Research Articles (Sports Medicine)

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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.
Sleep interventions in elite sport – a systematic review
(Academy of Science of South Africa, 2025-02) Bilgoe, Sharaisha; Den Hollander, Steve; Janse van Rensburg, Dina Christina; Hendricks, Sharief; Kerkhoffs, Gino M.M.J.; Gouttebarge, Vincent
BACKGROUND : Elite athletes encounter various situations and conditions that may disrupt their sleep, a crucial factor for optimal performance and well-being. OBJECTIVES : The aim of this study was to synthesise existing research on the effect of sleep interventions on sleep quantity and quality in elite sports and to provide evidence-based guidance for athletes, coaches, and other stakeholders in elite sports who seek to enhance sleep quantity and quality. METHODS : This review followed the PRISMA guidelines, whereas the search was executed in September 2023 utilising the electronic databases SCOPUS, PubMed and Web of Science. Studies were included if they met the inclusion criteria. RESULTS : A total of 1014 studies were retrieved from the databases, and data extraction was performed on 32 studies. The included studies evaluated sleep hygiene education/strategies, acute cold exposure, light therapies, supplementation, neurostimulation/neurofeedback, and other (mindfulness and massage therapy) strategies. Sleep hygiene education was the most effective intervention to improve sleep quantity. Supplementation and light therapy interventions showed improved sleep quality and quantity. Additionally, cold water immersion and mindfulness showed improved sleep quality, but further studies are required for confirmation. CONCLUSION : Future research should use reliable and valid methods to improve the quality of evidence and ensure conclusive findings.
Gynaecological health patterns and motherhood experiences of female professional football players
(MDPI, 2025-02) Ramagole, Dimakatso Althea; Janse van Rensburg, Dina Christina; Cowie, Charlotte; Mehta, Ritan; Ramkilawon, Gopika Devi; Pluim, Babette M.; Kerkhoffs, Gino M.M.J.; Gouttebarge, Vincent
The aim of this paper is to explore the gynaecological health patterns, contraceptive use, body perception, and motherhood experiences of female professional football players. The participants were recruited via email using FIFPRO (Football Players Worldwide). Online questionnaires were completed by consenting participants. The mean age at menarche was 13.5 years with an average cycle length of 26 days, and a bleeding period of 5 days. Cycle irregularities were experienced by 30%, and menstrual symptoms by 74%. Half of the participants used contraceptives, 60% using hormonal contraceptives, primarily oral contraceptive pills (38%), followed by implants (20%). The body satisfaction score was normal but there was a high drive-for-thinness (DT) score. The motherhood rate was low (1%), with participants experiencing normal conception, vaginal delivery, return to training after 6 weeks, and return to competition after 12 weeks. Our findings are consistent with findings in other elite female athletes with cycle irregularities and a significant number of cycle-related symptoms. The majority of those using contraceptives preferred hormonal contraceptives, reflecting trends seen in other elite athletes. While body satisfaction scores were normal, there was a high DT score, similar to that observed in lean and weight-category sports. The motherhood rate was low, consistent with previous findings in professional football players and other elite athletes. This may be due to a lack of financial support during pregnancy and the post-partum period. FIFPRO and its affiliated unions are negotiating better contracts for female football players.
Rating of perceived exertion associated with acute symptoms in athletes with recent SARS-CoV-2 infection : athletes with acute respiratory infection (AWARE) VI study
(National Athletic Trainers' Association, 2024-01) Kaulback, Kelly; Schwellnus, Martin Peter; Sewry, Nicola; Jordaan, Esme; Wood, Paola
CONTEXT : SARS-CoV-2 infection can affect the exercise response in athletes. Factors associated with the exercise response have not been reported. OBJECTIVE : To (1) describe heart rate (HR), systolic blood pressure (SBP), and rating of perceived exertion (RPE) responses to exercise in athletes with a recent SARS-CoV-2 infection and (2) identify factors affecting exercise responses. DESIGN : Cross-sectional, experimental study. PATIENTS OR OTHER PARTCIPANTS : Male and female athletes (age ¼ 24.2 6 6.3 years) with a recent (,28 days) SARS-CoV-2 infection (n ¼ 72). SETTING : A COVID-19 Recovery Clinic for athletes. MAIN OUTCOME MEASURE(S) : Heart rate, SBP, and RPE were measured during submaximal exercise (modified Bruce protocol) at 10 to 28 days after SARS-CoV-2 symptom onset. Selected factors (demographics, sport, comorbidities, preinfection training variables, and symptoms during the acute phase of the infection) affecting the exercise response were analyzed using random coefficient (linear mixed) models. RESULTS : Heart rate, SBP, and RPE increased progressively from rest to stage 5 of the exercise test (P ¼ .0001). At stage 5 (10.1 metabolic equivalents), a higher HR and a higher SBP during exercise were associated with younger age (P ¼ .0007) and increased body mass index (BMI; P ¼ .009), respectively. Higher RPE during exercise was significantly associated with a greater number of whole-body (P ¼ .006) and total number (P ¼ .004) of symptoms during the acute phase of infection. CONCLUSIONS : A greater number of symptoms during the acute infection was associated with a higher RPE during exercise in athletes at 10 to 28 days after SARS-CoV-2 infection. We recommend measuring RPE during the first exercise challenge after infection, as this may indicate disease severity and be valuable for tracking progress, recovery, and return to sport.
Effect of neuromuscular injury prevention strategies on injury rates in adolescent males playing sport : a systematic review protocol
(Lippincott, Williams & Wilkins, 2024-04) Olivier, Franso-Mari; Olivier, Benita; MacMillan, Candice; Briel, Sonia
OBJECTIVE : This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports. INTRODUCTION : Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This review will include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population. INCLUSION CRITERIA : Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies that evaluate neuromuscular injury prevention strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and training, warm up, cool down, stretches, neuromuscular control) vs no intervention or standard training and competition exposure will be included. The outcomes of interest are injury incidence and prevalence rates. METHODS : Databases searched will include MEDLINE (PubMed), CINAHL Complete (EBSCOhost), ClinicalKey, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCOhost), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer. REVIEW REGISTRATION : PROSPERO CRD42022327047.
A survey on current practices, needs, responsibilities and preferences for knowledge dissemination in the field of injury and illness prevention among competitive snow sports stakeholders
(Springer, 2025-02) Monsonis, Oriol Bonell; Sporri, Jorg; Gouttebarge, Vincent; Bolling, Caroline; Verhagen, Evert
BACKGROUND : Injury and illness prevention practices in competitive snow sports must be better understood among stakeholders. In particular, there is a need for a greater understanding of what context-specific stakeholders require for prevention. Therefore, this study surveyed stakeholders’ current practices, needs, responsibilities and knowledge dissemination preferences related to injury and illness prevention in competitive snow sports and described the main commonalities and differences between stakeholder groups. METHODS : We conducted a cross-sectional study that used an online survey developed using Kipling’s principle (the “5W1H” method) and targeted athletes, coaches, team staff, ski racing suppliers, and representatives from all competition levels and all competitive snow sports governed by the International Ski and Snowboard Federation. The data were analysed following both quantitative and qualitative descriptive analyses. RESULTS : Most of the 436 respondents believed in and reported needing more information on injury and illness prevention. The participants stated that the main goal of prevention was to avoid injuries and minimise their time away from being on snow, and they stressed their different underlying motivations. Despite the differences across subgroups, participants highlighted knee and head injuries and concussions as their primary injury prevention targets and priorities for additional information. Respiratory and cardiovascular illnesses were reported as their main targets of illness prevention, but more information on all illnesses was reported. Current practices and priorities for additional information fell under athlete-, equipment-, snow/environment-, and course-related prevention areas. Moreover, stakeholders highlighted their need for more information on mental health and training. Shared responsibilities were identified across the development, dissemination, and implementation of prevention, along with stakeholders’ preferred communication channels. CONCLUSIONS : Our study provides meaningful insights across athlete, equipment-, snow/environment-, and course-related prevention areas related to snow sports, roles, and competition levels. These insights may inform the development, dissemination and further implementation of any tailored and context-driven preventive measure by better addressing end-users’ needs. These findings may support successful future preventive interventions by providing key elements and a clear path to improve athletes’ health and safety.
Air quality, respiratory health and performance in athletes : a summary of the IOC consensus subgroup narrative review on ‘Acute Respiratory Illness in Athletes’
(BMJ Publishing Group, 2025-03) Bougault, Valerie; Carlsten, Christopher; Adami, Paolo Emilio; Sewry, Nicola; Schobersberger, Wolfgang; Soligard, Torbjorn; Engebretsen, Lars; Budgett, Richard; Schwellnus, Martin Peter; Fitch, Ken
With the WHO stating that nearly 99% of the global population is exposed to air pollution levels that increase the risk of chronic diseases, the question of exercising in polluted environments is relevant to the health of athletes. Major sporting events held under conditions of poor air quality (AQ) have highlighted the lack of answers to concerns raised by organisers and athletes about the associated health risks. This evidence-based narrative review compiles current knowledge and identifies gaps regarding the relationship between AQ and sport. It is a summary of a more comprehensive report prepared for the International Olympic Committee (IOC) Medical and Scientific Commission. This article discusses the various sources of air pollutants encountered during exercise, summarises current AQ guidelines and provides insights into AQ conditions during the Paris 2024 Olympic and Paralympic Games (OPG) as well as in Los Angeles over the past four summers, in preparation for the 2028 OPG. It also summarises the effects of air pollution on the respiratory health and performance of athletes, while proposing mitigation strategies, with a particular emphasis on AQ education.
Illness is more prevalent than injury in trail runners participating in a mountainous ultra trail race
(Taylor and Francis, 2025) Boshielo, Patience Matshepo; Jansen van Rensburg, Audrey; Viljoen, Carel Thomas; Botha, Tanita; De Villiers, Christina Elizabeth; Ramagole, Dimakatso Althea; Seyani, Limbikani; Janse van Rensburg, Dina Christina
OBJECTIVES : Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race. METHODS : This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported. RESULTS : Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified. CONCLUSIONS : Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.
A high incidence of serious life-threatening cardiovascular medical encounters during a marathon (2014-2019) calls for prevention strategies : SAFER XL
(Taylor and Francis, 2025) Green, Darren; Sewry, Nicola; Derman, Wayne; Killops, Jannelene; Boer, Pieter Henk; Jordaan, Esme; Schwellnus, Martin Peter
OBJECTIVES : The aim of this study was to determine the incidence and nature (severity and type by organ system and specific diagnosis) of all medical encounters (MEs), including serious/life-threatening MEs (SLMEs) during a South African road marathon. METHODS : This descriptive study was a retrospective analysis of data collected over 6 years at the Cape Town Marathon from 2014 to 2019, which included 40 446 starters. All MEs were collected and described as per the consensus statement for mass community-based sporting events. Incidences (I; per 1000 starters; 95% CI) are described for all MEs, SLMEs, and by organ system and specific diagnosis. RESULTS : The incidence of all MEs was 8.7 (95% CI: 7.8–9.6) per 1000 starters. The largest contributor to all MEs, by organ system affected, was cardiovascular-related, with an incidence of 1.8 (95% CI: 1.4–2.2), where exercise-associated postural hypotension was the most common specific diagnosis (I = 1.3; 95% CI: 1.0–1.7). The incidence of all SLMEs was 1.0 (95% CI: 0.7–1.4) making up 11.7% (41/350) of all MEs. The incidence of SLMEs by organ system was highest in the cardiovascular system (I = 0.4; 95% CI: 0.3–0.7), with acute coronary syndrome (ACS) (I = 0.2; 95% CI: 0.1–0.4) the most common specific diagnosis. There were no sudden cardiac deaths (SCD) nor sudden cardiac arrests (SCA). CONCLUSION : There was a high proportion of cardiovascular-related medical encounters, as well as SLMEs. We recommend that event organizers and race medical directors investigate prevention strategies to mitigate against risk of SLMEs, specifically acute cardiovascular SLMEs.
Para athlete concussion care following the Amsterdam 2022 International Consensus Statement on Concussion in Sport : an urgent need for inclusivity within concussion research
(BMJ Publishing Group, 2025-01) Weiler, Richard; Dalton, Kristine; Guenther, Anna; Mitchell, Katelyn; Van de Vliet, Peter; Babul, Shelina; Blauwet, Cheri; Clarke, David; Dea, Jenny; Derman, Wayne; Emery, Carolyn A.; Fagher, Kristina; Gouttebarge, Vincent; Haider, Mohammad Nadir; Hunt, Tamerah; Lee, Kenneth; Lexell, Jan; Moran, Ryan N.; Pilon, Francine; Prince, Francois; Runciman, Phoebe; Smetana, Racheal; Verhagen, Evert; Webborn, Nick; Ahmed, Osman Hassan
No abstract available.
Methods for recording and reporting of epidemiological data on injury and illness in tennis : ReFORM synthesis of the International Olympic Committee consensus statement
(BMJ Publishing Group, 2025-01) Tooth, Camille; Verhagen, Evert; Pluim, Babette M.; Cabri, Jan; Bieuzen, Francois; Edouard, Pascal
No abstract available.
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
No abstract available.
Health status of senior netball players, their medication use and attitudes towards doping
(Frontiers Media, 2024-09) De Abreu, Micaela; Nolte, Kim; Janse van Rensburg, Dina Christina; Swart, Xan
Limited research exists on the health and injuries of South African senior netball players. Senior netball players may be at greater risk of injuries and chronic disease due to their age. To treat these conditions, they may use prescription and over-the-counter (OTC) medications and, therefore, may be more vulnerable to unintentional doping. The primary aim of this study was to determine the health status, medication use and attitudes towards doping of South African senior netball players. A cross-sectional descriptive design was employed to collect data by means of an online survey. The validated 8-item Performance Enhancement Attitudes Scale (PEAS) was used to gather information on the netball player’s attitudes towards doping. Descriptive statistics were used to describe the data using proportions (categorical), means (normally distributed, continuous) and medians (non-normal distributed, continuous). Doping prevalence and accompanying 95% confidence interval were calculated. Sixty senior netball players consented and completed the self-report questionnaire. The prevalence of chronic disease was 11.67%. Asthma and other conditions such as depression and attentiondeficit/hyperactivity (ADHD) had the highest prevalence of 3.33%. The prevalence of chronic prescription medication use was 8.33% and 66.67% of the netball players reported receiving prescription injections, medications or utilizing OTC medications for treating injury or illness suffered 1–6 weeks before or during competition. The netball players do not have a lenient attitude towards doping. The prescription and OTC medication use could put this cohort of netball players at risk of unintentional doping. Anti-doping education aimed at senior athletes may be beneficial to reduce the risk of unintentional doping due to prescription and OTC medication use for injury or illness.
What do we know about beach soccer injuries? Systematic video analysis of four consecutive years with 580 match injuries
(Routledge, 2024) Lima, Yavuz; Gouttebarge, Vincent; Bayraktar, Buelent
The aim of the present study was to evaluate the characteristics of match injury in male beach soccer players. Video recordings of all official beach soccer tournaments in which the European national male beach soccer teams participated from 2018 to 2021 were analysed by two sports medicine specialists retrospectively. Regarding each injury, data including the mechanism, location of the injury, whether the injury led to time-loss, and the relationship of the injury to the bicycle kick (BK), etc. were documented. A total of 632 injuries were documented, corresponding to 234.9 injuries/1000 player hours. Video footage was available for 580 injuries. Whilst 79.8% of medical attention injuries occurred due to opponent contact, 19.5% of time-loss injuries occurred due to non-contact, and 12.2% of indirect opponent contact (p < 0.01). The most common location of the BK related injury was the head/neck (68.7%), whereas most common location of the BK unrelated injury was the lower extremity (54.1%) (p < 0.01). The findings demonstrated that beach soccer injury incidence was quite high; the most common injury location was head/neck and head/neck injuries were associated with BK. In light of these results, some rule regulations, particularly those associated with BK, and the use of protective equipment should be considered to prevent these injuries.
Discrepancies between pre-specified and reported primary outcomes : a cross-sectional analysis of randomized controlled trials in gastroenterology and hepatology journals
(Public Library of Science, 2024-11) Shang, Bing-Han; Yang, Fang-Hui; Lin, Yao; Bialka, Szymon; Janse van Rensburg, Dina Christina; Tonelli, Adriano R.; Islam, Sheikh Mohammed Shariful; Kawagoe, Izumi; Rheaume, Caroline; Zhang, Kai-Ping
BACKGROUND : Previous research has raised concerns regarding inconsistencies between reported and pre-specified outcomes in randomized controlled trials (RCTs) across various biomedical disciplines. However, studies examining whether similar discrepancies exist in RCTs focusing on gastrointestinal and liver diseases are limited. This study aimed to assess the extent of discrepancies between registered and published primary outcomes in RCTs featured in journals specializing in gastroenterology and hepatology. METHODS : We retrospectively retrieved RCTs published between January 1, 2017 and December 31, 2021 in the top three journals from each quartile ranking of the 2020 Journal Citation Reports within the "Gastroenterology and Hepatology" subcategory. We extracted data on trial characteristics, registration details, and pre-specified versus published primary outcomes. Pre-specified primary outcomes were retrieved from the World Health Organization’s International Clinical Trials Registry Platform. Only trials reporting specific primary outcomes were included in analyzing primary outcome discrepancies. We also assessed whether there was a potential reporting bias that deemed to favor statistically significant outcomes. Statistical analyses included chi-square tests, Fisher’s exact tests, univariate analyses, and logistic regression. RESULTS : Of 362 articles identified, 312 (86.2%) were registered, and 79.8% of the registrations (249 out of 312) were prospective. Among the 285 trials reporting primary outcomes, 76 (26.7%) exhibited at least one discrepancy between registered and published primary outcomes. The most common discrepancies included different assessment times for the primary outcome (n = 32, 42.1%), omitting the registered primary outcome in publications (n = 21, 27.6%), and reporting the registered secondary outcomes as primary outcomes (n = 13, 17.1%). Univariate analyses revealed that primary outcome discrepancies were lower in the publication year 2020 compared to year 2021 (OR = 0.267, 95% CI: 0.101, 0.706, p = 0.008). Among the 76 studies with primary outcome discrepancies, 20 (26.3%) studies were retrospectively registered, and 32 (57.1%) of the prospectively registered trials with primary outcome discrepancies showed statistically significant results. However, no significant differences were found between journal quartiles regarding primary outcome consistency and potential reporting bias (p = 0.14 and p = 0.28, respectively). CONCLUSIONS : This study highlights the disparities between registered and published primary outcomes in RCTs within gastroenterology and hepatology journals. Attention to factors such as the timing of primary outcome assessments in published trials and the consistency between registered and published primary outcomes is crucial. Enhanced scrutiny from journal editors and peer reviewers during the review process is necessary to ensure the reliability of gastrointestinal and hepatic trials.
Risk factors associated with a history of iliotibial band syndrome (hITBS) in distance runners : a cross-sectional study in 76 654 race entrants - a SAFER XXXIII study
(Taylor and Francis, 2024) Marais, Jandre V.; Jansen van Rensburg, Audrey; Schwellnus, Martin Peter; Jordaan, Esme; Boer, Pieter Henk
BACKGROUND : Despite the numerous health benefits of distance running, it is also associated with the development of ‘gradual onset running-related injuries’ (GORRIs) one of which is Iliotibial Band Syndrome (ITBS). Novel risk factors associated with a history of ITBS (hITBS) have not been described in a large cohort of distance runners. OBJECTIVE : To identify risk factors associated with hITBS in distance runners. DESIGN : Descriptive cross-sectional study. SETTING : 21.1 km and 56 km Two Oceans Marathon races (2012–2015). PARTICIPANTS : 106 743 race entrants completed the online pre-race medical screening questionnaire. A total of 1 314 runners confirmed an accurate hITBS diagnosis. METHODS : Selected risk factors associated with hITBS explored included: demographics (race distance, sex, age groups), training/running variables, history of existing chronic diseases (including a composite chronic disease score) and history of any allergy. Prevalence (%) and prevalence ratios (PR; 95% CI) are reported (uni- & multiple regression analyzes). RESULTS : 1.63% entrants reported hITBS in a 12-month period. There was a higher (p < 0.0001) prevalence of hITBS in the longer race distance entrants (56 km), females, younger entrants, fewer years of recreational running (PR = 1.07; p = 0.0009) and faster average running speed (PR = 1.02; p = 0.0066). When adjusted for race distance, sex, age groups, a higher chronic disease composite score (PR = 2.38 times increased risk for every two additional chronic diseases; p < 0.0001) and a history of allergies (PR = 1.9; p < 0.0001) were independent risk factors associated with hITBS. CONCLUSION : Apart from female sex, younger age, fewer years of running and slower running speed, two novel independent risk factors associated with hITBS in distance runners are an increased number of chronic diseases and a history of allergies. Identifying athletes at higher risk for ITBS can guide healthcare professionals in their prevention and rehabilitation efforts.
Injury-inciting circumstances of sudden-onset hamstring injuries : video analyses of 63 match injuries in male professional football players in the Qatar Stars League (2013-2020)
(BMJ Publishing Group, 2024-10) Vermeulen, Robin; Van Dyk, Nicol; Whiteley, Rod; Chamari, Karim; Gregson, Warren; Lolli, Lorenzo; Bahr, Roald; Tol, Johannes L.; Serner, Andreas
OBJECTIVE : To describe and categorise the injury-inciting circumstances of sudden-onset hamstring match injuries in professional football players using systematic video analysis. METHODS : Using a prospective injury surveillance database, all sudden-onset hamstring match injuries in male football players (18 years and older) from the Qatar Stars League between September 2013 and August 2020 were reviewed and cross-referenced with broadcasted match footage. Videos with a clear observable painful event (ie, a player grabbing their posterior thigh) were included. Nine investigators independently analysed all videos to describe and categorise injury-inciting circumstances. We used three main categories: playing situation (eg, time of injury), player action(s) (eg, running) and other considerations (eg, contact). Player action(s) and other considerations were not mutually exclusive. RESULTS : We included 63 sudden-onset hamstring match injuries out of 295 registered injuries between 2013 and 2020. Running was involved in 86% of injuries. Hamstring injuries occurred primarily during acceleration of 0–10 m (24% of all injuries) and in general at different running distances (0–50 m) and speeds (slow to fast). At 0–10 m distance, indirect player-to-player contact and inadequate balance were involved in 53% and 67% of the cases, respectively. Pressing occurred in 46% of all injuries (injured player pressing opponent: 25%; being pressed by opponent: 21%) and frequently involved player-to-player contact (69% of the cases when the injured player was pressing vs 15% of the cases when the opponent was pressing) and inadequate balance (82% vs 50%, respectively). Other player actions that did not involve running (n=9, 14% of all injuries) were kicking (n=6) and jumping (n=3). CONCLUSION : The injury-inciting circumstances of sudden-onset hamstring match injuries in football varied. The most common single-player action (24%) was acceleration over a distance of <10 m. Pressing, inadequate balance and indirect contact were frequently seen player actions. Injury prevention research in football should look beyond high-speed running as the leading risk factor for sudden-onset hamstring injuries.
Most elite athletes return to preinjury competitive activity after surgical treatment for medial malleolus stress fractures
(Wiley, 2024-12) Ramsodit, Kishan R.; Zwiers, Ruben; Dalmau‐Pastor, Miki; Gouttebarge, Vincent; Kerkhoffs, Gino M.M.J.
PURPOSE : To provide return‐to‐performance outcomes after surgical treatment for medial malleolus stress fractures in the elite athlete. Additionally, to describe an individualised surgical approach in the management of medial malleolus stress fractures. METHODS : Five athletes (six ankles) underwent surgical treatment for a medial malleolus stress fracture. The surgical technique was based on the extent of the fracture line in steps with first arthroscopic debridement of bony spurs, microfracturing of the fracture line and screw fixation. Return‐toperformance data included time to return to sport‐specific training, normal training, first competitive activity, performance and the return‐toperformance rate. RESULTS : Patients returned to sport‐specific training at a median of 10 weeks. They started normal training at 16 weeks postoperatively and returned to their first competitive activity after 19 weeks. All patients had bony spurs on the distal tibia which were arthroscopically debrided. One patient received arthroscopic debridement of bony spurs alone. Four patients received additional microfracturing of the fracture line and three patients received screw fixation. All patients achieved clinical and radiographic union on follow‐up computed tomography scan at 3 months postsurgery. At latest follow‐up, no refractures nor hardware complications, nor any other complications were observed. CONCLUSION : Arthroscopic debridement of bony spurs, debridement and microfracturing of the fracture line and screw fixation are all viable surgical tools in the management of medial malleolus stress fractures in elite athletes. The surgical approach containing these options should be tailored to the individual athlete based on the fracture line in the sagittal plane. While most athletes return to full competitive activity in 3–4 months, time to selfreported return to full performance is often much longer.

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