搜索结果：Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine

Orthobiologics are increasingly sought-after interventions in sports medicine for treatment of musculoskeletal injuries and conditions. Despite this trend, differences exist across sports medicine fellowship programs regarding foundational knowledge, educational curricula, and practical experience with orthobiologic therapies (eg, platelet-rich plasma, bone marrow aspirate concentrate, microfragmented adipose tissue). This represents an important educational gap for those training in sports medicine fellowships. To address this gap, an educational toolkit was envisioned with the sports medicine fellowship director and trainee in mind. Collective observations from physician experts in sports medicine education established the variations in curricula and expertise of graduating fellows. A literature review was conducted to source English-language peer reviewed articles from the online PubMed database. The scope of this project did not include an independent systematic analysis or statistical assessments. An educational toolkit consisting of 12 adaptable modules was developed, each with a suggested reading list from the published literature. The modules may be rearranged to support each program's learning schedule. The information and lessons contained herein may be valuable to all healthcare providers interested in the evidence-based application of orthobiologics and insightful interpretation of related research. By implementing an educational toolkit, sports medicine fellowships may improve the quality of education on orthobiologics. This is intended to improve the knowledge and skill set of fellowship graduates, thus promoting the scientific, responsible use of orthobiologic interventions.

To determine current trends in surgical technique and postoperative rehabilitation of anterior cruciate ligament (ACL) reconstruction among Canadian orthopedic surgeons, with comparison with the previous survey study in 2008. Descriptive study. Data were collected at the Pan Am Clinic, a sports medicine clinic in Winnipeg, Canada. Active members of the Canadian Orthopaedic Association and Arthroscopic Association of Canada. N/A. Number of surgeons selecting preferred surgical techniques (graft type, method of femoral tunnel drilling) and postoperative rehabilitation protocols (return to sport criteria) for ACL reconstruction were assessed and compared with 2008 survey findings. Responses from 91 participants were included. Consistent with the findings in 2008, hamstring tendon autograft remained the most common graft choice in 2022, with 79.1% of surgeons selecting this graft. Quadriceps tendon accounted for 8.8% of responses. The preferred technique for femoral tunnel creation shifted from transtibial drilling (69.9%, 2008) to anteromedial portal drilling (77.4%, 2022). In addition, 80.6% of surgeons used functional assessment criteria to determine return to sport, with testing performed by themselves or by other professionals. This survey study provides an important update of the current preferences among Canadian orthopedic surgeons regarding ACL reconstruction. In addition to demonstrating the impact of evidence-based medicine on surgical management, the trends identified in this study also serve as a benchmark against which other surgeons can compare their own surgical techniques and clinical decision-making.

To assess the prevalence of ultrasound-detected abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among Division I collegiate athletes and to identify associated demographic and sport-related risk factors. Multi-institutional, 3-year observational study. Preseason screening evaluations conducted at collegiate athletic programs. A total of 533 Division I collegiate athletes representing 18 sports. All participants underwent ultrasound imaging of bilateral patellar tendons, Achilles tendons, and plantar fasciae. Abnormalities were defined as the presence of hypoechogenicity, morphologic thickening, or neovascularity. Prevalence of sonographic abnormalities and their association with demographic and sport-specific variables, along with the presence or absence of symptoms at the time of scanning. The highest prevalence of abnormalities was observed in the patellar tendon (36.1%), followed by the Achilles tendon (7.1%) and plantar fascia (2.4%). Most abnormalities were asymptomatic, although athletes with abnormalities were significantly more likely to report current pain. Older age was associated with increased risk of Achilles tendon and plantar fascia abnormalities, while male sex and participation in explosive or running sports were linked to higher prevalence of patellar tendon abnormalities. This study represents the largest known assessment of tendon and fascia ultrasound abnormalities in a collegiate athlete cohort. Findings support the use of ultrasound as an accessible, real-time diagnostic tool for early identification of subclinical pathology, which may allow for targeted interventions aimed at reducing time-loss injuries and optimizing long-term athlete health.

A subset of patients with concussion report neck pain that may increase the likelihood of persistent postconcussive symptoms, but the prevalence of comorbid neck pain with concussion has not been well studied. Hence, the primary objective of this study was to define the prevalence of comorbid neck pain and disability in patients after concussion. A cross-sectional electronic survey. Two different academic medical center concussion clinics. A convenience sample of adult (age ≥18 years) concussion patients with a Glasgow Coma Score of 13 to 15 and presenting at the concussion clinic. No other specific exclusion criteria. Not applicable. Survey questions on demographics, concussion-related clinical history, neck pain, neck-related disability, and headache. 299 adults completed the one-time anonymous survey. In total, 183 respondents (61%) reported having comorbid neck pain, with a mean numeric pain score of 5.0 ± 2 (0-10 range) and a mean neck disability index score of 38%. In total, 68% of respondents with neck pain reported the upper cervical region as the most frequent location of pain. The subset of respondents reporting neck pain with headache were more likely to report their headache radiating forward (40%; OR 4.58, CI, 2.39-8.77) and getting worse with pushing the neck (19%; OR 11.62, CI 2.73-49.55) or with movements of the head and neck (39%; OR 3.71, CI, 1.99-6.90). The findings of this study reveal a high prevalence of comorbid neck pain with moderate levels of pain and disability in patients with concussion.

The effect of isometric exercise on pain and strength for various tendinopathies has been investigated but there are no published studies on proximal hamstring tendinopathy (PHT). The objective of this trial was to determine the effectiveness of isometric versus isotonic exercise on pain and strength in people with PHT. Prospective, crossover, assessor blinded randomized trial. Neuroplasticity laboratory at La Trobe University, Melbourne, Australia. A total of 20 participants with clinical features of PHT (greater than 3 months in duration) were included. All participants completed 1 session of isometric and 1 session of isotonic exercise with a 3 to 7 days washout period between sessions. Participants were randomly allocated to the order of interventions. Primary outcomes were pain measured with a functional task (modified arabesque) assessed at 0 minutes, 45 minutes, and 24 hours postintervention, strength was measured with a dynamometer, assessed at 0 minutes and 45 minutes postintervention. A secondary outcome was pain with sitting assessed at 24 hours postintervention. Of the 20 enrolled participants, 19 (95%) completed both intervention sessions. There were no statistically significant differences between groups at any timeframe for pain with a functional task, strength, or sitting symptoms. There was no significant difference in the number of participants who achieved a clinically relevant reduction in pain with a functional task or sitting symptoms. There were no differences between isometric and isotonic exercise for strength, pain with a functional task, or sitting symptoms in participants with PHT. This is the first trial to evaluate the effect of isometric compared with isotonic exercise for pain and strength in PHT. No difference was found between groups. Selection of exercise type for PHT may be on a 'trial and error' basis and with consideration of long-term outcomes.

(1) To radiographically examine morphologies consistent with femoroacetabular impingement (FAI) syndrome in youth ice hockey and ringette athletes aged 14 to 24 years; (2) to examine FAI syndrome diagnosis because it relates to positive findings on special tests. Cross-sectional. University, Sport Medicine Center. Male and female ice hockey/ringette athletes at 14 to 24 years with no history of traumatic hip/pelvic injuries/surgeries. Examination of a novel screening protocol, using a cluster of tests, for FAI syndrome. Clinical hip findings (hip passive range of motion [p-ROM]; hip muscle strength testing; hip impingement special tests [ST]), radiographic evidence of FAI syndrome (α angle; lateral center edge angle [LCEA]; crossover sign). A convenience sample of 28 males and 30 females consented from a larger cohort to undergo radiographs. FAI syndrome was present in 61% of males and 67% of females. Males demonstrated higher odds of cam morphologies unilaterally relative to females (OR = 4.29, 95% CI, 1.52-12.23), and based on point estimates, females displayed higher odds of pincer morphologies, both unilaterally (OR = 2.68, 95% CI, 0.95-7.73) and bilaterally (OR = 2.41, 95% CI, 0.73-8.12). Males displayed higher α angle than females (b 2 = 6.05, 95% CI, -9.75 to -2.34). No other covariates were associated with α angle/LCEA. With each additional positive ST, the odds of having evidence of FAI syndrome increased 3-fold (OR = 3.34, 95% CI, 1.91-5.83). Youth male and female ice hockey and ringette athletes display similar prevalence of FAI syndrome; however, specific morphologies differ by sex. This study provides evidence that a cluster of tests may increase the certainty with which suspected FAI syndrome can be assessed through screening.

To identify status of and barriers to sports health care providers engaging in discussions to guide athletes considering retirement (also known as disqualification) in the context of sports-related concussion (SRC). An observational, 1-time questionnaire. In advance of the in-person 2018 Big10-Ivy League Traumatic Brain Injury Consortium meeting, a clinical-research summit on SRC, all invitees were asked to complete an anonymous survey. Health professionals and staff supporting multiple Division I organized collegiate sports medicine programs. Survey instrument. Measuring of attitudes, awareness, and gaps in SRC retirement care. Eighty-one participants included 40 from the Ivy League (53%) and 30 from Big10 (39%). Most were athletic trainers (n = 31, 38%) or physicians (n = 23, 28%). On average clinicians were 16.0 years (SD = 13.0) from their terminal degree; most were aware of medical retirement post-SRC and engage in discussions (n = 62, 86%). Physicians were more aware of a published tool for decision making (39% for MDs, 7% for trainers, P = 0.03); trainers were more likely to discuss retirement only in special cases (56% vs 23%, overall P = 0.03). Knowledge, preparedness, and confidence with discussions did not differ by role; years of provider experience was not associated with any outcomes. Safe return to athletics and academics after SRC follows protocols, but processes by which medical retirement takes place remain in development and without consensus. Guidance for medical retirement after SRC exists but this survey suggests gaps remain between skills and self-perceived abilities to discuss medical retirement after SRC. Retirement is considered important in SRC care but remains underdeveloped in sports medicine education. These findings identify gaps in knowledge and skills training around retirement discussions and provide opportunities for closing these gaps with targeted training.

To evaluate the influence of social disadvantage on time to presentation to care after sport-related concussion (SRC). Retrospective cohort study. The study was conducted using a REDCap database of former patients treated at a regional sports concussion clinic. Athletes 13 to 17-year-old, who sustained an SRC and were examined at the regional sports concussion clinic between 11/2017 and 04/2022. Area Deprivation Index (ADI) score was calculated using the patient's zip codes. Time to present to a regional sports concussion clinic (days) and time to present to any healthcare setting (days). &#x3c7;2 analysis and logistic regression assessed for differences between ADI quartiles and predictors of time to presentation, respectively. A total of 916 patients were included (mean age = 15.8 &#xb1; 1.3). The median time to presentation to any healthcare setting was 2 days (IQR: 0-6). Highest ADI quartile patients (ie, most socially disadvantaged) were more likely to be Hispanic/Latino (P = 0.003), non-White (P < 0.001), public school attendees (P < 0.001), and have had nonprivate insurance (P < 0.001). These patients also took longer to present to a regional sports concussion clinic (P < 0.001) compared with lower ADI quartiles. ADI score (B = 0.095, P < 0.001) and family history of migraines (B = 0.177, P = 0.006) significantly predicted longer times to clinic presentation. Greater social disadvantage was associated with a longer time to present to concussion specialty care. Ensuring those with fewer resources have early access to sports concussion care represents an actionable opportunity to reduce this healthcare disparity. Social determinants of health may be barriers to timely and equitable access to specialty concussion care.

This study aimed to investigate the prevalence of hip-related groin pain (HRGP), and femoroacetabular impingement (FAI) syndrome-related signs and symptoms, in ice hockey and ringette athletes, considering important covariables (eg, age, sex). Intra and interrater reliability and cross-sectional. University, Sport Medicine Centre. Male and female ice hockey/ringette athletes at 14 to 24 without a history of traumatic hip/pelvic injuries/surgeries. Novel screening for the assessment of HRGP and signs and symptoms associated with FAI syndrome. HGRP-focused hip history questionnaire, International Hip Outcome tool, clinical hip screen (hip passive range of motion (ROM), p-ROM; hip muscle strength testing; hip impingement special tests). HRGP was reported by 61% of participants [105/166 (63%) male, 60/104 (57%) female]. Men with HRGP had reduced ROM in flexion (with = 124 degrees, 95% CI, 122-125 degrees; without = 126 degrees, 95% CI, 124-127 degrees, t = 1.81, P = 0.04), adduction (with = 26 degrees, 95% CI, 25-27 degrees; without = 28 degrees, 95% CI, 27-29 degrees; t = 0.21, P = 0.01), and internal rotation (with = 31 degrees, 95% CI, 30-33 degrees; without = 34 degrees, 95% CI, 33-35 degrees; t = 2.86, P = 0.002) compared with male without HRGP. Both male and female with HRGP reported up to 5-fold increased odds of positive findings on impingement tests compared with those without HRGP [flexion-adduction-internal rotation (FADIR): male, odds ratio (OR = 2.84, 95% CI, 1.73-4.69; female OR = 5.37, 95% CI, 2.21-14.87)]. When modelled and fit with other covariates, FADIR (OR = 0.76, 95% CI, 0.51-1.12) and maximal squat distance (OR = 1.69, 95% CI, 1.30-3.60) increased odds of having HRGP. International Hip Outcome scores (OR = 0.96, 95% CI, 0.95-0.98) displayed an inverse relationship with HRGP. Findings from this study provide evidence to support the use of hip screening in athletes at risk of FAI syndrome. Challenges to the assessment of the hip joint continue to limit the reliability of screening tools.

To characterize the injury profile and return-to-play (RTP) timelines of elite pickleball players on the Professional Pickleball Association (PPA) Tour. Retrospective observational study. Professional pickleball tournaments held on the PPA Tour or professional circuits between 2018 and 2025. One hundred thirteen elite pickleball players (48 male, 65 female), ranging in age from late teens to mid-40s (mean age &#x223c;31 years). Descriptive analysis of publicly documented injury reports and RTP data. Injury type, location, mechanism, competition withdrawal, and RTP duration. Seventy-five injuries were recorded in 52 players (46%) during the 7-year period. Lower extremity injuries were most common (49%), particularly ankle sprains (13) and knee injuries (8), along with Achilles ruptures and Anterior Cruciate Ligament (ACL) tears. Head and face injuries (13%) were often from paddle or ball impacts and included concussions. Upper extremity injuries (12%), such as wrist ligament tears and elbow tendinopathies, were less frequent. Approximately 68% of injuries led to at least 1 tournament withdrawal. Return to play varied: 35% returned within days, 15% in weeks, and &#x223c;19% required multiple months. Several severe injuries, including ACL tears and Achilles ruptures, were season ending. Elite pickleball players sustain a diverse array of injuries, with lower extremity sprains being the most prevalent. Although many athletes return quickly, others experience prolonged recovery. These results highlight the need for enhanced injury prevention efforts, centralized injury surveillance, and targeted conditioning programs to support player health as the sport continues to grow. These findings can inform injury prevention strategies and medical monitoring for professional pickleball players.

To systematically compile and analyze studies on cheerleading-related injuries in the United States, with a focus on injury patterns and trends. PubMed, Embase, and Cochrane Central Register of Controlled Trials. Search terms included ("cheerleader" OR "cheerleading" OR "cheer athlete" OR "spirit leader") AND ("injuries" OR "trauma" OR "accidents"). Included studies reported cheerleading injury data from 1982 to 2019. Extracted data included study characteristics, participant demographics, injury type, anatomical location, mechanism, maneuver, event, and time lost. A systematic review using the above data sources was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 372 studies were identified, and 14 studies met inclusion criteria. Inclusion criteria were original clinical studies (level of evidence 1-4) which examined cheerleaders of various expertise and ages who sustained athletic injuries. 28&#x2009;998 cheerleaders sustained 239&#x2009;361 injuries. Participants were 96.5% female with a mean age of 16.0 years. Most injuries occurred among high school athletes, primarily during practice. Sprains and strains were the most common injury types, often caused by contact with another athlete. Ankle injuries were most common, followed by head, brain, and neck injuries. This systematic review is the first to compile all studies on cheerleading-related injuries in the United States and to examine associated risk factors, injury patterns, the most common types, locations, and timing of injuries. However, the absence of standardized injury reporting in cheerleading poses a significant barrier to draw definitive conclusions across studies. Our findings highlight the need for mandatory reporting systems to enhance data reliability.

To examine the impact of mild traumatic brain injury (mTBI) on transitive inference (TI) task performance in subjects with concussion history. TI relies on brain executive function, which may be vulnerable to concussion-induced axonal disruption and impairment in inter-regional communication. Analytical cross-sectional comparison. Institutional study in a university setting. University students with and without a history of concussion. Participants with and without a history of concussion. Assessment of participants' learning and transitive inference abilities using a 5-item TI test that provided performance scores on learning premise pairs and transitive inference pairs. In a 5-item TI task consisting of training in premise pairs and a test, participants with a history of 1 or more concussions performed as well as controls on the premise pairs. However, although performance was similar on 1 transitive pair, the final transitive pair was strongly compromised in those with a history of concussion (47% and 71%, respectively). Previously unreported in the literature, our data demonstrated a specific impairment of executive function in participants with a history of concussion despite their normal learning ability. The pattern of the impaired TI task performance indicates the collapse of the TI symbolic distance effect and may reflect disrupted inter-regional communication because of concussion-related axonal damage.

The aim of this study was to evaluate, in runners participating in the 2019 Rome Marathon, the interaction between resilience and coping and how they are influenced by sex, age, body weight, height, number of weekly training sessions, and the time of the last marathon. Cross-sectional study. The 2019 Marathon of Rome. Six hundred eighty-two athletes (513 men and 169 women; mean age: 47.7 &#xb1; 10.6 years, range 19-80 years). Runners filled in the Connor-Davidson Resilience Scale and Athletic Coping Skills Inventory (ACSI) questionnaires. Statistical analyses were performed by means of the Shapiro-Wilk test, the Mann-Whitney U test, the Kruskal-Wallis test and the Spearman rho. An a priori power analysis was calculated. Connor-Davidson Resilience Scale (for resilience) and ACSI (for coping) questionnaires. Overall, 682 athletes (513 men and 169 women; mean age: 47.7 &#xb1; 10.6 years; mean weight: 70.2 &#xb1; 9.6 kg; mean height: 172.8 &#xb1; 7.5 cm; mean BMI 23.5 &#xb1; 2.5) were included. A statistically significant positive correlation was found between resilience and coping (rho = 0.49 and P < 0.001). No statistically significant difference was found in resilience and coping according to sex, age, BMI, and impact profile (number of training sessions per week). No statistically significant correlations were observed between resilience and performance (ie, last marathon time) and between coping and performance (rho = 0.02 and P = 0.565, rho = 0.04 and P = 0.316; respectively). Higher levels of resilience correspond with higher levels of coping in adult marathon runner athletes. These factors/characteristics do not correlate with marathon times (sports performance). Physical or demographic features do not influence resilience and coping strategies in adult athletes.

To analyze the relationship between the joint characteristics of the lower limb and the onset of posterior muscle discomfort in competitive swimmers. Cross-sectional observational study. This is a private practice studio. A total of 157 competitive swimmers (86 men and 71 women) were included: 35 in the infant category (14-15 years), 38 in the junior category (16-20 years), 36 in the absolute category (older than 21 years), and 48 in the master category (older than 25 years). Range of motion (ROM) of the lumbar region, hip (flexion, extension, rotation), knee (flexion and extension), and ankle dorsiflexion (with knee flexed and extended) were measured. Flexibility was assessed using the Seat and Reach Test and the Straight Leg Raise Test. Discomfort in the posterior muscle chain was self-reported and classified by anatomical region (lumbar, hamstrings, gastrocnemius, plantar muscles). Joint ROM values and self-reported posterior muscle discomfort. Women showed greater ROM in most joints, except hip extension. Freestyle swimmers reported the highest rates of posterior discomfort, particularly in the gastrocnemius. Swimmers in the absolute and master categories experienced more gastrocnemius and plantar muscle discomfort, while younger swimmers reported fewer issues. Reduced lumbar and hamstring flexibility was associated with increased discomfort in those areas. Swimmers with gastrocnemius and plantar discomfort had significantly lower ankle dorsiflexion. Competitive swimmers who reported posterior muscle discomfort during swimming showed poorer flexibility in the hamstrings and gastrocnemius, along with reduced ankle dorsiflexion, compared with those without discomfort. These findings may help guide injury prevention strategies and training planning.

To investigate the associations between the novel acromial angle (NAA), critical shoulder angle (CSA), acromial index (AI), and rotator cuff tears. Retrospective cohort study. A single hospital with complete imaging data (scapular anteroposterior radiography, scapular outlet radiographs, and shoulder magnetic resonance imaging). A total of 207 patients (100 males, 107 females) aged 57.73 &#xb1; 16.74 (normal group) and 59.48 &#xb1; 13.00 (injury group) years were included. NAA, CSA, AI. Rotator cuff tears. The NAA in the normal group was (149.1 &#xb1; 5.96)&#xb0;, and in the injury group was (142.3 &#xb1; 6.56)&#xb0;, with a statistically significant difference (P < 0.001); the CSA in the normal group was (37.61 &#xb1; 5.83)&#xb0;, and in the injury group was (42.4 &#xb1; 7.56)&#xb0;, with a statistically significant difference (P < 0.001); the AI in the normal group was (0.745 &#xb1; 0.088), and in the injury group was (0.779 &#xb1; 0.117), with a statistically significant difference (P = 0.03). On the receiver operating characteristic curve, the area under the curve for NAA was 0.749, for CSA 0.683, and for AI 0.585. The NAA in the injury group was generally lower than in the normal group, whereas the CSA and AI were generally higher in the injury group than in the normal group. The measurement value of NAA was better than that of CSA and AI. Therefore, NAA, CSA, and AI are risk factors for rotator cuff tears, and measuring NAA, CSA, and AI helps predict the probability of rotator cuff tears occurrence.

This study aimed to evaluate the general population's perceptions of conservative treatment compared with surgical intervention for anterior cruciate ligament (ACL) tears. Cross-sectional survey study analyzing public opinions on ACL treatment approaches. A 44-question survey constructed by the current authors. Participants were recruited from a web-based survey that was developed using Amazon Mechanical Turk (MTurk), a validated online crowd source platform. This study recruited adult participants &#x2265;18 years of age and those residing in the United States. Demographic data, prior exposure to ACL injuries, and preferences for surgical versus nonsurgical treatment. Demographic, educational, vocational, and prior surgical variables were collected. 529 participants were included with mean age of 43.4 &#xb1; 12.5 years. A total of 38.5% of respondents preferred surgical treatment, while 61.5% chose nonoperative care. Among competitive athletes, 73.6% favored surgery compared with only 25.7% of nonathletes who preferred operative treatment (P < 0.01). Physician recommendations significantly influenced decisions, with 76.7% of participants stating they would follow their surgeon's advice if they initially preferred surgery but were recommended to surgery by their surgeon. The main reasons for choosing surgery were concerns for long-term joint health and the desire to return to high-level activity. Public perception of ACL injury management is influenced by athletic participation, trust in medical professionals, and concerns about surgery. These findings highlight the need for enhanced patient education and shared decision making to align treatment choices with individual goals and clinical outcomes. Future research should explore targeted educational interventions and their impact on treatment preferences, particularly in younger, high-risk populations.

Exercise-induced purpura is a distinctive condition occurring after prolonged physical exertion. It is often misdiagnosed as an immune-mediated vasculitis, raising concerns about autoimmune disorders. Although this condition affects physically active individuals, it remains underrepresented in comprehensive reviews on purpura and nontraumatic sports dermatology. To enhance awareness about this condition and to advance understanding of its clinical and histologic features, we conducted a systematic literature review. This study was preregistered in the International Prospective Register of Systematic Reviews (CRD42024557652). The United States National Library of Medicine, Excerpta Medica, and Google Scholar were screened for the terms "exercise-induced vasculitis" OR "exercise-induced purpura" OR "exercise-induced capillaritis." Data extraction encompasses demographics, symptoms, time latency and recovery, predisposing factors, ancillary tests (blood values and histology), and popular terminology. We identified 40 typical cases and three case series reporting an additional 71 individuals. Exercise-induced purpura predominantly affected middle-aged women, often in association with chronic venous disease. Petechiae, purpura, or ecchymoses-often accompanied by burning, itching, or mild pain-appeared within 24 hours after prolonged physical activity, especially in warm conditions, and characteristically involved the lower limbs, sparing areas covered by clothing. Symptoms and lesions resolved spontaneously within 1 to 2 weeks. Laboratory tests were unremarkable, and histology revealed leukocytoclastic vasculitis without IgA deposits. Exercise-induced purpura deserves greater visibility in sports medicine due to its frequency, benign course, and potential for misdiagnosis. Diagnosis is clinical. Early recognition avoids unnecessary investigations and unwarranted concern.

The vestibular ocular motor screen (VOMS) and the Sport Concussion Assessment Tool 6 (SCAT6) are point-of-care concussion assessments administered immediately or soon after sports participation or exercise. To retain validity and accuracy, the results of these tests should not be affected by sporting activity. We assessed the effect on the mVOMS (modified VOMS) and SCAT6 immediately and 20 minutes after performance training in high school athletes. Nonrandomized pilot experimental study. High School, Buffalo, NY. Nonconcussed athletes (n = 23, 39% male, 15.5 &#xb1; 1.0 years). Performance Training (pretraining, post-training, 20 minutes post-training). mVOMS and SCAT6 scores (standardized assessment of concussion, modified balance error scoring system, timed tandem gait [TTG], dual task tandem gait [DTTG]). TTG (P = 0.005) and DTTG (P = 0.045) improved significantly from prepractice to immediate postpractice and from pretraining to 20 minutes post-training (TTG [P = 0.002], DTTG [P = 0.006]). There were no other differences in SCAT6 or mVOMS scores among the 3 time points. SCAT6 and mVOMS performance was not adversely affected by moderately intense exercise training in high school athletes. TTG and DTTG performance improved after exercise, consistent with the learning effect. Further research should be conducted across other populations to increase generalizability. Clinicians should be confident that fatigue and exertion from acute performance training activities are not likely to affect the performance of these widely used sideline concussion assessment tools.

To compare the change in the functional cross-sectional area (FCSA) of lumbar paraspinals (multifidus-primary; erector spinae-secondary) between participants prescribed rest before physical therapy (PT) and those starting PT immediately in adolescent athletes with active lumbar spondylolysis. Multicenter randomized controlled trial. Two pediatric hospitals in the United States. Fifty-three adolescent athletes (mean age 14.1 &#xb1; 1.5 years; 40% female) were randomized to immediate PT (n = 25) or rest before PT (n = 28). Immediate PT participants began within 1 week of diagnosis. Rest before PT participants delayed PT until their pain resolved with daily activities for 2 consecutive days. Change in FCSA of the lumbar multifidus (primary outcome) and erector spinae at the L4-L5 level, measured by magnetic resonance imaging at baseline and 3 months. The immediate PT group demonstrated significantly greater improvements in multifidus FCSA compared with the rest before PT group [7% increase vs 1.4% decrease; mean difference 8.4% (95% CI, 1.5-18.0); P = 0.03; partial &#x3b7;2 = 0.09]. Multifidus atrophy occurred in 50% of rest before PT group and only 20% of the immediate PT group. Time to PT initiation was associated with multifidus size at 3 months ( r = 0.41, P < 0.001). No significant change or between-group differences were observed in erector spinae FCSA ( P = 0.69). Immediate PT preserved and increased multifidus FCSA, while rest before PT was associated with higher rates of atrophy. Early rehabilitation may protect lumbar stabilizing musculature in adolescent athletes with spondylolysis, potentially reducing risk of recurrent or chronic low back pain.