The 8 Most Common Sports Injuries

December 5, 2023Kolton Opdahl
Wrist Pain

Sports injuries are an unfortunate but common occurrence among athletes of all levels, from weekend warriors to professional competitors. Understanding these injuries, how to prevent them, and how to recover is crucial for anyone engaging in physical activities. In this comprehensive guide, we will delve deep into the world of sports injuries, covering the eight most common ones, their prevention, treatment options, and the road to recovery. We will explore the impact of sports injuries on athletes’ lives and careers, highlighting the importance of injury awareness, prevention, and proper management. Let’s begin our journey into the world of sports injuries.

The 8 Most Common Sports Injuries

1. Sprains

Sports injuries often start with a sprain. A sprain occurs when ligaments—the bands that connect bones—get overstretched or torn. It can happen in various sports and activities, such as soccer, basketball, and even everyday activities. Understanding the underlying anatomy and mechanics of sprains can shed light on why they are so prevalent in the sports world.

Definition and Causes of Sprains

Sprains are injuries that involve the stretching or tearing of ligaments, the strong bands of connective tissue that hold bones together. These injuries typically happen when a joint is forced beyond its normal range of motion, causing the ligaments to stretch or tear. The specific causes of sprains can vary widely depending on the sport or activity. For example, a sudden change in direction on the basketball court can lead to an ankle sprain, while a fall in gymnastics may result in a wrist sprain.

Symptoms

Recognizing a sprain involves looking out for specific symptoms. These may include pain, swelling, bruising, and a reduced range of motion in the affected joint. The severity of a sprain can vary, from mild stretching of the ligaments (Grade I) to partial tearing (Grade II) to complete tearing (Grade III). Understanding these distinctions is crucial for appropriate treatment and recovery, as more severe sprains often require more extensive rehabilitation.

Treatment Options

Treatment for sprains typically involves the RICE method: Rest, Ice, Compression, and Elevation. Resting the injured joint helps prevent further damage, while applying ice reduces swelling and pain. Compression with a bandage and elevating the injured limb can also help control swelling and promote healing. Additionally, healthcare professionals may recommend specific exercises and physical therapy modalities tailored to the type and severity of the sprain. These treatment approaches aim not only to heal the injury but also to restore strength and stability to the affected joint, reducing the risk of re-injury.

2. Strains

Strains, often confused with sprains, involve the overstretching or tearing of muscles or tendons. These injuries can sideline athletes for weeks or even months.

Definition and Causes of Strains

A strain is an injury to a muscle or tendon, the fibrous tissues that connect muscles to bones. It occurs when the muscle fibers or tendons are stretched beyond their capacity or torn. Strains can result from overexertion, sudden movements, or excessive force placed on the muscle or tendon. For example, a weightlifter may strain their hamstring while attempting to lift a heavy weight. Understanding the intricate interplay between muscles and tendons and the biomechanics of strains is crucial for injury prevention and effective rehabilitation.

Symptoms

Symptoms of a muscle or tendon strain typically include pain, muscle spasms, swelling, and limited mobility in the affected area. The severity of a strain can range from mild, involving minor stretching of muscle fibers, to severe, with complete tearing of the muscle or tendon. It’s important to note that early recognition of symptoms and prompt intervention can make a significant difference in the recovery process.

Treatment Options

Initial treatment for strains involves rest, ice, compression, and elevation (RICE) to reduce pain and swelling. Over-the-counter pain relievers may be used to manage discomfort, but healthcare professionals should be consulted, especially for moderate to severe strains. Physical therapy plays a significant role in the rehabilitation process, focusing on strengthening the injured muscle or tendon and restoring flexibility. Chiropractic care and regenerative medicine are also key therapies to reduce soreness, pain and mobility. Severe strains may require a longer recovery period and, in some cases, surgical intervention to repair the torn tissue. Understanding the importance of progressive rehabilitation exercises and the role of therapeutic modalities in strains’ recovery can help athletes regain their full strength and function.

3. Fractures

Fractures are breaks in bones and are one of the more severe sports injuries. They can occur in contact sports or as a result of high-impact accidents.

Definition and Causes of Fractures

A fracture is a break or crack in a bone. It can happen when a bone is subjected to more force than it can withstand. In sports, fractures often result from falls, collisions, or direct blows to a bone. For instance, a skateboarder may fracture their wrist when landing on an outstretched hand after a fall. Understanding the different types of fractures, such as hairline fractures, stress fractures, and compound fractures, provides valuable insights into the injury’s severity and the necessary treatment approach.

Symptoms

Symptoms of a fracture include severe pain, swelling, bruising, and deformity in the affected area. A bone fracture may also result in an inability to use the injured limb or joint. Fractures can vary in severity, from hairline fractures, which are small cracks in the bone, to compound fractures, where the bone breaks through the skin. It’s crucial to recognize the signs of a fracture promptly to seek immediate medical attention and minimize complications.

Treatment Options

Immediate care for fractures involves immobilizing the injured area to prevent further damage. This may be done by splinting or casting the bone. In some cases, surgical intervention is necessary to realign the broken bone fragments and secure them with internal hardware. After the initial treatment, physical therapy may be required to regain strength and mobility in the affected area. The recovery timeline depends on the type and location of the fracture, as well as the individual’s age and overall health. Understanding the nuances of fracture management, including the importance of follow-up imaging and assessments, is essential for a successful recovery.

4. Dislocations

A dislocation happens when two connected bones become separated from their normal position. These injuries are often seen in sports with high contact or high-velocity movements.

Definition and Causes of Dislocations

A dislocation occurs when the bones that form a joint are forced out of their normal alignment. This typically happens due to a sudden impact or extreme joint movement. Dislocations are common in contact sports such as rugby, football, and wrestling, where players are at risk of collisions and tackles that can force joints out of place. Understanding the unique mechanics of dislocations and the vulnerability of certain joints, such as the shoulder and hip, is crucial for injury prevention and recognition.

Symptoms

Recognizing the signs of a dislocation includes severe pain, swelling, and deformity of the joint. The affected joint may appear visibly misaligned, and there may be a loss of mobility or function. Dislocations can be extremely painful, and immediate medical attention is required to reduce the joint and prevent further damage. Understanding the importance of timely reduction and the potential complications of untreated dislocations, such as nerve or blood vessel damage, underscores the need for swift action.

Treatment Options

Emergency care for a dislocation involves reducing the joint, which is typically done by a medical professional. Once the joint is back in place, it may be immobilized with a splint or brace to allow the surrounding tissues to heal. Rehabilitation and physical therapy are essential for regaining strength and range of motion in the joint. In some cases, surgery may be necessary to repair damaged ligaments or other structures. Understanding the rehabilitative process after a dislocation, including the gradual reintroduction of activity and functional exercises, is crucial for a full recovery.

5. Tendonitis

Tendonitis is a painful condition characterized by inflammation or irritation of tendons. It can result from overuse or repetitive movements in sports and physical activities.

Definition and Causes of Tendonitis

Tendonitis, also known as tendinitis, is the inflammation or irritation of a tendon. Tendons are tough, fibrous cords that connect muscles to bones. Tendonitis often occurs due to repetitive movements or overuse of a specific tendon. Athletes who engage in activities that require repetitive motions, such as runners and tennis players, are at risk of developing tendonitis. Understanding the microscopic changes that occur in tendons during tendonitis, including collagen breakdown and cell proliferation, can provide insights into treatment strategies.

Symptoms

Symptoms of tendonitis include pain, tenderness, and swelling in the affected tendon. The pain is often worse during or after physical activity and may improve with rest. In some cases, there may be a noticeable lump or thickening of the tendon. Tendonitis can become chronic if left untreated, leading to persistent pain and reduced range of motion. Recognizing the difference between acute and chronic tendonitis is essential for developing an appropriate treatment plan.

Treatment Options

Treatment for tendonitis begins with rest and activity modification. Avoiding activities that exacerbate symptoms is crucial for recovery. Applying ice and taking anti-inflammatory medications can help reduce pain and inflammation. Physical therapy focuses on stretching and strengthening the affected tendon and surrounding muscles. In severe cases, regenerative medicine can be used to regrow tissue and cartilage with the help of stem cell and PRP therapy. Understanding the role of inflammation in tendon healing and the importance of gradual return to activity can guide athletes through the recovery process.

6. Concussions

Concussions are traumatic brain injuries resulting from a blow to the head or a sudden, violent shaking of the head. They are often associated with contact sports.

Definition and Causes of Concussions

A concussion is a mild traumatic brain injury that occurs when the brain is jolted or shaken within the skull. It can result from a direct blow to the head, a sudden deceleration, or a strong impact to the body that transmits force to the head. Concussions are frequently seen in contact sports like football, hockey, and boxing, where head injuries are a significant risk. Understanding the biomechanics of concussions, including the role of rotational forces on brain tissue, is crucial for injury prevention and management.

Symptoms

Recognizing the signs of a concussion is essential for early diagnosis and proper management. Symptoms can vary but often include headache, confusion, dizziness, nausea, and sensitivity to light or noise. Some individuals may lose consciousness briefly, while others do not. It’s crucial to note that symptoms may not appear immediately after the injury and can develop over hours or days. Understanding the range of symptoms and their potential delayed onset is essential for timely intervention.

Treatment Options

Immediate response to a suspected concussion involves removing the athlete from play and seeking medical evaluation. Rest and cognitive rest, which includes limiting screen time and mental exertion, are essential components of concussion management. Gradual return-to-play protocols are followed to ensure that the athlete is symptom-free and fully recovered before resuming sports activities. In some cases, specialized concussion clinics or neuropsychological testing may be recommended. Understanding the importance of a multidisciplinary approach to concussion care, including medical evaluation, cognitive assessment, and gradual reintegration into sports, is crucial for an athlete’s safety and long-term brain health.

7. Overuse Injuries

Overuse injuries occur gradually and result from repetitive stress on a specific body part. They can affect athletes in various sports and require careful management.

Definition and Causes of Overuse Injuries

Overuse injuries are a result of repetitive stress on a specific body part, such as a joint or muscle. These injuries develop gradually over time, often due to excessive training or repetitive movements. Athletes who engage in activities that involve repetitive motions, like runners, swimmers, and baseball pitchers, are particularly susceptible to overuse injuries. Understanding the cumulative effects of repetitive stress, as well as the role of biomechanical factors and training volume in overuse injuries, is essential for injury prevention and early intervention.

Symptoms

Identifying overuse injuries requires paying attention to the body’s signals. Symptoms may include pain, tenderness, stiffness, and a gradual loss of performance. Overuse injuries are often characterized by persistent discomfort during and after physical activity. Recognizing these signs early can prevent the development of more severe injuries. Understanding the concept of the “overuse threshold” and how it varies among individuals can guide athletes in balancing training intensity and recovery.

Treatment Options

The initial step in managing overuse injuries is rest and activity modification. Athletes should reduce or temporarily halt the activities that contribute to the injury. Physical therapy plays a crucial role in rehabilitation, focusing on strengthening the affected area, improving flexibility, and correcting any biomechanical issues that may contribute to the injury. Preventing the recurrence of overuse injuries involves modifying training routines, incorporating adequate rest, and addressing any underlying issues contributing to the injury. Understanding the principles of progressive loading and recovery periods in overuse injury management can help athletes make informed decisions about their training regimens.

8. Muscle Cramps

Muscle cramps are sudden, involuntary contractions of muscles and are common in sports that require intense physical effort.

Definition and Causes of Muscle Cramps

Muscle cramps are sudden and involuntary muscle contractions that can be extremely painful. They can occur in various muscle groups and often happen during or after intense physical activity. Dehydration, electrolyte imbalances, and muscle fatigue are common causes of muscle cramps in sports. Understanding the physiological mechanisms behind muscle cramps, including the role of electrolyte imbalances and neuromuscular excitability, can guide athletes in preventing and managing cramps effectively.

Symptoms

Recognizing muscle cramps involves identifying sudden and intense muscle pain, often accompanied by visible muscle contraction or bulging. Cramps can occur in various muscle groups, such as the calf, thigh, or abdomen. The pain can range from mild discomfort to severe and incapacitating. Understanding the triggers and patterns of muscle cramps in individual athletes can help pinpoint underlying causes and preventive strategies.

Treatment Options

Immediate measures to alleviate muscle cramps include gentle stretching and massaging of the affected muscle. Applying heat or cold to the area may also provide relief. Prevention of muscle cramps involves staying well-hydrated, maintaining balanced electrolyte levels, and ensuring adequate muscle conditioning and flexibility. Stretching before and after exercise can help reduce the risk of cramps. Additionally, athletes can explore strategies such as hydration plans, dietary adjustments, and targeted supplementation to address specific cramp triggers. Understanding the role of hydration, electrolytes, and neuromuscular factors in muscle cramps can empower athletes to proactively manage this common issue.

How to Treat Sports Injuries

Sports injuries can be challenging to manage, but the right approach can significantly expedite the healing process and reduce the risk of complications.

The Rest, Ice, Compression, Elevation (RICE) method serves as a crucial initial step in injury management. Resting the injured area is paramount, allowing the body to allocate resources to repair the damaged tissues and prevent further harm. Ice application within the first 48 hours plays a dual role: it reduces pain and mitigates swelling by constricting blood vessels. Properly timing and executing ice application is essential. Compression, often achieved through an elastic bandage or brace, helps control swelling by preventing excessive fluid accumulation. Lastly, elevating the injured limb above heart level facilitates fluid drainage, reducing inflammation, and improving circulation, key elements in promoting a swift recovery. Mastering the nuances of each component of the RICE method, such as ice application duration and compression techniques, can optimize its effectiveness in injury management.

Beyond the RICE method, effective pain management techniques are essential during recovery. Over-the-counter pain relievers, including non-steroidal anti-inflammatory drugs (NSAIDs), can provide much-needed relief from pain and inflammation. However, it’s crucial to follow usage guidelines and consult a healthcare professional if pain persists or worsens. A comprehensive understanding of pain management principles, encompassing potential side effects and medication interactions, empowers athletes to make informed decisions in consultation with their healthcare providers.

Physical therapy and rehabilitation are integral components of sports injury recovery. A skilled physical therapist designs a customized rehabilitation program tailored to the specific injury and individual requirements. These programs focus on strengthening weakened muscles, restoring flexibility, and reestablishing the normal range of motion. Rehabilitation exercises are pivotal in preventing muscle atrophy and ensuring a safe return to sporting activities. Recognizing the progressive nature of rehabilitation, including the significance of targeting specific muscle groups and addressing biomechanical concerns, empowers athletes to regain their functional abilities fully.

In some instances, surgical interventions become necessary when conservative treatments, like rest and physical therapy, fall short. Common sports-related surgeries encompass repairing torn ligaments (e.g., ACL reconstruction), utilizing internal hardware (e.g., pins or plates) to mend fractures, and addressing severe soft tissue injuries. These surgical procedures are followed by an extensive rehabilitation process to ensure optimal recovery. A profound understanding of surgical indications, potential approaches, and the expected post-surgical rehabilitation timeline is crucial for athletes facing surgical interventions.

Seeking professional medical advice is paramount when dealing with sports injuries. Healthcare professionals, such as orthopedic specialists, sports medicine physicians, physical therapists, and chiropractors possess the expertise to accurately diagnose injuries, recommend appropriate treatments, and monitor progress. Their guidance is indispensable in ensuring a safe and effective recovery. Recognizing the value of multidisciplinary care and the collaborative efforts of healthcare providers in managing sports injuries empowers athletes to make informed decisions regarding their treatment plans.

What Sports Result in the Most Injuries

Understanding which sports are associated with higher injury rates can help athletes and coaches make informed decisions about participation and injury prevention.

Certain sports and activities have a higher propensity for injuries due to their inherent characteristics. Collision sports like American football and rugby, high-impact sports like skiing and snowboarding, and sports with rapid directional changes like soccer and basketball often have elevated injury rates. Recognizing the risks associated with specific sports can inform injury prevention strategies. Additionally, data on sports injury rates can help athletes and coaches make informed decisions about participation and tailor training and prevention programs accordingly.

Various factors contribute to injury risks in different sports. For example, the nature of the sport, including contact level and intensity, plays a significant role. Rules and regulations, such as helmet use in football or protective gear in hockey, influence injury rates. Additionally, athlete experience, skill level, and training techniques also impact the likelihood of injuries. Understanding the interplay of these factors and their influence on injury risk in specific sports can guide athletes, coaches, and sports organizations in implementing targeted injury prevention measures.

Injury statistics provide valuable insights into the prevalence of injuries in various sports. For instance, data may show that soccer players are prone to ankle sprains, while baseball players face a higher risk of shoulder injuries. Real-life examples of athletes who have suffered injuries and successfully recovered can inspire and motivate individuals to prioritize safety and injury prevention in their chosen sports. Understanding injury patterns and common mechanisms in specific sports can empower athletes to take proactive steps in reducing their risk of injury.

How to Recover Quickly from Sports Injuries

A swift and effective recovery from a sports injury is essential for athletes looking to return to their chosen activities as soon as possible.

Rest is a fundamental component of the recovery process, allowing the body to heal and repair damaged tissues. However, patience is equally crucial. Rushing the recovery process can lead to setbacks and reinjury. Athletes must understand that recovery timelines vary depending on the type and severity of the injury. Listening to the body and adhering to medical advice are key to a successful recovery. Understanding the balance between rest and gradual progression in the recovery journey can help athletes achieve optimal outcomes.

Rehabilitation exercises play a vital role in restoring strength, flexibility, and function after an injury. Physical therapists develop personalized exercise programs that target the injured area while considering the athlete’s overall fitness level. Consistent engagement in rehabilitation exercises is essential for a successful recovery. Athletes should expect gradual progress and be prepared to work on rebuilding strength and endurance. Understanding the principles of progressive loading, exercise specificity, and the importance of adherence to the rehabilitation program can facilitate a quicker return to sports.

Proper nutrition and hydration are integral to the recovery process. Nutrient-rich foods provide the essential building blocks for tissue repair and regeneration. Adequate hydration supports overall bodily functions and helps transport nutrients to injured tissues. Athletes should consult with a sports nutritionist to ensure they are meeting their nutritional needs during recovery. Understanding the role of macronutrients, micronutrients, and hydration in tissue repair and the body’s energy demands during recovery can optimize the healing process.

In addition to physical healing, athletes must address their mental and emotional well-being during recovery. Coping with the emotional impact of an injury, such as frustration, anxiety, or depression, is essential. Mental health professionals can provide guidance and support for athletes navigating the psychological aspects of injury. Staying connected with teammates, coaches, and a support network can also contribute to a positive emotional recovery. Understanding the importance of mental health care and the potential emotional challenges of recovery can help athletes prioritize their well-being.

The recovery process is not static; it requires ongoing assessment and adjustments. Monitoring progress through regular follow-up appointments with healthcare professionals is essential. Treatment plans may need modification based on how the injury is healing and the athlete’s response to rehabilitation. Flexibility in adapting the treatment plan ensures that the athlete receives the most effective care throughout the recovery journey. Understanding the role of ongoing assessments, imaging, and performance metrics in tracking progress can guide athletes and healthcare providers in optimizing the recovery process.

How to Prevent Sports Injuries

Prevention is the foundation of injury management. Implementing proactive strategies can significantly reduce the risk of sports injuries.

Warm-up and cool-down routines are essential components of injury prevention. A proper warm-up prepares the body for exercise by increasing blood flow, raising core body temperature, and enhancing muscle flexibility. Conversely, a cool-down routine gradually reduces heart rate and helps prevent muscle stiffness. Athletes should incorporate dynamic stretching and mobility exercises into their warm-up and static stretching into their cool-down routines. Understanding the purpose of each routine and the specific exercises that benefit different sports can enhance their effectiveness in injury prevention.

Selecting and maintaining the appropriate equipment and gear is crucial for injury prevention. Helmets, padding, footwear, and protective gear should fit correctly and be in good condition. Athletes should regularly inspect their equipment for signs of wear and tear and replace it as needed. Helmets, mouthguards, and other protective gear can significantly reduce the risk of head and facial injuries. Understanding the importance of proper gear selection, fit, and maintenance in injury prevention can safeguard athletes during sports activities.

Effective training and conditioning programs are fundamental to injury prevention. Athletes should focus on improving strength, flexibility, and endurance specific to their sport. Gradual progression of training intensity and volume helps the body adapt to increased demands, reducing the risk of overuse injuries. Coaches and trainers play a pivotal role in designing safe and effective training regimens. Understanding the principles of periodization, progressive overload, and sport-specific training can optimize an athlete’s physical preparedness for their chosen sport.

Injury prevention programs, often conducted as part of team sports, target specific injury risks. These programs may include neuromuscular training to improve balance and stability, proprioceptive exercises to enhance joint awareness, and plyometric exercises to boost strength and power. Participation in injury prevention programs can significantly reduce the likelihood of injuries. Understanding the components of injury prevention programs and their evidence-based effectiveness in reducing injury rates can motivate athletes and teams to incorporate them into their training routines.

Proper technique and form are critical for minimizing injury risks. Athletes should receive instruction on correct body mechanics and technique, especially for sports that involve complex movements. Coaches and trainers can provide guidance on safe and efficient techniques. Continuous skill assessment and improvement are essential to maintaining good form and reducing injury risks. Understanding the biomechanics of specific sports movements, as well as the role of skill development and feedback, can enhance an athlete’s ability to perform safely and effectively.

One of the most valuable tools in injury prevention is listening to one’s body. Athletes should pay close attention to pain, discomfort, or signs of overexertion. Ignoring warning signs can lead to injuries. Rest, recovery, and addressing minor discomfort promptly can prevent more significant issues from developing. Athletes should communicate with coaches, trainers, and healthcare professionals about any concerns regarding their physical condition. Understanding the body’s signals and the importance of self-monitoring can empower athletes to make informed decisions about training and participation.

What Age Do Most Sport Injuries Happen

Understanding the age groups most vulnerable to sports injuries helps tailor injury prevention efforts and promote safe participation in sports.

Sports injuries can affect individuals of all ages, but certain age groups are more prone to specific types of injuries. For example, children and adolescents are more likely to experience growth plate injuries due to their developing skeletal systems. Adults may face a higher risk of overuse injuries due to the cumulative effects of long-term physical activity. Senior athletes may be at increased risk of fractures due to age-related changes in bone density.

Children and adolescents are unique in terms of injury risk because their growing bodies are susceptible to growth plate injuries. These areas of cartilage near the ends of bones are not fully developed and are more prone to fractures. Adults, on the other hand, may experience overuse injuries related to prolonged physical activity. They may also be at risk of injuries associated with age-related changes, such as decreased bone density and joint degeneration. Understanding these age-related factors is crucial for tailoring injury prevention strategies.

Tailoring training and supervision to different age groups is essential for injury prevention. Children and adolescents should engage in age-appropriate activities that consider their physical development. Coaches and trainers should provide guidance on proper training techniques and ensure that young athletes are not overexerted. For adults, it’s essential to maintain a balanced exercise routine that includes strength training and flexibility exercises to mitigate age-related injury risks. Senior athletes should prioritize strength and balance exercises to prevent falls and fractures. Understanding the principles of age-appropriate training and supervision can help promote safe and enjoyable sports participation across the lifespan.

Conclusion

In the world of sports, injuries are a part of the game, but they need not be a barrier to continued participation and success. By understanding the most common sports injuries, knowing how to prevent them, and having a plan for treatment and recovery, athletes can stay on the field, court, or track and continue to pursue their passion. Remember, sports injuries can happen to anyone, but with the right knowledge and preparation, you can minimize the risks and maximize your athletic potential while staying injury-free.

________________________________________________________________________________________________________________

References

Michener LA, Heitzman J, Abbruzzese LD, Bondoc SL, Bowne K, Henning PT, Kosakowski H, Leggin BG, Lucado AM, Seitz AL. Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association. Phys Ther. 2023 Jun 5;103(6):pzad041. doi: 10.1093/ptj/pzad041. PMID: 37115808; PMCID: PMC10256270.

Wasserman EB, Sauers EL, Register-Mihalik JK, Pierpoint LA, Currie DW, Knowles SB, Dompier TP, Comstock RD, Marshall SW, Kerr ZY. The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in US High School Boys’ Baseball (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Men’s Baseball (2004-2005 Through 2013-2014). J Athl Train. 2019 Feb;54(2):198-211. doi: 10.4085/1062-6050-239-17. PMID: 30951387; PMCID: PMC6464305.

Zhang J, Li F, Augi T, Williamson KM, Onishi K, Hogan MV, Neal MD, Wang JH. Platelet HMGB1 in Platelet-Rich Plasma (PRP) promotes tendon wound healing. PLoS One. 2021 Sep 16;16(9):e0251166. doi: 10.1371/journal.pone.0251166. PMID: 34529657; PMCID: PMC8445483.