Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis

Background: Sports-related concussion (SRC) is an injury with important implications, especially in collision and contact sports, and has a high symptom burden. Student athletes face particular psychosocial challenges, especially female students with pre-existing anxiety/depression are at increased risk for SRC, and have a higher symptom burden before and after injury. Objectives: Describing female SRC presenting features at a collegiate campus-based sports medicine service; examining the association of prior concussion history (PCONC) and pre- existing anxiety/depression (PMHDx) with SRC. Methods: A retrospective cohort and statistical analysis (including corrected effect sizes) of Sport Concussion Assessment Tool (versions 3/5) data (Step 1: PCONC and PMHDx history; Step 2: symptom evaluation) of collegiate female athletes with SRC between 2012 and 2018. Results: Forty females with SRC were identified (age 23 ± 3). The five most frequent symptoms were headache (n = 34; 85%), feeling slowed down (n = 33; 83%), pressure in head (n = 33; 83%), don't feel right (n = 32; 80%) and fatigue/low-energy (n = 32; 80%). These five symptoms also had the highest self-rated severity (median (IQR): headache (3 (2-4)), feeling slowed down (3 (1-4)), fatigue/low-energy (3 (1-5)), don't feel right (3 (1-4)) and pressure in head (3 (2-4)). PMHDx (n = 8; 62.9 vs 38.6; p = 0.0192; Hedges' gs = 0.95; large ES), and not PCONC (n = 13; 51.0 vs 39.8; p = 0.2183; Hedges' gs = 0.48; small ES) was associated with increased mean total symptom severity. Conclusion: Headache, feeling slowed down, pressure in head, don't feel right and fatigue/low-energy had the highest symptom burden. Total symptom severity was no different in those with and without PCONC, but significantly higher in those with PMHDx.

Weak Hip Strength Increases Dynamic Knee Valgus in Single-Leg Tasks of Collegiate Female Athletes

Clinical Scenario: Dynamic knee valgus (DKV) is a mechanical alteration in the knee that leads to increased risk of injury. Weakness of hip musculature in hip abduction (HABD), extension (HEXT), and external rotation (HER) may contribute to increased DKV in single-leg landing tasks. Focused Clinical Question: Is decreased hip strength associated with an increase in DKV during a single-leg landing task in collegiate female athletes? Summary of Key Findings: Three studies were included: One randomized control trial (RCT), one cohort study, and one case-control. All three studies found that decreases in HABD and HER strength contributed to increased DKV during single-leg landing tasks. One study also found that the hip extensors contribute to controlling hip adduction, a common factor in many mechanisms of injuries. These three studies recommended strengthening HABD, HEXT, and HER to decrease DKV and reduce the risk of injury at the knee. Clinical Bottom Line: Weak HABD, HEXT, and HER contribute to increased DKV in college female athletes, but strengthening HABD, HEXT, and HER can lead to decreases in DKV and, overall, reduce the risk of injury at the knee. Strength of Recommendation: These articles were graded with a level of evidence of III or higher, giving a grade of B strength of recommendation that weak HABD, HEXT, and HER are associated with increased DKV in collegiate female athletes.

Energy Availability with or without Eating Disorder Risk in Collegiate Female Athletes and Performing Artists

CONTEXT: Female athletes/performing artists can present with low energy availability (LEA) either through unintentional (e.g., inadvertent undereating) or intentional methods (e.g., eating disorder [ED]). While LEA and ED risk have been examined independently, little research has examined these simultaneously. Awareness of LEA with or without ED risk may provide clinicians with innovative prevention and intervention strategies. OBJECTIVE: To examine LEA with or without ED risk (e.g., eating attitudes, pathogenic behaviors) in female collegiate athletes/performing artists. DESIGN: Cross-sectional and descriptive. SETTING: Free-living in sport-specific settings. PARTICIPANTS: Collegiate female athletes/performing artist (n=121; age: 19.8±2.0 years; height: 168.9±7.7 cm; weight: 63.6±9.26 kg) in equestrian (n=28), volleyball (n=12), softball (n=17), beach volleyball (n=18), ballet (n=26) and soccer (n=20) participated in this study. MAIN OUTCOME MEASURES: Anthropometric measurements (height, weight, body composition), resting metabolic rate, energy intake, total daily energy expenditure, exercise energy expenditure, Eating Disorder Inventory-3 (EDI-3), and EDI-3 Symptom Checklist were assessed. Chi-square analysis examined differences between LEA and sport type, LEA and ED risk, ED risk and sport type, and pathogenic behaviors and sport type. RESULTS: Female athletes/performing artists (81%; n=98) displayed LEA and significant differences were found between LEA and sport type (χ25=43.8, P<.01). Female athletes/performing artists (76.0%; n=92) presented with ED risk with no significant difference between ED risk and sport. EDI-3 Symptom Checklist revealed 61.2% (n=74) engaged in pathogenic behaviors, with dieting the most common (51.2%; n=62). Athletes/performing artist displayed LEA with ED risk (76.0%; n=92). No significant differences were found between LEA with ED risk and sport. Softball was the highest with 82.4% (n=14) reporting LEA with ED risk followed by ballet (76%; n=19). CONCLUSION: Our results suggest a large proportion of collegiate female athletes/performing artists are at risk for LEA with ED risk, thus warranting education, identification, prevention, and intervention strategies relative to fueling for performance.

Associations between Multimodal Fitness Assessments and Rowing Ergometer Performance in Collegiate Female Athletes

The purpose was to examine the association of critical power from a three-minute all-out row (CP3-min) and peak power from a one-stroke maximum test (1-Stroke) with laboratory-based fitness assessments (peak oxygen consumption [V.O2peak] and Wingate anaerobic test [WAnT]) and 6000 m (6K) and 2000 m (2K) rowing ergometer performance. Thirty-one female collegiate rowers (20.2 ± 1.1 years, 70.9 ± 6.9 kg, and 172.2 ± 4.8 cm) participated in fitness and rowing performance testing. Pearson’s correlations, linear regression, and Cohen’s q were used to determine statistical relationships. Absolute V.O2peak values displayed significant correlations with 6Ktotal (−0.68), 6Ksplit (−0.68), 2Ktotal (−0.64), and 2Ksplit (−0.43). Relative V.O2peak displayed significant correlations with 6Ktotal (−0.36), and 6Ksplit (−0.37). CP3-min demonstrated significant correlations with 6Ktotal (−0.62), 6Ksplit (−0.62), 2Ktotal (−0.61), and 2Ksplit (−0.99). For 2Ksplit, a significant difference was observed between relative V.O2peak and CP3-min correlations with a “large” effect size (q = 2.367). Furthermore, 1-Stroke showed significant associations with 6Ktotal (−0.63), 6Ksplit (−0.63), 2Ktotal (−0.62), and 2Ksplit (−0.44), while WAnT produced non-significant correlations. Absolute V.O2peak CP3-min accounted for significant proportions of variance observed with performance measures (p < 0.05). Practitioners should consider incorporating CP3-min and 1-Stroke as additional tests for gauging rowing performance.