Sports Physiotherapy is a specialised area of practice requiring specific competencies and standards to be met. The initial Sports Physiotherapy Competencies and Standards at the international level were first developed in 2005. With the sports physiotherapy landscape evolving, ensuring the currency and an update of the 2005 competencies was important. Through the SportsComp project (Higher Education to Improve Competency in Sports Physiotherapy) funded by an Erasmus+ grant, a consortium of five partners, including the International Sports and Exercise Physiotherapy Assocation, updated these competencies and standards. Using a three-phase process that incorporated perspectives from experienced sports physiotherapists including a Delphi study, a qualitative study of focus groups and interviews of stakeholders, and a consensus meeting of expert sports physiotherapy researchers and educators, the International Sports Physiotherapy Competencies and Standards (2025) ("the Competencies") were finalized. The final competencies are at a Master's level, and are contemporary and relevant to the current context of the practice of sports physiotherapy. The knowledge and behaviors to be demonstrated and standards to be achieved are able to be implemented in sports physiotherapy career pathways internationally. An overview of the key changes in the Competencies is presented and the full list of the Competencies are included as Supplementary Material. # Level of Evidence 5.
Chronic low back pain (CLBP) is a disabling injury for athletes with an unclear pathway to return to sport (RTS). Biopsychosocial (BPS) treatment can address the complex needs of athletes recovering from injury by considering the interplay between body and mind. Current BPS models lack specific guidelines for clinicians. This case report presents and applies a novel BPS framework, SPORT (Systematic Progressive Overload Rehabilitation Training) to a young athlete with CLBP. An accomplished 18-year-old male athlete who engaged in soccer, football, and powerlifting presented with CLBP. The symptoms originated with kicking and worsened for 13 months. Despite five months of treatment from clinicians, there was no RTS or improvement in pain and disability. The SPORT framework consisting of 18 evidence-based principles was implemented. The outcomes tracked were strength, sport participation, and reported pain and function. A 17-week intervention resulted in strength gains as measured by performances on the squat and deadlift. Squat improved from 45 lb to 335 lb. Deadlift improved from 45 lb to 385 lb. The subject's recreational sport participation increased from inactivity to 45 minutes of play for five consecutive days. He improved from daily pain and disability to near pain-free living and function. Seven weeks post treatment, post-case outcomes included a 435 lb squat, 465 lb deadlift, participation in recreational sports, sustained improvements in pain and function, and successful flare-up management. The subject presented with unique challenges which required a holistic approach to RTS. SPORT provided tools for managing his CLBP. Future studies could compare SPORT to other treatments for CLBP in young athletes, ideally on a larger scale and with diverse populations. The case presents the creation and application of an original BPS framework, resulting in reductions in pain and a RTS in a young athlete suffering from CLBP. 4.
To evaluate whether 100 consecutive pitches induce clinically meaningful increases in medial elbow joint space gap (MJS) in high school baseball players and to examine associations with player characteristics, including early multi-sport participation. In a randomized controlled trial, 34 healthy male high school baseball players were allocated to a pitching group (n = 17) or a control group (n = 17). The pitching group threw 100 fastballs at maximal effort, whereas controls rested for an equivalent duration. MJS was measured by ultrasonography before and after pitching or rest. The minimal clinically important difference (MCID) for MJS change (mm and %) was calculated using a distribution-based method (0.5 × SD of the pitching group's MJS increase). Group × time effects were tested using a two-way repeated-measures ANOVA, and univariate analyses explored relationships between MJS change and participant characteristics. No significant group × time interaction was observed (p = 0.427). In the pitching group, MJS increased by 0.2 ± 1.1 mm (8.3 ± 24.6%), remaining below the MCID thresholds (0.55 mm; 12.3%). Early multi-sport experience during elementary school was associated with smaller MJS expansion (p = 0.009), and the number of non-baseball sports correlated negatively with MJS change (r = -0.628, p = 0.007). No associations were found with pitch velocity or body composition. A single bout of 100 pitches did not produce clinically meaningful MJS widening in high school baseball players. However, early multi-sport participation was related to reduced MJS expansion, suggesting that diversified sport experience may be an important background factor when refining pitch-count guidance.
Sideline medical care is an integral part of a sports medicine physician's responsibilities. While traveling with a sports team, the practice environment is much different than a standard clinic, training room, or emergency department. Planning and consideration are necessary to ensure that the correct supplies are available. This article addresses pre-event planning, packing, and travel requirements for a sports medicine physician's medical bag to ensure that the physician will be able to address common medical concerns.
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This study examined 5-year longitudinal changes in athletic training services in U.S. high schools. Variables included per-school averages of student-athletes, sports, athletic trainers, full-time athletic trainers, and part-time athletic trainers; weekly average of total contracted and actual athletic training services hours; and ratios of student-athletes:athletic trainers, sports:athletic trainers, contracted athletic training services hours:student-athletes, actual athletic training services hours:student-athletes, contracted athletic training services hours:sports, and actual athletic training services hours:sports. Over 5 years, student-athletes increased by 20.02, sports by 1.14, athletic trainers by 0.03, full-time athletic trainers by 0.10, contracted athletic training services hours by 3.63, actual athletic training services hours by 3.03, and sports: athletic trainers by 0.69, while part-time athletic trainers decreased by -0.10 (all P < 0.050). Despite increases in student-athletes and sports, athletic trainers, contracted athletic training services hours, and actual athletic training services hours also increased, while student-athletes: athletic trainers, contracted athletic training services hours: student-athletes, and actual athletic training services hours: student-athletes did not significantly change (all P > 0.050). Our findings also suggest a shift toward full-time athletic trainer staffing, which is encouraging. This study provides valuable evidence for future athletic training services research and for improving policies on high school sports safety.
 Effective communication between deaf swimmers and their coaches is vital for the athlete. Swimmers who wear amplification devices are often disadvantaged when engaging in the sport, as the devices cannot be worn, thereby impacting communication.  To explore the communication experiences between deaf and hearing-impaired (D and HI) competitive swimmers and their coaches.  An exploratory phenomenological qualitative research design using online questionnaires was utilised. Non-probability, purposive sampling was employed to select 11 participants (eight D and HI competitive swimmers and three coaches).  Facilitators of effective communication included lip reading, the use of specific made-up signs and writing. Made-up signs are utilised; however, Sign Language was not considered to be the main form of communication because of the lack of knowledge by coaches, thus making communication difficult for swimmers who use Sign Language as their first language. Not being able to wear amplification devices when swimming and the lack of visual-based alerting systems in the swimming arena were identified as barriers. Communication between D and HI swimmers and a deaf coach was described as 'seamless', as an understanding of communication modes is established while working together. Inclusivity in the swimming environment is evident; however, there are instances where D and HI swimmers feel isolated.  Communication experiences within the swimming environment included challenges and barriers for both groups of participants. The coach's relationship with the D and HI swimmer plays a major role in the effectiveness of communication.Contribution: Fostering positive relationships between coaches and D and HI swimmers is mutually beneficial. Audiologists can play a role in encouraging and facilitating communication strategies with such sports men and women.
Exercise is beneficial in adult congenital heart disease, but patients with prosthetic materials, including valve-in-valve right ventricle-to-pulmonary artery (RV-PA) conduits, require tailored advice regarding high-impact sports. A 19-year-old man with repaired pulmonary atresia, ventricular septal defect, and valve-in-valve RV-PA conduit placement developed exertional dyspnea after blunt chest trauma during competitive ice hockey. Imaging revealed significant prosthetic conduit stenosis due to stent compression. He underwent urgent surgical conduit replacement, with full recovery. This case illustrates a rare complication of blunt trauma leading to prosthetic conduit failure. It highlights the need for dynamic imaging and reinforces guideline-based counseling to avoid collision sports in those with valve-in-valve RV-PA conduits. Holistic approaches including shared decision-making regarding exercise prescription and regular reassessment is essential in managing exercise safely in patients with adult congenital heart disease. Trauma threatens anterior prosthetic valves, with timely dedicated imaging and personalized exercise prescription being essential.
Disordered eating and mindful eating are under-studied among athletes with disabilities; clarifying their interplay could inform potential prevention strategies. This study examined the relationship between disordered eating and mindful eating in athletes across different sexes and ability statuses, addressing the limited research in disabled populations. In this cross-sectional study, 140 Turkish athletes (70 with physical disabilities; 70 without) completed the Eating Disorder Examination-Questionnaire and the 30-item Mindful Eating Questionnaire. Group differences, Pearson correlations and multiple linear regression were calculated. Global disordered-eating and mindful-eating scores did not differ by disability status or sex. Athletes with disabilities reported lower Emotional Eating (17.6 ± 4.7 vs. 19.4 ± 4.5; p = 0.023) and, among men, higher Mindfulness sub scores (16.0 ± 2.6 vs. 14.6 ± 2.7; p = 0.006). Mindful eating correlated inversely with disordered eating in both groups (with disabilities: r = -0.49, p < 0.001; without: r = -0.32, p = 0.014) and was strongest in women with disabilities (r = -0.76, p < 0.001). Disordered eating emerged as a significant predictor of lower mindful eating (β = -4.66, p < 0.001), explaining 1% of its variance after controlling for age, sex, body-mass index and disability status. Mindful eating is inversely associated with disordered eating across athletes, with the relationship particularly pronounced in women with disabilities. Interventions that cultivate mindful eating could be relevant for managing disordered eating in para-sport. This study explored the link between disordered eating and mindful eating in athletes with and without physical disabilities. A total of 140 Turkish athletes (70 with disabilities, 70 non-disabled athletes) completed questionnaires on their eating behaviours and mindfulness around food. The results showed that athletes with disabilities and non-disabled athletes had similar overall levels of disordered eating and mindful eating. However, athletes with disabilities reported less emotional eating, and men with disabilities reported being more mindful while eating compared to non-disabled men. Importantly, across all groups, higher mindful eating was linked to lower disordered eating. This association was strongest in women with disabilities, suggesting that mindfulness may be particularly protective for them. Further analysis confirmed that disordered eating was the main factor predicting lower mindful eating, regardless of age, sex, body mass index, or disability status. These findings highlight that promoting mindful eating may help reduce disordered eating behaviours in athletes with disabilities and non-disabled athletes. Interventions that teach athletes to pay closer attention to hunger, satiety, and emotional triggers around food could support healthier eating and mental well-being, especially in parasport.
This study aimed to examine the differential effects of two Tabata-based high-intensity interval training (HIIT) modalities-calisthenic/plyometric-focused versus kettlebell-focused exercise-on neuromuscular performance and physiological adaptations in competitive table tennis athletes. Twenty-four male athletes (aged 18-24 years) were randomly assigned to a calisthenic/plyometric HIIT group (n = 12) or a kettlebell HIIT group (n = 12). Both groups performed their respective Tabata protocols in addition to regular table tennis training, three days per week for eight weeks. Flexibility, agility, sprint performance, vertical jump height, peak and average power output, and maximal oxygen uptake (VO₂max) were assessed before and after the intervention. Analysis of normally distributed data was performed using a 2 (group) × 2 (time) mixed-design analysis of variance (ANOVA). When significant interaction effects were detected, post-hoc comparisons were conducted using paired t-tests with Bonferroni correction. Statistical significance was set at p < 0.05. Both HIIT methods resulted in significant improvements in most measured parameters (p < 0.05). The calisthenic/plyometric protocol led to greater gains in agility, flexibility, and vertical jump performance, indicating enhanced neuromuscular function. Conversely, the kettlebell protocol elicited superior improvements in sprint performance. Both groups demonstrated increases in VO₂max; however, these changes were not significantly different between groups. Tabata-based HIIT effectively enhances neuromuscular and physiological performance in table tennis athletes; however, adaptations differ based on exercise modality. Calisthenic/plyometric-focused HIIT preferentially improves agility, mobility, and explosive leg power, while kettlebell-focused HIIT yields greater benefits for speed and aerobic capacity. These findings demonstrate that modality-specific HIIT programming is a practical and time-efficient approach to target sport-specific performance demands in racket sport athletes. ClinicalTrials.gov (NCT07403461), registered on 16/01/2026.
Sports performance depends on multiple components, including strength, power, and balance. Both dynamic balance and hip muscle strength influence horizontal hop performance, but it remains unclear whether balance predicts hop performance differently across varying levels of hip strength. The objectives of the present study were to i) investigate whether better dynamic balance was a predictor of better hop performance in Danish volunteers without musculoskeletal conditions, and ii) investigate whether this predictive association varies between groups with maximal isometric hip muscle strength below or above the sample mean in hip flexion, extension, abduction, and adduction. Cross-Sectional Study. One hundred thirty-five healthy volunteers aged 18-50 years were recruited from the general population via personal networks, social media, and posters on various institutions and companies in Aarhus and Horsens, Denmark. Dynamic balance was assessed with the Y-Balance test measuring reach in the anterior, posteromedial, and posterolateral directions, summed to calculate a Composite Reach Distance. Horizontal forward hop performance was assessed using the Single-leg Hop for Distance test. Maximal isometric hip muscle strength of the flexors, extensors, abductors, and adductors was measured using a fixated dynamometer. All tests were performed on the right leg. A univariate linear regression model was used with regression coefficient as measure of association. To investigate differences in the slope of the linear regressions, participants were divided into groups based on whether their maximal isometric hip muscle strength was below or above the sample mean. Better dynamic balance was associated with better horizontal hop performance (β = 0.59, [95% CI 0.29-0.88], p<0.001), similar associations were found for the posterior directions. This finding was consistent regardless of whether hip muscle strength was below or above the sample mean for all four directions (p>0.05). Individuals with better dynamic balance displayed better horizontal hop performance. These findings provide data on subjects without musculoskeletal conditions, which can be used as reference points when compared with symptomatic populations. 3b.
Comprehensive bibliometric analysis of magnetic resonance imaging applications in multiple sclerosis research remains scarce despite exponential growth. This study maps 25-year global MS-MRI trends (2000-2024) to identify transformative shifts. We analyzed 8,038 publications from the Web of Science Core Collection using VOSviewer, Bibliometrix, and CiteSpace. Machine learning clustering quantified collaboration networks, while dual-map overlays and burst detection quantified interdisciplinary bridges and paradigm shifts. Publication growth showed three phases: steady (2005-2011, +6.2%/year), accelerated (2011-2021, peak 480 publications), and stabilization (2022-2024), with recent decline linked to diagnostic criteria simplification and artificial intelligence-driven consolidation. The USA dominated total output (24.2%), while the UK led international collaboration (44.2% multi-country publications). China's unique focus on psychoneuroimmunology contrasts with Western clinical-translational priorities. The strongest interdisciplinary link connected Neurology/Sports/Ophthalmology and Molecular/Biology/Genetics fields (Z-score = 5.3). Artificial intelligence drove paradigm shifts, with deep learning showing the highest keyword burst strength (413.27). Central authors (e.g., Massimo Filippi, Frederik Barkhof) bridged magnetic resonance imaging biomarkers and therapeutic innovation. MS-MRI research is evolving from descriptive observations to AI-driven precision medicine. Future success relies on a closed-loop paradigm integrating ultra-high-field MRI and multi-omics. This analysis reveals: (1) Magnetic resonance imaging-artificial intelligence-biomarker integration resolves clinical-radiological paradoxes, enabling dynamic patient stratification; (2) ultra-high-field magnetic resonance imaging and multi-omics provide a roadmap for precision neurology in therapy personalization; (3) global collaboration synergies may democratize advanced multiple sclerosis care.
Capacitive resistive monopolar radiofrequency (CRMF) improves muscle extensibility and local tissue oxygen saturation in the trunk region. However, its effects on the lower extremities, particularly the rectus femoris, remain unclear. To examine the immediate effects of 448-kHz CRMF on muscle stiffness and hemodynamics of the rectus femoris in female collegiate soccer players. Randomized crossover study. Healthy female collegiate soccer players from a university team were recruited. Those with a history of thigh muscle injury or orthopedic disorders such as fractures within the previous year, any history of neurological or cardiac disease, and presence of a cardiac pacemaker were excluded. Each participant received three interventions (CRMF, hot pack, and sham) in randomized order with ≥2-day washout periods. Muscle stiffness (kPa) was assessed using shear wave elastography; hemodynamics (oxygenated hemoglobin [Oxy-Hb], deoxygenated hemoglobin [deOxy-Hb], total-Hb, and tissue oxygen saturation [StO₂]) were measured using near-infrared spectroscopy at depths of 1.5 and 3.0 cm. Measurements were performed at pre-intervention, immediately post-intervention, and 30 min post-intervention. 18 female soccer players (mean age ± standard deviation, 20.2 ± 1.4 years) participated in and completed the study protocol. CRMF significantly reduced rectus femoris stiffness immediately post-intervention in the stretch position compared with hot pack (p < 0.001) and sham (p = 0.006). In the resting position, stiffness did not differ significantly across conditions. At 3 cm depth, CRMF and hot pack significantly increased Oxy-Hb immediately compared with sham (p = 0.008 and 0.025, respectively). CRMF also exhibited higher total-Hb at 3 cm immediately (p = 0.028). StO₂ at 3 cm was higher with CRMF than with the hot pack immediately (p = 0.002) and sham at 30 min (p = 0.030). CRMF reduced rectus femoris muscle stiffness in the stretched position and increased deep-tissue Oxy-Hb, total-Hb, and StO₂ in female collegiate soccer players. Effects were immediate, and some hemodynamic responses persisted up to 30 min, suggesting that CRMF may be an effective thermotherapy for improving deep-tissue oxygenation and reducing muscle stiffness in sports and rehabilitation settings. 2.
Participation of athletes with impairment (AWI) in mass-participation endurance events is rapidly expanding, necessitating tailored logistical and medical planning to ensure safety, equity, and competitive integrity. Here we outline key considerations for event organizers and medical teams to prepare for and support AWI. Although AWI often share similar injury patterns with able-bodied athletes, they also present unique medical and logistical challenges, including accessibility barriers, equipment-specific issues, and specialized medical needs. We propose the "ACES" framework-"A": Access and Accommodations, "C": Course and Competition Safety, "E": Equipment and Emergency Preparedness, and "S": Support and Specialized Needs-as a guide for organizing inclusive endurance events. This framework facilitates comprehensive planning for venue access, course layout, adaptive equipment, emergency readiness, and inclusion of support personnel and service animals, thereby promoting safer and more inclusive sporting environments for AWI.
Basketball is a high-intensity sport that often results in lower extremity muscle and tendon injuries due to its rapid tempo and complex movement mechanics. Consequently, plyometric exercises are widely implemented in basketball training programs to enhance athletic performance and reduce the risk of injury. Recently, however, the benefits and drawbacks of plyometrics performed in various conditions have been widely debated. The aim of this study was to examine the effects of land- and aquatic-based plyometric training on lower-limb performance parameters including jumping, sprinting, agility, and flexibility in young male basketball players. A total of 32 male basketball players aged 15.15 ± 0.807 years participated in the study. Participants were assigned to one of four groups: aquatic vertical plyometric (AVP, n = 8), land-based vertical plyometric (LVP, n = 8), land-based horizontal plyometric (LHP, n = 8), and a control group (CG, n = 8). The training program was conducted three days per week for eight weeks, with each session lasting approximately 90 min in total, including warm-up, plyometric exercises, and cool-down phases. The sit-and-reach, standing long jump, vertical jump, 30 m sprint, RAST, agility T-test, and lane agility tests were administered before and after the intervention. Significant improvements were found in flexibility performance in the aquatic vertical plyometric group (+ 1.62 cm, + 4.8%; p = 0.001). The land-based horizontal plyometric group showed a significant increase in standing long jump performance (+ 0.05 m, + 2.3%; p = 0.006). In the land-based vertical plyometric group, agility performance improved significantly, as evidenced by reductions in both lane agility test time (- 0.07 s, - 0.6%; p = 0.035) and agility T-test time (- 0.62 s, - 6.1%; p = 0.015). No statistically significant improvement was detected in vertical jump performance in the aquatic group (+ 0.71 cm, + 1.8%; p > 0.05). Between-group analysis revealed a significant post-test difference in RAST fatigue index values (ANCOVA, p = 0.021), indicating differential training responses among the intervention groups. The study demonstrated that plyometric training can effectively improve specific anaerobic performance parameters in young basketball players. Among the examined methods, aquatic plyometric training produced more favorable outcomes in flexibility and fatigue-related parameters and may represent a potentially lower-impact training alternative for young athletes.
The aim of this study is to determine the demographic characteristics of patients with closed or open globe injuries at a tertiary referral center and to analyze the risk factors associated with the occurrence of ocular trauma. Data on age, gender, education level, affected eye, type of trauma (closed or open globe), and location (workplace, home, traffic), and any accompanying systemic injuries, ocular trauma score, and visual acuity were recorded for all patients. A total of 1,638,568 adult and pediatric emergency department visits were analyzed in the study. Of these visits, 4546 involved patients with ocular trauma. Among patients with ocular trauma, 589 were children, and 3957 were adults. Work-related injuries were reported in 869 of the patients in our study. Of the patients with work-related injuries, 804 were male. The risk of a work-related injury was found to be 6.56 times higher in males compared with females. Only 15 of these patients were wearing protective eyewear and/or a welding shield at the time of the incident. All patients with sports injuries and bullet/gunshot wounds were male. The age distribution of patients with ocular trauma due to falls peaked in 2 age groups: young males aged 20 to 30 and adults aged 70 and older. In conclusion, ocular trauma is more common among males and is frequently associated with workplace accidents. Closed globe injuries are the predominant type, and high-energy trauma, such as bullet wounds, is associated with poorer visual acuity. Furthermore, the fact that falls and injuries from sharp/piercing tools are among the most common causes, combined with the very low rate of protective equipment use, indicates that these injuries are largely preventable. Therefore, enhancing workplace safety measures, promoting the widespread use of protective equipment, and developing educational programs to raise public awareness will play a critical role in reducing the frequency and severity of ocular trauma.
Hamstring muscle injuries are among the most common lower-extremity injuries in active individuals. Hamstring injuries follow a consistent pattern with a consistent medical history, which includes a sudden, explosive type of movement (sprinting, kicking, jumping, or lunging). The onset of pain is usually acute in the posterior thigh. They may describe a "pop," "snap," or sensation as if someone kicked them in the back of the thigh. An accurate diagnosis of medial hamstring overuse, partial tears, or ruptures is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating hamstring injuries, including tendinopathy, muscle strains (partial tears), and ruptures. MSKUS is excellent at detecting changes in tendon and muscle composition and continuity. This manuscript will review the utility of MSKUS in evaluating medial hamstring tendon and muscle injuries, including anatomy, common injury mechanisms, sonographic techniques, and clinical implications for the rehabilitation profession. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with hamstring injuries. # Level of Evidence 5.