associated with performance outcomes in women’s rugby, providing a reference to inform coaching practice and the implementation of tackle education resources and law changes. Further research is warranted to explore techniques associated with injury risk, and interactions between match situations and subsequent tactical/technical tackle actions.
May the (horizontal) force be with you : the role of ankle function and horizontal force production on hamstring injury risk and rehabilitation
(BMJ Publishing Group, 2025) Van Dyk, Nicol; Pecci, Javier
Hamstring injuries remain one of the most prevalent and challenging issues in field-based sports such as football, with injury rates showing no signs of decline despite extensive research efforts. The underlying mechanisms and risk factors associated with hamstring injury have been well established, including previous injury, age, strength, range of motion, and function. Recent evidence also highlights the role of sprint running mechanics as a key risk factor. Most preventative and rehabilitation strategies have focused on the hamstring muscle itself, emphasising eccentric strength, flexibility and symmetry between limbs. Primarily, these programmes address hamstring strength and flexibility in isolation. Failure to address the complexity of lower limb function in high-speed movements, where multiple joints and muscle groups interact dynamically, could lead to a higher risk of injury or incomplete rehabilitation. The interconnected nature of the kinetic chain suggests that a narrow focus on the hamstrings might overlook critical contributors to injury risk, as established by previous research investigating broader kinetic chain approaches. It has long been accepted that distal structures, such as the ankle joint, may influence proximal biomechanics through altered range of motion, force transmission and movement efficiency. We propose a possible mechanism by which these deficiencies or restrictions may lead to compensatory mechanics that increase hamstring strain.
Pre-race medical clearance in 60,609 distance running race entrants : which entrants sought clearance, what physicians did, and what was the outcome? SAFER XXXVII
(Edizioni Minerva Medica, 2025-04) Muller, Christili; Schwellnus, Martin Peter; Janse van Rensburg, Dina Christina; Jordaan, Esme; Sewry, Nicola Ann; nicola.sewry@up.ac.za
BACKGROUND : Medical clearance is often recommended for athletes prior to endurance exercise. The primary aim was to determine the percentage (%) of race entrants that sought medical clearance prior to participation in endurance running events, describe the diagnostic modalities used by doctors to assess entrants seeking medical clearance, and the clearance advice given. Secondary aims were to investigate the factors associated with seeking and outcome of clearance. METHODS : All consenting race entrants who completed an online screening questionnaire during registration to participate in the 21.1 km or 56 km Two Oceans marathon races from 2013-2015 (N.=60,609) were included. Runners were stratified into four risk categories: low risk (LR), intermediate risk (IR), high risk (HR) and very high risk (VHR). Runners were asked if they consulted with a medical doctor to obtain medical clearance. Follow-up questions enquired about what the doctor did when they sought medical clearance and what advice the doctor gave as an outcome of the medical clearance consultation. Prevalence (%, 95% CI) and Prevalence Ratios (PRs) are reported. RESULTS : Over the 3-year period, 14.8% of entrants sought medical clearance. For clearance, doctors used history only (9.9%), history and physical examination (36.7%) and history, physical examination, and special investigations (53.0%). Most entrants seeking medical clearance were fully cleared to race (87.7% in 21.1 km and 85.9% in 56 km) (P=0.0156). Factors associated with seeking medical clearance include longer race distance, older age and a higher risk category (P<0.0001). CONCLUSIONS : The methods doctors use when conducting medical clearance consultations vary greatly. Further research is suggested to develop a protocol that doctors can use for medical consultations.
Years of running, chronic diseases, and allergies are associated with gradual onset Achilles tendon injuries in 61,252 running race entrants
(Wiley, 2024-11) Young, Jonah Dylan; Wood, Paola Silvia; Schwellnus, Martin Peter; Jordaan, Esme; Swanevelder, Sonja
BACKGROUND : Gradual-onset Achilles tendon injuries (GoATIs) in runners are common. Data show that chronic diseases are associated with GoATI. OBJECTIVE : To determine risk factors associated with a history of GoATIs among long-distance runners (21.1 and 56 km) entering a mass community-based running event. METHODS : Online pre-race medical screening questionnaire data from 76,654 consenting Two Ocean Marathon race entrants (71.8% entrants) were collected prospectively over 4 years (2012-2015); this cross-sectional study is a retrospective analysis of these data. A total of 617 entrants (0.8%) reported a GoATI in the last 12 months; 60,635 entrants reported no history of any running injury (controls). Categories of factors associated with GoATI were explored (univariate and multiple regression analyses): demographics (age group, sex, race, distance), training/racing history, and history of allergy, history of chronic disease, and Composite Chronic Disease Score. Prevalence and prevalence ratios (PRs; 95% CI) are reported. RESULTS : Factors associated with a higher prevalence of a history of GoATI (univariate analysis vs. controls) were older age (>31 years) (p < .001), male sex (PR = 1.76; p < .001), and longer race distance (56 km vs. 21.1 km) (PR = 2.06; p < .001). Independent factors associated with a history of GoATI (multiple regression) were increased years of recreational running (PR = 1.17 for every 5-year increase, p < .001), higher Composite Chronic Disease Score (PR = 2.07 for every 2-unit increase, p < .001), and allergy history (PR = 1.98 p < .001). CONCLUSION : Novel independent factors associated with a history of GoATI in distance runners were increased years of recreational running, chronic disease history, and allergy history. Runners at risk for GoATI could be targeted for injury prevention interventions. Future studies should focus on establishing a causal relationship.
International Ski and Snowboard Federation consensus statement on warm-up and cool-down in competitive alpine and freestyle skiers and snowboarders
(BMJ Publishing Group, 2025-04) Spörri, Joerg; Beck, Lisa; Bonell Monsonis, Oriol; Alhammoud, Marine; Bahr, Roald; Bekker, Sheree; Collins, Dave; Engebretsen, Lars; Harvey, Julie; Hoerterer, Hubert; Mitterbauer, Gerald; Scherr, Johannes; Schobersberger, Wolfgang; Seiler, Jan; Valtonen, Maarit; Waibel, Karlheinz; Weirather, Tina; Gouttebarge, Vincent; Bolling, Caroline; Verhagen, Evert
In diverse sports, warm-up (WUP) and cool-down (CD) activities are highly effective at improving performance-relevant factors and reducing the risk of injury when applied systematically; however, scientific evidence is widely lacking in snow sports. Similarly, there is a lack of international harmonisation with current best practices; this especially applies to prevention efforts targeting younger athletes. This International Ski and Snowboard Federation (FIS) consensus statement aims to develop and promote recommendations regarding physical and psychological WUP&CD in competitive alpine and freestyle skiers and snowboarders. The selected panel members represented a group of experts diverse in terms of gender, expertise/background, level of competition and skiing and snowboarding discipline. They included researchers, officials, physicians, physiotherapists, coaches or former athletes with extensive experience in the subject area. However, there was a gender imbalance in the composition of the panel (7 women and 13 men) and certain freestyle disciplines (eg, aerials and moguls) were under-represented. Most importantly, there was a strong over-representation of European members (85%) on the consensus panel. For the consensus process, the RAND-UCLA Appropriateness Method was used. The panellists were asked to rate, discuss and rerate statements derived from the literature or expert/panellist opinions. The process was based on three online consensus sessions with different preparatory and follow-up tasks and three rounds of an online survey to vote on the statements. The final version of the FIS consensus statement was developed and approved after two iterative rounds of manuscript revision by the panel members. It is intended to guide athletes, coaches, medical staff of international and national federations and other entities who can promote and support appropriate WUP&CD practices for competitive alpine and freestyle skiers and snowboarders by providing support, resources or infrastructure.
Point-of-care testing to detect respiratory infections in athletes : what is the role?
(BMJ Publishing Group, 2024-09) Hull, James H.; Schwellnus, Martin Peter; Valtonen, Maarit
Acute respiratory illness (ARI) is the most common reason athletes seek acute medical care and represents a significant challenge to the sport and exercise medicine (SEM) clinician working ‘in the field’. Faced with this issue, there is a need to determine if symptoms are caused by an acute respiratory infection (ARInf), establish if a specific antimicrobial treatment is indicated, evaluate the risk of transmission and provide appropriate advice regarding the safety of ongoing sports participation.
Mass-gatherings in sport : medicine, leadership and mentorship
(BMJ Publishing Group, 2024-05) Hendricks, Sharief; Rotunno, Adrian; Gordon, Leigh; Ganda, Janesh; Zondi, Phathokuhle Cele; Derman, Wayne; Holtzhausen, Louis; Falvey, Eanna Cian; Janse van Rensburg, Dina Christina
The World Health Organistion (WHO) defines a mass gathering as a planned or spontaneous event where the number of people attending could strain the planning and response resources of the community or country hosting the event. The seed for mass-gathering medicine as a specialty was sown in the 2009 Hajj, which was held during the 2009 HIN1 influenza pandemic. Major international sporting events are also mass gatherings that require the planning and delivery of healthcare, not only for the athlete and their team, but also for the attendees and event staff. Typically, the Chief Medical Officer (CMO) is appointed to lead a team of medical officers responsible for the planning, organising, managing and delivery of healthcare. In addition to a strong grasp of sports medicine, medical officers at sporting events need leadership and organisational skills, some of which are not typically taught at medical schools. Understanding the demands and challenges of the role may strengthen young sports medicine physicians’ aspirations to become a CMO in the future.
Number of symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with multiorgan involvement : AWARE III
(Lippincott Williams and Wilkins, 2025) Snyders, Carolette; Dyer, Marlise; Jordaan, Esme; Scholtz, Leonie; Du Plessis, Andre; Mpe, Martin; Kaulback, Kelly; Schwellnus, Martin Peter; carolette.cloete@semli.co.za
OBJECTIVE : Acute respiratory infections (ARinf), including SARS-CoV-2 infection, can affect multiple organ systems that may influence return to sport (RTS) in athletes. Factors associated with multiorgan involvement in athletes with ARinf are lacking. The aim of this study was to explore whether factors such as demographics, sport participation, history of comorbidities/allergies, and number of acute symptoms are associated with multiorgan involvement in athletes with recent SARS-CoV-2 infection. DESIGN : Prospective cohort study with cross-sectional analysis. SETTING : Institutional clinical research facilities. PARTICIPANTS : Ninety-five athletes (18–60 years) underwent a comprehensive medical assessment 10 to 28 days after SARS-CoV-2 infection. INDEPENDANT FACTORS : Demographics, sport participation, history of comorbidities/allergies, and the number of acute symptoms (in 3 subgroups:1 = ≤5, 2 = 6-9, or 3 ≥ 10). MAIN OUTCOME MEASURES : Number of organs involved in athletes with recent SARS-CoV-2 infection. RESULTS : The number of organ systems involved was not associated with demographics (age, sex), sport participation (level and type), or history of comorbidities and allergies. However, the number of organ systems involved was significantly higher in athletes with 6 to 9 symptoms (subgroup 2) compared with those with ≤5 symptoms (subgroup 1) and this was more pronounced when comparing athletes with ≥10 symptoms (subgroup 3) with those with ≤5 symptoms (subgroup 1) (P < 0.0001). CONCLUSIONS : Total number of acute symptoms of SARS-CoV-2 infection is related to number of organ systems involved, which is a measure of disease severity, and could therefore influence RTS decision making. Future studies should explore whether this observation holds for athletes with ARinf caused by other pathogens.

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