Christine Baugh, PhD, MPH, assistant professor of medicine at the University of Colorado School of Medicine and member of the CU Center for Bioethics and Humanities, is the corresponding author of the article, “Accuracy of US College Football Players’ Estimates of Their Risk of Concussion or Injury.”
Baugh and co-authors report on survey results of 296 college football players from four teams in the Power 5 Conferences of the National Collegiate Athletic Association. Athletes were surveyed in 2017. The researchers found that between 43 percent and 91 percent of respondents underestimated their risk of injury and between 42 percent and 63 percent underestimated their risk of concussion.
To measure the accuracy of football players’ risk estimations, the researchers modeled individual athletes’ probabilities of sustaining a concussion or injury and compared model estimates to athlete perceptions. While recognizing that many people underestimate health risks, the authors point out that the risks college football athletes face may be more severe or debilitating than those faced by many in the general population. Given this elevated risk profile, they say it is concerning that athletes tend to underestimate the likelihood of these risks. These results raise questions about informed consent and how much risk should be acceptable in the context of a game, Baugh and her co-authors write.
“That athletes underestimated their risk of concussion and injury in this study raises important ethical considerations,” Baugh and her colleagues write. “What is the threshold for college athletes to be sufficiently informed of the risks and benefits of football to make decisions that align with their values and preferences?”
In addition to Baugh, four co-authors are listed. Those authors are affiliated with the University of Washington, the Seattle Children’s Research Institute, Boston Children’s Hospital, and Harvard Medical School, where Baugh completed a Post-Doctoral Fellowship in Mental Health Policy prior to joining the CU School of Medicine.
Being able to exercise without pain or injury: it’s every athlete’s dream as well as the goal of RunEASI, a new spin-off of KU Leuven. RunEASI’s wearable measures the impact experienced by runners and provides scientific feedback that can help them avoid and recover from injuries. The spin-off is supported by the Gemma Frisius Fund and the Freshmen investment fund.
Runners typically use a heart rate monitor, but this device does not offer insight into how the body responds to the impact caused by the feet landing on the ground. And yet, this impact is precisely what determines the risk of injuries. RunEASI – which originated from a collaboration between movement and computer scientists at KU Leuven – has therefore developed a wearable application that does assess these important parameters.
This is achieved using a sensor that is attached to the lower back with a belt and is connected to an app. The sensors measures the impact on the body while running and detects any movement compensations that may occur. The app provides feedback to improve the running pattern. RunEASI is the first application that can perform such an analysis and intervention in a scientifically validated and efficient way. The application will be available on the market as of mid-February 2021.
Stability, symmetry, impact
“We are trying to establish the link between the way in which someone runs, the associated impact loads, and the risk of injuries,” says Professor Benedicte Vanwanseele from the Human Movement Biomechanics unit at KU Leuven. “Three parameters are key to this: stability, symmetry, and impact.”
“Research has shown that trunk instability increases with a runner’s fatigue level. When this is combined with high impact loads, this creates a compensatory pattern that increases the risk of overuse injuries. Symmetry shows whether the impact is equally divided between left and right: after an injury, for instance, a runner may favour one leg without realising it. Last, but not least, the impact parameter shows how the body responds to the shocks that occur when the foot strikes the ground.”
“Our tool intervenes when the data show that the runner has a harmful running pattern,” says computer science professor Jesse Davis. “AI allows us to analyse when the body is exposed to the most severe impacts. This can depend on the surface, the pace, the duration of the training, the runner’s fatigue, and other factors. On the basis of this analysis, coaches and physiotherapists can proactively adjust the runners’ training.”
More insight and better support
“With RunEASI we want to help runners, whether it be professional or recreational ones, to achieve their goals with less risk of injury,” explain co-founders Kurt Schütte (CEO) and Tim Op De Beéck (CTO). “The way our sensor is attached is unique and was developed in cooperation with the orthopaedic experts at Steunzoolpunt. It enables us to measure our new movement metrics very efficiently and accurately. Physiotherapists can use this scientific analysis to better assess when someone is ready to resume training after an injury.”
“We strongly believe in digital tools that improve a person’s quality of life, and this ambition is also reflected in RunEASI,” says Steven Spittaels of the Freshmen investment fund. “It’s an application that, thanks to its scientific feedback, can be of great added value to runners and professional healthcare providers. Athletes obviously want to know how to stay injury free and we want to support RunEASI to help them achieve this.”
“We are extremely grateful for the belief and financial support of the Gemma Frisius Fund and Freshmen Fund,” responds CEO Kurt Schütte. “With their support, we can fulfil our mission and ambition to make the world run better.”
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More information
The RunEASI wearable can be pre-ordered and will be available as of mid-February 2021. Check the website for further information: runeasi.ai
PULLMAN, Wash. – States with college teams in strong conferences, in particular the Southeastern Conference (SEC), were among the last to take up regulations on youth concussions, according to a recent study. The study, which investigated the association between youth sport participation and passage of concussion legislation, uncovered the importance of SEC affiliation, and found a similar connection in states with high rates of high school football participation.
In contrast, states with higher gender equality, measured by the number of women in the labor force, were early adopters.
Washington State University sociologists Thomas Rotolo and Michael Lengefeld, a recent WSU Ph.D. now at Goucher College, analyzed the wave of youth concussion laws from 2007 to 2014, specifically looking at return-to-play guidelines: a mandated 24-hour wait period before sending a player with a possible concussion back on to the field.
“We explored a lot of different ways of measuring college football presence, and the thing that just kept standing out was SEC membership,” said Rotolo, the lead author on the study published in the journal Social Science & Medicine. “Every college town thinks they have a strong college football presence, but the SEC is a very unique conference.”
Co-author Lengefeld, a former high school football player from Texas, knows first-hand how important the sport is throughout the South, but the data showed a specific correlation between resistance to youth concussion regulations among SEC states in particular.
“This SEC variable was similar to the South effect, but not all southern states have an SEC school–and in SEC states the resistance to concussion laws was a bit stronger,” he said.
Lengefeld added that the SEC also stands out since it has the largest number of viewers and brings in more profits than any other conference.
Scientists have known for more than a century that youth concussions were a serious health issue, but the movement to create concussion health policies for youth sports did not gain any ground until a Washington state middle school player was badly injured. In 2006, Zackery Lystedt was permanently disabled after being sent back onto the field following a concussion. The Seattle Seahawks took up the cause in the state, followed by the NFL which took the issue nationwide.
Even though the NFL advocated for youth concussion policy changes, the states responded differently. Washington state, Oregon and New Mexico were among the first to adopt the new return-to-play guidelines, while states like Georgia and Mississippi were among the last.
“There’s clearly something culturally going on that was different in those states,” said Lengefeld.
The researchers also investigated the role of gender equity in concussion adoption since football is often viewed as hyper-masculine. They used women’s participation in the labor market as a rough indicator of a state’s gender egalitarian views and found a statistically significant difference showing that states with higher levels of women’s labor market participation enacted the concussion legislation more quickly.
Lengefeld said the methodology they used in this study can also be applied to analyze how many other health policies are enacted across different states.
“As we were submitting this research for publication, COVID-19 was just starting, and we noticed all the differences in the way states are behaving,” Lengefeld said. “It’s not new for sociologists to study the diffusion of laws at the state level, but this is another way of doing that that incorporates a set of ideas about culture.”
OAK BROOK, Ill. — Racket sports like tennis and racquetball appear to accelerate knee joint degeneration in overweight people with osteoarthritis, according to a study being presented at the annual meeting of the Radiological Society of North America (RSNA).
Knee joint osteoarthritis, a gradual wearing down of the protective cartilage that cushions the ends of the bones, is a major cause of pain and disability worldwide, affecting approximately 14 million people in the U.S. alone. Excess body weight is a major risk factor.
Physical activity offers a host of benefits for people who are overweight, but the wrong type of exercise could potentially damage knee joints and hasten the need for knee replacement surgery. The effects of different types of exercise on overweight people have seldom been studied with MRI, the most sensitive imaging method for assessing structural changes to the knee joint.
For the new study, researchers used high-powered MRI to assess the rate of degeneration of the knee joint in 415 overweight and/or obese patients, average age 59, drawn from the Osteoarthritis Initiative, a National Institutes of Health-supported study of individuals with mild to moderate osteoarthritis.
Study participants kept detailed records of their participation in six different types of physical activity, including ball sports, bicycling, jogging/running, elliptical trainer, racket sports and swimming. The researchers performed baseline MRIs and then measured changes in the patients’ knees over four years using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). A higher score indicates more degeneration.
Patients regularly participating in racket sports saw their overall WORMS score increase significantly, compared to patients regularly using the elliptical trainer over the study period. Surprisingly, the overall WORMS score also increased significantly in the racket sports group compared to the jogging/running group. Racket sports participants saw significantly greater degeneration in the medial tibial cartilage compartment, the compartment on the inside of the knee where arthritis often first appears.
Participants using the elliptical trainer showed the smallest changes in structural degeneration over four years.
“In our study, progression of overall knee joint degeneration was consistently higher in overweight and/or obese patients engaging in racket sports,” said the study’s lead author Silvia Schirò, M.D., from the University of California San Francisco and the University of Parma in Parma, Italy. “We also found that workouts using an elliptical trainer were associated with reduced progression of overall knee joint and cartilage defects. Moreover, our findings showed that when comparing different low impact activities with each other, such as bicycling, elliptical trainer and swimming, the elliptical trainer was associated with the lowest increase in WORMS sub-scores over 48 months.”
The more rapid degeneration of the knee joints in people who participated in racket sports is likely due to the high-speed lateral movements inherent to such sports, Dr. Schirò said. These movements can affect the femoral-tibia compartment, a structure in the knee made up of the femur condyle, the rounded end of the thighbone that helps it slide over the tibia, or shinbone, and the meniscus, the rubbery, C-shaped cartilage between the thighbone and the shinbone.
“A large lateral force imparted at the foot during side-to-side movements may be driving large knee adduction moments, a key feature in medial compartment disease, which imparts high compressive loads on the medial tibia and femoral condyle,” she said. “In support of this premise, the racket sports group showed elevated cartilage degeneration in the medial tibia.”
The researchers theorize that joint mechanics are impaired in overweight and obese individuals, with a harmful joint overload triggering increased contact stress on the meniscus. Damage to the meniscus compromises the protective cushion on the cartilage of the knee.
“High impact physical activity with elevated load and high shear forces may trigger and accelerate this process,” Dr. Schirò said. “Moreover, participants who played racket sports showed significantly more meniscal degeneration when compared to the remainder of the study group.”
The data suggests that overweight individuals who continue to play racket sports could slow degeneration in their knees by making modifications to their activities, such as switching to sports with less fast-paced and high shear loads like badminton or doubles tennis.
However, Dr. Schirò emphasized that the degenerative process is complex and individual joint mechanics are highly variable.
“It is possible that some individuals with sufficient strength and motor control may be able to safely play these sports,” she said. “Our data suggests that as a group, though, overweight and obese individuals who play racket sports are at higher risk for disease progression.”
Co-authors are Sarah C. Foreman, M.D., Magdalena Posadzy, M.D., Gabby B. Joseph, Nicola Sverzellati, M.D., Richard B. Souza, Ph.D., Charles E. McCulloch, Michael C. Nevitt, Ph.D., and Thomas M. Link, M.D., Ph.D.
Some of the elites runners were tested at Exeter Arena
Press Release:
Elite runners need a specific combination of physiological abilities to have any chance of running a sub-two-hour marathon, new research shows.
The study is based on detailed testing of athletes who took part in Nike’s Breaking2 project – an ambitious bid to break the two-hour barrier.
Professor Andrew Jones, of the University of Exeter, said the findings reveal that elite marathon runners must have a “perfect balance” of VO2 max (rate of oxygen uptake), efficiency of movement and a high “lactate turn point” (above which the body experiences more fatigue).
The VO2 measured among elite runners shows they can take in oxygen twice as fast at marathon pace as a “normal” person of the same age could while sprinting flat-out.
“Some of the results – particularly the VO2 max – were not actually as high as we expected,” Professor Jones said.
“Instead, what we see in the physiology of these runners is a perfect balance of characteristics for marathon performance.
“The requirements of a two-hour marathon have been extensively debated, but the actual physiological demands have never been reported before.”
The runners in the study included Eliud Kipchoge, who took part in Breaking2 – falling just short of the two-hour target – but later achieving the goal in 1:59:40.2 in the Ineos 1:59 challenge.
Based on outdoor running tests on 16 athletes in the selection stage of Breaking2, the study found that a 59kg runner would need to take in about four litres of oxygen per minute (or 67ml per kg of weight per minute) to maintain two-hour marathon pace (21.1 km/h).
“To run for two hours at this speed, athletes must maintain what we call ‘steady-state’ VO2,” Professor Jones said.
“This means they meet their entire energy needs aerobically (from oxygen) – rather than relying on anaerobic respiration, which depletes carbohydrate stores in the muscles and leads to more rapid fatigue.”
In addition to VO2 max, the second key characteristic is running “economy”, meaning the body must use oxygen efficiently – both internally and through an effective running action.
The third trait, lactate turn point, is the percentage of VO2 max a runner can sustain before anaerobic respiration begins.
“If and when this happens, carbohydrates in the muscles are used at a high rate, depleting glycogen stores,” Professor Jones explained.
“At this point – which many marathon runners may know as ‘the wall’ – the body has to switch to burning fat, which is less efficient and ultimately means the runner slows down.
“The runners we studied – 15 of the 16 from East Africa – seem to know intuitively how to run just below their ‘critical speed’, close to the ‘lactate turn point’ but never exceeding it.
“This is especially challenging because – even for elite runners – the turn point drops slightly over the course of a marathon.
“Having said that, we suspect that the very best runners in this group, especially Eliud Kipchoge, show remarkable fatigue resistance.”
The testing, conducted in Exeter and at Nike’s performance centre in Oregon, USA, provided a surprising experience for a group of amateur runners in the UK.
“We tested 11 of the 16 runners at Exeter Arena a few years ago,” Professor Jones said.
“Some local runners were there at the time, and it was a real eye-opener for them when a group of the world’s best athletes turned up.
“The elite runners were great – they even joined in with the local runners and helped to pace their training.”
