Shelby Baez

Background : Epidemiological studies indicate that female athletes are two times more likely to develop a bone stress injury (BSI) than males. Among athletic populations, female long-distance runners in early adulthood have been shown to be at an especially high risk for BSIs. Purpose : To identify which risk factors may predict BSI occurrence in female distance runners ages 18–26. Methods : A computerized search using PubMed, CINAHL, and PsychInfo was conducted in January 2025 to identify recent observational/cohort prognosis studies that included primary data collection on BSI risk factors in female distance runners ages 18–26. The search yielded 37 studies and three were appropriate for inclusion. The included studies were critically appraised and assessed using the QUIPS Risk of Bias Assessment. Information related to study design, participants, methods, risk factors, and outcomes was summarized. Results : BSI rates decreased by 5% for each cadence increase of one step per minute. BSI rates were 6.42 times higher in individuals with a history of stress fracture, 2.70 times higher for each standard deviation (SD) decrease in bone mineral content, 1.11 times higher for each 100 mg decrease in calcium intake, 1.42 times higher for each one-year decrease in age, and 1.92 times higher for each one-year decrease in age at menarche. BSI risk decreased by 40% for every additional daily serving of dairy and by 68% in individuals with a dietary pattern of high dairy and low fat intake. Conclusion : Risk factors for stress fractures in female distance runners in early adulthood include low step rate, BSI history, low bone mineral content, low calcium/dairy consumption, and younger age.

Objective To examine the independent association of kinesiophobia with meeting physical activity (PA) guideline recommendations in individuals with axial spondyloarthritis (axSpA). Methods This cross-sectional study recruited U.S.-based adults with axSpA via online platforms and support groups between October and December 2020, during the COVID-19 pandemic. Participants completed a digital survey including demographic and clinical information and validated outcome measures for kinesiophobia (TSK-11), disease activity (BASDAI), function (BASFI), quality of life (ASQoL), and PA participation. PA participation was categorized as meeting American College of Sports Medicine (ACSM) guidelines for moderate, vigorous, and strengthening activity. Logistic regression models assessed the association of TSK-11 scores with meeting ACSM PA recommendations, adjusting for age, sex, disease duration, and disease activity. Results 180 participants completed the survey. Overall, 31%, 26%, and 34% met ACSM guidelines for moderate, vigorous, and strengthening activity, respectively. Higher kinesiophobia was significantly associated with reduced odds of meeting PA guidelines across all activity types. In adjusted models, sample sizes ranged from 141 to 142 participants across activity outcomes due to incomplete data; each one-point increase in TSK-11 was associated with 11% lower odds of meeting strengthening activity guidelines (OR = 0.89, 95% CI: 0.83–0.96), 8% lower odds for meeting moderate activity guidelines (OR = 0.92, 95% CI: 0.86–0.99), and 9% lower odds for meeting vigorous activity guidelines (OR = 0.91, 95% CI: 0.84–0.98). No covariates included in the adjusted models (age, sex, disease duration, BASDAI) were significant predictors. Conclusion Kinesiophobia was independently associated with lower odds of meeting PA guidelines among individuals with axSpA, beyond demographic and disease-related factors. These findings underscore the need for routine assessment and targeted intervention strategies to address fear-avoidant behaviors in activity and exercise counseling for axSpA. Key Points • Higher levels of kinesiophobia were independently associated with lower odds of meeting moderate, vigorous, and strengthening physical activity recommendations among adults with axial spondyloarthritis. • Most participants did not meet recommended levels of physical activity, with a substantial proportion reporting no participation in vigorous or strengthening activities. • Kinesiophobia may represent a clinically meaningful barrier to physical activity participation and a potential target for intervention in axial spondyloarthritis.

Background: Psychological responses to injury are common after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and have been linked to knee-related pain during early recovery. However, it remains unknown whether anxiety and depression symptoms are associated with knee pain severity at later stages of recovery, when unresolved or recurrent psychological distress may persist. Purpose/Hypothesis: The purpose of this study was to examine the association of anxiety and depression symptoms with knee pain severity in individuals 3 to 12 months after ACLR. It was hypothesized that individuals who exhibited more severe anxiety and depression symptoms would report more knee pain. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In total, 131 individuals who were 3 to 12 months after primary, unilateral ACLR (time since ACLR = 5.7 ± 1.7 months; age = 18.3 ± 2.1 years; 37.4% male) were included. Anxiety and depression symptoms were measured with the Patient-Reported Outcomes Measurement Information System Anxiety and Depression 4-item short forms, respectively, where higher scores reflect more severe symptoms. Knee pain was measured with the Knee injury and Osteoarthritis Outcome Score Pain subscale, where higher scores indicate less or no knee pain. Separate multiple hierarchical regression analyses were conducted to examine the association of self-reported anxiety and depression symptoms with knee pain severity. Sex, age, and time since ACLR were entered in step 1 of each model. Anxiety and depression symptom scores were entered in step 2 of their respective models, and the change in R ² was examined. Results: Sex, age, and time since ACLR explained 3% of the variance in knee pain severity ( R ² = 0.031, P = .23). Anxiety symptoms accounted for an additional 25.7% of the variance in knee pain severity (Δ R ² = 0.257, P < .001), while depression symptoms accounted for an additional 15.7% of the variance in knee pain severity (Δ R ² = 0.157, P < .001). Conclusion: Self-reported anxiety and depression symptoms were significantly associated with knee pain severity in individuals 3 to 12 months after ACLR. These findings support assessment of anxiety, depression, and knee pain, even in the later phases of ACLR rehabilitation, to help inform clinical decision-making.

About 1 in 3 individuals will sustain a secondary anterior cruciate ligament (ACL) injury within 24 months of returning to sport after ACL reconstruction (ACLR). While aberrant biomechanics and poor quadriceps strength have been associated with secondary ACL injury risk, unresolved injury-related fear has also been identified as a potential risk factor for additional ACL injuries in previously high-functioning, physically active populations. Virtual reality mindfulness meditation (VRMM) is a psychological intervention that may reduce injury-related fear and improve an individual's ability to stay in the present moment during stressful situations such as sport. There is a critical need to identify whether VRMM is a feasible intervention that could be implemented to address injury-related fear and reduce secondary ACL injury risk. This study aims to determine the feasibility, acceptability, and preliminary efficacy of a VRMM intervention with neuromuscular training rehabilitation (NTR) to reduce injury-related fear and improve jump-landing biomechanics in females with a history of ACLR, when compared to a sham virtual reality (VR) intervention+NTR. A double-blinded, 2-arm feasibility trial of 48 participants (24 per group) comparing VRMM+NTR and VR sham+NTR will be conducted. Recruitment, retention, adherence, and acceptability outcomes will be collected throughout the trial. Injury-related fear will be measured using the 11-Item Tampa Scale of Kinesiophobia. Jump-landing biomechanics will be assessed via peak knee abduction moment and peak knee flexion excursion. The change in outcomes will be compared between groups using 2×2 repeated measures ANOVA and partial η2 effect sizes. Significance will be set at P<.05. The study was funded in May 2021. The trial started in September 2023 and is anticipated to be completed in May 2027, with the first results expected to be submitted for publication in winter 2027. We expect to observe acceptable rates of retention, adherence, and acceptability to the VRMM intervention and more favorable outcomes in the VRMM+NTR group compared to the VR sham+NTR group. As of now, 55 participants have been screened for eligibility, of which 33 were ineligible. Twelve participants have been randomized, and 10 have completed the trial. Two participants withdrew from the trial before the completion of the full intervention protocol due to the study time commitment. The results of this trial will improve our understanding of the feasibility of VRMM and inform the next steps in behavioral intervention development to test the efficacy of VRMM in reducing injury-related fear in females after ACLR.

Context : Pain catastrophizing, a psychological response to actual or anticipated pain, has been shown to negatively impact attention and is commonly observed in individuals with anterior cruciate ligament reconstruction (ACLR) and other musculoskeletal conditions. In sport settings, attentional changes associated with pain catastrophizing, combined with environmental distractions, may impair injury-related perceptual-motor skills, such as visuomotor reaction time (VMRT). Characterizing the association between pain catastrophizing and VMRT in an environment that simulates sport-related distractions may highlight the need to address psychological factors that impact attention post-ACLR. The purpose of this study was to examine the association between pain catastrophizing and lower-extremity VMRT among individuals with ACLR under conditions with and without sport-specific visual and auditory stimuli. Design : Cross-sectional. Setting : Research laboratory. Methods : Twenty-three participants (age = 20.4 [3.0] y) postunilateral primary ACLR (time since ACLR = 28.6 [13.0] mo). Participants completed the Pain Catastrophizing Scale (PCS) and a lower-extremity VMRT task in a 360° immersive visualization room under 2 conditions: (1) distraction (sport-specific visual and auditory stimuli playing) and (2) control (no sport-specific visual and auditory stimuli playing). Separate multiple linear regression analyses were conducted to examine the association of PCS scores with ACLR and contralateral limb VMRT (milliseconds) in each condition. Time since ACLR was included as a covariate in each model. Results : In the distraction condition, PCS scores were significantly associated with ACLR limb VMRT ( P = .02, β = 2.71), but not contralateral limb VMRT ( P = .14, β = 2.65). In the control condition, PCS scores were not significantly associated with lower-extremity VMRT (ACLR limb VMRT: P = .20, β = 2.31, contralateral limb VMRT: P = .45, β = 1.74). Conclusion : Individuals with ACLR who exhibited greater pain catastrophizing demonstrated slower ACLR limb VMRT when exposed to a simulated sport-related distraction. Evaluating pain catastrophizing in this population may help rehabilitation specialists identify individuals who could experience lower-extremity VMRT changes in environments with sport-related distractions.

Clinical Scenario: Although chronic ankle instability (CAI) and ankle sprains are highly prevalent, there has been little advancement in treatment strategies. A challenging aspect of CAI rehabilitation is the multifaceted nature of CAI. Sensorimotor deficits particularly dynamic postural control impairments, are well documented in those with CAI relative to uninjured controls and likely contribute to the high prevalence of CAI. Because CAI is associated with deficits in sensory pathways, mind–body interventions may help enhance a patient’s awareness and processing of sensory information (ie, proprioception). Improved proprioception may subsequently result in more confidence in bodily movements, which we hypothesize would manifest as improved dynamic postural control. Focused Clinical Question: Do mind–body interventions, relative to a control condition, improve dynamic postural control in patients with CAI? Summary of Key Findings: Two studies found that a 12-week Yang style Tai Chi resulted in significantly greater improvements in all Star Excursion Balance Test reach directions compared with the respective control groups. One study found that a 4-week walking meditation program (which entails the participant slowly walking back and forth while keeping their concentration on movements of the body) resulted in significant improvements on some Star Excursion Balance Test reach directions, but these changes were not different from the changes observed in the control group. Clinical Bottom Line: The results indicate that mind–body interventions, especially Tai Chi, can improve dynamic postural control in those with CAI. Strength of Recommendation: Overall consistent high-quality evidence was present in the 3 studies, suggesting grade A evidence for the use of mind–body interventions in the rehabilitation of patients with CAI.

Context: Thirty percent of athletes go on to sustain a secondary anterior cruciate ligament (ACL) injury after return to sport. Those that went on to suffer a secondary injury had greater kinesiophobia levels at time of return to sport; however, these relationships have primarily been observed in patients after primary ACL reconstruction (ACLR). The purpose of this study is to compare differences in kinesiophobia 4 to 8 months after an individual’s primary versus secondary ACLR. Methods: This is a secondary analysis of an ongoing point of care study. To create our analytic sample, we identified participants between the ages of 14 and 35 years in the study protocol who provided data after primary and secondary ACLR, were 4 to 8 months status post-ACLR, and reported no concomitant surgical procedures at the time of primary or secondary ACLR that significantly delayed their rehabilitation protocol (e.g., meniscal repair). Demographic and participant characteristics and the Tampa Scale of Kinesiophobia-17 scores were collected after both primary and secondary ACLR. This study is a within-subjects design. Paired t tests were used to compare Tampa Scale of Kinesiophobia-17 scores between the primary and secondary ACLR. Results: Sixteen participants (male = 10, female = 6; height = 172.2 [11.5] cm, weight = 72.2 [20.9] kg) met inclusion criteria for the present study. Participants were 18.2 (3.0) years old and 5.6 (1.0) months since surgery after primary ACLR and 19.0 (1.0) years old and 5.9 (1.0) months since surgery after secondary ACLR. The average score for Tampa Scale of Kinesiophobia-17 was not different ( P = .77) after the primary (32.7 [5.0]) and secondary ACLR (33.1 [5.2]). Conclusion: There were no significant differences in kinesiophobia levels in individuals after their primary and secondary ACLR. Although nonsignificant, there is lack of resolution of kinesiophobia between primary and secondary ACLR.

Delayed visuomotor reaction time has been linked to slower motor responses and increased injury risk, emphasizing the need for accurate and repeatable assessment tools. Portable light-based systems offer an accessible method for evaluating visuomotor reaction time, but their reliability for upper-extremity tasks has not been established. This study examined the test–retest reliability of an upper-extremity visuomotor reaction time task using a novel portable light-based device. Forty healthy participants completed two sessions 7–10 days apart, performing a 60-s task in which nine light-emitting diode targets illuminated in a randomized sequence and were deactivated as quickly as possible. Reaction time, total hits, and total misses were recorded, and reliability was assessed using intraclass correlation coefficients (ICCs). Reaction time (ICC = .80; 95% confidence interval [.62, .89]), misses (ICC = .83; 95% confidence interval [.67, .91]), and hits (ICC = .76; 95% confidence interval [.54, .87]) demonstrated good test–retest reliability. These findings indicate that this portable system provides consistent measures of upper-extremity reaction time and task accuracy in healthy individuals. The tool may offer a practical option for clinicians and researchers assessing visuomotor performance, with future work needed to determine its utility in injury risk screening and clinical populations.