South African Journal of Sports Medicine

Entering the era of artificial intelligence (AI) in publishing

Mike Lambert — 2023-08-30

No Abstract

Partnerships between players, practitioners and researchers: the story of three stumps and two bails

Benita Olivier — 2023-08-30

No Abstract

The great pretender: Multi-system tuberculosis and pathological fracture masquerading as a severe acute football groin injury ‒ Case study with a 5-year follow-up

M. Lichaba — 2023-08-30

In this clinical case, a man presented with a groin injury on his dominant side, which he apparently sustained in football (soccer) practice on the previous day. The man was unable to walk unassisted and had to be transported in a wheelchair. The consulting practitioner grew suspicious upon finding minimal clinical evidence and nothing notable on the X-ray to suggest a severe acute injury. A subsequent detailed workup revealed extrapulmonary tuberculosis (EPTB) of the musculoskeletal (MSK) and genitourinary tract (GUT) systems, complicated by a pathological fracture of the acetabulum, as the cause of the groin injury. Management of the EPTB resolved the condition with no relapse nor long-term sequelae beyond five years, despite being immunocompromised. We present the clinical case and a five year follow-up. The case serves as a reminder of the possibility that other conditions may mimic sports injuries and further illustrates a rare presentation of such a condition.

Exercise intervention for post-acute COVID-19 syndrome – do FITT-VP principles apply? A case study

G. Torres — 2023-08-30

The lack of standardisation of reporting exercise interventions hampers the development of best practice guidelines for long COVID patients. This case study on the effect of an exercise intervention in a long COVID patient applied the Consensus on Exercise Reporting Template (CERT) for reporting interventions. FITT-VP exercise prescription principles for long COVID rehabilitation are also suggested. A 58-year-old male, previously hospitalised for 14 days in the ward for the intensive care for the management of severe COVID-19 infection, joined an exercise rehabilitation programme. A medical history, anthropometric, biochemical, lung function, blood pressure, cardiorespiratory fitness and strength measures were all assessed before and after the eight week exercise intervention programme. Positive changes were found in all lung function test measures. Cardiorespiratory fitness, endurance capacity and muscle strength improved. However, the greatest improvements occurred in functional status, fatigue, dyspnoea and the state of depression levels. This case study suggested that in the absence of other instruments, the FITTVP principles may be used for long COVID patients, and CERT for reporting interventions, but these should be further researched.

Headers and concussions in elite female and male football: a pilot study

S. den Hollander — 2023-08-30

Background: Heading is a risk factor for neurogenerative disease in football. However, the exposure to heading in elite football training is understudied.

Objectives: The primary purpose of this study was to determine the exposure to headers in elite men’s and women’s football and to describe the effects of the headers on ocular markers.

Methods: Exposure to headers was observed over three days of women’s and men’s football. The number of headers at each session was determined through video analysis, and the G-force was determined via an impact tracker. Ocular markers were assessed at the start and end of the three days, and the results were compared to determine if there were any changes. Self-reported exposure to heading was recorded after each session and compared to the number of headers observed through video analysis, to assess the validity of players’ self-reporting.

Results: Female players made an average of 11 headers per player per session. Ninety percent of the headers were below 10G, and none were above 80G. Male players made an average of three headers per player per session, with 74% of the headers recording a G-force above 10G and 3% above 80G. No meaningful changes were observed post-session in the ocular markers, and no concussions were observed. Neither cohort was able to accurately self-report exposure to headers.

Conclusion: Longitudinal studies should be designed and conducted across different levels of play in both women and men’s football as a prerequisite to develop evidence-based measures to prevent or mitigate the potential risks associated with headers and concussions in elite football.

Team approach to osteoarthritis management: Viewpoints of biokineticists and physiotherapists in South Africa

R. Gilchrist — 2023-08-30

Background: The rehabilitative nature of biokinetics and physiotherapy in osteoarthritis management highlights a complex interaction between different professions to achieve effective outcomes for the patient. The success of a team approach is dependent on key competencies for optimal patient-focused care and appropriate cross-referral systems.

Objectives: To explore and describe the viewpoints of biokineticists and physiotherapists regarding a team approach to osteoarthritis management in the South African public and private healthcare setting.

Methods: A descriptive methodology with a convenience sampling technique was used. The target population consisted of biokineticists (n=47) and physiotherapists (n=165) located within the South African healthcare sectors. A selfadministered, online questionnaire surveyed rehabilitative professionals’ views of a team approach to osteoarthritis management.

Results: There is no evidence that the biokineticists and physiotherapists differ with respect to how they rate the communication between team members in osteoarthritis management (p=0.68). Communication was viewed as neither of a high nor low quality by biokineticists (43%) and physiotherapists (36%). Biokineticists (54%) and physiotherapists (69%) felt adequately equipped on their understanding of the role of various healthcare professions involved in osteoarthritis management (p=0.22). However, 43% of rehabilitative professionals indicated that they had not been exposed to interprofessional education initiatives (p=0.61).

Conclusion: Both professions were well-versed on the roles of various professions involved in osteoarthritis management, however, communication was not optimal. While this study creates an awareness of the benefits of team-based management for osteoarthritis, the findings could stimulate debate on the optimal implementation of key competencies required for effective teamwork, thereby facilitating patientfocused care and referral systems.

University and stakeholder partnerships to innovate in sport – the development of the South African Cricketers’ Association (SACA) career transition screening tool

S. Hendricks — 2023-08-30

In sports, the value and mutual benefit of university–stakeholder partnerships have been well-recognised. It has been argued that cricket has a unique set of challenges compared to other team sports. In 2016, the South African Cricketers’ Association (SACA) and the University of Cape Town established a partnership to (i) conduct novel research on professional cricketers and (ii) ensure SACA programmes and initiatives are informed by said research and/or the currently available literature. As the demand on professional cricketers has increased, so has the interest in their career transitioning. That is, how do professional cricketers manage stressors created by changes (or non-changes) throughout their playing careers? To help identify gaps for intervention as a cricketer transitions through their professional career, the purpose of this short report is to describe how a university–stakeholder partnership developed a career transitioning screening tool for professional cricketers in South Africa.

Female cricket pace bowling: kinematic and anthropometric relationships with ball release speed

Charlotte Lyons — 2023-08-30

Background: Despite an increase in the professionalism and participation of female cricket, the coaching of female pace bowling is still reliant on male-derived knowledge.

Objectives: To investigate the association between key malederived kinematic and anthropometric parameters and ball release speed (BRS) in female pace bowlers.

Methods: Eleven female pace bowlers participated in this study. BRS, and four anthropometric and five kinematic parameters were determined. Stepwise linear regression and Pearson Product Moment correlations were used to identify anthropometric and kinematic parameters linked to BRS.

Results: The best predictor of BRS explaining 89% of the observed variance was the bowling shoulder angle at ball release. The best anthropometric predictor of BRS was height explaining 53% of the observed variance. Other parameters correlated with BRS included: run-up speed (r = 0.75, p = 0.013) and arm length (r = 0.61, p = 0.046). When height was controlled for, the front knee angle at front foot contact was also correlated to BRS (r = 0.68, p = 0.044). No relationship was found between trunk flexion and BRS.

Conclusion: Faster BRS were characterised by faster run-up speeds, straighter front knees, and delayed arm circumduction similar to male pace bowlers. The lack of relationship between trunk flexion and BRS may highlight female pace bowlers adopting a bowling technique where BRS is contributed to by trunk rotation as well as trunk flexion. This knowledge is likely to be useful in the talent identification and coaching of female pace bowlers.

Prevalence and associated factors with mental health symptoms among semi-professional cricket players after the resumption of sporting activities following an extensive lockdown

L. Malele — 2023-08-30

Background: Mental health of cricket players has been a topic of debate for a considerable time across the globe.

Objectives: The purpose of this study was to investigate the prevalence of mental health symptoms among semi-professional male cricket players experienced during COVID-19, as well as the relationship between age and the Depression, Anxiety, Stress Scale (DASS-21) sub-scale.

Methods: Mental health symptoms were assessed among cricket players (n = 90) using the following instruments, respectively: Depression, Anxiety, Stress Scale – 21 (DASS – 21); Athlete Burnout Questionnaire (ABQ) and Satisfaction with Life Scale (SWLS). Descriptive (means ± standard deviations) and inferential (Spearman’s correlations) statistics were calculated using SPSS (IBM Version 27.0) at a significance level of p < 0.05.

Results: The study reported that 5.6% (n = 5) of cricketers believed life was futile, and 10% (n = 9) thought they were useless most of the time. However, on the anxiety sub-scale, 27% (n = 24) of cricketers indicated low confidence. In addition, 23% (n = 21) of cricketers reported being stressed. Spearman's correlations revealed a positive and significant association between the DASS-21 sub-scales and that cricketers' DASS-21 sub-scale symptoms are unrelated to age.

Conclusion: The study found that there were moderate levels of anxiety, a reduced sense of achievement and a neutral feeling towards satisfaction with life. Reducing mental health symptoms would extend the playing careers of cricket players. De-stigmatising mental health may result in more robust and accurate self-reports of mental health illness among elite athletes, which can enable sustainable change.

Darkness stopping play? An update on cricket and mental health

T. McCabe — 2023-08-30

Mental health within elite cricket continues to be an area of focus for researchers and practitioners working within the game. Support structures for psychological issues within differing administrations and franchises vary. This may lead to inconsistent practice and levels of resource allocation. Elite level cricketers are exposed to stressors as a result of the congested international and domestic calendar, contract insecurity, injury and pressure to perform. Within the following commentary, the authors consider the existing medical literature, franchise and women-specific challenges and suggest ways to build on existing structures in order to optimise mental health within elite-level cricket.

The role of selected pre-match covariates on the outcome of One-day International (ODI) cricket matches

K. McEwan — 2023-08-30

Background: The identification of key factors that systematically influence a team’s success is important and has led to the application of statistical models in sport. Predicting the outcome of a One Day International (ODI) cricket match, using only pre-match covariates, has been minimally investigated.

Objectives: This research sought to investigate the impact that venue, toss outcome, toss decision, and match type have on the chances of winning an ODI match.

Methods: A total of 1228 men’s international ODI matches were analysed. A logistic regression model was used to identify the significance of these pre-match covariates on the result of the matches.

Results: The results varied across all teams, suggesting that there are individualised factors driving these differences and that generalising the impact pre-match covariates have in every team is unrealistic. New Zealand and India displayed a significant home advantage effect, whereas Australia had a strong tendency towards a significant disadvantage when they won the toss. However, for most teams, toss outcome, toss decision, and match type did not significantly impact the outcome of an ODI match.

Conclusion: New Zealand and Australia were the most predictable teams, whereas South Africa and Pakistan were regarded as unpredictable when pre-match covariates were used to forecast the outcome of their ODI matches.

Factors promoting and hindering sporting success among South African former Olympians from historically disadvantaged areas

S. Mthombeni — 2023-08-30

There are various contributing factors to sporting success among elite athletes, including Olympians. The purpose of this paper was to investigate the enablers and/or barriers to sporting success among South African former Olympians from historically disadvantaged areas (HDAs) using the SPLISS framework. This would enable an understanding of the factors that lead to sporting success among athletes from HDAs. A qualitative research design was employed for this study, whereby semi-structured interviews were conducted among 15 former Olympians who represented South Africa between the 1992 and 2016 Olympic Games. The ATLAS.ti (version 22) software tool was used to analyse the data. The study found that athletes from HDAs attributed their sporting success to the functional competition structure, sports access at community level, access to scholarships and bursaries to elite schools/universities, good coaching support and mentorship, access to local and international competitions, as well as community and peer athlete support. The highest barriers reported by athletes were inadequate financial support, a dysfunctional school sport system, lack of sports facilities, equipment and transport system, poor post-career and scientific support. Elite athletes from HDAs need consistent financial support, school/foundation level sport access, quality sports facilities, equipment, and reliable transport to training and competitions, post-career, as well as scientific support to achieve their full potential and attain international sporting success.

An analysis of specific batting demands in the women’s The Hundred competition

S. Nicholls — 2023-08-30

Background: No research has investigated the shortest format of the game of cricket, The Hundred competition. Furthermore, women’s cricket research is particularly limited, with most focusing on injuries and little literature investigating specific batting demands. These demands are important if training programmes are to mimic the game’s movement patterns.

Objectives: The purpose of this study was to analyse specific batting demands and variables associated with the women’s The Hundred competition.

Methods: Thirty-one matches from the Women’s 2021 The Hundred competition were analysed using Hudl Sportscode Elite. Variables analysed included: bowler type (seam or spin), free hits, no ball runs, reason for no ball (height/wide/front foot), run scored (0, 1, 2, 3, 4, 6), type of key event (fall of wicket, bowling referral, batting referral, umpire referral, bowling time out, rain delay, or injury) as well as time between deliveries and sets, overall and between the power play and non-power play. A total of 6073 deliveries were analysed.

Results: A significant difference (p<0.05) was observed for time between deliveries for spin bowlers (26.90±22.16 s) compared to seam bowlers(31.70±20.37 s) as well as time between sets for the power play (58.00±13.28 s) and nonpower play phases (63.70±42.00 s). Additionally, in the power play, most runs were made up of “1’s” and “4’s”. In the nonpower play phase, “1’s” made up the biggest contribution of runs (as a percentage).

Conclusion: The fact that singles make up a significant portion of a typical match means that strength and conditioning coaches should incorporate high-intensity sprint-type training into training programmes to mimic these demands.

Kinematic differences between left- and right-handed cricket fast bowlers during the bowling action

B. Olivier — 2023-08-30

Background: Despite differences between left- and righthanded athletes in other sports, minimal evidence exists regarding biomechanical similarities and differences between left- and right-handed cricket fast bowlers performing an equivalent task.

Objectives: This study aimed to compare the kinematics between left and right-handed fast bowlers performing an equivalent task (i.e. bowling ‘over the wicket’ to a batter of the same handedness as the bowler).

Methods: Full body, three-dimensional kinematic data for six left-handed and 20 right-handed adolescent, male, fast bowlers were collected using the Xsens inertial measurement system. Time- normalised joint and segment angle time histories from back foot contact to follow-through ground contacts were compared between groups via statistical parametric mapping. Whole movement and subphase durations were also compared.

Results: Left-handed players displayed significantly more trunk flexion from 49%-56% of the total movement (ball release occurred at 54%; p = 0.037) and had shorter back foot contact durations on average (0.153 vs 0.177 s; p = 0.036) compared to right-handed players.

Conclusion: Left- and right- handed bowlers displayed similar sagittal plane kinematics but appeared to use non-sagittal plane movements differently around the time of ball release. The kinematic differences identified in this study can inform future research investigating the effect of hand dominance on bowling performance and injury risk.

Physical activity and quality of life of patients with fibromyalgia

L. Smith — 2023-08-30

Background: Fibromyalgia Syndrome (FMS) has been linked to decreased social functioning, poor mental health, and quality of life (QOL). Increased physical functioning and activity can result in improvements in social, mental and overall health, as well as lowered depression and anxiety levels.

Objectives: The aim of this study was to determine physical activity levels and QOL amongst patients diagnosed with fibromyalgia in the Johannesburg region of South Africa.

Methods: The research design was cross-sectional. Descriptive and quantitative data were collected. FMS patients (n=38) completed an online questionnaire on the Google Forms platform. The questionnaire was comprised of four components, namely Demographics, the Global Physical Activity Questionnaire (GPAQ), the Fibromyalgia Impact Questionnaire (FIQR), and the Short Form-36 (SF-36). During data analysis, descriptive characteristics and correlations were computed. The significance level was set at p ≤ 0.05.

Results: Results revealed high FIQR scores (67%) accompanied with low QOL scores (<50% in all domains). There was no correlation between physical activity and FIQR, and physical activity and QOL.

Conclusion: High scores on the impact of FMS were associated with lower overall QOL scores. However, the relationship between physical activity, and the impact of FMS and QOL remain inconclusive.

Strengthening the biokinetics workforce for improved services: A human resources for health review from 2000 to 2020

R. Tiwari — 2023-08-30

Background: Biokinetics is a South African (SA) health profession within the private health care sector. Biokineticists register with the Health Professions Council of SA (HPCSA).

Objectives: To describe the demographic trends of HPCSA registered biokineticists from 2000 to 2020 to understand the supply and status of human resources for health within the profession.

Methods: The following data were collected and analysed: i) health personnel category, ii) geographical location, iii) age, iv) sex, and v) population category.

Results: The number of HPCSA registered biokineticists grew from 136 in 2000, to 1831 in January 2020 (67.8% women, 32.2% men). There was a sharp decline in numbers after the age of 45 years. The Western Cape (5.8) and Gauteng (5.1) provinces had the most biokineticists per 100 000 of the population, whilst smaller provinces like Kwazulu-Natal (1.6), Mpumalanga (1.6), North-West (1.6) and Limpopo (0.9) lagged. The demographic profile of registered Biokineticists changed steadily from 2000 to 2020. Registered biokineticists classified as White decreased from 91.6% to 80.4%, whilst substantial increases were observed among Black (5.0% to 8.3%), Coloured (0.02% to 5.3%) and Indian/Asian (0.02% to 6.0%) biokineticists. Thirteen tertiary institutions offered Biokinetics programmes in 2022. Seven offered the 3+1-year (Honours) programme and six have migrated to a 4-year professional degree.

Conclusion: The profession is well established, growing, and dominated by women. The demographic profile has transformed steadily; however, the need to transform the profession remains strong. Strengthening investments aimed at the employment of biokineticists in the public health sector may serve as a key turning point for healthcare workforce planning.

Management of lumbar bone stress injury in cricket fast bowlers and other athletes

J.W. Orchard — 2023-08-30

Background: Recent guidelines (including a special series in The Lancet) have emphasised a minimal role for imaging when assessing low back pain in adults, as the majority of patients will have non-specific findings on imaging that do not correlate well with pain.
Objective: To assess whether the diagnosis of lumbar bone stress injuries in young athletes should be considered an exception to the recommendation to avoid imaging for low back pain in adults.
Method: Narrative review.
Results: Early lumbar bone stress injury diagnosis has been available via traditional MRI sequences (and its precursor Single Photon Emission Computed Tomography (SPECT)) for 25-30 years. MRI assessments using bone window sequences (such as Volumetric Interpolated Breath-hold Examination (VIBE)) have allowed a better understanding of the diagnosis and prognosis of lumbar bone stress injury in young athletes. MRI with bone sequences has allowed non-radiating scans to serially follow the healing of unilateral stress fractures. In the majority of cases, non-chronic unilateral fractures can heal; however, this takes threesix months rather than the six-ten weeks that would be the typical unloading period if using symptoms (only) as a guide. The use of MRI to provide evidence of bony healing (as opposed to fibrous union, which creates the pars defect that predisposes to further bone stress lesions) can lead to better long-term outcomes in athletes. There is evidence to flag this as a structural lesion which is both painful and, more importantly, can heal/resolve if managed correctly. Therefore it represents an important ‘specific’ diagnostic subset within adult low back pain. Conclusion: Structural (rather than functional) management of bone stress injuries in high-demand athletes, such as cricket pace bowlers, is in contrast to the recommendation of functional management for general back pain in adults. Structural management is justified when there are demonstrable superior outcomes of having better structure. Although this has not yet been shown in randomised trials of elite athletes, apparent lengthier Test cricket careers of pace bowlers who do not have pars defects suggest better athletic outcomes if bony healing is achieved. For lower demand young adults, or athletes with established bilateral pars defects, functional management may be more pragmatic.