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Professional and amateur athletes alike are burdened by shoulder injuries. 7,44,48,49,78,88 Shoulder pain affects athlete performance, training, and daily life. 61,64 More than half of elite collegiate American football players sustain at least 1 shoulder injury during their career. 48 Shoulder injuries are a problem for athletes in sports as diverse as rugby, 54 baseball, 34 handball, 20 diving, 73 water polo, 73 and kayaking. 41 Yet, there is a lack of quality evidence to guide clinicians, athletes, and coaches in managing shoulder injury risk or return to sport (RTS) post injury. The absence of quality evidence hinders those who wish to produce clinical practice guidelines. Previous consensus statements have targeted specific shoulder pathologies 4,31,60,89 and the scapula. 50 However, questions remain: • Which exercises are most appropriate for supporting primary prevention of shoulder injury in athletes? • Does screening for muscle weakness, such as a loss of rotational strength in the shoulder, hold value for athletes? • Which load management measures are relevant for the athlete with shoulder injury?U SYNOPSIS: There is an absence of high-quality evidence to support rehabilitation and return-tosport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future.

IntroductionRunning-related injuries (RRIs) occur from a combination of training load errors and aberrant biomechanics. Impact loading, measured by peak acceleration, is an important measure of running biomechanics that is related to RRI. Foot strike patterns may moderate the magnitude of impact load in runners. The effect of foot strike pattern on peak acceleration has been measured using tibia-mounted inertial measurement units (IMUs), but not commercially available insole-embedded IMUs. The aim of this study was to compare the peak acceleration signal associated with rearfoot (RFS), midfoot (MFS), and forefoot (FFS) strike patterns when measured with an insole-embedded IMU.Materials and MethodsHealthy runners ran on a treadmill for 1 min at three different speeds with their habitual foot strike pattern. An insole-embedded IMU was placed inside standardized neutral cushioned shoes to measure the peak resultant, vertical, and anteroposterior accelerations at impact. The Foot strike pattern was determined by two experienced observers and evaluated using high-speed video. Linear effect mixed-effect models were used to quantify the relationship between foot strike pattern and peak resultant, vertical, and anteroposterior acceleration.ResultsA total of 81% of the 187 participants exhibited an RFS pattern. An RFS pattern was associated with a higher peak resultant (0.29 SDs; p = 0.029) and vertical (1.19 SD; p < 0.001) acceleration when compared with an FFS running pattern, when controlling for speed and limb, respectively. However, an MFS was associated with the highest peak accelerations in the resultant direction (0.91 SD vs. FFS; p = 0.002 and 0.17 SD vs. RFS; p = 0.091). An FFS pattern was associated with the lowest peak accelerations in both the resultant and vertical directions. An RFS was also associated with a significantly greater peak acceleration in the anteroposterior direction (0.28 SD; p = 0.033) than an FFS pattern, while there was no difference between MFS and FFS patterns.ConclusionOur findings indicate that runners should be grouped by RFS, MFS, and FFS when comparing peak acceleration, rather than the common practice of grouping MFS and FFS together as non-RFS runners. Future studies should aim to determine the risk of RRI associated with peak accelerations from an insole-embedded IMU to understand whether the small observed differences in this study are clinically meaningful.

IntroductionPrimary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures.MethodsTo collect and aggregate informed opinions, an expert panel—the Young Athlete’s Hip Research Collaborative—rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies.ResultsA diverse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries; 6 stakeholder groups; 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership); (2) terminology—use ‘morphology’ and not terms with a negative connotation like ‘lesion’, ‘abnormality’ or ‘deformity’; (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research.ConclusionThis consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history.

1 run*.mp. (191128) 2 running.mp. or *Running/ (65348) 3 1 or 2 (191128) 4 insole.mp. (838) 5 IMU.mp. (870) 6 Wearable Electronic Devices/ or wearable.mp. (10889) 7 4 or 5 or 6 (12343) 8 kinetic.mp. or Kinetics/ (575422) 9 kinematic.mp. or *Biomechanical Phenomena/ (24482) 10 Accelerometry/ or acceler*.mp. (259557) 11 8 or 9 or 10 (842654) 12 3 and 7 and 11 (180)