Performance Nutrition for the Adolescent Athlete: A Realistic Approach No abstract available

A Preliminary Study of the Effect of Early Aerobic Exercise Treatment for Sport-Related Concussion in Males Objective: To study the effect of early prescribed aerobic exercise versus relative rest on rate of recovery in male adolescents acutely after sport-related concussion (SRC). Design: Quasi-experimental design. Setting: University sports medicine centers. Participants: Exercise group (EG, n = 24, 15.13 ± 1.4 years, 4.75 ± 2.5 days from injury) and rest group (RG, n = 30, 15.33 ± 1.4 years, 4.50 ± 2.1 days from injury). Interventions: Exercise group performed a progressive program of at least 20 minutes of daily subthreshold aerobic exercise. Rest group was prescribed relative rest (no structured exercise). Both groups completed daily online symptom reports (Postconcussion Symptom Scale) for 14 days. Main Outcome Measures: Days to recovery after treatment prescription. Recovery was defined as return to baseline symptoms, exercise tolerant, and judged recovered by physician examination. Results: Recovery time from initial visit was significantly shorter in EG (8.29 ± 3.9 days vs 23.93 ± 41.7 days, P = 0.048). Mixed-effects linear models showed that all symptom clusters decreased with time and that there was no significant interaction between treatment group and time. No EG participants experienced delayed recovery (>30 days), whereas 13% (4/30) of RG participants experienced delayed recovery. Conclusions: These preliminary data suggest that early subthreshold aerobic exercise prescribed to symptomatic adolescent males within 1 week of SRC hastens recovery and has the potential to prevent delayed recovery.

Factors Affecting Recovery Trajectories in Pediatric Female Concussion Objective: Up to one-third of children with concussion have persistent postconcussion symptoms lasting beyond 4 weeks. Females have been shown to have prolonged concussion recovery compared with males. This study examined characteristics in pediatric athletes with concussion to investigate the underlying factors that may contribute to this difference and their relation to recovery trajectories in females compared with males. Design: A retrospective cohort study of pediatric patients with sports-related concussion (SRC). Setting: A subspecialty pediatric concussion program. Subjects: One hundred ninety-two records were reviewed, 75 females and 117 males, ages 7 to 18 years old. Assessment of Risk Factors: Sex of patient, time to presentation to specialty care after injury, presence of vision, and vestibular deficits on initial clinical examination. Main Outcome Measures: The main outcome of interest was time to clinical recovery, defined by resolution of symptoms, recovery of physical examination deficits, including vision and vestibular examination, recovery of neurocognitive function, and return to school, exercise, and sport. Results: Pediatric females, on average, presented later to specialty care for evaluation after SRC than males. Females also took longer to recover on 5 markers of recovery: time to return to school without accommodations, time to return to noncontact exercise, time to return to full sport, time to recovery of neurocognitive function on computerized testing, and time to clinical recovery of vision and vestibular deficits on examination including smooth pursuits, saccades, gaze stability, near point of convergence, and balance. These sex-based differences in recovery disappeared when controlling for time to presentation to specialty care. Conclusions: In this cohort of pediatric patients, ages 7 to 18 years old with SRC, females took longer to recover than males. Our results indicate, however, that a modifiable extrinsic factor, time to presentation to specialty care, may contribute to this difference in recovery between the sexes.

Sports Specialization Is Not Associated With Greater Odds of Previous Injury in Elite Male Youth Soccer Players Objective: To determine the relationship between sport specialization and previous injury in elite male youth soccer players. Design: Retrospective survey. Setting: U.S. Soccer Development Academy. Participants: Male youth soccer players (N = 2123). Assessment of Risk Factors: Sport specialization, weekly training volume, training ratio, and age. Main Outcome Measures: Previous sports-related injury, injury type (traumatic vs overuse), injury severity, and injury location. Results: Of 2099 participants (average age 13.2 ± 1.8 years), 61.7% were specialized in soccer (played soccer >8 mo/yr and no other sports) and 38.3% were nonspecialized (played soccer >8 mo/yr and also played other organized sports). Specialized athletes were older than nonspecialized athletes (13.7 ± 1.9 vs 12.5 ± 1.4, P < 0.0001). Thirty-three percent (690/2099) of athletes reported at least one previous sports-related injury for a total of 765 traumatic injuries and 25 overuse injuries. Distribution of injury type was similar for specialized and nonspecialized athletes. Among athletes with overuse injuries, nonspecialized athletes were more likely to report upper-extremity and trunk overuse injuries than specialized athletes. After accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury compared with nonspecialized athletes [odds ratio (OR), 0.78; 95% confidence interval (CI), 0.64-0.95], and similar odds of reporting a previous lower-extremity (LE) overuse injury as nonspecialized athletes (OR, 0.70; 95% CI, 0.56-1.1). However, specialized athletes missed more practices due to injury than nonspecialized players [median = 3, interquartile range (IQR) 2-4 vs median = 2, IQR 2-4, P = 0.0003]. Conclusions: In this national sample of elite, male youth soccer players, after accounting for age and weekly training volume, specialized athletes had decreased odds of reporting any previous injury and similar odds of reporting a previous LE overuse injury as nonspecialized athletes. These data suggest the need for further research to determine whether injury risk related to sports specialization depends on sex, chosen sport, and skill/competitive level.

Performance Times for the King-Devick Test in Children and Adolescents Objective: To establish the King-Devick test (KD) performance values for children and adolescents. Design: Prospective cohort. Setting: Pediatric sports medicine clinics. Participants: Five hundred seven athletes presenting to a pediatric sports medicine clinic for non–concussion-related evaluations. Independent Variables: Age, sex, and risk factors for abnormal concussion recovery. Main Outcome Measures: The King-Devick test time. Results: Four hundred eighty-three participants were included in the final analysis, which included 60.5% girls (n = 292) and 39.5% boys (n = 191). The KD test performance varied by age with a steady decrease in test time yearly from 8 years through 14 years of age, where some plateauing occurred. Baseline scores changed approximately 31 seconds over ages 8 to 18. Analysis of variance results revealed a strong effect of age on overall mean KD time (P < 0.001). The KD test performance was not associated with sex or other studied concussion risk factors or comorbid conditions. Conclusions: The KD test performance was reported in a cohort of youth aged 8 to 18 years, allowing for comparison of performance in individuals who may not have a baseline assessment. If baseline testing is desired, at least yearly intervals seems to be appropriate through childhood and early adolescence.

Association Between Flexibility and Low Back Pain in Female Adolescent Gymnasts Objective: To determine the relationship between low back pain (LBP), flexibility, and individual demographic characteristics in competitive adolescent female gymnasts. Design: Cross-sectional observational study. Setting: Gymnastics facilities in Colorado. Participants: Six- to 18-year-old gymnasts who participate in the USA Gymnastics Women's Artistic Junior Olympic Program levels 3 to 10. Independent Variables: Demographic data included height, weight, menstrual status, gymnastics level, and participation hours per week. Flexibility measurements were obtained on the gymnasts. Gymnasts also completed a questionnaire documenting LBP in the past 12 months. Univariable (t test and χ2) analyses were used to assess between-group differences; multivariable logistic regression model was used to assess the association between LBP, flexibility, and demographics/injury history. Main Outcome Measures: Low back pain within the past 12 months. Results: Thirty (45%) of 67 gymnasts reported LBP within the past year. Those who reported LBP were older (11.7 vs 13.7 years, P = 0.005), heavier (37.5 vs 43.4 kg, P = 0.049), and participated in gymnastics more often (19.1 vs 22.4 h/wk, P = 0.017). A greater proportion of gymnasts with LBP had experienced menarche compared with those without LBP (47% vs 16%; P = 0.008). On multivariable analysis, gymnasts with LBP were less likely to have left Iliotibial (IT) band tightness compared with those without LBP [adjusted odds ratio (aOR) = 0.186; 95% confidence interval (CI), 0.04-0.82] and more likely to have experienced menarche (aOR = 8.0; 95% CI, 1.2-50.9). Conclusions: Low back pain is more common in gymnasts who experienced menarche, whereas limited joint flexibility does not seem to be associated with LBP in this population.

Relationships Between Sport Specialization, Sleep, and Subjective Well-Being in Female Adolescent Athletes Objective: To evaluate the relationship between sport specialization, sleep, and subjective well-being in female youth soccer players. Design: Prospective cohort study. Setting: Community soccer organization. Methods: During a 4-month season, 52 female youth soccer players (aged 13-18 years) reported daily training load (TL) and every morning recorded sleep duration and stress, mood, fatigue, soreness, and sleep quality from −3 (worst) to +3 (best). As all the athletes participate in soccer as their primary sport for over 8 months of the year, players were considered specialized if they participated in soccer exclusively and had previously quit another sport to focus on soccer. Least-square mean values from linear mixed effects models were used to compare TL, subjective well-being, and sleep while adjusting for individual repeated measures. Results: Daily TL during the season did not differ between specialized and nonspecialized athletes (412 ± 24 vs 415 ± 19 arbitrary units, P = 0.96, respectively). Despite similar nightly sleep duration (8.10 ± 0.14 vs 8.25 ± 0.11 hours, P = 0.42), specialized athletes were found to have lower (worse) fatigue (1.02 ± 0.14 vs 1.50 ± 0.11, P = 0.010), soreness (0.66 ± 0.18 vs 1.23 ± 0.14, P = 0.013), mood (1.32 ± 0.12 vs 1.72 ± 0.10, P = 0.013), and sleep quality (1.07 ± 0.13 vs 1.42 ± 0.10, P = 0.035) than the nonspecialized group. Although stress was lower (worse) among the specialized athletes, the difference was not statistically significant (0.97 ± 0.16 vs 1.32 ± 0.13, P = 0.092). Conclusions: Among female youth soccer players, sport specialization was associated with impairments in subjective well-being and sleep quality. Additional research is necessary to determine whether this relationship is causal or if factors that influence sport specialization also influence sleep and subjective well-being.

Concussion Symptom Profiles Among Child, Adolescent, and Young Adult Athletes Objectives: (1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptom profiles are associated with duration of postconcussion symptoms, and whether they vary by age group. Design: A total of 689 patients (20% children 7-12 years of age, 69% adolescents 13-18 years of age, and 11% young adults 19-30 years of age) were seen and diagnosed with a concussion within 21 days after injury. Patients completed the Post-Concussion Symptom Scale (PCSS) and were followed until they no longer required care. Setting: Two specialty care sport concussion clinical practices. Main outcome measures: Overall PCSS score was obtained, as well as severity ratings from somatic, vestibular–ocular, cognitive, sleep, and emotional symptom domains. We also calculated total symptom duration time. Results: No significant main effect of age, or age by sex associations were identified among the symptom domains. Females endorsed a higher somatic symptom severity rating than males (9.8 ± 6.7 vs 8.1 ± 6.7; P = 0.03). For patients between 7 and 12 years of age, higher somatic [β-coefficient = 1.57, 95% confidence interval (CI), 1.47-1.67] and cognitive (β-coefficient = 2.50, 95% CI, 2.32-2.68) symptom severities were associated with longer duration of concussion symptoms. Among adolescents, longer total symptom duration was associated with more severe somatic (β-coefficient = 1.25, 95% CI, 0.34-2.15) and vestibular–ocular (β-coefficient = 2.36, 95% CI, 1.49-3.23) symptoms. Conclusions: Within 21 days after concussion, symptom-reporting behavior seems to be similar across the age spectrum, but the relationship between symptom profiles and time to symptom resolution varies by age. Although overall symptom ratings are beneficial in determining clinical pathways, symptom domain use may provide a beneficial method to determine individualized patient care that differs between children and adolescents after concussion.

Implementation of Safety Standards for Youth Sports Leagues: The “Safe Stars” Example in Tennessee Objective: Discuss the implementation of the nation's first statewide standardized youth sports safety program and review the current culture and status of youth sports which led to its development. Design: Descriptive. Setting: State of Tennessee. Interventions: The “Safe Stars” Initiative. Main Outcome Measures: Provide a summary of the process of devising, developing, and deploying a set of evidence-based and best practice criteria to improve the health, safety, and well-being of youth athletes. Conclusions: Safe Stars provides a structured opportunity for every child to play sports and develop successful habits and skills for life while safely doing so. We intend for this to serve as a roadmap for others to adopt and institute a statewide philosophy that emphasizes the importance of a safe, positive, and high-quality experience for children while holding their respective youth sports communities accountable for its achievement. Currently, very few leagues meet the recommended minimum standards of safety. Continued advancement of strategic partnerships as well as research into the program's impact on sports participation, health, and safety will be some of the critical next steps in realizing the full value of this program.

Clinical and Biomechanical Evaluation of the Softball Pitcher: A Review of Current Concepts and Clinical Commentary Background: The windmill softball pitch (WSP) is a vastly understudied human motion relative to its counterpart the overhand baseball pitch (OBP). A large body of research has been conducted to understand the kinematics and kinetics of the OBP. Better understanding of the kinematics and kinetics of the WSP may help provide better pitch volume guidelines, physical performance preparation, and injury prevention programs. Evidence Acquisition: A comprehensive review of the literature was performed to gain a full understanding of all currently available biomechanical and clinical evidence surrounding the WSP and related softball injuries. Study Design: Clinical Review. Level of Evidence: Level 5. Results: The softball pitch is a highly complex series of coordinated movements, in which the force generated by the large muscles of the lower extremity and trunk during the wind-up and stride phases are transferred to the ball through the shoulder and arm. Biomechanical evidence has demonstrated relatively equivocal distraction forces at the shoulder for both the softball pitch and baseball pitch. Conclusions: Altered pitching biomechanics, high pitch velocity, elevated pitch counts, decreased rest between outings, and increased pitcher fatigue may increase tissue stress on the upper extremity of a softball pitcher. There is convincing evidence that each of these variables have a compounding effect on injury risk for a softball pitcher. Therefore, coaches and clinicians need more research to promote upper extremity health in the softball pitcher at all levels of competition including pitch volume guidelines and injury prevention strategies.