The term Little Ice Age was originally coined by F Matthesin 1939 to describe the most recent 4000 year climaticinterval (the Late Holocene) associated with a particularlydramatic series of mountain glacier advances and retreats,analogous to, though considerably more moderate than, thePleistocene glacial ﬂuctuations. This relatively prolongedperiod has now become known as the Neoglacial period.The term Little Ice Age is, instead, reserved for the mostextensive recent period of mountain glacier expansion and isconventionally deﬁned as the 16th–mid 19th century periodduring which European climate was most strongly impacted.This period begins with a trend towards enhanced glacialconditions in Europe following the warmer conditions ofthe so-called medieval warm period or medieval climaticoptimum of Europe (

http://www.meteo.psu.edu/holocene/public_html/shared/articles/littleiceage.pdf

Little Ice Age

The health, fitness and other advantages of youth sports participation are well recognised. However, there are considerable challenges for all stakeholders involved— especially youth athletes—in trying to maintain inclusive, sustainable and enjoyable participation and success for all levels of individual athletic achievement. In an effort to advance a more unified, evidence-informed approach to youth athlete development, the IOC critically evaluated the current state of science and practice of youth athlete development and presented recommendations for developing healthy, resilient and capable youth athletes, while providing opportunities for all levels of sport participation and success. The IOC further challenges all youth and other sport governing bodies to embrace and implement these recommended guiding principles.

https://bjsm.bmj.com/content/bjsports/49/13/843.full.pdf

International Olympic Committee consensus statement on youth athletic development

### Background

Youth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout.

### Purpose

To provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2)delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention.

### Methodology

Medical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system.

### Definition of overuse injury

Overuse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscle-tendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries.

### Epidemiology

It is estimated that 27 million US youth between 6 and 18 years of age participate in …

https://bjsm.bmj.com/content/bjsports/48/4/287.full.pdf

Overuse Injuries and Burnout in Youth Sports: APositionStatementfromtheAmericanMedicalSocietyfor Sports Medicine

Division of Sports Medicine and Non-Operative Orthopaedics, Departments of Family Medicine and Orthopaedics, University of California, Los Angeles, California, USA Departments of Pediatrics and Orthopaedic Surgery, University of Chicago, Chicago, Illinois, USA Department of Pediatrics, Eastern Virginia School of Medicine, Norfolk, Virginia, USA Departments of Orthopedics and Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA Departments of Family Medicine and Orthopaedic Surgery and Rehabilitation, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA Departments of Pediatrics and Orthopedics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA Departments of Orthopaedics and Family Medicine, University of California, San Francisco, California, USA

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine.

Background Physical activity is important in both prevention and treatment of many common diseases, but sports injuries can pose serious problems.

Objective To determine whether physical activity exercises can reduce sports injuries and perform stratified analyses of strength training, stretching, proprioception and combinations of these, and provide separate acute and overuse injury estimates.

Material and methods PubMed, EMBASE, Web of Science and SPORTDiscus were searched and yielded 3462 results. Two independent authors selected relevant randomised, controlled trials and quality assessments were conducted by all authors of this paper using the Cochrane collaboration domain-based quality assessment tool. Twelve studies that neglected to account for clustering effects were adjusted. Quantitative analyses were performed in STATA V.12 and sensitivity analysed by intention-to-treat. Heterogeneity (I2) and publication bias (Harbord's small-study effects) were formally tested.

Results 25 trials, including 26 610 participants with 3464 injuries, were analysed. The overall effect estimate on injury prevention was heterogeneous. Stratified exposure analyses proved no beneficial effect for stretching (RR 0.963 (0.846–1.095)), whereas studies with multiple exposures (RR 0.655 (0.520–0.826)), proprioception training (RR 0.550 (0.347–0.869)), and strength training (RR 0.315 (0.207–0.480)) showed a tendency towards increasing effect. Both acute injuries (RR 0.647 (0.502–0.836)) and overuse injuries (RR 0.527 (0.373–0.746)) could be reduced by physical activity programmes. Intention-to-treat sensitivity analyses consistently revealed even more robust effect estimates.

Conclusions Despite a few outlying studies, consistently favourable estimates were obtained for all injury prevention measures except for stretching. Strength training reduced sports injuries to less than 1/3 and overuse injuries could be almost halved.

https://bjsm.bmj.com/content/bjsports/48/11/871.full.pdf

The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials

Objective To determine the effectiveness of coach-led neuromuscular warm-up on reducing lower extremity (LE) injuries in female athletes in a mixed-ethnicity, predominantly low-income, urban population. Design Cluster randomized controlled trial. Setting Chicago public high schools. Participants Of 258 coaches invited to participate, 95 (36.8%) enrolled (1558 athletes). Ninety coaches and 1492 athletes completed the study. Interventions We randomized schools to intervention and control groups. We trained intervention coaches to implement a 20-minute neuromuscular warm-up. Control coaches used their usual warm-up. Main Outcome Measures Coach compliance was tracked by self-report and direct observation. Coaches reported weekly athlete exposures (AEs) and LE injuries causing a missed practice or game. Research assistants interviewed injured athletes. Injury rates were compared between the control and intervention groups using χ 2 and Fisher exact tests. Significance was set at P Results There were 28 023 intervention AEs and 22 925 control AEs. Intervention coaches used prescribed warm-up in 1425 of 1773 practices (80.4%). Intervention athletes had lower rates per 1000 AEs of gradual-onset LE injuries (0.43 vs 1.22, P P P  = .01), and LE injuries treated surgically (0 vs 0.17, P  = .04). Regression analysis showed significant incidence rate ratios for acute-onset noncontact LE injuries (0.33; 95% CI, 0.17-0.61), noncontact ankle sprains (0.38; 95% CI, 0.15-0.98), noncontact knee sprains (0.30; 95% CI, 0.10-0.86), and noncontact anterior cruciate ligament injuries (0.20; 95% CI, 0.04-0.95). Conclusion Coach-led neuromuscular warm-up reduces noncontact LE injuries in female high school soccer and basketball athletes from a mixed-ethnicity, predominantly low-income, urban population. Trial Registration clinicaltrials.org Identifier:NCT01092286

/pdf/effect-of-neuromuscular-warm-up-on-injuries-in-female-soccer-45yokswngs.pdf

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools: Cluster Randomized Controlled Trial

OBJECTIVE
To determine the effectiveness of coach-led neuromuscular warm-up on reducing lower extremity (LE) injuries in female athletes in a mixed-ethnicity, predominantly low-income, urban population.


DESIGN
Cluster randomized controlled trial.


SETTING
Chicago public high schools.


PARTICIPANTS
Of 258 coaches invited to participate, 95 (36.8%) enrolled (1558 athletes). Ninety coaches and 1492 athletes completed the study.


INTERVENTIONS
We randomized schools to intervention and control groups. We trained intervention coaches to implement a 20-minute neuromuscular warm-up. Control coaches used their usual warm-up.


MAIN OUTCOME MEASURES
Coach compliance was tracked by self-report and direct observation. Coaches reported weekly athlete exposures (AEs) and LE injuries causing a missed practice or game. Research assistants interviewed injured athletes. Injury rates were compared between the control and intervention groups using χ(2) and Fisher exact tests. Significance was set at P < .05. Poisson regression analysis adjusted for clustering and covariates in an athlete subset reporting personal information (n = 855; 57.3%).


RESULTS
There were 28 023 intervention AEs and 22 925 control AEs. Intervention coaches used prescribed warm-up in 1425 of 1773 practices (80.4%). Intervention athletes had lower rates per 1000 AEs of gradual-onset LE injuries (0.43 vs 1.22, P < .01), acute-onset noncontact LE injuries (0.71 vs 1.61, P < .01), noncontact ankle sprains (0.25 vs 0.74, P = .01), and LE injuries treated surgically (0 vs 0.17, P = .04). Regression analysis showed significant incidence rate ratios for acute-onset noncontact LE injuries (0.33; 95% CI, 0.17-0.61), noncontact ankle sprains (0.38; 95% CI, 0.15-0.98), noncontact knee sprains (0.30; 95% CI, 0.10-0.86), and noncontact anterior cruciate ligament injuries (0.20; 95% CI, 0.04-0.95).


CONCLUSION
Coach-led neuromuscular warm-up reduces noncontact LE injuries in female high school soccer and basketball athletes from a mixed-ethnicity, predominantly low-income, urban population. TRIAL REGISTRATION CLINICALTRIALS.ORG IDENTIFIER: NCT01092286.

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools

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Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools: Cluster Randomized Controlled Trial

Effect of Neuromuscular Warm-up on Injuries in Female Soccer and Basketball Athletes in Urban Public High Schools