Personalized Injury Reduction Strategies in Sports Medicine: Lessons Learned from Advances in Breast Cancer Treatment: A Clinical Commentary

Background Injury rates across sport have risen over the past twenty years, despite increased efforts in training and injury prevention. The rise in injury rates suggest that current approaches to estimating injury risk and risk management are not effective. One factor limiting progress is the inconsistency in screening, risk assessment, and risk management strategies to guide injury mitigation approaches. Clinical Question How can sports physical therapists identify and apply lessons learned from other healthcare fields to improve athlete injury risk and risk management strategies? Key Results Breast cancer mortality has consistently decreased over the last 30 years, largely attributed to advances in personalizing the prevention and treatment strategies which include modifiable and non-modifiable factors when assessing risk, the transition to personalized medicine, and the systematic approach used to investigate individual risk factors. Three critical phases have facilitated the identification and importance of individual risk factors and developing targeted, personalized strategies for breast cancer risk including: 1) Establishing the potential relationship between factors and outcomes; 2) Prospectively investigate the strength and direction of the relationship; 3) Investigating if intervening on identified factors alters prognosis. Clinical Application Applying lessons learned from other healthcare fields could improve shared decision making between the clinician and athlete concerning risk assessment and management. Examples include calculating only non-modifiable risk, creating individualized screening schedules based on risk assessment, or calculating the influence of each intervention on the athlete’s injury risk. A systematic approach to identify and intervene on risk is needed to improve athlete outcomes.

[1]  R. Butler,et al.  Baseball pitching biomechanics in relation to pain, injury, and surgery: A systematic review. , 2020, Journal of science and medicine in sport.

[2]  N. Arden,et al.  The Relationship Between Baseball Participation and Health: A Systematic Scoping Review. , 2020, The Journal of orthopaedic and sports physical therapy.

[3]  Masahito Yoshida,et al.  The differences of humeral torsion angle and the glenohumeral rotation angles between young right-handed and left-handed pitchers. , 2019, Journal of shoulder and elbow surgery.

[4]  Kristen S Purrington,et al.  Polygenic Risk Scores for Prediction of Breast Cancer and Breast Cancer Subtypes , 2018, American Journal of Human Genetics.

[5]  Max L. Balter,et al.  The growing role of precision and personalized medicine for cancer treatment , 2018, Technology.

[6]  M. Nozaki,et al.  Left-handed skeletally mature baseball players have smaller humeral retroversion in the throwing arm than right-handed players. , 2017, Journal of shoulder and elbow surgery.

[7]  Karen G Roos,et al.  Rankings of High School Sports Injury Rates Differ Based on Time Loss Assessments , 2017, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[8]  E. McCarty,et al.  An Epidemiological Comparison of Elbow Injuries Among United States High School Baseball and Softball Players, 2005-2006 Through 2014-2015 , 2017, Sports health.

[9]  M. Greenwood,et al.  Examining the influence of physical size among major league pitchers. , 2017, The Journal of sports medicine and physical fitness.

[10]  C. Thigpen,et al.  Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits , 2017, Sports health.

[11]  C. Nissen,et al.  Biomechanical differences between left- and right-handed baseball pitchers , 2017, Sports biomechanics.

[12]  M. Axe,et al.  Exceeding Pitch Count Recommendations in Little League Baseball Increases the Chance of Requiring Tommy John Surgery as a Professional Baseball Pitcher , 2017, Orthopaedic journal of sports medicine.

[13]  W. Willett,et al.  Population Attributable Risk of Modifiable and Nonmodifiable Breast Cancer Risk Factors in Postmenopausal Breast Cancer. , 2016, American journal of epidemiology.

[14]  J. Agel,et al.  Collegiate ACL Injury Rates Across 15 Sports: National Collegiate Athletic Association Injury Surveillance System Data Update (2004-2005 Through 2012-2013) , 2016, Clinical Journal of Sports Medicine.

[15]  W. Willett,et al.  Breast Cancer Risk From Modifiable and Nonmodifiable Risk Factors Among White Women in the United States. , 2016, JAMA oncology.

[16]  Roald Bahr,et al.  Why screening tests to predict injury do not work—and probably never will…: a critical review , 2016, British Journal of Sports Medicine.

[17]  Christopher L. Camp,et al.  Injury Trends in Major League Baseball Over 18 Seasons: 1998-2015. , 2016, American journal of orthopedics.

[18]  C. Ahmad,et al.  Epidemiology of Medial Ulnar Collateral Ligament Reconstruction , 2016, The American journal of sports medicine.

[19]  Hanbing Zhou,et al.  Evaluation of Hip Internal and External Rotation Range of Motion as an Injury Risk Factor for Hip, Abdominal and Groin Injuries in Professional Baseball Players , 2015, Orthopedic reviews.

[20]  Kyle T. Aune,et al.  Deficits in Glenohumeral Passive Range of Motion Increase Risk of Shoulder Injury in Professional Baseball Pitchers , 2015, The American journal of sports medicine.

[21]  J. C. Garrison,et al.  BASEBALL PLAYERS WITH ULNAR COLLATERAL LIGAMENT TEARS DEMONSTRATE DECREASED ROTATOR CUFF STRENGTH COMPARED TO HEALTHY CONTROLS. , 2015, International journal of sports physical therapy.

[22]  Ellen Shanley,et al.  Humeral Torsion as a Risk Factor for Shoulder and Elbow Injury in Professional Baseball Pitchers , 2015, The American journal of sports medicine.

[23]  K. Moons,et al.  Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD): the TRIPOD statement , 2015, BJOG : an international journal of obstetrics and gynaecology.

[24]  Douglas G. Altman,et al.  Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) , 2015, Circulation.

[25]  Glenn S. Fleisig,et al.  Deficits in Glenohumeral Passive Range of Motion Increase Risk of Elbow Injury in Professional Baseball Pitchers , 2014, The American journal of sports medicine.

[26]  J. C. Garrison,et al.  Lower extremity balance is improved at time of return to throwing in baseball players after an ulnar collateral ligament reconstruction when compared to pre-operative measurements. , 2014, International journal of sports physical therapy.

[27]  J. C. Garrison,et al.  Baseball players diagnosed with ulnar collateral ligament tears demonstrate decreased balance compared to healthy controls. , 2013, The Journal of orthopaedic and sports physical therapy.

[28]  Kyle T. Aune,et al.  Glenohumeral Passive Range Of Motion And The Correlation To Elbow Injuries In Professional Baseball Pitchers , 2013, Orthopaedic Journal of Sports Medicine.

[29]  B. Hagel,et al.  Assessing the representativeness of Canadian Hospitals Injury Reporting and Prevention Programme (CHIRPP) sport and recreational injury data in Calgary, Canada , 2013, International journal of injury control and safety promotion.

[30]  C. la Vecchia,et al.  The decline in breast cancer mortality in Europe: an update (to 2009). , 2012, Breast.

[31]  Ellen Shanley,et al.  Incidence of injuries in high school softball and baseball players. , 2011, Journal of athletic training.

[32]  Ellen Shanley,et al.  Shoulder Range of Motion Measures as Risk Factors for Shoulder and Elbow Injuries in High School Softball and Baseball Players , 2011, The American journal of sports medicine.

[33]  Brett D Owens,et al.  Epidemiology of Major League Baseball Injuries , 2011, The American journal of sports medicine.

[34]  Glenn S Fleisig,et al.  Correlation of Glenohumeral Internal Rotation Deficit and Total Rotational Motion to Shoulder Injuries in Professional Baseball Pitchers , 2011, The American journal of sports medicine.

[35]  F. Collins,et al.  The path to personalized medicine. , 2010, The New England journal of medicine.

[36]  C. la Vecchia,et al.  Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[37]  Frank E Harrell,et al.  Preseason Shoulder Strength Measurements in Professional Baseball Pitchers , 2010, The American journal of sports medicine.

[38]  M. Torry,et al.  Association of Maximum Pitch Velocity and Elbow Injury in Professional Baseball Pitchers , 2010, The American journal of sports medicine.

[39]  R Dawn Comstock,et al.  Shoulder Injuries in US High School Baseball and Softball Athletes, 2005–2008 , 2010, Pediatrics.

[40]  Timothy J Wilt,et al.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. , 2009, Annals of internal medicine.

[41]  V. Tjan-Heijnen,et al.  Surgical resection of the primary tumour is associated with improved survival in patients with distant metastatic breast cancer at diagnosis. , 2009, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[42]  O. Olopade,et al.  Advances in Breast Cancer: Pathways to Personalized Medicine , 2008, Clinical Cancer Research.

[43]  A. Trentham-Dietz,et al.  Proportion of invasive breast cancer attributable to risk factors modifiable after menopause. , 2008, American journal of epidemiology.

[44]  C. Collins,et al.  Epidemiological Features of High School Baseball Injuries in the United States, 2005–2007 , 2008, Pediatrics.

[45]  R Spicer,et al.  Cost of injuries from a prospective cohort study of North Carolina high school athletes , 2007, Injury Prevention.

[46]  Bingshu E. Chen,et al.  Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[47]  W. Kelly Is baseball a global sport? America's ‘national pastime’ as global field and international sport , 2007 .

[48]  C. Emery,et al.  Survey of Sport Participation and Sport Injury in Calgary and Area High Schools , 2006, Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.

[49]  Eva Negri,et al.  Monitoring the decrease in breast cancer mortality in Europe , 2005, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[50]  W E Garrett,et al.  Injury history as a risk factor for incident injury in youth soccer , 2005, British Journal of Sports Medicine.

[51]  Y Wang,et al.  Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials , 2005, The Lancet.

[52]  Glenn S. Fleisig,et al.  Ulnar Collateral Ligament Reconstruction in High School Baseball Players , 2004, The American journal of sports medicine.

[53]  J. Powell,et al.  Injury patterns in selected high school sports: a review of the 1995-1997 seasons. , 1999, Journal of athletic training.

[54]  J. Samet,et al.  Invited Commentary: Epidemiology and Risk Assessment , 1998 .

[55]  Willem H. Meeuwisse,et al.  Assessing Causation in Sport Injury: A Multifactorial Model , 1994 .

[56]  Division on Earth Risk Assessment in the Federal Government: Managing the Process , 1983 .

[57]  J. Andrews,et al.  Epidemiology of Shoulder and Elbow Injuries Among United States High School Baseball Players: School Years 2005-2006 Through 2014-2015 , 2018, The American journal of sports medicine.

[58]  N. Hagemann,et al.  Performance Differences Between Left- and Right-Sided Athletes in One-on-One Interactive Sports , 2016 .

[59]  Sarah K Fields,et al.  Shoulder injuries among United States high school athletes during the 2005-2006 and 2006-2007 school years. , 2009, Journal of athletic training.

[60]  Douglas G. Altman,et al.  Methodological challenges in the evaluation of prognostic factors in breast cancer , 2004, Breast Cancer Research and Treatment.

[61]  G. Murrell,et al.  Reliability of five methods for assessing shoulder range of motion. , 2001, The Australian journal of physiotherapy.