British Journal of Sports Medicine

ObjectiveLow back pain (LBP) impacts the performance and quality of life of elite athletes during and beyond their career. Our aim was to explore the lived experiences of elite athletes with persistent LBP (pLBP) with a focus on understanding the biopsychosocial factors that influence their recovery.MethodsAustralian elite athletes with pLBP (>3 months) participated in semistructured interviews which focused on their pLBP experience. Recordings were transcribed verbatim, and data were analysed using Braun and Clarke’s reflexive thematic analysis. We partnered with athletes throughout the research process, including study design and data analysis.Results17 elite national and international athletes who competed in 10 Summer Olympic sports were included (mean symptom duration 18 months and current pain of 3.5/10 (SD+/-2.1)). Four themes were generated to represent participants’ experiences: (1) the burden of pLBP, (2) validation, agency and feeling empowered to manage pain, (3) perceived barriers and coping strategies in recovery and (4) culture and interpersonal relationships for managing persisting low back pain.ConclusionsElite athletes with pLBP report disruption to identity, self-confidence and perceived worth. The culture of elite sport magnifies psychosocial determinants of pain and recovery. Agency was fostered through validation of their pain experience, enhanced by education, diagnostic labelling and a culture of openness. Recovery was influenced by mental health and relationships within and beyond sport. Clinicians play a key role in facilitating athlete agency, contextualising pain and supporting psychological and social well-being.

ObjectiveTo compare body composition and physical fitness between transgender and cisgender individuals.DesignSystematic review with meta-analysis.Data sourcesPubMed, Web of Science, Embase and SportDiscus.Eligibility criteriaInclusion criteria comprised studies of transgender individuals comparing body composition or physical fitness pre-to-post gender-affirming hormone therapy (GAHT) or versus cisgender controls.Results50 studies (n=6099) were included. Transgender women had similar relative fat mass (standardised mean difference (SMD) −0.29, 95% CI −0.63 to 0.05, Grading of Recommendations Assessment, Development and Evaluation (GRADE): very low), relative lean mass (SMD 0.19, 95% CI −0.14 to 0.53, GRADE: low), upper-body strength (SMD 0.92, 95% CI −0.52 to 2.35, GRADE: very low), lower-body strength (SMD −0.10, 95% CI −1.07 to 0.86, GRADE: very low) and maximal oxygen consumption (SMD −0.28, 95% CI −0.81 to 0.25, GRADE: very low) in comparison to cisgender women. Transgender men exhibited higher relative fat mass (SMD 1.09, 95% CI 0.66 to 1.53, GRADE: moderate), lower relative lean mass (SMD −6.42, 95% CI −12.26 to −0.58, GRADE: moderate) and lower upper-body strength (SMD −1.20, 95% CI −1.96 to −0.45, GRADE: moderate) than cisgender men. In transgender women, GAHT was associated with increased fat mass and reduced lean mass and upper-body strength over 1–3 years. Transgender men demonstrated reduced fat mass and increased lean mass and strength following GAHT.ConclusionWhile transgender women exhibited higher lean mass than cisgender women, their physical fitness was comparable. Current evidence is mostly low certainty and has heterogenous quality but does not support theories of inherent athletic advantages for transgender women over cisgender.PROSPERO registration numberCRD42024562210.

ObjectivesTo explore the injury-inciting situational characteristics of indirect and non-contact muscle injuries in sports, commonly referred to as muscle strains; and to investigate differences and similarities of injury patterns across muscle groups.Data sourcesPubMed, Web of Science, SPORTDiscus and Google Scholar.Eligibility criteria for selecting studiesStudies investigating injury-inciting situational characteristics (among others, injury contact mechanisms, joint positions, movement directions) of indirect and non-contact muscle injuries in sports through video recordings.ResultsTwenty-one studies reporting the injury-inciting situational characteristics of 728 indirect and non-contact muscle injuries were included. Non-contact mechanisms were more common (74%) than indirect contact mechanisms (26%). Most injuries were either running-related or occurred during sport-specific manoeuvres involving muscle-tendon unit length changes under active muscle contraction. For hamstring injuries, the most frequently reported injury kinematics comprised a knee joint position close to extension (underlying movement direction: flexion to extension) and a flexed hip joint position (underlying movement direction: variable). For adductor injuries, injury kinematics were characterised by rapid muscle lengthening due to hip extension, abduction and external rotation. For rectus femoris injuries, the observed injury kinematic comprised a flexing hip joint movement and extending knee joint movement. For calf injuries, the typical injury pattern comprised an ankle dorsiflexion movement with the knee being close to extension and the ankle in >10° dorsiflexion at the assumed injury time.ConclusionThis systematic review found distinct, identifiable injury patterns for indirect and non-contact muscle injuries. While similar situational characteristics were identified across injuries, some patterns were more specific to particular injury locations and sports.PROSPERO registration numberPROSPERO registration number CRD42023472252.