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Elite athletes endeavour to train and compete even when ill or injured. Their motivation may be intrinsic or due to coach and team pressures. The sports medicine physician plays an important role to risk-manage the health of the competing athlete in partnership with the coach and other members of the support team. The sports medicine physician needs to strike the right ethical and operational balance between health management and optimising performance. It is necessary to revisit the popular delivery model of sports medicine and science services to elite athletes based on the current reductionist multispecialist system lacking in practice an integrated approach and effective communication. Athlete and coach in isolation or with a member of the multidisciplinary support team, often not qualified or experienced to do so, decide on the utilisation of services and how to apply the recommendations. We propose a new Integrated Performance Health Management and Coaching model based on the UK Athletics experience in preparation for the London Olympic and Paralympic Games. The Medical and Coaching Teams are managed by qualified and experienced individuals operating in synergy towards a common performance goal, accountable to a Performance Director and ultimately to the Board of Directors. We describe the systems, processes and implementation strategies to assist the athlete, coach and support teams to continuously monitor and manage athlete health and performance. These systems facilitate a balanced approach to training and competing decisions, especially while the athlete is ill or injured. They take into account the best medical advice and athlete preference. This Integrated Performance Health Management and Coaching model underpinned the Track and Field Gold Medal performances at the London Olympic and Paralympic Games.
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... Each team has the potential to rise or fall based on the group of people who share the same passion and goals and are working together to achieve success [1]. This narrative is very common in elite sport, an environment that presents considerable health and performance challenges to the athlete and those charged with the responsibility of supporting them [2]. Considering that the success of athlete support teams is often measured by athletic performance outcomes [3], evidence supports the notion that contemporary athlete achievement can be strongly influenced by the function of the athlete support team [4,5]. ...
... Individuals within elite sport support teams include team/athlete coaches and the sports medicine and science team members who are constantly looking for ways to improve the performance and health of the athletes with whom they work [8]. Although varying in definition across sporting contexts, this team of individuals supporting the athlete form the high-performance team (HPT; see Fig. 1) [2,[9][10][11]. Teamwork refers to the behavioural processes that team members (e.g. members of a HPT) use to achieve work within the team (e.g. ...
... Challenges within HPTs in the elite sport setting arise because of factors such as organisational climate, professional conflict, power and influence challenges coupled with employment insecurities [19]. Additionally, high risk to reward scenarios, the demand to have a competitive advantage, and the emphasis on winning, have fractured the modern sports culture resulting in disparity and separation of athlete support staff and coaching staff within the same team [2,27,28]. Effective team function underpins the achievement of desired outcomes of collaborative work [12]. Consequently, suboptimal teamwork has at times catastrophic results for outcomes of such work [29]. ...
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Background The primary aim of our systematic scoping review was to explore the factors influencing team function and performance across various industries and discuss findings in the context of the high-performance sport support team setting. These outcomes may also be used to inform future research into high-performance teamwork in sport. Methods A systematic scoping review of literature published in English since 2000 reporting team-based performance outcomes and included a performance metric that was ‘team outcome based’ was conducted using search of the Academic Search Ultimate, Medline, Business Source Ultimate, APA PsycInfo, CINAHL, SPORTDiscus, and Military database (ProQuest) using the terms: ‘team’, ‘function’ OR ‘dysfunction’, ‘Perform*’ OR ‘outcome’. Results Application of the search strategy identified a total of 11,735 articles for title and abstract review. Seventy-three articles were selected for full-text assessment with the aim to extract data for either quantitative or qualitative analysis. Forty-six of the 73 articles met our inclusion criteria; 27 articles were excluded as they did not report a performance metric. Eleven studies explored leadership roles and styles on team performance, three studies associated performance feedback to team performance, and 12 studies explored the relationship between supportive behaviour and performance. Team orientation and adaptability as key figures of team performance outcomes were explored in 20 studies. Conclusions Our findings identified 4 key variables that were associated with team function and performance across a variety of industries; (i) leadership styles, (ii) supportive team behaviour, (iii) communication, and (iv) performance feedback. High-performance teams wishing to improve performance should examine these factors within their team and its environment. It is widely acknowledged that the dynamics of team function is important for outcomes in high-performance sport, yet there is little evidence to provide guidance. This inequality between real-world need and the available evidence should be addressed in future research.
... Furthermore, while a range of personnel collected AMS data, 44% of respondents did not indicate that athlete monitoring data were collected by their medical team. These findings contradict previous research that has demonstrated a close relationship between the medical team and elite athletes, with periodic health reviews and illness/injury monitoring being standard practice (Dijkstra et al., 2014). These apparent differences could be due to misinterpretation of the survey questions, but, more likely, it is a result of confidential medical information being kept separately from day-to-day athlete monitoring data. ...
... These apparent differences could be due to misinterpretation of the survey questions, but, more likely, it is a result of confidential medical information being kept separately from day-to-day athlete monitoring data. While privacy may demand the separation of these datasets, it risks causing a silo'd approach to both data management and thinking, which, unless addressed, could prevent a holistic understanding of athlete health and training status (Dijkstra et al., 2014) Data collection for AMS was primarily completed via mobile devices (72% of respondents). While this might be an intuitive approach, the efficacy of mobile devices as a data collection modality is unclear. ...
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Athlete monitoring systems (AMS) aid performance optimisation and support illness/injury prevention. Nonetheless, limited information exists on how AMS are employed across elite sports in the United Kingdom. This study explored how athlete monitoring (AM) data, in particular athlete self-report measures, were collected, analysed and disseminated within elite sports. Thirty elite sports practitioners representing 599 athletes responded to a survey on their AM methodologies. The majority, 83%, (n = 25) utilised an AMS, and a further 84% (n = 21) stated the collection of their AMS data was underpinned by a scientific rationale. Athlete self-report measures (ASRM) were the most commonly employed tool, with muscle soreness, sleep and energy levels amongst the most frequently collected measures. The ubiquitous use of custom single-item ASRM resulted in considerable variability in the questionnaires employed, thus potentially impacting questionnaire validity. Feedback processes were largely felt to be ineffective, with 44% (n = 11) respondents indicating that athletes did not receive sufficient feedback. Some respondents indicated that AMS data was never discussed with athletes and/or coaches. Overall, significant disparities exist in the use of athlete monitoring systems between research and elite sports practice, and the athlete, coach and practitioner experience of monitoring risks being poor if these disparities are not addressed.
... The ethos of the British Athletics team's rehabilitation process is an integrated approach between the medical team and the coach. 38 Rehabilitation was provided by full time British Athletics doctors and physiotherapists with a team philosophy of progressive, functional, and strength-based rehabilitation. This included eccentric exercise, an early return to dynamic loading activity, including running, limited by pain and integration with the athletic coach. ...
... The athlete's fitness to train was formally recorded in each clinical record. 38 ...
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Rectus femoris (RF) injuries are common in sports requiring maximal acceleration and sprinting. The British Athletics Muscle Injury Classification (BAMIC) describes acute muscle injury based on the anatomical site of injury and has been associated with return to play in hamstring and calf muscle injury. The aim of this study was to describe and compare the time to return to full training (TRFT) and injury recurrence for BAMIC‐classified RF injuries sustained by elite track and field (T&F) athletes over a 9‐year period. All rectus femoris injuries sustained by elite T&F athletes on the British Athletics World Class Program between September 2010 and September 2019 that were investigated with an MRI within 7 days of acute onset anterior thigh pain were included. Injuries were graded from the MRI by a specialist musculoskeletal radiologist using the BAMIC, and TRFT and injury recurrence were determined by evaluation of the Electronic Medical Record. Athlete demographics and World Athletics event discipline were recorded. Specific injury details including mechanism, location of injury and whether surgical or rehabilitation management was undertaken were recorded. There were 38 RF injuries in 27 athletes (24.7±2.3 years; 10 male, 17 female). Average TRFT for rehabilitation managed cases was 20.4±14.8 days. Grade 1 injuries had significantly shorter TRFT compared to grades 2 (p=0.04) and 3 (p=0.01). Intratendinous (c) and surgically managed RF injuries each had significantly longer TRFT compared to other injury classes (p<0.001). Myofascial (a) injuries had reduced repeat injury rates compared to b or c classes (p=0.048). Grade 3 injuries had an increased repeat injury rate compared to other grades (p=0.02). There were 4 complete (4c) proximal free tendon injuries sustained during sprinting and all in female athletes. The average TRFT for RF injuries in elite T&F is similar to that previously identified in elite football and Australian Rules. Similar to previous research in hamstring and calf injury, RF injuries extending into the tendon (BAMIC class c) had delayed TRFT which may reflect the longer duration required for tendon healing and adaptation. Grade 3 injuries had in increased repeat injury rate compared to grades 1 and 2. The BAMIC diagnostic framework may provide useful information for clinicians managing rectus femoris injuries in T&F.
... External pressures (eg, from technical staff, supporters, media, agents, etc) may negatively influence clinical decision-making leading to poor clinical practice or unethical behaviours. 12 Thirty-five percent of respondents' surveyed reported that they felt under pressure to make decisions which were not in keeping with best practice during the COVID-19 pandemic. The 'high stakes' attached to some pressure not to substitute a player with a potential concussion. ...
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Objectives The purpose of this study was to explore the leadership experiences of elite football team physicians during the COVID-19 pandemic. Methods A pilot-study based on a cross-sectional design by means of an electronic survey was conducted. The survey relied on 25 questions divided into distinct sections including among others professional and academic experience, leadership experiences and perspectives. Results A total of 57 physicians (91% male; mean age: 43 years) gave their electronic informed consent and completed the survey. All participants agreed that the demands of their role had increased during the COVID-19 pandemic. Fifty-two (92%) participants reported that they felt they were expected to take more of a leadership role during the COVID-19 pandemic. Eighteen (35%) reported feeling under pressure to make clinical decisions which were not in keeping with best clinical practice. Additional roles, duties and demands expected of team doctors during the COVID-19 pandemic were subdivided into communication, decision-making, logistical, and public health demands. Conclusion The findings from this pilot study suggest that the way in which team physicians at professional football clubs operate has altered since the onset of the COVID-19 pandemic, with greater demands placed on leadership skills including decision-making, communication and ethical stewardship. This has potential implications for sporting organisations, clinical practice and research.
... Such information sources act as the basis for generating evidence necessary for managing rugby union players in those professional environments. Athlete health management models proposed for professional sporting settings clearly illustrate that the decisions made relating to player management can involve multiple stakeholders (e.g., coaches and physicians) (Dijkstra et al., 2014). Hence, it may suggest that the transition from evidence to knowledge creation required for player management could primarily occur based on the consensus generated from collective decision-making processes. ...
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In sporting environments, the knowledge necessary to manage athletes is built on information flows associated with player management processes. In current literature, there are limited case studies available to illustrate how such information flows are optimized. Hence, as the first step of an optimization project, this study aimed to evaluate the current state and the improvement opportunities in the player management information flow executed within the High-Performance Unit (HPU) at a professional rugby union club in England. Guided by a Business Process Management framework, elicitation of the current process architecture illustrated the existence of 18 process units and two core process value chains relating to player management. From the identified processes, the HPU management team prioritized 7 processes for optimization. In-depth details on the current state (As-Is) of the selected processes were extracted from semi-structured, interview-based process discovery and were modelled using Business Process Model and Notation (BPMN) and Decision Model and Notation (DMN) standards. Results were presented for current issues in the information flow of the daily training load management process, identified through a thematic analysis conducted on the data obtained mainly from focus group discussions with the main stakeholders (physiotherapists, strength and conditioning coaches, and HPU management team) of the process. Specifically, the current state player management information flow in the HPU had issues relating to knowledge creation and process flexibility. Therefore, the results illustrate that requirements for information flow optimization within the considered environment exist in the transition from data to knowledge during the execution of player management decision-making processes.
... The integration of new technologies in elite populations will also require closer collaborations between research and practitioners, and then directly to the athlete and coach (Bartlett and Drust, 2021). However, multidisciplinary sport science and medicine teams do not come without challenges and clear communication, roles and responsibilities are essential (Dijkstra et al., 2014) with the athlete and coach at the centre of accountability. ...
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Sports nutrition is a relatively new discipline; with ~100 published papers/year in the 1990s to ~3,500+ papers/year today. Historically, sports nutrition research was primarily initiated by university-based exercise physiologists who developed new methodologies that could be impacted by nutrition interventions (e.g., carbohydrate/fat oxidation by whole body calorimetry and muscle glycogen by muscle biopsies). Application of these methods in seminal studies helped develop current sports nutrition guidelines as compiled in several expert consensus statements. Despite this wealth of knowledge, a limitation of the current evidence is the lack of appropriate intervention studies (e.g., randomized controlled clinical trials) in elite athlete populations that are ecologically valid (e.g., in real-life training and competition settings). Over the last decade, there has been an explosion of sports science technologies, methodologies, and innovations. Some of these recent advances are field-based, thus, providing the opportunity to accelerate the application of ecologically valid personalized sports nutrition interventions. Conversely, the acceleration of novel technologies and commercial solutions, especially in the field of biotechnology and software/app development, has far outstripped the scientific communities' ability to validate the effectiveness and utility of the vast majority of these new commercial technologies. This mini-review will highlight historical and present innovations with particular focus on technological innovations in sports nutrition that are expected to advance the field into the future. Indeed, the development and sharing of more “big data,” integrating field-based measurements, resulting in more ecologically valid evidence for efficacy and personalized prescriptions, are all future key opportunities to further advance the field of sports nutrition.
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Background: Athletics (also known as track and field) is one of the most popular sports in the world and is the centrepiece of the Summer Olympic Games. Participation in athletics training and competition involves a risk of illness and injury. Purpose: To describe injury and illness in British Olympic track and field athletes over three full training and competition seasons. Study design: Descriptive Epidemiology Study. Methods: A total of 111 athletes on the British national program were followed prospectively for three consecutive seasons between 2015-2018. Team medical personnel recorded all injuries and illnesses during this time, following current consensus-based methods. All data pertaining to these records were reviewed and analyzed for sports injury and illness epidemiological descriptive statistics. Results: The average age of the athletes was 24 years for both males and females (24 years, +/- 4). Total exposure for the three seasons was 79 205 athlete days (217 athlete years). Overuse injuries (56.4%) were more frequent than acute injuries (43.6%). The thigh was the most common injury location (0.6 per athlete year), followed by the lower leg (0.4 per athlete year) and foot (0.3 per athlete year). Muscle and tendon were the most commonly injured tissues, while strains and tears were the most common pathology type. Hamstring muscle strain was the most common diagnosis causing time loss, followed by Achilles tendinopathy and soleus muscle strain. Respiratory illness was the most common illness type (0.3 per athlete year). Conclusion: Hamstring strains, Achilles tendinopathy, and soleus strains are the most common injuries in athletics and have highest burden. Respiratory illness is the most common illness and has the highest burden. Knowledge of this injury and illness profile within athletics could be utilised for the development of targeted prevention measures within the sport at the elite level. Level of evidence: 3.
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To understand elite athlete, coach and support staff experiences, perceptions and beliefs in women’s water polo with managing upper limb injuries and monitoring training loads. Inductive qualitative design. Twenty athletes, coaches and support staff were purposively recruited and participated in semistructured interviews. Participants either had experienced an upper limb injury or had experience managing athletes with upper limb injuries. Interviews were conducted in-person or virtually, audio-recorded, deidentified, transcribed verbatim and cleaned to ensure accuracy. Data were thematically analysed. Analysis identified five cohesive themes: (1) upper limb injury management is adequate—but prevention, communication and knowledge need improving, (2) current training load monitoring generates uncertainty and lack of consistency of processes—due to reliance on internal, and lack of external load monitoring, (3) optimal training load monitoring requires objective measurement of training load—that accurately measures the external load of athletes’ upper limbs, (4) athlete-centred philosophy matters—including athlete-centred care to facilitate individually tailored rehabilitation programmes and their inclusion in management decisions, (5) mental, social and emotional aspects of upper limb injury management matter—acknowledging feelings of loss of team inclusion, fear of missing out and frustration felt by athletes as well as the emotional labour felt by coaches when supporting athletes with an upper limb injury. Upper limb injury management and training load monitoring are evolving areas where objective measurement of training load may assist in increasing consistency of communication, collaboration and coordination between all stakeholders, and to address uncertainty. Stakeholders placed value in intangible qualities such as trust and care in their relationships with other collaborators—facilitating athlete physical, mental and emotional recovery following upper limb injuries.
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The aim of this review is to highlight the prevalence of allergic rhinitis in athletes and the impact this condition may have on their athletic performance. Furthermore, the optimal management of medical conditions in the elite athlete forms an important part of protecting the health of the athlete. The use of pharmacological intervention in the treatment of allergic rhinitis in elite athletes requires careful planning. A variety of factors must be considered prior to prescription such as drug efficacy and safety both at rest and in conjunction with strenuous exercise, associated side effects on athletic performance and well being and whether the chosen drug is on the World Anti-Doping Agency (WADA) banned list. Allergic rhinitis is common in elite athletes and may impair athletic performance and recovery. We advise that all elite and professional athletes should be screened for allergic rhinitis using validated questionnaire such as the Allergy Questionnaire for Athletes (AQUA) alongside skin prick testing or specific IgE blood tests for inhalant allergens. Intranasal corticosteroids are highly recommended as the management drug of choice for athletes in conjunction with second-generation antihistamines (severity dependant) and when practicable, allergen avoidance.