Nicholas Peirce

Risk factors for stress fracture in female endurance athletes : a cross-sectional study

Objective To identify psychological and physiological correlates of stress fracture in female endurance athletes. Design A cross-sectional design was used with a history of stress fractures and potential risk factors assessed at one visit. Methods Female-endurance athletes (58 runners and 12 triathletes) aged 26.0±7.4 years completed questionnaires on stress fracture history, menstrual history, athletic training, eating psychopathology and exercise cognitions. Bone mineral density, body fat content and lower leg lean tissue mass (LLLTM) were assessed using dual-x-ray absorptiometry. Variables were compared between athletes with a history of stress fracture (SF) and those without (controls; C) using χ², analysis of variance and Mann-Whitney U tests. Results Nineteen (27%) athletes had previously been clinically diagnosed with SFs. The prevalence of current a/oligomenorrhoea and past amenorrhoea was higher in SF than C (p=0.008 and p=0.035, respectively). SF recorded higher global scores on the eating disorder examination questionnaire (p=0.049) and compulsive exercise test (p=0.006) and had higher LLLTM (p=0.029) compared to C. These findings persisted with weight and height as covariates. In multivariate logistic regression, compulsive exercise, amenorrhoea and LLLTM were significant independent predictors of SF history (p=0.006, 0.009 and 0.035, respectively). Conclusions Eating psychopathology was associated with increased risk of SF in endurance athletes, but this may be mediated by menstrual dysfunction and compulsive exercise. Compulsive exercise, as well as amenorrhoea, is independently related to SF risk.

Stress fracture injury in female endurance athletes in the United Kingdom: A 12‐month prospective study

Studies of stress fracture (SF) incidence are limited in number and geographical location; this study determined the incidence of SF injury in female endurance athletes based in the United Kingdom. A total of 70 athletes aged between 18 and 45 years were recruited and prospectively monitored for 12 months. Questionnaires at baseline and 12 months assessed SF, menstrual and training history, eating psychopathology, and compulsive exercise. Peak lower leg muscle strength was assessed in both legs using an isometric muscle rig. Bone mineral density (BMD) of total body, spine, hip, and radius was assessed using dual X‐ray absorptiometry. Among the 61 athletes who completed the 12‐month monitoring, two sustained a SF diagnosed by magnetic resonance imaging, giving an incidence rate (95% confidence intervals) of 3.3 (0.8, 13.1) % of the study population sustaining a SF over 12 months. The SF cases were 800 m runners aged 19 and 22 years, training on average 14.2 h a week, eumenorrheic with no history of menstrual dysfunction. Case 1 had a higher than average energy intake and low eating psychopathology and compulsive exercise scores, while the reverse was true in case 2. BMD in both cases was similar to mean values in the non‐SF group. The incidence of SF in our female endurance athlete population based in the United Kingdom was 3.3%, which is lower than previously reported. Further work is needed to confirm the current incidence of SF and evaluate the associated risk factors.

Common attributes in retired professional cricketers that may enhance or hinder quality of life after retirement: a qualitative study

Objectives Retired professional cricketers shared unique experiences and may possess specific psychological attributes with potential to influence quality of life (QOL). Additionally, pain and osteoarthritis can be common in retired athletes which may negatively impact QOL. However, QOL in retired athletes is poorly understood. This study explores the following questions from the personal perspective of retired cricketers: How do retired cricketers perceive and experience musculoskeletal pain and function in daily life? Are there any psychological attributes that might enhance or hinder retired cricketers’ QOL? Design A qualitative study using semistructured interviews, which were subject to inductive, thematic analysis. A data-driven, iterative approach to data coding was employed. Setting All participants had lived and played professional cricket in the UK and were living in the UK or abroad at the time of interview. Participants Eighteen male participants, aged a mean 57±11 (range 34–77) years had played professional cricket for a mean 12±7 seasons and had been retired from professional cricket on average 23±9 years. Results Fifteen participants reported pain or joint difficulties and all but one was satisfied with their QOL. Most retired cricketers reflected on experiences during their cricket career that may be associated with the psychological attributes that these individuals shared, including resilience and a positive attitude. Additional attributes included a high sense of body awareness, an ability to self-manage pain and adapt lifestyle choices to accommodate physical limitations. Participants felt fortunate and proud to have played professional cricket, which may have further contributed to the high QOL in this group of retired cricketers. Conclusions Most retired cricketers in this study were living with pain or joint difficulties. Despite this, all but one was satisfied or very satisfied with their QOL. This may be partly explained by the positive psychological attributes that these retired cricketers shared.

Physical activity in former elite cricketers and strategies for promoting physical activity after retirement from cricket: a qualitative study

Objectives The health benefits of professional sport dissipate after retirement unless an active lifestyle is adopted, yet reasons for adopting an active or inactive lifestyle after retirement from sport are poorly understood. Elite cricket is all-encompassing, requiring a high volume of activity and unique physical demands. We aimed to identify influences on physical activity behaviours in active and insufficiently active former elite cricketers and provide practical strategies for promoting physical activity after cricket retirement. Design 18 audio-recorded semistructured telephone interviews were performed. An inductive thematic approach was used and coding was iterative and data-driven facilitated by NVivo software. Themes were compared between sufficiently active and insufficiently active participants. Setting All participants formerly played professional cricket in the UK. Participants Participants were male, mean age 57±11 (range 34–77) years, participated in professional cricket for 12±7 seasons and retired on average 23±9 years previously. Ten participants (56%) were classified as sufficiently active according to the UK Physical Activity Guidelines (moderate-intensity activity ≥150 min per week or vigorous-intensity activity ≥75 min per week). Eight participants did not meet these guidelines and were classified as insufficiently active. Results Key physical activity influences were time constraints, habit formation, intrinsic and extrinsic motivation, physical activity preferences, pain/physical impairment and cricket coaching. Recommendations for optimising physical activity across the lifespan after cricket retirement included; prioritise physical activity, establish a physical activity plan prior to cricket retirement and don’t take a break from physical activity, evaluate sources of physical activity motivation and incorporate into a physical activity plan, find multiple forms of satisfying physical activity that can be adapted to accommodate fluctuations in physical capabilities across the lifespan and coach cricket. Conclusions Physically active and less active retired cricketers shared contrasting attributes that informed recommendations for promoting a sustainable, physically active lifestyle after retirement from professional cricket.

Bone density changes following stress fracture in female athletes

BACKGROUND: Poor lower limb stability during dynamic movement is thought to increase the risk of musculoskeletal injury. Biomechanically, stability is determined by a number of factors including the external load and contributions from passive and active tissues. One approach for studying lower limb stability is the single leg squat (SLS) test, which requires coordinated lower limb movement across a range of joint motions under external load. Although clinicians typically assess SLS quality from a single point of view (i.e. frontal plane), a 3D investigation of SLS kinematics would help to determine factors that differentiate clinician-defined “good” from “poor” quality performance. PURPOSE: To determine the kinematic parameters that characterise a good or a poor SLS performance in young adults. METHODS: 22 healthy young adults (13 male, 9 female; age: 23.8 ±3.1 years; height: 1.73 ±0.07 m; mass: 69.4 ±12.7 kg) free from musculoskeletal impairment were recruited. Video footage was collected in the frontal plane as participants performed three SLSs on each leg. SLS quality was assessed by a panel of physiotherapists using a ten-point ordinal scale. Performances were subsequently divided into tertiles corresponding to poor, intermediate and good SLS technique. 3D trajectories of 28 reflective markers attached to the pelvis, and lower limbs were simultaneously recorded at 200 Hz using a 10-camera, motion capture system (Vicon Motion Systems, Oxford, UK). Pelvis, hip and knee angles were calculated using a validated lower limb biomechanical model that incorporated functional identification of hip and knee joint centres. RESULTS: Mean rating of SLS quality as assessed by the panel of physiotherapists was 6.3±1.9 (range: 2.4 - 9.1). 3D analysis of SLS performance revealed that poor squatters had increased hip adduction (22.4 ±6.1 vs 14.7 ±4.7 deg, p<0.01), reduced knee flexion (73.1 ±8.7 vs 90.1 ±12.1 deg, p<0.01) and increased medal-lateral displacement of the knee joint centre (53.7 ±16.8 vs 38.4 ±14.3 mm, p=0.02) compared to good squatters. CONCLUSION: In healthy young adults a poor SLS is characterised by inadequate knee flexion and excessive frontal plane motion at the knee and hip. It is recommended that clinicians standardise knee flexion angle when using the SLS test as it might confound the perception of SLS quality.Purpose: To evaluate changes in performance and cardiac autonomic control (i.e. heart rate [HR] variability [HRV]) in elite soccer players during their pre-season training regime. Methods: Eight Spanish Premier League soccer players were examined at the first (week 1) and the last week (week 8) of the pre-season period (July-September). Nocturnal HR recordings on 4 days per week were averaged to evaluate the weekly HRV. Players also completed the Yo-Yo intermittent recovery test level 1 (Yo-Yo IR1) for the assessment of specific fitness. Results: During the pre-season period, there was no significant change (4.5 ± 23.9%) in Yo-Yo IR1 performance (2,475 ± 421 vs. 2,600 ± 786 m, p=0.55), while there was a significant decrement (6.3 ± 4.3%) in maximal HR (HRmax) recorded during the test (191 ± 7 vs. 179 ± 8 bpm, p = 0.004). Over the 8-week pre-season, significant increases in the standard deviation of the long-term continuous HRV (SD2) (174 ± 56 vs. 212 ± 53 ms, p = 0.017), and in the standard deviation of all HR intervals (SDNN) (135 ± 50 vs. 163 ± 41 ms, p = 0.023) were noted. No significant correlations were identified between Yo-Yo IR1 and HRV measures at week 1. In contrast, Yo-Yo IR1 performance was significantly correlated with SDNN (r =0.89, p=0.007) and SD2 (0.92, p=0.003) at week 8. Greater values in HRV at week 1 were substantially associated with lower HRV changes at the end of pre-season (r values ranged from -0.79 to -0.98, p< 0.05). Furthermore, HRV changes were significantly correlated with decreases in HRmax during the pre-season (r values from 0.83 to 0.94, p<0.05). Conclusions: The current results confirm that despite minimal changes in specific fitness (i.e. Yo-Yo IR1), pre-season training significantly improved various HRV indices in elite soccer players with greater changes evident for those with lower initial HRV levels. Nocturnal HRV may provide an important monitoring tool for identification of cardiovascular function changes in top-class soccer players during pre-season regimes.

Vitamin D status in female endurance runners based in the United Kingdom

BACKGROUND: Poor lower limb stability during dynamic movement is thought to increase the risk of musculoskeletal injury. Biomechanically, stability is determined by a number of factors including the external load and contributions from passive and active tissues. One approach for studying lower limb stability is the single leg squat (SLS) test, which requires coordinated lower limb movement across a range of joint motions under external load. Although clinicians typically assess SLS quality from a single point of view (i.e. frontal plane), a 3D investigation of SLS kinematics would help to determine factors that differentiate clinician-defined “good” from “poor” quality performance. PURPOSE: To determine the kinematic parameters that characterise a good or a poor SLS performance in young adults. METHODS: 22 healthy young adults (13 male, 9 female; age: 23.8 ±3.1 years; height: 1.73 ±0.07 m; mass: 69.4 ±12.7 kg) free from musculoskeletal impairment were recruited. Video footage was collected in the frontal plane as participants performed three SLSs on each leg. SLS quality was assessed by a panel of physiotherapists using a ten-point ordinal scale. Performances were subsequently divided into tertiles corresponding to poor, intermediate and good SLS technique. 3D trajectories of 28 reflective markers attached to the pelvis, and lower limbs were simultaneously recorded at 200 Hz using a 10-camera, motion capture system (Vicon Motion Systems, Oxford, UK). Pelvis, hip and knee angles were calculated using a validated lower limb biomechanical model that incorporated functional identification of hip and knee joint centres. RESULTS: Mean rating of SLS quality as assessed by the panel of physiotherapists was 6.3±1.9 (range: 2.4 - 9.1). 3D analysis of SLS performance revealed that poor squatters had increased hip adduction (22.4 ±6.1 vs 14.7 ±4.7 deg, p<0.01), reduced knee flexion (73.1 ±8.7 vs 90.1 ±12.1 deg, p<0.01) and increased medal-lateral displacement of the knee joint centre (53.7 ±16.8 vs 38.4 ±14.3 mm, p=0.02) compared to good squatters. CONCLUSION: In healthy young adults a poor SLS is characterised by inadequate knee flexion and excessive frontal plane motion at the knee and hip. It is recommended that clinicians standardise knee flexion angle when using the SLS test as it might confound the perception of SLS quality.Purpose: To evaluate changes in performance and cardiac autonomic control (i.e. heart rate [HR] variability [HRV]) in elite soccer players during their pre-season training regime. Methods: Eight Spanish Premier League soccer players were examined at the first (week 1) and the last week (week 8) of the pre-season period (July-September). Nocturnal HR recordings on 4 days per week were averaged to evaluate the weekly HRV. Players also completed the Yo-Yo intermittent recovery test level 1 (Yo-Yo IR1) for the assessment of specific fitness. Results: During the pre-season period, there was no significant change (4.5 ± 23.9%) in Yo-Yo IR1 performance (2,475 ± 421 vs. 2,600 ± 786 m, p=0.55), while there was a significant decrement (6.3 ± 4.3%) in maximal HR (HRmax) recorded during the test (191 ± 7 vs. 179 ± 8 bpm, p = 0.004). Over the 8-week pre-season, significant increases in the standard deviation of the long-term continuous HRV (SD2) (174 ± 56 vs. 212 ± 53 ms, p = 0.017), and in the standard deviation of all HR intervals (SDNN) (135 ± 50 vs. 163 ± 41 ms, p = 0.023) were noted. No significant correlations were identified between Yo-Yo IR1 and HRV measures at week 1. In contrast, Yo-Yo IR1 performance was significantly correlated with SDNN (r =0.89, p=0.007) and SD2 (0.92, p=0.003) at week 8. Greater values in HRV at week 1 were substantially associated with lower HRV changes at the end of pre-season (r values ranged from -0.79 to -0.98, p< 0.05). Furthermore, HRV changes were significantly correlated with decreases in HRmax during the pre-season (r values from 0.83 to 0.94, p<0.05). Conclusions: The current results confirm that despite minimal changes in specific fitness (i.e. Yo-Yo IR1), pre-season training significantly improved various HRV indices in elite soccer players with greater changes evident for those with lower initial HRV levels. Nocturnal HRV may provide an important monitoring tool for identification of cardiovascular function changes in top-class soccer players during pre-season regimes.

Editorial was wide of the mark

Holm and McNamee acknowledge that sport and exercise medicine is littered with ethical dilemmas—especially in elite sport—but they seem not to appreciate that specialists in sport medicine are highly experienced and skilled.1 Although they identify several pressures arising from athletes, coaches, agents, families, and even sometimes other medical practitioners, they do not recognise that these pressures are …