Stronger Athlete Identity Is a Risk Factor for More Severe Depressive Symptoms After Musculoskeletal Injury in Pediatric Athletes: a Systematic Review

Adolescent Athletes with Stronger Athletic Identity Perceptions Have Weaker Fear Avoidance Perceptions During Musculoskeletal Injury Rehabilitation Return to Sports Preparation

BACKGROUND

Adolescent athletes who sustain a musculoskeletal sports injury are at high re-injury risk. This prospective study evaluated athletic identity perception and fear avoidance perception relationships during the return to sport preparation phase of musculoskeletal injury rehabilitation.

METHODS

From 140 consecutive physical therapy outpatients, 50 (26 females, 24 males) adolescent athletes (mean age 16.8, range 14 to 22 y) completed the 7-item Athletic Identity Measurement Scale (AIMS), the 10-item Athletic Fear Avoidance Questionnaire (AFAQ), and the AFAQ with 2 additional movement-related fear and pain questions (AFAQ+). Correlational analysis was performed of overall AIMS and AIMS subscale scores (social identity, exclusivity, negative affectivity), with AFAQ and AFAQ+ scores (P≤0.05).

RESULTS

Adolescent athletes were receiving treatment for musculoskeletal injuries sustained during soccer (n=10), lacrosse (n=7), baseball (n=6), basketball (n=5), volleyball (n=5), track or cross country (n=4), American football (n=4), field hockey or ice hockey (n=3), softball (n=2), tennis (n=2), and gymnastics (n=2). Lower extremity conditions included anterior cruciate ligament reconstruction (n=23) or other lower extremity conditions (n=17). Upper extremity conditions included shoulder dislocation or labral repair (n=6), elbow sprain or fracture (n=3), and clavicle fracture (n=1). The AIMS score displayed moderate inverse relationships with AFAQ (r=-0.40, P=0.008) and AFAQ+ (r=-0.41, P<0.004) scores. The "social identity" AIMS subscale score displayed a moderate inverse relationship with AFAQ (r=- 0.48, P<0.001) and AFAQ+ (r=-0.46, P=0.001) scores. The "exclusivity" AIMS subscale score displayed moderate inverse relationships with AFAQ (r=-0.40, P=0.005) and AFAQ+ (r=-0.46, P=0.001) scores. The "negative affectivity" subscale did not display significant relationships with AFAQ or AFAQ+ scores. Subject age displayed moderate inverse relationships with the AIMS "social identity" (r=-0.56, P<0.001) and "exclusivity" (r=-0.42, P=0.004) subscale scores and weak direct relationships with AFAQ (r=0.30, P=0.04) and AFAQ+ (r=0.32, P=0.02) scores.

CONCLUSION

Adolescent athletes with stronger athletic identity perceptions during the return to the sports preparation phase of musculoskeletal injury rehabilitation had weaker fear avoidance perceptions. As age increased from early to late adolescence, athletic identity perceptions became weaker, and fear avoidance perceptions became stronger. To decrease re-injury rates, early identification and surveillance of injured adolescent athletes with stronger, more exclusive athletic identity perceptions and weaker fear avoidance perceptions may influence rehabilitation progression and return to play decisions.

LEVEL OF EVIDENCE

Level-II, prospective cohort, correlational study.

Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up

Purpose

To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy.

Methods

A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data.

Results

Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months.

Conclusions

All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications.

Level of Evidence

Level IV, case series, therapeutic.

Same game, different worlds? General conditions, perceived stress, and associations between stress and past season injuries in elite female and male ice hockey players

BACKGROUND

Ice hockey is played by women and men but the arena they play in may differ substantially. Potential differences in general conditions to play the sport may be associated to perceived stress, which has shown to be related to athletic injury in other sports. Therefore, this study aimed to describe and compare general conditions for playing ice hockey, stress levels, and the association between perceived stress and injury occurrence among elite female and male players.

METHODS

Prior to the 2022-2023 season all female and male players from the top ice hockey leagues in Sweden were invited to an online survey. Players provided information about their general conditions for playing ice hockey and reported perceived stress during the previous season on the Perceived Stress Scale (PSS-10; sum score range 0-40) and current stress on the Single Item Stress Question (SISQ; scale range 1-5). Injuries during the previous season were self-reported on a modified version of the Oslo Sports Trauma Research Center - Overuse Injury Questionnaire.

RESULTS

We received responses from 360 players (170 females and 190 males). Female players more frequently reported additional occupations besides ice hockey and less medical support during games and practices than male players (p < .001). General stress levels were significantly higher among female players (mean PSS score [SD]: 17.4 [5.6] vs 14.1 [5.6], p < 0.001; SISQ median [IQR]: 3 [2-3] vs 2 [1-3], p < 0.001). There was a statistically significant but weak correlation between past season injury and perceived stress (PSS score: rho 0.29; SISQ: rho 0.24). This correlation was stronger among males than females (PSS score: 0.38 vs 0.162; SISQ: 0.29 vs 0.16, p's < 0.05). Players with substantial injuries during previous season had higher previous and current stress levels than players without injury, a difference that was largest and statistically significant only among male players.

CONCLUSIONS

General conditions for playing elite ice hockey are inequal for female and male athletes. Stress levels of elite ice hockey players were comparable to the general population. Experience of severe injuries during the previous season was associated to higher levels of perceived stress. This association is stronger among male players, which may be due to greater economic dependency.

Global knee function rating more strongly influences adolescent athletes that sustain a sports-related surgical ACL re-injury or contralateral ACL injury

PURPOSE

This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re-injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2).

METHODS

At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS-SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level.

RESULTS

By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re-evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 (p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score (r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS-SAS score change and postprogramme GRKF score (r = 0.60, p = 0.04).

CONCLUSION

Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re-injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re-injury or contralateral ACL injury risk.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

The relationship between passion and athlete identity in sport: the mediating and moderating role of dedication

BACKGROUND

In addition to the fact that the concept of passion in sports plays a significant role in the formation of the identity concept of athletes, the dedication of athletes to the sports branches they are interested in also has a significant impact on their passion for the sport they are interested in as well as their identity as an athlete. In this direction, the research aims to investigate the role of dedication as a mediator and moderator in the relationship between athlete identity and passion in sport.

METHODS

The research was designed using the quantitative research technique of relational surveying. As data collection instruments for the research, the athlete identity scale, the passion in sport scale, and the sports commitment scale were utilized. 237 amateur and professional athletes, of which 142 were male and 95 were female (Mage = 22.7), participated voluntarily in the study by random sampling. The data were analyzed with the PROCESS and Jamovi programs in order to examine the direct and indirect effects.

RESULTS

Significant effects of sports passion on commitment and athlete identity were found. Since both dedication and athlete identity had a significant effect on passion for sports, it was determined that passion for sports continues to influence athlete identity through the medium of dedication. The moderator significance of medium, high, and low values of devotion was determined.

ETHICS APPROVAL NUMBER

226394, date of registration: 03/11/2022.

CONCLUSION

On the basis of the results of the statistical analyses, it was determined that the concept of dedication has a mediating and moderating effect on the relationship between sports passion and athlete identity.

Differences in athletic identity, sport participation, and psychosocial factors following anterior cruciate ligament rehabilitation in youth athletes

Introduction

While youth sports benefits the developing athlete, athletes may also be subject to injury and subsequent return-to-sport protocols. The current return-to-sport criteria emphasize physical measures; however, psychological measures may also be valuable to inform providers of an athlete's readiness. One such measure is athletic identity defined as the degree to which an individual identifies with the athlete role. To better understand athletic identity in return-to-sport, this study aimed to identify relationships and trends between the Athletic Identity Measurement Scale (AIMS), demographic variables, sport participation measures, and the Athletic Coping Skills Inventory-28 (ACSI-28) in youth athletes during rehabilitation following anterior cruciate ligament reconstruction (ACLR).

Methods

A retrospective review was completed of patients who underwent ACLR at a sports medicine clinic between October 2019 and May 2021. Patients responded to a series of patient reported outcomes (PROs) regarding physical and psychological function at a pre-surgical baseline and after 1 year of rehabilitation. Patients were then divided into groups of high/low AIMS and an increased/decreased AIMS between 1 year and baseline for comparison. Independent samples t-tests and ANOVAs were performed as appropriate with a 95% confidence interval.

Results

In the final sample, 87 patients (15.3 ± 1.8 years) were included, with 51.7% being females. Total AIMS scores decreased from 50.3 to 47.5 over rehabilitation (p = 0.019). Furthermore, results indicated that nearly all AIMS scores decreased during rehabilitation, with none showing an increase; however, not all domains were significant. Conversely, all sport participation and coping ability PROs increased over time points except for ACSI-Confidence and Achievement Motivation. Generally, those in the groups with high AIMS and an increase in AIMS also had higher scores in physical function and coping ability PROs, with the groups separated by high/low AIMS exhibiting more frequent statistical significance.

Discussion

Given these results, it appears that athletes may lose identification with the athlete role after ACLR and struggle even 1 year for rehabilitation, but those who recover athletic identity the best may also be those able to cope most effectively with the stressors induced by injury.

Mental Health in the Specialized Athlete

PURPOSE OF REVIEW

The aim of this review is to interpret the existing evidence regarding the psychological aspects of sport specialization within the context of a developmental framework.

RECENT FINDINGS

The growing trend toward early sport specialization is associated with increased risk for injury and burnout, both of which have significant implications for mental health. Mental health literacy programs designed to promote awareness, decrease stigma, and encourage help-seeking behaviors can be an effective way to increase resilience and early recognition of those in need. The trend toward early sport specialization is likely motivated in large part by the expectation that it will increase the likelihood of long-term athletic success. However, recent studies suggest that the majority of elite athletes delay specialization at least until mid to late adolescence. It is essential to consider the developmental psychology of children and adolescents and to avoid imposing expectations that are beyond their neurocognitive capabilities. In addition to depression, anxiety, and burnout, young athletes who are pressured to perform to excessively high standards are likely to internalize athletic failures as feelings of shame. This can lead to maladaptive perfectionistic traits and potentially overtraining, clinical eating disorders, or other harmful behaviors that will result in declines in performance, physical health, and overall wellbeing. Further work is needed to better inform sport-specific recommendations regarding sport specialization and to optimize the beneficial effects of sport participation while limiting the risks of harm.