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Volleyball is an under-researched sport, particularly in relation to risk factors for head impacts and sports-related concussion (SRC). This study aimed to estimate the self-reported lifetime prevalence of SRC, post-injury help-seeking behaviour, and associations between SRC and age, sex at birth, playing experience, playing league, and playing position. A cross-sectional study was conducted using an online questionnaire to examine lifetime prevlaance and associations between SRC and personal and sport-related factors. The questionnaire collected demographic information, SRC history, and help-seeking behaviour. Descriptive statistics were used to estimate SRC prevalence and help-seeking behaviours among players with a history of SRC. A mixed-effect binary logistic model was conducted at a univariable and multivariable level to assess associations between SRC with playing experience, league, position, age, and gender. A total of 74 volleyball players, 44 females and 30 males, completed the questionnaire. The estimated self-reported lifetime prevalence of SRC was 35% (males 33%, females 36%). Medical support was limited both during and following a SRC. Only 39% of players reporting a SRC were diagnosed, with just 23-27% seeking medical help. Older and more experienced athletes had higher odds of reporting SRC. Those aged 28 years and above showed greater odds (OR=4.58-8.91) of reporting a SRC compared to those aged 16-21, and those with more than 13 years of experience showed greater odds (OR=4.04-9.51) than those with 1-3 years' experience. Professional players showed reduced odds (OR=0.05) compared to high school and university players in the multivariable model. SRC occur in volleyball with a lifetime prevalence of 35%, yet many incidents go undiagnosed and unmanaged. Older, more experienced players had greater odds of reporting a SRC, while professional-level athletes showed reduced odds when all factors are considered. Increased awareness and appropriate guidance are needed across all levels in volleyball.

Research into relative energy deficiency in sport (RED-S) has increased substantially over recent years given the impact on athletes' health and performance. Most studies have considered sports that place emphasis on the aesthetics, endurance, or weight-restriction. Fewer studies exist in team sports. Netball is a team sport yet to be explored despite players potentially being at risk of RED-S given the high training volumes, sporting culture, internal and external pressures, and small network of coaches and medical professionals. A qualitative case study was used to explore the perspective of athletes, coaches, and medical professionals on RED-S. Semi-structured interviews were conducted with 13 players, 4 coaches and 4 medical professionals affiliated to a Super League club. Interviews were recorded and transcribed verbatim. The data was analysed using thematic analysis. Five main themes were identified in this study. Awareness of RED-S amongst athletes and coaches was generally inadequate whereas medical professionals had some awareness of RED-S. Some athletes used contraception to reduce discomfort/pain during menstruation whilst others expressed concerns around long-term contraceptive use and previous menstrual cycle disturbance. Sporting demands, individual and contextual factors, and a preoccupation with body image were associated with nutritional restriction, whilst appearance was a source of internal and external pressure. External pressures also extended to coaches, assessments/feedback, social media, and commentary. Strategies suggested to reduce the risk of RED-S included \"hard hitting cases\", multidisciplinary team involvement, and support from the governing body. The findings of this study provide insight into factors potentially associated with the risk of RED-S from an athletes, coaches, and medical professional perspective. This insight can be used to increase overall awareness of RED-S in key stakeholders as well as improve the recognition for the pressures netball athletes face that might alter the level of risk.

The objective was to investigate the effectiveness of a person-centred active rehabilitation programme on symptoms associated with suspected Chronic Traumatic Encephalopathy (CTE). This was accomplished by (1) assessing the effect that a person-centred active rehabilitation programme had on participant symptoms, and (2) exploring how temporal contextual factors affected the participants' experience with, and perceived effectiveness of, the active rehabilitation programme. A twelve-month mixed-methods single case experimental research design was used with six cases (participants). Individual cases were involved in a 51-week study period including an initial interview and three-week baseline phase. Cases were then randomly allocated to one of two n-of-1 study designs (i.e., A-B, B-A, B-A, A-B or B-A, A-B, A-B, B-A) where A and B represent a non-intervention and intervention phase, respectively. Interviews were conducted regularly throughout the study whilst outcome measures were assessed at each follow-up. Analysis of the data included visual, statistical, and qualitative analysis. Visual and statistical analysis of cognitive and executive function, and mindful attention, demonstrated trivial-to-large effects with the summary reflecting positive or unclear results. A mixed picture was observed for mood and behaviour with effects considered trivial-to-large, and the summary demonstrating positive, unclear and negative effects. Qualitative analysis indicated a perceived improvement in outcome measures such as memory, attention, anxiety, and emotional control despite mixed quantitative findings whilst a clear impact of contextual factors, such as COVID-19, the political atmosphere, exercise tolerance, programme progression, and motivation were evident during the intervention. This study has provided primary-level evidence to suggest active rehabilitation as a potential intervention for the management of suspected CTE symptoms. This study has also demonstrated the benefit of a person-centred approach to both clinical research and practice, particularly by considering contextual factors for a better understanding of an intervention effect.

The purpose of this study was to investigate the effects of a 12% carbohydrate (CHO) beverage on tackling technique and running performance during rugby league activity. Using a double-blind, placebo-controlled, randomised, crossover design, 15 academy rugby league players ingested a 250 ml bolus of a 12% CHO solution (30 g maltodextrin and 30 g sucrose in 500 ml) 15 minutes before two bouts of rugby activity. The rugby league match simulation for interchange players was used to standardise the movement patterns of activity and provide reliable outcome measures, whilst also reflecting the duration of a typical field-based conditioning session. Measures of tackling technique, external responses (e.g., fatigue index from sprint data) and rating of perceived exertion (RPE) were recorded throughout. Gut discomfort was measured before each bout. The interaction effect was largely compatible with the hypothesis for relative distance ( P <0.001, η 2 = 0.217) and fairly compatible for tackling technique ( P = 0.068, η 2 = 0.0640). The time effect for tackling technique, relative and high-intensity distance, sprint, and sprint to contact velocity, time at high metabolic power, PlayerLoad™, and RPE (all P <0.05; η 2 = 0.131–0.701) was compatible with the hypothesis. Data for tackling technique, relative and high-intensity distance, sprint, and sprint to contact velocity, sprint, and sprint to contact fatigue index (all P <0.05; η 2 = 0.189–0.612) was compatible with a supplement effect overall despite few differences in the pattern of change (interaction). Minimal gut discomfort was reported for the CHO (bout 1 = 27 ± 17; bout 2 = 23 ± 17 AU) and placebo (bout 1 = 23 ± 18 AU; bout 2 = 24 ± 13) trials. This study shows that a 12% CHO beverage before two bouts of standardised rugby activity is a practical and effective strategy for retaining tackling technique, increasing external responses, and reducing RPE without compromising gut comfort.

This review sought to address an evidence gap and lay a foundation for future Chronic Traumatic Encephalopathy (CTE) management studies by evaluating and appraising the literature which reports the effect that active rehabilitation has on other tauopathies, a group of conditions with hyperphosphorylation and aggregation of tau protein that can lead to neurodegeneration. Umbrella review. Meta-analyses and systematic reviews were identified using CINAHL, Medline, Cochrane, Web of Science, PubMed, and SPORTDiscus. Systematic review or meta-analyses that examine the effect active rehabilitation has on outcome measures of symptoms associated with CTE. Studies with men and women diagnosed with Alzheimer's disease, Parkinson's disease, Lewy Body dementia, Frontotemporal degeneration/dementia or Corticobasal degeneration. All types of active rehabilitation were included. Control group was usual care, no intervention, or light-intensity physical activity. Twelve reviews were included. A large pooled standardized mean difference (SMD) was observed for balance (SMD = 0.88, P<0.001) and motor function (SMD = 0.83, P<0.001). A moderate pooled SMD was observed for cognitive function (SMD = 0.66, P<0.116). A small pooled SMD was observed for mobility (SMD = 0.45, P = 0.002). A trivial pooled SMD was observed for gait speed/velocity (SMD = 0.11, P = 0.372). No findings for mood/behavioral symptoms. All pooled effects demonstrated substantial to considerable heterogeneity (74.3% to 91.9%, P<0.001). A positive effect of active rehabilitation was observed in patients with tau pathologies suffering from motor, vestibular and cognitive impairments supporting the use of active rehabilitation for CTE management; however, the findings need to be considered with caution given the limited research in some of the tau pathologies, large between-study heterogeneity and wide 95% prediction intervals.

Competitive horse racing is the second largest sport in Great Britain by spectator attendance, employability, and revenue. It is a lucrative yet hazardous sport, with high injury rates, particularly from falls. Clavicular fractures are one of the most common injuries reported, yet their management, especially regarding return to racing, is under-researched. The purpose of this study was to explore the factors associated with the time to return to competition following a clavicular fracture in jockeys competing in Great Britain. This review of medical records utilised data from the British Horseracing Authority spanning 2011-2018, inclusive. Data included the jockey's age, sex, type of licence, race discipline, location of incident, and fracture management. Descriptive statistics and univariable and multivariable generalised linear models were constructed to analyse the impact of these factors on the time to return to racing. Out of 212 records of clavicular fractures, 169 were analysed. The majority (82.8%) of fractures were managed conservatively, with the remainder requiring surgery. The median time to return to racing was 40 days, with an interquartile range of 34 days. Following a clavicular fracture, the results from the univariable and multivariable models indicated that the management approach, whether the fracture is displaced, and the type of race in which the injury occurred have the greatest influence on extending the time to return to racing. In contrast, professional, conditional and amateur licence types, as well as experiencing the injury at a racecourse, were associated with reduced time to return to racing, which may indicate greater risk-taking behaviour. This study offers unique insights into key medical and contextual factors that influence the time to return to racing among jockeys in Great Britain, contributing to tailoring medical management and return to racing protocols to support jockeys' health and career longevity. Clinicians working within horse racing can use the findings of this study to provide return to racing guidance to trainers, riders and other medical professionals based on the key contextual information reported in this study.

Low energy availability (LEA) is a core feature of the female athlete triad and relative energy deficiency in sport (REDs). LEA underpins multiple adverse health and performance outcomes in various athletic populations, including weight category, endurance and aesthetic sports. Recent reports suggest LEA is highly prevalent in female football, volleyball and netball, with little known on male team-sport athletes. Therefore, the study aims to identify the prevalence of LEA among male academy football players (16–23 years), using surrogate markers that align with the International Olympic Committee REDs Clinical Assessment Tool-Version 2. A cross-sectional study design will be used with physiological and perceptual markers of LEA measured. The study will seek to recruit 355 players to complete several online questionnaires believed to be associated with LEA, measured using a 24-hour food and activity diary. Of the 355 players, a subsample (n=110) will complete an additional 3-day food and activity diary, provide a venous blood sample to measure levels of total testosterone and free triiodothyronine, and have resting metabolic rate (RMR) measured to determine RMRratio. The prevalence of LEA will be determined using the low (<30 kcal·kgFFM-1·day-1) domain of energy availability and divided by the total number of participants. Descriptive statistics will be used to summarise the whole group and difference status of energy availability (eg, low, reduced, optimal, high). A univariable and multivariable binary logistic regression analysis will be modelled to assess the association of various surrogate markers with the presence of LEA.

Purpose To determine the association between sport nutrition knowledge, nutritional intake, energy availability, and training characteristics with the risk of an eating disorder amongst highly trained competitive cyclists. Methods Using an observational cohort study design, 36 male cyclists (age = 23.1 ± 3.9 years) provided information on personal characteristics, training history and functional threshold power. The cyclists completed the sports nutrition knowledge questionnaire (SNKQ) and brief eating disorder in athletes questionnaire (BEDA-Q) before submitting a three-day food diary to quantify energy and macronutrient intake, and calculate energy availability. Results The estimated lean body mass, years training, weekly on-bike training and functional threshold power were 57.6 ± 3.9 kg, 5.9 ± 3.0 years, 16.4 ± 3.2 h and 355 ± 33 W, respectively. The mean score for the SNKQ was 60.0 ± 8.4% whilst the BEDA-Q score was 4.3 ± 4.1 AU. Training and rest day energy availability was 16 ± 18 kcal·kg eLBM −1 and 44 ± 14 kcal·kg eLBM −1 , respectively. Associations between SNKQ with energy intake ( r  = 0.13, P  = 0.553) and availability ( r  = 0.21, P  = 0.345) were trivial to small. There was a large, negative association between SNKQ and BEDA-Q ( r  = –0.55, P  = 0.006) suggesting that for every correct answer on the SNKQ, the BEDA-Q score reduced by 0.3 AU. All other association with the BEDA-Q were trivial to small ( r  = –0.29–0.27, all P  > 0.05). Conclusion The results indicate that sport nutrition knowledge and energy intake was insufficient to match their training demand on training days. The large, negative association between SNKQ and BEDA-Q suggests that those highly trained cyclists with less sport nutrition knowledge may be at a greater risk of an eating disorder.

Semi-structured interviews were conducted with 13 players, 4 coaches and 4 medical professionals affiliated to a Super League club. Interviews were recorded and transcribed verbatim. The data was analysed using thematic analysis. Five main themes were identified in this study. Awareness of RED-S amongst athletes and coaches was generally inadequate whereas medical professionals had some awareness of RED-S. Some athletes used contraception to reduce discomfort/pain during menstruation whilst others expressed concerns around long-term contraceptive use and previous menstrual cycle disturbance. Sporting demands, individual and contextual factors, and a preoccupation with body image were associated with nutritional restriction, whilst appearance was a source of internal and external pressure. External pressures also extended to coaches, assessments/feedback, social media, and commentary. Strategies suggested to reduce the risk of RED-S included \"hard hitting cases\", multidisciplinary team involvement, and support from the governing body. The findings of this study provide insight into factors potentially associated with the risk of RED-S from an athletes, coaches, and medical professional perspective. This insight can be used to increase overall awareness of RED-S in key stakeholders as well as improve the recognition for the pressures netball athletes face that might alter the level of risk.

To determine the extent to which various factors are associated with greater or lesser odds of reporting non-specific low back pain (NS-LBP) in field hockey. To meet the objective of the study, a cross-sectional study design was used with a purposive sampling strategy. A total of 194 responses (~18% of those accessible) from Premier and Division One players within the UK were received using a UK-based online survey. Data collected included information on NS-LBP, participant characteristics, injury history, training related factors, and work and personal factors. The overall and category-specific prevalence of NS-LBP was calculated. Univariable and multivariable logistic regression was used in conjunction with clinical value to identify associations. The overall prevalence of NS-LBP was 44.0%, with this varying from 23.5 to 70.0% for categories with responses of \"yes\" and \"no\" to experiencing NS-LBP. A total of ten individual factors associated with a greater odds ratio (OR) of reporting NS-LBP (OR = 1.43-7.39) were identified in Premier and Division One players. Five individual factors were associated with reduced odds (OR = 0.11-0.60) of reporting NS-LBP. Seven factors (age, stature, playing position, playing internationally, performing a drag flick, low back stiffness/tightness and occupational factors) were deemed particularly pertinent to those working in field hockey given the magnitude of association and clinical value to clinicians. Clinicians working in field hockey can consider the key risk factors identified in this study that are associated with NS-LBP when assessing injury risk, movement screening approaches, and overall athlete management.