Publications by authors named "Michael K Drew"

41 Publications

The Utility of the Low Energy Availability in Females Questionnaire to Detect Markers Consistent With Low Energy Availability-Related Conditions in a Mixed-Sport Cohort.

Int J Sport Nutr Exerc Metab 2021 Jul 20:1-11. Epub 2021 Jul 20.

Australian Catholic University.

The Low Energy Availability in Females Questionnaire (LEAF-Q) was validated to identify risk of the female athlete triad (triad) in female endurance athletes. This study explored the ability of the LEAF-Q to detect conditions related to low energy availability (LEA) in a mixed sport cohort of female athletes. Data included the LEAF-Q, SCOFF Questionnaire for disordered eating, dual-energy X-ray absorptiometry-derived body composition and bone mineral density, Mini International Neuropsychiatric Interview, blood pressure, and blood metabolic and reproductive hormones. Participants were grouped according to LEAF-Q score (≥8 or <8), and a comparison of means was undertaken. Sensitivity, specificity, and predictive values of the overall score and subscale scores were calculated in relation to the triad and biomarkers relevant to LEA. Fisher's exact test explored differences in prevalence of these conditions between groups. Seventy-five athletes (18-32 years) participated. Mean LEAF-Q score was 8.0 ± 4.2 (55% scored ≥8). Injury and menstrual function subscale scores identified low bone mineral density (100% sensitivity, 95% confidence interval [15.8%, 100%]) and menstrual dysfunction (80.0% sensitivity, 95% confidence interval [28.4%, 99.5%]), respectively. The gastrointestinal subscale did not detect surrogate markers of LEA. LEAF-Q score cannot be used to classify athletes as "high risk" of conditions related to LEA, nor can it be used as a surrogate diagnostic tool for LEA given the low specificity identified. Our study supports its use as a screening tool to rule out risk of LEA-related conditions or to create selective low-risk groups that do not need management as there were generally high negative predictive values (range 76.5-100%) for conditions related to LEA.
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http://dx.doi.org/10.1123/ijsnem.2020-0233DOI Listing
July 2021

Male basketball players who report hip and groin pain perceive its negative impact both on- and off-court: A cross-sectional study.

J Sci Med Sport 2021 Jul 20;24(7):660-664. Epub 2021 Feb 20.

School of Environmental & Life Sciences, The University of Newcastle, Australia.

Objectives: To identify if basketball players aged <20 years (U20) self-report hip and/or groin pain and if they perceive this as a problem. To determine potential differences in self-reported playing (training and match play) loads and Copenhagen Hip and Groin Outcome Score (HAGOS) between those with and without hip/groin pain.

Design: Cross-sectional.

Methods: Fifty-one pre-elite (state/national representative level) male U20 basketball players (Australian n=38; Italian n=13) self-reported current/historical hip/groin 'discomfort/pain' and 'problems', and playing loads. A two-factor regression model was fitted including main effects for hip/groin pain and Cohort and their interaction, with outcome variables playing loads and HAGOS subscale scores and dependent variable hip/groin pain.

Results: Twenty-one players (41%) self-reported hip/groin 'discomfort/pain', of which nine perceived no 'problems'. Two of these nine players reported training/playing time loss due to pain. Those self-reporting hip/groin discomfort/pain scored lower than those without in HAGOS subscales Symptoms (mean difference in score 8.94; 95%CI -25.24, -5.97), Pain (5.00; -16.42, -2.81), Function in daily living (0.00; -26.72 to -5.59), Function in sport and recreation (6.25; -21.24, -5.33), and hip and/or groin Quality of Life (5.00; -28.63, -8.10), indicating worse hip/groin problems. Participation subscale scores were different only for Italian players (36.25; -51.25, -20.00), with players self-reporting hip/groin discomfort/pain scoring lower.

Conclusion: Most players who perceive both hip/groin 'discomfort/pain' and 'problems' also report training/playing time loss, suggesting players' perceptions of problematic symptoms and time-loss are associated. Adolescent basketball players perceive hip/groin pain to negatively impact their daily lives and sporting function.
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http://dx.doi.org/10.1016/j.jsams.2021.02.005DOI Listing
July 2021

Impaired recovery is associated with increased injury and illness: A retrospective study of 536 female netball athletes.

Scand J Med Sci Sports 2021 Mar 18;31(3):691-701. Epub 2020 Nov 18.

Centre for Exercise and Sports Science Research, Edith Cowan University, Joondalup, WA, Australia.

Sport science and medicine practitioners are interested in the relationships between training load, injury, and illness. The extent to which training preparedness is associated with workload-related injury and illness risk is debated. Therefore, this study applied multi-level mixed effect logistic regression to investigate time-dependent (±7- and ±28-day) relationships between training preparedness (fatigue, mood, motivation, soreness, stress, sleep duration, and quality), training load, injury, and illness in 536 elite and pre-elite female netball athletes. Absolute risk (AR ± 95% CI) of sustaining an injury (0.98 ± 0.06%, n = 1122 injuries, N = 254 athletes) or illness (1.09 ± 0.10%, n = 2881, N = 432 athletes) was calculated. All training preparedness variables combined resulted in an absolute risk of 0.88%-5.88% and 0.87%-20% for injury and illness, respectively. Injury and illness had significant (P < .05) bidirectional (ie, both increased and decreased) associations with physical (soreness) and physiological (sleep duration and quality), while illness also had negative (mood, motivation) and positive (stress) associations with psychological training preparedness variables. Low sleep duration in the 48-h period prior was associated (P = .005) with increased injury risk (OR = 0.91 ± 0.03; AR = 4.00%), while "very poor" sleep quality (OR = 0.59 ± 0.02; AR = 7.83%) or extremes of too little (<5 hours, OR = 1.01 ± 0.03; AR = 3.13%-14.29%) and too much (>10 hours, OR = 1.01 ± 0.03; AR = 2.61%-10.98%) sleep had bidirectional associations (P < .001) with an increased illness risk. Changes in training preparedness variables demonstrated bidirectional associations with injury and illness. These outcomes suggest that sport science and medicine practitioners should monitor sleep, physical, and psychological recovery status, to aid early detection and intervention regarding injury and illness symptomology.
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http://dx.doi.org/10.1111/sms.13866DOI Listing
March 2021

Spatial muscle activation patterns during different leg exercise protocols in physically active adults using muscle functional MRI: a systematic review.

J Appl Physiol (1985) 2020 10 27;129(4):934-946. Epub 2020 Aug 27.

School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.

An emerging method to measure muscle activation patterns is muscle functional magnetic resonance imaging (mfMRI), where preexercise and postexercise muscle metabolism differences indicate spatial muscle activation patterns. We evaluated studies employing mfMRI to determine activation patterns of lumbar or lower limb muscles following exercise in physically active adults. Electronic systematic searches were conducted until March 2020. All studies employing ≥1.5 Tesla MRI scanners to compare spatial muscle activation patterns at the level of or inferior to the first lumbar vertebra in healthy, active adults. Two authors independently assessed study eligibility before appraising methodological quality using a National Institutes of Health assessment tool. Because of heterogeneity, findings were synthesized without meta-analysis. Of the 1,946 studies identified, seven qualified for inclusion and pertained to hamstring ( = 5), quadriceps ( = 1) or extrinsic foot ( = 1) muscles. All included studies controlled for internal validity, with one employing assessor blinding. MRI physics and differing research questions explain study methodology heterogeneity. Significant mfMRI findings were: following Nordic exercise, hamstrings with previous trauma (strain or surgical autograft harvest) demonstrated reduced activation compared with unharmed contralateral muscles, and asymptomatic individuals preferentially activated semitendinosus; greater biceps femoris long head to semitendinosus ratios reported following 45° hip extension over Nordic exercise; greater rectus femoris activation occurred in "flywheel" over barbell squats. mfMRI parameters differ on the basis of individual research questions. Individual muscles show greater activation following specific exercises, suggesting exercise specificity may be important for rehabilitation, although evidence is limited to single cohort studies comparing interlimb differences preexercise versus postexercise.
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http://dx.doi.org/10.1152/japplphysiol.00290.2020DOI Listing
October 2020

Thirty-seven jump-landing biomechanical variables are associated with asymptomatic patellar tendon abnormality and patellar tendinopathy: A systematic review.

Phys Ther Sport 2020 Sep 18;45:38-55. Epub 2020 Apr 18.

University of Newcastle, School of Environmental and Life Sciences, Ourimbah, NSW, Australia; University of Newcastle, Priority Research Centre for Physical Activity and Nutrition, Callaghan, NSW, Australia. Electronic address:

Objective: To identify studies that report three-dimensional (3D) biomechanical analysis of jump-landing tasks in relation to athletes with current patellar tendinopathy (PT), and/or asymptomatic with history of PT or patellar tendon abnormality (PTA) on diagnostic imaging.

Methods: Five electronic databases were searched. Included articles were required to: (1) investigate the 3D biomechanics of a jump-landing task; (2) be cross-sectional or longitudinal in design; and (3) include participants that had symptomatic PT, were asymptomatic with a history of PT, asymptomatic with PTA on diagnostic imaging and/or asymptomatic with an unknown pathology or PT history.

Results: Thirty-seven statistically significant jump-landing variables were associated with PT, history of PT and/or PTA. The only consistent variable that could be replicated between studies was knee flexion angle at initial foot-ground contact (IC) and an altered hip flexion/extension strategy during a horizontal land phase of a vertical stop-jump.

Conclusion: Isolated vertical landings or take-offs alone may not be sensitive enough to identify key jump-landing variables associated with PT, thus clinicians and researchers should incorporate a whole jump-landing task with a horizontal landing component. Sagital plane hip and knee kinematics in a horizontal landing phase appear to provide the most valuable information for evaluating those with PT.
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http://dx.doi.org/10.1016/j.ptsp.2020.03.011DOI Listing
September 2020

Key viral immune genes and pathways identify elite athletes with URS.

Exerc Immunol Rev 2020 ;26:56-78

School of Medical Science and Menzies Health Institute QLD, Griffith University, Southport, QLD, Australia, Griffith University, QLD, Australia.

Purpose: Habitual intense exercise may increase the incidence of upper respiratory symptoms (URS) in elite athletes. This study investigated whether immune gene expression could identify gene markers that discriminate athletes with a higher prevalence of URS.

Methods: This cross-sectional analysis of elite Australian athletes from various sports investigated whether athletes retrospectively reporting URS for two days or more in a month (n=38), had an altered immune gene expression profile compared with asymptomatic athletes (n=33). Peripheral blood samples were collected during Olympic selection events with corresponding URS data collected for the one-month period before sampling. Digital immune gene expression analysis was undertaken using the NanoString PanCancer Immune Profiling panel.

Results: Fifty immune genes were differentially expressed between the groups (p<0.05) and approximately 78% of these genes were more highly expressed in athletes reporting URS. Many of these genes were interferon-stimulated genes or genes involved in the Jak/Stat signalling pathway. Only interferon alpha inducible protein 27 (IFI27), an interferon stimulated gene involved in viral response, remained significantly higher in athletes reporting URS (log2 fold-difference=2.49, odds ratio 1.02 per unit increase; p<0.01) post-adjustment and discriminated athletes reporting URS from asymptomatic athletes with 78% accuracy.

Conclusions: Expression of IFI27 could differentiate athletes reporting URS from asymptomatic athletes, a gene that is upregulated in the immune response to viral infection. Upregulation of viral signalling pathways provides novel information on the potential aetiology of URS in elite Olympic athletes.
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March 2020

A prospective study of health problems at the 2018 17/U and 19/U Australian National Netball Championships with comparison of surveillance methodology.

J Sci Med Sport 2020 Mar 15;23(3):215-221. Epub 2019 Oct 15.

Athlete Availability Program, Australian Institute of Sport, Australia; Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Australia.

Objective: To investigate the incidence, site, nature and cause of injuries sustained during and four weeks following the 2018 Australian National Netball Championships (ANNC's) using medical attention and self-report surveillance tools.

Design: Prospective cohort study.

Method: Injuries were recorded prospectively using medical attention and self-report data collection methods. One hundred and ninety-two athletes competed at the 2018 ANNC's with 96 athletes in each age group (17/U & 19/U).

Results: There were 103 medical attention injuries sustained by 80 athletes resulting in an incidence rate of 89.4 per 1000 player hours. The most frequently recorded medical attention injury diagnoses across both age groups were lateral ankle ligament sprain (n=14, 13.6%), foot blisters (n=11, 10.7%), and lumbar pain (n=10, 9.7%). Ankle sprains (n=4), anterior cruciate ligament (ACL) ruptures (n=3) and concussion (n=3) recorded as the highest sports incapacity injuries. The self-report data collection revealed that 46 (27.2%) athletes arrived at the tournament with an existing self-reported injury/illness and 57 (39.3%) athletes had a self-reported injury/illness at the conclusion of the ANNC (RR 1.44 95%CI 1.05-1.99, p=0.030).

Conclusion: There are no recent studies reporting injury rates specifically in pre-elite netball players. This study found an incidence rate of 89.4 per 1000 player hours. Ankle sprains are the highest medical attention and sports-incapacity injury in pre-elite netball athletes. Foot blisters and low back pain also feature in the highest medical attention injuries and ACL rupture and concussion were high sports incapacity injuries at the ANNC's. Finally, combining both the medical attention and self-report injury/illness data collection methods identified more injuries/illnesses than the use of one method alone.
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http://dx.doi.org/10.1016/j.jsams.2019.10.004DOI Listing
March 2020

Jump-landing mechanics in patellar tendinopathy in elite youth basketballers.

Scand J Med Sci Sports 2020 Mar 20;30(3):540-548. Epub 2020 Jan 20.

School of Environmental and Life Sciences, University of Newcastle, Ourimbah, NSW, Australia.

Patellar tendinopathy (PT) is a leading cause of morbidity in jump-landing athletes. Landing mechanics are identified as a factor associated with PT and/or patellar tendon abnormality. This study aimed to identify key jump-landing variables associated with PT. Thirty-six junior elite basketball players (men n = 18, women n = 18) were recruited from a Basketball Australia development camp. Three-dimensional (3D) kinematic and ground reaction force (GRF) data during a stop-jump task were collected as well as ultrasound scans of the patellar tendons and recall history of training load data. Mixed-model factorial analyses of variance were used to determine any significant between-group differences. Of the 23 participants included for statistical analyses, 11 had normal bilateral patellar tendons (controls) and eight reported PT (currently symptomatic); however, the four participants categorized as asymptomatic with patellar tendon abnormality on diagnostic imaging were excluded from statistical analyses due to their small sample size. Athletes with PT displayed a similar knee flexion angle at initial foot-ground contact (IC) and hip extension strategy during a stop-jump horizontal landing. Despite a similar kinematic technique, athletes with PT utilized a strategy of a longer stance duration phase from IC to peak force. This strategy did not lead to those athletes with PT decreasing their peak vertical GRF nor patellar tendon force during landing but enabled these athletes to land with a lower rate of loading (control 59.2 ± 39.3 vs. PT 29.4 ± 33.7 BW.s-1). Athletes with PT still reported significantly reduced training volume (control 4.9 ± 1.8 vs PT 1.8 ± 1.1 sessions/wk; total training time/wk control 2.4 ± 1.0 vs PT 1.4 ± 1.1 h/wk).
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http://dx.doi.org/10.1111/sms.13595DOI Listing
March 2020

Epidemiology of bone stress injuries in Australian high performance athletes: A retrospective cohort study.

J Sci Med Sport 2019 Oct 29;22(10):1114-1118. Epub 2019 Jun 29.

Medical School, Australian National University, Australia.

Objectives: To examine the epidemiology of bone stress injuries in an elite sports institute.

Design: Retrospective cohort study at the Australian Institute of Sport.

Methods: A retrospective analysis of the clinical records contained within the Australian Institute of Sport Athlete Management System electronic database was performed. Records with Orchard Sports Injury Classification System codes relating to bone stress injuries and stress fractures were reviewed and descriptive statistics relating to sport, site of injury, athlete age, sex and activity were analysed.

Results: In the three-year period January 2014-2017, 11,942 injuries were recorded across 48 sports. 181 bone stress injuries (0.15% of all injuries) were recorded across 16 sports. BSIs in the foot and lumbar spine were the most common accounting for 30% and 23% of all the reported BSIs respectively. Gymnasts had a high frequency of lumbar spine stress injuries (n=24, 51%) and rowers had a high frequency of rib stress injuries (n=22, 88%). The most common location for stress injuries, equally distributed across a variety of sports, were in the foot (n=54, 30%). Female athletes recorded more BSIs than males.

Conclusion: Across a three-year period, 0.15% of injuries were related to bone stress injuries. Almost double the cases were recorded in female athletes. Sport specific injury sites were observed in the dataset.
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http://dx.doi.org/10.1016/j.jsams.2019.06.008DOI Listing
October 2019

Comparison of subsequent injury categorisation (SIC) models and their application in a sporting population.

Inj Epidemiol 2019 11;6. Epub 2019 Mar 11.

1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.

Background: The original subsequent injury categorisation (SIC-1.0) model aimed to classify relationships between chronological injury sequences to provide insight into the complexity and causation of subsequent injury occurrence. An updated model has recently been published. Comparison of the data coded according to the original and revised subsequent injury categorisation (SIC-1.0 and SIC-2.0) models has yet been formally compared.

Methods: Medical attention injury data was prospectively collected for 42 elite water polo players over an 8 month surveillance period. The SIC-1.0 and SIC-2.0 models were retrospectively applied to the injury data. The injury categorisation from the two models was compared using descriptive statistics.

Results: Seventy-four injuries were sustained by the 42 players (median = 2, range = 0-5), of which 32 injuries (43.2%) occurred subsequent to a previous injury. The majority of subsequent injuries were coded as occurring at a different site and being of a different nature, while also being considered clinically unrelated to the previous injury (SIC-1.0 category 10 = 57.9%; SIC-2.0 clinical category 16 = 54.4%). Application of the SIC-2.0 model resulted in a greater distribution of category allocation compared to the SIC-1.0 model that reflects a greater precision in the SIC-2.0 model.

Conclusions: Subsequent injury categorisation of sport injury data can be undertaken using either the original (SIC-1.0) or the revised (SIC-2.0) model to obtain similar results. However, the SIC-2.0 model offers the ability to identify a larger number of mutually exclusive categories, while not relying on clinical adjudication for category allocation. The increased precision of SIC-2.0 is advantageous for clinical application and consideration of injury relationships.
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http://dx.doi.org/10.1186/s40621-019-0183-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582673PMC
March 2019

Epidemiology of elite sprint kayak injuries: A 3-year prospective study.

J Sci Med Sport 2019 Oct 13;22(10):1108-1113. Epub 2019 Jun 13.

La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia.

Objectives: To analyse the characteristics of injuries sustained by elite sprint kayak athletes, to investigate relationships between initial and subsequent injuries, and to examine injury differences between male and female athletes.

Design: Descriptive epidemiology study.

Methods: Data from 63 athletes (37 male, 26 female) of the Australian national sprint kayak squad were prospectively collected over three continuous years (September 2014-August 2017). All medical attention injuries were recorded irrespective of time-loss and modality of training. Descriptive analyses were performed, and frequency comparisons across genders assessed with chi squared tests.

Results: Forty-nine athletes (78%) sustained 146 injuries (median=2, interquartile range=1-4, range=0-12). Most injuries were to the upper limb (48%), with the shoulder being the most common body site injured (27%). Thirty-one athletes (49%) sustained at least one subsequent injury, equating to 97 subsequent injuries. The majority (68%) of subsequent injuries occurred at a different site and nature to previous injuries. Male athletes were more likely to sustain an injury than remain injury free compared to female athletes (Chi=6.75, p=0.009), but there was no difference between males and females who thereafter sustained a subsequent injury (Chi=0.84, p=0.359).

Conclusions: Injury occurrence is common in sprint kayak, with many athletes experiencing more than one injury. Small variations in injury characteristics exist between male and female athletes in sprint kayak. This study identifies upper limb and trunk, and joint and muscle injuries as the most prevalent sprint kayak injuries, providing a focus for the development of future injury prevention strategies.
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http://dx.doi.org/10.1016/j.jsams.2019.06.002DOI Listing
October 2019

Subsequent Injury Risk Is Elevated Above Baseline After Return to Play: A 5-Year Prospective Study in Elite Australian Football.

Am J Sports Med 2019 07 14;47(9):2225-2231. Epub 2019 Jun 14.

Athlete Availability Program, Australian Institute of Sport, Canberra, Australia.

Background: The risk of sustaining a subsequent injury is elevated in the weeks after return to play (RTP) from an index injury. However, little is known about the magnitude, duration, and nature by which subsequent injury risk is increased.

Purpose: To quantify and describe the risk of injury in a 12-week period after RTP from an index injury in Australian football players.

Study Design: Cohort study; Level of evidence, 2.

Methods: Injury data were collected from 79 players over 5 years at 1 Australian Football League club. Injuries were classified with the Orchard Sports Injury Classification System and by side of the body. Furthermore, injury severity was classified as time loss (resulting in ≥1 matches being missed) or non-time loss (no matches missed). Subsequent injury was categorized with the SIC-2.0 model and applied to the data set via an automated script. The probability of a time loss subsequent injury was calculated for in-season index injuries for each week of a 12-week period after RTP via a mixed effect logistic regression model.

Results: Subsequent injury risk was found to be highest in the week of RTP for both time loss injuries (9.4%) and non-time loss injuries (6.9%). Risk decreased with each week survived after RTP; however, it did not return to baseline risk of participation (3.6%).

Conclusion: These findings demonstrate that athletes returning to play are at an increased risk of injury for a number of weeks, thus indicating the requirement for tertiary prevention strategies to ensure that they survive this period.
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http://dx.doi.org/10.1177/0363546519852622DOI Listing
July 2019

Injury prevention strategies specific to pre-elite athletes competing in Olympic and professional sports - A systematic review.

J Sci Med Sport 2019 Aug 12;22(8):887-901. Epub 2019 Mar 12.

Athlete Availability Program, Australian Institute of Sport, Australia; Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Australia.

Objectives: To describe and evaluate injury prevention interventions for pre-elite athletes who compete in an Olympic or professional sport.

Design: Systematic review.

Methods: This review was prospectively registered (PROSPERO CRD42017065083) and a systematic electronic search was conducted in May 2017. The following inclusion criteria were applied: (1) studies including and analysing data specific to pre-elite athletes (determined by the T3/T4 levels of the FTEM model); (2) featured injury prevention interventions; (3) provided sufficient data related to injury such that the effect can be analysed e.g. injury rates, incidence, prevalence, injury rate ratios; (4) featured randomised and non-randomised controlled trials or prospective cohorts.

Results: A total of 13,480 articles were retrieved with 121 titles identified and 11 studies satisfying the inclusion criteria. No studies demonstrated a low risk of bias. Four different interventions were identified: exercise (n=7, 64%), psychological (n=2, 18%), equipment (n=1, 9%), nutrition (n=1, 9%). Of the seven exercise interventions, four showed a protective effect and three found no significant effect, providing conflicting evidence. Caution is advised due to high risk of bias, low intervention reporting and minimal evidence for implementation planning in all seven studies.

Conclusions: There is limited evidence from level 2 and 3 studies suggesting exercise and psychology interventions may prevent injury in pre-elite athletes. There is an absence of evidence to support the use of equipment and nutrition interventions in pre-elite athletes. There is a need for quality research designs confirming the clinical impact of existing injury prevention interventions for pre-elite athletes.
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http://dx.doi.org/10.1016/j.jsams.2019.03.002DOI Listing
August 2019

What Is Performance? A Scoping Review of Performance Outcomes as Study Endpoints in Athletics.

Sports (Basel) 2019 Mar 16;7(3). Epub 2019 Mar 16.

Athletics Research Centre, Linköping University, 581 83 Linköping, Sweden.

Purpose: This review set out to summarise, define, and provide future direction towards the use of performance outcome measures as endpoints in research performed at international benchmark events in athletics.

Methods: Scoping review methodology was applied through a search of the PubMed and Sports Discus databases and a systematic article selection procedure. Articles that met the inclusion criteria underwent triage for further quantitative and qualitative analysis. A concept chart was generated to describe the methods by which performance had been measured and introduce descriptive labels for theoretical and practical application.

Results: None of 2972 articles primarily identified from the database search met the triage standards for quantitative data extraction. Eleven articles were included in a qualitative analysis. The analysis identified the common methods by which performance has been measured, reported and analysed. The resulting concept chart collates labels from the qualitative analysis (categories, themes, and constructs) with sports practice labels (performance metrics, framework, and analysis).

Conclusions: The state of knowledge concerning methods to employ performance metrics as endpoints in studies performed at major competitions in athletics has been summarised. Constructing a methodology that combines the performance metric variables (continuous and ordinal) that are currently utilised as endpoints remains a challenge.
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http://dx.doi.org/10.3390/sports7030066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473619PMC
March 2019

A 2-Year Prospective Study of Injury Epidemiology in Elite Australian Rugby Sevens: Exploration of Incidence Rates, Severity, Injury Type, and Subsequent Injury in Men and Women.

Am J Sports Med 2019 05 19;47(6):1302-1311. Epub 2019 Feb 19.

La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.

Background: Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only.

Purpose: To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only.

Study Design: Descriptive epidemiology study.

Methods: Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed.

Results: Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P = .011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence.

Conclusion: Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injuries sustained in rugby sevens, and they are typically different from previous types of sustained injuries. After each successive injury, the risk profile for future injury occurrence appears to be altered, which warrants further investigation to inform injury prevention strategies in rugby sevens.
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http://dx.doi.org/10.1177/0363546518825380DOI Listing
May 2019

Knee flexion not hip extension strength is persistently reduced following hamstring strain injury in Australian Football athletes: Implications for Periodic Health Examinations.

J Sci Med Sport 2018 Oct 3;21(10):999-1003. Epub 2018 Apr 3.

Department of Physical Therapies, Australian Institute of Sport (AIS), Australia; Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia.

Objectives: Determine whether clinically feasible tests of isometric lower limb strength and range of motion (ROM) in Australian Football (AF) athletes are useful in Periodic Health Examinations to identify persistent deficits following hamstring strain injury (HSI).

Design: Case-control.

Methods: Thirty-seven male, semi-professional AF athletes (mean±SD; age, 20.2±2.9years; height, 1.7±0.5m; mass, 81±9.2kg) participated, ten athletes (37%) reported HSI within the previous three seasons of competition. Comparisons of pre-season isometric knee flexion and hip extension strength variables (peak force, torque and torque normalised to body mass) and hip, knee and ankle ROM measures were made between athletes with and without past-history of HSI using linear mixed-effect models. A logistic regression evaluated whether any of the outcome measures could differentiate athletes with a past-history of HSI.

Results: Knee flexion peak force, torque and torque normalised to body mass were significantly reduced in athletes with a past-history of HSI (coefficient, 95% CI) (-44.8N, -86.3 to -3.3), (-22.2Nm, -40.5 to -3.7) and (-0.2Nmkg, -0.4 to 0.0) respectively. Knee flexion peak torque normalised to body mass (Nmkg) approached significance as a test was able to differentiate athletes with history of HSI (p=0.068). There were no differences between groups for any hip extension strength or lower limb ROM outcome measures.

Conclusions: Deficits in isometric peak knee flexion strength persist for up to three seasons following HSI in AF athletes. Isometric knee flexion strength testing may be a clinically feasible option for Periodic Health Examinations and inform tertiary injury prevention strategies.
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http://dx.doi.org/10.1016/j.jsams.2018.03.014DOI Listing
October 2018

Rating of perceived exertion is a stable and appropriate measure of workload in judo.

J Sci Med Sport 2018 Oct 15;21(10):1008-1012. Epub 2018 Mar 15.

Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia; Exercise Science Department, Southern Connecticut State University, United States.

Objectives: Heart rate (HR), blood lactate concentration [La] and/or rating of perceived exertion (RPE) have been utilised to monitor judo training load in technical and randori (competition training) sessions, but are yet to be investigated in mixed sessions containing both elements. Therefore the purpose of this study was to: (1) determine the stability of these variables, and (2) to assess the efficacy of RPE as a load variable for mixed judo sessions.

Design: Cross-sectional study.

Methods: Twenty-nine athletes attended two mixed training sessions at an international training camp. Bout and session characteristics, including RPE, physical and mental effort, heart rate (HR) and post-session [La] were recorded. A two-way random-effects intra-class correlation assessed variable stability. Multilevel mixed-effects ordered logistic regression investigated relationships between RPE and other variables for bouts and sessions.

Results: Average and minimum HR across sessions correlated highly (ICC=0.95 and 0.94, respectively). Good correlations existed between [La], session-RPE and mental effort, and fair correlation of max HR and physical effort. No relationships existed between [La]/HR and session-RPE. A unit increase in bout-RPE resulted in a 2.09 unit increase in physical, or a 1.36 unit increase in mental, effort holding all other bout variables constant. Gender and competitive level did not influence statistical models.

Conclusions: Results provide further evidence that RPE can be used across a range of competitive levels and genders to monitor workload of mixed sessions and individual randori in judo. Physical effort may play a larger role than mental effort when athletes reflect on exertion during training.
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http://dx.doi.org/10.1016/j.jsams.2018.02.013DOI Listing
October 2018

Improvement of Prediction of Noncontact Injury in Elite Australian Footballers With Repeated Exposure to Established High-Risk Workload Scenarios.

Int J Sports Physiol Perform 2018 Oct 19;13(9):1130-1135. Epub 2018 Oct 19.

Objectives: To assess the effect of multiple high-risk-scenario (HRS) exposures on noncontact injury prediction in elite Australian footballers.

Design: Retrospective cohort study.

Methods: Sessional workload data (session rating of perceived exertion, global positioning system-derived distance, sprint distance, and maximum velocity) from 1 club (N = 60 players) over 3 seasons were collated; several established HRSs were also defined. Accumulated HRS sessional exposures were calculated retrospectively (previous 1-8 wk). Noncontact injury data were documented. Univariate and multivariate Poisson regression models determined injury incidence rate ratios (IRRs) while accounting for moderating effects (preseason workload volume and playing experience). Model performance was evaluated using receiver operating characteristics (area under curve).

Results: Very low (0-8 sessions: IRR = 5.76; 95% confidence interval [CI], 1.69-19.66) and very high (>15 sessions: IRR = 4.70; 95% CI, 1.49-14.87) exposures to >85% of an individual's maximal velocity over the previous 8 wk were associated with greater injury risk compared with moderate exposures (11-12 sessions) and displayed the best model performance (area under curve = 0.64). A single session corresponding to a very low chronic load condition over the previous week for all workload variables was associated with increased injury risk, with sprint distance (IRR = 3.25; 95% CI, 1.95-5.40) providing the most accurate prediction model (area under curve = 0.63).

Conclusions: Minimal exposure to high-velocity efforts (maximum speed exposure and sprint volume) was associated with the greatest injury risk. Being underloaded may be a mediator for noncontact injury in elite Australian football. Preseason workload and playing experience were not moderators of this effect.
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http://dx.doi.org/10.1123/ijspp.2017-0696DOI Listing
October 2018

Knee flexion strength is significantly reduced following competition in semi-professional Australian Rules football athletes: Implications for injury prevention programs.

Phys Ther Sport 2018 May 2;31:9-14. Epub 2018 Feb 2.

Department of Physical Therapies, Australian Institute of Sport (AIS), Canberra, Australia; Australian Collaboration for Research into Injury in Sport and Its Prevention (ACRISP), Federation University Australia, Ballarat, Australia.

Objectives: To evaluate strength and flexibility measures pre- and post- Australian Football (AF) competition to determine their potential utility as secondary prevention measures.

Design: Cohort study.

Setting: Semi-professional AF club.

Participants: Ten male AF athletes (mean ± SD; age, 21.3 ± 2.2 years; height, 186.1 ± 6.3 cm; weight, 83.5 ± 8.6 kg).

Main Outcome Measures: Maximal unilateral isometric knee flexion strength performed in 45 degrees of hip flexion and 30 degrees of knee flexion, flexibility measures of hip and knee extension and ankle dorsiflexion. All outcome measures were evaluated pre-match to determine baseline measurements and repeated acutely post-match and at 26, 50 and 74 h following. Comparisons were made between baseline measures and all other time points.

Results: Knee flexion strength was significantly reduced at a group level acutely (-122.8N, 95%CI -156.2 to -89.4, p = 0.000) and at 26 h (-89.6N, 95%CI -122.9 to -56.2, p = 0.000) following competition. Hamstring flexibility was significantly reduced at all time periods following competition (all p < 0.05), however these values were not clinically meaningful.

Conclusions: Knowledge that unilateral isometric knee flexion strength returns to pre-competition levels by 50 h following match-play in AF athletes is valuable for planning recovery time frames and may inform implementation of secondary prevention strategies.
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http://dx.doi.org/10.1016/j.ptsp.2018.01.001DOI Listing
May 2018

An Updated Subsequent Injury Categorisation Model (SIC-2.0): Data-Driven Categorisation of Subsequent Injuries in Sport.

Sports Med 2018 09;48(9):2199-2210

Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia.

Background: Accounting for subsequent injuries is critical for sports injury epidemiology. The subsequent injury categorisation (SIC-1.0) model was developed to create a framework for accurate categorisation of subsequent injuries but its operationalisation has been challenging.

Objectives: The objective of this study was to update the subsequent injury categorisation (SIC-1.0 to SIC-2.0) model to improve its utility and application to sports injury datasets, and to test its applicability to a sports injury dataset.

Methods: The SIC-1.0 model was expanded to include two levels of categorisation describing how previous injuries relate to subsequent events. A data-driven classification level was established containing eight discrete injury categories identifiable without clinical input. A sequential classification level that sub-categorised the data-driven categories according to their level of clinical relatedness has 16 distinct subsequent injury types. Manual and automated SIC-2.0 model categorisation were applied to a prospective injury dataset collected for elite rugby sevens players over a 2-year period. Absolute agreement between the two coding methods was assessed.

Results: An automated script for automatic data-driven categorisation and a flowchart for manual coding were developed for the SIC-2.0 model. The SIC-2.0 model was applied to 246 injuries sustained by 55 players (median four injuries, range 1-12), 46 (83.6%) of whom experienced more than one injury. The majority of subsequent injuries (78.7%) were sustained to a different site and were of a different nature. Absolute agreement between the manual coding and automated statistical script category allocation was 100%.

Conclusions: The updated SIC-2.0 model provides a simple flowchart and automated electronic script to allow both an accurate and efficient method of categorising subsequent injury data in sport.
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http://dx.doi.org/10.1007/s40279-018-0879-3DOI Listing
September 2018

A systematic review of prospective epidemiological research into injury and illness in Olympic combat sport.

Br J Sports Med 2018 Jan 27;52(1):8-16. Epub 2017 Sep 27.

Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Victoria, Australia.

Background: Combat sports involve body contact through striking, kicking and/or throwing. They are anecdotally referred to as 'dangerous', yet long-term investigation into specific injury rates is yet to be explored.

Objective: To describe incidence and prevalence of injury and illness within Olympic combat sports and to investigate risk of bias of prospective injury and illness research within these sports.

Methods: We systematically searched literature published up until May 2016. We included prospective studies of injury/illness in elite combat athletes lasting more than 12 weeks. Risk of bias was assessed using a modified version of the Downs and Black checklist for methodological quality. Included studies were mapped to the Oxford Centre for Evidence-Based Medicine levels of evidence.

Results: Nine studies were included, and most (n=6) had moderate risk of bias. Studies provided level 1/2b evidence that the most frequently injured areas were the head/face (45.8%), wrist (12.0%) and lower back (7.8%) in boxing; the lower back (10.9%), shoulder (10.2%) and knee (9.7%) in judo; the fingers (22.8%) and thigh (9.1%) in taekwondo; and the knee (24.8%), shoulder (17.8%) and head/face (16.6%) in wrestling. Heterogeneity of injury severity classifications and inconsistencies inexposure measures prevented any direct comparisons of injury severity/incidence across combat sports.

Conclusions: There is currently a lack of consensus in the collection of injury/illness data, limiting the development of prevention programmes for combat sport as a whole. However, sport-specific data that identify body areas with high injury frequency can provide direction to clinicians, enabling them to focus their attention on developing pathologies in these areas. In doing so, clinicians can enhance the practical elements of their role within the integrated combat sport performance team and assist in the regular update of surveillance records.
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http://dx.doi.org/10.1136/bjsports-2016-097313DOI Listing
January 2018

Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis.

Br J Sports Med 2017 Dec 7;51(23):1670-1678. Epub 2017 Aug 7.

University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australian Capital Territory, Australia.

Background: Previous injury is a strong risk factor for recurrent lower limb injury in athletic populations, yet the association between previous injury and a subsequent injury different in nature or location is rarely considered.

Objective: To systematically review data on the risk of sustaining a subsequent lower limb injury different in nature or location following a previous injury.

Methods: Eight medical databases were searched. Studies were eligible if they reported lower limb injury occurrence following any injury of a different anatomical site and/or of a different nature, assessed injury risk, contained athletic human participants and were written in English. Two reviewers independently applied the eligibility criteria and performed the risk of bias assessment. Meta-analysis was conducted using a random effects model.

Results: Twelve studies satisfied the eligibility criteria. Previous history of an ACL injury was associated with an increased risk of subsequent hamstring injury (three studies, RR=2.25, 95% CI 1.34 to 3.76), but a history of chronic groin injury was not associated with subsequent hamstring injury (three studies, RR=1.14, 95% CI 0.29 to 4.51). Previous lower limb muscular injury was associated with an increased risk of sustaining a lower limb muscular injury at a different site. A history of concussion and a variety of joint injuries were associated with an increased subsequent lower limb injury risk.

Conclusions: The fact that previous injury of any type may increase the risk for a range of lower limb subsequent injuries must be considered in the development of future tertiary prevention programmes.

Systematic Review Registration Number: CRD42016039904 (PROSPERO).
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http://dx.doi.org/10.1136/bjsports-2017-097500DOI Listing
December 2017

Use of a tibial accelerometer to measure ground reaction force in running: A reliability and validity comparison with force plates.

J Sci Med Sport 2018 Jan 16;21(1):84-88. Epub 2017 Jun 16.

Australian Institute of Sport, Discipline of Physical Therapies, Australia; University of Canberra, Discipline of Physiotherapy, University Drive, Australia; University of Canberra, Research Institute for Sport and Exercise, University Drive, Australia.

Objectives: The use of microsensor technologies to conduct research and implement interventions in sports and exercise medicine has increased recently. The objective of this paper was to determine the validity and reliability of the ViPerform as a measure of load compared to vertical ground reaction force (GRF) as measured by force plates.

Design: Absolute reliability assessment, with concurrent validity.

Methods: 10 professional triathletes ran 10 trials over force plates with the ViPerform mounted on the mid portion of the medial tibia. Calculated vertical ground reaction force data from the ViPerform was matched to the same stride on the force plate. Bland-Altman (BA) plot of comparative measure of agreement was used to assess the relationship between the calculated load from the accelerometer and the force plates. Reliability was calculated by intra-class correlation coefficients (ICC) with 95% confidence intervals.

Results: BA plot indicates minimal agreement between the measures derived from the force plate and ViPerform, with variation at an individual participant plot level. Reliability was excellent (ICC=0.877; 95% CI=0.825-0.917) in calculating the same vertical GRF in a repeated trial. Standard error of measure (SEM) equalled 99.83 units (95% CI=82.10-119.09), which, in turn, gave a minimum detectable change (MDC) value of 276.72 units (95% CI=227.32-330.07).

Conclusions: The ViPerform does not calculate absolute values of vertical GRF similar to those measured by a force plate. It does provide a valid and reliable calculation of an athlete's lower limb load at constant velocity.
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http://dx.doi.org/10.1016/j.jsams.2017.06.010DOI Listing
January 2018

Multivariate modelling of subjective and objective monitoring data improve the detection of non-contact injury risk in elite Australian footballers.

J Sci Med Sport 2017 Dec 25;20(12):1068-1074. Epub 2017 May 25.

School of Sport Science, Exercise and Health, The University of Western Australia, Australia.

Objectives: To assess the association between workload, subjective wellness, musculoskeletal screening measures and non-contact injury risk in elite Australian footballers.

Design: Prospective cohort study.

Methods: Across 4 seasons in 70 players from one club, cumulative weekly workloads (acute; 1 week, chronic; 2-, 3-, 4-week) and acute:chronic workload ratio's (ACWR: 1-week load/average 4-weekly load) for session-Rating of Perceived Exertion (sRPE) and GPS-derived distance and sprint distance were calculated. Wellness, screening and non-contact injury data were also documented. Univariate and multivariate regression models determined injury incidence rate ratios (IRR) while accounting for interaction/moderating effects. Receiver operating characteristics determined model predictive accuracy (area under curve: AUC).

Results: Very low cumulative chronic (2-, 3-, 4- week) workloads were associated with the greatest injury risk (univariate IRR=1.71-2.16, 95% CI=1.10-4.52) in the subsequent week. In multivariate analysis, the interaction between a low chronic load and a very high distance (adj-IRR=2.60, 95% CI=1.07-6.34) or low sRPE ACWR (adj-IRR=2.52, 95% CI=1.01-6.29) was associated with increased injury risk. Subjectively reporting "yes" (vs. "no") for old lower limb pain and heavy non-football activity in the previous 7 days (multivariate adj-IRR=2.01-2.25, 95% CI=1.02-4.95) and playing experience (>9 years) (multivariate adj-IRR=2.05, 95% CI=1.03-4.06) was also associated with increased injury risk, but screening data were not. Predictive capacity of multivariate models was significantly better than univariate (AUC=0.70, 95% CI 0.64-0.75; AUC range=0.51-0.60).

Conclusions: Chronic load is an important moderating factor in the workload-injury relationship. Low chronic loads coupled with low or very high ACWR are associated with increased injury risk.
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http://dx.doi.org/10.1016/j.jsams.2017.05.010DOI Listing
December 2017

Australian football players experiencing groin pain exhibit reduced subscale scores of Activities of Daily Living and Sport and Recreation on the HAGOS questionnaire: A case-control study.

Phys Ther Sport 2017 Jul 20;26:7-12. Epub 2017 Apr 20.

School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.

Objectives: To report normative responses to the HAGOS questionnaire for Australian football players and to determine whether any of the HAGOS questionnaire sub scales can differentiate players with and without groin pain.

Design: Case-control.

Setting: Clinical setting.

Participants: Professional (n = 66) and semi-professional (n = 9) Australian football (AF) players with current groin pain (n = 16) and controls (n = 57) without current groin pain.

Main Outcome Measure: The HAGOS subscales were compared between players with and without groin pain using the Wilcoxon rank-sum test with effect sizes (ES) calculated. Floor and ceiling effects were examined. A post-hoc factor analysis was undertaken.

Results: Participants with current groin pain showed lower Physical Function of Daily Living (PFDL) and Physical Function in Sport and Recreation (PFSR) subscale scores (p < 0.05, ES: 0.77 and 0.90 respectively). Any groin pain (current and/or historical) lowered the Pain and Quality of Life (QOL) subscale scores (p < 0.05, ES: 0.38 and 0.72 respectively). Factor analysis showed 8 significant factors with one main factor identified representing items describing forceful activities (Eigenvalue = 18.02, Proportion = 0.49).

Conclusions: The HAGOS can distinguish AF players with current groin pain in the PFDL and PFSR subscales but not in the other four subscales. Any current or historical groin pain lowers scores on the QOL and Pain sub scales.

Level Of Evidence: Aetiology, Individual Case-Control Study, Level 3b.
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http://dx.doi.org/10.1016/j.ptsp.2017.04.004DOI Listing
July 2017

Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review.

Sports Med 2017 Oct;47(10):2011-2026

Faculty of Science, Health, Engineering and Education, School of Health and Sport Science, University of the Sunshine Coast, Sippy Downs, QLD, Australia.

Background: Groin injury is a common musculoskeletal complaint for athletes competing in a variety of sports. The extent to which exercise interventions incorporating external load are an appropriate option for the treatment and prevention of groin injury in athletes is not yet clear.

Objectives: The aim of this review was to describe and evaluate exercise therapy interventions and outcomes for the treatment and prevention of groin injury with specific attention to application of external load.

Data Sources: The databases Medline, PubMed, SPORTDiscus, Web of Science, and Cochrane were searched on 18 April 2016.

Study Eligibility Criteria: This review was registered as PROSPERO CRD42016037752 and a systematic search was conducted with the following inclusion criteria: any study design evaluating exercise interventions for the prevention or treatment of groin pain in athletes.

Data Analysis: Two independent authors screened search results, performed data extraction, assessed risk of bias using the modified Downs and Black appraisal tool and determined strength and level of evidence. Reporting standards for exercise interventions were assessed using the Consensus for Exercise Reporting Template (CERT).

Results: A total of 1320 titles were identified with 14 studies satisfying the inclusion criteria, four (29%) of which demonstrated low risk of bias. Ten (71%) studies utilised external load as a component of the exercise intervention. Reporting standards for exercise intervention scores ranged from 0 to 63%.

Conclusion: There is limited evidence from level 2 and 3 studies indicating exercise therapy may reduce the incidence and hazard risk of sustaining a groin injury in athletes. There is strong evidence from level 4 studies indicating exercise therapy is beneficial as a treatment for groin injury in athletes in terms of symptom remission, return to sport and recurrence outcomes. However, there are limited studies with low risk of bias, and exercise interventions for the treatment of groin injury are poorly described.
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http://dx.doi.org/10.1007/s40279-017-0742-yDOI Listing
October 2017

Injuries impair the chance of successful performance by sportspeople: a systematic review.

Br J Sports Med 2017 Aug 26;51(16):1209-1214. Epub 2017 Apr 26.

Department of Physical Therapies, Australian Institute of Sport, Bruce, Australia.

Background: Cost-benefit analyses have been proposed for determining acceptable risk of injury regarding training and competition participation. Currently, there is no best evidence synthesis of the literature evaluating the relationship between injury/illness and chance of success or failure.

Objective: To evaluate the relationship between injury and/or illness and success and/or failure in athletic populations (individual and team sports).

Methods: This review was prospectively registered (PROSPERO CRD42016036729) and a systematic electronic search was conducted in May 2016. Inclusion criterion was any study design describing the association between injury and/or illness and success or failure in athletic performance. Two independent authors screened search results, performed data extraction and assessed methodological quality and strength of evidence using a modified Downs and Black appraisal tool and a modified van Tulder method, respectively.

Results: Of 10 546 titles identified, 14 satisfied the inclusion criteria and 7 had low risk of bias. Outcome measures associated with success and/or failure included: (1) availability of team members, (2) injury incidence, (3) injury burden, (4) squad utilisation and (5, 6) precompetition and in-competition injury. There was strong evidence that (1) increased availability of team members/athletes decreased the risk of failure and (2) precompetition and in-competition injuries were associated with increased risk of failure.

Conclusions: Injuries have a detrimental impact on team and individual athletic success. Increased player availability improves chances of success. Conversely, injuries sustained both prior to and during competition may increase risk of failure. Injury prevention should therefore be a priority for maximising athletic performance.
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http://dx.doi.org/10.1136/bjsports-2016-096731DOI Listing
August 2017

A multifactorial evaluation of illness risk factors in athletes preparing for the Summer Olympic Games.

J Sci Med Sport 2017 Aug 21;20(8):745-750. Epub 2017 Mar 21.

Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.

Objectives: Illness can disrupt training and competition performance of athletes. Few studies have quantified the relative contribution of the known medical, behavioural and lifestyle risk factors.

Design: Cross-sectional.

Methods: Olympic athletes from 11 sports (n=221) were invited to complete questionnaires administered nine months before the Rio 2016 Olympic Games. These included the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. An illness (case) was defined as an event which limited training or competition for greater hours in the prior month. Odds ratios and attributable fractions in the population (AFP) were utilised for categorical variables with independent t-tests or Wilcoxon rank-sum for continuous variables.

Results: Eighty-one athletes responded (male, n=26; female, n=55). There were 16 illness cases and 65 controls. Female athletes were at higher odds of illness (OR=9.4, 95%CI 1.3-410, p=0.01, AFP=0.84). Low energy availability (LEAF-Q score ≥8: OR=7.4, 95%CI 0.78-352, p=0.04, AFP=0.76), depression symptoms (DASS-21: depression score >4, OR=8.4, 95%CI 1.1-59, p<0.01; AFP=0.39) and higher perceived stress (PSS: 10-item, p=0.04) were significantly associated with illness.

Conclusions: Female sex, low energy availability, and mental health are associated with sports incapacity (time loss) due to illness. Low energy availability had high attributable fractions in the population and stands out as a primary association with illness.
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http://dx.doi.org/10.1016/j.jsams.2017.02.010DOI Listing
August 2017

Who 'owns' the injury or illness? Who 'owns' performance? Applying systems thinking to integrate health and performance in elite sport.

Br J Sports Med 2017 Jul 22;51(14):1054-1055. Epub 2017 Mar 22.

Department of Physical Therapies, Australian Institute of Sport, Bruce, Canberra, Australia.

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http://dx.doi.org/10.1136/bjsports-2016-096649DOI Listing
July 2017

Risky business: An example of what training load data can add to shared decision making in determining 'acceptable risk'.

J Sci Med Sport 2017 Jun 24;20(6):526-527. Epub 2016 Oct 24.

Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia; Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Australia.

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http://dx.doi.org/10.1016/j.jsams.2016.10.006DOI Listing
June 2017
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