Developmental Training Model for the Sport Specialized Youth Athlete: A Dynamic Strategy for Individualizing Load-Response During Maturation

2021 ◽  
pp. 194173812110560
Author(s):  
Neeru Jayanthi ◽  
Stacey Schley ◽  
Sean P. Cumming ◽  
Gregory D. Myer ◽  
Heather Saffel ◽  
...  

Context: Most available data on athletic development training models focus on adult or professional athletes, where increasing workload capacity and performance is a primary goal. Development pathways in youth athletes generally emphasize multisport participation rather than sport specialization to optimize motor skill acquisition and to minimize injury risk. Other models emphasize the need for accumulation of sport- and skill-specific hours to develop elite-level status. Despite recommendations against sport specialization, many youth athletes still specialize and need guidance on training and competition. Medical and sport professionals also recommend progressive, gradual increases in workloads to enhance resilience to the demands of high-level competition. There is no accepted model of risk stratification and return to play for training a specialized youth athlete through periods of injury and maturation. In this review, we present individualized training models for specialized youth athletes that (1) prioritize performance for healthy, resilient youth athletes and (2) are adaptable through vulnerable maturational periods and injury. Evidence Acquisition: Nonsystematic review with critical appraisal of existing literature. Study Design: Clinical review. Level of Evidence: Level 4. Results: A number of factors must be considered when developing training programs for young athletes: (1) the effect of sport specialization on athlete development and injury, (2) biological maturation, (3) motor and coordination deficits in specialized youth athletes, and (4) workload progressions and response to load. Conclusion: Load-sensitive athletes with multiple risk factors may need medical evaluation, frequent monitoring, and a program designed to restore local tissue and sport-specific capacity. Load-naive athletes, who are often skeletally immature, will likely benefit from serial monitoring and should train and compete with caution, while load-tolerant athletes may only need occasional monitoring and progress to optimum loads. Strength of Recommendation Taxonomy (SORT): B.

2017 ◽  
Vol 10 (2) ◽  
pp. 160-168 ◽  
Author(s):  
Lindsay J. DiStefano ◽  
Eleanor M. Beltz ◽  
Hayley J. Root ◽  
Jessica C. Martinez ◽  
Andrew Houghton ◽  
...  

Background: Sport sampling is recommended to promote fundamental movement skill acquisition and physical activity. In contrast, sport specialization is associated with musculoskeletal injury risk, burnout, and attrition from sport. There is limited evidence to support the influence of sport sampling on neuromuscular control, which is associated with injury risk, in youth athletes. Hypothesis: Athletes who participated in only 1 sport during the previous year would demonstrate higher Landing Error Scoring System (LESS) scores than their counterparts. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 355 youth athletes (age range, 8-14 years) completed a test session with a jump-landing task, which was evaluated using the LESS. Participants were categorized as single sport (SS) or multisport (MS) based on their self-reported sport participation in the past year. Their duration of sport sampling (low, moderate, high) was determined based on their sport participation history. Participants were dichotomized into good (LESS <5) or poor (LESS ≥5) categories. Chi-square tests were performed to evaluate for the association between control category (good, poor) and participation (MS, SS), as well as sport-sampling duration (low, moderate, high). Results: The MS group was 2.5 times (95% CI, 1.9-3.1) as likely to be categorized as having good control compared with the SS group (χ2(355) = 10.10, P < 0.01). Recreational participants in the “high” sport-sampling duration group were 5.8 times (95% CI, 3.1-8.5) and 5.4 times (95% CI, 4.0-6.8) as likely to be categorized as having good control compared with the moderate and low groups (χ2(216) = 11.20, P < 0.01). Conclusion: Sport sampling at a young age is associated with improved neuromuscular control, which may reduce injury risk in youth athletes. Clinical Relevance: Youth athletes should be encouraged to try participating in multiple sports to enhance their neuromuscular control and promote long-term physical activity.


2019 ◽  
Vol 12 (1) ◽  
pp. 12-22 ◽  
Author(s):  
Colleen Hanlon ◽  
Joseph J. Krzak ◽  
Janey Prodoehl ◽  
Kathy D. Hall

Background: Understanding how existing youth injury prevention programs affect specific modifiable injury risk factors will inform future program development for youth athletes. Objective: To comprehensively evaluate the effects of injury prevention programs on the modifiable intrinsic risk factors associated with lower extremity performance in youth athletes. Data Sources: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, EBSCOhost [including CINAHL, Medline, and SPORTDiscus], and PEDro). Secondary references were appraised for relevant articles. Article types included randomized or cluster randomized controlled trials and randomized cohort designs with youth athletes engaged in organized sports, along with outcomes that included at least 1 physical performance outcome measure. Study Selection: Eight studies met inclusion and exclusion criteria and were reviewed by 2 independent reviewers, with a third consulted in the case of disagreement, which was not needed. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Included studies underwent review of methodological quality using the Physiotherapy Evidence Database scale. Results: Studies included mixed-sex samples of youth athletes who predominantly participated in soccer at different skill levels. The FIFA 11+ series was the most commonly used injury prevention program. Among studies, the mean percentage of improvement identified was 11.3% for force generation, 5.7% for coordination, 5.2% for posture, and 5.2% for balance. The lowest mean percentage improvement was in speed (2.2%). Endurance was not significantly affected by any of the programs. Conclusion: This systematic review shows that injury prevention programs improve several modifiable intrinsic risk factors of lower extremity performance among youth athletes, particularly force generation. However, several intrinsic risk factors were either not significantly affected or specifically addressed by existing programs.


2021 ◽  
pp. 194173812199409
Author(s):  
CPT Connor B. Venrick ◽  
Story F. Miraldi ◽  
Lindsay J. DiStefano ◽  
Karen Y. Peck ◽  
LTC Matthew A. Posner ◽  
...  

Background: Sport specialization in youth athletes is associated with increased risk for musculoskeletal injury; however, little is known about whether sport specialization is associated with lower extremity movement quality. The purpose of this study was to examine differences in lower extremity movement quality by level of sport specialization in US Service Academy cadets. Hypothesis: Cadets who report an increased level of sport specialization would have a lower level of movement quality than those who are less specialized. Study Design: Cross-sectional analysis from an ongoing prospective cohort study. Level of Evidence: Level 3. Methods: Cadets completed the Landing Error Scoring System (LESS) and a baseline questionnaire evaluating level of sport specialization during high school. Data were analyzed using separate 1-way analysis of variance models. Results: Among all participants (n = 1950), 1045 (53.6%) reported low sport specialization, 600 (30.8%) reported moderate sport specialization, and 305 (15.6%) reported high sport specialization at the time of data collection during the first week. Ages ranged from 17 to 23 years. Men (1491) and women (459) reported comparable specialization levels ( P = 0.45). There were no statistically significant differences in lower extremity movement quality by level of specialization for all subjects combined ( P = 0.15) or when only men were included in the analyses ( P = 0.69). However, there were statistically significant differences in movement quality by level of specialization in women ( P = 0.02). Moderately specialized women had the best movement quality (mean, 4.63; SD, 2.21) followed by those with high specialization (mean, 4.90; SD, 2.08) and those with low levels of specialization (mean, 5.23; SD, 2.07). Conclusion: Women reporting moderate sport specialization had improved movement quality and significantly better LESS scores compared to those with high/low specialization. Clinical Relevance: Athletes, especially women, should be encouraged to avoid early sport specialization to optimize movement quality, which may affect injury risk.


2012 ◽  
Vol 40 (11) ◽  
pp. 2517-2522 ◽  
Author(s):  
Robert H. Brophy ◽  
Leah Schmitz ◽  
Rick W. Wright ◽  
Warren R. Dunn ◽  
Richard D. Parker ◽  
...  

Background: There is limited information on outcomes and return to play (RTP) after anterior cruciate ligament reconstruction (ACLR) in soccer athletes. Purpose: The purpose of this study was to (1) test the hypotheses that player sex, side of injury, and graft choice do not influence RTP and (2) define the risk for future ACL injury in soccer players after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: Soccer players in a prospective cohort were contacted to determine RTP after ACLR. Information regarding if and when they returned to play, their current playing status, the primary reason they stopped playing soccer (if relevant), and incidence of subsequent ACL surgery was recorded. Results: Initially, 72% of 100 soccer athletes (55 male, 45 female) with a mean age of 24.2 years at the time of ACLR returned to soccer. At average follow-up of 7.0 years, 36% were still playing, a significant decrease compared with initial RTP ( P < .0001). Based on multivariate analysis, older athletes ( P = .006) and females ( P = .037) were less likely to return to play. Twelve soccer athletes had undergone further ACL surgery, including 9 on the contralateral knee and 3 on the ipsilateral knee. In a univariate analysis, females were more likely to have future ACL surgery (20% vs 5.5%, P = .03). Soccer athletes who underwent ACLR on their nondominant limb had a higher future rate of contralateral ACLR (16%) than soccer athletes who underwent ACLR on their dominant limb (3.5%) ( P = .03). Conclusion: Younger and male soccer players are more likely to return to play after ACL reconstruction. Return to soccer after ACLR declines over time. ACLR on the nondominant limb potentially places the dominant limb at risk for future ACL injury.


2021 ◽  
Vol 23 (2) ◽  
pp. 128-133
Author(s):  
M.J. Encarnacion Ramirez

Introduction. Neurosurgery trainees are finding it increasingly difficult to obtain operative experience as the main surgeon in aneurysm procedure. Good quality cadaver dissection opportunities are also not widely available for neurosurgery residents. Simulation is emerging as a useful training aid for neurosurgery. Surgical treatment of cerebral aneurysms requires specialized skills development and proficient use of microsurgical instruments. Furthermore, any advance in neurosurgical training methods is of potential value to both neurosurgeons and patients.The study objective is to introduce a 3D aneurysm clipping training model to enhance skill acquisition and development.Materials and methods. The brain model is made using a 3D printed resin mold. The mold is filled with silicone Ecoflex 00–10 and mix with Silc Pig pigment additives to replicate the color and consistency of brain tissue. Dura is made from quick drying silicone paste with grey dye. The blood vessels are made from a silicone 3D printed mold of a magnetic resonance angiography. Liquid with paprika oleoresin (E160c) dye is used to simulate blood and is pumped through the vessels to simulate pulsatile motion.Results and conclusion. These models offer an alternative method to train residents and preoperative planning. They are affordable and easy to recreate and hence can standardize training in multiple centers. With advancing technology, 3D technology is becoming an import part of medical education.


2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098207
Author(s):  
Sachin Allahabadi ◽  
Favian Su ◽  
Drew A. Lansdown

Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.


2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0017
Author(s):  
Sophia M. Ulman ◽  
Laura Saleem ◽  
Kirsten Tulchin-Francis

Background: The Functional Movement Screen (FMS) is a tool designed to establish a baseline for fundamental movement capacity, highlight limitations and limb asymmetries, and identify potential injury risk. Previous research has shown that individual components of the screen are also indicative of injury risk, as well as potential predictors of athletic performance unlike the FMS composite scores. However, this literature is limited and lacks statistical power. Identifying which component scores are predictive of injury risk and athletic performance would provide a quick, powerful tool for coaches and trainers to evaluate athletes. Purpose: To determine if individual component scores of the FMS are associated with athletic performance in highly-active youth athletes. Methods: Youth athletes participated in the Specialized Athlete Functional Evaluation (SAFE) Program. Data collection was extensive, however, for the purpose of this abstract, only a selection of data was analyzed – age, BMI, years played, total number of past injuries, isokinetic knee strength, 10- and 20-meter sprint, single-leg hop (SLH) distance, and FMS scores. Seated knee flexion/extension strength was collected at 120°/second using a Biodex System 4, and peak torque was normalized by body weight. The maximum distance of three SLHs was recorded for each leg and normalized to leg length. FMS scores used for analysis included the total composite and component scores, including the deep squat, hurdle step, in-line lunge, shoulder mobility, active straight-leg raise, trunk stability push-up, and rotary stability. Wilcoxon Signed Ranks Tests were used to determine side-to-side differences, and Kruskal-Wallis tests were performed to determine differences in athletic performance based on FMS scores ( α<0.05). Results: A total of 38 highly-active, youth athletes (26F; 15.4±2.6 years; BMI 21.0±5.3) were tested. Participants reported playing organized sports for 8.7±3.4 years, having 2.0±1.2 past sports-related injuries, and 74% reported specializing in a single sport. No side-to-side differences were found. While the composite FMS score significantly differed by number of past injuries ( p=0.036), it was not associated with athletic performance. Alternatively, left knee strength, sprint speeds, and right hop distance significantly differed by the hurdle step component score (Table 1). Conclusion: While the composite FMS score was not an indicator of athletic performance, the hurdle step component score was associated with strength, speed, and jump performance. This individual task could be a beneficial tool for coaches and trainers when evaluating athletic ability and injury risk of athletes. Tables/Figures: [Table: see text]


2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096853
Author(s):  
Braden McKnight ◽  
Nathanael D. Heckmann ◽  
Xiao T. Chen ◽  
Kevork Hindoyan ◽  
J. Ryan Hill ◽  
...  

Background: Ulnar collateral ligament (UCL) reconstruction is frequently performed on Major League Baseball (MLB) pitchers. Previous studies have investigated the effects of UCL reconstruction on fastball and curveball velocity, but no study to date has evaluated its effect on fastball accuracy or curveball movement among MLB pitchers. Purpose/Hypothesis: The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A repeated-measures analysis of variance with a Tukey-Kramer post hoc test was used to determine statistically significant changes in performance over time. Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Results: We identified 56 pitchers with a total of 230,995 individual pitches for this study. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. The mean presurgery fastball pitch-to-target distance was 32.9 cm. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). The mean presurgery curveball movement of 34.49 cm vertically and 5.89 cm horizontally also did not change significantly ( P = .937 and .161, respectively). Conclusion: Fastball accuracy among MLB pitchers significantly decreased after UCL reconstruction for up to 3 years postoperatively. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers.


2020 ◽  
Vol 35 (1) ◽  
pp. 28-34
Author(s):  
Shaw Bronner ◽  
Ivetta Lassey ◽  
Jessie R Lesar ◽  
Zachary G Shaver ◽  
Catherine Turner

OBJECTIVES: To investigate intra- and inter-rater reliability of a ballet-based Dance Technique Screening Instrument used by physical therapists (PTs) and student PTs (SPTs) with prior dance medicine or dance experience. METHODS: Ten pre-professional dancers were video-recorded in the sagittal and frontal planes while performing four dance sequences: 1) second position grand plié; 2) développé à la seconde; 3) single-limb passé relevé balance; and 4) jumps in first position. Dance videos and electronic versions of the demographics and scoring forms were provided through a secure online survey to 28 PTs and SPTs who served as raters. Raters reviewed a training video prior to scoring the 10 dancers. Raters were asked to repeat their assessments 1–2 wks later. Intraclass correlations (ICC) were assessed for all-raters, PTs, and SPTs for total and sequence scores. RESULTS: Twenty-eight raters assessed the videos one time. Inter-rater reliability was ICC=0.98 (CI95=0.96–0.99) (all-raters), with PTs and SPTs displaying similar values (ICC=0.96 and 0.96, respectively). Eighteen raters (11 PTs, 7 SPTs) repeated the video analysis. Intra-rater reliability was ICC=0.78 (CI95=0.72–0.83) with PTs ICC=0.81 and SPTs ICC=0.70. CONCLUSIONS: Correlations were high for all-raters. SPTs were as reliable as PTs in inter-rater comparisons. PTs exhibited higher intra-rater reliability compared to SPTs. These results substantiate the reliability of a standardized testing instrument to conduct dance technique assessment. Validity of this instrument was demonstrated in a previous study which found dancers with better technique were less likely to sustain injury. The ability to identify technique deficits can guide preventative programs that may reduce injury risk. LEVEL OF EVIDENCE: Level III.


2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.


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