Anxiety and Depression during COVID-19 in Elite Rugby Players: The Role of Mindfulness Skills

The COVID-19 pandemic created stressors that raised the likelihood of elite athletes experiencing mental health problems. Understanding how individual traits promote resilience is key to offering treatments specific to this population. This prospective study explores the relationship between mindfulness skills, resilience, and athletic identity on anxiety and depression. The initial assessment was during the first UK lockdown April–May 2020 (T1), and the second during the return to competition July-August 2020 (T2). The sample was 160 elite rugby players. Measures included: Personal Health Questionnaire-9, General Anxiety Disorder-7, Cognitive Affective Mindfulness Scale, Connor-Davidson Resilience Scale, and Athletic Identity Measurement. The prevalence of anxiety and depression was profiled with descriptive statistics, and relationships between variables with bi-variate correlations and forward stepwise regression modelling. Depression decreased significantly between lock down (T1) and return to competition (T2) (MT1 = 4.20, MT2 = 3.24, p < 0.01), with no significant change in anxiety. Significant correlations were found between mindfulness, resilience, and anxiety and depression (≤0.001). Regression showed that mindfulness (T1) predicted lower anxiety and depression during the return to competition (T2) after controlling for baseline mental health symptoms. Returning to competition after lockdown was associated with a reduction in depression but not anxiety. Mindfulness skills potentially confer protection against anxiety and depression.

The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery?

Background: The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented. Purpose: To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level. Study Design: Case series; Level of evidence, 4. Methods: Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%). Results: After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%. Conclusion: Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics.

SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players

Background There is increasing evidence of cardiac involvement in SARS-COV-2 infections. This may not only apply to symptomatic infections but may also affect asymptomatic athletes. This study aimed to characterize the possible acute cardiac involvement of SARS-COV-2 infection in athletes both morphologically and functionally. Methods and results Eight elite handball players (27±3.5 y) with past SARS-COV-2 infection were retrospectively analyzed and compared with four uninfected team-mates (22±2.6 y). Athletes were examined 19±7 d after positive PCR-test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed after SARS-CoV2 infection (−17.7% vs. −18.1%) but magnetic resonance imaging showed minor signs of acute inflammation/edema in all patients (T2-mapping: +4.1ms) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (−292 ml/min, −7.0%), oxygen-pulse (−2.4 ml/beat, −10.4%), and respiratory minute volume (VE) (−18.9 l/min, −13.8%) in athletes with a history of SARS-CoV2 infection (p&lt;0.05, respectively). The parameters were unchanged in the control group. Conclusion SARS-CoV2 infection caused functional impairment of cardiopulmonary performance primarily under stress in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection at least with spiroergometry to mark performance limitations and to ensure an optimal return to competition. FUNDunding Acknowledgement Type of funding sources: None.

SARS-CoV2 infection: functional and morphological cardiopulmonary changes in elite handball players

There is increasing evidence of cardiac involvement post-SARS-CoV-2 infections in symptomatic as well as in oligo- and asymptomatic athletes. This study aimed to characterize the possible early effects of SARS-CoV-2 infections on myocardial morphology and cardiopulmonary function in athletes. Eight male elite handball players (27 ± 3.5 y) with past SARS-CoV-2 infection were compared with four uninfected teammates (22 ± 2.6 y). Infected athletes were examined 19 ± 7 days after the first positive PCR test. Echocardiographic assessment of the global longitudinal strain under resting conditions was not significantly changed (− 17.7% vs. − 18.1%). However, magnetic resonance imaging showed minor signs of acute inflammation/oedema in all infected athletes (T2-mapping: + 4.1 ms, p = 0.034) without reaching the Lake-Louis criteria. Spiroergometric analysis showed a significant reduction in VO2max (− 292 ml/min, − 7.0%), oxygen pulse (− 2.4 ml/beat, − 10.4%), and respiratory minute volume (VE) (− 18.9 l/min, − 13.8%) in athletes with a history of SARS-CoV2 infection (p < 0.05, respectively). The parameters were unchanged in the uninfected teammates. SARS-CoV2 infection caused impairment of cardiopulmonary performance during physical effort in elite athletes. It seems reasonable to screen athletes after SARS-CoV2 infection with spiroergometry to identify performance limitations and to guide the return to competition.

Return-to-Competition Criteria After Ulnar Collateral Ligament Reconstruction: A Systematic Review and Meta-analysis

Background: Injury to the ulnar collateral ligament of the elbow is common among overhead throwing athletes and can result in significant functional limitations. While surgical reconstruction offers high rates of return to competition, there are no validated or universally accepted guidelines for determining when an athlete can safely resume play. Purpose: To assess the existing scientific literature for return-to-competition criteria utilized after ulnar collateral ligament reconstruction. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: The PubMed database was searched for clinical investigations of ulnar collateral ligament reconstruction in overhead throwing athletes published between January 2000 and June 2020. Only studies that had a minimum follow-up of 1 year and included at least 1 specific return-to-competition criterion were considered. Results: A total of 15 studies were included in the final analysis, encompassing 1156 patients with an average age of 20.7 years (SD, 2.0 years). Baseball players composed 96.3% of patients for whom sport was specified, and 92.4% of baseball players were pitchers. The most common return-to-competition criterion, identified in 87% of studies, was completion of a return-to-throwing program, which started on average 16.7 weeks (range, 12-18 weeks) after surgery. A return-to-mound program was utilized in 53% of studies, starting on average 7.4 months (range, 6-9 months) postoperatively. Minimum time from surgery was used in 73% studies, with players waiting 7 to 12 months (mean, 9.7; SD, 1.4 months) after surgery before return-to-competition consideration. The overall rate of return to competition at the preinjury level or higher was 85.7% (SD, 8.5%) at an average of 12.2 months (SD, 0.6 months). Conclusion: In general, we observed a paucity of literature describing the return-to-competition process after ulnar collateral ligament reconstruction in overhead throwing athletes. Only 3 explicit return-to-competition criteria were identified across all studies: completion of a return-to-throwing program, completion of a return-to-mound program for pitchers, and minimum time from surgery. Increased transparency regarding postoperative rehabilitation protocols and further research are necessary to identify and validate sport-specific return-to-competition criteria, which will ultimately help athletes return to play in a safe and timely fashion after ulnar collateral ligament reconstruction.

Development of a modified cross-over hop test to reduce measurement errors in return-to-competition testing

Context Hop tests play an important role in the rehabilitation process after injuries. A comparison of the jumping distances of both extremities allows for an evaluation of the injured limb. In the conventional cross-over hop test for distance, the jump width (medial vs. lateral) that the athlete has to cross during the jump is not standardised and therefore highly variable. This affects the absolute jump length in each jump series. Hypothesis Modifying the test may reduce the jump length variance between test series of an athlete as well as the test-dependent variations in the cross-over hop for distance. Methods N = 47 athletes from the German and French national Judo youth teams were included in the study (age: 15.3 years ± 13–17). A modified version of the cross-over hop for distance was developed with a cross-over width of 50 cm and a fixed landing zone of 10 cm. The jump lengths of the conventional test and the modified test were documented. The change in jump length variations of the two sexes were compared. Results The mean value of the coefficient of variation decreased significantly from 4.09 % to 2.83 % (p < 0.01) due to the test modification. This resulted in an absolute improvement in accuracy of 1.26 % and a relative improvement of 30.8 %. A comparison of the limb symmetry index between the conventional and the modified cross-over hop for distance revealed no significant differences. Conclusion The modified cross-over hop for distance showed a significantly lower variation in jump lengths compared with the conventional cross-over hop for distance. As a result, more accurate statements can be made regarding the patient’s return-to-competition progress.