The Effect of Key Anthropometric and Biomechanics Variables Affecting the Lower Back Forces of Healthcare Workers

Wearable devices are becoming ubiquitous and can be used to better estimate postures and movements to reduce the risk of injuries. Thirty-three participants were recruited in this study to perform two daily repetitive patient transfer tasks while the full body movements were acquired using a set of magneto-inertial wearable devices. The use of wearable devices allowed for the estimation of the forces provoked on the lower back during the entire task performance. In postures where the forces exceeded the warning threshold found in the literature, healthcare workers were considered to have a greater risk of injury. Additionally, the maximum force exerted by each hand to avoid injury to the spinal column was also estimated. Knowing the key anthropometric variables associated with musculoskeletal disorders (MSDs) will enable engineers and researchers to design better assistive devices and injury prevention programs in diverse workplaces.

Activity Distribution Among the Hamstring Muscles During the Nordic Hamstring Exercise: A Multichannel Surface Electromyography Study

This study assessed activity distribution among the hamstring muscles during the Nordic hamstring exercise (NHE). The objective was to compare muscle activity between and within muscles during the NHE to add insights in its underlying protective mechanism. Through multichannel electromyography, we measured muscle activity in male basketball players during the NHE. Electromyography was assessed at 15 locations: 5 for biceps femoris long head, 4 for semitendinosus, and 6 for semimembranosus. For each percent of the eccentric phase of the NHE, muscle activity was calculated for each electrode location within each hamstring muscle individually. To quantify whole muscle head activity, means and variances across electrodes within each muscle were calculated. Thirty-five noninjured participants were included (mean age, 18 [2] y; mass, 87 [12] kg; height, 192 [9] cm). Heterogeneous muscle activity was found between 38% and 62% and over the whole eccentric contraction phase within the semitendinosus and the semimembranosus, respectively. Muscle activity of the semitendinosus was significantly higher than that of the biceps femoris long head. During the NHE, the relative contribution of the semitendinosus is the highest among hamstring muscles. Its strong contribution may compensate for the biceps femoris long head, the most commonly injured hamstring muscle head.

Evaluation of muscle energy in isometric maintenance as an index of muscle fatigue in roller speed skating

Roller speed skating is a discipline in which muscle fatigue plays an important role in athletes; in this work, we wanted to evaluate whether a methodological approach based on the energy required to maintain an isometric muscle contraction for one minute, indexed on the MVIC (maximum voluntary isometric contraction), i.e. % RMS/MVIC can give results similar to the frequency decay analysis/time in terms of usability for athlete training and injury prevention. Right and left gluteus maximus and vastus lateralis muscles (involved in the propulsive phase of skating ) were examined separately by surface electromyography in three competitive athletes in short-track speed skating on asphalt. The results showed an asymmetry between the right (less resistant) and left (more resistant) lower limb, in all three athletes, from the point of view of fatigue, in both investigated muscles. Furthermore, a trend in terms of fatigue resistance was found that was directly proportional to skill in both muscles studied. This can be of help in better planning the training of street speed skaters (which although similar to the discipline on ice is not completely superimposable) with the dual purpose of improving their performance and preventing injuries, often linked to the degree of right-left muscle asymmetry.

The Relationship Between Health and Movement Screens and Field-Based Physical Fitness Tests in Reserve Officer Training Corps Students

The purpose of the present study was to evaluate the relationship between scores achieved in physical fitness tests and outcomes of health and movement screens (HMS) in ROTC students. Twenty-eight students (20 males: 21.8 yrs [± 3.4] & 8 females: 20.7 yrs [± 1.8]) enrolled in an ROTC branch (Army, Air Force, Navy, or Marines) completed a series of screens, including body composition analysis via Dual-Energy X-Ray Absorptiometry (DXA), balance and functional movement tasks via a lower-quarter Y-Balance test, and knee and hip joint concentric strength testing on an isokinetic dynamometer. Official ROTC PFT scores were collected from the respective military branch leadership. HMS outcomes were compared to PFT scores via Pearson Product-Moment Correlation and linear regression analyses. Across branches, total PFT scores were significantly correlated to visceral adipose tissue (r = -0.52, p = 0.01) and android:gynoid fat ratio (r = -0.43, p = 0.04). Visceral adipose tissue (R ² = 0.27, p = 0.011) and android to gynoid ratio (R ² = 0.18, p = 0.042) significantly predicted total PFT scores. No further significant correlations between HMS and overall PFT scores were observed. HMS scores revealed significant bilateral differences in lower extremity body composition (p < 0.001; d = 0.23) and strength (p = 0.002; d = 0.23). Across ROTC branches, HMS were poorly correlated with PFT performance yet indicated significant bilateral differences in lower extremity strength and body composition. The inclusion of HMS may ease the increasing injury rate among the military population by assisting in detection of movement shortcomings.

Current Practices, Willingness and Perceived Ability to Implement an Injury Prevention Exercise Program Among Post-Primary Physical Education Teachers

BACKGROUND

Musculoskeletal injuries are common in adolescents, and recently schools have been suggested as an opportune location for injury prevention strategies. This study aimed to identify the current practices and perceptions of post-primary PE teachers in Ireland on injury prevention exercise programs (IPEP), which are key to informing potential implementation strategies.

METHODS

Post-primary PE teachers (n = 287) completed an online anonymous survey. Outcome measures included current IPEP practices in PE class, teachers' attitudes toward IPEPs, willingness to implement, and perceived ability to implement an IPEP in PE class. Descriptive statistics were calculated, and Mann-Whitney U tests were used to compare differences between groups.

RESULTS

Results indicated that only 1 in 5 PE teachers currently used an IPEP in class. Of these, no teacher used an existing IPEP exactly as intended, while most teachers were willing to implement an IPEP (80.5%). Those who previously received formal IPEP education or were aware of an existing IPEP had significantly higher perceived ability to implement an IPEP in class (p < .001).

CONCLUSIONS

This study demonstrates that despite a willingness among PE teachers to implement IPEPs in class, few currently do. Thus, post-primary PE class may be an under-utilized setting for adolescent injury prevention and warrants further investigation.

Single-Leg Hop Stabilization Throughout Concussion Recovery: A Preliminary Biomechanical Assessment

CONTEXT

Aberrant movement patterns among individuals with concussion history have been reported during sport-related movement. However, the acute postconcussion kinematic and kinetic biomechanical movement patterns during a rapid acceleration-deceleration task have not been profiled and leaves their progressive trajectory unknown. Our study aimed to examine single-leg hop stabilization kinematics and kinetics between concussed and healthy-matched controls acutely (≤7 d) and when asymptomatic (≤72 h of symptom resolution).

DESIGN

Prospective, cohort laboratory study.

METHODS

Ten concussed (60% male; 19.2 [0.9] y; 178.7 [14.0] cm; 71.3 [18.0] kg) and 10 matched controls (60% male; 19.5 [1.2] y; 176.1 [12.6] cm; 71.0 [17.0] kg) completed the single-leg hop stabilization task under single and dual task (subtracting by 6's or 7's) at both time points. Participants stood on a 30-cm tall box set 50% of their height behind force plates while in an athletic stance. A synchronized light was illuminated randomly, queuing participants to initiate the movement as rapidly as possible. Participants then jumped forward, landed on their nondominant leg, and were instructed to reach and maintain stabilization as fast as possible upon ground contact. We used 2 (group) × 2 (time) mixed-model analyses of variance to compare single-leg hop stabilization outcomes separately during single and dual task.

RESULTS

We observed a significant main group effect for single-task ankle plantarflexion moment, with greater normalized torque (mean difference = 0.03 N·m/body weight; P = .048, g = 1.18) for concussed individuals across time points. A significant interaction effect for single-task reaction time indicated that concussed individuals had slower performance acutely relative to asymptomatic (mean difference = 0.09 s; P = .015, g = 0.64), while control group performance was stable. No other main or interaction effects for single-leg hop stabilization task metrics were present during single and dual task (P ≥ .051).

CONCLUSIONS

Greater ankle plantarflexion torque coupled with slower reaction time may indicate stiff, conservative single-leg hop stabilization performance acutely following concussion. Our findings shed preliminary light on the recovery trajectories of biomechanical alterations following concussion and provide specific kinematic and kinetic focal points for future research.

Relationship of Subtalar Joint Range of Motion to Ankle Injuries in NBA G League and Collegiate Basketball Players

BACKGROUND

This study sought to determine whether range of motion (ROM) of the ankle and subtalar joint complex (STJ) is correlated with ankle injuries in National Basketball Association (NBA) G-league and collegiate basketball players to identify an at-risk population that may benefit from participation in an ankle injury prevention program.

METHODS

This prospective cohort study encompassed 103 player-seasons (68 collegiate, 35 NBA G-League). Patient demographics, passive ankle and STJ range of motion measurements, anterior drawer, and talar tilt tests were collected at preseason physicals along with plain radiographs. Subtalar eversion and inversion measurements were added to assess the Combination Motion (CM) of the STJ and subtracted to calculate the Subtalar Difference (SD). We defined the ratio of CM to SD as Subtalar Mobility Index (SMI=CM/SD).

RESULTS

Twenty-one ankle injuries occurred with 10 405 player exposures yielding an incidence of 2.11/1000 exposures, resulting in 113 days of missed playing time. No direct measures of ankle, subtalar, or combined motion were associated with risk of injury, rejecting our original hypothesis that increased STJ ROM would predispose to ankle injuries. However, we did find that athletes with CM >16 degrees in combination with either SD <6 degrees (P = .025) or SMI >3.75 (P = .032) were nearly 3 times more likely to have an ankle injury (3.14 vs 2.97, respectively).

CONCLUSION

Using the predictive subtalar mobility thresholds found in this study may help identify at-risk players that may benefit from targeted ankle injury prevention programs.

LEVEL OF EVIDENCE

Level II, prospective cohort study.

Applying a muscle fatigue model when optimizing load-sharing between muscles for short-duration high-intensity exercise: A preliminary study

Introduction: Multiple different mathematical models have been developed to represent muscle force, to represent multiple muscles in the musculoskeletal system, and to represent muscle fatigue. However, incorporating these different models together to describe the behavior of a high-intensity exercise has not been well described. Methods: In this work, we adapted the three-compartment controller (3CCr) muscle fatigue model to be implemented with an inverse-dynamics based optimization algorithm for the muscle recruitment problem for 7 elbow muscles to model a benchmark case: elbow flexion/extension moments. We highlight the difficulties in achieving an accurate subject-specific approach for this multi-level modeling problem, considering different muscular models, compared with experimental measurements. Both an isometric effort and a dynamic bicep curl were considered, where muscle activity and resting periods were simulated to obtain the fatigue behavior. Muscle parameter correction, scaling and calibration are addressed in this study. Moreover, fiber-type recruitment hierarchy in force generation was added to the optimization problem, thus offering an additional novel muscle modeling criterion. Results: It was observed that: i) the results were most accurate for the static case; ii) insufficient torque was predicted by the model at some time points for the dynamic case, which benefitted from a more precise calibration of muscle parameters; iii) modeling the effects of muscular potentiation may be important; and iv) for this multilevel model approach, the 3CCr model had to be modified to avoid reaching situations of unrealistic constant fatigue in high intensity exercise-resting cycles. Discussion: All the methods yield reasonable estimations, but the complexity of obtaining accurate subject-specific human models is highlighted in this study. The proposed novel muscle modeling and force recruitment criterion, which consider the muscular fiber-type distinction, show interesting preliminary results.

Impact of COVID-19 on U.S. Hospital-Based Injury Prevention Professionals: A National Survey

BACKGROUND

COVID-19 challenged U.S. trauma centers to grapple with demands for expanded services with finite resources while also experiencing a concurrent increase in violent injuries.

OBJECTIVE

The purpose of this study was to describe the impact of COVID-19 on the roles and duties of U.S. hospital-based injury prevention professionals.

METHODS

This descriptive cross-sectional survey study of hospital-based injury prevention professionals was conducted between June 2021 and August 2021. Participants were recruited from six organizational members of the national Trauma Prevention Coalition, including the American Trauma Society, Emergency Nurses Association, Injury Free Coalition for Kids, Safe States Alliance, Society for Trauma Nurses, and Trauma Center Association of America. Results were analyzed using descriptive and inferential statistics.

RESULTS

A total of 216 participants affiliated with 227 trauma centers responded. The following changes were reported during 2020: change in injury prevention position (range = 31%-88%); change in duties (range = 92%-100%); and change to hospital-based injury prevention programs (range = 75%-100%). Sixty-one (43%) single-center participants with a registered nurse license were reassigned to clinical duties compared with six (10%) nonlicensed participants (OR = 5.6; 95% CI [1.96, 13.57]; p < .001). Injury prevention programs at adult-only and combined adult and pediatric trauma centers had higher odds of suspension than pediatric-only trauma centers (OR = 3.6; 95% CI [1.26, 10.65]; p < .017).

CONCLUSION

The COVID-19 response exposed the persistent inequity and limited prioritization of injury prevention programming as a key deliverable for trauma centers.

Adult golf cart injuries: A rising hazard off the course

OBJECTIVE

Golf carts are increasingly being used as a means of transportation for travel in neighborhoods, city areas, and unpaved surfaces. The catchment area of our regional trauma center has seen an increase in golf cart use for transportation. In fact, Georgia has recently changed legislation to support the growing need for more defined laws around golf cart use. This study aims to further evaluate injury and outcome patterns in the adult population of northeast Georgia.

METHODS

We performed a retrospective review of adult golf cart injured patients from 2018 to 2022. We evaluated key demographics, such as age and gender, along with the length of stay, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS). Outcomes included the injury type.

RESULTS

The results showed that orthopedic injuries were the most common (n = 24). Most patients were in the driver's seat (76%). Ejection from the golf cart was common (82%). Geriatric patients, 65 and older, had an increased length of stay compared to patients under the age of 65 (10 vs 3.9 days).

CONCLUSION

Based on these results, future work includes injury prevention, increased awareness of injury patterns in prehospital and hospital settings, and communities updating their ordinances.

Difference of Hamstring Activity Between Bilateral and Unilateral Nordic Hamstring Exercises With a Sloped Platform

CONTEXT

This study aimed to examine the differences in electromyographic (EMG) activity of the biceps femoris long head (BFlh) and semitendinosus (ST) muscles, break-point angle (BPA), and the angle at peak BFlh EMG activity between bilateral and unilateral Nordic hamstring exercise (NHE) on a sloped platform.

DESIGN

This study was designed as a case-control study.

METHODS

Fourteen men participated in the study. The participants initially performed maximum voluntary isometric contraction (MVIC) on the prone leg curl to normalize the peak hamstring EMG amplitude as the %MVIC. Then, participants were randomized to perform the following 3 variations of NHE: bilateral (N40) or unilateral (N40U) NHE with a platform angle of 40°, and unilateral NHE with a platform angle of 50° (N50U). The EMG activities of the BFlh and ST and the knee flexion angle during the NHE variations were recorded to calculate the EMG activity of the BFlh and ST in terms of the %MVIC, the angle at peak BFlh EMG, and BPA.

RESULTS

The BFlh %MVIC was significantly higher in N40U (P < .05) and N50U (P < .05) than in N40. A significant difference in BFlh %MVIC and ST %MVIC was observed between N40U (P < .05) and N50U (P < .05). The mean values of BPA and the angle at peak BFlh EMG were <30° for all NHE variations.

CONCLUSIONS

In the late swing phase of high-speed running, BFlh showed higher EMG activity; thus, unilateral NHE may be a specific hamstring exercise for hamstring injury prevention.

A Study on the Injury Rate of Spanish Competitive Athletes as a Consequence of the COVID-19 Pandemic Lockdown

The COVID-19 lockdown may have had collateral effects on the conditions of athletes, with possible increases in injury risks upon the return to sports. Due to the existence of multiple factors of injury risks based on the lockdown and the return to sports, the aim of this study was to analyze the injury rates after the lockdown in competitive athletes. A non-experimental quantitative design based on a survey was carried out, and 94 athletes (42 males and 52 females; 23.57 ± 6.20 years) participated. Statistical analyses were carried out using non-parametric tests. Injury rates did not increase significantly after the lockdown, and there were no statistical differences between performance levels, types of sports, the design of a specific training program by sports professionals during the lockdown, the moment of injury, and the mechanism of injury. It is important to develop injury prevention protocols to prepare athletes after such a long period of detraining.

Investigation of factors influencing submarining mitigation with child booster seats

OBJECTIVE

Automobile booster seats are intended to improve belt fit for children that are too large for a harness-style child restraint, but not yet big enough to fit properly in an adult seat belt. Our objective was to prospectively study the relationship between booster seat design and interaction with the seat belt (specifically, submarining risk) for a child occupant using computer simulation of automobile crash events.

METHODS

Frontal-impact simulations were performed with a 6-year-old child human body model. Simplified models of booster seats were developed using an automated process designed to capture key characteristics of booster geometry, stiffness, belt guide construction, and attachment to the vehicle seat. The child model was positioned in a range of postures from upright to slouched. Our main interest was submarining, where the child's pelvis slips under the lap belt and the belt loads into the abdomen (defined based on the motion of the lower lap belt edge relative to the ASIS).

RESULTS

Among the parameters studied, the factors that had the greatest effect on submarining risk were the booster's stiffness and the child's posture. Booster models of a low-stiffness construction (similar to an inflatable booster) nearly always resulted in submarining, regardless of the other design characteristics of the booster. A slouched posture also substantially increased the likelihood of submarining (even for high-stiffness boosters).

CONCLUSIONS

These results suggest that booster seats of a stiffer construction, and booster seats that promote an upright posture may provide a protective benefit compared to softer boosters and boosters that are more likely to result in slouching of the child.

Dimensions of Hybrid and Nanohybrid Mouthguards for Mixed Martial Arts Fighters-Evaluation of a New Method of Fabrication

Ethylene vinyl acetate mouthguards are the most often used custom protective intraoral appliances by combat sports practitioners. However, due to the difficulties in maintaining the hygiene of such mouthguards and thinning during fabrication, resulting in difficulty in predicting final dimensions, they may not be the optimal solution. The aim of this research was to evaluate an innovative method of mouthguard formation using intraoral modeling of the mouthguard pattern, hybrid acrylic material, and the addition of ZnO nanoparticles. Seventeen mouthguards patterns and 34 custom mouthguards were evaluated: 17 hybrid and 17 nanohybrid. A total of 1122 measurements were performed: each mouthguard and pattern was measured at 22 points. Statistical analyses were performed with the use of IBM^® SPSS^® Statistics 27.0.0 software (IBM, Armonk, NY USA). The mean thickness of the patterns and mouthguards at all labial areas of central incisors were between 4.65 and 4.80 mm. The thickness at the buccal surface of the first molar was between 3.71 and 4 mm, and at the occlusal surface between 3.40 and 3.56 mm in the cusp area. All measurements of hybrid and nanohybrid mouthguards were strongly and highly correlated with the measurements of the mouthguard patterns. Hybrid and nanohybrid mouthguards are an advantageous alternative to thermoformed custom appliances.

Exercise history predicts focal differences in bone volume fraction, mineral density and microdamage in the proximal sesamoid bones of Thoroughbred racehorses

Medial proximal sesamoid bones (PSBs) from Thoroughbred racehorses that did (Case) or did not (Control) experience unilateral biaxial PSB fracture were evaluated for bone volume fraction (BVF), apparent mineral density (AMD), tissue mineral density (TMD), and microdamage in Case fractured, Case contralateral limb intact, and Control bones. A majority of Case bones had a subchondral lesion with high microdamage density, and low BVF, AMD, and TMD. Lesion microdamage and densitometric measures were associated with training history by robust linear regression. Exercise intensity was negatively related to BVF (0.07 ≤ R²  ≤ 0.12) and positively related to microcrack areal density (0.21 ≤ R²  ≤ 0.29) in the lesion; however, in an undamaged site, the relationships were opposite in direction. Regardless of location, TMD decreased with event frequency for both Case and Control, suggesting increased bone remodeling with exercise. Measures of how often animals were removed from active training (layups) predicted a decrease in TMD, AMD, BVF, and microdamage at regions away from the lesion site. A steady-state compartment model was used to organize the differences in the correlations between variables within the data set. The overall conclusions are that at the osteopenic lesion site, repair of microdamage by remodeling was not successful (e.g., lower bone mass, increased damage, and lower mineralization) but that in regions away from the lesion remodeling successfully controlled damage (e.g., higher bone mass, less microdamage, and lower mineralization).

Assessment of the effectiveness of parent-targeted interventions for the use of child restraint systems: a systematic review and meta-analysis

BACKGROUND

It is essential to implement parent-targeted interventions to increase the use of child restraint systems (CRS) and thus reduce the injuries and deaths of children due to motor vehicle collisions. To optimize future intervention designs, this meta-analysis sought to quantify the effects of parent-targeted interventions and explore potential intervention moderators.

METHODS

Studies met inclusion criteria if they included a parents-targeted intervention that focused on increasing CRS use for children, published from the inception of the databases to January 2022, were systematically retrieved from the PubMed, Embase, Cochrane library, Web of Science, Sinomed, Wanfang, and CNKI databases. Next, 2 researchers independently screened the retrieved articles, evaluated their quality according to the Cochrane Tool, and extracted the data. Finally, Stata12.0 was used for the meta-analysis. Heterogeneity was examined with I², stratified analyses, and meta-regression.

RESULTS

Of the 1,690 articles retrieved, 9 studies, comprising 22,329 parents of children aged 0-12 years, were ultimately included in the analysis. The results of the meta-analysis showed that the CRS use rate of the intervention group was 1.62 times higher than that of the control group [95% confidence interval (CI): 1.25-2.11, Z=3.616, P<0.001], indicating the positive effect of parent-targeted interventions on promoting the use of CRS. The subgroup analysis found that interventions guided by behavioral theories increased the use of CRS (odds ratio: 1.44, 95% CI: 1.27-1.63, n=5). The difference in the use of CRS between the groups in the studies that were not guided by theories was not statistically significant, indicating that interventions guided by behavioral theories may be the source of the heterogeneity. Risk of bias was low in most studies.

CONCLUSIONS

It is necessary to conduct interventions with parents to increase the use of CRS. The effects on CRS use appear to differ depending on whether the interventions are guided by behavioral theories. In-depth research needs to be conducted to explore the characteristics of the interventions, especially those guided by different behavioral theories, to reduce child vehicle injuries.

Efficacy of Injury Prevention Using Functional Movement Screen Training in High-School Baseball Players: Secondary Outcomes of a Randomized Controlled Trial

This study of a randomized controlled trial aimed to clarify the effect of functional movement screen (FMS) training on the FMS score and the number of injuries in high-school baseball players. Accordingly, 71 high-school baseball players (age: 15-17 years) were randomized into an intervention group (n = 37; FMS training 4 times per week for 12 weeks on the ground of each team) or a control group (n = 34; team practice without limits). No significant differences were observed in terms of the participant characteristics of the two groups. The FMS score of the intervention group significantly increased after 12 weeks of training compared with the control group. However, there was no difference between the groups in terms of the FMS score after 24 weeks. Injuries in the intervention group were significantly reduced after 24 weeks. The time lost due to noncontact injuries (12 weeks/follow-up) was 56.5 h/113 h in the intervention group and 33 h/325.5 h in the control group. Injuries were found all over the body. Based on these results, FMS training was proven to reduce injury in high-school baseball players. Although continued training is required to improve FMS scores, the number of injuries decreased after training.

Load and fatigue monitoring in musicians using an online app: A pilot study

Background/aims

High occupational injury rates are reported in musicians, with a career prevalence of up to 89%. Fatigue and playing (over)load are identified as key risk factors for musicians' injuries. Self-report fatigue management strategies in sport have demonstrated preventive effects. A self-report fatigue management tool for musicians was developed based on a Delphi survey of international experts and hosted in an online app. The aims of this study are to evaluate the content validity and uptake of this new tool, and explore associations between collected performance quality, physical/psychological stress, pain, injury and fatigue data.

Methods

University and professional musicians were asked to provide entries into the online app twice per week for 1-6 months. Entries into the app were designed to take 2-3 min to complete and consisted of the following: 6 questions regarding playing load over the previous 72 h; 5 questions regarding current levels in key physical/psychological stress domains (sleep, recovery, overplaying, pain, fitness); one question self-rating of performance quality over the previous day; one question regarding current musculoskeletal symptoms; a reaction time task to evaluate psychomotor fatigue.

Results

N = 96 participants provided an average of 2 app entries (range 0-43). Increased playing time, rating of perceived exertion (RPE), and feelings of having to "play too much" were consistently associated with increased self-rated performance quality (p ≤ 0.004; 6.7 <| t |< 2148.5). Increased ratings of feeling fit and recovering well were consistently associated with reduced pain severity (p < 0.001; 3.8 <| t |< 20.4). Pain severity was increased (6.5/10 vs. 2.5/10; p < 0.001) in participants reporting playing-related musculoskeletal disorders (PRMDs; symptoms affecting playing).

Conclusion

The prospective value of regular individual self-report playing load, stress, and performance data collection in musicians is clear. However, limited uptake of the online fatigue management app piloted in this study indicates that new approaches to the collection of these data are needed to realize their potential impact.

Gender-Specific Effects of 8-Week Multi-Modal Strength and Flexibility Training on Hamstring Flexibility and Strength

The purpose of this study was to investigate the effects of multi-modal strength training or flexibility training on hamstring flexibility and strength in young males and females. A total of 20 male and 20 female college students (aged 18-24 years) participated in this study and were randomly assigned to either a multi-modal flexibility intervention group or strength intervention group. Passive straight leg raise and isokinetic strength test were performed before and after the intervention to determine flexibility and strength of the participants. Multivariate repeated-measure ANOVA was used to determine the effect of training group and gender on hamstring strength and flexibility. Both male and female participants in the strength intervention group significantly increased peak torque, relative peak torque, and flexibility (all p ≤ 0.029). Both male and female participants in the flexibility intervention group significantly increased flexibility (both p ≤ 0.001). Female participants in the flexibility intervention group significantly increased peak torque and relative peak torque (both p ≤ 0.023). However, no change was seen in peak torque and relative peak torque of male participants in the flexibility intervention group (p ≥ 0.676). An 8-week strength training program involving various training components can increase flexibility in both males and females, although the flexibility of male participants only increased slightly. While hamstring flexibility training protocol consisted of different types of stretching improved both flexibility and strength in female participants, male participants increased only flexibility but not strength, indicating such effects were gender-specific. For subjects with relatively low strength (e.g., older adults, sedentary women, postoperative rehabilitation population, etc.), strength training alone or flexibility training alone may increase both strength and flexibility.

Parental Perceptions of Their Children's Access to Household Firearms

OBJECTIVES

To provide a nationally representative estimate of the proportion of gun owners who report a child has independent access to one of their guns, and to describe characteristics of these gun owners relative to other gun-owning parents.

STUDY DESIGN

We conducted a cross-sectional analysis of online survey data collected in 2019 from a nationally representative sample of US adults in households with firearms (n = 4030, response 65%). The sample comprised gun-owning respondents living in homes with children (n = 689) who were asked questions about their firearms, including how they were stored, and about who other than themselves had access to their guns: "If you were not there, who in your household could get one of your guns (and load it if it is not loaded already) if they needed to?"

RESULTS

Twelve percent of US gun owners in homes with children report that a child has independent access to one of their guns (about one-fifth of those having children under age 12 years only). Gun owners who reported child access were more likely than those who reported no child access to store guns, unlocked and loaded, but still one-fifth of those reporting access, stored all guns locked and unloaded.

CONCLUSIONS

We find that more than 10% of gun owners with children report that a child can independently access one of their guns, including parents who store all guns locked and unloaded; suggesting that guidance to parents should focus on access in addition to firearm storage.

The effect of rigid tape on wrist postures during tree planting

Taping has been suggested to reduce the incidence of tendinopathy in tree planters. However, the ability of taping to reduce wrist postures during planting has not yet been formally evaluated. The primary aim was to test the effect of rigid taping on wrist postures during tree planting tasks. Eleven tree planters planted up to 50 trees in three conditions: no-tape (NT), tape-on-the-dorsum-of-the-hand (T1) and tape-on-the-thumb (T2) in a randomised cross-over, within-participant, repeat-measures design. Electrogoniometers (EG) recorded continuous wrist postures. Digital video recordings were used to segment EG traces of each planting cycle (one planted tree) into 4 kinematically distinct Phases. The tree and shovel wrist were analysed separately. Tree-wrist peak ulnar deviation and frequency of shovel-wrist awkward frontal plane postures were significantly reduced in the T2 condition. Taping may be effective at reducing non-neutral postures and should be researched further to determine its effectiveness in reducing tree planting injuries.Practitioner summary: The effect of rigid taping on wrist postures during tree planting has not yet been formally evaluated. A randomised cross-over, within-participant, repeat measures design was used to evaluate the effect of rigid taping on wrist postures during planting. Thumb rigid taping appeared to reduce wrist range of motion during planting. KEY POINTSTaping of the thumb reduced peak ulnar deviation of the tree wrist and frequency of awkward frontal plane postures of the shovel wrist.While taping of the dorsum of the hand appeared to be more restrictive, it did not significantly reduce wrist movement; this is likely because only its effect on sagittal plane posture was assessed which had a higher variance.Upon application, tape appeared to restrict voluntary movement patterns, decreased voluntary grip force exertion and physically restrain wrist movement.Overall, rigid tape was found to be an acceptable intervention for the tree planting occupation, with financial costs and perceived effort identified as the primary barriers to acceptability.

The Ecological Validity of Countermovement Jump to On-Court Asymmetry in Basketball

Jump-based asymmetry is often used as an indicator of sport performance and may be used to discern injury susceptibility. Due to task specificity, however, countermovement jump asymmetry may not be representative of on-court asymmetry. As such, we assessed the association between countermovement jump asymmetry and on-court impact asymmetry metrics (n=3, and n=4, respectively) using linear regressions (α=0.05). Fifteen female basketball athletes completed countermovement jump and on-court sessions across a competitive season. A significant negative association was found between peak landing force asymmetry and both overall and medium acceleration on-court asymmetry (b=–0.1, R ² =0.08, p<0.001; b=–0.1, R ² =0.11, p<0.001, respectively), as well as between peak propulsive force asymmetry and on-court medium acceleration asymmetry (b=–0.24, R ² =0.04, p=0.01). Alternatively, both peak landing and peak propulsive force asymmetry were significantly positively associated with on-court high acceleration asymmetry (b=0.17, R ² =0.08, p<0.001; b=0.35, R ² =0.02, p=0.04, respectively). While some overlap may exist, countermovement jump and on-court impact asymmetry appear to be independent. Thus, sport-specific monitoring may be necessary to adequately monitor injury susceptibility using asymmetry.

The Triple Step in Recreational Swing Dancers: A Kinematic Analysis

Swing dancing is gaining popularity, yet our biomechanical understanding of swing dance remains poor, creating barriers to the development of training protocols and evaluation of performances. This study aimed to determine whether dancing with or without a partner affects the lower extremity kinematics of the triple step, and if the kinematics differ among the three steps of the dance element. Eight recreational swing dancers completed three sets of rightward triple steps with and without a partner. The angles in the sagittal, frontal and transverse planes were determined for bilateral lower limb joints and pelvis based on the kinematics collected by a motion capture system. Results illustrated that dancing with a partner has a significant effect on the angular kinematics of the lower extremity and pelvis. Dancers showed more restricted motion at the knee and hip in the sagittal and frontal planes when dancing with a partner. Additionally, differences were observed among the steps with most differences occurring between steps one and two and steps two and three in all three planes. These findings expand our knowledge of swing dancing biomechanics, possibly informing the design of future studies that will further expand our understanding of swing dancing.

An exploration of factors impacting implementation of a multisystem hospital-based violence intervention program

Community violence, particularly gun violence, is a leading cause of morbidity and mortality in young people in the United States. Because persons experiencing violence-related injuries are likely to receive medical care through emergency departments, hospitals are increasingly seen as primary locations for violence intervention services. Currently, there is little research on how best to implement hospital-based violence intervention programs (HVIPs) across large hospital systems. This study explored the factors influencing the implementation of a multi-site HVIP using qualitative interviews with a purposive sample of 20 multidisciplinary stakeholders. Thematic analysis was used to generate several themes that included: (1) reframing gun violence as a public health issue; (2) developing networks of community-hospital-university partners; (3) demonstrating effectiveness and community benefit; and (4) establishing patient engagement pathways. Effective implementation and sustainment of HVIPs requires robust and sustained multidisciplinary partnerships within and across hospital systems and the establishment of HVIPs as a standard of care.

Regular-Season Injury Rates in the National Football League After an Attenuated Preseason Due to COVID-19

BACKGROUND

The preseason is a crucial time period for professional athletes to prepare for the upcoming season. However, due to the coronavirus 2019 (COVID-19) pandemic, the 2020 National Football League (NFL) preseason was canceled. As the regular season progressed, an increased number of injuries became apparent.

PURPOSE/HYPOTHESIS

The purpose of this study was to compare injury rates between the 2019 and 2020 NFL regular seasons after the canceled 2020 preseason. It was hypothesized that injury rates in the 2020 season would be the same or higher compared with 2019.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

A public database of all 32 NFL teams was used to examine the movement of all players to injured reserve status as well as every player who missed a regular-season game due to injury for both the 2019 and the 2020 NFL regular seasons. Data collection consisted of tallying the total number of reported musculoskeletal injuries for each team. Comparisons of injury rates between the 2 seasons were made using a Wilcoxon signed-rank statistical analysis.

RESULTS

The total number of musculoskeletal injuries was 632 for the 2019 regular season and 765 for the 2020 regular season (P = .0324). Compared with 2019, statistically significant increases in injury rates in 2020 were seen for calf or Achilles tendon strain (17 vs 39; P = .009), groin injury (25 vs 46; P = .018), and anterior cruciate ligament tear (14 vs 29; P = .016). There were several other increased trends in soft tissue injury rates in the 2020 season (eg, hamstring injury [87 vs 114; P = .085]); however, these did not reach statistical significance.

CONCLUSION

This study showed a significant increase in total injuries during the 2020 COVID-19-affected NFL regular season compared with 2019. Several major soft tissue injuries reached statistical significance in their increase from 2019 to 2020 after the cancellation of the 2020 preseason due to COVID-19. These findings suggest that organized team preseason training and conditioning could have an effect on the prevention of sport-related injury at the highest level.

Search and rescue incidents among persons 65 years and older in the USA: Examination of factors associated with death

OBJECTIVES

Older people are vulnerable to becoming lost from home, especially if alone and in unfamiliar environments. Incidents of older persons becoming lost are frequently reported and often requiring a search and rescue (SAR) response. Becoming lost is distressing to the person concerned, their carer, and family and may result in physical injury and/or death. This study examined what factors are associated with death among older persons reported lost from home.

METHODS/DESIGN

A retrospective cross-sectional study. Data were obtained from the International Search and Rescue Incident Database from 1985 to 2013. Participants comprised persons aged 65 years and older living in the United States. Individual, SAR incident, and environmental factors were analysed. The primary outcome of this study was lost person found alive or found dead on arrival. Relationships between categorical variables and outcome were summarised with contingency tables, chi-squared test p-values (or Fisher's-exact-test), and odds ratios (OR) with 95% confidence intervals (CI). Association between continuous variables and outcome were examined using multiple logistic regression. p-value of <0.05 was considered significant.

RESULTS

Among the 5242 SAR incidents, 1703 met the inclusion criteria, of which 87.8% (n = 1495) were found alive and 12.2% (n = 208) were found dead. Factors associated with death included: male gender (OR 1.46; CI 1.01-2.13; p = 0.048), cognitively intact (OR 0.32; CI 0.22-0.47; p < 0.001), prolonged SAR duration (OR: 1.028; CI: 1.021-1.035; p < 0.001), found in water/wetlands (OR 7.40; CI 3.37-16.24; p < 0.001), and extreme weather (OR: 2.06; 95% CI: 1.10-3.86; p = 0.024).

CONCLUSIONS

Older people have a fundamental human right to protection from preventable deaths. Findings indicate these rights are not being protected with deaths occurring frequently among older people who have become lost from home. To minimise fatalities, knowledge of factors associated with death could inform the development suitable assessment and intervention strategies for SAR teams and caregivers.

Association of Training and Game Loads to Injury Risk in Junior Male Elite Ice Hockey Players: A Prospective Cohort Study

BACKGROUND

Training and game loads are potential risk factors of injury in junior elite ice hockey, but the association of training and game loads to injuries is unknown.

PURPOSE

To investigate the association of chronic training and game loads to injury risk in junior male elite ice hockey players.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

In this prospective cohort study, we monitored all health problems among 159 male junior ice hockey players (mean age, 16 years; range, 15-19 years) at sports-specific high schools during the 2018-2019 school year. Players reported their health problems every week using the Oslo Sports Trauma Research Center Overuse Questionnaire on Health Problems (OSTRC-H2). The number of training sessions and games was reported for 33 weeks. We calculated the previous 2-week difference in training/game loads as well as the cumulative training/game loads of the previous 2, 3, 4, and 6 weeks and explored potential associations between training/game loads and injury risk using mixed-effects logistic regression.

RESULTS

The players reported 133 acute injuries, 75 overuse injuries, and 162 illnesses in total, and an average of 8.8 (SD ±3.9) training sessions and 0.9 (SD ± 1.1) games per week. We found no association between the difference of the two previous weeks or the previous 2- 3- and 4-week cumulative, training or game load and acute injuries, nor the difference of the two previous weeks, or the previous 4- and 6-week cumulative, training or game load and overuse injuries (OR, ∼1.0; P > .05 in all models).

CONCLUSION

In the current study of junior elite ice hockey players, there was no evidence of an association between cumulative exposure to training/game loads and injury risk.

The Effect of FIFA 11+ on the Isometric Strength and Running Ability of Young Soccer Players

Soccer is the world's game, and keeping athletes healthy while playing the game has often been a focus of study. There is a high occurrence of musculoskeletal injuries reported in soccer. FIFA 11+ was developed as an intervention to help prevent such injuries. FIFA 11+ has previously been studied for its efficacy as an injury prevention program, but not for its effect on sports performance in an adolescent population. The purpose of this study was to look at the effect of implementing the FIFA 11+ intervention on strength, speed, and agility. Twenty youth soccer players were randomly divided into an intervention group (INT) and a control group (CON). The intervention lasted for eight weeks and performance assessments were completed pre- and post-intervention. Post-test INT knee flexor strength was significantly higher than pre-test scores (p < 0.05). INT also demonstrated significantly higher hamstring to quadriceps strength ratio (H/Q) after the intervention (p < 0.05), while the CON H/Q did not change significantly. 30-m sprint performance of both groups improved from pre- to post-test (p < 0.05). Shuttle run performance was significantly improved in post-test scores for INT players (p < 0.05), but did not change significantly for the CON players. It is suggested that implementing FIFA 11+ before training in young soccer players can lead to performance benefits as well as injury prevention benefits.

Balancing Safety, Comfort, and Fall Risk: An Intervention to Limit Opioid and Benzodiazepine Prescriptions for Geriatric Patients

Introduction

This study reports on the impact of a clinical decision support tool embedded in the electronic medical record and characterizes the demographics, prescribing patterns, and risk factors associated with opioid and benzodiazepine misuse in the older adult population.

Significance

This study reports on prescribing patterns for patients ≥65 years-old who presented to Emergency Departments (ED) or Urgent Care (UC) facilities across a large healthcare system following a fall (n = 34,334 encounters; n = 25,469 patients). This system implemented a clinical decision support intervention which provides an alert when the patient has an evidence-based risk factor for prescription drug misuse; prescribers can continue, amend or cancel the prescription.

Results

Of older adults presenting with a fall, 31.4% (N = 7986) received an opioid or benzodiazepine prescription. Women and younger patients (65-74) had a higher likelihood of receiving a prescription (P < .0001). 11% had ≥1 risk factor. Women were more likely to receive an early refill (P = .0002) and younger (65-74) men were more likely to have a past positive toxicology (P < .0001). A prescription was initiated in 8,591 encounters, and 946 (9.0%) triggered an alert. In 58 cases, the alert resulted in a prescription modification, and in 80 the prescription was canceled.

Conclusions

Documented risk for opioid misuse in the elderly was 10% among patients presenting to the ED/UC after a fall. The dangers associated with opioid/benzodiazepine use increase with age as does fall risk. Awareness of risk factors is an important first step; more work is needed to address potentially hazardous prescriptions in this population.

Head Trauma Exposure in Mixed Martial Arts

Combat sports training involves a high risk of head injury. Previously published research on head trauma exposure in MMA evaluated only the knockouts (KO), without calculating all head strikes. The aim of the research was to evaluate the total head trauma exposure during MMA competitions among male and female fighters. Two thousand four hundred and eighty-eight MMA fights from all numbered UFC events between 2000 and 2021 were analyzed. A database containing the results from officially published scorecards with information such as the outcome of a fight, its duration, number of strikes (significant and total amount of hits) depending on location and knockdowns was created. Additional video verification of the knockout technique was carried out. The athletes received an average of 2.41 significant head strikes out of a total of 6.30 head strikes per minute. Head strikes were more common in female fights than in male. Women executed more total and significant head strikes per minute than men. Head trauma caused the ending of 31.6% of all fights-more often in male fights (32.2%) than female (23.1%). It was the most common cause of knockouts-88.1%. Professional fights in mixed martial arts involve high exposure to head trauma. A careful evaluation of the risk involved in training in such a discipline is necessary to provide adequate prevention methods.

Sports Injuries of a Portuguese Professional Football Team during Three Consecutive Seasons

Professional football players are exposed to high injury risk due to the physical demands of this sport. The purpose of this study was to characterize the injuries of a professional football team in the First Portuguese League over three consecutive sports seasons. Seventy-one male professional football players in the First Portuguese Football League were followed throughout the sports seasons of 2019/2020, 2020/2021, and 2021/2022. In total, 84 injuries were recorded. Each player missed an average of 16.6 days per injury. Lower limbs were massively affected by injuries across all three seasons, mainly with muscular injuries in the quadriceps and hamstrings and sprains in the tibiotarsal structure. Overall, the injury incidence was considerably higher in matches than in training. The two times of the season that proved most conducive to injuries were the months of July and January. Our results emphasize the importance of monitoring sports performance, including injury occurrence, and assisting in identifying risk factors in professional football. Designing individualized training programs and optimizing prevention and recovery protocols are crucial for maximizing this global process.

Impact of Two Types of Fitness Programs on Soldier Physical Fitness

This study compared an expert supervised, fully resourced physical training (PT) program compared to a traditional physical training PT plan on Army Officer Candidate School (OSC) soldier fitness outcomes. This retrospective cohort study compared 228 OCS soldiers (179 male [26.74±3.78 years] and 49 female [26.55±4.18 years]) in two companies for 12 weeks. One company participated in a fully resourced PT program designed by fitness experts to improve overall fitness and mobility (TAP-C). One company participated in traditional physical training designed to excel on the Army combat fitness test (ACFT, includes deadlift, power throw, push up, sprint-drag-carry, core strength, run) developed and led by OCS soldiers with standard resources. We assessed performance on the ACFT events, and grip strength, standing broad jump, overhead squat, and 90/90 switch assessment. Analysis of covariance was used to compare main effects of company on ACFT measures, controlling for covariates of pretest score differences and sex. Results included a significant effect of group on ACFT performance (N=228), F(1, 223) = 12.8, p<0.001 and on performance of five of the six ACFT events: MDL, F(1, 223) = 5.44, p = 0.021; HRP, F(1, 223) = 11.67, p < 0.001; SDC, F(1, 223) = 20.06, p < 0.001; LTK, F(1, 223) = 16.95, p < 0.001; and 2MR, F(1, 223) = 23.76, p < 0.001. The traditional company performed significantly better on ACFT muscular, anerobic and aerobic endurance focused events; the TAP-C company performed significantly better on muscular strength/explosive power events and mobility assessments.

Collegiate athletes opinions regarding helmet use while riding scooters or mopeds

Many collegiate athletes use scooters and mopeds for transportation, and they are at greater risk for head injury without helmets. Objective: Investigate college athletes' reasons for wearing/not wearing helmets while riding a scooter or moped. Participants, Methods: 125 Division I athletes across five teams (two with helmet mandates) completed a cross sectional survey on rates and attitudes about helmet use on scooters or mopeds. Results: Helmet use on mandated vs non-mandated teams was 100% vs 3.6% (OR 1141; 95% CI 56.97, 22,850). For the question, "if you do not wear a helmet, what might make you change your mind and wear one?", players most commonly wrote in a law or coaches' rule (57%). Conclusions: A coach's rule is associated with a higher rate of helmet use in collegiate athletes, and athletes primarily report a rule or law as the reason they would wear a helmet on a scooter or moped.

Pediatric spinal injury patterns and management in all-terrain vehicle and dirt bike crashes, 2010-2019

OBJECTIVE

Pediatric spinal injuries in all-terrain vehicle (ATV) and dirt bike crashes are relatively uncommon but may be associated with significant morbidity. There are no recent studies examining these injuries, their management, and outcomes. Therefore, a retrospective study was performed to characterize pediatric spinal injuries related to ATV and dirt bike crashes over the last decade.

METHODS

Data on all patients involved in ATV or dirt bike crashes evaluated at a regional level 1 pediatric trauma center over a 10-year period (2010-2019) were analyzed. Descriptive statistics were analyzed and chi-square, Fisher exact, and Mann-Whitney U-tests were performed comparing the demographics, injury characteristics, and clinical outcomes in patients with versus those without spinal injuries.

RESULTS

Of 680 patients evaluated, 35 (5.1%) were diagnosed with spinal injuries. Over the study period, both spinal injuries and emergency department visits related to ATV or dirt bike crashes increased in frequency. All spinal injuries were initially diagnosed on CT scans, and 57.9% underwent spinal MRI. Injuries were most commonly thoracic (50%), followed by cervical (36.8%). The injuries of most patients were classified as American Spinal Injury Association (ASIA) grade E on presentation (86.8%), while 2 (5.3%) had complete spinal cord injuries (ASIA grade A) and 3 patients (8.6%) were ASIA grade B-D. Operative management was required for 13 patients (28.9%). Nonoperative management was used in 71.1% of injuries, including bracing in 33% of all injuries. Patients with spinal injuries were older than those without (13.4 ± 3.35 vs 11.5 ± 3.79 years, p = 0.003). Spinal injuries occurred via similar crash mechanisms (p = 0.48) and in similar locations (p = 0.29) to nonspinal injuries. Patients with spinal injuries more frequently required admission to the intensive care unit (ICU; 34.2% vs 14.6%, p = 0.011) and had longer hospital stays (mean 4.7 ± 5.5 vs 2.7 ± 4.0 days, p = 0.0025).

CONCLUSIONS

Although infrequent among young ATV and dirt bike riders, spinal injuries are associated with longer hospital stays, increased ICU use, and required operative intervention in 29%. Increasing awareness among ATV and dirt bike riders about the severity of riding-related injuries may encourage safer riding behaviors.

Evaluation of the WAVE Drowning Detection SystemTM for use with children's summer camp groups in swimming pools: A prospective observational study

Background

Groups of children swimming during summer camp or child care are generally monitored by a small number of lifeguards and staff. The high child-to-staff ratio can make pool monitoring less effective, increasing drowning risk. The aim of this study is to evaluate novel drowning detection technology that could supplement pool monitoring.

Methods

The WAVE™ Drowning Detection System was deployed at a camp pool for 8 weeks. The WAVE™ Drowning Detection System entails headbands worn by swimmers that send alerts to vibrating staff bracelets and audible alarms when submerged for a period of time. Data on the number of alerts were collected, and staff were surveyed.

Results

One or two alerts were initiated every hour. Staff reported that risky underwater play and exiting the pool area were top reasons for alerts. Staff found the awareness brought to risky pool behavior useful and had a neutral attitude about false alarms. Staff found the system easy to learn and use but suggested headband fit and comfort could be improved. Staff believed the system could help save someone's life.

Conclusions

The WAVE system is low-risk, easy-to-use technology that may supplement lifeguard monitoring of large groups of children in pools.

Managing the Wellbeing of Elite Rugby Union Players from an Occupational Safety and Health Perspective

The intense, physical contact nature of rugby union often encourages the normalization of risk-taking behaviour resulting in a relatively high acceptance of risk. This study aims to explore safety culture in rugby union from an OSH perspective, with the purpose of assisting coaches and management in their decision-making processes to improve players' health, welfare, and long-term well-being. In terms of data collection, this study involved semi-structured interviews with senior support staff (n = 15) in elite rugby union. Interview transcripts underwent inductive analysis prior to an abductive analysis that was guided by an established occupational-safety-and-health (OSH) framework. Rugby union players' safety can be considered from two dimensions: management's commitment to safety (i.e., safety prioritization, safety empowerment, and safety justice), players' involvement in safety (i.e., safety prioritization, and trust in other players' safety competence, and players' safety concern for the opposition players). Within the themes identified, players' attitude towards their opponents' safety which has been rarely considered as a factor for injury prevention is also discussed in this study. If sport support staff (i.e., managers/coaches/medical) can become more involved in players' performance-orientated training using OSH management processes to aid in their decision-making, their exists the capacity to benefit players' safe return to play after injury rehabilitation. Meanwhile, directing the development of appropriate behavioural educational interventions to raise safety-awareness amongst players can improve their long-term health and well-being and provide them with the necessary safety and health information to support their own decision-making processes. As a multidisciplinary design, this study contributes new multidisciplinary insights that have the potential to advance managerial practices utilizing an OSH perspective, including decision-making supporting risk alleviation for safety and long-term health and wellbeing initiatives in competitive team sports.

Mortality in Recreational Mountain-Biking in the Austrian Alps: A Retrospective Study over 16 Years

Despite recreational mountain-biking's growing popularity worldwide, the literature on mortality in this leisure sporting activity is scarce. Therefore, the aim of the present study was to investigate the characteristics of fatal accidents as well as resulting dead victims during recreational mountain-biking in the Austrian Alps over the past 16 years. For this purpose, a retrospective study based on Austrian institutional documentation from 2006 to 2021 was conducted. In total, 97 fatalities (1 woman) with a mean age of 55.6 ± 13.9 years were recorded by the Austrian Alpine Police. Of those, 54.6% died due to a non-traumatic (mostly cardio-vascular) and 41.2% due to a traumatic event. Mountain-bikers fatally accidented for non-traumatic reasons frequently belonged to older age classes (p = 0.05) and mostly (73.6%) died during the ascent, whereas traumatic events mainly (70.0%) happened during the descent (p < 0.001). Throughout the examined period, the absolute number of fatalities slightly increased, whereas the mortality index (proportion of deaths/accidented victims) did not (mean value: 1.34 ± 0.56%). Factors such as male sex in general, above average age and uphill riding for non-traumatic accidents, as well as downhill riding for traumatic events, seem to be associated with fatalities during recreational mountain-biking in the Austrian Alps. These results should be considered for future preventive strategies in recreational mountain-biking.

Wood-Splitter-Related Upper-Limb Injuries: A Single-Centered Case-Series Study

(1) Background: Injuries to the upper limbs during wood splitting can affect social and economic life. We aimed to describe the clinical information concerning these injuries in Japan. (2) Methods: We identified patients from our patient database from April 2015-November 2021 and extracted data from their medical records, which includes age, gender, occupation, month, time and location of the injury, diagnosis, duration of hospitalization, ICU admission, treatment interventions including surgery, outcome, and medical costs. (3) Result: Seventeen cases were identified. Most of the patients were male (n = 15), with median age being 68 years old. Regarding the patients' backgrounds, six were apple farmers and three were unemployed. Injuries to the index finger was most common (n = 9), followed by injuries to the thumb in five cases (n = 5). Most of the incidents occurred at home or on the patient's farm estate. No injuries were due to incidents at work. (4) Conclusion: The wood splitter-related injuries required long-term treatment and frequently damaged the thumb, a functionally important digit. All the injuries were sustained during non-occupational use of a wood splitter. Therefore, we suggest that safety training should be provided to prevent traumatic injuries when these products are being sold.

Implementation of a road traffic crash injury surveillance tool in a trauma referral hospital in Kisumu City, Western Kenya: Lessons learned from the pilot study

OBJECTIVE

Road traffic injury (RTI) is a major public health concern in Kenya with more than 13,000 deaths estimated annually. The primary objective of this study was to design and implement an injury surveillance tool for the collection of injury data, and assess the tool's feasibility for the development of a hospital-based trauma registry in a leading Kenyan referral hospital. Secondarily, an epidemiologic profile was created to characterize RTI in the region.

METHODS

An injury surveillance tool was developed and implemented, on a pilot basis, in a level 5 trauma hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), in Kisumu City, Western Kenya, for a 4-week period from 2019-07-15 to 2019-08-11. A descriptive statistical analysis summarized injury frequency counts and percentages.

RESULTS

Over the pilot phase, 371 patients had forms completed, but 488 official injury-related hospital registrations, indicating that 117 injury patients (24%) were missed. A process evaluation of the tool implementation revealed issues in the collection protocol that required revisions, resulting in improved data form completeness rates. For the 368 cases with cause documented, the most common mechanisms of injury were RTI (46.5%; n = 171), assaults (23.9%; n = 88), and falls (14.9%; n = 55). For RTI patients, the median age was 28 years (IQR = 16) and 77% (n = 132) were males, with motorbike collision injuries (n = 91; 53.2%) the leading RTI mechanism. There were 348 injuries for 171 patients. The most common anatomical regions for RTI were the lower limb 32.8% (n = 114), upper limb (15.2%; n = 53), followed by head lacerations 8.6% (n = 30) and concussions 7.2% (n = 25). Two-thirds of patients (n = 113; 66.1%) were discharged from ED, just over a quarter (n = 46; 26.9%) were admitted to hospital and 9 patients succumbed to RTI (5.3%).

CONCLUSIONS

This injury surveillance pilot study produced the first injury dataset in Kisumu City, demonstrating the significant magnitude of RTI in Western Kenya, the leading cause of injury for the region. This dataset can be replicated in other hospitals to create an injury surveillance system for the collection of trauma data, needed for the development of countermeasures for the reduction of trauma, as well as for quality initiatives to improve patient outcomes.

Tackle Technique and Changes in Playerload™ During a Simulated Tackle: An Exploratory Study

In collision sports, the tackle has the highest injury incidence, and is key to a successful performance. Although the contact load of players has been measured using microtechnology, this has not been related to tackle technique. The aim of this study was to explore how PlayerLoad™ changes between different levels of tackling technique during a simulated tackle. Nineteen rugby union players performed twelve tackles on a tackle contact simulator (n = 228 tackles). Each tackle was recorded with a video-camera and each player wore a Catapult OptimEyeS5. Tackles were analysed using tackler proficiency criteria and split into three categories: Low scoring(≤5 Arbitrary units (AU), medium scoring(6 and 7AU) and high scoring tackles(≥8AU). High scoring tackles recorded a higher PlayerLoad™ at tackle completion. The PlayerLoad™ trace was also less variable in the high scoring tackles. The variability in the PlayerLoad™ trace may be a consequence of players not shortening their steps before contact. This reduced their ability to control their movement during the contact and post-contact phase of the tackle and increased the variability. Using the PlayerLoad™ trace in conjunction with subjective technique assessments offers coaches and practitioners insight into the physical-technical relationship of each tackle to optimise tackle skill training and match preparation.

Preliminary Report on the Train the Brain Project, Part I: Sensorimotor Neural Correlates of Anterior Cruciate Ligament Injury Risk Biomechanics

CONTEXT

Anterior cruciate ligament injury commonly occurs via noncontact motor coordination errors that result in excessive multiplanar loading during athletic movements. Preventing motor coordination errors requires neural sensorimotor integration activity to support knee-joint neuromuscular control, but the underlying neural mechanisms driving injury-risk motor control are not well understood.

OBJECTIVE

To evaluate brain activity differences for knee sensorimotor control between athletes with high or low injury-risk mechanics.

DESIGN

Case-control study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Of 38 female high school soccer players screened, 10 were selected for analysis based on magnetic resonance imaging compliance, injury-risk classification via 3-dimensional biomechanics during a drop vertical jump, and matching criteria to complete neuroimaging during knee motor tasks.

MAIN OUTCOME MEASURE(S)

Peak knee-abduction moment during landing was used for group allocation into the high (≥21.74 newton meters [Nm], n = 9) or low (≤10.6 Nm, n = 11) injury-risk classification (n = 11 uncategorized, n = 7 who were not compliant with magnetic resonance imaging). Ten participants (5 high risk, 5 low risk) with adequate data were matched and compared across 2 neuroimaging paradigms: unilateral knee-joint control and unilateral multijoint leg press against resistance.

RESULTS

Athletes with high injury-risk biomechanics had less neural activity in 1 sensory-motor cluster for isolated knee-joint control (precuneus, peak Z score = 4.14, P ≤ .01, 788 voxels) and greater brain activity for the multijoint leg press in 2 cognitive-motor clusters: the frontal cortex (peak Z score = 4.71, P < .01, 1602 voxels) and posterior cingulate gyrus (peak Z score = 4.43, P < .01, 725 voxels) relative to the low injury-risk group.

CONCLUSIONS

The high injury-risk group's lower relative engagement of neural sensory resources controlling the knee joint may elevate demand on cognitive motor resources to control loaded multijoint action. The neural activity profile in the high injury-risk group may manifest as a breakdown in neuromuscular coordination, resulting in elevated knee-abduction moments during landing.

Tailoring a Child Injury Prevention Program for Low-Income U.S. Families

Objective

Unintentional injuries are the leading cause of death for children in the United States (U.S.), and young children ages (1-4) are particularly at risk. Supervising for Home Safety (SHS) is a Canadian intervention that has been shown to reduce children's injury risk by increasing caregiver supervision. Given that low-income children are at greatest risk for injury, this study describes a process of modifying the SHS program to be culturally appropriate for low-income families of U.S. preschool children.

Methods

Two rounds of focus groups were completed; feedback from the first round of focus groups was used to modify program materials prior to the second round.

Results

Caregivers gleaned important take-away messages from both the original and modified materials, including the idea that injuries can happen quickly and that caregivers can prevent injuries. Modifications to the intervention included increased diversity in the families represented in the videos as well as inclusion of U.S. injury statistics. Caregivers in both rounds of focus groups noted that the program messages were relatable and realistic and that the materials were impactful in increasing their awareness of children's injury risk.

Conclusion

We were able to successfully modify the SHS program to be appropriate for low-income U.S. families while preserving the core program messages.

Preliminary Report on the Train the Brain Project, Part II: Neuroplasticity of Augmented Neuromuscular Training and Improved Injury-Risk Biomechanics

CONTEXT

Neuromuscular training (NMT) facilitates the acquisition of new movement patterns that reduce the anterior cruciate ligament injury risk. However, the neural mechanisms underlying these changes are unknown.

OBJECTIVE

To determine the relationship between brain activation and biomechanical changes after NMT with biofeedback.

DESIGN

Cohort study.

SETTING

Research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Twenty female high school soccer athletes, with 10 in an augmented NMT group and 10 in a control (no training) group.

MAIN OUTCOME MEASURE(S)

Ten participants completed 6 weeks of NMT augmented with real-time biofeedback to reduce knee injury-risk movements, and 10 participants pursued no training. Augmented neuromuscular training (aNMT) was implemented with visual biofeedback that responded in real time to injury-risk biomechanical variables. A drop vertical jump with 3-dimensional motion capture was used to assess injury-risk neuromuscular changes before and after the 6-week intervention. Brain-activation changes were measured using functional magnetic resonance imaging during unilateral knee and multijoint motor tasks.

RESULTS

After aNMT, sensory (precuneus), visual-spatial (lingual gyrus), and motor-planning (premotor) brain activity increased for knee-specific movement; sensorimotor cortex activity for multijoint movement decreased. The knee-abduction moment during landing also decreased (4.66 ± 5.45 newton meters; P = .02; Hedges g = 0.82) in the aNMT group but did not change in the control group (P > .05). The training-induced increased brain activity with isolated knee movement was associated with decreases in knee-abduction moment (r = 0.67; P = .036) and sensorimotor cortex activity for multijoint movement (r = 0.87; P = .001). No change in brain activity was observed in the control group (P > .05).

CONCLUSIONS

The relationship between neural changes observed across tasks and reduced knee abduction suggests that aNMT facilitated recruitment of sensory integration centers to support reduced injury-risk mechanics and improve sensorimotor neural efficiency for multijoint control. Further research is warranted to determine if this training-related multimodal neuroplasticity enhances neuromuscular control during more complex sport-specific activities.

Recovery During a Congested Schedule and Injury in Professional Football

PURPOSE

To analyze the relationships between the recovery kinetics experienced by professional football players and noncontact injury.

METHODS

A cohort of 46 professional football players (age 24.2 [4.7] y) from the same team (French Ligue 1) was monitored each day between matches when the team played twice a week. The recovery monitoring procedure was implemented after 38 matches and included some questionnaires: duration of sleep, Hooper scale (quality of sleep, level of stress, fatigue, and muscle soreness), perceived recovery status scale, creatine kinase concentrations, a countermovement jump, and an isometric force test. Noncontact injuries were collected during these periods.

RESULTS

Noncontact injuries were associated with perceived fatigue and muscle soreness 2 days (relative risk [RR] = 1.89 and 1.48, respectively) and 3 days following the matches (RR = 2.08 and 2.08, respectively). An increase of sleep quantity during the 2 nights following a match was significantly associated with a lower RR (RR = 0.65), as well as a lower decrement score on the isometric force test on each of the 3 days after the matches (RR = 0.97, RR = 0.99, and RR = 0.97, respectively). No other association was reported for the variables sleep quality, stress, perceived recovery, creatine kinase concentrations, countermovement jump, and noncontact injuries.

CONCLUSION

During a congested schedule, implementing a recovery monitoring protocol including questionnaires about fatigue, muscle soreness, quantity of sleep, and a physical test of isometric force could help practitioners prevent injuries.

Injuries to Ice Hockey Referees and Linesmen: A Survey of International Ice Hockey Federation Officials

Background

Ice hockey referees and linesmen are at risk for musculoskeletal injuries because of the lack of protective equipment and contact with players, sticks, pucks, the ice surface and boards.

Purpose

To quantify and analyze injuries reported by officials of the International Ice Hockey Federation (IIHF).

Study Design

Descriptive epidemiology study.

Methods

A 61-question survey tool was designed by an interdisciplinary team to evaluate musculoskeletal injuries experienced by ice hockey officials. This survey was administered to 600 active IIHF referees and linesmen. Only completed survey responses were included in the statistical analysis. Continuous variables were analyzed using unpaired t-tests, while categorical data were assessed utilizing chi-square tests.

Results

Of the 600 surveys administered, 264 surveys were completed by officials from 45 countries (44% response rate). Of the respondents, 72% were male, and 28% were female, with a mean age of 31.1 ± 5.8 years. Officiating experience averaged 11.4 ± 6.0 years (6.3 ± 4.5 years with the IIHF). A total of 295 injuries were reported by 55% of the officials. Injuries occurred more frequently during games compared with training, and officials who worked year-round had more total injuries than those who took time off (P = .03). The most common injuries involved the wrist and hand (n = 64 [22%]), head and face (n = 58 [20%]), and the knee (n = 47 [16%]). Wrist and hand trauma included 23 fractures. Knee and shoulder injuries were most likely to require surgery compared with other body areas (P < .001); 30 officials underwent surgery because of an acute knee injury (10%). Injury prevention activities were effective at reducing injuries (P = .04).

Conclusion

Most ice hockey officials experienced musculoskeletal injuries during their career. The risk of trauma to the wrist and hand can possibly be reduced via equipment modifications including protective gloves. A greater emphasis should be placed on injury prevention programs and time away from officiating competitions.

Description of ROM-SPORT I Battery: Keys to Assess Lower Limb Flexibility

Limited range of motion (ROM) is considered one of the most important intrinsic and modifiable risk factors for the most common sports-related injuries. In addition, controlling and monitoring an athlete's ROM is a strategy to achieve optimal ROM and improve athletic performance in sports, especially those that require high ROM in the major joints. Therefore, assessing ROM (pre-participation, during a rehabilitation process, on return to play, etc.) is important not only as a method to prevent sports injuries, but also as a quantitative determinant of the potential of athletic performance. However, despite the variety of different ROM assessment methods described in the literature, there is no consensus on which methods are best suited for this goal. Recently, the ROM-SPORT I battery has been shown to have advantages over other ROM assessment methods. This tool has not yet been fully described in detail for researchers, sports professionals, and clinicians to learn. The main objective of this study is to describe the ROM-SPORT I battery tests in detail using the following criteria: test description, simplicity of the test procedure, low need for human and material resources, predictive validity, and reliability.

The Impact of Footwear on Occupational Task Performance and Musculoskeletal Injury Risk: A Scoping Review to Inform Tactical Footwear

The aim of this scoping review was to investigate the impact of footwear on worker physical task performance and injury risk. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews protocol and registered in the Open Science Framework. Key search terms were entered into five academic databases. Following a dedicated screening process and critical appraisal, data from the final articles informing this review were extracted, tabulated, and synthesised. Of 19,614 identified articles, 50 articles informed this review. Representing 16 countries, the most common populations investigated were military and firefighter populations, but a wide range of general occupations (e.g., shipping, mining, hairdressing, and healthcare workers) were represented. Footwear types included work safety boots/shoes (e.g., industrial, gumboots, steel capped, etc.), military and firefighter boots, sports shoes (trainers, tennis, basketball, etc.) and various other types (e.g., sandals, etc.). Occupational footwear was found to impact gait and angular velocities, joint ranges of motion, posture and balance, physiological measures (like aerobic capacity, heart rates, temperatures, etc.), muscle activity, and selected occupational tasks. Occupational footwear associated with injuries included boots, conventional running shoes, shoes with inserts, harder/stiffer outsoles or thin soles, and shoes with low comfort scores-although the findings were mixed. Occupational footwear was also linked to potentially causing injuries directly (e.g., musculoskeletal injuries) as well as leading to mechanisms associated with causing injuries (like tripping and slipping).

Relationship between Lower Extremity Fitness Levels and Injury Risk among Recreational Alpine Skiers: A Prospective Cohort Study

Background: Although the importance of physical fitness for injury prevention is recognized in sports medicine and rehabilitation, few studies have investigated this factor among recreational alpine skiers. Objective: To determine the effect of lower extremity fitness on the risk and severity of injury among recreational alpine skiers. Method: This prospective cohort study involved 117 recreational skiers at two alpine resorts during the 2021−2022 winter season. Anthropometric characteristics, skiing skills, and lower extremity agility (hexagon test), balance (Y-Balance Test), and endurance (60-s squat test) were assessed before the winter season. All of the participants were divided into an injured group and an uninjured group, based on whether an injury was recorded throughout the season. Results: In binary logistic regression, the hexagon test duration and composite Y-Balance Test score were significant injury risk factors (p < 0.05). Ordinal polytomous logistic regression revealed no significant factors for injury severity (p > 0.05). Conclusions: Recreational alpine skiers with inferior lower extremity agility or balance may have a higher injury risk and this must be considered when assessing individual risk. In the context of injury prevention, regular neuromuscular training and testing, including agility and balance aspects should be recommended to skiers.

Identifying Health-Related Social and Unintentional Injury Risks Among Patients Presenting to a Pediatric Urgent Care

OBJECTIVE

Many families seek medical care at pediatric urgent care centers. The objective of this study was to determine social and unintentional injury risks reported by these families.

METHODS

This cross-sectional study surveyed a convenience sample of guardians of patients 1 to 5 years of age presenting to our pediatric urgent care, 9/10/21 to 2/25/22. Outcomes were the number of reported social and unintentional injury risks. Predictors and covariates included child and parent demographic characteristics and a neighborhood socioeconomic deprivation index. Chi-square, Student's t test, Pearson's correlation tests, and multinominal regression were used.

RESULTS

A total of 273 guardians (and children) were included; 245 of guardians (89.7%) were female; 137 (50.2%) of included children identified as Black. Approximately 60% reported ≥1 social risk; 31.5% reported ≥3. Approximately 90% reported ≥1 unintentional injury risk; 57.9% reported ≥3. There were significant associations between social risk presence and Black race, public/no insurance, and neighborhood deprivation (all P < .05). There were no significant associations between unintentional injury risks and assessed predictors. Black guardians were more likely than those of other races to report a greater number of social risks (adjusted odds ratio [AOR] 2.90, 95% confidence interval [CI] 1.50, 5.58 for ≥3 vs 0 risk). Children with public/no insurance compared to private insurance were more likely to experience a greater number of social risks (AOR 3.34, 95% CI 1.42, 7.84 for ≥3 vs 0 risks).

CONCLUSIONS

Many presenting to pediatric urgent cares experience social and unintentional injury risks. Risk identification may guide equitable responses.