Current Issue Highlights

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    Fasciculoventricular Pathway in a Young Athlete—A Case Report

    November 2026: 36(6):675-678

    Background:

    Fasciculoventricular pathways (FVPs) are an uncommon cause of pre-excitation that can be mistaken for other more common accessory pathways in clinical practice. This case report highlights the key features of FVPs and their management.

    Case Summary:

    A 12-year-old male athlete was referred to the pediatric arrhythmia outpatient clinic with an asymptomatic pre-excitation on baseline routine electrocardiogram. Exercise stress test showed sustained pre-excitation throughout maximum heart rate. An electrophysiologic study documented an FVP and no inducible arrhythmia. No ablation was attempted, and the patient was discharged with return to play authorization without restrictions.

    Discussion:

    Although they are not substrates for re-entrant tachycardia and are not associated with sudden death, diagnosis of FVPs is important to prevent unnecessary ablation and undue exercise restriction.

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    The Role of Collagen Supplementation in Bone Metabolism and Structure: A Scoping Review

    November 2026: 36(6):664-674

    Objective:

    To evaluate the current literature on the role of collagen peptide supplementation in bone health, focusing on changes in bone turnover markers (BTMs) and bone mineral density (BMD).

    Data Sources:

    A search was conducted following PRISMA guidelines in the databases Academic Search Premier, APA PsychInfo, CINAHL Plus, GreenFILE, MEDLINE, and SPORTDiscus. Keywords included “collagen supplementation,” “bone turnover,” and “bone structure.” Studies published between January 2000 and March 2024 were included if they involved human subjects, oral collagen supplementation, and skeletal-related outcomes (BTMs or BMD). Risk of bias was assessed using the modified Physiotherapy Evidence Database (PEDro) scale.

    Main Results:

    Fifteen studies met the inclusion criteria. Collagen supplementation was associated with improvements in BTMs such as procollagen type I N-terminal propeptide and C-terminal telopeptide of type I collagen, as well as increases in BMD at whole body, femoral neck, and lumbar spine sites, particularly in postmenopausal women. However, neutral findings and substantial heterogeneity in study design, population characteristics, and dosing protocols were also observed.

    Conclusions:

    Collagen supplementation shows promise for supporting bone health, particularly in postmenopausal women, but the evidence remains inconsistent. Future research should address these gaps by focusing on premenopausal populations, standardizing dosing protocols, and exploring broader orthopedic applications, such as reducing stress fractures and enhancing recovery from musculoskeletal injuries.

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    Incidence and Risk Factors for Lumbar Spondylolysis in Adolescent Rugby Players: A Prospective Study

    November 2026: 36(6):658-663

    Objective:

    The aim of this study was to investigate the incidence and risk factors of lumbar spondylolysis in adolescent rugby players.

    Design:

    A prospective cohort design over a 9-month season (June 1, 2021–February 28, 2022) was used.

    Setting:

    A set of adolescent rugby players of male sex participated in this study and physical function examination were measured before injury surveillance.

    Participants:

    A total of 185 adolescent rugby players participated in this study.

    Assessment of Risk Factors:

    Bilateral passive range of motion of the hip, rectus femoris muscle flexibility, hamstring flexibility, and thoracic kyphosis angle were assessed.

    Main Outcome Measures:

    All participants were followed for a 9-month season (from June 2021 to February 2022) to determine the injury incidence during matches and training.

    Results:

    A total of 25 players (14.4%) had a lower back injury. The 18 players (72.0%) who reported injuries of the lower back were diagnosed with spondylolysis. A smaller passive hip external rotation range of motion on the right side and larger thoracic kyphosis angle were associated with lumbar spondylolysis.

    Conclusions:

    Restricted hip external rotation flexibility and round posture may be risk factors for lumbar spondylolysis in adolescent rugby players.

    Level of evidence:

    Prospective cohort, level 2.

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    A Video Analysis Study Examining Neuromuscular Training Warm-Up Practices in Youth Soccer

    November 2026: 36(6):650-657

    Objectives:

    To investigate time spent completing neuromuscular training (NMT) exercises in youth soccer team warm-up across a season considering sex, level of play, session type, and coach exposure and awareness of NMT.

    Design:

    Cross-sectional video-analysis study.

    Setting:

    Youth soccer, Calgary, Canada.

    Participants:

    Tier 1-3 youth (U13-U18) soccer teams (n = 22) from 6 clubs during the 2022 outdoor season (11v11).

    Interventions:

    Across a 5-month season (May-September), 10 warm-ups (1 practice, 1 game) were filmed for each team at each time point.

    Main Outcome:

    Time spent (s) by NMT components (aerobic, balance, strength, agility, head-on-neck control). Coaches' current knowledge of NMT was also collected in relation to current warm-up structure.

    Results:

    Twenty-two teams completing 171 warm-ups (87 practices, 84 games) were analyzed. Mean active time (seconds; s) spent in warm-ups was 322.4s (95% CI, 250.3-394.5). NMT components account for 202.2s (95% CI, 150.3-254.2), with majority spent in aerobic (156.9s, 95% CI, 137.3-176.6) and less than 1 minute (22.3%) in more critical components (balance, strength, agility). No head-on-neck components were observed. Changes in warm-up composition did not change across time points. Female elite teams spent 335.8 s (95% CI, 257.8-413.8) less than elite males in practices. There were not differences in elite game warm-ups or across nonelite groups. Of 13 coaches, 38.5% knew about NMT warm-up programs, whereas only 3 (23.1%) reported implementing NMT warm-up programs.

    Conclusion:

    Despite previous implementation efforts, time spent in critical NMT component (balance, strength, agility), apart from aerobic, was limited. Increased engagement and evaluation of head-on-neck control should be considered. Targeted implementation strategies are essential to maximize injury prevention efforts.

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    Development of the sBESS, a Pragmatic Dual-Task Balance Test in Adolescents With Acute Concussion

    November 2026: 36(6):642-649

    Objective:

    Develop a clinically pragmatic dual-task balance test to identify balance problems in acutely concussed adolescents more accurately than the current standard.

    Design:

    Observational cohort study.

    Setting:

    Pediatric emergency department.

    Participants:

    Adolescents aged 10 to 18 years with acute (<48 hours) concussion.

    Independent Variables:

    Single tasks: balance (mBESS errors); cognitive function (Oral Trail-Making Test-B [OTMT-B] completion rate and accuracy); vestibular–oculomotor function (gaze stabilization test); and symptom change (pre-/post-test numeric pain rating scale). Dual tasks: (1) balance + cognitive function; (2) balance + vestibular–oculomotor function.

    Main Outcome Measures:

    Primary outcome was change in center-of-pressure (COP) on a force plate (95% ellipse sway area), during single and dual tasks. We evaluated associations between clinical outcomes and gold-standard COP sway area using Spearman correlation coefficients and P-values.

    Results:

    Eighty-three adolescents (median [IQR] age = 12.86 [11.52-15.41 years; 62.65% male; median [IQR] time from injury = 3.03 [2.08-13.37] hours) were included. Balance errors during dual-task gaze stabilization with tandem stance correlated more strongly with sway area (rs = 0.77, P < 0.001) than with mBESS balance errors (double-leg stance, rs = 0.44, P < 0.001; tandem stance, rs = 0.58, P < 0.001; single-leg stance, rs = 0.39, P < 0.001). Cognitive dual task (OTMT-B completion rate) was associated with fewer balance errors and decreased sway area in tandem stance (rs = −0.28, P = 0.02) and single-leg stance (rs = −0.21, P = 0.07). Pre-/post-test symptom change was not associated with sway area.

    Conclusions:

    Dual-task gaze stabilization with tandem stance (“sharpened BESS” [sBESS]) is a new vestibular dual task that is more strongly associated with gold-standard balance performance in concussed adolescents than mBESS. Diagnostic and prognostic accuracy studies are needed to determine the clinical utility of sBESS to inform concussion diagnosis and return to sport decisions.

Latest Articles

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    Nonoperative Management of Juvenile Osteochondritis Dissecans Lesions of the Medial Femoral Condyle: Comparing Cylinder Cast, Hinged Knee Brace Locked Into Extension, and Activity Modification

    Clinical Journal of Sport Medicine. October 26, 2026

    Objective:

    Compare nonoperative treatment options in juvenile osteochondritis dissecans (OCD) lesions of the medial femoral condyle.

    Design:

    Descriptive, retrospective cohort study.

    Setting:

    Single academic pediatric tertiary referral center.

    Patients (or Participants):

    Male/female patients ages 0 to 18 evaluated in the sports/orthopedic ambulatory setting who were found to have OCD lesions in the medial femoral condyle.

    Interventions (or Assessment of Risk Factors or Independent Variables):

    Cast immobilization, hinged knee brace locked into extension, and activity modification.

    Main Outcome Measures:

    Nonoperative treatment effectiveness between the 3 groups was evaluated by radiographic healing and symptom resolution, with failure defined as progression to surgery.

    Results:

    A total of 148 patients with 168 MFC JOCD lesions of the knee were identified. Median age was 11 years old. Patients were 65.5% male and 77% participated in sports. Sixty-two (37%) lesions were treated in a HKB locked into extension, 55 (32%) were casted in a cylinder cast, and 51 (31%) were treated with activity modification alone. Approximately 19% of HKB locked into extension, 22% of casted MFC JOCD, and 16% of activity-modified MFC JOCD lesions progressed to surgery. At 6 months, 76% of the HKB locked into extension, 71% of the cylinder cast, and 71% of the activity modification group had resolution of clinical symptoms and returned to activity.

    Conclusions:

    MFC JOCD lesions of the knee can be appropriately treated with a HKB brace locked in extension, cast, or activity modification with consistent success rates.

    Clinical Relevance:

    This study provides practical evidence regarding conservative management of MFC JOCD lesions.

    Level of Evidence:

    III.

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    Conservative Management of a Displaced Iliopsoas Avulsion in an Adolescent: A Case Report and Systematic Review

    Clinical Journal of Sport Medicine. October 23, 2026

    Objective:

    To report a case of traumatic iliopsoas tendon avulsion with displacement exceeding the commonly cited 2-cm surgical threshold, managed successfully without surgery, and to systematically review the literature on optimal treatment and return-to-sport outcomes.

    Design:

    Case report combined with a PRISMA-compliant systematic review of PubMed, Cochrane Library, and Embase.

    Setting:

    Level I university trauma center; systematic review of published case reports and series.

    Participants:

    A 16-year-old male competitive soccer player (index case) and 58 additional patients from the literature, predominantly adolescent males with sports-related iliopsoas avulsion.

    Interventions:

    The index patient received conservative treatment with staged weight bearing and structured physiotherapy. Across the literature, 90% (52/58) were treated conservatively and 10% operatively.

    Main Outcome Measures:

    Clinical recovery, strength restoration, radiographic union on MRI, and return to sport.

    Results:

    Eighteen studies (58 patients; 59 including this case) were analyzed. A bony lesser-trochanter avulsion was present in 98% (57/58). Of at least 9 patients with displacement >2 cm, 5 recovered fully nonoperatively. The index patient was pain-free with full strength and unrestricted soccer return at 3 months; 6-month MRI showed radiographic nonunion despite complete functional recovery. Return to sport approached 100%, typically within 10 to 12 weeks.

    Conclusions:

    Available very low-certainty evidence suggests that nonoperative management can achieve favorable clinical recovery and return to sport after traumatic iliopsoas avulsion, including in some cases with displacement greater than 2 cm. Return-to-sport decisions may reasonably prioritize restored, pain-free function over radiographic union, but larger prospective studies are needed.

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    Gait Retraining for Patellofemoral Pain Syndrome: A Biomechanical Approach to Pain Relief and Performance Optimization

    Clinical Journal of Sport Medicine. October 13, 2026

    Objective:

    Patellofemoral pain syndrome (PFPS) is common among runners and is linked to biomechanical dysfunctions that increase patellofemoral joint stress. Gait retraining has been proposed to redistribute this loading, but the effectiveness of different retraining strategies and their long-term impact remain unclear. This scoping review synthesizes existing evidence on gait retraining strategies for PFPS, focusing on pain, function, and biomechanics.

    Data Sources:

    MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science were searched, following the methodological framework of the Joanna Briggs Institute for scoping reviews. Studies investigating gait retraining interventions in runners diagnosed with PFPS were included. Key outcomes were pain reduction, functional improvement, biomechanical adaptations, and adverse effects.

    Main Results:

    Three randomized controlled trials met the inclusion criteria, examining cadence modification, impact reduction, and foot strike adjustments. Intervention groups experienced significant pain reduction, with Visual Analog Scale scores improving by 2 to 4 points, alongside functional gains reflected by increased Kujala and Knee Outcome Survey of the Activities of Daily Living Scale scores. Biomechanical adaptations included decreased patellofemoral joint stress, lower impact forces, and improved load distribution. Some participants reported transient calf discomfort during the adaptation period, which resolved over time.

    Conclusions:

    Gait retraining is an effective intervention for runners with PFPS, showing sustained pain relief, functional improvement, and biomechanical benefits. Individualized protocols and gradual implementation are essential to optimize outcomes and minimize discomfort. Future research should address long-term retention of gait modifications, optimal training parameters, and applicability beyond runners.

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