Clinical Journal of Sport Medicine最新文献

{"title":"Identifying High-Risk Combat Sport Athletes: Position Statement of the Association of Ringside Physicians.","authors":"Junaid Munshi, George Velasco, Richard A Giovane, Alex Houser, Nitin K Sethi, Kirlos N Haroun, Abhilash R Davlapur, Mario Iglesias-Muñiz, Donald Ours, Ashley James, Joe Ghorayeb, Thomas John, Kevin deWeber","doi":"10.1097/JSM.0000000000001403","DOIUrl":"10.1097/JSM.0000000000001403","url":null,"abstract":"<p><strong>Abstract: </strong>Criteria that identify combat sports athletes with significantly increased risk of injury and mortality in combat sports competition include the following:• Age younger than 13 years or older than 35 years (LOE V).• Three consecutive losses, particularly by KO/TKO (professional) or Referee Stops Contest (RSC) (amateur) (LOE III).• Inactivity exceeding 1 year (professional) (LOE V).• No prior wins (LOE V).• Significant mismatches in record, experience, age, or physical conditioning (LOE V).• History of concussion, lack of full recovery and clearance from most recent concussion, or history of other significant neurological injury (LOE II).• Severe prebout hypertension (SBP >160 or DBP >100 mm Hg in adults, or stage 2 hypertension in pediatric athletes) (LOE V).• Any medical condition identified on licensing or prebout medical examination that compromises defensive abilities (LOE V).</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":"218-223"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Surgery to Sports Career: The Long-Term Fate of Athletes With Discoid Meniscus.","authors":"Tunay Erden, Muzaffer Agir, Jotyar Ali, Berkin Toker, Omer Taser","doi":"10.1097/JSM.0000000000001369","DOIUrl":"10.1097/JSM.0000000000001369","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the long-term effectiveness of different surgical techniques for discoid meniscus in athletes.</p><p><strong>Design: </strong>This retrospective cohort study included 44 athletes (51 knees) who underwent arthroscopic surgery for symptomatic discoid meniscus between 1996 and 2019.</p><p><strong>Setting: </strong>The study was conducted at a tertiary-level sports medicine center.</p><p><strong>Patients: </strong>Athletes aged 15 to 35 years with symptomatic discoid meniscus confirmed by magnetic resonance imaging and requiring surgical treatment were included. Exclusion criteria were cartilage injuries (Outerbridge grades 3-4), concomitant ligament injuries requiring surgery, osteochondritis dissecans, and prior knee surgery.</p><p><strong>Interventions: </strong>Patients underwent arthroscopic partial, subtotal, or total meniscectomy, with or without meniscus repair.</p><p><strong>Main outcome measures: </strong>Functional outcomes were assessed using Visual Analog Scale (VAS), International Knee Documentation Committee (IKDC), and Lysholm scores. Osteoarthritis progression was evaluated using the Kellgren-Lawrence classification. Return to sports time and total career duration were also recorded and compared between the surgical groups.</p><p><strong>Results: </strong>The mean follow-up was 13.5 ± 6.2 years (range: 5-27 years). At the final follow-up, 72% of the meniscus-preserving group (partial meniscectomy and repair) had KL grade 0 osteoarthritis, whereas 38% of the subtotal/total meniscectomy group developed KL grades 3 to 4 osteoarthritis ( P < 0.001). All groups showed significant postoperative functional improvements ( P < 0.001), but career duration and return to play time were significantly longer in the meniscus-preserving group ( P = 0.004, P < 0.001, respectively).</p><p><strong>Conclusions: </strong>Subtotal/total meniscectomy significantly accelerates osteoarthritis progression. Meniscus-preserving techniques provide better long-term outcomes.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":"261-266"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Squatting Biomechanics After Femoroacetabular Impingement Surgery: A Systematic Review and Meta-analysis.","authors":"Talissa O Generoso, Alexandre R M Pelegrinelli, Felipe F Gonzalez, Lucas V Pallone, Renato Locks, Eliane C Guadagnin, Jorge Chahla, Jonathan A Gustafson, Leonardo Metsavaht, Gustavo Leporace","doi":"10.1097/JSM.0000000000001371","DOIUrl":"10.1097/JSM.0000000000001371","url":null,"abstract":"<p><strong>Objective: </strong>Femoroacetabular impingement syndrome (FAIS) is a prevalent cause of hip pain, characterized by distinctive motion patterns. However, the impact of surgical intervention on squatting biomechanics remains underexplored. This review aims to evaluate the effects of surgical treatment on biomechanical outcomes during squatting in patients with FAIS.</p><p><strong>Data sources: </strong>A comprehensive search was conducted across multiple databases following PRISMA guidelines (Prospero registration number CRD42023473974). Data of longitudinal, prospective/retrospective cohorts, case-control, and clinical trial studies with 3-dimensional motion analysis describing kinematics and/or kinetics for any joint during squatting in patients with FAIS comparing presurgical to postsurgical biomechanical data on the same patients were included. Quality assessment was performed using MINORS criteria. Both qualitative and quantitative analyses were performed.</p><p><strong>Main results: </strong>Six studies met the inclusion criteria for qualitative review and 5 were suitable for meta-analysis. The overall quality of the studies was moderate based on MINORS criteria. The postsurgical motion analysis was performed between 6 and 32 months postoperatively. Although most studies reported no significant changes in kinematic or kinetic variables postsurgery, individual studies reported specific increases in squat depth, pelvic sagittal range of motion, anterior pelvic tilt, hip and knee flexion, and ankle dorsiflexion angles. Meta-analysis revealed no significant differences in the kinematic parameters analyzed.</p><p><strong>Conclusions: </strong>These findings underscore the multifaceted nature of FAIS, suggesting that bone deformities alone do not account for the biomechanical limitations observed during squatting in these patients. This highlights the need for further biomechanical investigations.</p><p><strong>Level of evidence: </strong>Systematic Review of Level II-III studies.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":"296-307"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exertional Heat Stroke at the Vermont City Marathon, 2012 to 2023: High Incidence Despite Spring Season in the Northern United States.","authors":"Aaron Brillhart, Katie Dolbec, Emily Speck, Peter Callas, Andrew Park, Sameer Sethi, Sarah Schlein","doi":"10.1097/JSM.0000000000001367","DOIUrl":"10.1097/JSM.0000000000001367","url":null,"abstract":"<p><strong>Objective: </strong>This study characterizes Vermont City Marathon (VCM) exertional heat stroke (EHS) cases to better understand current EHS trends in US marathon runners.</p><p><strong>Design: </strong>Retrospective review.</p><p><strong>Setting: </strong>VCM medical tent for 10 years: 2012 to 2019 and 2022 to 2023.</p><p><strong>Patients or participants: </strong>In total, 22 224 marathon runners, including 26 patients with EHS.</p><p><strong>Independent variables: </strong>Demographic, treatment, and environmental data.</p><p><strong>Main outcome measures: </strong>To characterize patients with EHS and incidence at VCM and compare with other marathons.</p><p><strong>Results: </strong>Of 22 224 marathon starters, 26 patients with EHS yielded an incidence of EHS of 12/10 000 (0.12%). Compared with all VCM marathon starters, patients with EHS were younger (mean 33 vs 39 years, P = 0.01), but sex did not differ (62% vs 54% male, P = 0.44). All patients with EHS were treated with cold water immersion (CWI) with 100% survival. Cooling rate during CWI was 0.17°C/min and CWI time averaged 16 minutes. Since protocol updates in 2016, only 23% of patients with EHS have required hospital transport. For every 1°C of increasing wet bulb globe temperature (WBGT), EHS incidence at VCM increased by 1.2 cases per 10 000 runners ( P = 0.04). Exertional heat stroke at VCM was more frequent than at the Boston Marathon (12 vs 3.7/10 000, P < 0.001), consistent with higher mean WBGT at VCM (20°C vs 14°C, P = 0.04).</p><p><strong>Conclusions: </strong>This study is the first to characterize patients with EHS at VCM and compare these data to other US marathons. A linear correlation was established between WBGT and EHS incidence. Despite the early season and northerly setting of VCM, EHS was prevalent and important for medical tent preparation. Appropriate EHS treatment was life-saving.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":"267-272"},"PeriodicalIF":1.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injuries.","authors":"Ryan C Kruse, Kyle J Biscoglia, Krit Petrachaianan","doi":"10.1097/JSM.0000000000001460","DOIUrl":"https://doi.org/10.1097/JSM.0000000000001460","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of platelet-poor plasma (PPP) for the treatment of acute quadriceps muscle strains.</p><p><strong>Design: </strong>Cohort study.</p><p><strong>Setting: </strong>Outpatient Sports Medicine Clinic.</p><p><strong>Participants: </strong>Consecutive patients from January 2021 to January 2023 with an acute quadriceps muscle injury were included.</p><p><strong>Interventions: </strong>Quadriceps muscle strain PPP injection.</p><p><strong>Main outcome measures: </strong>Number of days until return to full unrestricted participation in sport.</p><p><strong>Results: </strong>Thirty-seven consecutive patients were included. Twelve (32%) of patients were female. The rectus femoris muscle was most commonly involved (73%), followed by the vastus medialis (21.6%). In total, 48.7% of injuries were modified British Athletics Muscle Injury Classification grade 3b. On average, patients returned to full activity 30 days (±15) postinjury when including all injury grades. One recurrent quadriceps muscle injury was seen within 12 months postinjury.</p><p><strong>Conclusions: </strong>Platelet-poor plasma may be considered an effective treatment for acute quadriceps muscle injuries with a low injury recurrence rate, and may expedite time until return to activity.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Physical Therapy and Lumbar Muscle Atrophy in Adolescent Athletes With Spondylolysis.","authors":"Mitchell Selhorst, Emily A Sweeney, Breven Dalsemer, Jingzhen Yang, Anastasia Fischer","doi":"10.1097/JSM.0000000000001469","DOIUrl":"https://doi.org/10.1097/JSM.0000000000001469","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>Multicenter randomized controlled trial.</p><p><strong>Setting: </strong>Two pediatric hospitals in the United States.</p><p><strong>Patients: </strong>Fifty-three adolescent athletes (mean age 14.1 ± 1.5 years; 40% female) were randomized to immediate PT (n = 25) or rest before PT (n = 28).</p><p><strong>Interventions: </strong>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.</p><p><strong>Main outcome measures: </strong>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.</p><p><strong>Results: </strong>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 η2 = 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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Soccer Injuries Among Goalkeepers Presenting to US Emergency Departments: A 5-Year Descriptive Study.","authors":"Logan Lake, Esha Reddy, Paul McMillan, Isaac Hale, Brian Grawe","doi":"10.1097/JSM.0000000000001471","DOIUrl":"https://doi.org/10.1097/JSM.0000000000001471","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the epidemiology, diagnosis, and mechanisms of soccer-related injuries among goalkeepers and compare them with those sustained by field players, stratified by age and sex.</p><p><strong>Design: </strong>Descriptive epidemiological study.</p><p><strong>Setting: </strong>United States emergency departments reporting to the National Electronic Injury Surveillance System between January 2019 and December 2023.</p><p><strong>Patients or participants: </strong>All individuals who presented to US emergency departments with a soccer-related injury during the study period (n = 29 309 cases; national estimate 806 446). A subset of 562 cases were confirmed to have occurred while playing goalkeeper.</p><p><strong>Interventions or assessment of risk factors: </strong>Goalkeeper cases were identified through narrative key-term searches (\"goalkeeper,\" \"keeper,\" or \"goalie\"). Data were analyzed by age group, sex, diagnosis, body part injured, and mechanism of injury (MOI).</p><p><strong>Main outcome measures: </strong>National weighted injury estimates were used to assess differences in injury characteristics, diagnosis, and MOI between goalkeepers and field players, and across age groups and sex.</p><p><strong>Results: </strong>Goalkeepers were twice as likely as field players to be diagnosed with concussion (12.8% vs 6.4%). They sustained higher proportions of upper extremity injuries, particularly wrist and finger injuries. The mean goalkeeper age was 15.1 years, with most cases in adolescents aged 12 to 17 years (55%). School-aged children (6-11 years) were more likely to present after being struck by a soccer ball [odds ratios (OR) = 3.03] and to sustain fractures (OR = 2.21). Adolescents had increased odds of player-to-player collision injuries (OR = 2.26) and concussions (OR = 2.61). Young adults had greater odds of ground-related injuries (OR = 1.96) and joint dislocations (OR = 4.75). Men were more likely than women to be injured through collision with another player ( P = 0.015).</p><p><strong>Conclusions: </strong>There are distinct position- and age-specific patterns in soccer-related injuries presenting to US emergency departments. Goalkeepers face a disproportionate risk of upper extremity injuries and concussions, underscoring the importance of tailored injury-prevention strategies and greater awareness among coaches, trainers, and players.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Retirement From Sport After Concussion: A Survey of Perspectives and Experiences of Collegiate Physicians and Athletic Trainers.","authors":"William M Savage, Thomas S Bottiglieri, Cecilia Davis-Hayes, William N Levine, Natasha N Desai, James M Noble","doi":"10.1097/JSM.0000000000001451","DOIUrl":"https://doi.org/10.1097/JSM.0000000000001451","url":null,"abstract":"<p><strong>Objective: </strong>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).</p><p><strong>Design: </strong>An observational, 1-time questionnaire.</p><p><strong>Setting: </strong>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.</p><p><strong>Participants: </strong>Health professionals and staff supporting multiple Division I organized collegiate sports medicine programs.</p><p><strong>Assessment: </strong>Survey instrument.</p><p><strong>Main outcome measures: </strong>Measuring of attitudes, awareness, and gaps in SRC retirement care.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Summary statement: </strong>These findings identify gaps in knowledge and skills training around retirement discussions and provide opportunities for closing these gaps with targeted training.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survey Study of Canadian Orthopedic Surgeons on the Surgical Management of Anterior Cruciate Ligament Injury.","authors":"Emily Chan, Sheila McRae, Dan Ogborn, Brittany Bruinooge, Jarret Woodmass, Peter MacDonald","doi":"10.1097/JSM.0000000000001465","DOIUrl":"https://doi.org/10.1097/JSM.0000000000001465","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Design: </strong>Descriptive study.</p><p><strong>Setting: </strong>Data were collected at the Pan Am Clinic, a sports medicine clinic in Winnipeg, Canada.</p><p><strong>Participants: </strong>Active members of the Canadian Orthopaedic Association and Arthroscopic Association of Canada.</p><p><strong>Intervention: </strong>N/A.</p><p><strong>Main outcome measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of an Exertion Protocol on Cognitive and Functional Performance in Adolescents After Concussion.","authors":"Ashley L Erdman, Sophia Ulman, Alex M Loewen, Jara Chandler, Jacob C Jones, Henry B Ellis, Jane S Chung, C Munro Cullum, Shane M Miller","doi":"10.1097/JSM.0000000000001449","DOIUrl":"https://doi.org/10.1097/JSM.0000000000001449","url":null,"abstract":"<p><strong>Background: </strong>Over the last decade, prevalence of reported concussions has increased 60%, particularly in the adolescent population. Premature return-to-play is associated with prolonged recovery, worsening symptoms, and higher rates of subsequent musculoskeletal injury. Better understanding of the effects of physical exertion after concussion is needed to ensure safer return-to-play.</p><p><strong>Hypothesis: </strong>Cognitive performance would decline, and biomechanical deficits would become more apparent with increasing task difficulty in an exerted state.</p><p><strong>Study design: </strong>Cross-sectional.</p><p><strong>Level of evidence: </strong>Level 3.</p><p><strong>Methods: </strong>Adolescents diagnosed with concussion completed testing when cleared to begin return-to-play progression, which included simple (SG), dual-task (DT), and multi-task (MT) gait, completed before and after an exertion protocol. For SG, participants walked 10 meters. Dual-task required walking while reciting 3-digit numbers in reverse order, and MT involved typing a recited statement into a smart device while walking. Temporal parameters were calculated, and performance was recorded for DT and MT. Wilcoxon signed-rank tests were performed to compare variables of interest pre- and post-exertion (α = 0.05).</p><p><strong>Results: </strong>Thirty patients (20 female, age 14.4 ± 1.9 years) were tested within 2 weeks after clearance to begin return-to-play progression. Participants demonstrated decreased cadence and walking speed with SG post-exertion, whereas these increased during DT and MT. Multi-task performance improved from 77% pre-exertion to 90% post-exertion (P = 0.034), whereas DT performance did not significantly improve (P = 0.298). Variability of temporal parameters decreased for SG, whereas no differences in variability were observed for DT and MT.</p><p><strong>Conclusions: </strong>Significant cognitive and functional performance changes were observed after an exertion protocol in adolescent athletes recently cleared to begin the return-to-play progression. Predominantly, MT elicited improved performance and faster walking speed, with longer strides compared with pre-exertion. Minimal differences were observed in variability comparing pre-exertion with post-exertion gait tasks.</p><p><strong>Clinical relevance: </strong>Post-exertion testing may provide additional information in the determination of concussion recovery and return-to-play beyond what is measured clinically.</p>","PeriodicalId":10355,"journal":{"name":"Clinical Journal of Sport Medicine","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}