The 100 Most Influential Studies in Sports Medicine

One measure of the affect of a scientific idea is how frequently it receives cited

One measure of the affect of a scientific idea is how frequently it receives cited by other researchers. The major-cited paper of all time, in accordance to a 2014 examination by Mother nature, has now been cited by 344,007 other scientific article content due to the fact its publication in 1951. (The subject? You’d never guess, for good reasons we’ll get into down below.) Researchers’ job prospective clients are affected by their h-index, a measure that rewards possessing a significant range of closely cited papers (and possibly, though no one would in fact confess it, by their Kardashian index, which compares their cumulative citations to the range of Twitter followers they have).

You can also use equivalent tactics to assess complete fields, which is what a new review led by Omeet Khatra of the University of British Columbia attempts for sporting activities and training medicine. In the Orthopaedic Journal of Sports Drugs, Khatra and his colleagues set collectively a listing of the a hundred article content with the most citations in the industry, providing a snapshot of the influence of equally particular person papers and broader trends. There are a bunch of attention-grabbing findings, but possibly the most telling is this: only one of the a hundred papers is a randomized managed demo, which is the gold-typical style of experimental proof.

The Discipline

One vital caveat for this examination is that the boundaries of sporting activities and training medicine are rather hazy. Khatra’s definition incorporates running sporting activities injuries, maximizing athletic general performance, and the use of training to increase well being. That is extremely broad, but the process applied to discover major papers was a very little much more idiosyncratic. They started by figuring out a listing of forty six journals concentrated on sporting activities and training medicine, and then determined the a hundred most-cited article content from within just all those journals.

That means sizeable papers printed in non-specialist journals really do not clearly show up on the listing. A.V. Hill’s original 1923 study on VO2 max was printed in the Quarterly Journal of Drugs Karlman Wasserman’s 1964 paper on the anaerobic threshold was printed in the American Journal of Cardiology. In reality, you’d count on that the most floor-breaking findings are the most possible to make it into generalist journals like Mother nature and Science (the place, for illustration, a basic 1937 paper on the cardio electric power of globe record-placing runners was printed).

So it’s not a thorough listing, but it continue to addresses a big fraction of the industry. It’s dominated by Drugs & Science in Sports & Training, the flagship journal of the American Higher education of Sports Drugs, which contributes no a lot less than 49 of the papers. Future on the listing are the American Journal of Sports Drugs, with eighteen, and Sports Drugs, with 7. The oldest paper on the listing is from 1973, reflecting the field’s relatively latest emergence as a distinctive willpower: MSSE, for illustration, was only introduced in 1969.

The Winner

Topping the listing with 7,228 citations was Gunnar Borg’s 1982 paper, “Psychophysical bases of perceived exertion.” Borg is the man who sophisticated the concept of a subjective scale of perceived exertion, which initially ran from 6 to twenty, whilst there’s a much more sensible modified variation that runs from zero to ten. He started building this idea in the 1960s, but the 1982 English-language paper is the one that receives cited when people today chat about perceived exertion. (A further one of Borg’s papers on the subject, from 1973, demonstrates up at 48th on the listing.)

You might not imagine that inquiring people today to assign a range to how tricky they’re doing the job is a significant scientific breakthrough. But Borg’s get the job done has experienced a enormous influence. He argued that his scale is “the one very best indicator of the degree of actual physical pressure,” integrating indicators from the muscle tissue, lungs, heart, and brain. In the previous two a long time, much more and much more researchers have taken that argument very seriously as they’ve tried to reveal the brain’s part in figuring out our actual physical restrictions, and also as a functional instrument for guiding instruction. Base line: I’d say Borg’s paper is a worthy winner.

The Themes

The largest group of papers on the listing focus on methodological applications: how to operate a VO2 max exam, how to compute system composition, how to calibrate your pedometers and accelerometers, what validated questionnaires to use to inquire your topics about their training habits, and so on. That is also what is noticed in other fields: the all-time most cited paper that I stated at the major is a strategies paper on “protein measurement with the folin phenol reagent.”

Procedures papers may possibly not sound all that fascinating, but they can unquestionably be controversial. Various of the papers on the listing focus on statistics, like the range nine paper, from 2008, by Will Hopkins and colleagues: “Progressive statistics for reports in sporting activities medicine and training science.” That tactic to statistics is designed to tease out refined general performance results in reports with small sample sizes. But it has come underneath rigorous criticism, most notably subsequent a 2018 posting in FiveThirtyEight by Christie Aschwanden arguing that it is much more possible to generate false-positive findings than classic statistical strategies.

A further massive bucket is formal guidelines, mainly the ones issued by the American Higher education of Sports Drugs on subjects like resistance instruction, doing exercises with cancer, hydration, body weight loss, blood stress, and exercises for more mature grown ups. These are helpful overviews to cite in the introduction to an posting when you want to again up typical statements like “exercise is great for you” or what ever, but they’re not significantly floor-breaking.

Immediately after that, it’s much more of a combined bag. The most common aspect of the anatomy is the knee, which is the focus of 15 papers, mainly relating to ACL injuries. Future is the brain, which characteristics in a few papers on concussion in activity. Two other themes that rack up a number of mentions: the enduring thriller of delayed-onset muscle mass soreness, and the rising well being scourge of also significantly sitting.

There are a few papers on the physiology of soccer, one on the biomechanics of baseball pitching, and one on Hakan Alfredson’s famed heel-fall protocol for Achilles tendinosis, which squeaks in at 98th location. (Humorous backstory: Alfredson is an orthopedic surgeon who experienced Achilles issues again in the nineteen nineties. When his boss refused to give him time off for operation mainly because the situation wasn’t significant sufficient, he determined to aggravate his Achilles with painful heel drops—but unintentionally healed himself.)

The Evidence

I stated at the major that only one of the reports on the listing is a randomized managed demo, indicating that topics were being randomly assigned to either acquire either an intervention or a placebo. Alternatively, most of the experimental papers use lessen degrees of proof this sort of as cohort reports and case sequence, neither of which use randomization or control teams. The most significant one group, with 38 papers, is narrative opinions, which study the outcomes of a number of reports on a subject but really do not pool them into one massive meta-examination.

I imagine most sporting activities researchers would concur that the industry requirements much more randomized trials, along with other methodological advancements like more substantial subject teams and much more sophisticated statistical analyses. But the faults in the major-a hundred listing most likely aren’t specific to sporting activities science. Watson and Crick’s discovery of the framework of DNA and Einstein’s idea of typical relativity really do not make their respective lists either: the most significant breakthroughs develop into textbook material that does not even need a quotation. “If citations are what you want,” Yale University chemist Peter Moore explained to Mother nature, “devising a process that helps make it probable for people today to do the experiments they want at all, or much more effortlessly, will get you a ton further than, say, finding the solution of the Universe.”

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