The ulnar collateral ligament of the elbow (UCL) is frequently injured in throwing athletes, most commonly baseball pitchers. The ligament is reconstructed through bone tunnels using palmaris longus or gracilis autograft.
This study highlights the following technique for UCL reconstruction in over 2000 athletes.2
When conservative management fails, ligament reconstruction can allow the athlete to return to their sport.1
Ulnar Collateral Ligament; UCL; Tommy John; Thrower’s elbow
Osteochondritis dissecans (OCD) of the capitellum is most often seen in adolescents who participate in sports that involve repetitive loading of the elbow. Unstable defects typically require surgical intervention that involves fragment fixation, debridement, or reconstruction with an osteochondral autograft transfer. Optimum surgical management of unstable defects remains controversial.
Type of Study:
Relevant articles published after 1992 were identified using MEDLINE, the EMBASE database, and the Cochrane Library.
Both debridement and osteochondral autograft transfer for treatment of capitellar OCD lesions result in good short- and midterm outcomes with a high rate of return to sports. Larger defects involving more than 50% of the articular surface or involving the lateral margin of the capitellum may have worse outcomes after debridement and may be better treated with fragment fixation or osteochondral autograft transfer.
High-level evidence is lacking to determine the superiority of debridement or osteochondral autograft transfer for the treatment of capitellar OCD lesions. A prospective longitudinal multicenter study, using validated outcome measures, that enrolls a large number of patients is needed to establish optimal treatment for unstable capitellar OCD lesions.
osteochondritis dissecans; elbow; capitellum
The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive overuse, leading to tissue failure. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether following injury or postsurgical, must follow a progressive and sequential order, building on the previous phase, to ensure that healing tissues are not compromised. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control while gradually applying loads to healing tissue. In addition, when one is creating a rehabilitation plan for athletes, it is imperative to treat the entire upper extremity, core, and legs to create and dissipate the forces generated at each joint.
ulnar collateral ligament; valgus extension overload; baseball pitcher
Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations.
The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy.
Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments.
Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury.
tendinopathy; lateral epicondylitis; medial epicondylitis; distal biceps rupture; distal triceps rupture
Medial elbow injuries are common among baseball pitchers. Easily accessed methods to assess medial elbow stress may be useful in identifying individuals with increased injury risk.
Pitch velocity (PV) is positively associated with higher medial elbow adduction moments.
Cohort study; Level of evidence, 2.
Participants included 26 uninjured high school pitchers, 15 to 18 years in age. Three-dimensional data and PV were collected as athletes threw 10 fastballs for strikes to a regulation-distance target. Variables of interest were the normalized peak internal elbow adduction moment and peak PV. Linear regression was performed to evaluate the influence of PV on the adduction moment.
For the group, mean PV was 71 mph (range, 58-81 mph), and the adduction moment was 0.558 Nm/Ht × mass (range, 0.378-0.723). PV was positively associated with the adduction moment (P < 0.01, R2= 0.373).
Talented young pitchers may be more susceptible to elbow injuries as a consequence of a biomechanical coupling between PV and upper extremity joint moments.
PV may be measured easily and serve as an indicator of medial elbow stress.
biomechanics; throwing; upper extremity; adolescent; injury risk
Ketorolac tromethamine (Toradol®) is a non-steroidal anti-inflammatory drug that has potent analgesic and anti-inflammatory properties. It can be administered orally, intravenously, intramuscularly, or via a nasal route. Ketorolac injections have been used for several years in the National Football League (NFL), in both the oral and injectable forms, to treat musculoskeletal injuries and to prevent post-game soreness. In an attempt to determine the appropriate use of this medication in NFL players, the NFL Team Physician Society appointed a Task Force to consider the best available evidence as to how ketorolac should be used for pain management in professional football players. These treatment recommendations were established based on the available medical literature taking into consideration the pharmacokinetic properties of ketorolac, its accepted indications and contraindications, and the unique clinical challenges of the NFL. The Task Force recommended that 1) ketorolac should only be administered under the direct supervision and order of a team physician; 2) ketorolac should not be used prophylactically as a means of reducing anticipated pain either during or after participation in NFL games or practices and should be limited to those players diagnosed with an injury or condition and listed on the teams’ injury report; 3) ketorolac should be given in the lowest effective therapeutic dose and should not be used in any form for more than 5 days; 4) ketorolac should be given in its oral preparation under typical circumstances; 5) ketorolac should not be taken concurrently with other NSAIDs or by those players with a history of allergic reaction to ketorolac, other NSAIDs or aspirin; and 6) ketorolac should not be used by a player with a history of significant gastrointestinal bleeding, renal compromise, or a past history of complications related to NSAIDs.
Toradol; Ketorolac; NFL; Football
Ulnar collateral ligament (UCL) insufficiency of the elbow can be a debilitating injury that often prevents athletes from competing effectively. The overhead athlete is particularly susceptible to this injury because the anterior bundle of the UCL is the primary restraint to the valgus stress that is created during the throwing motion. Repetitive trauma from constant overhead or throwing activity can ultimately render the ligament incompetent and cause recurrent pain and instability.
The authors currently use a “docking” technique that provides excellent graft fixation and reduces ulnar nerve related complications.
This article details the assessment of the throwing athlete with valgus instability secondary to UCL insufficiency and highlights the technical aspects for reconstruction. The majority of athletes who undergo UCL reconstruction of the elbow can successfully return to their preinjury function.
Strength-of-Recommendation Taxonomy (SORT):
overhead athlete; ulnar collateral ligament; docking technique
Although baseball is a relatively safe sport, numerous reports suggest a rapid rise in elbow injury rate among youth baseball pitchers.
PubMed was searched for epidemiologic, biomechanical, and clinical studies of elbow injuries in baseball (keywords: “youth OR adolescent” AND baseball AND pitching AND “ulnar collateral ligament OR elbow”; published January 2000 – April 2012). Studies with relevance to youth baseball pitchers were reviewed. Relevant references from these articles were also retrieved and reviewed. Original data, insight, and recommendations were added.
The majority of baseball elbow injuries are noncontact injuries to the dominant arm resulting from repetitive pitching. Five percent of youth pitchers suffer a serious elbow or shoulder injury (requiring surgery or retirement from baseball) within 10 years. The risk factor with the strongest correlation to injury is amount of pitching. Specifically, increased pitches per game, innings pitched per season, and months pitched per year are all associated with increased risk of elbow injury. Pitching while fatigued and pitching for concurrent teams are also associated with increased risk. Pitchers who also play catcher have an increased injury risk, perhaps due to the quantity of throws playing catcher adds to the athlete’s arm. Another risk factor is poor pitching biomechanics. Improper biomechanics may increase the torque and force produced about the elbow during each pitch. Although throwing breaking pitches at a young age has been suggested as a risk factor, existing clinical, epidemiologic, and biomechanical data do not support this claim.
Some elbow injuries to youth baseball pitchers can be prevented with safety rules, recommendations, education, and common sense. Scientific and medical organizations have published safety rules and recommendations, with emphasis on prevention of overuse and pitching while fatigued.
Strength-of-Recommendation Taxonomy (SORT):
pitcher; pitch count; ulnar collateral ligament; Tommy John surgery; curveball
Ehlers-Danlos syndrome is a heterogeneous connective tissue condition characterized by varying degrees of skin hyperextensibility, joint hypermobility, and vascular fragility. Joint dislocations, musculoskeletal pain, atrophic scars, easy bleeding, vessel/viscera rupture, severe scoliosis, and obstetric complications may occur. These manifestations are secondary to abnormal collagen, with specific molecular defects in types I, III, and V collagen; they may also be related to tenascin-X, which has been identified in some patients. Ehlers-Danlos syndrome has been classified into 6 types, with variable degrees of joint instability, skin hyperextensibility, wound healing difficulty, and vascular fragility. Diagnosis begins with recognition of the signs and symptoms of global hypermobility and referring appropriate patients for genetic consultation. It is important to accurately identify patients with Ehlers-Danlos syndrome to initiate appropriate musculoskeletal treatment, optimize anesthetic and postoperative management, perform appropriate vascular screening, and help families address their concerns with other families and advocacy groups.
Ehlers-Danlos; ligament laxity; instability
The imaging of pediatric sports injuries of the elbow requires an understanding of the interaction between biomechanical forces common in sports and the developing skeleton.
A PubMed search was performed using the terms elbow, radiology, and sports with the search limited to children up to 18 years of age. No limits were set on the range of years searched. Articles were reviewed for relevance with an emphasis of the changing nature of sports injuries about the pediatric elbow.
A clear progression of injuries about the elbow can be identified as the skeleton matures. Sports most commonly associated with injuries in the pediatric age group were baseball and gymnastics.
Most pediatric sports injuries result from overhand throwing, especially in baseball or gymnastics. The manifestation of the injuries shifts as the physes progress toward closure.
elbow; adolescent; injury; chronic
Time allowing, euhydration can be achieved in the vast majority of individuals by drinking and eating normal beverages and meals. Important to the competitive athlete is prevention and treatment of dehydration and exercise-associated muscle cramps, as they are linked to a decline in athletic performance. Intravenous (IV) prehydration and rehydration has been proposed as an ergogenic aid to achieve euhydration more effectively and efficiently.
PubMed database was searched in November 2011 for all English-language articles related to IV utilization in sport using the keywords intravenous, fluid requirements, rehydration, hydration, athlete, sport, exercise, volume expansion, and performance.
Limited evidence exists for prehydration with IV fluids. Although anecdotal evidence does exist, at this time there are no high-level studies confirming that IV prehydration prevents dehydration or the onset of exercise-associated muscle cramps. Currently, there are no published studies describing IV fluid use during the course of an event, at intermission, or after the event as an ergogenic aid.
The use of IV fluid may be beneficial for a subset of fluid-sensitive athletes; this should be reserved for high-level athletes with strong histories of symptoms in well-monitored settings. Volume expanders may also be beneficial for some athletes. IV fluids and plasma binders are not allowed in World Anti-Doping Agency–governed competitions. Routine IV therapy cannot be recommended as best practice for the majority of athletes.
intravenous fluids; rehydration; hydration; athlete; volume expander
The female athlete triad (the triad) is an interrelationship of menstrual dysfunction, low energy availability (with or without an eating disorder), and decreased bone mineral density; it is relatively common among young women participating in sports. Diagnosis and treatment of this potentially serious condition is complicated and often requires an interdisciplinary team.
Articles from 1981 to present found on PubMed were selected for review of major components of the female athlete triad as well as strategies for diagnosis and treatment of the conditions.
The main goal in treatment of young female athletes with the triad is a natural return of menses as well as enhancement of bone mineral density. While no specific drug intervention has been shown to consistently improve bone mineral density in this patient population, maximizing energy availability and optimizing vitamin D and calcium intake are recommended.
Treatment requires a multidisciplinary approach involving health care professionals as well as coaches and family members. Prevention of this condition is important to minimize complications of the female athlete triad.
female athlete triad; disordered eating; amenorrhea; bone mineral density
Benign neck pain is common in athletes and is usually the result of minor sprains, strains, or contusions. Athletes with neck pain may have deficits in cervical and/or upper thoracic mobility, muscle recruitment, strength and endurance, repositioning acuity, postural stability, and oculomotor control.
A Medline search was performed via PubMed to locate articles of any publication date through December 2011 using the search terms cervical pain, neck pain, athlete, athletic, therapeutic exercise, and rehabilitation. Reference lists of retrieved articles were searched for additional relevant references.
Therapeutic exercise has promise as an intervention for individuals with neck pain, although reports on isolated athletic populations are lacking. To date, recommendations for specific therapeutic exercises have been derived largely from anecdotal or uncontrolled level IV or V evidence.
Clinicians should consider deficits, functional limitations, irritability level, and the sport’s cervical spine stress profile when selecting exercises for athletes with neck pain.
cervical; strengthening; endurance training
Genetic association studies demonstrate a relationship between several collagen gene variants and anterior cruciate ligament (ACL) injury, yet the mechanism of these relationships is still unclear. Joint laxity is a heritable trait; increased magnitudes of anterior knee laxity (AKL), genu recurvatum (GR), and general joint laxity (GJL) have been consistently associated with a greater risk of ACL injury. Joint laxity may constitute an important intermediate phenotype for the genetic association with ACL injury that can be measured clinically.
To determine if genetic variants within the COL1A1, COL5A1, and COL12A1 genes, previously associated with ACL injury, were also associated with greater magnitudes of AKL, GR, and GJL.
Descriptive laboratory study.
Blood samples and measures of AKL, GR, and GJL were obtained from 124 (50 male, 74 female) healthy, recreationally active subjects. Genomic DNA was extracted from the blood samples and genotyped for single-nucleotide polymorphisms previously examined relative to ACL injury. Univariate analyses of variance compared the magnitude of each laxity variable across the 3 genotypes for each single-nucleotide polymorphism in both sex-combined and sex-specific models.
Specific genotypes were associated with greater GR in all subjects. Some genotypes were associated with greater magnitudes of GR, AKL, and GJL in females only.
Gene variants previously associated with ACL injury risk were in large part also associated with joint laxity. Sex-specific genetic associations with joint laxity were consistent with those previously reported for ACL injury.
These data provide insight into potential pathways through which genotypic variants in collagen genes have the potential to alter ligament structure and behavior and, thus, ACL injury risk.
joint laxity; genetic variations; anterior cruciate ligament injury; collagen genes; sex differences
Muscle impairments associated with knee osteoarthritis (OA) are the primary underlying cause of functional limitations. Understanding the extent of muscle impairments, its relationship with physical function and disease progression, and the evidence behind exercise therapy that targets muscle impairments is crucial.
An electronic search for relevant articles using MEDLINE and CINHAL databases up to September 2011 was performed. In addition to the electronic search, retrieved articles were searched manually for relevant studies.
Quadriceps, hamstrings, and hip muscles are significantly impaired in subjects with knee OA compared with age-matched controls. Muscle strength, especially quadriceps, is a major determinant of both performance-based and self-reported physical function. Whether stronger quadriceps is protective against knee OA onset and progression is not clear. Exercise therapy, including global and targeted resistance training, is effective in reducing pain and improving function in subjects with knee OA.
Subjects with knee OA have significant muscle impairments. These muscle impairments affect physical function and should be targeted in therapy. Further research is needed to explore the relationship between quadriceps strength and knee OA initiation and progression and to determine the optimal exercise prescription that augments outcomes in this patient population.
Osteoarthritis; Impairment; Functional limitation; Knee; Exercise
Information regarding the structure, composition, and function of the knee menisci has been scattered across multiple sources and fields. This review contains a concise, detailed description of the knee menisci—including anatomy, etymology, phylogeny, ultrastructure and biochemistry, vascular anatomy and neuroanatomy, biomechanical function, maturation and aging, and imaging modalities.
A literature search was performed by a review of PubMed and OVID articles published from 1858 to 2011.
This study highlights the structural, compositional, and functional characteristics of the menisci, which may be relevant to clinical presentations, diagnosis, and surgical repairs.
An understanding of the normal anatomy and biomechanics of the menisci is a necessary prerequisite to understanding the pathogenesis of disorders involving the knee.
knee; meniscus; anatomy; function
Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding.
The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention.
Descriptive epidemiology study.
In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment.
A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically.
The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury.
Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury.
anterior cruciate ligament; injury; reconstruction; wakeboarding; extreme sports; water skiing
This case demonstrates the potential serious consequences of the female athlete triad and its effects on bone. Displaced femoral neck stress fractures cause significant morbidity, and this case highlights the preventable nature of this injury. The treatment was focused on improving low energy availability, and, although challenging, improvements were made. This injury could have been prevented if the signs and symptoms of her injury had been addressed and there had been better knowledge of her risk factors. This case highlights the need for further education in the sports and health communities.
female athlete triad; low energy availability; cross-country; bone mineral density; menstrual dysfunction; hip fracture
Pain control is a factor in the sideline treatment of competitive athletes. Ketorolac injections by team physicians as a pain control measure are seemingly becoming more mainstream, although there have been very little data published on its use.
Intramuscular ketorolac injections are being used regularly by orthopaedic surgeons and primary care sports medicine physicians in their care of athletes.
Descriptive epidemiology study.
A 19-question survey was generated online for physician members of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North America, and the American Medical Society for Sports Medicine. The survey link was e-mailed, with reminders sent every 1 to 2 weeks, and results were collected from April to June 2011.
The survey was e-mailed to 6950 physicians, with 1100 respondents completing it (60% orthopaedic surgeons, 40% nonsurgical sports medicine physicians). Approximately 49% use intramuscular ketorolac in the treatment of athletes, primarily at the collegiate and professional levels; 95.8% reported effective pain control after administration; 2.9% reported bleeding complications; and 1.9% reported kidney complications from its use.
Intramuscular ketorolac injections are used by approximately half of all team physicians in their sideline treatment of competitive athletes.
Toradol; Ketorolac; NSAIDs; Pain Control
The relationship between biological tissue healing following knee injury or surgery and long-term clinical outcome has come to the forefront of sports medicine practice. This has led many knee surgeons to incorporate biologically mediated healing factors into the management of knee injuries. In particular, the clinical use of mesenchymal stem cells has opened new horizons.
Relevant studies were identified through a search of PubMed from January 2000 to April 2011, combining the term mesenchymal stem cells with articular cartilage, anterior cruciate ligament, and meniscus. Relevant citations from the reference lists of selected studies were also reviewed.
Knee injury treatment with mesenchymal stem cells shows potential. Most reports represent animal model studies; few advances have been translated to human clinical applications.
Mesenchymal stem cell use to promote healing following knee injury is likely to increase. There are scientific methodological concerns and ethical and legal issues regarding mesenchymal stem cell use for treating knee injuries.
biological tissue healing; cell-based therapy; cartilage repair
Magnetic resonance imaging (MRI) is routinely used in the diagnosis of sports-related knee injuries.
To determine the accuracy, sensitivity, and specificity of MRI compared with clinical evaluation in the diagnosis of meniscal pathology when the MRI facility and the radiologist are not preselected.
A total of 288 knee arthroscopies were retrospectively compared. Patients were divided into 3 groups: those who had MRI performed and interpreted at a single institution, MRI performed and interpreted at community facilities, or a clinical evaluation by a senior orthopaedic surgeon.
The sensitivity, specificity, and accuracy of the diagnosis of medial meniscal pathology at a single institution were 90%, 59%, 76%; in community facilities, 73%, 68%, 70%; and by a clinical evaluation, 93%, 55%, 73%, respectively. For lateral meniscal pathology, the results were as follows: single institution, 75%, 76%, 81%; community facilities, 60%, 88%, 79%; and clinical evaluation, 45%, 90%, 79%, respectively. Sensitivity for medial meniscus was greater than for lateral meniscus, but specificity of diagnosis was better for lateral meniscus by MRI and clinical evaluation. While not statistically significant, there was increased sensitivity in the diagnosis of medial meniscus and lateral meniscus at SIs, but they have less specificity than at community facilities. The number of false-positive diagnoses (ie, no intra-articular pathology) that resulted in surgery was 4 of 288 (1.39%). The overall accuracy for medial meniscus by MRI was 73% vs 73% for clinical evaluation. The overall accuracy for MRI for lateral meniscus was 78% vs 79% for clinical evaluation.
Routine MRI may not be more beneficial than clinical evaluation when there is no preselection of MRI facility and interpreting radiologist.
The use of MRI for diagnosing meniscal pathology should be reserved for those cases where the orthopaedic clinical examination is ambiguous.
magnetic resonance imaging; meniscus; clinical evaluation; knee
Rowing is one of the original modern Olympic sports and was one of the most popular spectator sports in the United States. Its popularity has been increasing since the enactment of Title IX. The injury patterns in this sport are unique because of the stress applied during the rowing stroke.
This review summarizes the existing literature describing the biomechanics of the rowing stroke and rowing-related injury patterns. Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December, 2011) as well as from textbook chapters and rowing coaching manuals.
Rowing injuries are primarily overuse related. The knee, lumbar spine, and ribs are most commonly affected. The injury incidence is directly related to the volume of training and technique.
Familiarity of the injury patterns and the biomechanical forces affecting the rowing athlete will aid in prompt diagnosis and appropriate management.
rowing; rowing injuries; overuse injuries; rib stress fractures; lumbar degenerative disc disease
Pain and injuries suffered by youth pitchers are ongoing concerns that have been addressed through the institution of rules and recommendations regarding pitch counts and rest periods. The aim of our study was to see if coaches of youth baseball pitchers in our region were aware of the recommended guidelines and if they followed them.
An Internet-based survey consisting of 18 items including demographic information and questions concerning the USA Baseball Medical and Safety Advisory Committee pitching guidelines was sent to coaches affiliated with a local youth league to assess their knowledge of and reported compliance with these recommendations.
Ninety-five of 228 coaches (41.4%) participated in the survey. On average, coaches answered 43% of questions regarding pitch count and rest periods correctly; 73% reported that they followed the recommendations, while only 53% felt that other coaches in the league abided by the recommendations. Thirty-five percent of coaches stated that their pitchers reported shoulder or elbow pain during the season, and 19% reported that one of their pitchers pitched a game with a sore or fatigued arm during the season. No coaches reported any pitching-related injuries among their players requiring surgery. Fewer than 10% of coaches reported that their players pitched in multiple leagues or participated in showcases, while 91% reported that pitchers attended camps or received specific instruction to improve their pitching form.
This study shows that this subset of youth baseball coaches is deficient with regard to knowledge of the USA Baseball Medical and Safety Advisory Committee pitching guidelines. This situation may put youth pitchers at increased risk for upper extremity pain and injuries.
pediatric; baseball; pitcher; injuries; pitch count
Prolonged transmeridian air travel can impart a physical and emotional burden on athletes in jet lag and travel fatigue. Jet lag may negatively affect the performance of athletes.
A Medline search for articles relating to jet lag was performed (1990-present), as was a search relating to jet lag and athletes (1983-January, 2012). The results were reviewed for relevance. Eighty-nine sources were included in this descriptive review.
Behavioral strategies are recommended over pharmacological strategies when traveling with athletes; pharmacological aides may be used on an individual basis. Strategic sleeping, timed exposure to bright light, and the use of melatonin are encouraged.
There is strong evidence that mood and cognition are adversely affected by jet lag. Some measures of individual and team performance are adversely affected as well.
jet lag; athletes; travel; fatigue; circadian rhythms