The effectiveness of baby books for providing pediatric anticipatory guidance to new mothers

OBJECTIVE

To assess whether embedding pediatric anticipatory guidance into books read to infants is an effective way to educate low-income, first-time mothers about injury-prevention and health-promotion practices.

PATIENTS AND METHODS

Primiparous women (N = 168) were randomly assigned to 1 of 3 groups: an educational-book group; a noneducational-book group; or a no-book group. Knowledge of anticipatory-guidance topics regarding children from birth to 12 months of age (eg, injury prevention, parenting, nutrition) was assessed during the third trimester of pregnancy and again when infants were approximately 2, 4, 6, 9, 12, and 18 months of age.

RESULTS

Women in the educational-book group scored consistently higher on knowledge than did those in the other 2 groups. Those in the educational-book group were found to have significantly higher knowledge scores than those in both the noneducational-book group (effect size [ES]: 0.3, P < .001) and the no-book group (ES: 0.3, P < .001) in the longitudinal model.

CONCLUSIONS

Books read by mothers to infants seem to be an effective way to provide anticipatory guidance to new mothers. However, future work is needed to determine if increased knowledge translates into safer and more developmentally appropriate parenting practices.

GIS and injury prevention and control: history, challenges, and opportunities

Intentional and unintentional injury is the leading cause of death and potential years of life lost in the first four decades of life in industrialized countries around the world. Despite surgical innovations and improved access to emergency care, research has shown that certain populations remain particularly vulnerable to the risks and consequences of injury. Recent evidence has shown that the analytical, data linkage, and mapping tools of geographic information systems (GIS) technology provide can further address these determinants and identify populations in need. This paper traces the history of injury prevention and discusses current and future challenges in furthering our understanding of the determinants of injury through the use of GIS.

Thigh muscle activity, knee motion, and impact force during side-step pivoting in agility-trained female basketball players

CONTEXT

Improving neuromuscular control of hamstrings muscles might have implications for decreasing anterior cruciate ligament injuries in females.

OBJECTIVE

To examine the effects of a 6-week agility training program on quadriceps and hamstrings muscle activation, knee flexion angles, and peak vertical ground reaction force.

DESIGN

Prospective, randomized clinical research trial.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty female intramural basketball players with no history of knee injury (age = 21.07 +/- 2.82 years, height = 171.27 +/- 4.66 cm, mass = 66.36 +/- 7.41 kg).

INTERVENTION(S)

Participants were assigned to an agility training group or a control group that did not participate in agility training. Participants in the agility training group trained 4 times per week for 6 weeks.

MAIN OUTCOME MEASURE(S)

We used surface electromyography to assess muscle activation for the rectus femoris, vastus medialis oblique, medial hamstrings, and lateral hamstrings for 50 milliseconds before initial ground contact and while the foot was in contact with the ground during a side-step pivot maneuver. Knee flexion angles (at initial ground contact, maximum knee flexion, knee flexion displacement) and peak vertical ground reaction force also were assessed during this maneuver.

RESULTS

Participants in the training group increased medial hamstrings activation during ground contact after the 6-week agility training program. Both groups decreased their vastus medialis oblique muscle activation during ground contact. Knee flexion angles and peak vertical ground reaction force did not change for either group.

CONCLUSIONS

Agility training improved medial hamstrings activity in female intramural basketball players during a side-step pivot maneuver. Agility training that improves hamstrings activity might have implications for reducing anterior cruciate ligament sprain injury associated with side-step pivots.

Online training in sports concussion for youth sports coaches

The purpose of this study was to evaluate ACTive: Athletic Concussion Training using Interactive Video Education, an interactive e-learning program designed to train community coaches of youth ages 10-18 in effective sports concussion prevention and management practices. Seventy-five youth sports coaches from across the country completed the study over the Internet. Results of a randomized control trial demonstrated significant differences between treatment and control participants on measures of (a) knowledge about sports concussion, management, and prevention; (b) attitudes about the importance of preventing sports concussion; and (c) intention and self-efficacy in sports concussion management and prevention. The results suggest that ACTive is an effective method of training youth sports coaches who are in an important position to reduce risks associated with sports concussion.

Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments

BACKGROUND

It has been proposed that female athletes who limit knee and hip flexion during athletic tasks rely more on the passive restraints in the frontal plane to deceleration their body center of mass. This biomechanical pattern is thought to increase the risk for anterior cruciate ligament injury. To date, the relationship between sagittal plane kinematics and frontal plane knee motion and moments has not been explored.

METHODS

Subjects consisted of 58 female club soccer players (age range: 11-20 years) with no history of knee injury. Kinematics, ground reaction forces, and surface electromyography were collected while each subject performed a drop landing task. Subjects were divided into two groups based on combined sagittal plane knee and hip flexion angles during the deceleration phase of landing (high flexion and low flexion).

FINDINGS

Subjects in the low flexion group demonstrated increased knee valgus angles (P=0.02, effect size 0.27), increased knee adductor moments (P=0.03, effect size 0.24), decreased energy absorption at the knee and hip (P=0.02, effect size 0.25; and P<0.001, effect size 0.59), and increased vastus lateralis EMG when compared to subjects in the high flexion group (P=0.005, effect size 0.35).

INTERPRETATION

Female athletes with limited sagittal plane motion during landing exhibit a biomechanical profile that may put these individuals at greater risk for anterior cruciate ligament injury.

Myths concerning alpine skiing injuries

There are many commonly discussed myths about ski safety that are propagated by industry, physicians, and skiers. Through a review of the literature concerning 12 such topics, this article demonstrates that the following are untrue: (1) Broken legs have been traded for blown-out knees. (2) If you know your DIN (a slang term for release indicator value), you can adjust your own bindings. (3) Toe and heel piece settings must be the same to function properly. (4) Formal ski instruction will make you safer. (5) Very short skis do not need release bindings. (6) Spending a lot of money on children's equipment is not worth the cost. (7) Children need plenty of room in ski boots for their growing feet. (8) If you think you are going to fall, just relax. (9) Exercise can prevent skiing injuries. (10) Lower release settings can reduce the risk of anterior cruciate ligament injury. (11) Buying new ski equipment is safer than renting. (12) Skiing is among the most dangerous of activities. It is important for the skiing public, physicians, and all those interested in improving skiing safety to verify the measures they advocate. The statements analyzed here are simply untrue and have the potential to cause harm if taken as fact by those exposed to these unsupported opinions.

Sagittal-plane trunk position, landing forces, and quadriceps electromyographic activity

CONTEXT

Researchers have suggested that large landing forces, excessive quadriceps activity, and an erect posture during landing are risk factors for anterior cruciate ligament (ACL) injury. The influence of knee kinematics on these risk factors has been investigated extensively, but trunk positioning has received little attention.

OBJECTIVE

To determine the effect of trunk flexion on landing forces and quadriceps activation during landing.

DESIGN

Two (sex) x 2 (task) repeated-measures design.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Forty healthy, physically active volunteers (20 men, 20 women).

INTERVENTION(S)

Participants performed 2 drop-landing tasks. The first task represented the natural, or preferred, landing strategy. The second task was identical to the first except that participants flexed the trunk during landing.

MAIN OUTCOME MEASURE(S)

We measured peak vertical and posterior ground reaction forces and mean quadriceps electromyographic amplitude during the loading phase of landing (ie, the interval from initial ground contact to peak knee flexion).

RESULTS

Trunk flexion decreased the vertical ground reaction force (P < .001) and quadriceps electromyographic amplitude (P < .001). The effect of trunk flexion did not differ across sex for landing forces or quadriceps electromyographic activity.

CONCLUSIONS

We found that trunk flexion during landing reduced landing forces and quadriceps activity, thus potentially reducing the force imparted to the ACL. Research has indicated that trunk flexion during landing also increases knee and hip flexion, resulting in a less erect landing posture. In combination, these findings support emphasis on trunk flexion during landing as part of ACL injury-prevention programs.

Mechanisms of noncontact anterior cruciate ligament injury

OBJECTIVE

To examine and summarize previous retrospective and observational studies assessing noncontact anterior cruciate ligament (ACL) injury mechanisms and to examine such reported ACL injury mechanisms based on ACL loading patterns due to knee loadings reported in in vivo, in vitro, and computer simulation studies.

DATA SOURCES

We searched MEDLINE from 1950 through 2007 using the key words anterior cruciate ligament + injury + mechanisms; anterior cruciate ligament + injury + mechanisms + retrospective; and anterior cruciate ligament + injury + mechanisms + video analysis.

STUDY SELECTION

We selected retrospective studies and observational studies that specifically examined the noncontact ACL injury mechanisms (n = 7) and assessed ACL loading patterns in vivo, in vitro, and using computer simulations (n = 33).

DATA EXTRACTION

The motion patterns reported as noncontact ACL injury mechanisms in retrospective and observational studies were assessed and critically compared with ACL loading patterns measured during applied external or internal (or both) forces or moments to the knee.

DATA SYNTHESIS

Noncontact ACL injuries are likely to happen during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension. Higher ACL loading during the application of a quadriceps force when combined with a knee internal rotation moment compared with an external rotation moment was noted. The ACL loading was also higher when a valgus load was combined with internal rotation as compared with external rotation. However, because the combination of knee valgus and external rotation motions may lead to ACL impingement, these combined motions cannot be excluded from the noncontact ACL injury mechanisms. Further, excessive valgus knee loads applied during weight-bearing, decelerating activities also increased ACL loading.

CONCLUSIONS

The findings from this review lend support to ACL injury prevention programs designed to prevent unopposed excessive quadriceps force and frontal-plane or transverse-plane (or both) moments to the knee and to encourage increased knee flexion angle during sudden deceleration and acceleration tasks.

A systematic review of prophylactic braces in the prevention of knee ligament injuries in collegiate football players

OBJECTIVE

To determine the relative risk reduction associated with prophylactic knee braces in the prevention of knee injuries in collegiate football players.

DATA SOURCES

An exhaustive search for original research was performed using the PubMed, SportDiscus, and CINAHL databases from 1970 through November 2006, with the search terms knee brace, knee braces, knee bracing and football, prophylactic brace, and prophylactic knee braces.

STUDY SELECTION

Seven studies comparing knee injuries among braced and non-braced collegiate football players were included. Study methods were assessed using the Physiotherapy Evidence Database (PEDro) scale. PEDro scores ranged from 2 to 5.

DATA EXTRACTION

The number of participants and frequency of knee injuries were used to calculate the relative risk reduction or increase.

DATA SYNTHESIS

We found a relative risk reduction for 3 studies with point estimates of 10% (36% to -26%), 58% (25% to 76%), and 56% (13% to 77%). Four studies demonstrated an increased risk of injury, with point estimates of 17% (19% to -71%), 49% (-31% to -69%), 114% (23% to -492%), and 42% (-18% to -70%).

CONCLUSIONS

Data from existing research are inconsistent. Based on a Strength of Recommendation Taxonomy level of evidence of 2 with a grade B recommendation, we cannot conclusively advocate or discourage the use of prophylactic knee braces in the prevention of knee injuries in collegiate football players.

Systematic review of postural control and lateral ankle instability, part II: is balance training clinically effective?

OBJECTIVE

To answer the following clinical questions: (1) Can prophylactic balance and coordination training reduce the risk of sustaining a lateral ankle sprain? (2) Can balance and coordination training improve treatment outcomes associated with acute ankle sprains? (3) Can balance and coordination training improve treatment outcomes in patients with chronic ankle instability?

DATA SOURCES

PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway.

STUDY SELECTION

Only studies assessing the influence of balance training on the primary outcomes of risk of ankle sprain or instrumented postural control measures derived from testing on a stable force plate using the modified Romberg test were included. Studies had to provide results for calculation of relative risk reduction and numbers needed to treat for the injury prevention outcomes or effect sizes for the postural control measures.

DATA EXTRACTION

We calculated the relative risk reduction and numbers needed to treat to assess the effect of balance training on the risk of incurring an ankle sprain. Effect sizes were estimated with the Cohen d for comparisons of postural control performance between trained and untrained groups.

DATA SYNTHESIS

Prophylactic balance training substantially reduced the risk of sustaining ankle sprains, with a greater effect seen in those with a history of a previous sprain. Completing at least 6 weeks of balance training after an acute ankle sprain substantially reduced the risk of recurrent ankle sprains; however, consistent improvements in instrumented measures of postural control were not associated with training. Evidence is lacking to assess the reduction in the risk of recurrent sprains and inconclusive to demonstrate improved instrumented postural control measures in those with chronic ankle instability who complete balance training.

CONCLUSIONS

Balance training can be used prophylactically or after an acute ankle sprain in an effort to reduce future ankle sprains, but current evidence is insufficient to assess this effect in patients with chronic ankle instability.

Lower extremity kinematics and ground reaction forces after prophylactic lace-up ankle bracing

CONTEXT

Long-term effects of ankle bracing on lower extremity kinematics and kinetics are unknown. Ankle motion restriction may negatively affect the body's ability to attenuate ground reaction forces (GRFs).

OBJECTIVE

To evaluate the immediate and long-term effects of ankle bracing on lower extremity kinematics and GRFs during a jump landing.

DESIGN

Experimental mixed model (2 [group] x 2 [brace] x 2 [time]) with repeated measures.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 37 healthy subjects were assigned randomly to either the intervention (n = 11 men, 8 women; age = 19.63 +/- 0.72 years, height = 176.05 +/- 10.58 cm, mass = 71.50 +/- 13.15 kg) or control group (n = 11 men, 7 women; age = 19.94 +/- 1.44 years, height = 179.15 +/- 8.81 cm, mass = 74.10 +/- 10.33 kg).

INTERVENTION(S)

The intervention group wore braces on both ankles and the control group did not wear braces during all recreational activities for an 8-week period.

MAIN OUTCOME MEASURE(S)

Initial ground contact angles, maximum joint angles, time to reach maximum joint angles, and joint range of motion for sagittal-plane knee and ankle motion were measured during a jump-landing task. Peak vertical GRF and the time to reach peak vertical GRF were assessed also.

RESULTS

While participants were wearing the brace, ankle plantar flexion at initial ground contact (brace = 35 degrees +/- 13 degrees , no brace = 38 degrees +/- 15 degrees , P = .024), maximum dorsiflexion (brace = 21 degrees +/- 7 degrees , no brace = 22 degrees +/- 6 degrees , P = .04), dorsiflexion range of motion (brace = 56 degrees +/- 14 degrees , no brace = 59 degrees +/- 16 degrees , P = .001), and knee flexion range of motion (brace = 79 degrees +/- 16 degrees , no brace = 82 degrees +/- 16 degrees , P = .036) decreased, whereas knee flexion at initial ground contact increased (brace = 12 degrees +/- 9 degrees , no brace = 9 degrees +/- 9 degrees , P = .0001). Wearing the brace for 8 weeks did not affect any of the outcome measures, and the brace caused no changes in vertical GRFs (P > .05).

CONCLUSIONS

Although ankle sagittal-plane motion was restricted with the brace, knee flexion upon landing increased and peak vertical GRF did not change. The type of lace-up brace used in this study appeared to restrict ankle motion without increasing knee extension or vertical GRFs and without changing kinematics or kinetics over time.

The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes

BACKGROUND

Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men.

PURPOSE

To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury.

STUDY DESIGN

Case control study; Level of evidence, 3.

METHODS

From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures.

RESULTS

A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension > 90 degrees (P = .71), side-to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament-injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament-injured status increased 4-fold (95% confidence interval, 1.68-9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament-injured status 5-fold (95% confidence interval, 1.24-18.44).

CONCLUSION

The current results indicate that increased knee-laxity measures may contribute to increased risk of anterior cruciate ligament injury. The methods to quantify knee joint laxity in this report may be used in conjunction with measures of neuromuscular control of the knee joint to identify high-risk female athletes with high accuracy. Once high-risk female athletes are identified, they may be targeted to the appropriate interventions to reduce injury risk.

Relationship between maximum shoulder external rotation angle during throwing and physical variables

The amount of stress imposed on shoulder and elbow appears to be directly correlated with the degree of maximum shoulder external rotation (MER) during throwing motions. Therefore, identifying risk factors contributing to the increase of MER angle may help to decrease the throwing injuries occurrence in baseball players. The purpose of the present study was to demonstrate the correlation between MER and the kinematic variables at stride foot contact (SFC) during the early cocking phase, the passive range of motion (ROM), and the shoulder strength. The subjects were 40 high school baseball players. Each subject carried out five throwing tasks with his maximum effort. A three-dimensional analysis was performed to obtain the MER, and the shoulder angles of external rotation (ER), extension and abduction at SFC in the early cocking phase. The ROM and muscle strength of the shoulder ER and internal rotation (IR) were also measured. Significant moderate linear correlations were found between the MER and the ER (r = -0.32, p = 0.04) at SFC, extension angle ( r= 0.35, p = 0.03) at SFC, IR strength (r = -0.30, p = 0.04) and passive ROM of ER (r = 0.46, p = 0.01). The shoulder IR and extension angles at SFC may determine the degree of the MER angle. Furthermore, weak IR muscle strength and excessive ROM of ER might be risk factors for shoulder and elbow injuries. The finding will enable us to establish better prevention and rehabilitation strategies for throwing injuries in baseball players. Key pointsIt has been reported that the amount of stress imposed on shoulder and elbow joints is correlated with the degree of maximum shoulder external rotation angle (MER) during throwing. Therefore, controlling MER within a normal range plays a key role in the prevention for throwing-related injuries in baseball players.Physical and biomechanical factors related to the degree of MER must be addressed to advance the current prevention and rehabilitation strategies for the shoulder and elbow injuries.The current finding demonstrated that there was a significant moderate leaner correlation between shoulder internal rotation angle at the initial foot contact in the early cocking phase and MER.

Ankle sprain injuries: a 2-year prospective cohort study in female Greek professional basketball players

CONTEXT

Ankle sprains are a common basketball injury. Therefore, examination of risk factors for injury in female professional basketball players is worthwhile.

OBJECTIVE

To examine rates of ankle sprains, associated time missed from participation, and risk factors for injury during 2 consecutive seasons.

DESIGN

Prospective cohort study.

SETTING

Eighteen professional basketball facilities.

PATIENTS OR OTHER PARTICIPANTS

We observed 204 players from 18 female professional basketball teams for 2 consecutive seasons during a 2-year period.

MAIN OUTCOME MEASURE(S)

Using questionnaires, we recorded the incidence of ankle sprains, participation time missed, and mechanisms of injury in games and practice sessions. Potential risk factors, such as age, body mass, height, training experience, and history of ankle sprain, were examined using multivariate logistic regression.

RESULTS

Fifty of the 204 participants sustained ankle injuries; injuries included 32 ankle sprains, which translated to an ankle sprain rate of 1.12 per 1000 hours of exposure to injury. The 32 players missed 224.4 training and game sessions and an average of 7.01 sessions per injury. Most injuries occurred in the key area of the basketball court and were the result of contact. Injury rates during games were higher than injury rates during practice sessions. Centers, followed by guards and forwards, had the highest rate of injury. Players who did not wear an external ankle support had an odds ratio of 2.481 for sustaining an ankle sprain.

CONCLUSIONS

Female professional basketball athletes who did not wear an external ankle support, who played in the key area, or who functioned as centers had a higher risk for ankle sprain than did other players.

Descriptive epidemiology of collegiate women's soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003

OBJECTIVE

To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's soccer and identify potential areas for injury prevention initiatives.

BACKGROUND

The number of NCAA schools sponsoring women's soccer has grown tremendously, from 271 in 1988- 1989 to 879 schools in 2002-2003. During that time, the NCAA Injury Surveillance System has collected game and practice injury data for women's soccer across all 3 NCAA divisions.

MAIN RESULTS

The rate of injury was more than 3 times higher in games than in practices (16.44 versus 5.23 injuries per 1000 athlete-exposures, rate ratio = 3.2, 95% confidence interval = 3.1, 3.4, P < .01), and preseason practices had an injury rate that was more than 3 times greater than the rate for in-season practices (9.52 versus 2.91 injuries per 1000 athlete-exposures, rate ratio = 3.3, 95% confidence interval = 3.1, 3.5, P < .01). Approximately 70% of all game and practice injuries affected the lower extremities. Ankle ligament sprains (18.3%), knee internal derangements (15.9%), concussions (8.6%), and leg contusions (8.3%) accounted for a substantial portion of game injuries. Upper leg muscle-tendon strains (21.3%), ankle ligament sprains (15.3%), knee internal derangements (7.7%), and pelvis and hip muscle strains (7.6%) represented most of the practice injuries. Injuries were categorized as attributable to player contact, "other contact" (eg, contact with the ball, ground, or other object), or no contact. Player-to-player contact accounted for more than half of all game injuries (approximately 54%) but less than 20% of all practice injuries. The majority of practice injuries involved noncontact injury mechanisms. Knee internal derangements, ankle ligament sprains, and concussions were the leading game injuries that resulted in 10 or more days of time lost as a result of injury.

RECOMMENDATIONS

Ankle ligament sprains, knee internal derangements, and concussions are common injuries in women's soccer. Research efforts have focused on knee injuries and concussions in soccer, and further epidemiologic data are needed to determine if preventive strategies will help to alter the incidence of these injuries. Furthermore, the specific nature of the player contact leading to concussions and lower extremity injuries should be investigated. Preventive efforts should continue to focus on reducing knee injuries, ankle injuries, and concussions in women collegiate soccer players.

Descriptive epidemiology of collegiate men's baseball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's baseball and identify potential areas for injury prevention initiatives.

BACKGROUND

Prevention and management of collegiate baseball injuries may be facilitated through injury research aimed at defining the nature of injuries inherent in the sport. Through the NCAA Injury Surveillance System, 16 years of collegiate baseball data were collected for the academic years 1988-1989 through 2003-2004.

MAIN RESULTS

College baseball has a relatively low rate of injury compared with other NCAA sports, but 25% of injuries are severe and result in 10+ days of time loss from participation. The rate of injury was 3 times higher in a game situation than in practice (5.78 versus 1.85 injuries per 1000 athlete-exposures [A-Es], rate ratio = 3.1, 95% confidence interval = 3.0, 3.3, P < .01). Practice injury rates were almost twice as high in the preseason as in the regular season (2.97 versus 1.58 per 1000 A-Es, rate ratio = 1.9, 95% confidence interval = 1.8, 2.0, P < .01). A total of 10% of all game injuries occurred from impact with a batted ball, an injury rate of 0.56 injuries per 1000 game A-Es. Sliding was involved in 13% of game injuries.

RECOMMENDATIONS

Proper preseason conditioning is important to reduce injuries. Athletic trainers covering practices and games should be prepared to deal with serious, life-threatening injuries from batted balls and other injury mechanisms. Further study of batted-ball injuries is warranted, and the use of breakaway bases to prevent sliding injuries should be supported in college baseball.

Descriptive epidemiology of collegiate women's gymnastics injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's gymnastics and identify potential areas for injury prevention initiatives.

BACKGROUND

In the 1988-1989 academic year, 112 schools were sponsoring varsity women's gymnastics teams, with approximately 1550 participants. By 2003-2004, the number of varsity teams had decreased 23% to 86, involving 1380 participants. Significant participation reductions during this time were particularly apparent in Divisions II and III.

MAIN RESULTS

A significant annual average decrease was noted in competition (-4.0%, P < .01) but not in practice (-1.0%, P = .35) injury rates during the sample period. Over the 16 years, the rate of injury in competition was more than 2 times higher than in practice (15.19 versus 6.07 injuries per 1000 athlete-exposures; rate ratio = 2.5, 95% confidence interval [CI] = 2.3, 2.8). A total of 53% of all competition and 69% of all practice injuries were to the lower extremity. A participant was almost 6 times more likely to sustain a knee internal derangement injury in competition than in practice (rate ratio = 5.7, 95% CI = 4.5, 7.3) and almost 3 times more likely to sustain an ankle ligament sprain (rate ratio = 2.7, 95% CI = 2.1, 3.4). The majority of competition injuries (approximately 70%) resulted from either landings in floor exercises or dismounts.

RECOMMENDATIONS

Gymnasts with a previous history of ankle sprain should either wear an ankle brace or use prophylactic tape on their ankles to decrease the risk of recurrent injury. Preventive efforts may incorporate more neuromuscular training and core stability programs in the off-season and preseason conditioning to enhance proper landing and skill mechanics. Equipment manufacturers are encouraged to reevaluate the design of the landing mats to allow for better absorption of forces.

Descriptive epidemiology of collegiate men's ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's ice hockey and to identify potential areas for injury prevention initiatives.

BACKGROUND

The NCAA began injury surveillance of men's ice hockey during the 1988-1989 academic year. These data represent all 3 NCAA divisions; the last Division II championship, however, was held during the 1998-1999 academic year.

MAIN RESULTS

The rate of injury was more than 8 times higher in games than in practices (16.27 versus 1.96 injuries per 1000 athlete-exposures [A-Es], rate ratio = 8.3, 95% confidence interval [CI] = 7.9, 8.8). A significant average annual increase of 1.3% in game injury rates occurred over the sample period (P = .05), but practice rates stayed static (P = .77). Preseason practice injury rates were more than twice as high as regular-season practice rates (5.05 versus 1.94 injuries per 1000 A-Es, rate ratio = 2.6, 95% CI = 2.4, 2.9, P < .01). The majority of game and practice injuries occurred to the lower extremity. Knee internal derangement (13.5%) was the most common lower extremity injury reported for games, whereas pelvis and hip muscle strains (13.1%) were the most common injury reported during practices. Player-to-player contact was the most frequent game mechanism of injury (50.0%). The majority of injuries occurred between the blue line and face-off circles (28.0%), in the corner (23.5%), and in the neutral zone (21.4%).

RECOMMENDATIONS

Preventive efforts should focus on strategies that limit player-to-player contact in the neutral zone and at the top of the offensive and defensive zones. In addition, clinicians and researchers should identify risk factors and interventions for muscle strains at the pelvis and hip region.

Descriptive epidemiology of collegiate women's lacrosse injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association injury surveillance data for women's lacrosse and identify potential areas for injury prevention initiatives.

BACKGROUND

Women's lacrosse is a fast-paced, primarily noncontact sport. Participation in collegiate women's lacrosse almost doubled between the 1988-1989 and 2003-2004 seasons. Lacrosse equipment consists of sticks made of wood or a synthetic material and a hard rubber ball. Until recently, mouth guards were the only required protective equipment.

MAIN RESULTS

Collegiate women's lacrosse game injury rates increased over the 16-year study period. More than 60% of all severe game injuries were lower extremity sprains and strains and knee internal derangements, most frequently the result of noncontact incidents. The most common injury scenarios by injury mechanism and player activity were no contact while ball handling (16.4%) and contact from a stick while ball handling (10.5%). Contact from a stick or a ball accounted for 5.6% and 5.2% of injuries sustained during shooting activities, respectively. Approximately 22% of all game and 12% of all practice injuries involved the head and neck. Contact from a stick accounted for the majority (56.0%) of above-the-neck injuries in games; contact from the ball accounted for 20.0% of these injuries. Participants had 5 times the risk of sustaining a concussion in a game as in a practice (0.70 versus 0.15 injuries per 1000 athletic-exposures, rate ratio = 4.7, 95% confidence interval = 3.8, 6.5).

RECOMMENDATIONS

To reduce the lower extremity injuries that comprise the greatest injury burden in women's lacrosse, future researchers should evaluate proprioceptive, plyometric, and balance training interventions designed specifically for female players. Other research areas of great interest involve determining whether protective eyewear (mandated in 2004) reduces injuries to the eye, orbit, and nasal area and identifying any unintended consequences of the mandate, such as increased risk of injuries to other areas of the face or more aggressive play.

Descriptive epidemiology of collegiate women's volleyball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of NCAA injury surveillance data for women's volleyball and to identify potential areas for injury prevention initiatives.

BACKGROUND

Participation in NCAA women's volleyball has increased greatly over the past 16 years. As with all sports, women participating in volleyball assume an inherent risk of injury each time they practice or participate in a game. In order for clinicians to better understand the risks associated with volleyball, it is critical to gather data that illustrates injury rates and patterns among volleyball athletes. Furthermore, with knowledge of injury mechanisms and risk factors comes the ability to initiate prevention strategies to minimize future injury.

MAIN RESULTS

Over the past 16 years, the rate of injury in a game situation was slightly higher than in practice (4.58 versus 4.10 game injuries per 1000 athlete-exposures, rate ratio = 1.1, 95% confidence interval = -1.0, 1.2, P < .01). A total of 2216 injuries from more than 50 000 games and 4725 injuries from more than 90 000 practices were reported. The lower extremity accounted for more than 55% of all game and practice injuries, with ankle ligament sprains representing 44.1% of game injuries and 29.4% of practice injuries. Approximately 20% of all game injuries involved the upper extremity. The majority of injuries during a game situation occurred while athletes were in one of the front 3 positions. A player landing on another player and contact with the floor each accounted for 21% of game injuries.

RECOMMENDATIONS

Ankle injuries appear to be the most common injuries in women's volleyball. Future preventive efforts should focus on preventing first-time ankle sprains and acute traumatic knee injuries, as well as reducing the risk of ankle sprain recurrence.

Descriptive epidemiology of collegiate men's wrestling injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's wrestling and identify potential areas for injury prevention initiatives.

BACKGROUND

From 1988-1989 through 2003-2004, 17% of NCAA schools sponsoring varsity men's wrestling programs participated in annual Injury Surveillance System (ISS) data collection.

MAIN RESULTS

Patterns of injury were consistent with the person-to-person, combative contact between wrestlers. The musculoskeletal system and head were the most vulnerable areas during competitions; skin infections are a continuing concern in the practice environment. The incidence of injuries in practices exhibited no significant increase over time, a positive trend that may be consistent with the influence of the recent NCAA weight management rules.

RECOMMENDATIONS

Expansion of the present ISS to include indirect causes of injury, such as weight loss practices, would strengthen the analysis of data. Efforts by referees to be vigilant for potentially dangerous holds and by athletic trainers to improve wrestler and mat hygiene should be continued.

Descriptive epidemiology of collegiate men's football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's football and identify potential areas for injury prevention initiatives.

BACKGROUND

Football is a high-velocity collision sport in which injuries are expected. Football tends to have one of the highest injury rates in sports. Epidemiologic data helps certified athletic trainers and other clinicians identify injury trends and patterns to appropriately design and institute injury prevention protocols and then measure their effects.

MAIN RESULTS

During the 16-year reporting period, about 19% of the Division I, II, and III NCAA institutions sponsoring football participated in the Injury Surveillance System. The results from the 16-year study period show little variation in the injury rates over time: games averaged 36 injuries per 1000 athlete-exposures (A-Es); fall practice, approximately 4 injuries per 1000 A-Es; and spring practice, about 10 injuries per 1000 A-Es. The game injury rate was more than 9 times higher than the in-season practice injury rate (35.90 versus 3.80 injuries per 1000 A-Es, rate ratio = 9.1, 95% confidence interval = 9.0, 9.2), and the spring practice injury rate was more than 2 times higher than the fall practice injury rate (9.62 versus 3.80 injuries per 1000 A-Es, rate ratio = 2.5, 95% confidence interval = 2.5, 2.6). The rate ratio for games versus fall practices was greatest for upper leg contusions (18.1 per 1000 A-Es), acromioclavicular joint sprains (14.0 per 1000 A-Es), knee internal derangements (13.4 per 1000 A-Es), ankle ligament sprains (12.0 per 1000 A-Es), and concussions (11.1 per 1000 A-Es).

RECOMMENDATIONS

Football is a complex sport that requires a range of skills performed by athletes with a wide variety of body shapes and types. Injury risks are greatest during games. Thus, injury prevention measures should focus on position-specific activities to reduce the injury rate. As equipment technology improves for the helmet, shoulder pads, and other protective devices, appropriate injury surveillance procedures should be performed to determine the effect of the new equipment on injury rates. A consistent evaluation of injury trends and patterns will assist decision makers in designing injury prevention techniques in areas that warrant the greatest attention and suggesting rule changes and modifications based on the data.

Descriptive epidemiology of collegiate men's soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003

OBJECTIVE

To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's soccer and to identify potential areas for injury prevention initiatives.

BACKGROUND

The NCAA sanctioned its first men's soccer championship in 1959. Since then, the sport has grown to include more than 18 000 annual participants across 3 NCAA divisions. During the 15 years from 1988-1989 to 2002-2003, the NCAA Injury Surveillance System accumulated game and practice injury data for men's soccer across all 3 NCAA divisions.

MAIN RESULTS

The injury rate was 4 times higher in games compared with practices (18.75 versus 4.34 injuries per 1000 athlete-exposures, rate ratio = 4.3, 95% confidence interval = 4.2, 4.5), and preseason practices had a higher injury rate than in-season practices (7.98 versus 2.43 injuries per 1000 athlete-exposures, rate ratio = 3.3, 95% confidence interval = 3.1, 3.5). In both games and practices, more than two thirds of men's soccer injuries occurred to the lower extremities, followed by the head and neck in games and the trunk and back in practices. Although player-to-player contact was the primary cause of injury during games, most practice injuries occurred without direct contact to the injured body part. Ankle ligament sprains represented the most common injury during practices and games, whereas knee internal derangements were the most common type of severe injury (defined as 10+ days of time loss).

RECOMMENDATIONS

Sprains, contusions, and strains of the lower extremities were the most common injuries in men's collegiate soccer, with player-to-player contact the primary injury mechanism during games. Preventive efforts should focus on the player-to-player contact that often leads to these injuries and greater enforcement of the rules that are in place to limit their frequency and severity. Emphasis also should be placed on addressing the high rate of first-time and recurrent ankle ligament sprains.

Descriptive epidemiology of collegiate women's softball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's softball and to identify potential areas for injury prevention initiatives.

BACKGROUND

The NCAA Injury Surveillance System has tracked injuries in all divisions of NCAA softball from the 1988-1989 to the 2003-2004 seasons. This report describes what was found and why the findings are important for the safety, enhancement, and continued growth of the sport.

MAIN RESULTS

Across all divisions, preseason practice injury rates were more than double the regular-season practice injury rates (3.65 versus 1.68 injuries per 1000 athlete-exposures, rate ratio = 2.2, 95% confidence interval [CI] = 2.0, 2.4, P < .01). The rate of injury in a game was 1.6 times that in a practice (4.30 versus 2.67 injuries per 1000 athlete-exposures, rate ratio = 1.6, 95% CI = 1.5, 1.7). A total of 51.2% of game injuries resulted from "other-contact" mechanisms, whereas 55% of practice injuries resulted from noncontact mechanisms. In games, ankle ligament sprains and knee internal derangements accounted for 19% of injuries. Twenty-three percent of all game injuries were due to sliding, most of which were ankle sprains. In practices, ankle ligament sprains, quadriceps and hamstring strains, shoulder strains and tendinitis, knee internal derangements, and lower back strains (combined) accounted for 38% of injuries.

RECOMMENDATIONS

Ankle ligament sprains, knee internal derangements, sliding injuries, and overuse shoulder and low back injuries were among the most common conditions in NCAA women's softball. Preventive efforts should focus on sliding technique regardless of skill level, potential equipment changes, neuromuscular training programs, position-specific throwing programs, and mechanisms of low back injury. Further research is needed on the development and effects of these preventive efforts, as well as in the area of windmill-pitching biomechanics.

Descriptive epidemiology of collegiate men's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's basketball and identify potential areas for injury prevention initiatives.

BACKGROUND

Collegiate men's basketball is a contact sport in which numerous anatomical structures are susceptible to both acute and overuse injuries. To date, no comprehensive reporting of injury patterns in NCAA men's basketball has been published.

MAIN RESULTS

The overall rate of injury was 9.9 per 1000 athlete-exposures for games and 4.3 per 1000 athlete-exposures for practices. Approximately 60% of all injuries were to the lower extremity, with ankle ligament sprains being the most common injury overall and knee internal derangements being the most common injury causing athletes to miss more than 10 days of participation. A trend of increasing incidence of injuries to the head and face was noted over the 16-year span of the study, which may be related to an observed increase in physical contact in men's basketball over the past 2 decades.

RECOMMENDATIONS

These results provide the most comprehensive description of injury patterns in NCAA men's basketball to date. Many of the most common injuries seen in men's basketball, such as ankle ligament sprains and knee internal derangements, may be at least partially preventable with interventions such as taping and bracing and neuromuscular training. However, randomized controlled trials assessing the efficacy of such preventive measures among collegiate men's basketball players are clearly lacking. The increase in head and facial injuries may indicate that officials need to assess the increased tolerance for physical contact in men's basketball seen over the past 2 decades.

Descriptive epidemiology of collegiate women's field hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003

OBJECTIVE

To review 15 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's field hockey and identify potential areas for injury prevention initiatives.

BACKGROUND

Field hockey is one of the most popular sports worldwide and is growing in participation in the United States, particularly among women. From 1988-1989 to 2002-2003, participation in NCAA women's field hockey increased 12%, with the largest growth among Division III programs. In 2002- 2003, 253 colleges offered women's field hockey and 5385 women participated.

MAIN RESULTS

Game injury rates showed a significant average annual 2.5% decline over 15 years, most likely fueled by drops in ankle ligament sprain, knee internal derangement, and finger fracture injuries. Despite this, ankle ligament sprains were common (13.7% of game and 15.0% of practice injuries) and a frequent cause of severe injuries (resulting in 10+ days of time-loss activity). Concussion and head laceration injuries increased over this same time, and the risk of sustaining a concussion in a game was 6 times higher than the risk of sustaining one during practice. Overall, injury rates were twice as high in games as in practices (7.87 versus 3.70 injuries per 1000 athlete-exposures, rate ratio = 2.1, 95% confidence interval = 2.0, 2.3). Most head/neck/face (71%) and hand/finger/thumb (68%) injuries occurred when the player was near the goal or within the 25-yd line and were caused by contact with the stick or ball (greater than 77% for both body sites); for 34% of head/neck/ face injuries, a penalty was called on the play.

RECOMMENDATIONS

Equipment (requiring helmets and padded gloves) and rule changes (to decrease field congestion near the goal) as well as evidence-based injury prevention interventions (eg, prophylactic ankle taping/bracing, neuromuscular balance exercise programs) may be viable prevention initiatives for reducing injury rates in women's collegiate field hockey players.

Descriptive epidemiology of collegiate women's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's basketball and to identify potential areas for injury prevention initiatives.

BACKGROUND

The number of colleges participating in women's college basketball has grown over the past 25 years. The Injury Surveillance System (ISS) has enabled the NCAA to collect and report injury trends over an extended period of time. This has allowed certified athletic trainers and coaches to be more informed regarding injuries and to adjust training regimens to reduce the risk of injury. It also has encouraged administrators to make rule changes that attempt to reduce the risk of injury.

MAIN RESULTS

From 1988-1989 through 2003-2004, 12.4% of schools across Divisions I, II, and III that sponsor varsity women's basketball programs participated in annual ISS data collection. Game and practice injury rates exhibited significant decreases over the study period. The rate of injury in a game situation was almost 2 times higher than in a practice (7.68 versus 3.99 injuries per 1000 athlete-exposures, rate ratio = 1.9, 95% confidence interval = 1.9, 2.0). Preseason-practice injury rates were more than twice as high as regular-season practice injury rates (6.75 versus 2.84 injuries per 1000 athlete-exposures, rate ratio = 2.4, 95% confidence interval = 2.2, 2.4). More than 60% of all game and practice injuries were to the lower extremity, with the most common game injuries being ankle ligament sprains, knee injuries (internal derangements and patellar conditions), and concussions. In practices, ankle ligament sprains, knee injuries (internal derangements and patellar conditions), upper leg muscle-tendon strains, and concussions were the most common injuries.

RECOMMENDATIONS

Appropriate preseason conditioning and an emphasis on proper training may reduce the risk of injury and can optimize performance. As both player size and the speed of the women's game continue to increase, basketball's evolution from a finesse sport to a high-risk contact sport also will continue. The rates of concussions and other high-energy trauma injuries likely will increase. The NCAA ISS is an excellent tool for identifying new risk factors that may affect injury rates and for developing consistent injury definitions in order to improve the research and provide a source of clinically relevant data.

Descriptive epidemiology of collegiate women's ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 2000-2001 through 2003-2004

OBJECTIVE

To review 4 years of National Collegiate Athletic Association (NCAA) injury surveillance data for women's ice hockey and to identify potential areas for injury prevention initiatives.

BACKGROUND

The NCAA ISS prospectively collects data on injuries sustained during collegiate participation. Women's NCAA ice hockey began participation in the ISS during the 2000-2001 season. On average, over the 4 years, 15.6% of the eligible schools elected to send their injury data.

MAIN RESULTS

Over the 4 years of study, the rate of injury in games was more than 5 times higher than the injury rate in practices (12.6 versus 2.5 injuries per 1000 athlete-exposures, rate ratio = 5.0, 95% confidence interval = 4.2, 6.1, P < .01). Preseason practice injury rates were almost twice as high as in-season practice rates (4.2 versus 2.3 injuries per 1000 athlete-exposures, rate ratio = 1.8, 95% confidence interval = 1.7, 2.0, P < .01). Concussions were the most common injury in both games (21.6%) and practices (13.2%). The rate of concussions in games appeared to be trending upward over the study period. The greatest number of game injuries (approximately 50%) resulted from player contact, whereas practice injuries were from either contact with another object or noncontact mechanisms.

RECOMMENDATIONS

Women's ice hockey is an evolving NCAA sport. Only 4 years of ISS data are available and, therefore, data should be interpreted with caution. Women's ice hockey does not allow for formal body checking; however, approximately 50% of all game injuries were reported to result from contact with another player. Future researchers need to evaluate the effectiveness of the no-checking rule. Additional years of data collection will be required to allow the data to become more stable, and to increase attention to mechanism-of-injury issues. We anticipate that the hypothesized inconsistencies in skill level across and within the various women's teams also will be reduced as more consistently skilled players develop, allowing for more stability in the injury scenario.

Descriptive epidemiology of collegiate men's lacrosse injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004

OBJECTIVE

To review 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for men's lacrosse and identify potential areas for injury prevention initiatives.

BACKGROUND

During the sample period, the number of sponsoring institutions and the number of participants in men's college lacrosse grew significantly. Overall, an average of 18% of NCAA institutions participated in the annual NCAA Injury Surveillance System data collection for this sport.

MAIN RESULTS

Over the sample period, athletes were almost 4 times more likely to sustain injuries in games than in practices (12.58 versus 3.24 injuries per 1000 athlete-exposures [A-Es], rate ratio = 3.9, 95% confidence interval = 3.7, 4.1). Approximately half of all game (48.1%) and practice (58.7%) injuries were to the lower extremity, followed by the upper extremity (26.2% in games, 16.9% in practices), and the head and neck (11.7% in games, 6.2% in practices). In games and practices, the most common injuries were ankle ligament sprains (11.3% and 16.4%, respectively). The disparity among preseason, regular-season, and postseason injuries may be due to athlete acclimatization to the rigors of the sport throughout the season. Changes in helmet design may account for the rise in the concussion rate since the 1995-1996 season.

RECOMMENDATIONS

We recommend research into the mechanism of head injuries and the implications of design changes to protective helmets, as well as further investigation of the best designs for shoulder and chest protection.

The effect of gender and fatigue on the biomechanics of bilateral landings from a jump: peak values

Female athletes are substantially more susceptible than males to suffer acute non-contact anterior cruciate ligament injury. A limited number of studies have identified possible biomechanical risk factors that differ between genders. The effect of fatigue on the biomechanics of landing has also been inadequately investigated. The objective of the study was to examine the effect of gender and fatigue on peak values of biomechanical variables during landing from a jump. Thirty-two recreational athletes performed bilateral drop jump landings from a 40 cm platform. Kinetic, kinematic and electromyographic data were collected before and after a functional fatigue protocol. Females landed with 9° greater peak knee valgus (p = 0.001) and 140% greater maximum vertical ground reaction forces (p = 0.003) normalized to body weight compared to males. Fatigue increased peak foot abduction by 1.7° (p = 0.042), peak rectus femoris activity by 27% (p = 0.018), and peak vertical ground reaction force (p = 0.038) by 20%. The results of the study suggest that landing with increased peak knee valgus and vertical ground reaction force may contribute to increased risk for knee injury in females. Fatigue caused significant but small changes on some biomechanical variables. Anterior cruciate ligament injury prevention programs should focus on implementing strategies to effectively teach females to control knee valgus and ground reaction force. Key pointsFemale athletes landed with increased knee valgus and VGRF which may predispose them to ACL injury.Fatigue elicited a similar response in male and female athletes.The effectiveness of sports injury prevention programs may improve by focusing on teaching females to land softer and with less knee valgus.

Prevention and Treatment of Swimmer's Shoulder

Swimmer's shoulder is a musculoskeletal condition that results in symptoms in the area of the anterior lateral aspect of the shoulder, sometimes confined to the subacromial region. The onset of symptoms may be associated with impaired posture, glenohumeral joint mobility, neuromuscular control, or muscle performance. Additionally, training errors such as overuse, misuse, or abuse may also contribute to this condition. In extreme cases, patients with swimmer's shoulder may have soft tissue pathology of the rotator cuff, long head of the biceps, or glenoid labrum. Physical therapists involved in the treatment of competitive swimmers should focus on prevention and early treatment, addressing the impairments associated with this condition, and analyzing training methods and stroke mechanics. The purpose of this clinical commentary is to provide an overview of the biomechanics of swimming, the etiology of the clinical entity referred to as swimmer's shoulder, and strategies for injury prevention and treatment.

Neuromuscular control training programs and noncontact anterior cruciate ligament injury rates in female athletes: a numbers-needed-to-treat analysis

OBJECTIVE

To determine the numbers needed to treat (NNT) and relative risk reduction (RRR) associated with neuromuscular training programs aimed at preventing noncontact anterior cruciate ligament (ACL) injuries in female athletes.

DATA SOURCES

We searched PubMed, MEDLINE, SPORT Discus, CINAHL, and Web of Science from 1966 through 2005 using the terms knee, injury, anterior cruciate ligament, ACL, prevention, plyometric, and neuromuscular training.

STUDY SELECTION

Selected articles were from peer-reviewed journals written in English that described original research studies comparing neuromuscular training programs with control programs to determine the number of noncontact ACL injuries per event exposure or hours of playing time. Five studies met the inclusion criteria and were independently rated by 3 reviewers using the Physiotherapy Evidence Database (PEDro) scale. Consensus PEDro scores ranged from 4 to 7 out of 10.

DATA EXTRACTION

We used numbers of subjects, ACL injuries, and injury exposure rates to calculate NNT and RRR for each study. The NNT calculations from all studies were based on the number of players across 1 competitive season and were described as NNT benefit or NNT harm.

DATA SYNTHESIS

All 5 studies demonstrated a prophylactic effect due to the neuromuscular training programs. The pooled NNT estimates showed that 89 individuals (95% confidence interval: 66 to 136) would need to participate in the prophylactic training program to prevent 1 ACL injury over the course of 1 competitive season. Pooled RRR was 70% (95% confidence interval: 54% to 80%) among individuals who participated in the intervention program. One high-quality randomized control trial and 4 medium-quality prospective cohort studies showed mostly consistent findings. Thus, a Strength of Recommendation Taxonomy level of evidence of 1 with a grade B recommendation supports the use of neuromuscular training programs in the prevention of noncontact ACL injuries in female athletes.

Fatigue, vertical leg stiffness, and stiffness control strategies in males and females

CONTEXT

Fatigue appears to influence musculoskeletal injury rates during athletic activities, but whether males and females respond differently to fatigue is unknown.

OBJECTIVE

To determine the influence of fatigue on vertical leg stiffness (K (VERT)) and muscle activation and joint movement strategies and whether healthy males and females respond similarly to fatigue.

DESIGN

Repeated-measures design with all data collected during a single laboratory session.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Physically active males (n = 11) and females (n = 10).

INTERVENTION(S)

Subjects performed hopping protocols at 2 frequencies before and after fatigue, which was induced by repeated squatting at submaximal loads.

MAIN OUTCOME MEASURE(S)

We measured K (VERT) with a forceplate and peak muscle activity of the quadriceps, hamstrings, gastrocnemius, soleus, and anterior tibialis muscles with surface electromyography. Sagittal-plane kinematics at the knee and ankle were recorded with an electrogoniometer.

RESULTS

After fatigue, K (VERT) was unchanged for all subjects. However, both males and females demonstrated reduced peak hamstrings ( P = .002) and anterior tibialis ( P = .001) activation, coupled with increased gastrocnemius ( P = .005) and soleus ( P = .001) peak activity, as well as increased quadriceps-hamstrings ( P = .005) and gastrocnemius/soleus-anterior tibialis coactivation ratios ( P = .03) after fatigue. Overall, females demonstrated greater quadriceps-hamstrings coactivation ratios than males, regardless of the fatigue condition ( P = .026). Only females showed increased knee flexion at initial contact after fatigue during hopping ( P = .03).

CONCLUSIONS

Although K (VERT) was unaffected, the peak muscle activation and joint movement strategies used to modulate K (VERT) were affected after fatigue. Once fatigued, both males and females used an ankle-dominant strategy, with greater reliance on the ankle musculature and less on the knee musculature. Also, once fatigued, all subjects used an antagonist inhibition strategy by minimizing antagonist coactivation. Overall, females used a more quadriceps-dominant strategy than males, showing greater quadriceps activity and a larger quadriceps-hamstrings coactivation ratio. Changes in muscle activation and coactivation ratios because of fatigue and sex are suggested to alter knee joint stability and increase anterior cruciate ligament injury risk.

Acute muscle stretching and shoulder position sense

CONTEXT

Stretching is common among athletes as a potential method for injury prevention. Stretching-induced changes in the muscle spindle properties are a suggested mechanism, which may imply reduced proprioception after stretching; however, little is known of this association.

OBJECTIVE

To evaluate whether acute stretching of the shoulder muscles affects position sense.

DESIGN

A crossover design with subjects randomized to 3 groups.

SETTING

A university human research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Nine male (age = 24 +/- 3 years) and 9 female (age = 21 +/- 2 years) healthy volunteers.

INTERVENTION(S)

Stretching of shoulder (1) agonists or (2) antagonists or (3) nonstretching control.

MAIN OUTCOME MEASURE(S)

We determined position sense acuity of the right shoulder before and after the interventions by having subjects attempt to reproduce arm positions of 15 degrees and 30 degrees (shoulder adduction) while starting at 45 degrees to the sagittal plane. The outcome variables were response variability (variable error) and overall accuracy (absolute error).

RESULTS

The relative change in variable error (ie, variable error after/variable error before) was not significantly different between the interventions ( P = .38). Similarly, no change in absolute error was found ( P = .76). Furthermore, no differences were noted regarding test sequence or the interaction of intervention x sequence for either variable error ( P = .73 and .53, respectively) or absolute error ( P = .71 and .67, respectively).

CONCLUSIONS

We found no effect on shoulder position sense after an acute bout of stretching of either agonist or antagonist shoulder muscles.

Issues in estimating risks and rates in sports injury research

OBJECTIVE

To describe 3 measures of incidence used in sports injury epidemiology.

BACKGROUND

To promote safety in sports, athletic trainers must be able to accurately interpret and apply injury data and statistics. Doing so allows them to more efficiently articulate this information to school administrators in recommending increases in medical resources, such as more personnel, better services, and safer facilities and equipment.

DESCRIPTION

Using data from a study of high school sports injuries, we review incidence rates, epidemiologic incidence proportions, and clinical incidence. The incidence rate is the number of injuries divided by the number of athlete-exposures and is based on the epidemiologic concept of person-time at risk. It accounts for variation in exposure between athletes and teams and is widely used by researchers. The epidemiologic incidence proportion is the number of injured athletes divided by the number of athletes at risk. It is a valid estimator of average injury risk, yet it is rarely used in sports injury epidemiology to communicate information about such risks to nonscientists. Clinical incidence is a hybrid between the epidemiologic incidence proportion and the incidence rate in that it uses the number of injuries in the numerator but the number of athletes at risk in the denominator. It has been widely used in research on high school football injury but is neither a valid estimator of risk nor a true rate.

ADVANTAGES

Athletic trainers who understand the causes of and risk factors for sport-related injury are better positioned to make safe return-to-play decisions and decrease the likelihood of reinjury in athletes.

Residency work-hours reform. A cost analysis including preventable adverse events

BACKGROUND

In response to proposed federal legislation, the Accreditation Council for Graduate Medical Education limited resident work-hours in July 2003. The cost may be substantial but, if successful, the reform might lower preventable adverse event costs in hospital and after discharge.

OBJECTIVES

This study sought to estimate the reform's net cost in 2001 dollars, and to determine the reduction in preventable adverse events needed to make reform cost neutral from teaching hospital and societal perspectives.

DESIGN

Cost analysis using published literature and data. Net costs were determined for 4 reform strategies and over a range of potential effects on preventable adverse events.

RESULTS

Nationwide, transferring excess work to task-tailored substitutes (the lowest-level providers appropriate for noneducational tasks) would cost 673 million dollars; mid-level providers would cost 1.1 billion dollars. Reform strategies promoting adverse events would increase net teaching hospital and societal costs as well as mortality. If task-tailored substitutes decrease events by 5.1% or mid-level providers decrease them by 8.5%, reform would be cost neutral for society. Events must fall by 18.5% and 30.9%, respectively, to be cost neutral for teaching hospitals.

CONCLUSIONS

Because most preventable adverse event costs occur after discharge, a modest decline (5.1% to 8.5%) in them might make residency work-hours reform cost neutral for society but only a much larger drop (18.5% to 30.9%) would make it cost neutral for teaching hospitals, unless additional funds are allocated. Future research should evaluate which reform approaches prevent adverse events and at what cost.

A national program for injury prevention in children and adolescents: the injury free coalition for kids

Injury is the leading cause of death and a major source of preventable disability in children. Mechanisms of injury are rooted in a complex web of social, economic, environmental, criminal, and behavioral factors that necessitate a multifaceted, systematic injury prevention approach. This article describes the injury burden and the way physicians, community coalitions, and a private foundation teamed to impact the problem first in an urban minority community and then through a national program. Through our injury prevention work in a resource-limited neighborhood, a national model evolved that provides a systematic framework through which education and other interventions are implemented. Interventions are aimed at changing the community and home environments physically (safe play areas and elimination of community and home hazards) and socially (education and supervised extracurricular activities with mentors). This program, based on physician-community partnerships and private foundation financial support, expanded to 40 sites in 37 cities, representing all 10 US trauma regions. Each site is a local adaptation of the Injury Free Coalition model also referred to as the ABC's of injury prevention: A, "analyze injury data through local injury surveillance"; B, "build a local coalition"; C, "communicate the problem and raise awareness that injuries are a preventable public health problem"; D, "develop interventions and injury prevention activities to create safer environments and activities for children"; and E, "evaluate the interventions with ongoing surveillance." It is feasible to develop a comprehensive injury prevention program of national scope using a voluntary coalition of trauma centers, private foundation financial and technical support, and a local injury prevention model with a well-established record of reducing and sustaining lower injury rates for inner-city children and adolescents.

Promoting child safety in primary care: a cluster randomised controlled trial to reduce baby walker use

BACKGROUND

Baby walkers are commonly used items of nursery equipment, but cause more than 3000 injuries each year in the UK. There is currently little evidence regarding the effectiveness of interventions in primary care to reduce walker use.

AIM

To evaluate the effectiveness of an educational package provided by midwives and health visitors to reduce baby walker possession and use.

DESIGN OF STUDY

Cluster randomised controlled trial.

SETTING

Sixty-four general practices in Nottingham and North Nottinghamshire, UK.

METHOD

An educational package aimed at discouraging mothers-to-be from obtaining and using a walker was delivered by midwives and health visitors to 1174 mothers-to-be of at least 28 weeks gestation. The control arm received usual care. Primary outcome measures were the possession and use of a walker. Secondary outcome measures included the frequency and duration of walker use, knowledge and attitudes towards walkers, plans to use a walker with future children, recommending a walker to a friend, and use of stair gates and fire guards.

RESULTS

Intervention arm participants were significantly less likely to own (odds ratio [OR] = 0.63, 95% confidence interval [CI] = 0.43 to 0.93) or to use a walker (OR = 0.26, 95% CI = 0.08 to 0.84). They were significantly less likely to plan to use a walker with their next child (OR = 0.52, 95% CI = 0.31 to 0.86) or to agree that walkers keep children safe (OR = 0.35, 95% CI = 0.16 to 0.78). There was some evidence that they were less likely to recommend a walker to a friend (OR = 0.51, 95% CI = 0.28 to 0.91) or to agree that they help children to walk more quickly (OR = 0.53, 95% CI = 0.29 to 0.95).

CONCLUSION

An educational package delivered by midwives and health visitors was effective in reducing baby walker possession and use. Providers of primary healthcare services should include baby walker education in their injury prevention strategy and child health promotion programme.

The application of the Haddon matrix to public health readiness and response planning

State and local health departments continue to face unprecedented challenges in preparing for, recognizing, and responding to threats to the public's health. The attacks of 11 September 2001 and the ensuing anthrax mailings of 2001 highlighted the public health readiness and response hurdles posed by intentionally caused injury and illness. At the same time, recent natural disasters have highlighted the need for comparable public health readiness and response capabilities. Public health readiness and response activities can be conceptualized similarly for intentional attacks, natural disasters, and human-caused accidents. Consistent with this view, the federal government has adopted the all-hazards response model as its fundamental paradigm. Adoption of this paradigm provides powerful improvements in efficiency and efficacy, because it reduces the need to create a complex family of situation-specific preparedness and response activities. However, in practice, public health preparedness requires additional models and tools to provide a framework to better understand and prioritize emergency readiness and response needs, as well as to facilitate solutions; this is particularly true at the local health department level. Here, we propose to extend the use of the Haddon matrix--a conceptual model used for more than two decades in injury prevention and response strategies--for this purpose.

On-the-Field Resistance-Tubing Exercises for Throwers: An Electromyographic Analysis

Context: Athletes who throw commonly use rubber-tubing resistance exercises in the field setting to assist with warm-up before throwing. Yet no researchers have described which muscles are being activated or which exercises are most effective during rubber-tubing exercises used by throwers for warm-up.Objective: To describe the effectiveness of 12 rubber-tubing resistance exercises commonly used by throwers in activating the shoulder muscles important for throwing.Design: Descriptive research design.Setting: An applied biomechanics research laboratory.Patients or Other Participants: Fifteen physically active male subjects with no history of shoulder injury.Main Outcome Measure(s): Subjects randomly performed 12 rubber-tubing resistance exercises while we assessed muscle activation of the subscapularis, supraspinatus, teres minor, and rhomboid major by indwelling electromyography. Activation of the sternal portion of the pectoralis major, anterior deltoid, middle deltoid, latissimus dorsi, serratus anterior, biceps brachii, triceps brachii, lower trapezius, and infraspinatus muscles was assessed by surface electromyography.Results: Performance of 7 exercises (external rotation at 90 degrees of abduction, throwing deceleration, humeral flexion, humeral extension, low scapular rows, throwing acceleration, and scapular punch) resulted in the highest level of muscle activation of all muscles tested.Conclusions: These 7 exercises exhibited moderate activation (>20% maximal voluntary isometric contraction) in each muscle of the rotator cuff, the primary humeral movers, and the scapular stabilizer muscles. The results suggest that these exercises are most effective in activating the muscles important to the throwing motion and may be beneficial for throwers during their prethrowing warm-up routine.

Child pedestrians: the role of parental beliefs and practices in promoting safe walking in urban neighborhoods

The purpose of this study was to describe parents' child pedestrian safety practices, knowledge, risk perceptions, and beliefs. We surveyed 732 parents from four elementary schools in urban neighborhoods that differed in income, and child pedestrian injury risks. Findings indicated that most parents taught their children street safety. Few (16%) knew basic pedestrian safety facts; 46% believed children younger than 10 years could safely cross streets alone; 50% believed a child pedestrian crash was likely. Parents in lower income neighborhoods reported the highest rates of unpleasant walking environments and concerns about drug dealers, crime, violence, and trash. We conclude that education should focus on children's risk, developmental capabilities, and supervision needs. Promoting physical activity in urban neighborhoods, especially lower income ones, must address concerns about the physical and social environment.

Eccentric Training and Static Stretching Improve Hamstring Flexibility of High School Males

OBJECTIVE: To determine if the flexibility of high-school-aged males would improve after a 6-week eccentric exercise program. In addition, the changes in hamstring flexibility that occurred after the eccentric program were compared with a 6-week program of static stretching and with a control group (no stretching). DESIGN AND SETTING: We used a test-retest control group design in a laboratory setting. Subjects were assigned randomly to 1 of 3 groups: eccentric training, static stretching, or control. SUBJECTS: A total of 69 subjects, with a mean age of 16.45 +/- 0.96 years and with limited hamstring flexibility (defined as 20 degrees loss of knee extension measured with the thigh held at 90 degrees of hip flexion) were recruited for this study. MEASUREMENTS: Hamstring flexibility was measured using the passive 90/90 test before and after the 6-week program. RESULTS: Differences were significant for test and for the test-by-group interaction. Follow-up analysis indicated significant differences between the control group (gain = 1.67 degrees ) and both the eccentric-training (gain = 12.79 degrees ) and static-stretching (gain = 12.05 degrees ) groups. No difference was found between the eccentric and static-stretching groups. CONCLUSIONS: The gains achieved in range of motion of knee extension (indicating improvement in hamstring flexibility) with eccentric training were equal to those made by statically stretching the hamstring muscles.

National Athletic Trainers' Association Position Statement: Head-Down Contact and Spearing in Tackle Football

OBJECTIVE: To present recommendations that decrease the risk of cervical spine fractures and dislocations in football players. BACKGROUND: Axial loading of the cervical spine resulting from head-down contact is the primary cause of spinal cord injuries. Keeping the head up and initiating contact with the shoulder or chest decreases the risk of these injuries. The 1976 rule changes resulted in a dramatic decrease in catastrophic cervical spine injuries. However, the helmet-contact rules are rarely enforced and head-down contact still occurs frequently. Our recommendations are directed toward decreasing the incidence of head-down contact. RECOMMENDATIONS: Educate players, coaches, and officials that unintentional and intentional head-down contact can result in catastrophic injuries. Increase the time tacklers, ball carriers, and blockers spend practicing correct contact techniques. Improve the enforcement and understanding of the existing helmet-contact penalties.

Prophylactic Ankle Taping and Bracing: A Numbers-Needed-to-Treat and Cost-Benefit Analysis

OBJECTIVE: Taping and bracing are thought to decrease the incidence of ankle sprains; however, few investigators have addressed the effect of preventive measures on the rate of ankle sprains. Our purpose was to examine the effectiveness of ankle taping and bracing in reducing ankle sprains by applying a numbers-needed-to-treat (NNT) analysis to previously published studies. DATA SOURCES: We searched PubMed, CINAHL, SPORT Discus, and PEDro for original research from 1966 to 2002 with key words ankle taping, ankle sprains, injury incidence, prevention, ankle bracing, ankle prophylaxis, andnumbers needed to treat. We eliminated articles that did not address the effects of ankle taping or bracing on ankle injury rates using an experimental design. DATA SYNTHESIS: The search produced 8 articles, of which 3 permitted calculation of NNT, which addresses the clinical usefulness of an intervention by providing estimates of the number of treatments needed to prevent 1 injury occurrence. In a study of collegiate intramural basketball players, the prevention of 1 ankle sprain required the taping of 26 athletes with a history of ankle sprain and 143 without a prior history. In a military academy intramural basketball program, prevention of 1 sprain required bracing of 18 athletes with a history of ankle sprain and 39 athletes with no history. A study of ankle bracing in competitive soccer players produced an NNT of 5 athletes with a history of previous sprain and 57 without a prior injury. A cost- benefit analysis of ankle taping versus bracing revealed taping to be approximately 3 times more expensive than bracing. CONCLUSIONS/RECOMMENDATIONS: Greater benefit is achieved in applying prophylactic ankle taping or bracing to athletes with a history of ankle sprain, compared with those without previous sprains. The generalizability of these results to other physically active populations is unknown.

Sex-Related and Age-Related Differences in Knee Strength of Basketball Players Ages 11-17 Years

OBJECTIVE: To assess hamstrings and quadriceps strength of basketball players ages 11-13 and 15-17 years. DESIGN AND SETTING: This cross-sectional study occurred during the 2000 American Youth Basketball Tour National Tournament. We investigated whether sex- or age-related strength differences existed among study participants. SUBJECTS: Forty-one tournament participants (22 girls, 19 boys; 11-13 or 15-17 years old) who reported no history of knee sprain or surgery were recruited. MEASUREMENTS: We used a Cybex II dynamometer to obtain isokinetic concentric peak torques relative to body mass (Nm/kg) at 60 degrees /s for hamstrings and quadriceps bilaterally. From average peak torques, we determined ipsilateral hamstrings:quadriceps and homologous muscle-group ratios. RESULTS: Correlations between hamstrings and quadriceps strength measures ranged from 0.78 to 0.97. Players 15-17 years old had greater relative hamstrings and quadriceps strength than 11- to 13-year-old athletes. Age and sex interacted significantly for quadriceps strength. The quadriceps strength of 15- to 17-year-old girls did not differ from that of 11- to 13-year-old girls, whereas 15- to 17-year-old boys had stronger quadriceps than 11- to 13-year-old boys. Boys 15-17 years old had greater quadriceps strength than girls 15-17 years old. CONCLUSIONS: This study is unique in providing normative data for the hamstrings and quadriceps strength of basketball players 11-13 and 15-17 years old. Age-related strength differences did not occur consistently between the sexes, as girls 11-13 and 15-17 years old had similar relative quadriceps strength.

Baby, Be Safe: the effect of tailored communications for pediatric injury prevention provided in a primary care setting

Injuries are a major cause of morbidity and mortality to young children. The provision of individually tailored educational materials in primary care settings may be an effective and efficient way to promote adoption of injury prevention measures by parents. A randomized controlled study compared the effectiveness of tailored and generic persuasive communications delivered in a primary care setting on the adoption of home and car safety behaviors. During routine well-child visits, a primarily African-American sample of parents of children ages 6-20 months (n=213) was randomized to receive either tailored or generic information regarding the prevention of injuries to their child. At follow-up, participants who received tailored information reported greater adoption of home and car safety behaviors than those receiving generic information. In addition, within the tailored information group, those who discussed the information with their physician showed significantly greater change than those who did not. However, this difference was not observed among those receiving generic information. Findings support the use of office-based tailored injury prevention education as a component of routine well-child care.

Enforcement of Mouthguard Use and Athlete Compliance in National Collegiate Athletic Association Men's Collegiate Ice Hockey Competition

OBJECTIVE: To determine enforcement patterns and athlete compliance with the National Collegiate Athletic Association (NCAA) rule requiring the wearing of mouthguards in men's collegiate ice hockey games during a single competitive season. DESIGN AND SETTING: We developed a questionnaire and sent it to certified athletic trainers (ATCs) directly responsible for men's varsity collegiate ice hockey at 127 NCAA-affiliated institutions. Then chi(2) analyses were conducted to determine whether significant differences existed in the pattern of responses by division of play (Division I, II, or III or independent). SUBJECTS: A total of 104 ATCs responded. We obtained data from 94 questionnaires with complete answers to primary questions addressing program enforcement of the rule and mouthguard use. MEASUREMENTS: Our questionnaire asked about types of mouthguards used, attitudes of the sports medicine and coaching staffs regarding the role of mouthguards in prevention of injury, enforcement of mouthguard use, and actual numbers of athletes wearing mouthguards in competition. Respondents also provided an estimate of the number of penalties assessed against their team for mouthguard violations during the previous season. RESULTS: Most ATCs (93%) reported that they believed mouthguards play a role in injury prevention. Respondents indicated someone on the coaching or sports medicine staff enforced the rule at 74% of the institutions, with a trend toward greater enforcement at the Division II and III levels. Overall, ATCs reported 63% of athletes consistently wore mouthguards in competition, with significantly higher compliance at the Division II and III levels. A total of 19 penalties were reportedly assessed for violation of the mouthguard rule the previous season. CONCLUSIONS: Our data suggest that the use of mouthguards in competition is not consistently enforced by ATCs, coaches, or game officials and that mouthguards are not routinely worn by athletes. These results raise legitimate concerns for all physicians, athletic trainers, coaches, and governing bodies involved with men's collegiate ice hockey.

Can Chronic Ankle Instability Be Prevented? Rethinking Management of Lateral Ankle Sprains

OBJECTIVE: To pose the question, "Can chronic ankle instability be prevented?" The evaluation and treatment of chronic ankle instability is a significant challenge in athletic health care. The condition affects large numbers of athletes and is associated with reinjury and impaired performance. The management of acute injuries varies widely but in athletic training has traditionally focused on initial symptom management and rapid return to activity. A review of practice strategies and philosophies suggests that a more detailed evaluation of all joints affected by the injury, correction of hypomobility, and protection of healing structures may lead to a more optimal long-term outcome. BACKGROUND: Sprains to the lateral ankle are common in athletes, and the reinjury rate is high. These injuries are often perceived as being isolated to the anterior talofibular and calcaneofibular ligaments. It is, however, becoming apparent that a lateral ankle sprain can injure other tissues and result in joint dysfunction throughout the ankle complex. DESCRIPTION: We begin by addressing the relationship between mechanical and functional instability. We then discuss normal ankle mechanics, sequelae to lateral ankle sprains, and abnormal ankle mechanics. Finally, tissue healing, joint dysfunction, and the management of acute lateral ankle sprain are reviewed, with an emphasis on restoring normal mechanics of the ankle-joint complex. A treatment model based on assessment of joint function, treatment of hypomobile segments, and protection of healing tissues at hypermobile segments is described.

Cerebral Concussion: Causes, Effects, and Risks in Sports

OBJECTIVE: To characterize the causes, effects, and risks associated with concussion in sports. BACKGROUND: Concussion is an injury associated with sports and is most often identified with boxing, football, ice hockey, and the martial arts. In addition, recent research has shown that concussion occurs in many different sports. In the decade of the 1990s, concussion became a primary issue for discussion among the media, sports sponsors, sports medicine professionals, and athletes. DESCRIPTION: Concussion is an injury that results from a wide variety of mechanisms and has numerous signs and symptoms that are common to different types of injury. Continued improvement in prevention and management strategies for concussion requires a strong body of research from a variety of different disciplines. It is essential that research efforts focus on both prevention and management and that researchers and clinicians work closely toward their common goals. CONCLUSIONS/RECOMMENDATIONS: Until the research community is able to provide sound recommendations for the prevention and management of the concussion, the care of the injured player falls squarely on the clinician. It is important for sports medicine professionals to continue to stay up to date on the advances in understanding concussions and how to care individually for each player who sustains a concussion.

Youth Sports: A Pediatrician's Perspective on Coaching and Injury Prevention

OBJECTIVE

My objective is to review the factors that influence youth participation in sports, to discuss the role coaches may play in youth sports injuries, and to call on athletic trainers and other health professionals to become involved in youth sports in an effort to limit injury risk.

BACKGROUND

Millions of American youths participate in team sports. Their primary motivation to participate is to have fun. Unfortunately, large numbers of participants have sustained correspondingly large numbers of injuries. Many injuries can be attributed to improper technique and conditioning methods taught by volunteer coaches. Although not the only contributors to injuries, these may be the most amenable to preventive measures, such as formal instruction for coaches in the areas of proper biomechanics and player-coach communication.

DESCRIPTION

I provide an overview of the reasons why children participate in sports, discuss participation motivation, and review the literature on coaches' communication methods that have been proved effective in maximizing learning and enjoyment for young athletes.

CLINICAL ADVANTAGES

This article provides certified athletic trainers with the background knowledge needed to take an active role in youth sports injury prevention at the community level.