Sports Science Research Update

March 2021
Age of first exposure of football is not associated with midlife brain health problems. Journal
of Neurotrauma, 38: 538-545, 2021.
Caffeine use or napping to enhance repeated sprint performance after partial sleep
deprivation: Why not both? International Journal of Sports Physiology and Performance,
Ahead of Print: 1-8, 2021.
Common questions and misconceptions about creatine supplementation: What does the
scientific evidence really show? Journal of the International Society of Sports Nutrition, 18: 1-
17, 2021.
Decreased performance and return to play following anterior cruciate ligament
reconstruction in National Football league wide receivers. Arthroscopy, Sports Medicine,
Rehabilitation, Ahead of Print: 1-7, 2021.
Eccentric knee flexor strength of professional football players with and without hamstring
injury in the prior season. European Journal of Sport Science, 21(1): 131-139, 2021.
Eccentric strength assessment of hamstring muscles with new technologies: A systematic
review of current methods and clinical implications. Sports Medicine – Open, 7(10): 1-15,
2021.
Hamstrings neuromuscular function after anterior cruciate ligament reconstruction: A
systematic review and meta-analysis. Sports Medicine, Ahead of Print: 1-19, 2021.
Improving the Game: The Football Players Health Study at Harvard University and the 202
NFL-NFLPA Collective Bargaining Agreement. Journal of Sports and Entertainment Law:
Harvard Law School, 12: 1-68, 2021.
Lower limb muscle injury location shift from posterior lower leg to hamstring muscles with
increasing discipline-related running velocity in international athletics championships.
Journal of Science and Medicine in Sport. Ahead of Print: 1-7, 2021.

Sports Science Research Update

Sports Science Research Update
Maximum strength, relative strength, and strength deficit: Relationships with performance
and differences between elite sprinters and professional Rugby Union players. International
Journal of Sports Physiology and Performance, Ahead of Print: 1-6, 2021.
Nutritional factors in sport-related concussion. Neurochirurgie, Ahead of Print: 1-4, 2021.
Opportunities for prevention of concussion and repetitive head impact exposure in college
football players: A Concussion Assessment, Research, and Education (CARE) Consortium
Study. JAMA Neurology, 1-5, Feb. 1, 2021.
Optimal training sequences to develop lower body force, velocity, power, and jump height: A
systematic review with meta-analysis. Sports Medicine, Ahead of Print: 1-27, 2021.
Relationship between training load and recovery in collegiate American football players
during pre-season training. Science and Medicine in Football, Ahead of Print: 1-10, 2021.
Should we base training prescription on the force-velocity profile? Exploratory study of its
between-day reliability and differences between methods. International Journal of Sports
Physiology and Performance, Ahead of Print: 1-7, 2021.
Sleep quality and athletic performance according to chronotype. BMC Sports Science,
Medicine, and Rehabilitation, 13(2): 1-7, 2021.
The association between poor sleep and the incidence of sport and physical training-related
injuries in adult athletic populations: A systematic review. Sports Medicine, Ahead of Print:
1-17, 2021.
The potential role of exercise-induced muscle damage in exertional heat stroke. Sports
Medicine, Ahead of Print: 1-10, 2021.

Sports Science Research Update

Sports Science Research Update
Age of first exposure of football is not associated with midlife brain health
problems. Journal of Neurotrauma, 38: 538-545, 2021.
Abstract: The purpose of this study was to determine if earlier age of first exposure (AFE) to football is
associated with worse brain health in middle-aged men who played high school football. We assessed
123 men 35–55 years of age, who played high school football, using (1) a survey of demographic
information as well as medical, sport participation, and concussion history; (2) the Patient Health
Questionnaire-8 (PHQ-8); and (3) the British Columbia Post-Concussion Symptom Inventory (BC-PSI).
Sixty-two (50.4%) men reported football participation starting before the age of 12 (i.e., AFE 12 years).
Compared with those with AFE >12 years, a similar proportion of former high school football players
who began playing tackle football before age 12 reported that they had been prescribed medications for
mental health problems or that they had recently experienced symptoms of anxiety, depression,
memory loss, chronic pain, or headaches. Moreover, there was no significant difference in their lifetime
history of treatment by a mental health professional. The groups did not differ significantly on PHQ-8 (U
= 1839.0, p = 0.791) or BC PSI total scores (U = 1828.5, p = 0.751). These findings suggest that earlier
AFE to football is not associated with worse brain health in middle-aged men in this sample who played
high school football.

Sports Science Research Update

Sports Science Research Update
Caffeine use or napping to enhance repeated sprint performance after partial
sleep deprivation: Why not both? International Journal of Sports Physiology
and Performance, Ahead of Print: 1-8, 2021.
Purpose: To compare the effect of a 20-minute nap opportunity (N20), a moderate dose of caffeine
(CAF; 5 mg·kg−1 ), or a moderate dose of caffeine before N20 (CAF+N) as possible countermeasures to
the decreased performance and the partial sleep deprivation–induced muscle damage.

Methods: Nine male, highly trained judokas were randomly assigned to either baseline normal sleep
night, placebo, N20, CAF, or CAF+N. Test sessions included the running-based anaerobic sprint test, from
which the maximum (Pmax), mean (Pmean), and minimum (Pmin) powers were calculated. Biomarkers
of muscle, hepatic, and cardiac damage and of enzymatic and nonenzymatic antioxidants were
measured at rest and after the exercise.

Results: N20 increased Pmax compared with placebo (P < .01, d = 0.75). CAF+N increased Pmax (P <
.001, d = 1.5; d = 0.94), Pmin (P < .001, d = 2.79; d = 2.6), and Pmean (P < .001, d = 1.93; d = 1.79)
compared with placebo and CAF, respectively. Postexercise creatine kinase increased whenever caffeine
was added, that is, after CAF (P < .001, d = 1.19) and CAF+N (P < .001, d = 1.36). Postexercise uric acid
increased whenever participants napped, that is, after N20 (P < .001, d = 2.19) and CAF+N (P < .001, d =
2.50) and decreased after CAF (P < .001, d = 2.96).

Conclusion: Napping improved repeated-sprint performance and antioxidant defense after partial sleep
deprivation. Contrarily, caffeine increased muscle damage without improving performance. For sleep-
deprived athletes, caffeine before a short nap opportunity would be more beneficial for repeated sprint
performance than each treatment alone.

Sports Science Research Update

Sports Science Research Update
Common questions and misconceptions about creatine supplementation: What
does the scientific evidence really show? Journal of the International Society of
Sports Nutrition, 18: 1-17, 2021.
Abstract: Supplementing with creatine is very popular amongst athletes and exercising individuals for
improving muscle mass, performance and recovery. Accumulating evidence also suggests that creatine
supplementation produces a variety of beneficial effects in older and patient populations. Furthermore,
evidence-based research shows that creatine supplementation is relatively well tolerated, especially at
recommended dosages (i.e. 3-5 g/day or 0.1 g/kg of body mass/day). Although there are over 500 peer-
refereed publications involving creatine supplementation, it is somewhat surprising that questions
regarding the efficacy and safety of creatine still remain. These include, but are not limited to: 1. Does
creatine lead to water retention? 2. Is creatine an anabolic steroid? 3. Does creatine cause kidney
damage/renal dysfunction? 4. Does creatine cause hair loss / baldness? 5. Does creatine lead to
dehydration and muscle cramping? 6. Is creatine harmful for children and adolescents? 7. Does creatine
increase fat mass? 8. Is a creatine ‘loading-phase’ required? 9. Is creatine beneficial for older adults? 10.
Is creatine only useful for resistance / power type activities? 11. Is creatine only effective for males? 12.
Are other forms of creatine similar or superior to monohydrate and is creatine stable in
solutions/beverages? To answer these questions, an internationally renowned team of research experts
was formed to perform an evidence-based scientific evaluation of the literature regarding creatine
supplementation.

Sports Science Research Update

Sports Science Research Update
Decreased performance and return to play following anterior cruciate ligament
reconstruction in National Football league wide receivers. Arthroscopy, Sports
Medicine, Rehabilitation, Ahead of Print: 1-7, 2021.
Purpose: To identify the time to return to play (RTP) and evaluate the performance level in wide
receivers in the National Football League following anterior cruciate ligament (ACL) reconstruction.

Methods: A total of 29 wide receivers in the National Football League who underwent ACL
reconstruction between 2013 and 2017 who met inclusion criteria were retrospectively identified and
reviewed. For each player, a matched control with similar demographics was identified to compare
various in-game performance measurements and seasons played.

Results: Of the wide receivers that met the inclusion criteria, 9 of 29 (31%) did not RTP in a regular
season game following ACL reconstruction. For players who did RTP, 20 of 29 (69%), the average time
was 10.9 months (331.4 ± 41.6 days). When we compared the tear group with the matched control
cohort, players with ACL tears ended their careers on an average of 1.9 seasons earlier (2.2 vs 4.1
seasons, P < .001) and also played less than half the number of games (25.5 vs 56.6 games, P = .001),
respectively. Those that RTP also saw decreased performance statistics in targets (353.6 vs 125.2 P <
.001), receptions (208.0 vs 74.4, P = .001), receiving yards (2691.0 vs 987.9, P = .001), and touchdowns
(17.4 vs 6.2, P = .002).

Conclusions: Sixty-nine percent of wide receivers who underwent ACL reconstruction were able to RTP
at an average of 10.9 months, or 331.4 days. Despite the majority of players being able to RTP, there
was a significant decrease in both statistical performance and career duration.

Level of Evidence: Level III, case-control study.

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Sports Science Research Update
Eccentric knee flexor strength of professional football players with and without
hamstring injury in the prior season. European Journal of Sport Science, 21(1):
131-139, 2021.
Abstract: Both injury history and eccentric knee flexor strength have been associated with risk of
football players sustaining hamstring strain injury (HSI). However, it remains unclear whether football
players who sustained HSIs in the prior season present persistent eccentric strength deficits. Therefore,
the aim of the present study was to verify the eccentric knee flexor strength of professional male
football players with and without history of HSI in the prior season. This case–control study assessed 210
professional male football players from 10 Brazilian clubs: 182 included in the control group and 28 in
the previously injured group. Players from the injured group had suffered unilateral HSI in the prior
season. We measured the knee flexors peak force during the Nordic hamstring exercise and calculated
the between-limb asymmetry. Groups were similar for age, body mass and height (p > 0.05). Control
group had similar strength values between left and right limbs (376.29 ± 61.77 N vs. 380.28 ± 61.77 N; p
= 0.27; d = 0.06), while the previously injured limb was weaker than the contralateral uninjured limb in
the injured group (350.87 ± 60.79 N vs. 385.75 ± 63.49 N; p < 0.01; d = 0.56). Thirty-seven percent of
players in the control group and 50% in the injured group presented between-limb asymmetry >10%.
This study demonstrates that players with history of HSI in the prior season present reduced eccentric
knee flexor strength in the injured limb, but half of them have between-limb asymmetry within the most
commonly adopted benchmark value of 10%.

Highlights

• Professional football players with unilateral HSI in the prior season present eccentric strength
deficit.
• Half of players with HSI in the prior season present between-limb strength asymmetry <10%.

Sports Science Research Update

Sports Science Research Update
Eccentric strength assessment of hamstring muscles with new technologies: A
systematic review of current methods and clinical implications. Sports Medicine
– Open, 7(10): 1-15, 2021.
Background: Given the severe economic and performance implications of hamstring injuries, there are
different attempts to identify their risk factors for subsequently developing injury prevention strategies
to reduce the risk of these injuries. One of the strategies reported in the scientific literature is the
application of interventions with eccentric exercises. To verify the effectiveness of these interventions,
different eccentric strength measurements have been used with low-cost devices as alternatives to the
widespread used isokinetic dynamometers and the technically limited handheld dynamometers.
Therefore, the purpose of the present systematic review was to summarize the findings of the scientific
literature related to the evaluation of eccentric strength of hamstring muscles with these new
technologies.

Methods: Systematic searches through the PubMed, Scopus, and Web of Science databases, from
inception up to April 2020, were conducted for peer reviewed articles written in English, reporting
eccentric strength of hamstrings assessed by devices, different to isokinetic and handheld
dynamometers, in athletes.

Results: Seventeen studies were finally included in the review with 4 different devices used and 18
parameters identified. The pooled sample consisted of 2893 participants (97% male and 3% female: 22 ±
4 years). The parameters most used were peak force (highest and average), peak torque (average and
highest), and between-limb imbalance (left-to-right limb ratio). There is inconsistency regarding the
association between eccentric hamstrings strength and both injury risk and athletic performance. There
is no standardized definition or standardization of the calculation of the used parameters.

Conclusions: The current evidence is insufficient to recommend a practical guide for sports professionals
to use these new technologies in their daily routine, due to the need for standardized definitions and
calculations. Furthermore, more studies with female athletes are warranted. Despite these limitations,
the eccentric strength of hamstring muscles assessed by different devices may be recommended for
monitoring the neuromuscular status of athletes.

Key Points

• Eccentric hamstrings strength using 4 different devices was evaluated with 18 different
parameters after 3-to-6 trials performed unilaterally or bilaterally. Peak force, peak torque, and
between-limb imbalance were the most used parameters.

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Sports Science Research Update
• Eccentric strength hamstring assessed by different devices can be a useful tool for monitoring
neuromuscular status of athletes in laboratory and field settings. The assessments should be
performed bilaterally with the average of 6 trials.
• There is a need of consensus for identifying the best procedures, definitions, and calculations for
evaluation of the eccentric strength of hamstrings in different sport settings.

Sports Science Research Update

Sports Science Research Update
Hamstrings neuromuscular function after anterior cruciate ligament
reconstruction: A systematic review and meta-analysis. Sports Medicine, Ahead
of Print: 1-19, 2021.
Background: Hamstrings neuromuscular function is a crucial component of functional movement, and
changes after anterior cruciate ligament (ACL) injury contribute to risk factors for secondary injury and
long-term sequelae. To effectively treat muscular impairments, an accurate understanding of hamstrings
neuromuscular function in patients with ACL reconstruction (ACLR) is needed.

Objective: A systematic review and meta-analysis were undertaken to describe and quantify hamstrings
neuromuscular function in individuals with ACLR compared to controls.

Methods: We searched PubMed, Web of Science, SPORTDiscus, CINAHL, and EBSCOhost databases in
October of 2020 for studies evaluating the difference between hamstrings electromyography (EMG)
between individuals with ACLR and controls. Two independent reviewers assessed each paper for
inclusion and quality. Means and standard deviations were extracted from each included study to allow
random-effect size (ES) meta-analysis calculations for comparison of results.

Results: Thirty-four studies were included for final review. From these, 5 categories of neuromuscular
outcomes were identified, and studies were grouped accordingly: (1) muscle activation levels (EMG
amplitude), (2) co-activation, (3) onset timing, (4) electromechanical delay, and (5) time-to-peak activity.
Moderate to strong evidence indicates that individuals with ACLR demonstrate higher hamstrings EMG
amplitude (normalized to % maximum voluntary isometric contraction) and hamstrings-to-quadriceps
co-activation during gait and stair ambulation compared to controls. In addition, there was moderate
evidence of longer electromechanical delay during knee flexion and greater hamstrings-to-quadriceps
co-activation during knee extension compared to controls.

Conclusions: Greater hamstrings EMG amplitude and co-activation during gait and ambulation tasks and
longer electromechanical delay of the hamstrings in individuals with ACLR align with clinical impairments
following ACLR and have implications for re-injury risk and long-term joint health, thus warranting
attention in rehabilitation.

Key Points

• Compared to controls, individuals with ACLR demonstrate greater hamstrings EMG amplitude
(normalized to activity during MVIC) and hamstrings-to-quadriceps co-activation during gait and
stair-related tasks.

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Sports Science Research Update
• Individuals with ACLR demonstrated longer electromechanical delay of the hamstrings during
knee flexion and greater hamstrings-to-quadriceps co-activation during knee extension
compared to controls.
• Overall, these results align with known clinical impairments following ACLR with implications for
re-injury risk and long-term joint health, thus warranting attention in rehabilitation.

Sports Science Research Update

Sports Science Research Update
Improving the Game: The Football Players Health Study at Harvard University
and the 202 NFL-NFLPA Collective Bargaining Agreement. Journal of Sports and
Entertainment Law: Harvard Law School, 12: 1-68, 2021.
This Article examines the connections between player health and safety provisions in
the 2020 NFL-NFLPA collective bargaining agreement (“CBA”) and research conducted, and
recommendations made, by the Football Players Health Study at Harvard (“FPHS”). More
specifically, between 2016 and 2019, the Law and Ethics Initiative of FPHS produced eight
publications “with the primary goal of understanding the legal and ethical issues that may
promote or impede player health and developing appropriate responsive recommendations.”
The Law and Ethics Initiative’s work, among other things, analyzed the legal and ethical
obligations of stakeholders in NFL player health; scrutinized the structure of club medical staffs;
compared the NFL’s health-related policies and practices to those of other sports leagues;
evaluated the application of the Americans with Disabilities Act, Genetic Information
Nondiscrimination Act, and Occupational Safety and Health Act to the NFL workplace; and
assessed challenges players face concerning mental health and transitioning out of the NFL.
The 2020 CBA responded to the Law and Ethics Initiative’s work in many ways, including
occasionally adopting wholesale some of its recommendations. This result is not surprising
given that the Law and Ethics Initiative regularly engaged with the NFL, NFLPA, and other
stakeholders during its work. The parties also made other changes to health and safety
provisions not discussed in FPHS work. Nevertheless, the NFL and NFLPA have still failed to
meaningfully address one of the principal legal and ethical issues concerning player health: the
conflicted structure in which club medical staff provide services to both players and the clubs.
Indeed, the NFL and NFLPA have yet to articulate a coherent response to the Law and Ethics
Initiative’s extensive analysis of, and recommendation toward, this issue. Consequently, while
the 2020 CBA represents important progress on player health and safety issues, there is still
work to be done.

Sports Science Research Update

Sports Science Research Update
Lower limb muscle injury location shift from posterior lower leg to hamstring
muscles with increasing discipline-related running velocity in international
athletics championships. Journal of Science and Medicine in Sport. Ahead of
Print: 1-7, 2021.
Objective: To analyze the rates of lower limb muscle injuries in athletics disciplines requiring different
running velocities during international athletics championships. Design: Prospective total population
study.

Methods: During 13 international athletics championships (2009–2019) national medical teams and
local organizing committee physicians daily reported all newly incurred injuries using the same study
design, injury definition and data collection procedures. In-competition lower limb muscle injuries of
athletes participating in disciplines involving running (i.e. sprints, hurdles, jumps, combined events,
middle distances, long distances, and marathon) were analyzed.

Results: Among the 12,233 registered athletes, 344 in-competition lower limb muscle injuries were
reported (36% of all in-competition injuries). The proportion, incidence rates and injury burden of lower
limb muscles injuries differed between disciplines for female and male athletes. The most frequently
injured muscle group was hamstring in sprints, hurdles, jumps, combined events and male middle
distances runners (43–75%), and posterior lower leg in female middle distances, male long distances,
and female marathon runners (44–60%). Hamstring muscles injuries led to the highest burden in all
disciplines, except for female middle distance and marathon and male long-distance runners. Hamstring
muscles injury burden was generally higher in disciplines requiring higher running velocities, and
posterior lower leg muscle injuries higher in disciplines requiring lower running velocities.

Conclusions: The present study shows discipline-specific injury location in competition context. Our
findings suggest that the running velocity could be one of the factors that play a role in the
occurrence/location of muscle injuries.

Sports Science Research Update

Sports Science Research Update
Maximum strength, relative strength, and strength deficit: Relationships with
performance and differences between elite sprinters and professional Rugby
Union players. International Journal of Sports Physiology and Performance,
Ahead of Print: 1-6, 2021.
Purpose: To test the relationships between maximum and relative strength (MS and RS), absolute and
relative peak force (PF and RPF), and strength deficit (SDef), with sprint and jump performance, and to
compare these mechanical variables between elite sprinters and professional rugby union players.

Methods: Thirty-five male rugby union players and 30 male sprinters performed vertical jumps, 30-m
sprint, and half-squat 1-repetition maximum (1RM), where these force-related parameters were
collected. Pearson correlation coefficients were used to test the relationships between the variables. An
independent t test and magnitude based inferences compared the mechanical variables between
sprinters and rugby players.

Results: Almost certain significant differences were observed for jump and sprint performance between
groups (P < .0001). The rugby union players demonstrated a likely significant higher MS (P = .03) but a
very likely lower RS (P = .007) than the sprinters. No significant differences were observed for PF
between them. The sprinters exhibited an almost certain significant higher RPF than the rugby players (P
< .0001). Furthermore, the rugby players demonstrated almost certain to likely significant higher SDef
from 40% to 70% 1RM (P < .05) compared with the sprinters. Overall, all strength-derived parameters
were significantly related to functional performance.

Conclusions: Elite sprinters present higher levels of RS and RPF, lower levels of SDef, and better sprint
and jump performance than professional rugby players. Relative strength-derived values (RS and RPF)
and SDef are significantly associated with speed–power measures and may be used as effective and
practical indicators of athletic performance.

Sports Science Research Update

Sports Science Research Update
Nutritional factors in sport-related concussion. Neurochirurgie, Ahead of Print:
1-4, 2021.
Background: Sports concussion is a major problem that affects thousands of people every year.
Concussion-related neurometabolic changes are thought to underlie neurophysiological alterations and
post-concussion symptoms, such as headaches and sensitivity to light and noise, disabilities of
concentration and tiredness. The injury triggers a complex neurometabolic cascade involving multiple
mechanisms. There are pharmaceutical treatments that target one mechanism, but specific nutrients
have been found to impact several pathways, thus offering a broader approach. This has prompted
intensive research into the use of nutrient supplements as a concussion prevention and treatment
strategy.

Method: We realized a bibliographic state of art providing a contemporary clinical and preclinical
studies dealing with nutritional factors in sport-related concussion.

Results: Numerous supplements, including n-3 polyunsaturated fatty acids, sulfur amino acids,
antioxidants and minerals, have shown promising results as aids to concussion recovery or prevention in
animal studies, most of which use a fluid percussion technique to cause brain injury, and in a few human
studies of severe or moderate traumatic brain injury. Current ongoing human trials can hopefully
provide us with more information, in particular, on new options, i.e. probiotics, lactate or amino acids,
for the use of nutritional supplements for concussed athletes.

Conclusion: Nutritional supplementation has emerged as a potential strategy to prevent and/or reduce
the deleterious effects of sports-related concussion and subconcussive impacts.

Sports Science Research Update

Sports Science Research Update
Opportunities for prevention of concussion and repetitive head impact exposure
in college football players: A Concussion Assessment, Research, and Education
(CARE) Consortium Study. JAMA Neurology, 1-5, Feb. 1, 2021.
IMPORTANCE: Concussion ranks among the most common injuries in football. Beyond the risks of
concussion are growing concerns that repetitive head impact exposure (HIE) may increase risk for long-
term neurologic health problems in football players.

OBJECTIVE: To investigate the pattern of concussion incidence and HIE across the football season in
collegiate football players.

DESIGN, SETTING, AND PARTICIPANTS: In this observational cohort study conducted from 2015 to 2019
across 6 Division I National Collegiate Athletic Association (NCAA) football programs participating in the
Concussion Assessment, Research, and Education (CARE) Consortium, a total of 658 collegiate football
players were instrumented with the Head Impact Telemetry (HIT) System (46.5% of 1416 eligible
football players enrolled in the CARE Advanced Research Core). Players were prioritized for
instrumentation with the HIT System based on their level of participation (ie, starters prioritized over
reserves).

EXPOSURE: Participation in collegiate football games and practices from 2015 to 2019.

MAIN OUTCOMES AND MEASURES: Incidence of diagnosed concussion and HIE from the HIT System.

RESULTS: Across 5 seasons, 528 684 head impacts recorded from 658 players (all male, mean age [SD],
19.02 [1.25] years) instrumented with the HIT System during football practices or games met quality
standards for analysis. Players sustained a median of 415 (interquartile range [IQR], 190-727) recorded
head impacts (ie, impacts) per season. Sixty-eight players sustained a diagnosed concussion. In total,
48.5% of concussions (n = 33) occurred during preseason training, despite preseason representing only
20.8% of the football season (0.059 preseason vs 0.016 regular-season concussions per team per day;
mean difference, 0.042; 95% CI, 0.020-0.060; P = .001). Total HIE in the preseason occurred at twice the
proportion of the regular season (324.9 vs 162.4 impacts per team per day; mean difference, 162.6; 95%
CI, 110.9-214.3; P < .001). Every season, HIE per athlete was highest in August (preseason) (median,
146.0 impacts; IQR, 63.0-247.8) and lowest in November (median, 80.0 impacts; IQR, 35.0-148.0). Over 5
seasons, 72% of concussions (n = 49) (game proportion, 0.28; 95% CI, 0.18-0.40; P < .001) and 66.9% of
HIE (262.4 practices vs 137.2 games impacts per player; mean difference, 125.3; 95% CI, 110.0-140.6; P <
.001) occurred in practice. Even within the regular season, total HIE in practices (median, 175.0 impacts
per player per season; IQR, 76.0-340.5) was 84.2% higher than in games (median, 95.0 impacts per
player per season; IQR, 32.0-206.0).
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CONCLUSIONS AND RELEVANCE: Concussion incidence and HIE among college football players are
disproportionately higher in the preseason than regular season, and most concussions and HIE occur
during football practices, not games. These data point to a powerful opportunity for policy, education,
and other prevention strategies to make the greatest overall reduction in concussion incidence and HIE
in college football, particularly during preseason training and football practices throughout the season,
without major modification to game play. Strategies to prevent concussion and HIE have important
implications to protecting the safety and health of football players at all competitive levels.

Sports Science Research Update

Sports Science Research Update
Optimal training sequences to develop lower body force, velocity, power, and
jump height: A systematic review with meta-analysis. Sports Medicine, Ahead
of Print: 1-27, 2021.
Background: Resistance training has been used to enhance a range of athletic abilities through correct
manipulation of several variables such as training load, training volume, set configuration, and rest
period.

Objective: The aim of this systematic review and meta-analysis was to compare the acute and chronic
responses of lower body cluster, contrast, complex, and traditional training across a range of athletic
performance outcomes (1-repetition maximum squat strength, jump height, peak power, peak force,
peak velocity, and sprint time).

Methods: A database search was completed (SPORTDiscus, Medline and CINAHL) followed by a quality
scoring system, which concluded with 41 studies being used in the meta-analysis. Effect sizes were
calculated for acute and training intervention changes compared to baseline. For acute cluster training,
effect sizes were used to represent differences between equated traditional and cluster sets.

Results: Acutely, contrast and cluster training can be implemented to enhance and maintain velocity.
Complex training does not acutely show a performance-enhancing effect on jump performance.

Conclusion: When looking to develop exercise-specific force, the exercise should be completed closer to
set failure with fewer repetitions still able to be completed, which can be achieved using complex or
high-volume contrast training to pre-fatigue the lighter exercise. When the objective is to improve
velocity for the target exercise, it can be combined with a heavier contrast pair to create a
postactivation performance enhancing effect. Alternatively, cluster set designs can be used to maintain
high velocities and reduce drop-of. Finally, traditional training is most effective for increasing squat 1-
repetition maximum.

Key Points

• It appears that completing training of an exercise close to the point of failure can provide a
stimulus that increases the force component that is expressed at that load, whilst training an
exercise at the fastest velocities possible can increase the velocity component.
• Traditional, complex, and contrast training sequences may be used to specifically achieve
velocity or force adaptations in either light or heavy exercise.
• Cluster training variations can be used with all three of these training sequences to maintain
exercise velocity, as well as enabling a higher load to be lifted.

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Sports Science Research Update
Relationship between training load and recovery in collegiate American football
players during pre-season training. Science and Medicine in Football, Ahead of
Print: 1-10, 2021.
Background: The purpose of this study was to examine the relationship between training load and next
day recovery in collegiate American football (AF) players during pre-season.

Methods: Seventeen athletes (Linemen, n = 6; Non-linemen, n = 11) participated in the 14-day study
wearing monitoring (accelerometer + heart rate) sensors during on-field practice sessions throughout
pre-season to assess the physiological (PL), mechanical load (ML) and recording of session RPE (sRPE
load) immediately post-practice. Prior to practice, participants completed a drop-jump reactive strength
index (RSI) test and reported perceived recovery status (PRS). Loaded counter movement vertical jump
was assessed before and after pre-season.

Results: For every one unit increase in sRPE load, RSI declined by 0.03. Non-linemen had a lower RSI
value of 73.1 units compared to linemen. For every one unit increase in ML, the PRS decreased by 0.01.
Non-linemen recorded higher average ML during week 2 (ES = 1.17) compared to linemen. Non-linemen
recorded higher RSI values in weeks 1 (ES = −1.41) and 2 (ES = −1.72) compared to linemen. All training
load and recovery parameters were lower week 2 compared to week 1 (p < 0.05) for all players.

Conclusions: Next-day RSI values were influenced by sRPE load while next-day PRS appears to be more
influenced by ML. No difference in PL or sRPE load was observed been groups despite non-linemen
completing a higher ML throughout the preseason. A combination of training load and recovery metrics
may be needed to monitor the fatigue and state of readiness of each player.

Should we base training prescription on the force-velocity profile? Exploratory

study of its between-day reliability and differences between methods.
Sports Science Research Update
Sports Science Research Update
International Journal of Sports Physiology and Performance, Ahead of Print: 1-7,
2021.
Purpose: To analyze the differences in the force–velocity (F–v) profile assessed under unconstrained (ie,
using free weights) and constrained (ie, on a Smith machine) vertical jumps, as well as to determine the
between-day reliability.

Methods: A total of 23 trained participants (18 [1] y) performed an incremental load squat jump test
(with ∼35%, 45%, 60%, and 70% of the subjects’ body mass) on 2 different days using free weights and a
Smith machine. Nine of these participants repeated the tests on 2 other days for an exploratory analysis
of between-day reliability. F–v variables (ie, maximum theoretical force [F0], velocity [v0], and power,
and the imbalance between the actual and the theoretically optimal F–v profile) were computed from
jump height.

Results: A poor agreement was observed between the F–v variables assessed under constrained and
unconstrained conditions (intraclass correlation coefficient [ICC] < .50 for all). The height attained during
each single jump performed under both constrained and unconstrained conditions showed an
acceptable reliability (coefficient of variation < 10%, ICC > .70). The F–v variables computed under
constrained conditions showed an overall good agreement (ICC = .75–.95 for all variables) and no
significant differences between days (P > .05), but a high variability for v0, the imbalance between the
actual and the theoretically optimal F–v profile, and maximal theoretical power (coefficient of variation
= 17.0%–27.4%). No between-day differences were observed for any F–v variable assessed under
unconstrained conditions (P > .05), but all of the variables presented a low between-day reliability
(coefficient of variation > 10% and ICC < .70 for all).

Conclusions: F–v variables differed meaningfully when obtained from constrained and unconstrained
loaded jumps, and most importantly seemed to present a low between-day reliability.

Sports Science Research Update

Sports Science Research Update
Sleep quality and athletic performance according to chronotype. BMC Sports
Science, Medicine, and Rehabilitation, 13(2): 1-7, 2021.
Background: When studying the quality of sleep in relation to athletic performance, the athlete’s
chronotype and habitual time consider important factors. We aim to investigate the sleep quality and
athletes’ performance according to chronotype in elite athletes.

Methods: Three hundred forty elite athletes (males = 261, females = 79) were recruited for the present
study. All participants were screening for chronotype by the Korean versions of the Morningness -
Eveningness Questionnaire (MEQ-K). The Pittsburgh Sleep Quality Index (PSQI) and Wingate Anaerobic
Test (WAnT) were measurement after screening.

Results: PSQI global score, PSQI sleep quality, PSQI sleep onset latency, PSQI sleep disturbance, and
PSQI daytime dysfunction were significant differences among the groups. WAnT mean power (W), mean
power (W/kg), peak power (W), and peak power (W/kg) were significant differences among the groups.
A negative correlation coefficient was found between PSQI score and WAnT mean power (W) (r = −
0.256, p < 0.01), mean power (W/kg) (r = − 0.270, p < 0.01), peak power (W) (r = − 0.220, p < 0.01), and
peak power (W/kg) (r = − 0.248, p < 0.01).

Conclusions: This study indicates that related poor sleep quality and late-type chronotype may reduce
the athletes’ performance in elite athletes. In addition, the sleep quality is much higher in the early-type
chronotype than in the late-type chronotype. Moreover, it also the athletic performance was better in
the early-type chronotype than in the late-type chronotype.

Sports Science Research Update

Sports Science Research Update
The association between poor sleep and the incidence of sport and physical
training-related injuries in adult athletic populations: A systematic review.
Sports Medicine, Ahead of Print: 1-17, 2021.
Background: The importance of achieving an adequate amount of sleep to optimize health and athletic
performance is well recognized. Yet, a systematic evidence compilation of the risk for sport-related
injury in adult athletic populations due to poor sleep does not exist.

Objective: To examine the association between poor sleep and sport and physical training-related
injuries in adult athletic populations.

Data Sources: Electronic databases were searched using keywords relevant to sleep quantity and
quality, and musculoskeletal injury and sport-related concussion (SRC).

Eligibility Criteria for Selecting Studies: Studies were included in this systematic review if they were
comprised of adult athletic populations, reported measures of sleep quantity or quality, followed
participants prospectively for injury, and reported an association between sleep and incidence of sport
or physical training-related injury.

Study Appraisal: The methodological quality of each study was assessed using the Newcastle–Ottawa
Scale for Cohort Studies.

Results: From our review of 12 prospective cohort studies, we found limited evidence supporting an
association between poor sleep and injury in adult athletic populations. Specifically, there is (a)
insufficient evidence supporting the associations between poor sleep and increased risk of injury in
specific groups of athletic adults, including professional or elite athletes, collegiate athletes, elite or
collegiate dancers, and endurance sport athletes; and (b) limited evidence of an association between
poor sleep and increased risk of SRC in collegiate athletes.

Conclusions: The current evidence does not support poor sleep as an independent risk factor for
increased risk of sport or physical training-related injuries in adult athletic populations. Given the
methodological heterogeneity and limitations across previous studies, more prospective studies are
required to determine the association between sleep and injury in this population.

Key Points

• Enhancing the quality and quantity of sleep has been advocated as a useful strategy for
improving the performance of adult athletic populations.

Sports Science Research Update

Sports Science Research Update
• There is limited evidence to suggest that poor sleep quantity and quality result in an increased
risk of sport and physical training-related injuries in adult athletic populations.
• Future investigations may consider examining the role of sleep as a moderator of other
potentially modifiable risk factors for sport-related injuries instead of as an isolated factor.

Sports Science Research Update

Sports Science Research Update
The potential role of exercise-induced muscle damage in exertional heat stroke.
Sports Medicine, Ahead of Print: 1-10, 2021.
Abstract: Exertional heat stroke (EHS) is a life-threatening condition that affects mainly athletes, military
personnel, freighters, and occupational workers. EHS is frequently observed in non-compensable
conditions (where the body is unable to maintain a steady thermal balance) as a result of heavy heat
stress and muscle contraction associated with prolonged and strenuous physical and occupational
activities, resulting in central nervous system dysfunction followed by multi-organ damage and failure.
Since the pathophysiology of EHS is complex and involves multiple organs and systems, any condition
that changes the interrelated systems may increase the risk for EHS. It has been suggested that exercise-
induced muscle damage (EIMD) can lead to thermoregulatory impairment and systemic inflammation,
which could be a potential predisposing factor for EHS. In this review article, we aim to (1) address the
evidence of EIMD as a predisposing factor for EHS and (2) propose a possible mechanism of how
performing muscle-damaging exercise in the heat may aggravate muscle damage and subsequent risk of
EHS and acute kidney injury (AKI). Such an understanding could be meaningful to minimize the risks of
EHS and AKI for individuals with muscle damage due to engaging in physical work in hot environments.

Key Points

• EIMD elevates inflammatory status and impairs thermoregulation, which may play a role in
predisposing to EHS in subsequent exercise-heat stress.
• Athletes, military personnel, freighters, and occupational workers who perform multiple
shifts/training sessions in a day or within less than 24 h over 2 days and consequently sustain
EIMD should be especially cautious when performing physical activities in hot/humid
environments.

Sports Science Research Update