Psychological Impact and Perceptions of Cardiovascular Pre-Participation Screening: A Mixed-Methods Study of Young Canadian Athletes

Nicholas Grubic, MSc1,2, Matthew Fraser2, Meghan Ford, MSc3, Braeden Hill, BHSc2, Laura Mantella, MD, PhD4, Valentina Mihajlovic, MSc3, Ryan Bennett, BPhED5, Jane S. Thornton, MD, PhD6, and Amer M. Johri, MD, MSc2

Affiliations:1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;2Department of Medicine, Queen's University, Kingston, Ontario, Canada;3Department of Psychology, Queen's University, Kingston, Ontario, Canada;4Department of Medicine, University of Toronto, Toronto, Ontario, Canada;5Queen's University Sports Medicine Clinic, Kingston, Ontario, Canada;6Western Centre for Public Health & Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.

Objective: To evaluate the psychological impact of cardiovascular pre-participation screening (PPS) on young athletes.

Study Design: Explanatory sequential mixed-methods design.

Subjects: Two hundred twenty-two (40.1% female, 76.6% White) post-secondary athletes that underwent cardiovascular PPS at a Canadian university.

Observation Technique: Athletes completed a cardiovascular history questionnaire and obtained an electrocardiogram and physical examination within their primary care network. A comprehensive survey was concurrently administered to athletes using an online portal to evaluate the psychological impact and perceptions of PPS. A sub-sample of athletes (n = 12) participated in virtual focus groups or individual interviews to explore PPS experiences and identify barriers to the screening process.

Outcome Measures: Survey components were measured on a 5-point Likert scale, ranging from strongly disagree (−2) to strongly agree (2). Levels of anxiety, stress, and worry surrounding the PPS process were compared across sub-groups of cardiovascular history, race, and sex using the Mann-Whitney U test. Themes and comments from qualitative data were summarized in line with a critical realist framework.

Results: Fifty-one athletes (23.0%) reported previous cardiovascular symptoms (ie, syncope, dyspnoea, angina) or a family history of cardiovascular conditions. Athletes did not report symptoms of anxiety (M = −1.29) or stress (M = −1.41) in relation to their participation in PPS. Athletes were not worried about the PPS process revealing a cardiovascular condition (M = −1.12) and agreed that PPS was beneficial for their safety (M = 1.25). Levels of anxiety, stress, and worry surrounding the PPS process were higher in athletes who reported a cardiovascular history (M = −1.02, M = −1.24, M = −0.73, respectively) than those who did not (M = −1.41, P < 0.01; M = −1.50, P < 0.03; M = −1.27, P < 0.01, respectively). No significant differences were observed by race or sex. Qualitative data confirmed that athletes exhibited minimal concern and anxiety surrounding PPS. Athletes found the screening process to be efficient and straightforward, without causing negative lifestyle implications. Physician availability was recognized as a barrier to the completion of PPS. Athletes desired post-screening educational materials and the opportunity for follow-up appointments to discuss screening results.

Conclusions: The PPS process does not cause anxiety, stress, or worry among Canadian post-secondary athletes. However, heightened levels of distress are observed for athletes who reported a cardiovascular history.

The Effect of COVID-19 on Injury and Illness in the National Hockey League

Adam Pinkoski, MSc1,2, Matthew Davies3, Mark Sommerfeldt, MD4, Dean Eurich, PhD1, and Don Voaklander PhD1

Affiliations:1Epidemiology, School of Public Health, University of Alberta, Edmonton, Canada;2Tampa Bay Buccaneers, Tampa, Florida, United States;3Computing Science, Faculty of Science, University of Alberta, Edmonton, Canada;4Orthopedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Objective: To determine the effect of the disruption of the competitive calendar due to the COVID-19 pandemic, compared to pre-COVID seasons, on injury and illness in professional hockey players.

Study Design: Retrospective cohort study.

Setting: Six seasons of public access injury, illness and performance data for National Hockey League players.

Participants: All players on active rosters in the NHL between 2016 to 2022.

Independent Variables: Time of season.

Main Outcome Measures: Incidence of injury/illness, point prevalence of injury, injury/illness severity (mean days lost; MDL). Incidence rate ratio (IRR) and point prevalence rate ratio (PR) comparing seasons since returning from COVID to pre-COVID seasons.

Results: IRR for illness peaked in December 2021 (IRR = 55.69, 95% CI 49.06-62.32). IRR for injuries was significantly higher in 2020-2021 (IRR = 1.18, 95% CI 1.07-1.31) and 2021-2022 (IRR = 1.20, 95% CI 1.10-1.30). Mean days lost to injury was significantly lower in the 2020-2021 season (MDL = 13.29, P < 0.001), and significantly higher in the 2021-2022 season (MDL = 19.04, P = 0.002), compared to pre-COVID seasons (MDL = 16.47).

Conclusions: Incidence of injuries increased in the 2020-21 and 2021-22 NHL regular seasons compared with the 4 seasons prior. Severity of injuries decreased in 2020-2021 while they increased in 2021-2022.

Clinical Relevance: Our analysis identified primary effects of COVID-19 (increased loss of time due to illness) as well as secondary effects (increased injury rates due to compression of schedule) on professional hockey players.

Discriminating Concussion Versus an Uninjured State—Development and Validation of a Diagnostic Accuracy Model

KJ Schneider, PT, PhD1,2,3,4,5, J-M Galarneau, PhD1, GM Schneider, PT, PhD5,6, PH Eliason, PhD1,2,3, S Sick, CAT(C), MSc1, V Lun, MD, MSc4, and CA Emery, PT, PhD1,2,3,7,8,9,10

Affiliations:1Sport Injury Research Prevention Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada;2Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada;3Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada;4Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada;5Evidence Sport and Spinal Therapy, Calgary, AB, Canada;6Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada;7O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada;8Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada;9Community Health Sciences, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada;10McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Objective: To develop and validate a prediction model to classify sport-related concussion (SRC) versus uninjured adolescent ice hockey players.

Study Design: Diagnostic accuracy study.

Subjects: Adolescent ice hockey players (ages 10-17 years) who participated in 2 prospective cohort studies (“Elite hockey study” 2011-2012 ages 13–17; “Safe2Play” 2013-2018 ages 10–17 years) and completed at least 1 pair (preseason and post-SRC) of measures in the same year of play.

Observation Technique: Players completed a SCAT3/5 and clinical measures at (1) Preseason and (2) Post-SRC at time of diagnosis by a sport medicine physician.

Outcome Measures: SRC was defined as per fourth/fifth Consensus on Concussion in Sport. SCAT3/5 subcomponents [for example, symptom severity score (SSS,/132), modified balance error scoring system (mBESS/30), immediate (/15) and delayed memory (/5), concentration score/5], cervical range of motion (ROM; full/limited), cervical flexor endurance (CFE; seconds), cervical flexion rotation test (CFRT; positive/negative), anterolateral cervical spine strength (CSpStrength; lbs), head perturbation test (HPT;/8), extra-ocular motion (EOM; normal/abnormal), head thrust test (HTT; positive/negative), clinical dynamic visual acuity (DVA; logMAR), Functional Gait Assessment (FGA;/30), Walking while talking test (WWTT) were completed by a physiotherapist/athletic therapist. Stochastic imputation was used to impute outcomes for participants who had at least 14/18 paired outcomes. An estimation sample and a randomly drawn validation sample were created (70/30% split). Variables with an individual AUC of 0.6 or more were entered together in a generalized linear latent mixed model.

Results: Four hundred eleven youth hockey players (366 males, 45 females, ages 10–17) were included. SSS, CFE, HPT, strength, FGA and WWTT complex were able to discriminate between preseason state and SRC diagnosis similarly within sample (N = 340) and with a randomly drawn out of sample cohort (N = 146) [sensitivity = 0.68 and 0.78; specificity = 0.91 and 0.74; and area under the curve = 0.84 and 0.82 respectively).

Conclusions: A combination of SSS and commonly used clinical measures (CFE, HPT, cervical spine strength, FGA, WWTT complex) could accurately discriminate between preseason state and SRC-diagnosis in youth hockey players at least 82% of the time. The use of imputation for missing outcomes did not decrease the accuracy of the model.

Acknowledgements: The Sport Injury Prevention Research Centre is 1 of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We acknowledge the funding from Canadian Institutes of Health Research, Alberta Innovates Health Solutions, Hotchkiss Brain Institute, and Alberta Children's Hospital Foundation (Integrated Concussion Research Program). Carolyn Emery holds a Canada Research Chair in Concussion. We would like to acknowledge Hockey Canada, Hockey British Columbia, Hockey Edmonton, Airdrie Minor Hockey Association, Hockey Calgary, and all team safety designates, coaches, players, and parents involved for their time and support in completing this research project.

Case Study: Isolated Traumatic First Rib Fracture in a High School Football Player

Hilary Noble, MD and Martin Heroux, MD

Affiliation: University of Saskatchewan, Regina, SK, Canada.

Objective: Isolated traumatic first rib fractures are rare injuries that can occur in various sports. Their management, particularly guidance on return to sport, is complicated by concerns of subsequent injury to the underlying brachial plexus, subclavian artery, and subclavian vein. The purpose of this case study was to describe the injury mechanism, signs/symptoms, imaging, and return to play decisions for an isolated first rib fracture with physical exam findings of subclavian artery compression in a 16-year-old high school football player.

Main Results: An initial XR following the injury demonstrated an isolated right first rib fracture with marked displacement. CTA (obtained on the advice of vascular surgery) did not demonstrate impingement of the subclavian artery or vein. Later clinical testing demonstrated positive Adson's, Wright's, and Roo's, likely secondary to impingement from callous formation. A repeat XR did not show bony healing. The plan for return to play was to obtain repeat XRs and to return once the patient was asymptomatic and imaging showed evidence of healing. The patient was then to monitor for symptoms suggesting arterial thoracic outlet syndrome which would require follow-up with the vascular surgeon. The patient returned to play 6 weeks following injury without seeking medical clearance.

Conclusions: Consider testing for arterial thoracic outlet syndrome with isolated first rib fractures. Callous formation may cause new symptoms and require monitoring for progression or resolution. Evidence of bone healing should be demonstrated on repeat imaging prior to return to sport.

Attitudes Toward Chiropractic: A Survey of Canadian Sport and Exercise Medicine Physicians

Cameron Borody, DC1, Janet D'Arcy, DC1, Jaime Waters, PhD2, Mark Leung, MD3, and Jason Busse, PhD4

Affiliations:1Canadian Memorial Chiropractic College, Toronto, ON, Canada;2The Open University, United Kingdom;3University of Toronto, Toronto, ON, Canada;4McMaster University, Hamilton, ON, Canada.

Objective: To determine the attitudes of Canadian sport and exercise medicine physicians (CSPs) toward chiropractic and its use for treatment of athletes and/or Canadians who are participating in sports or exercise (ACSE).

Study Design: Online survey.

Subjects: Active physician members of the Canadian Academy of Sport and Exercise Medicine (CASEM). Seventy CSPs completed the survey.

Intervention: An invitation to complete the survey was included in the monthly newsletter emailed to all CASEM members in March and April 2023. A card with a link to the survey was distributed to all attendees of the 2023 CASEM symposium.

Outcome Measures: The survey included a 20-item section, referred to as the Chiropractic Attitude Questionnaire (CAQ), which allowed respondents to indicate their attitudes towards chiropractic care for ACSE using a 5-point Likert scale. The responses to the CAQ was the primary outcome measure.

Results: Overall, the summed CAQ scores ranged from 31 to 51 with a mean of 40.2 and a SD of 3.8. CSPs hold a similar opinion toward chiropractic compared to previously published data from surveyed medical specialties. When compared to family physicians (surveyed in 2010 and again in 2019) and obstetricians the mean CAQ is almost identical—40.2 compared to 40.45, 41.7 and 41.2. Those CSPs who currently work with or have worked with a chiropractor in various sports medicine settings (ie private clinic, national team, major games, etc.) hold a more positive opinion of chiropractic, as indicated by a higher CAQ score. An independent-samples t test indicated that there was a significant difference between CAQ scores for those with previous experience of working with a chiropractor in various settings (M = 41.2727, SD = 4.32488) and those without (M = 39.2432, SD = 2.97588); t(68) = −2.308, P < 0.05.

Conclusions: CSPs attitudes toward chiropractic and its use for treatment of ACSE were overall positive and were less diverse than those of previously surveyed medical specialties. CSPs who reported to have worked with a chiropractor in a sports medicine setting have more positive attitudes than those that have not.

An Assessment of Rehabilitation Progress Using IMU Sensors: A Comparative Study of Pre- and Post-ACL Surgery Step Counts at 6 Months

Matthew Doan, MD, MSc1, Ramin Fathian, MSc2, Stephanie Nathanail, MA3, Hana Moosavi3, Yasir Mahmood, MSc2, Vahid Abdollah, PhD4, Hossein Rouhani, PhD2, and Mark F. Sommerfeldt, MD, MSc1,5

Affiliations:1Division of Orthopaedic Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada;2Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada;3Department of Science, University of Alberta, Edmonton, Alberta, Canada;3Orthopaedic Surgery, Alberta Health Services, Edmonton, Alberta, Canada;4Alberta Health Services, Edmonton, Alberta, Canada;5Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.

Objective: Utilize inertial measurement units (IMUs) to assess the number of steps taken by participants who underwent anterior cruciate ligament (ACL) reconstruction, at standardized follow up assessments up to 6 months after surgery.

Study Design: Observational cohort study.

Subjects: Thirteen participants (7 males, 6 females) who underwent primary ACL reconstruction.

Intervention/Observation Technique: Participants were instructed to wear an IMU sensor on the ankle of their surgical leg during observational time points for as many waking hours as possible prior to follow up appointments.

Outcome Measures: The IMU readout representing ankle motion was recorded with sampling frequency of 128 Hz. The IMU readouts throughout the 6-month rehabilitation period was recorded and then translated to daily step counts and activity time while the sensor was recording, specifically at 1 week prior to surgery, 6- weeks post-surgery, and 3- and 6-months post-surgery.

Results: Participants during the 2-to-6-week post-operative time period demonstrated an average of 142 steps per recorded hour. This improved by 3 months, with an average of 343 steps per hour and further at 6 months with an average of 490 steps per hour. This is in comparison to a pre-operative recorded step count average of 625. A similar trend was observed with activity time for these participants. At 6 weeks post operatively, only 3% of the time the sensor was on did the participant reach the active threshold. This increased to 12% and 10%, respectively, at 3 and 6 months. The pre-operative percentage of time was 13%, similar to what was observed at the 3- and 6-month timepoints.

Conclusions: Postoperative, participants objectively had a similar level of daily activity when compared to their pre-operative levels, although their step counts during the time of being active was diminished. The utilization of IMUs provided objective activity data in the early post-operative period and warrants further objective research to better inform post-operative management.

Mapping the Gap: A Study on the Reporting of Relative Energy Deficiency in Sport (REDs) in USPORTS Coaches and Athletes

Jenna M. Schulz, MPT, PhD1, Chloe M. Hewitt, MSc (c)1, Trent Stellingwerff, PhD2,3, Hilary Stellingwerff3, Kathryn Ackerman, MD4, and Jane S. Thornton, MD, PhD1

Affiliations:1Schulich School of Medicine and Dentistry, Western University, London, ON, Canada;2Canadian Sport Institute Pacific, Victoria, BC, Canada;3University of Victoria, Victoria, BC, Canada;4Boston Children's Hospital, Harvard University, Boston, MA.

Objective: To assess the knowledge and recognition of the signs/symptoms of Relative Energy Deficiency in Sport (REDs) both pre- and post-education session and panel discussion for USPORTS (Canadian University National Championships) cross-country (XC) athletes and coaches.

Study Design: Cross-sectional in-person survey; 39 pre- and 29 post-session questions, implemented around an education session and panel discussion occurring the day before the USPORTS XC Championships.

Participants: Sixty-eight USPORTS XC athletes [50 women, 58 (85%) between the ages of 19-24 years, 17 (25%) in year 1 and 17 (25%) in year 3]. 20 USPORTS XC coaches [13 men, 5 (25%) between 31 and 35 years, 6 (30%) >50 years, 10 (50%) with >10 years coaching experience].

Intervention: Education session, panel discussion and survey on REDs at USPORTS XC.

Outcome Measures: Confidence in knowledge and recognition of REDs. Quantitative pre-post data and athletes were analyzed using t-tests and Wilcoxon Sign-Ranked tests.

Results: Pre-panel, 80% (n = 16) of coaches and 59% (n = 40) of athletes were able to correctly identify the underlying cause of REDs [low energy availability (LEA)] – not a significant difference between groups (P = 0.08). However, only 50% (n = 8) of coaches and 13% (n = 9) of athletes were completely confident in their answers. The most identified symptoms for both coaches and athletes were fatigue [coaches = 40% (n = 8), athletes 53% (n = 36)] and amenorrhea [coaches = 30% (n = 6), athletes = 57% (n = 39, 34 women)]. Additionally, only 20% (n = 4) of coaches and 7% (n = 5) of athletes were completely confident in identifying the signs/symptoms of REDs. After the panel, the confidence levels of coaches in identifying signs/symptoms did not change [P = 0.52; pre-panel complete confidence = 20% (n = 4), post-panel completely confidence = 20% (n = 4)]. Confidence significantly improved in athletes [P < 0.001; pre-panel complete confidence = 7% (n = 5), post-panel complete confidence = 32% (n = 22)] Low libido in males was a commonly identified new learned symptom.

Conclusions: An education session/panel discussion surrounding REDs significantly increased the confidence in REDs knowledge and recognition among USPORTS XC athletes, but not among coaches. Further educational modules and panels should be developed, along with exploration of knowledge dissemination strategies, to improve awareness of REDs in Canadian athletes and coaches.

Pain in Parasport Athletes With amputation or Limb Deficiency: A Scoping Review

Matthew Pasquali, MD (in progress)1 and Courtney Frengopoulos, MD2

Affiliations:1Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada;2Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, ON, Canada.

Objective: The primary objective of this study was to determine the prevalence and patterns of pain in parasport athletes with amputation or limb deficiency using a scoping review of the literature. A secondary objective was to determine what pain management strategies were used.

Data Sources: The databases Medline, CINAHL, EMBASE, Scopus and Cochrane were searched from inception through November 25, 2023.

Main Results: The search identified 24 articles; 10 underwent full-text review and 3 were included in the final scoping review. All of the included studies focused on parasport athletes; none discussed those with amputation or limb deficiency alone. In total, 366 subjects were included in the studies in this scoping review, and of those, 54 subjects were athletes with limb deficiency or amputations. Types of pain identified in parasport athletes with amputation or limb deficiency included general musculoskeletal pain, bone stress injuries, and fractures. One study also explored the burden of illness and psychological conditions in subjects. Main outcomes were measured utilizing questionnaires that asked subjects to describe their musculoskeletal pain; all studies included used different questionnaires. Two of the 3 studies included delineated the association between type of disability and pain prevalence; in each of these studies, pain prevalence was highest in athletes with limb deficiency and amputation compared to other impairment groups such as spinal cord injury, cerebral palsy, other neurological impairment, and “les autres.” Only 1 study reviewed management strategies, however this was generic and only discussed medication use, physiotherapy, and diagnostic aids involved with sport-specific injuries.

Conclusions: In the current review, all included studies focused on parasport athletes as a broad category, with no study investigating amputation or limb deficiency alone. Two of the 3 included studies demonstrated that athletes with limb deficiency or amputation have a higher prevalence of musculoskeletal pain, injuries, and illness, compared to other parasport athletes. This review illustrates that there is a need for further high-quality research to determine possible reasons for increased pain prevalence in this population.

Three-Dimensional Modelling for Improved Injection Techniques

Neil M. Dilworth, MScCH, MB BCh BAO1,2, Wesley C. Clayden, MD1, Trevor J. G. Robinson, MSc, MD1, Logan Dohar3, Junior Caine3, Steve Cory3, and Mark Leung, MScCH, MD1

Affiliations:1University of Toronto, Department of Family and Community Medicine, Toronto, ON, Canada;2Halton Healthcare, Georgetown, ON, Canada;3Objex Unlimited, Toronto, ON, Canada.

Objectives: To develop a 3D shoulder model for teaching blind and US-guided injections.

Study Design: Descriptive Study.

Subjects: Thirty-seven-year-old male who had a right shoulder CT (consented to use of images).

Intervention: Three-dimensional (3D) printing of a shoulder joint and outer skin mould from re-formatted shoulder CT images.

Outcome Measures: 1. Production of a full-scale shoulder model consisting of a gel body around a 3D-printed shoulder joint. 2. Model accommodates blind injection as well as US-guided techniques.

Results: CT images were reformatted to STL files and subsequently used to print a 3D model at approximately 215oC. The model was printed using a mixture of polylactic acid filament and acrylonitrile butadiene styrene on a Stratasys Fortus 360. The 3D-printed mould was initially permeable to poured gel, but this was corrected using a liquid rubber product (Flex Seal Liquid) that was applied to the interior. The gel product was made from 7 cups of gelatin mixed in 7 L of cold water with 400 mL of hydrogen peroxide (as preservative and transparency additive) and slowly heated and mixed to 41oC. This was then poured into the closed mould from the opening at the top above the joint inside. The result was a 3D-printed shoulder joint consisting of upper 1/3 humerus, scapula and distal 2/3 of clavicle surrounded by a gelatin body. This model accommodated both blind injection techniques of the shoulder allowing visualization of injection vectoring and US- guided injections of the shoulder.

Conclusions: A 3D teaching shoulder model was created by pouring homemade gelatin into a life-sized 3D printed shoulder mould created from re-formatted CT images. Limitations include a lack of musculotendinous and neurovascular anatomy and injection of injectate. Although needle introduction leaves track marks, the gelatin can be reused by removing from the model and reheating and repouring into the mould. This is an important step to making musculoskeletal joint injection teaching more accessible and improving injection techniques before injecting patients. Future adaptation can be used for alternative joints and to allow for injection targets and accommodation of injectate.

Acknowledgements: Parents of one of the authors for providing access to their kitchen.

Variability in Patient-Incurred Costs and Protocols of Regenerative Medicine Procedures for Musculoskeletal Conditions in Canada

Alexandre McDougall, MD, Ellen Casey, MD, Jennifer Cheng, PhD, and Jesse Charnoff, MD

Affiliation: Department of Physiatry, Hospital for Special Surgery, New York, NY.

The submitting author (Alexandre McDougall) is currently modifying a protocol similar to previous publication with similar authors, but now with Canadian context. The protocol and survey are currently under review at the Hospital for Special Surgery regenerative medicine IRB.

The survey has been discussed and tentatively approved for distribution to CASEM members (among other Canadian societies) by Dawn Hawthorn. The goal of a podium and/or poster presentation would be to increase study visibility and participants.

Charnoff, Jesse, et al “Variability in patient-incurred costs and protocols of regenerative medicine procedures for musculoskeletal conditions in the United States.” HSS Journal 19.1 (2023): 77-84.

Original Research Abstract

Background: The use of regenerative medicine as an “off label” treatment for musculoskeletal conditions continues to increase in prevalence, however, the literature is sparse regarding their associated costs.

Purposes: We sought to determine the patient-incurred costs for regenerative medicine treatments performed by physicians for musculoskeletal conditions in Canada, according to primary specialty, geographic region, practice setting, and years in practice. We also sought to characterize pre- and posttreatment protocols and image guidance use.

Methods: We performed a cross-sectional study with data collection occurring between January 2024 and April 2024. It began with the distribution of an online survey through an email campaign by the Canadian Academy of Sport and Exercise Medicine to its members. Survey data included physician demographics, practice/training information, types/costs of regenerative medicine treatments performed, and pre-/post-procedure protocols.

Results: Pending.

Highlighting Female Athletes' Lived Experiences and Perceptions on Menstruation in Sport: It's About Time!

Tyndall K.A., Pardo A., and Thornton J.S. MD, PhD

Affiliation: University of Western Ontario Department of Kinesiology, London, ON, Canada.

Objective: To qualitatively: (1) investigate varsity female athletes' lived experiences regarding the impact of their menstrual cycle (MC) on sport performance, (2) explore their perceptions and unmet needs regarding varsity staff communication and education to optimize sport participation and performance.

Study Design: Individual semi-structured phenomenological interviews including a short survey were performed on Zoom. A thematic analysis was conducted using NVivo through inductive and theoretical coding. Agreement and inter-coder reliability were ensured as 2 coders (K.T., A.P.) established a Cohen's kappa value of ≥0.81 across shared transcripts.

Subjects: Ten female athletes between the ages of 17 to 25 on women's teams at Western University who have previously had or currently have an established MC.

Intervention/Observation Technique: Individual interviews.

Outcome Measures: Qualitative themes as described.

Results: Four overarching themes emerged through thematic analysis: (1) symptoms (2) perceived impact on sport performance, (3) communication and support, and (4) education and next steps. All athletes reported experiencing symptoms (eg cramps, fatigue), typically occurring before and during menstruation. Many athletes perceived that their symptoms negatively impacted their performance as well as their willingness and/or ability to participate in sport. Regarding communication and support, 7 athletes reported that they never communicated with varsity team staff regarding their MC due to feelings of discomfort and the perceived lack of understanding, particularly by male staff. Those that discussed their MC with staff did not feel that they received adequate guidance. Regarding education and next steps, all athletes perceived that varsity coaches and staff were not equipped to support their needs and desired a greater understanding and acknowledgement of the MC. Overall, athletes believed that team staff would benefit from education on symptoms, potential performance impact of the MC and recommended strategies to support their needs (eg, freely available menstrual products and pain relievers, adapted training programs).

Conclusions: This study highlighted the variability between athletes' perceptions of the impact of the menstrual cycle on participation and performance and emphasized the need for an individual-based approach to coaching and training. Greater education may improve dialogue between athletes and staff and decrease the stigmatization of the menstrual cycle.

Unchanged Cognitive Motor Integration in Male Youth Athletes During 8 Weeks of Soccer

Jeffrey S. Brooks, PhD1,2, Rachel S. Watson1, James P. Dickey, PhD1, and Haojie Mao, PhD2

Affiliations:1School of Kinesiology, Western University, London, ON, Canada;2Mechanical & Materials Engineering, Western University, London, ON, Canada.

Objective: To assess the relationship between cognitive motor integration (CMI) task performance and cumulative head impacts in male youth soccer players.

Study Design: A prospective cohort study of elite male youth soccer players from a single team during 1 season of play.

Subjects: A convenience sample of 18 male youth players (under-13 year old).

Intervention: Frequency, peak linear acceleration (PLA), and peak rotation velocity (PRV) of head impacts experienced during practices and games were measured via instrumented mouthguards. Eight weeks of head impacts including 3 CMI testing sessions (baseline and 2 follow-ups) were used for this analysis.

Outcome Measures: Reaction time, total movement time, peak velocity, full path length, and direction reversal errors were measured during the CMI tasks. Outcome measures are summarized using mean and SD for normally distributed parameters, or median and interquartile range for non-normally distributed parameters. Relationships between the number of head impacts and the 5 CMI performance variables were assessed using linear mixed effects modeling performed in R.

Results: Over 8 weeks, a total of 169 head impacts occurred during 12 games and 344 during 32 practices with players averaging 0.8 head impacts per game and 0.6 head impacts per practice. The median (25-75 percentile) PLA and PRV for head impacts were 14.7 (11.3-18.7) g and 7.0 (4.3-10.2) rad/s, respectively. Cumulative head impacts were not significantly associated with changes in any of the 5 CMI performance variables.

Conclusions: Players experience twice as many head impacts during practices than games. Low doses of head impact exposure do not result in measurable changes in cognitive motor integration tasks over a short period of soccer participation. Given the potential short- and long-term consequences of head impacts, soccer coaches should emphasize controlling the ball with the feet, and structure practices to reduce head impact exposure.

Age-Related Differences During Specific Athletic events Highlighting Strength and Speed Characteristics in Well-Trained Male and Female Adolescents

Eduard N. Bezuglov, DMSc, MD, Georgiy I. Malyakin, MD, Elizaveta S. Kapralova, MD, Anton Yu. Emanov, Timur M. Vakhidov, and Ryland Morgans, PhD

Affiliation: High Performance Sports Laboratory, Sechenov First Moscow State Medical University, Moscow, Russia.

Objective: To investigate any age-related differences during specific athletic events highlighting strength and speed characteristics in well-trained adolescents.

Study Design: Cross-sectional observational study.

Subjects: Six hundred young track and field athletes (300 females and 300 males) aged 10 to 15 year old.

Observation Technique: From each year group (U10, U11, U12, U13, U14, U15) the top 50 performance results from the final round of the national annual athletics tournament “Shipovka Yunykh” in 2017 to 2019 were analyzed. The winners were determined by the sum of 3 sporting disciplines, namely: 60-m sprint, 600-m, and long jump.

Outcome Measures: The outcome measurements were results in 60-m sprint, 600-m run and long jump. The results were measured by FinishLynx electronic timing system. ANOVA was used to compare the results for boys and girls of the same age, followed by (if necessary, the number of compared variables is more than 2 and the differences are significant) Tukey post-hoc analysis.

Results: Statistically significant differences are evident in boys at 12 year old from the 60-m sprint. However, in strength qualities as measured by the long jump, differences are contradictory. In boys, at 11 to 12 and 14 to 15 years, there are statistically significant differences, however, in girls statistically significant differences were only observed аt 13 year old. However, the effects of chronological age in boys and girls were significantly different in several age groups and in varying athletic events, thus the current results may be affected. For example, in boys at 13 years, the best physical performance was in the 60-m sprint, on average 4 months older than girls. While the best long jump performance in girls was observed at 13 year old, on average 2 months older than male peers.

Conclusions: In this current cohort of well-trained adolescents, differences in strength and speed commenced at 11 to 12 year old. For an accurate interpretation of the data, it is important to consider the exact chronological age at the time of performance rather than the year of birth.

Risk of Subsequent Concussion in Adolescent Ice Hockey Players with ≥2 Concussions

Sabrina Yusuf, MSc(c)1,2, Chinchin Wang, MSc, PhD(c)1, Russell J. Steele PhD3, Paul Eliason PhD4, Jean-Michel Galarneau PhD4, Carolyn Emery PT, PhD4, and Ian Shrier, MD, PhD1

Affiliation:1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada;2Department of Family Medicine, McGill University, Montreal, Quebec, Canada;3Department of Mathematics and Statistics, McGill University, Quebec, Canada;4Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.

Objective: A first concussion does not increase the risk of second concussion in adults who follow recommended concussion protocols. Our objective was to determine if a first concussion causally increases the risk of a second concussion among adolescents with ≥2 concussions who do not necessarily follow recommended concussion protocols.

Study Design: Five-year prospective cohort.

Subjects: Male and female adolescent ice hockey participants (age 11-17) with ≥2 concussions playing in either body-checking or non-body-checking leagues throughout both concussions, with valid data on number of practices and games.

Observation Technique: Secondary analysis of data collected using a validated injury surveillance methodology, including preseason baseline, weekly exposure, and injury data.

Outcome Measures: The probability of a concussion over time. We used Cox proportional hazard models to estimate hazard ratios (HR) with 95% CI using the number of games and practices as exposure time at risk. We included a random effect for participants to account for repeated measures. We also stratified analyses by body-checking versus non-body-checking leagues.

Results: Of 4430 participants in the cohort study, 30 participants (28 males, 2 females) met our eligible criteria. Overall, there was an 80% increased risk for a second versus first concussion (HR 1.80, 95% CI 1.12-2.88 P = 0.015). Participants in body-checking leagues (n = 18) had a >2-fold increased risk for a second concussion compared to first concussion (HR 2.20, 95% CI 1.16-4.16, P = 0.016). Participants in non-body-checking leagues (n = 12) had minimal increased hazard (HR 1.14, 95% CI 0.57-2.28, P = 0.713). Although these results suggest playing in a body-checking versus non-body-checking league modifies the effect of the first concussion, the uncertainty in the estimates was too large to be definitive (P = 0.08).

Conclusions: A first concussion causally increases the risk of second concussion in community adolescent ice hockey players with ≥2 concussions. The increased risk may be higher in body-checking leagues and minimal in non-body-checking leagues, but the uncertainty was considerable, and larger sample sizes are required for more definitive conclusions.

From Lineout to Lab: Comparability of Youth Rugby and Laboratory Simulated Head Impact Kinematics

Danyon Stitt, ME1, Natalia Kabaliuk, PhD1, Nicole Spriggs, BSc(Hons)2, Stefan Henley, MSc3, Keith Alexander, PhD1, and Nick Draper, PhD3

Affiliations:1Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand;2Department of Tourism, Sport, and Society, Lincoln University, Lincoln, New Zealand;3Faculty of Health Sciences, University of Canterbury, Christchurch, New Zealand.

Objective: To compare the head impact kinematics obtained through several laboratory drop-test methods, representing common drop-test conditions for assessing the impact mitigation of rugby headgear, to head impacts measured during youth rugby.

Study Design: Observational cohort study, Experimental/simulation study.

Subjects: Forty male and 18 female club rugby union players (age range: 13–17 year old). Dataset of physically simulated drop test head impacts using a Hybrid III headform and corresponding Hybrid III neck impacting a 1-inch MEP pad angled at 0 and 45 degrees.

Observation Technique: Participants were fitted with instrumented mouthguards over 2 seasons of gameplay to measure head impact kinematics. Three laboratory drop-test variations were carried out. The first 2 involved the headform with and without the neck impacting the 0° MEP pad. The third included the neck and used a 45 degrees MEP pad. Four impact locations (forehead, front boss, side, and rear boss) were impacted at 5 impact velocities (1.2–3.4 m·s−1).

Outcome Measures: Bootstrapped 95% confidence intervals (CI) quantified the differences in peak linear and rotational acceleration and rotational velocity (PLA, PRA, and PRV) and their respective durations along with the peak kinematics at a given change in linear velocity between drop tests and field impacts.

Results: Drop tests without the neck showed significantly lower PLA (CI [−6.2, −3.1 ms]), PRA ([−6.4, −2.3