Pain Perception in Contact Sport Athletes: A Scoping Review

Contact sports athletes are regularly facing acute physical pain in part of their practice. However, the literature investigating pain perception in these athletes remains scarce. This scoping review aimed to explore the literature surrounding pain perception in contact sport athletes and to compile and understand how it is studied. The search strategy consisted of using index terms and keywords in Medline, EMBASE, Sport-Discus, Web of Science, PsycINFO, CINAHL and ProQuest Dissertations & Theses Global search engines. Results revealed that a mix of team contact sports and combat sports are studied and included under the umbrella of contact sports. These athletes are being compared to non-athletes as well as athletes from non-contact sports. The cold pressor test and the pain pressure test are the two predominant methods used to investigate physical pain. This review highlights the need to clearly define sports based on contact levels expected in play to better define the types of pain athletes are facing in their practice. Athlete’s level of play as well as years of experience should also be more rigorously reported. While contact sport athletes seem to have a higher level of pain tolerance than both active controls and non-contact athletes, the methods of pain testing are not always justified and appropriate in relation to the pain induced during contact sports. Future experimental studies should use pain testing methods relevant to the pain experienced during contact sports and better justify the rationale for the choice of these methods.

Biomechanical Behavior Evaluation of a Novel Hybrid Occlusal Splint-Mouthguard for Contact Sports: 3D-FEA

Background: Orofacial injuries are common occurrences during contact sports activities. However, there is an absence of data regarding the performance of hybrid occlusal splint mouthguards (HMG), especially during compressive loading. This study amid to evaluate the biomechanical effects of wearing a conventional custom mouthguard (MG) or the HMG on the teeth, bone, and the device itself. Methods: To evaluate the total deformation and stress concentration, a skull model was selected and duplicated to receive two different designs of mouthguard device: one model received a MG with 4-mm thickness and the other received a novel HMG with the same thickness. Both models were subdivided into finite elements. The frictionless contacts were used, and a nonlinear analysis was performed simulating the compressive loading in occlusion. Results: The results were presented in von-Mises stress maps (MPa) and total deformation (mm). A higher stress concentration in teeth was observed for the model with the conventional MG, while the HMG design displayed a promising mechanical response with lower stress magnitude. The HMG design displayed a higher magnitude of stress on its occlusal portion (7.05 MPa) than the MG design (6.19 MPa). Conclusion: The hybrid mouthguard (HMG) reduced (1) jaw displacement during chewing and (2) the generated stresses in maxillary and mandibular teeth.

Effects of Cumulative Years of Contact/Collision Sports on Neuropsychological Outcomes

ObjectiveTo determine the relationship between prolonged exposure to repetitive head impacts (RHI) through contact sports, as assessed by cumulative years contact sport participation, and quality of life outcomes in current/former contact sport athletes.BackgroundCumulative lifetime RHI exposure may be a more meaningful measure than age of first exposure to contact sports to assess effects of RHI on neurologic function, however effects on young adults remain mixed.Design/MethodsTwenty-one physically active current/former contact sport athletes (35.0 ± 12.2 years, 66.7% male) completed an online questionnaire. To assess quality of life and psychological status, participants completed the Apathy Evaluation Scale-Self Rated (AES-S), Short Form 12 (SF-12), Satisfaction with Life Survey (SWLS), and Sport Concussion Assessment Tool 5 (SCAT5) Symptoms. Participants self-reported years of organized contact sport history (16.9 ± 10.5 years, range: 1–45) along with covariates (sex, LD/ADHD, age, concussion history). Generalized linear models were used to examine the association between cumulative years contact sport and psychological outcomes, while controlling for covariates.ResultsCumulative years contact sports was a significant positive predictor of better apathy ratings (p = 0.038) and SWLS (p = 0.001). For every year increase, there was an associated 1.1% reduction in AES-S and 1.6% improvement in SWLS. Cumulative years was not a significant predictor of SF-12 Mental Component Summary (p = 0.113), SF-12 Physical Component Summary (p = 0.289), or symptoms (p = 0.237).ConclusionsCumulative years of contact sport history was associated with better patient reported outcomes in current/former contact/collision sport athletes. This provides insight into later life effects of prolonged RHI exposure on neuropsychological outcomes in a more diverse subject pool outside of retired football players. Long-term neurologic effects remain to be elucidated, however, in early adulthood collision sports have positive mental health outcomes.

Rehabilitation of Persistent Neurocognitive Deficits Following Sports-Related Concussion in an Amateur Football Athlete: Case Study

ObjectiveDemonstrate neurocognitive improvements in an inactive, amateur football athlete following a functional neurology approach to multimodal neurorehabilitation.BackgroundAmerican Football has been reported to have one of the highest incidences of concussion in all contact sports. Given the high rate of concussive blows during play, the investigation of treatment modalities is warranted. This case study presents a 23-year-old male amateur football player who has sustained 3 diagnosed concussions with additional suspected concussions throughout his time participating in football. In addition, his symptoms persisted years after ceasing participation in all contact sports.Design/MethodsThe athlete was prescribed 10 treatment sessions over 5 consecutive days at an outpatient neurorehabilitation center specializing in functional neurology. The C3Logix neurocognitive assessment and Graded Symptom Checklist were utilized on intake and discharge. Multimodal treatment interventions included transcranial photobiomodulation, non-invasive neuromodulation of the lingual branch of the trigeminal nerve, neuromuscular reeducation of the limbs bilaterally, hand-eye coordination training, vestibular rehabilitation utilizing a three-axis whole-body off-axis rotational device, and cognitive training.ResultsOn intake, composite symptom score was reported as 10/162, Trails Making Test Part A was 20.8 seconds, Part B was 41.9 seconds, Digit Symbol Matching score was 53, Simple Reaction Time was 277 milliseconds, and Choice Reaction Time was 412 milliseconds. On discharge, the patient experienced a 70% in self-reported symptoms, Trails A improved to 14.8 seconds (+29%), Trails B improved to 30.3 seconds (+28%), Simple Reaction Time was 248 milliseconds (10% faster), and Choice Reaction Time was 340 milliseconds (17% faster).ConclusionsThe present case study demonstrates a meaningful improvement in symptoms and neurocognitive performance of a patient with multiple sports-related concussions. Therefore, the Press suggest further investigation into a functional neurology approach to multi-modal, intensive care to improve neurocognitive impairment in athletes that sustained concussions participating in footballs.

Effects of COVID-19 pandemic on the psychological states of youth and adult elite male athletes

Objective: Although the psychological states of athletes were negatively affected during the COVID-19 pandemic, there is a lack of studies examining the psychological impact on athletes according to age, sports discipline, and contact requirement of the sport. The aim of this study was to evaluate the psychological effects of the COVID-19 pandemic on elite athletes according to age, sport discipline (team-individual), and contact requirements of the sports (contact and non-contact). Material and methods: Three questionnaires (Depression anxiety stress scale-21, Impact of events scale (IES), International physical activity questionnaire (IPAQ)) were sent to participants’ smartphones, six weeks after professional football leagues were postponed. The online survey was completed by 440 athletes and 126 non-athlete volunteers. Athletes were divided into three groups as follows; team sports, individual contact, and individual non-contact-sports. Also, each group was subdivided into two age groups as youth and adult. Results: Depression, anxiety, and stress scores for the team sports were significantly lower than individual contact-sports (p<0.01 each) and individual non-contact-sports (p=0.02, p<0.01, p<0.01, respectively). IES score for the team sports was significantly lower than the individual contact sports, individual non-contact sports, and non-athlete volunteers (p<0.01, p=0.02, p=0.04, respectively). There was no other significant difference between the scale scores of the groups (athletes-control, or youth-adult) (p>0.05). Conclusion: Mental health status of team sport athletes were relatively protected, whereas, individual contact sports athletes were highly affected. The psychological states of individual contact athletes should be monitored closely, and necessary psychosocial support should be provided to create coping strategies.

Perceção de homofobia e discriminação da comunidade LGBTQIA+ no contexto da disciplina de Educação Física em Portugal

Background and Aim: The aim of this study was to investigate internalized homophobia and the feeling of everyday discrimination among LGBTQIA+ (Lesbian, Gay, Bisexual, Transsexual, Queer, Intersex, Asexual) community in physical education. Methods: Qualitative, quantitative, and exploratory study was used on a convenience sample, non-probabilistic, carried out from May 2021 to July 2021. One hundred eighty individuals, aged between 18 and 60, participated in the study by answering a sociodemographic questionnaire, a questionnaire evaluating comfort with sexual identity (the Internalized Homophobia Scale), and the Everyday Discrimination Scale. Results: Regarding the evaluation of internalized homophobia, the perception of external stigma presented moderate to high correlations with the variables associated with discrimination in school settings and physical education classes. It was possible to confirm statistically significant sex differences in favorite sports practiced in physical education classes, where girls preferred group contact sports and boys preferred individual/non-contact sports. Through qualitative analysis was noticeable that most participants recalled homophobic rhetoric from classmates during physical education classes. Conclusions: There is a need for a greater understanding of gender differences and physical education practice. Concerns arise associated with the abandonment of physical exercise or sport due to the discrimination felt by young students. Future studies should analyze the perspective of those involved in the development of the physical education curriculum, taking into account the evolution of society.

The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes

Context: The relationships between different sports, face mask use and COVID-19 risk among high school athletes remains unknown. Objective: The purpose of this study was to evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes. Design: Descriptive Epidemiology Study Setting: United States High School Athletic Departments Participants: Athletic Directors Interventions: None Main Outcome Measures: Surveys were completed regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no). Results: 991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49–0.60, p&lt;0.001) and non-contact versus contact sports (IRR=0.78 [0.70–0.87], p&lt;0.001), but not team versus individual sports (IRR=0.96 [0.84–1.1], p=0.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR=0.53 [0.37–0.73], p&lt;0.001), boys' basketball (IRR=0.53 [0.33–0.83], p=0.008) and girls' basketball (IRR=0.36 [0.19–0.63], p&lt;0.001), and approached statistical significance in football (IRR=0.79 [0.59–1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53–1.03], p=0.081). Conclusions: In this nationwide survey of high school athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.

Imaging of Neuroinflammation Due to Repetitive Head Injury in Currently Active Kickboxers

PURPOSEChronic traumatic encephalopathy refers to a neurodegenerative disease resulting from repetitive head injury of participants in contact sports. Similar to other neurodegenerative diseases, neuroinflammation is thought to play a role in the onset and progression of the disease. Limited knowledge is regarding the neuroinflammatory consequences of repetitive head injury in currently active contact sports athletes. PET imaging of the 18-kDa translocator protein (TSPO) allows quantification of microglial activation in vivo, a marker of neuroinflammation. METHODS11 rank A kickboxers and 11 age matched controls underwent TSPO PET using [11C]-PK11195, anatomical MRI, diffusion tensor imaging and neuropsychological testing. Relevant imaging parameters were derived an correlated with the outcomes on the neuropsychological testing.RESULTSOn a group level, no statistically significant differences were detected in non displacable binding potential (BPND) using PET. DTI parameters did not differ between groups. Individually, 3 kick boxers showed increased BPND’s in widespread regions of the brain without a correlation with other modalities.CONCLUSIONDespite negative results on a group level, individual results suggest that neuroinflammation may be present as a consequence of repetitive head injury in active kickboxers. Future studies using a longitudinal design may determine whether the observed TSPO upregulation is related to the future development of neuropsychiatric symptoms.

379. Abstract For Comparison of Mandatory vs Non-Mandatory Compliance Rates For SARS-CoV-2 Testing in Grades K-12

Background Rapid testing to identify asymptomatically infected students with SARS-CoV-2 in elementary schools has been suggested as a possible method to reduce risk for in person instruction. As of August 3, 2020 (updated on January 25, 2021), California schools who obtained a waiver to conduct in-person instruction are not required to have mandatory testing for asymptomatic students, except for high contact sports which are required to undergo weekly testing. We explored the uptake of voluntary vs mandatory testing in a private waivered school. Methods Between the dates January 25, 2021 to April 16, 2021, the K-12 school superintendent sent an email to all parents outlining the voluntary testing program with a link to the on-line sign up and consent form. All students were offered weekly self-collected anterior nares BinaxNOW Rapid Antigen Test. Signed parental consent was required and tests were performed at the school. Students participating in contact sports were required to undergo testing the week a varsity game was played as a condition of participation. Data was gathered from the school administration and de-identified. Results K-5 Lower school had a school population of 448 students. Testing was offered on 8 weeks during the period of 2/15-2/19 to 4/5-4/9. 2 students (0.45%) receive screening on the week of 3/22-3/26. The other seven weeks when screening was offered 0 students received screening. 6-12 Upper school had a school population of 360 enrolled students. Testing was offered 3/8-3/12 and 3/15-3/19. The upper school had 22 students (6.11%) receive testing on the week of 3/8-3/12 and 21 students (5.83%) on the week of 3/15-3/19. Contact sports teams had 67 students on their roster. Weekly testing was offered from 3/22-3/26 to 4/12-4/16. Contact sports teams had 10 students (14.93%) receive testing on the week of 3/22-3/26, 33 students (52.24%) on the week of 4/5-4/9, and 32 students (49.25%) on the week of 4/12-4/16. Figure 1. Percent of students from each campus and sports team screened per week offered. Conclusion Voluntary SARS-CoV-2 screening was not a feasible approach for detection of asymptomatically infected individuals due to low uptake, however in the same school, mandatory testing had high uptake and would be a feasible strategy. Disclosures All Authors: No reported disclosures

Biomechanical Behavior Evaluation of a Novel Hybrid Occlusal Splint-mouthguard for Contact Sports: 3D-FEA

Orofacial injuries are common occurrences during contact sports activities; however, there is an absence of data regarding the performance of hybrid occlusal splint mouthguards, especially during compressive loading. To evaluate the total deformation and stress concentration, a skull model was selected and duplicated to receive two different designs of mouthguard devices: one model received a conventional custom-made mouthguard (MG) with 4-mm thickness and the other received a novel hybrid occlusal splint-mouthguard (HMG) with the same thickness. Both models were subdivided into finite elements. The frictionless contacts were used, and a nonlinear analysis was performed simulating the compressive loading in occlusion. The results were presented in von-Mises stress maps (MPa) and Total Deformation (mm). A higher stress concentration in teeth was observed for the model with the conventional MG, while the HMG design displayed a promising mechanical response with lower stress magnitude. The HMG de-sign displayed a higher magnitude of stress on its occlusal portion than the MG design. The hybrid mouthguard (HMG) reduced (1) jaw displacement during chewing and (2) the generated stresses in maxil-lary and mandibular teeth.