What's new in sports medicine (primary care)

The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

IMAGING AND OTHER DIAGNOSTIC TECHNIQUES

Ultrasound screening for tendinopathy in asymptomatic athletes (February 2025)

The utility of ultrasound for identifying lesions that put asymptomatic athletes at risk of future injury remains unclear. In a systematic review and meta-analysis of 16 studies of asymptomatic, young adult athletes, including assessments of 810 Achilles and 1156 patellar tendons, abnormal ultrasound findings predicted the development of symptoms consistent with tendinopathy in only 27 percent of participants, while 92 to 93 percent of athletes without abnormalities remained symptom-free [1]. Ultrasound assessment may have a role in select athletes at high risk (eg, those with prior injury), but available evidence does not justify population-based screening. (See "Achilles tendinopathy", section on 'Diagnostic imaging' and "Patellar tendinopathy", section on 'Ultrasound'.)

MANAGEMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES

Ice for treating musculoskeletal injury (November 2024)

For many years, ice has been a standard treatment for acute muscle and tendon injuries. However, evidence supporting the effectiveness of cryotherapy is largely unstudied. The authors of a systematic review identified only 27 controlled studies of cryotherapy for acute soft tissue injury, of which 26 were animal studies, most involving muscle injury [2]. No randomized trials in humans were identified. While ice can provide analgesia and may offer benefits for acute treatment of minor injuries, its longer-term effects on more severe muscle or tendon injury are largely unknown. Pending further research, we believe it is reasonable to apply ice as part of the acute treatment of soft tissue musculoskeletal injury. (See "Initial management of soft tissue musculoskeletal injuries", section on 'Evidence'.)

MEDICAL ISSUES RELATED TO SPORTS AND EXERCISE

Exercise to prevent sarcopenia in older adults (May 2025)

Strength training has been studied as a method for preventing sarcopenia in older adults. In the randomized multicenter European DO-HEALTH trial, 1495 community-dwelling adults over 70 were assigned to an exercise intervention that consisted of five simple exercises using only bodyweight or light resistance with no planned increases in load or normal activities three times weekly [3,4]. This intervention had no impact on sarcopenia over three years. These data confirm prior studies that document the ineffectiveness of strength programs that do not emphasize robust exercises with progressive increases in load. (See "Practical guidelines for implementing a strength training program for adults", section on 'General principles'.)

Benefits of the weekend warrior exercise strategy (April 2025)

Evidence is growing that exercising for the same total period over two days ("weekend warriors") versus multiple days provides equivalent overall health benefits. According to a data registry study from over 95,000 participants in the United Kingdom, all-cause mortality rates were similarly lower for individuals who exercised multiple days of the week and "weekend warriors" compared with the higher rates found among inactive individuals [5]. Activity levels were determined by accelerometer-derived data. Although the weekend warrior approach is a reasonable exercise strategy for some, it may increase the risk for overuse injury, while those with comorbidities such as diabetes or hypertension may reap greater disease-modifying benefits from exercising most days of the week. (See "Exercise prescription and guidance for adults", section on 'Writing the aerobic exercise prescription'.)

Improved survival after sudden cardiac arrest in competitive athletes (April 2025)

Sudden cardiac arrest (SCA) is a leading cause of death among competitive athletes. Two recent observational studies evaluated outcomes after SCA in athletes:

●A study of over 29 million runners who completed marathons and half-marathons between 2010 and 2023 found that while the incidence of cardiac arrest remained stable over time, cardiac arrest mortality declined by nearly 50 percent [6].

●Another study of nearly 650 young competitive athletes who experienced SCA between 2014 and 2023 demonstrated a trend towards improved survival over this period; however, Black race and "other" (ie, non-Black and non-White) race were associated with lower survival [7].

While improvements in survival after SCA are likely due to better on-scene medical care (eg, bystander cardiopulmonary resuscitation, automatic external defibrillators), disparities in such care may explain the racial differences in observed outcomes. (See "Athletes: Overview of sudden cardiac death risk and sport participation", section on 'Prognosis of sudden cardiac arrest'.)

Effects of exercise on lipoproteins (February 2025)

Although numerous randomized trials document the benefits of exercise on serum lipid profiles, few analyses have compared the effects of different types of exercise on specific lipoproteins. In a meta-analysis of 148 randomized trials, exercise modestly improved total, low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) cholesterol and triglyceride levels, with changes that ranged from 3.5 to 11.7 percent [8]. Interventions combining aerobic and resistance exercise produced optimal reductions in serum lipoproteins. On meta-regression, each extra weekly aerobic session reduced total cholesterol by 7.68 mg/dL (0.2 mmol/L). These results provide important guidance for counseling patients on the benefits of exercise on lipid profiles. (See "Effects of exercise on lipoproteins and hemostatic factors", section on 'Type of exercise'.)

Sex-related differences in recovery from concussion (October 2024)

Debate continues about whether female and male athletes recover from concussion at different rates. Preliminary studies had suggested that female athletes recover more slowly, but subsequent research suggests this may not be true. A prospective study of over 1000 concussions among United States collegiate athletes found that, while female athletes reported higher symptom burdens throughout convalescence, there was no significant difference between females and males in the overall time to resolution of symptoms, attainment of preinjury function on routine concussion testing, and return to play [9]. (See "Clinic-based management of sports-related concussion in adolescents and adults", section on 'Predicting duration of symptoms'.)

OTHER PRIMARY CARE SPORTS MEDICINE

Suzetrigine, a first-in-class nonopioid analgesic, now available for acute pain (March 2025)

Suzetrigine, a first-in-class nonopioid oral analgesic, has been approved by the US Food and Drug Administration for management of acute pain in adults and is now available. Suzetrigine is a selective inhibitor of the Na_v 1.8 voltage-gated sodium channel, which is expressed in the dorsal root ganglia and is involved in transmission of nociceptive signals to the spinal cord. In randomized trials of 303 patients who had acute pain after abdominoplasty and 274 patients after bunionectomy, suzetrigine (100 mg orally followed by 50 mg orally every 12 hours) reduced pain scores compared with hydrocodone/acetaminophen (5 mg/325 mg orally every six hours) or placebo [10]. Further study is required to determine the role of suzetrigine in acute pain management. (See "Nonopioid pharmacotherapy for acute pain in adults", section on 'Suzetrigine, a novel Nav1.8 inhibitor'.)